Responding to climate change in BC: What can physicians do?

Climate change is happening now. Since 1900 the average temperature in BC has increased by 1.4 °C per century.[1] In addition to rising average temperature, BC can expect more frequent extreme weather events, retreat of glaciers, and sea level rise.[2] Climate change will impact human health in BC through various pathways including air- and water-quality deterioration, wildfires, flooding, extreme heat, loss of food sources, and range extension of pathogens and disease vectors.[3-5]

Air-quality impacts include increased ground-level ozone, smoke from wildfires, and aeroallergens from longer pollen seasons. These changes will exacerbate morbidity and mortality from chronic respiratory and cardiac conditions.[3,5,6]

Extreme weather events can lead to flooding, landslides, power disruptions, and damage to shelter, causing injury and death, drinking water contamination, waterborne disease outbreaks, indoor air–quality concerns, and mental health impacts.[3,5] More frequent drought conditions will impact agricultural production and drinking water quality and quantity. Extreme heat events will increase morbidity and mortality.[3,5,7]

Warmer water will lead to the proliferation and range extension of cyanobacteria, norovirus, vibrio species, and other pathogens, resulting in contaminated drinking water, recreational water, fish, and shellfish.[3,5]

Indigenous and northern communities that access traditional food sources are particularly vulnerable to the impacts of climate change. Additionally, older adults, pregnant women, young children, and socially and economically disadvantaged populations are more susceptible to the health impacts of events such as extreme heat and poor air quality. Also, coastal communities will see greater impacts due to rising sea levels, storm surges, and biodiversity changes.[3,5]

Actions and policies aimed at climate change have a variety of health benefits. For example, reducing fossil fuel use can improve air quality, adopting active modes of transportation can increase physical activity, increasing green space and tree canopy coverage can enhance heat resilience, and reducing greenhouse gas emitting livestock production can support reduced meat consumption.[8]

Physicians can respond to climate change in a number of ways:[9-11]
•    Keep up to date on the evidence of the health impacts from climate change and the benefits that come from taking action. Share this knowledge with your patients, families, and communities.[9,10,12]
•    Advocate for the meaningful inclusion of human health in climate change policy decisions.[9-11]
•    Help reduce greenhouse gas emissions from the health care sector.[9,10] Possible ways to decrease the health system’s carbon footprint include constructing energy-efficient buildings, using telemedicine to decrease travel, and optimizing reduce-reuse-recycle strategies in clinical care.
•    Prepare your practices, staff, and patients for extreme weather events:[13,14]

–    Assess your office’s vulnerabilities to incidents such as power outages, floods, extreme heat.
–    Assess your patient’s vulnerabilities, including adequacy of asthma/COPD management, and access to social support.
–    Monitor for public health messages such as air/water/food quality and extreme heat advisories.

Well-informed and engaged physicians can play a meaningful role in helping patients, families, and communities respond to climate change.

—Emily Peterson, MPH
—James Lu, MD

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This article is the opinion of the Environmental Health Committee, a subcommittee of Doctors of BC’s Council on Health Promotion, and is not necessarily the opinion of Doctors of BC. This article has not been peer reviewed by the BCMJ Editorial Board.

References

1.    Government of British Columbia. Climate change indicators. Accessed 20 March 2017. www2.gov.bc.ca/gov/content/environment/research-monitoring-reporting/reporting/environmental-reporting-bc/climate-change-indicators.
2.    Government of British Columbia. Climate change impacts. Accessed 20 March 2017. www2.gov.bc.ca/gov/content/environment/climate-change/policy-legislation-programs/adaptation/climate-change-impacts.
3.    Warren FJ, Lemmen DS, editors. Canada in a changing climate: Sector perspectives on impacts and adaptation 2014. Accessed 20 March 2017. www.nrcan.gc.ca/sites/www.nrcan.gc.ca/files/earthsciences/pdf/assess/2014/pdf/Full-Report_Eng.pdf.
4.    Watts N, Adger WN, Agnolucci P, et al. Health and climate change: Policy responses to protect public health. Lancet 2015;386(10006):1861-1914.
5.    2014 National Climate Assessment. US Global Change Research Program. Human Health. Accessed 20 March 2017. http://nca2014.globalchange.gov/report/sectors/human-health.
6.    Takaro TK, Henderson SB. Climate change and the new normal for cardiorespiratory disease. Can Respir J 2015;22:52-54.
7.    Kosatsky T, Henderson SB, Pollock SL. Shifts in mortality during a hot weather event in Vancouver, British Columbia: Rapid assessment with case-only analysis. Am J Public Health 2012;102:2367-2371.
8.    Barrett JR. Climate change mitigation: Assessing strategies that offer potential human health benefits. Environ Health Perspect 2014;122:A139.
9.    Hunter DJ, Frumkin H, Jha A. Preventive medicine for the planet and its peoples. N Engl J Med 2017;doi: 10.1056/NEJMp1702378. [Epub ahead of print].
10.   Crowley RA. Health and Public Policy Committee of the American College of Physicians. Climate change and health: A position paper of the American College of Physicians. Ann Intern Med 2016;164:608-610.
11.   Abelsohn A, Rachlis V, Vakil C. Climate change: Should family physicians and family medicine organizations pay attention? Can Fam Physician 2013;59:462-466.
12.   ecoAmerica 2016. Let’s talk health & climate: Communication guidance for health professionals. Accessed 20 March 2017. https://ecoamerica.org/wp-content/uploads/2016/10/Lets_Talk_Health_and_Climate_eA.pdf.
13.   Government of British Columbia. Top 10 hazards in BC. Accessed 20 March 2017. www2.gov.bc.ca/gov/content/safety/emergency-preparedness-response-recovery/preparedbc/know-the-risks.
14.   Victoria Division of Family Practice. Practice continuity workbook & guide for family physicians 2014. Accessed 20 March 2017. www.divisionsbc.ca/victoria/emergencyresponse.