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- Page navigation anchor for RE: Our fight against climate changeRE: Our fight against climate change
March 3, 2020
Dear Dr. Ladouceur,
Adding to the huge response to your editorial on climate change, we wish to emphasize one further role for family physicians in planetary health promotion: leadership in medical education.
Replies have highlighted the significance of this issue to learners as expressed by the International Federation of Medical Students1 and more locally the efforts of the Canadian Federation of Medical Students (CFMS),2,3 which includes student contributions to resources developed by the Canadian Association of Physicians for the Environment (CAPE.ca). To respond to these calls, family physicians need to equip themselves with strong foundational knowledge about planetary health and lead through example. As the largest single group of physicians in Canada, we have the greatest front-line advocacy impact, not only with patients but with our learners, too. All medical schools in Canada have Departments of Family Medicine, and family physicians are influential across the continuum of medical school, in undergraduate, postgraduate, and continuing medical education. Here we outline some ways family physicians can advocate for planetary health in medical education.
With students: Planetary health (PH) training can and should take place in family medicine (FM). FM clerks at the University of Calgary participate in a workshop which focuses on PH foundational knowledge. This includes encouraging students to think proactively about mea...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: Climate Change: Motive, Means and OpportunityRE: Climate Change: Motive, Means and Opportunity
Dear Dr. Ladouceur:
Thank you for your excellent recent editorial on climate change. It is an important issue to raise with the CFPC membership. Please find below a response to your question about what we can do.
Motive, means and opportunity
In many ways, what family physicians need to do to address climate change is the same as every other person – critically examine their every action, ask whether there is a more sustainable approach and then choose it.
But Canadian family physicians can and should do more, not only because the responsibility “to advocate public policy that promotes our patients’ health” is embedded within the principles of family medicine but because we, more than most others, are among those with the greatest opportunity to do so.
We cannot plead ignorance. We have the intellectual capacity to understand the science and its implications for the health of our children. We have the critical analytic skills to recognize that the climate crisis is being driven by the authors of this “fairy tale of endless economic growth”* who profit from the status quo, enticing us to buy ever more, peddling single use medical devices in the name of patient safety, and threatening us with economic collapse if we don’t “do our part” in sustaining the existing, carbon-based economy (despite examples from countries like Germany which prove this to be false).
With our six-figure incomes, working within the healthcare system of one of...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: what we can to to improve the environmentRE: what we can to to improve the environment
1. Make sure our offices recycle paper and boxes
2. Go plant based and share plant bases recipes with patients
3. Avoid single use plastic for example plastic water bottles, utensils even
when ordering out
4. Use organic biodegradable products to clean our offices, dishes, bathrooms
5. Use recycled toilet paper and paper towels
6. Go to more local conferences
7. Avoid single use coffee cups / pods, make real coffee in real cups
8. Bring lunches in reusable containers
9. Leave information on how to save the planet in our waiting roomsCompeting Interests: None declared. - Page navigation anchor for RE: Our fight against climate changeRE: Our fight against climate change
Thank you for the invitation to consider our role as family physicians relating to climate change.
We see an ability to act at three levels: 1. personally, 2. in our offices/practices/local communities and 3. advocating for change at the provincial and national level.You have highlighted in your article some of the things that individual family physicians are doing personally by changing their diets (1) and adopting active transportation (2) (cycling and walking instead of driving).
At the practice level, many interventions have appeared in the CFP (3) and are included in the https://greenhealthcare.ca/green-office-toolkit/. Establishing a clinic “green team” can help to support these office-based initiatives as physicians are often looked to for leadership.
The Climate Change Toolkit for Health Professionals, produced by CAPE, is a solid resource for both practice level and advocacy work: https://cape.ca/wp-content/uploads/2019/04/Module-8-FACTSHEET-READY-TO-U...
We know that translating clinical knowledge from study to practice takes time. Translating knowledge about climate change from basic science to practice and advocacy will also take time. Recognizing that time is not on our side in this issue, we need to create ways to decrease translation time by sharing with patients...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: What can Physicians do to mitigate the Climate Emergency?RE: What can Physicians do to mitigate the Climate Emergency?
‘What can doctors do to mitigate the climate emergency?’.
In Fall 2018 the UNIPCC came out with their unequivocal dire warning that there is a limited time to reduce our carbon footprint, in order to keep global temperature rise to less than 1.5 degrees Celsius. Right now is the narrow window of time to change our ways. If we don’t reduce emissions substantively and soon, feedback loops will take effect, so that later human efforts will have little impact.
This was an ambulance siren deafening my ears, and demanding attention, STAT!
I’m a physician, I should know what to do in an emergency. And this is a Climate Emergency.
But there I sat, wondering what I could do in my little life to make a difference.
Then along came Greta. If you’ve been under a rock for the past year, and don’t know Greta Thunberg, she is a 16 year old girl from Sweden who has single-handedly started an international Student led movement of Climate Awareness and Strikes, starting simply by sitting outside her parliament every Friday to demand government action on Climate Change.
As she so pointedly says, ‘The only hope is in action’.So here is my plan, feel free to adopt any and all ideas, and let me (and everyone else in your life) know if you have more suggestions.
There is so much that physicians can do, and I think ultimately must do. I believe as physicians we have a very unique and important voice to lend to the chorus demanding acti...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: Climate Change and HealthRE: Climate Change and Health
Thank you, Dr Ladouceur, from bringing this topic to the journal.
The WHO considers climate change to be the greatest health challenge of the century. As physicians, we are holders of knowledge in health matters, who act and advise with the best interests of our population in mind. As such, it behooves us firstly to educate ourselves on this critical health issue, and secondly be part of thoughtful solutions.
The CFPC can play a leadership role in providing such educational opportunities for family physicians, perhaps through the journal as well as through FMF and other live forums. We can learn about the ways our practice of medicine is impacting the climate (the health sector is estimated to contribute 5-10% of global greenhouse gases), as well as how the climate is impacting our health. We can learn ways to mitigate our impact on the environment, as well as how we can adapt our health systems to the changing climate. We can participate locally as well as help our colleagues globally where the impacts may be greatest. The CFPC can consider partnering with CAPE and other organizations to provide this education. Perhaps the CFPC can also develop ways to provide leadership and advise policy makers on the best way forward with solutions in the health sector.
A fundamental change in our world view is necessary as well. Our beautiful planet, even with it’s changing climate and natural disasters, is still our home, our vital source of nourishment and suste...
Show MoreCompeting Interests: None declared. - Page navigation anchor for Mitigating climate changeMitigating climate change
Please modify my letter (published on line on 28 November 2019.) Please change the third sentence in the second paragraph to read:
Anticipate flooding of low lying coastal parts of Canada, the United States, Europe, China, Bangladesh, several Pacific island nations; and the lower valley of rivers including the Fraser, St. Lawrence, Mississippi, Rhine, Po, and Yellow.
The rest of the letter remains unchanged.
Thank youCompeting Interests: None declared. - Page navigation anchor for RE:Mitigating climate changeRE:Mitigating climate change
The scientific evidence linking human burning of fossil fuel with climate change is overwhelming. Tens of thousands of Canadians were evacuated from their homes because of the wildfires in Alberta and British Columbia in 2017 and 2018. Salmon are becoming scare in BC rivers. These events are due to climate change.
In the future, farmers may have to give up on non-irrigated land in southern Alberta and Saskatchewan. Deserts will expand in the United States, Africa, India, and China. Anticipate flooding of low lying coastal parts of Canada, the United States, Europe, China, Bangladesh, several Pacific island nations; and the lower valley of rivers including the Fraser, St. Lawrence, Mississippi, Rhine, Po, and Yellow. Flooding will tend to occur during storms and high tides, as happened in the Netherlands in 1953, and in Venice in 2019.
Dr. Ladouceur asked, "What can we as the family medicine community ... do to be more involved in the fight against climate change?" I recommend that we lead by example, and that we advocate for positive change.
The use of a personal vehicle adds much carbon dioxide is added to the atmosphere. If possible, get around on foot or by bicycle. Such activity promotes cardiovascular fitness, weight loss, and raises HDL cholesterol. If you must drive, use a small gas-electric hybrid.
Eating meat, especially beef, requires the use of fossil fuel to produce fertilizer, to irrigate grass and cropland, and t...
Show MoreCompeting Interests: None declared. - Page navigation anchor for Our fight against climate change: Time for non-violent direct action?Our fight against climate change: Time for non-violent direct action?
I appreciated Dr. Ladouceur's article. One of the first proactive things we can do is to start talking to our patients about climate change, planetary health, and its connection to human health and mental health. By voicing our own concern about climate change and framing the discussion around health effects, we can have a role in improving patient understanding that this is a real thing (for the sceptics) and to act (for those who are already on-board but don't know what to do!). Actions such as active transportation, composting, reduced air travel, and dietary changes are important for us to model. And this can inspire our patients to do the same, ultimately translating to meaningful health and climate benefits in our communities. We can even be more proactive by being a voice within an organized group, such as CAPE, thereby sharing the message to wider forums such as other physicians in our communities.
But I submit that these actions will not translate to meaningful outcome without a coordinated commitment by our political and business leaders to step up to the plate also. We have got to where we are because governments have not heeded or acted on the warnings that have flown from multiple scientific bodies with increasing urgency for the best part of thirty years. And because of that wilful avoidance of the facts, we are now in an emergency situation with just 11 years to avoid a global climate catastrophe. So, whilst I agree that individual actio...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: Our Fight Against Climate ChangeRE: Our Fight Against Climate Change
Dear Editor,
Thank-you, Dr. Ladouceur, for appealing to Canadian family physicians for strategies to fight climate change and preserve our planet.
One idea is for CFPC and its provincial and territorial counterparts to demonstrate leadership at conferences, starting immediately. Serving predominantly plant-based meals, avoiding single-use plastics, and offering and accrediting “tele-presence” at conferences could all be done routinely. This would substantially decrease our carbon and environmental footprint as a group of health professionals (1–3). These efforts could be publicized to set an example.
Regrettably, at the Wednesday lunch of FMF 2019, for every 3 rows of plant-based offerings, there were 10 rows of meat (roast beef or chicken). This is in line with neither Canada’s Food Guide (4), nor the EAT-Lancet Commission (5). Thankfully, the packaging and utensils were mostly compostable. A large number of physicians flew across the country to attend the conference and it is unclear (after having inquired at CFPC) whether there were options for participating remotely.
In line with our CanMEDS-FM roles of leadership and advocacy, the Canadian public should view family physicians as exemplars in matters of health. We call on CFPC and its provincial and territorial colleges to immediately organize conferences to be consistent with current scientific evidence.
Dr. Tomislav Svoboda MD MSc PhD CCFP FRCPC, Associate Professor;
and Dr...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: What CFP can do to preserve our planetRE: What CFP can do to preserve our planet
I was struck by the title of this editorial. Perhaps as a matter of public health, we could have a policy of reframing the issue, from a « fight against climate change » to « standing for « a whole series of interrelated issues: clean air, clean water, a flourishing of all living things together, etc.
We understand the toxicity of anxiety and depression. Neither one is a nursery for effective action. Taking ANY action in the direction of what one loves and appreciates does ignite the participation of others: in actuality, a lot is going on in this direction even though our traditional media culture focuses on our failures. There certainly are plenty of failures to focus on.
Nevertheless, those who cultivate and pursue some vision (almost any vision?) outlive those who remain disheartened, however much data there may be to support the general view that things are going badly. We know how discouraged and disheartened many people are.Let us consciously advocate FOR, and leave to others the fighting against.
Competing Interests: None declared. - Page navigation anchor for RE: Our fight against climate changeRE: Our fight against climate change
I welcome the opportunity to respond to Dr. Ladouceur's challenge to the
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family medicine community to become more involved in addressing the climate
crisis. We need to acknowledge the public health effects of climate change,
educate our membership and patients about mitigation and adaptation
strategies, advocate for meaningful political change and contribute to local
adaptation efforts. Fortunately, in terms of reducing our professional
environmental impact we need not reinvent the wheel. The Green Office
Toolkit:
https://greenhealthcare.ca/wp-content/uploads/2018/04/Green-Office-Toolk...,
provides a practical approach to 'greening' ones practice. Likewise, CAPE has
published the Climate Change Toolkit for Healthcare Professionals:
https://cape.ca/campaigns/climate-health-policy/climate-change-toolkit-f...,
and the comprehensive resource guide: Preparing Health Care Facilities for
Climate Change:
https://www.greenhealthcare.ca/climateresilienthealthcare/CCGHC-Resilien...
offers a wealth of rel...Competing Interests: None declared. - Page navigation anchor for RE: Our fight against climate changeRE: Our fight against climate change
I felt I had to answer the question about what we can do as a medical community to be more involved in the fight against climate change, as this is an area in which I passionately believe and one which seems to be ignored by a portion of the medical community.
Dr. Ladouceur mentioned some of the individual contributions we can each make. Some of these include using active means of transportation to lessen our use of fossil fuels and eating less meat or no meat to decrease the impact of raising and harvesting animals for food. Other examples are decreasing our plastic purchasing and use, reducing our consumerism, and reusing items before thinking about recycling them or throwing them in landfills.
From a larger medical community perspective, we can attempt to influence our patients and colleagues by example and by discussions with them regarding healthier food and transportation choices which affect personal and climate health. We can encourage careful use of power sources in our clinics and hospitals by turning off computers, printers and lights when not needed, and turning down the heat in the winter and the air conditioning in the summer. We can adjust temperatures appropriately for nighttime and weekends when the clinic is empty. We can print on paper only when absolutely necessary and always two-sided on recycled paper. We can stop using paper patients’ gowns and sheets. We can take part in hospital planning to decrease the amount of garbage on patient f...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: Our fight against climate change, editorialRE: Our fight against climate change, editorial
Thanks to Dr. Ladouceur for an eloquent articulate editorial on a very crucial health issue.
Though cycling, buying electric vehicles and eating less meat are important to fight climate change, at this late stage these individual efforts will not be enough. After decades of unconscionable inaction, we must immediately begin a massive overhaul of our economic system, whose mantra of limitless growth is proving to be a fallacy, evidenced by the planet's increasing greenhouse gas levels, weather catastrophes, climate refugees and inequality.
Physicians, who are respected and influential in the eyes of the public, must venture outside their comfort zones into actions that urge our governments to address the influence of large corporations on public policies, corporations whose goal is to maximize profits at the expense of citizens and their health. Physician colleges and associations must take a public stand on this and meet with politicians to express the urgency of this health crisis.
As described by Naomi Klein in her recent book On Fire: The Burning Case for a Green New Deal, we cannot separate the climate crisis from the need for transformative change in our relationship with the Earth and in our economic system. Otherwise it will be too little too late, with the continuing demise of the planet’s health and our own.
Competing Interests: None declared. - Page navigation anchor for RE: our fight against climate changeRE: our fight against climate change
Dr Ladouceur asks “do family physicians have a specific role to play in all this (climate change)? My answer to this is an emphatic “no”. We certainly can have a role, but it need not be “specific”.
He worries that joining CAPE is not specific to family medicine. His concern is misplaced.
CAPE provides educational materials for physicians of all kinds who wish to understand climate change and educate their patients. Physicians of all specialties have in common a training in and an understanding of science, as well as having the confidence and trust of their patients. Climate change is not another example of difference between specialists and family physicians that we so commonly see. It is an issue that all physicians can see with the same lens.
If a family physician wants to know a role he or she can play, join CAPE.
One other point: many leaders within CAPE are and have been family physicians, and college members.
David Ouchterlony MD CCFP,FCFP (retired)
Competing Interests: None declared. - Page navigation anchor for Merci pour votre editorial : Our fight against Climate changeMerci pour votre editorial : Our fight against Climate change
Bonjour Roger,
Un petit mot d'appréciation pour cet editorial...
Je suis très préoccupée, je cherche mon chemin de contribution sans le trouver exactement. Je vais confirmer mon adhésion à CAPE (je fais partie du mouvement québécois).
Le CQMF débutera un groupe de travail à cet effet très prochainement pour ajouter sa voix aux autres voix en place.
Tiens-moi au courant si tu as vent d'autres manières de contribuer.Merci encore pour ton mot et au plaisir,
Maxine Dumas Pilon, MD, CCFP, FCFP
Family Medicine Center, St-Mary's Hospital
McGill UniversityCompeting Interests: None declared.