ECHO+ model: enhancing pharmaceutical care with integrated ecological outcomes

Dear editor, Global warming presents profound and largely irreversible threats to both environmental and human health. Ironically, the healthcare sector—while addressing these outcomes—also contributes substantially to carbon emissions, particularly through pharmaceutical production, distribution, and consumption. As such, it bears a dual responsibility: to care for those affected by climate change and to actively participate in its mitigation [1]. Aligned with Hippocrates’ maxim, ‘primum non nocere,’ health care must strive not only to protect patients but also to avoid harm to the environment. Preventive health services, by reducing morbidity, mortality, and healthcare utilization, may also generate indirect ecological benefits. Embedding ecological considerations into clinical practice supports more sustainable medication use and aligns pharmacological decision-making with environmental stewardship. Reflecting this imperative, the World Health Organization recently updated its guidance on climate-resilient health systems to include low-carbon strategies [2]. Pharmaceutical care aims to optimize medication use to achieve core economic, clinical, and humanistic outcomes (ECHO). Clinical outcomes reflect treatment effectiveness and safety; economic outcomes address resource use and costs; and humanistic outcomes capture patient-reported quality of life. The ECHO model balances these interconnected outcomes to guide evidence-based, multidimensional assessments in health care [3]. Expanding this framework to ECHO+ by integrating ecological outcomes enables pharmaceutical care to reduce the environmental footprint of medicines while maintaining high standards of patient care.