Health and global heating

From the ER to the climate emergency

Dr. Courtney Howard addressed the Canadian Medical Association Health Summit in Ottawa last week with emotion in her voice. While she may have standing on the stage in front of us, her mind was clearly with her co-workers in Yellowknife. At that very moment they were evacuating the hundred bed hospital where Courtney has worked as an emergency doctor for over a decade. She didn’t say so, but she must also have been wondering whether she and her family would have a house to return to, wondering what would happen to her patients, neighbours and friends heading south on the highway or being airlifted away from their homes. 

I’ll report more on the health care discussions at the CMA meeting in a later post, including a renewed debate about privatization, but what is worrying Courtney and should worry us all is literally a more burning concern. Fires in Kelowna and Yellowknife are threatening homes and lives right now. Red skies in New York from fires in Quebec, the massive blazes in Nova Scotia, the hundreds of kilometres burnt and communities like Buffalo Narrows and Île a-la-Crosse threatened in Northern Saskatchewan, it seems impossible to keep track of all of the fires in what is without question the worst fire season in Canadian history and the most visible manifestation of the climate emergency that Canadians have experienced to date. It’s also a source of a dangerous positive feedback mechanism as burning forests and tundra release more carbon and methane into the atmosphere, contributing to more heating that contributes to more fires.  

Speaking before Dr. Howard was former federal Minister of the Environment and Climate Change, Catherine McKenna. She also displayed a valid emotion: anger. “I’m pissed off,” she told the crowd of doctors. She spoke of her frustration at not having done more to protect her children’s generation from the devastating impacts of climate change, a striking statement from someone who helped negotiate the 2015 Paris Agreement and establish the Powering Past Coal Alliance. She expressed her anger at how, influenced by fossil fuel companies and the politicians in their pockets, the number of Canadians believing climate change is manmade has dropped to six in ten. 

Health impacts of Climate Change 

A young child presents to emergency in respiratory distress, his asthma worsened by smoke exposure. An elder has uncontrolled blood pressure because there wasn't time to get her medications when the evacuation orders came through. Scabies and other illnesses related to crowding spread quickly through the close quarters of the evacuees. Sudden departure from and worry about home bring significant mental stress.

A Healthy Society, 2017, p. 115.

As we come out of the hottest July in recorded history, climate change is already making people sick and prematurely ending lives, estimated to account for upwards of ten percent of global deaths. People who live in poorer countries, and poor people in wealthy countries, are at the greatest risk, a particularly perverse injustice given that the wealthiest people produce the most emissions.  

Direct effects of heat, smoke, fire and flood like the over 600 people who died in the BC heat dome of 2022, the doubling of asthma admissions in Yellowknife’s 2014 “Summer of Smoke,” or the tragic losses of life in the East Coast floods and Maui fires this summer. Indirect effects on climate refugees uprooted from their homes and the communities to which they are displaced. The shifting habitats of infectious disease vectors and the spread of zoonoses like Lyme disease and dengue fever. The enormous costs of insurance and repairs. The risks to food security from droughts like the multi-year dry spell plaguing southern Saskatchewan farmers and ranchers. The ways in which global heating can make us sick are many. 

These are among the many reasons why the World Health Organization describes climate change as the “greatest threat to global health in the 21^st century.” The most important response to this threat is to do all we can to decrease the pace and scale of warming. We will also have to mobilize more treatment resources in response to new and changing illness patterns. It’s important that the way we respond to the health challenges caused by climate change doesn’t contribute further to the problem. 

Net Zero Health Care 

Air quality problems secondary to climate change make people’s asthma worse. The propellants in metered-dose inhalers (MDIs) that are used as “puffers” are powerful greenhouse gases. Their increased use helps to increase global warming. More people are sick with asthma. It’s another example of a positive feedback loop, this time with the delivery of health care driving the need for health care. 

This was the focus of the session at the CMA Health Summit. The role of health care delivery in contributing to climate change may seem a bit niche, a minor part of the larger global heating question, but it is not insignificant. In Canada, 4.5 % of greenhouse gases (GHGs) come from health care delivery. That’s more than domestic aviation or shipping. Disposable materials increase the GHGs from manufacturing and off-gassing in landfills. MDIs and anaesthetic gases used in surgeries release powerful GHGs. Transport of materials, travel, heat, power etc., add up to a very resource and carbon-intensive sector. 

The United Kingdom has legislated a commitment to a “Net Zero: National Health Service” by 2040. In Canada, we suffer from the same problem we do in so many parts of our fragmented health care system. Some hospitals and health regions are doing great work, others are getting worse. Stephan Williams of the Centre Hospitalier de l’Université Montréal (CHUM) spoke of his hospitals work that has reduced emissions from anaesthetic gases like desflurane by 95% and decreased costs by 80%. Bringing a focus on reduction of GHGs to health care practice, including decreasing demand by addressing the social determinants of health, drive down emissions and keep attention on the human costs of climate change.  Howard wrote about this in the influential medical journal, the Lancet, as how working for net zero health care can be part of reaching a tipping point of social and policy support for decarbonization.

Barriers to Change 

These are worthwhile efforts, but they shouldn’t distract us from the truly important work of moving away from fossil fuels. That would be like telling someone wanting to avoid cancer to stop eating barbecue but keep smoking cigarettes. The burning of fossil fuels is the source of over 75% of global GHGs and nearly 90% of all carbon emissions.  The oil and gas industry itself is the single largest emitter, producing over 20% of the country’s GHGs. If we are serious about climate change, this is the obvious place to begin. We need to move away from coal and natural gas for power production and toward the use of clean electricity in transportation, heating and industry.

In places like Saskatchewan and Alberta, with economies that benefit greatly from oil and gas, there is obvious resistance to this necessary shift and a desire to be seen as an exception. As McKenna said to the CMA crowd, “everyone wants to be the last barrel”. This magical thinking can’t work, of course; if everyone whose economy benefits from fossil fuels insists that they are the exception, the change will never happen. And if every measure offered is unacceptable and no legitimate alternatives are put forward, it becomes clear we’re dealing with bad faith actors. Objections to specific policies are simply cover for climate skepticism and an unwillingness to take any meaningful action.  

Take, for instance, the federal policy of net zero power generation by 2035. Alberta and Saskatchewan have rejected the policy outright. Alberta, which had been the nation’s leader in wind and solar, seeing their production of power from renewables double to 17.6% in the last four years, has put a six month freeze on any new wind or solar projects. In Saskatchewan, SaskPower killed their popular solar net metering program in 2019, and the governing Sask Party has slapped an added tax on electric vehicles, abandoned earlier promises to decrease emissions by 32% by 2020 (for a thorough description of that history, see Tammy Robert’s Our Sask newsletter) and resisted efforts to stop burning coal. As a recent Globe and Mail editorial put it: “The absence of ambition is astounding.” 

Reaching net zero electricity in Saskatchewan and Alberta will be more challenging than in provinces with abundant, cheap hydroelectricity. That doesn’t mean it can’t be done. The Pembina Institute, the Canada Energy Regulator and experts in Saskatchewan have all laid out credible paths to get there. It is important for governments to set hard to reach targets all the time, it signals the willingness to try and lights a fire under stalled efforts. Prairie conservative governments are sending the opposite message. Instead of saying, “it’s hard here, we need extra help,” we hear “it’s too hard so we won’t even try.” Or more succinctly, as Scott Moe put it when speaking about Saskatchewan’s world-leading per capita emissions in 2021, “I don’t care.” 

The federal government, on the other hand, needs to recognize that caring is not enough. Reducing emissions from oil and gas won’t be easy and painless. Transitioning to other work will be very hard for people in the oil and gas industry. Transitioning an entire economy is an even greater challenge, especially in provinces that are already suspicious of interventions from Ottawa and feel unequally treated by equalization. If the federal government is serious about supporting Saskatchewan and Alberta to reduce emissions, they need to demonstrate that. Climate action has to go beyond hopeful words to real dollars, a climate equalization program that will compensate for the inevitable downturn of traditional energy industries and spur new investments and sustainable growth.  

Sadly, the political climate on climate in the prairies is a disaster. Any mention of GHGs or concern about the industries producing them brings criticism and ridicule. At times appears that the conflict, like pro-wrestling kayfabe, is ginned up. It may be good politics for a federal government focussed on votes in Ontario and Quebec to have a conservative climate villain in the prairies. It may play well for provincial parties to have a federal bully to rail against. But those finger-pointing games don’t lead to wise choices or good policy. Whatever the political calculations behind the battles, the environment for any discussion of climate policy has been poisoned. Owning (or disowning) the Libs is not a rational approach to such a crucial public policy. 

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This was one of the most frustrating realities of my time in Saskatchewan politics. Courtney and I wrote an article in 2016 that agreed with the sensible, evidence-based position from the Lancet that, “The single most powerful strategic instrument to inoculate human health against the risks of climate change would be for governments to introduce strong and sustained carbon pricing.” This was fuel for opposition attack ads and internal battles in a party scared to speak out for fear of the Sask. Party’s media machine and supermajority. As a result, we ended up playing defense instead of proposing bold made-in-Sask solutions. 

We did, however, put forward one policy worth re-upping: Renew Saskatchewan. This was an on-bill financing plan to help Saskatchewan homes and businesses make the switch to renewables or make conservation retrofits to use less energy. This would allow people to make changes today, see their bills go down immediately, and pay much less once the savings had paid for the initial build. I’m proud of this policy, it was a promising idea to decarbonize the grid and reduce costs for ordinary people. At the same time, I regret we didn’t emphasize it enough. 

Hope: taking the fight to the fire 

Regret, fear of the impacts of global heating, reluctance to take the risk needed to stop it, being “pissed off;” talk of the climate emergency stirs all kinds of emotions. Especially among young people, kids my son’s age, there is a growing feeling of ecological anxiety. There’s a sense of hopelessness that can come with that, an idea that it’s too hard and nothing will be done.  

I am not hopeless. There has been improvement, with emissions projected to peak this year and decline steadily There is proof that actions make a difference and we are technology is advancing and becoming more affordable every day. Still, we must do more. 

I was struck by a slide Courtney shared in her presentation about which professions are the most trusted among the public. At the top of the list were pharmacists, physicians and firefighters. At the very bottom were politicians and social media influencers. Not too surprising, but when you think of the reality, politicians and social media do command an extraordinary amount of influence on public opinion. That chart reflects who people think they should listen to, but not necessarily who they do listen to. We need people in the trusted helping professions to speak up, but also those in less officially trusted but highly influential roles to change their message.  

That’s easier said than done, as pandering to private interests in politically profitable. One key tool to change the debate is to ban corporate donations to political parties. Oil and gas companies spend a fortune to influence the outcomes of elections. Parties supported by fossil fuel dollars are able to set the terms of the debate, with even those parties that don’t receive that support forced to fight in a frame where global survival is secondary to short-term profits. Only when we see that corrupting influence gone from the public sphere will governments move away from subsidizing oil and gas companies to acting in the interests of the whole population.  

There is a lot of work to do for the world to respond to the massive collective action problem that is climate change. It’s daunting, frightening, frustrating and infuriating. It is, as a good friend of mine’s email signature reminds me, “okay to be angry about climate change.” It’s okay to grieve, okay to be anxious. What we can’t do is let those emotions get in the way of doing something about it.  

Dr. Howard’s career shift to world-renowned climate health researcher and advocate, came in response to her emotions of anxiety and fear. Today, as her home community is threatened by wildfires, as her fears become reality, I am struck by her bravery. However exhausting, she continues the fight. Why? Because giving up is far more painful. In her own words: “Action simply feels better than anxiety.”