Climate change is a health issue

There is something infinitely healing in the repeated refrains of nature—the assurance that dawn comes after night, and spring after winter.

Rachel Carson, The Sense of Wonder¹

As awareness of the climate crisis escalates, our role in primary care is being reframed with urgency. Climate change is a fundamental determinant of health. As public health advocates, family physicians have a responsibility to engage seriously in environmental activism.

Climate change and health are linked in innumerable ways, as discussed by Xie et al in this issue (page 725).² For example, the distribution of deer ticks in Canada is expanding as warming temperatures broaden their habitat. Rates of Lyme disease are increasing correspondingly.³ Heat waves are increasingly deadly—in British Columbia, 569 sudden deaths during 1 month this summer were heat related.⁴ Recent wildfires in Canada are more intense and more frequent than in previous years, resulting in droughts and displacement.⁵ In medicine, we are already seeing the consequences of climate change in our offices, emergency departments, and hospital wards.

The impact of climate change goes beyond physical health, with serious implications for mental health. The literature describes ecological grief as grief secondary to experienced or anticipated ecological losses.⁶ Stress and mood disorders are predictable reactions to floods, droughts, and fires. Physicians in rural and remote communities are witnessing the health consequences of these tragedies in real time. In Canada’s north, permafrost degradation and the loss of sea ice is affecting the stability and health of arctic communities, whose residents are now at risk of losing their homes, culture, and traditional way of life.^7,8 As climate change continues, the clinical consequences will only worsen.

In August, the Intergovernmental Panel on Climate Change published the first of 3 planned reports. The panel’s summary outlines the problem with clarity: “It is unequivocal that human influence has warmed the atmosphere, ocean and land.”⁹ The summary was equally clear on the impact that climate change is already having:

Human-induced climate change is already affecting many weather and climate extremes in every region across the globe. Evidence of observed changes in extremes such as heatwaves, heavy precipitation, droughts, and tropical cyclones, and, in particular, their attribution to human influence, has strengthened.⁹

The report identifies that the largest contributor is greenhouse gas emissions from fossil fuels. To slow climate change, these emissions would need to halt immediately.

What role can physicians play? A core competency of CanMEDS–Family Medicine is health advocacy¹⁰; environmental advocacy is a form of health advocacy. On a macro level, we can be allies with Indigenous peoples and their land, stand against large-scale polluters, or help change consumption as a society. Micro-level advocacy can happen in the clinic, as described by Green et al (page 739).¹¹

With the fourth wave of the pandemic upon us, many are feeling burned out, with our energy for advocacy waning. Tackling climate change might seem daunting or even impossible. But instead of viewing it as yet another crisis in addition to coronavirus disease 2019, we can think of our pandemic experience as a powerhouse of change making. We learned what can happen when massive action is taken on a global scale. A new vaccine was created in record time. Workplaces and conferences shifted online. Communities worked together for a common cause. Change can happen, if political and public support exists.

If we hope to keep our patients and the public safe and healthy into the next decades, we need to reframe environmental advocacy as a central responsibility in primary care. Whether we undertake advocacy on a large scale or through small interventions in our day-to-day work, these actions will make an impact if we do them collectively. Environmental activism in medicine can no longer be a fringe activity. We simply do not have the time.

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