Abstract
<jats:p>Pharmaceutical residues in aquatic environments are commonly framed as unintended by-products of modern healthcare; however, this perspective overlooks the structural conditions that shape their production, distribution, and persistence. This chapter reconceptualizes pharmaceutical contamination as a systemic output of socio-economic metabolism, reflecting how societies organize health, consumption, and infrastructure. Drawing on global evidence, it is shown that pharmaceutical contamination patterns are unevenly distributed and closely aligned with socio-economic inequalities, where disparities in healthcare access, wastewater treatment capacity, and monitoring infrastructure shape both environmental exposure and its visibility. By integrating environmental chemistry with socio-economic analysis, wastewater is reframed as an informational interface capable of encoding population-level dynamics, including disease burden, inequality, and collective behavior. Approaches such as wastewater-based epidemiology and urban water fingerprinting demonstrate that pharmaceutical residues function as chemical signatures of social organization across spatial and temporal scales. Green growth strategies are examined, highlighting their capacity to improve treatment efficiency and promote circular water systems, while emphasizing their limitations as end-of-pipe solutions that do not address the structural drivers of contamination. In contrast, the degrowth paradigm is explored as an alternative perspective that shifts attention toward upstream interventions, including the reconfiguration of healthcare systems, reduction of unnecessary pharmaceutical use, and the redistribution of environmental and material burdens.</jats:p>