“Environmentally Sustainable Primary Care” is a new book which has many contributing authors from Greener Practice and is available for pre-order from today.

There are three quizzes to introduce you to some of the contents of the book. Here is the first one (If you want a longer challenge there are some more week one questions here). You might enjoy trying either of them out on yourself or colleagues!

Please email contact@greenerpractice.com if you have identified ways to improve the clarity of the questions. You’re welcome to use these questions in your own not for profit work but please acknowledge the source!

1. If you do the same journey by bike, on foot or in a car, which one of these people gets the highest exposure to air pollution?

• A  The driver of a diesel or petrol vehicle
• B  The cyclist
• C  The walker
• D  The driver of an EV

Answer

A The driver of an Internal Combustion Engine vehicle
The driver has the worst air quality. Concentrations of air pollutants in cars can be considerably higher than concentrations faced by active travellers. Commuters sitting in cars both miss the benefits of physical activity, and the concentration of pollutants from outside and from their own proximity to an engine builds up in the cabin. Chapter 1 p3

2. The UK’s highest income households consume on average which one of the following?

• A  25% more tonnes of oil equivalents as the lowest 5 %
• B  50% more tonnes of oil equivalents as the lowest 5%
• C  100% more (i.e. doubled) tonnes of oil equivalents as the lowest 5%
• D  200% more (i.e. tripled) tonnes of oil equivalents as the lowest 5%

Answer

D
Inequality in consumption is a major feature of a very uneven current UK society. The impacts of climate change, including on their health, are disproportionately felt by the poorest.
Chapter 1 p9-10

3. The proportion of the NHS’ carbon footprint that is due to medication (including anaesthetics and metered dose inhalers) is which one of the following?

• A  7%
• B  12%
• C  18%
• D  25%
• E  35%

Answer

D 25%
20% for medicines + chemicals & 5% for anaesthetics + MDIs; Chapter 1 p11

4. Which one of the following dental prevention programmes has the lowest environmental impact?

• A  Attendance at a dental hygienist
• B  Fluoridation of the local water supply
• C  Regular checks and polishes with your dentist
• D  Toothbrushing with an electric toothbrush

Answer

B
Fluoridation has the lowest environmental impact compared to other community level dental prevention programmes. Toothbrushing with electric toothbrushes has not been demonstrated to be more effective environmentally than normal toothbrushing (and bamboo toothbrushes are not better than normal plastic ones for the environment). Chapter 2 p14

5. True or false. In dentistry, the evidence for single use plastics (SUP) over multi- use instruments does not clearly demonstrate advantages for SUP

Answer

True
The move to SUP is generated by an impression that it is better without clear evidence for this. Chapter 2 p15-16

6. The average UK household generates 412 Kg of waste per person each year. The waste generated by full-time contact lens wearers represents which of the following proportions of that?

• A  0.01%
• B  0.2%
• C  1%
• D  1.5%

Answer

B
Full-time contact lens wear represents just 0.20%–0.26% of the 412 kg of household waste generated per person per year in the United Kingdom. Chapter 4 p44

7. An estimated 1.14 billion prescription items were dispensed in England in 2021/2022. How much has this changed compared to 2014/2015?

• A  Reduced by 4.6%
• B  No significant change
• C  Increased by 3.3%
• D  Increased by 6.4%

Answer

D
An increase 6.4% from 1.07 billion items in 2014/2015. Prescribing is a major part of the carbon footprint of the NHS so reducing prescribing needs to be achieved to bring the total carbon footprint of the NHS on track. This is clearly going to be harder to achieve in the context of a 6.4% increase in overall prescribing of items over these 7 years.

Chapter 5 p 54-55. Looking at this with different statistics in 1996 the average number of prescriptions per head was 10 by 2016 this had doubled. Chapter 7.

8. How often, according to studies, is medication not taken as intended?

• A  Less than 10%
• B  10-20%
• C  20-30%
• D  Over 30%

Answer

D Research has found that between 30% and 50% of medication is not taken as intended. Evidence also suggests that people experiencing health inequalities are both less likely to seek help and advice and more likely to be prescribed medication inappropriately. Chapter 5 p 55

9. True or false. Considering pharmaceuticals in the environment which of the following are true?

• A  About 20% of oral medicines are excreted in the urine
• B  About 30-90% of oral medicines are excreted in the urine
• C  Pharmaceuticals are easily removed by normal Water Treatment plants (sewage works)
• D  Antibiotics are found unchanged in rivers and coastal areas from human excretion
• E  The commonest pharmaceuticals in the UK’s rivers are paracetamol and codeine

Answer

B, D and E are True
Between 30% and 90% of medicines taken orally are excreted and enter the waterways as “pharmaceuticals in the environment” (PIE) These drug residues are not removed by wastewater treatment plants and have known antimicrobial resistance (AMR) and possibly other unknown environmental impacts Chapter 5 p60 and Chapter 14

10. True or false. You need to prove your address to register with a GP.

Answer

False
GPs can accept patients without proof of address and can also refer those who are not accepted for hospital services on to practice attached mental health services or other practice-based services. Chapter 6 p73

11. 75% of UK rivers were assessed as posing a serious risk to human health in 2022. Which of the following are found in UK rivers?

• A  Insecticides (imidacloprid)
• B  Antibiotics
• C  NSAIDs
• D  Oestrogens
• E  Nanoparticles

Answer

All are found in UK rivers. Chapter 6 p78