Anna Gunz is an Assistant Professor in the Department of Paediatrics at Western University.Picture of Anna Gunz

A common metaphor used when talking about the climate emergency is that of the runaway train building momentum. The mantra is that we need to act now so that it does not continue to gain velocity. But, as compelling as the climate-train analogy is, we should not be bracing ourselves for one large impact. The effects of climate change on health and health systems are multiple, repeated, cumulative and compounding, and we need to respond in a way that acknowledges this.

This summer most Canadians have experienced climate change. Extreme heat warnings are common. Forest fires have raged across the continent; the haze of wildfire smoke spread hundreds of kilometers, creating air quality warnings. Communities watched as their homes were ravaged by fire or floods.

In the same week that the Intergovernmental Panel on Climate Change (IPCC) released their recent report, there was a heat warning where I live and the cooling systems in my hospital failed, leading to patient appointment and procedure cancellations.  In 2017, the wildfires in British Columbia forced the evacuation of 880 patients, affected 19 healthcare facilities and cost an estimated 2.7 million dollars in damage.  The Canadian Coalition for Green Health Care continues to collate records of damage to health infrastructure to track the impact of climate change.

For physicians and healthcare providers, this is a health emergency. The health literature is peppered with warnings, prediction models and evidence of the deleterious effects of climate change on human health.  Climate change affects the patients of almost all medical and surgical specialists: from the effects of heat on cardiovascular mortality and child health, to those of air pollution on cardiorespiratory health, pregnancy and cognition, to injury and toxic exposures during major weather events, to the effects on mental health, and beyond.  As the climate crisis continues to escalate, we will discover more associations between the environment and health. The realities of climate change are something every physician will have to grapple with from now on. Climate change not only affects health, but threatens our health system.

Immediate actions that physicians can take include:

1) Mitigation: Our healthcare industry is responsible for a substantial proportion of Canada’s greenhouse gas emissions (4.6%). Potential mitigation strategies are myriad and can be easily uncovered if we add a climate lens to our daily activities. We need large measures such as converting to clean energy and encouraging pharmaceutical and medical supply companies to increase reusables and commit to net-zero targets. We also need smaller measures, such as embracing Choosing Wisely (fewer tests and medications means less waste), judicious use of virtual care, creating havens for native trees and pollinator gardens on health facility grounds (coincidentally benefiting wellbeing) and encouraging healthy behaviours with environment benefit (such as active transportation).

2) Healthcare Adaptation: This will require a targeted look at our health systems. We need to examine the risks of climate change to regional populations, identify policies that create vulnerabilities at the individual, community and health infrastructure level, then reinvest in our services and infrastructure. To reach resiliency, we need to partner with traditionally underrepresented communities in solution-building and dismantle harmful policies. Research funding agencies should support climate health and adaptation research. To facilitate implementation, clinical leadership positions should be created that are dedicated to climate action.

3) Advocacy: The Canadian Medical Association has declared climate change and health a priority for advocacy.  At the local level, advocacy can take the form of conversations with patients (e.g. what to do in air quality & heat advisories). Clinicians can join organizations that advocate on behalf of this issue, such as the Canadian Association of Physicians for the Environment. It is crucial to engage policy makers as the solution to this healthcare crisis lies outside the bounds of our profession. Conversations with members of parliament and municipal councillors regarding the health impacts of climate change is important to put a human face to the urgency of the issue.

As daunting as the task ahead of us is, we have the skills and expertise in the Canadian healthcare system to prepare. We need to focus our collective energy and act now for the benefit of the health of future Canadians: slow the train, brace for impact and re-imagine the compartments so all passengers not only survive, but flourish.