From Fort St. John to Victoria, and Cranbrook to Dease Lake, effects of climate change, including wildfires, drought, flooding, and severe weather events, are occurring with increasing frequency and severity across the province.[1] It is estimated that there has been a 1.4 °C average temperature increase across British Columbia in the last century, with an increase of 1.3 to 2.7 °C projected by 2050.[1] The health effects of this warming are numerous and multifaceted with implications for clinical practice across specialties.[2]

Although often unseen, and less prominent in headlines, climate change and associated sequelae have both direct and indirect implications for mental health and psychosocial well-being.[2] Specifically, climate change has been associated with numerous mental health conditions including posttraumatic stress disorder (PTSD), depression, anxiety, grief, substance use disorders, and suicidal ideation among many others.[3] Older adults, children, those with pre-existing conditions, comorbidities, limited culturally safe supports, and/or lower socioeconomic status may be more vulnerable during emergencies.[4]

Over the last few years wildfires across the province, exacerbated by changing weather patterns and temperature increases, have resulted in poor air quality, displacement and housing insecurity, food and water insecurity, and social isolation, and have affected employment opportunities for some British Columbians—all with mental health implications for those affected. Studies of similar experiences in Fort McMurray, Alberta, after wildfires forced total evacuation in 2016, suggest that psychosocial impacts from the fires were widespread and likely to persist following evacuation.[5] In the context of disasters, health care providers and first responders are often among those affected. Despite growing appreciation of the mental health effects associated with climate change, measuring these effects has proven to be particularly challenging due to the problems of causation and attribution.[3]

For physicians and other health care providers, the mental health effects of climate change will undoubtedly continue to affect our patients, our practices, and our communities for years to come. In this context, support for mitigation and adaptation strategies by clinicians is essential.[6] Adaptation strategies focus on systemic modifications to reduce the risk of and cope with the negative effects of climate change. The 2018 Lancet Countdown Briefing for Canadian Policymakers recommended investing in research on the mental health effects of climate change and psychosocial adaptation.[7] Building a robust evidence base to inform adaptation measures to protect and promote mental health is a critical first step. Possible adaptation measures targeting mental health may include:

• Expanding access to mental health services, including cognitive behavioral therapy, crisis counseling, and individual/group therapy.
• Increasing primary care interventions to improve mental health and promote resilience.
• Improving surveillance and monitoring of mental health in the context of climate change–related events.
• Integrating robust, evidence-based measures to address psychosocial well-being in climate action plans as well as emergency preparedness planning.[4]
• Enhancing training for health care providers and first responders in addressing the psychosocial needs of patients.[3]

Given current climate-related projections, it is important that the BC physician community develop an awareness of the psychosocial implications of climate change and actively participate in efforts to prepare, advocate, and respond.
—Elizabeth Wiley, MD, JD, MPH

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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.    British Columbia Ministry of Environment. Indicators of climate change for British Columbia, 2016 update. 2016. Accessed 18 March 2019. https://www2.gov.bc.ca/assets/gov/environment/research-monitoring-and-reporting/reporting/envreportbc/archived-reports/climate-change/climatechangeindicators-13sept2016_final.pdf [10].

2.    Watts N, Adger WN, Agnolucci P, et al. Health and climate change: Policy responses to protect public health. Lancet 2015;386(10006):1861-1914.

3.    Hayes K, Blashki G, Wiseman J, Burke S, Reifels L. Climate change and mental health: Risks, impacts and priority actions. Int J Ment Health Syst 2018;12:28.

4.    Doctors of BC. Improving collaboration in times of crisis: Integrating physicians in disaster preparedness and health emergency management. Accessed 10 March 2019. https://www.doctorsofbc.ca/sites/default/files/disaster_preparedness_policy_paper_web_id_235753.pdf [11].

5.    Cherry N, Haynes W. Effects of the Fort McMurray wildfires on the health of evacuated workers: Follow-up of 2 cohorts. CMAJ Open 2017;5:e638-e645.

6.    Peterson E, Lu J. Responding to climate change in BC: What can physicians do? BCMJ 2017;59:227-229.

7.    Lancet countdown 2018 report: Briefing for Canadian policymakers. Accessed 10 March 2019. www.lancetcountdown.org/media/1418/2018-lancet-countdown-policy-brief-canada.pdf [12].