Canadian Medical Associations Recommend Health-Centered Approach to Climate Change

Carolyn Crist

November 03, 2022

Already in the throes of climate change, health systems must move toward a framework that recognizes the connection between human health and Earth's natural processes, according to a new report by Canadian medical professionals.

Canada needs healthcare systems that are designed to minimize climate effects and adapt to the risk of extreme weather events; incorporate indigenous worldviews that prioritize planetary well-being; and communicate evidence-based solutions in ways that improve health, the report advises.

Canadian medical associations partnered with The Lancet to produce a report that includes targeted recommendations to address the implications of climate change on human health in Canada. The report follows the publication of the annual Lancet Countdown: Tracking Progress on Health and Climate Change, which is an international collaboration focused on monitoring the evolving health profile of climate change. Each year, the findings are published ahead of United Nations (UN) climate change negotiations.

Dr Alika Lafontaine

"This year's report highlights how a holistic and health-centered approach to compounding crises — from climate shocks to the COVID-19 pandemic — can lead to a thriving future," Alika Lafontaine, MD, president of the Canadian Medical Association, told Medscape Medical News.

The report was published on October 26 by the Canadian Medical Association, the Canadian Nurses Association, and the Canadian Public Health Association.

The Countdown Report

The health effects of climate change are rapidly increasing and are intensifying worldwide, the latest Lancet Countdown report indicates. Even under the lowest-emission scenario modeled by the Intergovernmental Panel on Climate Change, global heating due to climate change is expected to accelerate until at least 2050.

The report points out that fossil fuel–related air pollution is implicated in 1 in 5 global deaths. Habitat loss threatens biodiversity and places humans in closer contact with wildlife and livestock, which contributes to the spread of vector-borne diseases and increases the risk of future pandemics. In Canada, recent extreme climate events such as the 2021 British Columbia Heat Dome have resulted in hundreds of deaths.

"Climate change is undermining the foundations of human health and health systems," according to the Canadian report. "This taxes a health system already strained from COVID-19 and its fallout."

The Canadian report outlines six recommendations to embrace a health-centered approach to climate change. First, Canada should establish a national secretariat to coordinate with provinces and territories, as well as international climate and health networks, such as the World Health Organization's (WHO's) Alliance for Transformative Action on Climate and Health. This secretariat would be responsible for transforming Canada's health system into a climate-resilient system that operates within planetary limits.

In addition, Canada should conduct province- and territory-led climate resilience analyses of its healthcare systems and use the findings to improve preparedness for climate-related extreme events. An integral part of that effort would be to reduce structural and social health inequities.

Third, Canada should accelerate the incorporation of the UN Declaration on the Rights of Indigenous Peoples into Canadian law to honor commitments, improve policy coherence, and enhance the well-being of current and future generations.

Next, Canadian leaders should support the implementation of Bill C-226, through which a national strategy would be developed to assess, prevent, and address environmental racism and promote environmental justice.

Fifth, Canadian governments should focus climate programs and communications on the health benefits of climate solutions, including those benefits in cost analyses of adaptation and mitigation policies.

Finally, media, academia, and nonprofit stakeholders should implement climate communications approaches that share positive stories of concrete actions being taken to adapt and mitigate in ways that improve health.

"Canada needs a cohesive national initiative to coordinate efforts across jurisdictions and support legislation and implementation of sustainable changes to health systems," the report says. "This would support Canada's 2021 commitment to the WHO's Health Programme at COP 26, made alongside 50 other countries, to develop a climate-resilient and low-carbon sustainable health system by 2050."

Taking Actionable Steps

Several local initiatives are emerging across the country. The Centre Intégré de Santé et de Services Sociaux de Laval recently conducted the first assessment of its greenhouse gas emissions. It shows that 90% of emissions come from indirect channels, such as supply chains, waste materials, and transportation. Likewise, health authorities in British Columbia have developed low-carbon resilience guidelines for healthcare, and health sector emissions are now reported to the provincial government annually.

"However, local health system initiatives are inconsistent and underresourced," the report says. "An isolated response by local health authorities cannot drive the structural changes needed to decarbonize Canada's health sector and would collectively be more costly than a coordinated national response."

Canada's health system has among the highest greenhouse gas emissions per capita globally. Those emissions constitute up to 5% of the country's total annual emissions. The Lancet Countdown data show that Canada's health systems' per capita emissions increased by 1.3% from 2018 to 2019, totaling 1139 kg of carbon dioxide equivalent per person, or about 9 million passenger vehicles on the road annually.

By coming together to issue a report, the Canadian Medical Association, the Canadian Nurses Association, and the Canadian Public Health Association hope that health authorities, medical professionals, and policymakers can make a change.

Helen Boyd, RN

"I believe our nursing role is to advocate for equity for all the populations we serve," Helen Boyd, RN, a registered nurse and the British Columbia representative to the Canadian Association of Nurses for the Environment, told Medscape Medical News.

"I spent a decade of my career working on the streets with the most marginalized populations who were falling between the cracks of our healthcare system," she said. "In the aftermath of floods and wildfires, I see firsthand how their profound suffering is compounded by climate change–induced extreme weather events. Now I choose to dedicate all my energy to climate justice and planetary health."

The report was published by the Canadian Medical Association, the Canadian Nurses Association, and the Canadian Public Health Association. Lafontaine and Boyd have disclosed no relevant financial relationships.

Canadian Medical Association et al. Published October 26, 2022. Full text

Carolyn Crist is a health and medical journalist who reports on the latest studies for Medscape, MDedge, and WebMD.

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