The commitment for physicians to “do no harm” extends to the planet.
Right now, however, the Canadian health care systems contribute 4.6% of greenhouse gas (GHG) emissions from lighting, cooling and heating hospitals, single-use medical items such as syringes, transportation in the medical supply chain, and a host of other standard practices across the continuum of care.
Recent data shows our per capita GHG emissions increased by 1.3% from 2018 to 2019 alone, the equivalent of more than nine million passenger vehicles on the road.
These emissions play a part in devastating ecosystems everywhere and contribute to what is now accepted as the greatest threat to human health.
But that can change with urgent action to create a net-zero health care system.
The path to net-zero involves reducing GHG emissions as much as possible and offsetting any remaining emissions. Canada’s strategy to achieve net-zero emissions relies on urgent action in many sectors, with goals ranging from improving access to public transit to making buildings more energy efficient to using carbon-capture technology.
In health care, reaching net-zero will require everything from creating climate-resilient infrastructure to minimizing medical waste to encouraging healthy living to keep people healthy and reduce the need for health services.
“Physicians witness the impact of climate change on patient health, whether it’s smoke inhalation from wildfires, the spread of infectious diseases, heat stroke, or a host of other preventable issues. We have a duty to act in the best interest of our patients, and our planet.”
Dr. Alika Lafontaine, CMA president
In 2021, Canada was one of more than 50 countries at COP26 to sign on to the World Health Organization’s initiative to develop climate resilient and low-carbon sustainable health systems.
The CMA is calling on the federal government to establish a national secretariat to ensure cross-country coordination and on all levels of governments, health care organizations and health care professionals in Canada to work towards a net-zero health goal.
The CMA is also committed to partnering with and being guided by First Nations, Inuit and Métis communities to advance and promote health care equity.
Climate change: Its impact on health in Canada
Warming at almost four times the global rate affects Northern food security and mental health; increasing rates of injury as people fall through melting ice.
Wildfire-related asthma and evacuation
Health care facilities in Alberta and the BC interior have to evacuate, with those displaced suffering anxiety and PTSD; wildfires of 2021 destroy the village of Lytton, BC.
Health care facilities close due to 2013 Alberta floods.
Uneven impact on crops, leading to food insecurity and socioeconomic distress.
Longer and more severe pollen seasons.
Three times as many cases of Lyme disease in Ontario in 2017 compared to the 2012-16. average.
A 2018 heat wave in southern Quebec is linked to 66 deaths and the 2021 heat dome in British Columbia leads to 619 deaths.
Newfoundland and Labrador
Climate-related drought and famine contribute to the Syrian refugee crisis.
Prince Edward Island
Relocation due to coastal erosion and storm damage
Hurricane Fiona destroys homes across the East Coast in 2022.
“I had been displaced due to flooding for over a year and dealt with contaminated water. The supports I needed were paid out of pocket. Moving forward, it will be our underserved populations and patients whose health is already compromised who will be affected the most. We are not ready for this to be our new normal and we need to do more to address the root causes of climate change.”
Elke Hutton, CMA Patient Voice advisory group
Strategies for net-zero health care
Expand virtual care
Create a robust primary health care system to alleviate pressure on hospitals
Supporting healthy living, including addressing the determinants of health, encouraging healthy eating and active living
Use energy efficiently, shifting to renewable energy sources and reducing the need for fossil fueled generators in hospitals
Practice sustainable prescribing, including reusable packaging when appropriate
Focus on community care to ensure health promotion and disease prevention, especially in rural and remote communities
Reduce waste through recycling and medical device reprocessing programs
Prepare for future climate emergencies with training and preparedness plans
Implement climate resilient infrastructure, such as flood doors and improved ventilation
What can clinicians do?
Choose sustainable procurement and health supplies
The majority of health sector emissions are embedded in the supply chain, including pharmaceuticals and medical devices. Clinicians can reduce waste and preferentially use lower-emission supplies. For example, by following appropriate prescribing guidelines to reduce unnecessary testing and treatments, and choosing reusable rather than single use medical devices, when possible.
Consider appropriate use of health services
The CMA is advocating for the implementation of robust primary care systems in Canada that everyone can access. Where appropriate, clinicians can help mitigate unnecessary use of hospital services by facilitating access to primary and community care service.
Reduce overall demand for health care
Integrative and comprehensive health care includes focusing on the determinants of health, chronic disease management, disease prevention and health promotion. Keeping people healthy will reduce the demand for energy intensive health services.
What would a net-zero health care system do?
Fossil fuel air pollution is believed to be responsible for one in five deaths worldwide. Preventing harm from pollution can improve patient experience and lead to better health outcomes.
Bolster system resilience
In coming years, heat waves alone may increase the number of emergency room visits and ambulance transports by 10 to 15%, which can exceed healthcare system capacity and reduce quality of care.
By 2050, climate change-related health costs in Canada will be between $59 billion (low emissions scenario) and $110 billion (high emissions).
A global community
Canada has an opportunity to join other countries in establishing net-zero health care systems.
In October 2020, England’s National Health Service (NHS) became the first health care system in the world to commit to net zero emissions. In July 2022, the NHS continued to lead the way, becoming the first health system to embed net-zero into legislation through the Health and Care Act 2022. It places a duty on the NHS to help tackle climate change.
In 2022, the WHO and NHS agreed to cooperate on activities to promote and facilitate the decarbonization of health care systems around the world.
Why is this a priority for the CMA?
The CMA is pressing for this solution as a partial response to the climate crisis and ongoing health inequities.
A net-zero health system by 2050 will lead to a healthier planet and a healthier population.
Our call for a net-zero system also builds on the CMA’s ongoing work to address the implications of climate change on human health, including contributions to Canada’s first national adaptation strategy and The Lancet Countdown on health and climate change.
What can I do to help?
Continued physician and public support for a net-zero health system is critical to making it a reality. Together, we have an impact with the CMA’s work, today.