Oct. 15, 2019

Can health care cure apathy? Feeling climate change in your bones

Climate change discussions usually revolve around environmental impact and damage to the planet. But it also has the potential to affect our health on personal and population-scale levels.

Climate change is often measured in centimetres and degrees, in parts per million, or dollars and cents. We're told waters will rise, flood plains will flood. But climate change will also be measured in more human terms.

During a flood, for example, freshwater supplies will become contaminated; stagnant waters will attract mosquitoes, which will lay eggs, potentially triggering outbreaks of malaria or dengue fever.

Organizations like the World Health Organization are planning ahead, recognizing that climate change will force people from their homes, and those people will put new burdens on the health care systems of their new homes. In extreme heat, pollen levels will rise, exacerbating respiratory problems for those with asthma. Changes in temperature and precipitation will threaten food production, which could lead to malnutrition.

Given our knowledge of climate change — in its empirical and more human dimensions — why are we so reluctant to act?

Taking the distance out of climate change

Taking action might require a fundamental shift in how we think about climate change. Norwegian psychologist and economist Per Espen Stoknes, who wrote What We Think About When We Try Not to Think About Global Warming, identifies distance as one of the key psychological barriers that prevent us from acting on climate change. People are not usually good at seeing problems as urgent when they appear on a distant horizon, both temporally and geographically. Climate change won’t be so bad in my lifetime, or, it’s happening way over there, people say.

The solution, according to Stoknes, is to flip the distance barrier and make climate change seem nearer, more personal, and more urgent.

Rooting the problem of climate change in local issues provides a visceral sense of urgency. For residents of Alberta, in 2013, as the banks of the Bow or Highwood Rivers gave way, the damp cling of silt on your palms may have brought home the reality of climate change. Or it may have been the stench of pumpkin-coloured smoke wafting across the sky as wildfires burned in British Columbia.

Framing climate change in terms of personal health can reduce the distance between the problem and the public. And this is where physicians come in: they can play key roles in helping people make connections between climate change and our physical and mental well-being.

Dr. Joe Vipond, MD, is a Calgary-based Emergency physician and clinical assistant professor in the Cumming School of Medicine’s Department of Emergency Medicine. He’s chair of the Alberta committee of Canadian Association of Physicians for the Environment (CAPE) and a member of the Cumming School of Medicine’s O’Brien Institute for Public Health. A prolific advocate for action on climate change, Vipond is brutally honest about the need to make climate activism personal.

“You can tell people that climate change endangers polar bears and certain kinds of frogs in Central America,” says Vipond, “and for a long time that was the key message. But it turns out people in Canada don’t care about polar bears and frogs. They care about themselves and their families.” Vipond’s key message is heartbreakingly simple: The health issues around climate change are going to impact those we love. “You start talking about cyclones in Bangladesh — or even flooding in Quebec — and our eyes start to glaze over,” says Vipond. “Then we go on with our lives.”

Knowing versus caring

Perhaps we can be forgiven for our lack of compassion for those we perceive as distant. Evidence suggests that we are hard-wired to empathize most strongly with those who are closest to us, our own communities, friends, family — and for ourselves. And it makes sense that if you don’t think climate change will affect you and yours, you may not take action.

Educating the public about the urgency of the problem is therefore vital. It might encourage you to know that awareness of climate change is growing, but a 2018 study by researchers at Yale University demonstrates that knowing about climate change and caring about it are two different things. The study reports that 70 per cent of men and 71 per cent of women know about climate change, but only 58 per cent of men and 63 per cent of women worry about it. Perhaps that’s because only 42 per cent of men and 48 per cent of women surveyed believe that climate change will affect them personally.

And so we return to the problem of reducing the distance people feel between themselves and climate change — helping them see that they, too, are vulnerable to its effects. It’s a problem Vipond tries to address with Albertans. “People say we’re relatively safe in our province because we have no coastline, no rising sea levels,” he says. “But just look at what’s happened here recently.” Alberta has been host to three of the five costliest natural disasters in Canadian history, all in the last ten years: the Fort McMurray and Slave Lake fires and the Southern Alberta flood.

Blue-skying Alberta

The smoky skies of 2018 served as a reminder that clean air is essential to good health, and to our enjoyment of the outdoors. The air quality in Alberta is imperfect at best, dispelling any myths that might linger about clean prairie skies. Air pollution often enters discussions on climate change, and it should be noted that reducing pollution is related to climate change as an after-effect of taking action.

“In Calgary we typically see ozone or smog,” says Vipond. “We’re not sheltered from air pollution in our city — it’s mainly due to transportation.” Our neighbours to the north fare no better. CAPE has shown that levels of harmful air pollutants in downtown Edmonton can be as much as 25 per cent higher than in downtown Toronto. Part of the problem in Edmonton is its proximity to coal-fired plants west of the city. Coal-based emissions, combined with other pollutants from sources like transportation, contribute to poor air quality.

Vipond has been vocal in calling for the phasing out of coal-powered electricity in Alberta. “It’s not so much a partisan issue as a smart policy,” he says. “We’re just learning about how varied the impacts of air pollution are. We’re seeing effects in brain development, pregnancy, cancer, emphysema and, of course, asthma. It even has an impact on mortality — this kills people.” 

The local side of global

Getting Albertans to understand that climate change isn’t just a distant concept is a good start. But thinking globally about the implications of climate change will be increasingly vital to our health in the years to come. As average temperatures and water levels rise, our world will shrink to the point where distance is a relative term. When nations across the globe are affected by climate change, the impact of those events ripples across oceans and continents. Vipond points out that issues like global supply chain instability can have health implications: “If we start losing links in that chain we will be even more unsafe.”

If the words “global supply chain threats” don’t exactly get you feeling a sense of urgency in your belly, try out this hypothetical scenario:

You’ve fallen ill and as you lie in a hospital bed, connected to an IV, you watch the news on TV. You learn that the country is facing a shortage of IV supplies due to the hurricanes in Puerto Rico, where bags of saline are manufactured.

Suddenly Puerto Rico is less distant and its hurricanes matter. Here is the effect of climate change in your own veins.

Taking climate change to medical school

Making connections between health risks and climate change are tasks to which physicians are well suited, but they could be better prepared to deal with the many aspects of climate-related health. Beginning discussions on climate health in medical school is one way to ensure the physicians of the future know how to treat patients in times of changing climates, and how to advocate for climate action.

At the Cumming School of Medicine, Dr. Andrea Hull, MD, and Dr. Julie Fisher, MD, unit co-chairs for the Global Health team, invited Vipond to participate on a panel about climate health advocacy in 2017. In response to increasing interest at Cumming, Vipond was asked back the following year to lead a two-hour session, and the goal is for climate health to play a permanent role in the curriculum.

Hull, a clinical lecturer and sessional instructor with the Department of Family Medicine at the Cumming School of Medicine,  and a family physician at the Mosaic Refugee Health Clinic, is actively pursuing that goal. “In time, we’d like to integrate the topic into all our courses,” she says. “In a respiratory course we should be talking about air pollution and wildfires. In a gastro-intestinal class we should talk about water-borne illnesses, or food insecurity. A psychiatry class should incorporate the impact of displacement.”

Hull would also like to see a focus on advocacy. “It’s important for our future physicians to join the discourse on climate change, and address broader systemic health issues related to climate.”

Kelsey MacQueen, a second-year student in Cumming’s MD program, is part of her school’s Planetary Health Interest Group, and is on the Canadian Federation of Medical Students’ Health and Environment Adaptive Response Task Force (HEART). Along with her interest group, she is working with Hull to incorporate more climate health programming into the curriculum.

In 2019, students will attend a mandatory lecture about climate health and will participate in a small-group session, developed in part by the Planetary Health interest group. “The small-group format gives students a chance to discuss a sample case and how it relates to climate change,” says MacQueen. 

Acute care for the planet

MacQueen feels a pressing need to increase the depth of climate health learning in the curriculum. “It will be my generation or the next who will deal with the bulk of the fallout from climate change,” she says. “So we’re highly invested in seeing changes in behaviours and attitudes.”

Vipond, although of a different generation, feels a similar sense of urgency in his advocacy work, equating it to his professional practice. “In emergency medicine you have to make decisions quickly, based on the information at hand. It’s like taking action on climate change. You know something needs to be done and you react as best you can. If that doesn’t work, you try something else. You don’t always have the luxury of waiting till you have the perfect answer.”

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Dr. Joe Vipond, MD, is a Calgary-based Emergency physician, chair of the Alberta committee of Canadian Association of Physicians for the Environment (CAPE) and a member of the Cumming School of Medicine’s O’Brien Institute for Public Health 

Dr. Andrea Hull, MD, is a clinical lecturer and sessional instructor at UCalgary's Cumming School of Medicine, and a family physician at the Mosaic Refugee Health Clinic.

Kelsey MacQueen is a second-year student at UCalgary's Cumming School of Medicine, is part of her school’s Planetary Health Interest Group, and is on the Canadian Federation of Medical Students’ Health and Environment Adaptive Response Task Force (HEART).

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