My parents were pioneers in the recycling movement. My sister and I remember bouncing around in the back of a rented pickup truck in small-town Dundas, Ont, in the 1970s as we helped them collect bundled up newspapers. They did not call themselves environmentalists, but their actions suggested mindfulness regarding resources.
“If you’re cold, put on a sweater!”
“Turn out the lights behind you!”
“Turn off the tap!”
Medical school
My bicycle served as a source of exercise and as a symbol of my determination not to buy a car. When I started medical school at McMaster University in Hamilton, Ont, in 1990, I figured I could ride 363 days a year. Even during snowy winters, the roads were impassable on only a handful of days.
My values were shared by a left-leaning cohort of medical school classmates. We protested the Gulf War, we were taught to critique the pharmaceutical industry, and we refused to do multiple-choice exams. We heard that students at a skit night at another university portrayed a stereotypical McMaster medical student, bearded and wearing Birkenstock sandals, who walks into a clinic and introduces himself: “Hi, I’m Al.… Al Truistic.” Touché!
Our class started a “green team” with the primary goal of removing disposable foam cups from the hospital cafeteria. The facility staff treated us like we were brats (we probably were). Thirty years later, the use of disposable single-use cups still persists in the hospital.
Climate harms
Back in the 1990s environmental risks did not seem as concerning. Today, a climate crisis is upon us and the stakes are enormous.
An Intergovernmental Panel on Climate Change report published in 2023 indicated that climate change has resulted in increased human fatalities due to intensified heat waves, droughts, and floods globally.1 While the Global North produces most of the world’s greenhouse gas (GHG) emissions, the Global South suffers disproportionately. Every year, approximately 5 million excess deaths occur globally because of air pollution from fossil fuel use,2 and more than 3 billion people are estimated to live in areas in danger of climate breakdown.1 Many have already been forcibly displaced and face heightened food insecurity and civil unrest, while critical ecosystems experience irreversible losses.1 If nothing changes, our planet is headed toward a global temperature increase of 4°C over the next 75 years, which is projected to result in catastrophic environmental changes.3 Temperature increases will not be uniform, and Canada’s climates are expected to face warming at faster rates.4
Canada is already seeing increases in the intensity of hurricanes, floods, heat waves, wildfires, and endemic climate grief as well as greater risks of acquiring vector-borne illnesses.5,6 Climate disasters not only have direct impacts on our health; they also affect health care infrastructure and our ability to deliver care.
Fossil fuels, climate, and health care
The biggest contributor to climate change is our use of fossil fuels. Extracting coal, gas, and oil and burning it for energy account for 65% of the GHGs that have led to global warming.7 Methane, primarily from agricultural sources, represents another 16% of global emissions and is the reason why plant-rich diets and efforts to decrease food waste are so important.7,8 Nevertheless, it is the extraction and use of fossil fuels that have created the greatest health care emergency of our time.
In the health sector we use fossil fuels for heat and transportation, but we also rely on fossil fuels to produce and transport almost everything we purchase. This includes the extraction, shipping, manufacturing, packaging, use, and elimination of all our health-related products, from personal protective equipment to imaging machines. Health care’s supply chain represents a massive proportion of its total carbon footprint, ranging from 62% to 90% depending on the analysis and location studied.9,10
Nudging suppliers
We can ensure we receive the best value for our money by purchasing the most sustainable products from the most sustainable suppliers. We can push manufacturers to make longer-lasting and robust products and incentivize them to promote sustainability in their operations. For example, we can require suppliers to lower their companies’ GHG emissions or heavily weigh industry commitments to science-based emissions reduction targets in the bid appraisal process. A CDP (Carbon Disclosures Project) report published in 2023 found that less than 3% of buyers require suppliers to disclose climate-related data and only 0.04% of buyers require suppliers to have a commitment to science-based emissions reduction targets.11
In health care sustainability some progress has been made toward achieving the goal of net-zero GHG emissions12 by 2050. The National Health Service in England13 has mandated that all suppliers must publicly report their carbon footprints by April 2027. Two of the largest health care group purchasers in Canada, Mohawk Medbuy and HealthPRO Canada, have each added sustainability or environmental, social, and governance priorities to their supplier contracts.14,15 Some hospitals in Canada have added a sustainability and environmental impacts component to their tendering documents.16 At the individual level, we can push local suppliers to disclose and reduce their environmental impacts and we can support companies that champion sustainability.17
Fossil fuels and investment
At the United Nations Climate Change Conference in December 2023, a long-awaited international agreement was reached to begin phasing out fossil fuels.18 To support this transition in our supply chains we will need investment in green energy infrastructure and sustainable energy systems. Collectively, our health care system invests financially through health care pension plans, hospital foundations, research endowments, and clinic and hospital banking as well as through our personal banking choices.19
Most organizations and individuals invest in gas and oil passively; we do not specifically ask asset managers to invest our money in oil, but we also do not proactively tell them to take our money out of oil. A report published in 2023 showed that every $1000 (US) held in savings with large US banks contributes to the generation of 240 kg of carbon dioxide emissions annually, approximately equivalent to the emissions generated by a commercial airplane flight from Montréal, Que, to Vancouver, BC.20
By intentionally decarbonizing our investments, we resist supporting the fossil fuel industry and discourage its expansion. Switching to renewable energy investments encourages the market to direct resources toward decarbonization, a foundational shift that has begun.21
There is movement in this area as many health-related institutions, including the Canadian Medical Association and several prominent universities in Canada, have adopted strategies to fully opt out of fossil fuel investment.22-24 Our health care facilities and hospital foundations have not yet followed their lead.24 This may be due to a lack of education or fears that they will sacrifice returns, despite evidence to suggest that divestment from fossil fuel stocks may have a slightly positive effect on returns.25,26
Call to action
As physicians, we are tasked with promoting the health of our patients and of our larger communities. In an era where we are facing an unprecedented climate emergency, health advocacy must look different. To protect and promote human health, we must recognize it as inextricably linked to the health of the environment. By working to decrease fossil fuel use, the largest producer of carbon dioxide emissions, we can maximize our impact in creating a sustainable future.
Ask your health care suppliers for sustainable products and incentivize them to commit to science-based emissions reduction targets.
Speak with your hospital board of directors, your research endowment fund committee, and your foundation board of directors about transitioning to a low-carbon investment strategy.
Talk to pension fund trustees and stakeholders about phasing out fossil fuel investments.
Ask your hospital, clinic manager, or colleagues about reconsidering where they do their banking.
To quote UN Secretary-General António Guterres: “[O]ur world needs climate action on all fronts—everything, everywhere, all at once.”27
If Canadian physicians do not step up, who will?
Footnotes
Competing interests
None declared
- Copyright © 2024 the College of Family Physicians of Canada