Canadian nurses’ unions issue a call for action on the climate health emergency

Nurses climatechange-cover-368x480The Canadian Federation of Nurses Unions (CFNU) is the umbrella organization representing approximately 200,000 nursing and front-line health professionals in unions across Canada. At their Biennial Convention in Fredricton in June, representatives passed Resolution #3, calling on the CFNU and its Member Organizations: …  to recognize within their position statements that climate change is “a global crisis and health emergency”; …to support sustainable health care practices to reduce greenhouse gas emissions in health care settings; …to “engage with community stakeholders, such as the Canadian Labour Congress, in initiatives and campaigns that raise the public’s awareness about the serious health implications of climate change”; and to call on the federal and provincial governments to undertake the necessary policies to meet Canada’s obligations under the United Nations Framework Convention on Climate Change (the Paris Agreement)….”

Also at the convention, the CFNU released a  discussion paper: Climate Change and Health: It’s Time for Nurses to Act . It is described as “a starting point for for advocacy and leadership”. It summarizes the well-established health impacts related to climate change in the Canadian environment – for example, heat stress, increased allergies and asthma, cardiorespiratory distress from air pollution due to wildfires, Lyme disease. It includes a special focus on mental health and anxiety impacts.  It also highlights three practical examples from  2018 : wildfire smoke exposure in B.C., flooding in Atlantic Canada, and heat waves in Ontario and Quebec.

The report concludes with these six recommendations for nurses:

  1. Work with your employers, unions and associations to reduce emissions and to “green” your workplace.  (sub-recommendations include “Promote the divestment of pension plans from high-emission sectors and the investment in clean technologies and low-emission sectors;”)
  2. Know about climate change science, and help educate patients and the general public about it.  (sub-recommendations include “Campaign for the ecological determinants of health to be included in nursing education to prepare future generations of nurses, who will see the greatest effects of climate change. Nursing education should support a basic level of climate change literacy.”)
  3. Call for meaningful federal and provincial actions to reduce and eliminate climate change-causing emissions to ensure Canada leads the world in implementing its obligations under the UN Framework Convention on Climate Change (The Paris Accord). (Sub-recommendation: Promote transitioning away from fossil fuels towards renewable energy. ….. By investing in renewal energy rather than in fossil fuels we are committing to a healthier future.)
  4. Be aware and plan for the emerging needs of patients resulting from climate change and help them take action to support a healthy planet. (Sub-recommendation: “ Be aware and prepare your workplaces for future influxes of climate refugees coming to Canada. This population may have experienced trauma or extreme environmental conditions and taken risks to enter this country.”)
  5. Be prepared for extreme weather events.
  6. Promote active transportation and local healthy agriculture and food systems to reduce emissions.

Climate-Change-Toolkit-for-Health-Professionals-2019-234x300The Discussion paper was launched as part of a panel which included Dr. Courtney Howard, president of the Canadian Association of Physicians for the Environment.  CAPE issued their latest Call to Action  in February 2019 , in collaboration with the Canadian Medical Association , the Canadian Nurses Association, the Urban Public Health Network , and the Canadian Public Health Association.  On April 30, CAPE released a Climate Change Toolkit for Health Professionals, which is available for download in either English or French , and offers eight stand-alone modules with seven factsheets. Topics include Climate Change Health Impacts Globally and Across Canada; Taking Climate Change Action at Health Facilities ; Preparing for Climate Change in our Communities;  and Engaging in Climate Change as Health Professionals, which highlights, for example,  CAPE’s role in the campaign to phase-out coal in Alberta. As part of their active advocacy campaign, CAPE  makes frequent media statements and was part of the health delegation which met with the federal Minister of Health on June 7 .

Climate change and health: more evidence of the dangers of extreme heat for workers

european health reportThe Imperative of Climate Action to Protect Human health in Europe was released on June 3  by the European Academies Science Advisory Council, urging that adaptation and mitigation policies give  health effects a greater emphasis, as well as proposing priorities for health policy research and data coordination in the EU.   The report also acts as a comprehensive literature review of the research on the present and future health impacts of climate change in EU countries.  It documents studies of direct and indirect health effects of extreme heat, forest fires, flooding, pollution, and impacts on food and nutrition.  Some of these impacts include communicable infectious diseases, mental illness, injuries, labour productivity, violence and conflict, and migration. It identifies the most vulnerable groups as the elderly, the sick, children, and migrating and marginalized populations, with city dwellers at greater risk of heat stress than rural populations.

construction drinking waterHeat as a Health risk for workers:  Although the report doesn’t highlight outdoor workers such as farmers and construction workers as a high risk group, it does weigh in on heat effects on labour productivity for indoor and outdoor workers.   For example,  “Even small increases in temperature may reduce cognitive and physical performance and hence impair labour productivity and earning power, with further consequences for health. Earlier analyses had concentrated on the effects of heat on rural labour capacity, but now it is appreciated that many occupations may be affected. For example, recent analysis by the French Agency for Food, Environmental, Occupational Health and Safety (ANSES 2018) concludes that productivity and health of workers in most business sectors will be affected in European countries by 2050. The effects of indoor high temperatures in terms of altered circadian rhythms were recently reported (Zheng et al. 2019) as part of a broader discussion of the literature on indoor high temperatures and human work efficiency. For temperature rises greater than 2°C, labour productivity could drop by 10–15% in some southern European countries (Ciscar et al. 2018). Meta-analysis of the global literature confirms that occupational heat strain has important health and productivity outcomes.”Canada Post Strike 20160705

Also: “with 1.5°C global temperature change, about 350 million people worldwide would be exposed to extreme heat stress sufficient to reduce greatly the ability to undertake physical labour for at least the hottest month in the year; this increases to about one billion people with 2.5°C global temperature change .”

And also: Hot and humid indoor environments may result in “mould and higher concentrations of chemical substances. Health risks include respiratory diseases such as allergy, asthma and rhinitis as well as more unspecific symptoms such as eye and respiratory irritation. Asthma and respiratory symptoms have been reported to be 30–50% more common in humid houses.”

Calls to improve heat standards for U.S. workers : A report in 2018,  Extreme Heat and Unprotected Workers , stated that  heat killed 783 workers in the U.S. and seriously injured nearly 70,000 between 1992 and 2017. The report was published by  Public Citizen, a coalition of social justice groups and labour unions. They continue to  campaign  for a dedicated federal standard regarding heat exposure – most recently with a  letter to the U.S. Department of Labor on April 26, 2019 which states: we “call on you to take swift action to protect workers from the growing dangers of climate change and rising temperatures in the workplace. …. The Occupational Safety and Health Administration has an obligation to prevent future heat-related injuries, illnesses and fatalities by issuing a heat stress standard for outdoor and indoor workers.”  The campaign is described in   “Worker advocates burned up over lack of federal heat protections” in FairWarning (May 9), with examples of some U.S. fatalities.  Notably, the death of a  63-year-old postal worker in her mail truck in Los Angeles in July 2018  resulted in  H.R. 1299,  the Peggy Frank Memorial Act, which was introduced in the House of Representatives in February 2019 and would require any Postal Service delivery vehicle to include air conditioning within three years. (It has languished in the House Standing Committee on Oversight and Reform since.)

The article also reports that in April,  California released a draft standard: Heat Illness Prevention in Indoor Places of Employment  which, if approved, would make California the first U.S. jurisdiction to cover both indoor and outdoor job sites. The proposed standard would require water and rest breaks for workers when indoor temperatures reach 82 F degrees, with additional requirements when temperatures hit 87 F. It is noteworthy that this is a slow process – even in progressive California, which has had heat protection for farm workers on the books since 2006,  the Advisory Committee leading this initiative has been meeting since 2017, and the draft standard still under consideration has been revised numerous times .

United Nations reports warn of health impacts of climate change, thawing Arctic

geo6 final 2019The Fourth United Nations Environment Assembly (UNEA) convened from March 11 – 15 in Nairobi, Kenya, under the sombre cloud of the crash of Ethiopian Airlines which killed many, including Canadians, on their way to attend the meetings.

The flagship report, produced by 250 global scientists and experts, is the Sixth Global Environmental Outlook, which the UN press release calls “the most comprehensive and rigorous assessment on the state of the environment completed by the UN in the last five years .. warning that damage to the planet is so dire that people’s health will be increasingly threatened unless urgent action is taken.”  It warns that, without such urgent action,  cities and regions in Asia, the Middle East and Africa could see millions of premature deaths by 2050, with pollutants in freshwater systems leading to deaths through increased  anti-microbial resistance, as well as impacts on  male and female fertility and impaired neurodevelopment of children, from endocrine disruptors.  A 28-page  Summary for Policymakers   is available in multiple languages besides English, including French .  GEO6-NA_cover_large

The official documents from the UNEA meetings are compiled here , including the closing press release summary, “World pledges to protect polluted, degraded planet as it adopts blueprint for more sustainable future” .

Other reports relevant to Canada:

1.The Assessment and Data Report for North America is one of the regional reports, all of which are compiled here .

2.  Global Resources Outlook 2019: Natural Resources for the Future We Want    examines the economic benefits and environmental costs of resource use, and finds that all resource sectors combined (including agriculture, mining, forestry ) account for 53% of the world’s carbon emissions. Extraction and primary processing of metals and other minerals  is responsible for 20% of health impacts from air pollution and 26% of global carbon emissions. The report warns that without change,  resource demand would more than double to 190bn tonnes a year, greenhouse gases would rise by 40% and demand for land would increase by 20%.   A summary of the report appeared in The Guardian.

3.   With a forecast even more dire than the 2018  IPCC report, Global linkages: A graphic look at the changing Arctic  warns that even if global emissions were to halt overnight, winter temperatures in the Arctic would still increase 4 to 5°C by 2100 because  of  greenhouse gases already emitted and ocean heat storage. The UNEA report warns of the dangers of thawing permafrost, predicting that by  2050, four million people, and around 70% of today’s Arctic infrastructure, will be threatened.  However, a critique by  the Carbon Brief    disputes this particular conclusion within the UNEA report, and states that  if humanity can mobilize to hit a -2 degrees C target, “future Arctic winter warming will be around 0.5 to 5.0°C by the 2080s compared to 1986-2005 levels, much lower than the 5.0 to 9.0°C values stated in the report.” … “This means that much of the future warming in the Arctic will depend on our emissions over the 21st century, rather than being ‘locked in’, as the report claims.” The Carbon Brief analysis is summarized in The  Energy Mix .

 

Climate change and health: a new call to action for doctors

Two new articles appeared in the January issue of the New England Journal of Medicine, recognizing the health impacts of climate change and the gap in environmental justice. Most frequently cited, sometimes with alarmist headlines, is  “The Imperative for Climate Action to Protect Health” (Jan. 17)  (registration required). The authors state that the World Health Organization may have underestimated the health effects of climate cop24_health_climate_change_reportchange when it predicted in a 2018 report that climate change will kill 250,000 people per year between 2030 and 2050.  The NEJM authors Haines and Ebi state: “We think the impact is more difficult to quantify because there is also population displacement and a range of additional factors like food production and crop yields, and the increase in heat that will limit labour productivity from farmers in tropical regions that wasn’t taken into account, among other factors. ”  They point to the need for investment and policies to promote adaptation to reduce health risks.

The other article in January’s New England Journal of Medicine is an overview of the issue and a more direct call to action for doctors.  ” Climate Change: A health emergency ”   by Drs. Caren G. Solomon and Regina C. LaRocque states:    “Disruption of our climate system, once a theoretical concern, is now occurring in plain view — with a growing human toll brought by powerful storms, flooding, droughts, wildfires, and rising numbers of insect borne diseases. Psychological stress, political instability, forced migration, and conflict are other unsettling consequences. In addition, particulate air pollutants released by burning fossil fuels are shortening human life in many regions of the world. These effects of climate disruption are fundamentally health issues, and they pose existential risks to all of us. People who are sick or poor will suffer the most….As physicians, we have a special responsibility to safeguard health and alleviate suffering. Working to rapidly curtail greenhouse gas emissions is now essential to our healing mission….  The authors’ call to action includes: “working with medical students on climate action, supporting the undergraduate divestment movement, joining forces with like-minded health professionals, and speaking with our legislators. “

In Canada, the Canadian Association for Physicians and the Environment (CAPE)   is leading the way on such education and advocacy – a compilation of their press releases  reveals the broad range of their actions. Most recently, on January 15, CAPE announced  that the Ontario Court of Appeal has granted intervenor status to the Intergenerational Climate Coalition, of which  CAPE is a member, to defend the constitutionality of the federal pricing of climate emissions, challenged by the Ontario provincial government in a case to be heard in April 2019.  Other members of the Intergenerational Climate Coalition are Generation Squeeze,  Saskatchewan Public Health Association, the Public Health Association of BC, the Canadian Coalition for the Rights of Children , and the Youth Climate Lab.  The same group announced in December 2018  that it has intervenor status in the Saskatchewan government’s challenge to the federal carbon tax plan.

UPDATE: 

A February 5 press release states: “Together, representatives from the Canadian Association of Physicians for the Environment (CAPE) , the Canadian Medical Association (CMA)  , the Canadian Nurses Association (CNA), the Canadian Public Health Association (CPHA) and the Urban Public Health Network (UPHN) are calling for action: asking federal parties to recognize that climate change is the greatest public health challenge of the 21st century, and to make climate solutions a priority in the 2019 federal election.”

Dr. Gigi Osler, President of the Canadian Medical Association (CMA) is quoted  : “Climate change is no longer some abstract idea that may harm future generations or people on the other side of the globe; it’s a reality that’s already harming the physical and mental health of Canadians. We cannot afford to treat climate change as a wedge issue. We must treat it as the public health crisis that it is.”

Lancet Report details health impacts of climate change with new estimates re heat impacts on labour

The latest landmark Report of the Lancet Countdown  was released at the end of November 2018, updating the global research on the health impacts of climate change.    The title of the press release reveals the focus : Extreme heat damaging our health and livelihoods and threatening to overwhelm hospitals around the world  . Using new methodology, the report estimates work hours lost to extreme heat: “153 billion hours of work were lost in 2017 due to extreme heat as a result of climate change. China alone lost 21 billion hours, the equivalent of a year’s work for 1.4% of their working population. India lost 75 billion hours, equivalent to 7% of their total working population.” lancet 2018 map heat and labour

Although the 2018 report emphasizes the increasing threats related to heat, it  measures 41 indicators related to disease, air pollution, extreme weather, and addresses economic and social impacts – including food security and climate migration.  Regarding energy, it states “ In 2017, renewable energy provided 10.3 million jobs – a 5.7% increase from 2016. But fossil fuel extraction industries increased to 11 million – an 8% increase from 2016.” The report estimates  deaths from air pollution by source attribution, with coal estimated to account for 16%  of deaths globally.  It also includes a new indicator mapping extremes of precipitation, identifying South America and southeast Asia among the regions most exposed to flood and drought and, on food security, the report points to 30 countries experiencing downward trends in crop yields, reversing a decade-long trend.

In addition to the main global report, national Briefings for Policymakers are provided for the Brazil, China, the EU, India, the Netherlands, Spain, U.K. and the U.S., as well as Canada. An excellent summary of the main report and the Canadian sub-report appears from the Canadian Association of Physicians for the Environment.

The Briefing for Canadian Policymakers  is written in collaboration with the Canadian Medical Association and the Canadian Public Health Association. It provides a Canada-specific view of  health impacts, and makes recommendations: for example, “Phase out coal-powered electricity in Canada by 2030 or sooner, with a minimum of two thirds of the power replaced by non-emitting sources ;…  increase ambition in reducing greenhouse gas emissions and air pollution in Canada and twin this with an emphasis on Just Transition Policies to support an equitable transition for people who work in the fossil fuel industry as the energy economy transforms;…. Apply carbon pricing instruments as soon and as broadly as possible, enhancing ambition gradually in a predictable manner, and integrate study of resulting air pollution-related health and healthcare impacts into ongoing policy decisions.” The report provides Canadian context for  the under-appreciated topic of  “Climate Change, Mental Health and Ecological Grief”, with examples from the Arctic and sub-Arctice: Rigolet, Nunatsiavut, and a study of  the SOS Summer-of-Smoke , when the area around  Yellowknife experienced  prolonged smoke and fire exposure in 2014.

Finally, the global Countdown report warns  that “A lack of progress in reducing emissions and building adaptive capacity threatens both human lives and the viability of the national health systems they depend on, with the potential to disrupt core public health infrastructure and overwhelm health services.”  It points to the growth of health-related advocacy groups , the divestment from fossil fuels, (including by the Canadian Medical Association), and the need for climate change-related training for health professionals.    The Canadian report also addresses this need for training for health professionals, stating:  “A well-trained workforce is required to respond to these challenges. The Canadian Public Health Association’s Ecological Determinants Group on Education has been working to integrate an ecosocial approach into public health education, including facilitating the participation of the Canadian Federation of Medical Students in an International Federation of Medical Students’ Associations initiative which seeks to see climate change and health gain a foothold in curricula by 2020 with fuller integration by 2025.”

The Lancet Countdown: Tracking Progress on Health and Climate Change is a global, interdisciplinary report funded by the Wellcome Trust, and researched through the collaboration of  27 academic institutions and inter-governmental organizations. The full report is here  (registration required).