Acknowledging land and Earth

Issue: BCMJ, vol. 65, No. 3, April 2023, Pages 77-78 Editorials

Most of us are now familiar with land acknowledgments: statements made at the beginning of a meeting or event that acknowledge the people and nations who culturally and physically inhabited a territory prior to colonization. These offerings have increased significantly since the 2015 report of the Truth and Reconciliation Commission.

I vividly remember the first time I, a descendant of settlers, heard a land acknowledgment. In 2014, I was waiting for the start of a local play about the Militant Mothers of Raymur, who in 1971 camped on railway tracks until an overpass was built for their kids to use to cross the tracks to get to school. Many of the women were marginalized, directly affected by racism and/or the gender dismissal of the time. When a woman stood to address us, I initially thought she was part of the introduction to the play. She introduced herself and her Indigenous affiliation; then her soft words lodged themselves firmly in me. Hearing for the first time an unvarnished, irrefutable truth directly from someone affected left me with the discomfort of culpability and the knowledge that she had a right to ask for accountability.

Since then, I have heard many land acknowledgments, often rote or performative. Indigenous leadership asks us now to help evolve these into more meaningful structures of reconciliation—correctly pronouncing names of the people and the lands, sharing details of historical context and complexity, and not only acknowledging the past but also defining current relationships with Indigenous groups and committing to inclusivity and reflection of Indigenous interests.

Indigenous cultures openly acknowledge and protect the land and water on Earth. My office partner, Dr Doug Courtemanche, an environmental activist for decades who walks the walk (read: bikes the bike, composts the compost), has set standards and examples for our group to follow, often crediting Indigenous knowledge. He recently presented excellent grand rounds about the climate emergency and what actions physicians can take. I asked his permission to amplify some of his most passionate points in this editorial.

First, this is not a drill. Climate change is real, the science is not theoretical, and the climate emergency has already had more impact than predicted. Dr Courtemanche took care to pause several times during the talk to give us time to breathe and centre ourselves as we learned of inexorable changes related to carbon dioxide, water, microplastics, landslides, and extreme weather events.

Climate change directly impacts human health. The largest number of single-day deaths from any public health emergency in BC occurred on the day Lytton reached an all-time national record temperature of 49.6 °C in the heat dome of 2021. Famously, a patient was diagnosed with climate change in a Nelson emergency room. Despite sudden massive floods and atmospheric rivers, we were on track to have the driest year since records have been kept. Drought leads to food and water insecurity, changes in vector and fish ecology, and agricultural collapse. Pollution and wildfire smoke directly worsen asthma and cardiovascular disease. Skin cancers are expected to increase. And climate anxiety, depression, suicide, and other mental health impacts are real and worrisome, especially in younger people.

In any emergency, physicians have agency and ethical obligations to engage and help to the best of our abilities. The climate emergency is a true public health emergency. It is frustrating that neither grassroot activism nor international organizations like the World Health Organization and United Nations have been able to create meaningful international government-level change. We, as physicians, are in a position to support planetary health.

Most Canadian doctors believe climate change is happening and are worried or very worried. Even when it feels like a tiny drop in a global bucket, change both in individual actions and at the health care system level can be effective.

Our family carbon footprints can be reduced by having fewer children, not using cars, curtailing air travel, and eating a more plant-based diet. Even partial reductions in these areas can help if enough of us participate.

Green committees in our hospitals and offices can implement reusable gowns, drapes, and equipment; more recycling and reprocessing; and fewer opened packages.

Canadian medical students have organized initiatives to integrate climate health into their curricula, and we can model green behavior for them. We can credibly inform climate debate, guide patients in green behaviors, and support more nontravel-based meetings for our education. We can read and recommend books focused on green and Indigenous traditions. We can vote and invest responsibly and personally acknowledge stewardship of the land.

And some of us can amplify the message in an editorial.
—Cynthia Verchere, MD

Additional reading: Land acknowledgments

Gehl L. Land acknowledgment. The Canadian Encyclopedia. Last updated 6 May 2022. Accessed 21 February 2023.

Native Governance Center. A guide to Indigenous land acknowledgment. 22 October 2019. Accessed 21 February 2023.

Additional reading: Climate change

Bressler RD. The mortality cost of carbon. Nat Commun 2021;12:4467.

Brousselle A, McDavid J. Evaluation for planetary health. Evaluation 2021;27:168-183.

Lautensach A. Sustainable health for all? The tension between human security and the right to health care. J Hum Secur 2015;11:5-18.


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Cynthia Verchere, MD. Acknowledging land and Earth. BCMJ, Vol. 65, No. 3, April, 2023, Page(s) 77-78 - Editorials.

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