CLIMATE CHANGE AND HEALTH - IT'S TIME FOR NURSES TO ACT -A Discussion Paper-Canadian Federation of Nurses Unions
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CLIMATE
CHANGE
AND
HEALTH
IT’S TIME FOR NURSES TO ACT
-A Discussion Paper-
Wanda Martin, RN, PhD
Lindsey Vold, RN, MN
JUNE 2019
CANADIAN FEDERATION OF
NURSES UNIONS (CFNU)
WE ARE CANADA’S NURSES.
We represent close to 200,000 frontline care providers and nursing students working in
hospitals, long-term care facilities, community health care and our homes. We speak to all
levels of government, other health care stakeholders and the public about evidence-based
policy options to improve patient care, working conditions and our public health care system.
Published by Project team ISBN
Canadian Federation of Sebastian Ronderos-Morgan 978-1-7753845-5-7
Nurses Unions Carol Reichert
2841 Riverside Drive Oxana Genina Printed & bound
Ottawa, ON K1V 8X7 Imprimerie Plantagenet
613-526-4661 Layout and graphics Printing
Alyster Mahoney
www.nursesunions.ca Cover images
Tatjana Djakova (front)
Francesco Ungaro (back)
© 2019 Canadian Federation of Nurses Unions
All rights reserved. No part of this book may be reproduced or transmitted in any form or by any
means without the permission of the publisher.
CONTENTS
MESSAGE FROM LINDA SILAS I
EXECUTIVE SUMMARY II
INTRODUCTION 1
FINDINGS 4
MAKING THE LINK ACROSS CANADA 12
MAKING THE CASE FOR CHANGE 18
CONCLUSION 23
REFERENCES 25
APPENDIX A: MESSAGE FROM LINDA SILAS (FRANÇAIS) 33
APPENDIX B: EXECUTIVE SUMMARY (FRANÇAIS) 35
AUTHORS’ BIOS 41
Photo credit: Jaymantri
4 CLIMATE CHANGE AND HEALTH Photo credit: rawpixel
MESSAGE FROM LINDA SILAS
climate crises affecting I would like to thank
other parts of the world will Dr. Wanda Martin, RN,
have reverberations here at and her research assistant
home. Lindsey Vold for their
research and preparation
Like all research on climate of this report. I would also
change, this discussion like to thank the CFNU
paper sheds light on the team, including Sebastian
major challenges ahead for Ronderos-Morgan and Carol
humanity and for health Reichert, for their significant
As nurses we instinctively care as our global climate contributions to this work.
know that patient health is changes and average
closely tied to the patient’s temperatures rise. This As the old saying goes,
environment. This discussion discussion paper also sets “think globally, act locally.”
paper on climate change out concrete steps and This mantra encourages us
and health urges nurses to actions that nurses and their to consider the health of
consider the macro-level unions can take to make a the entire planet as we take
of our environment: planet meaningful difference. As meaningful actions in our
Earth. Over the coming the Canadian Federation of own communities. It is my
decades, our rapidly chang- Nurses Unions we can and hope that this discussion
ing climate will pose the must do more to advocate paper will provide the tools
biggest threat to human for economic and social and the information for
health and well-being across transitions to reduce our Canada’s nurses to continue
every region of our planet. greenhouse gas emissions to build upon this work.
and to pass on a health-
According to the World ier and more sustainable
Health Organization, “…the planet to our children and IN SOLIDARITY,
health effects of a changing grandchildren. As well, we
climate are likely to be can and must do more to
overwhelmingly negative. create resiliency within our
Climate change affects health care communities
social and environmental and prepare effectively for
determinants of health – the challenges to come
clean air, safe drinking as our climate changes.
Linda Silas
water, sufficient food and The recommendations in President
secure shelter.” Canada will this discussion paper offer Canadian Federation of Nurses Unions
not escape these conse- nurses a starting-off point
quences. And as members of for advocacy and leadership
a global human community, to tackle climate change.
CANADIAN FEDERATION OF NURSES UNIONS I
EXECUTIVE SUMMARY
The World Health change-related impacts will Assessing vulnerability and
Organization has called affect all body systems, resilience to the impacts of
climate change the great- mental health, socioeco- climate change is new for
est challenge of the 21 st nomic status and the built many health care providers.
century.1 According to the (human made) environment. However, members of the
Intergovernmental Panel The health impacts of Canadian Federation of
on Climate Change (IPCC), climate change will include: Nurses Unions (CFNU) can
humanity has 12 years left prepare themselves and
• Higher rates of heat-
to take serious action on their health care commu-
stroke and stress; 4 5
climate change to prevent nities to help patients in
a catastrophic 2 degrees • Increased allergens the context of the climate
Celsius minimum rise in from more intense crisis ahead. Nurses can also
temperatures by the end and prolonged pollen become strong advocates
of the century. 2 Canada’s seasons, exacerbating for a sustainable and healthy
changing climate report, asthma sufferers’ health future for our planet.
released earlier this year, condition; 6
Nurses are one of the most
found that temperatures in • Displacement from trusted professions 14 able
this country are rising more wildfire and floods,
to assist communities to
than two times faster than accompanied by the
reduce greenhouse gasses
global averages. 3 Therefore, mental distress of
and transition to a climate-
it’s evident that Canadians loss; 7 8 9
friendly future in the name
will be on the frontlines of
• An acceleration in of improving our shared
our warming climate and will
the spread of Lyme health. Everyone in Canada
be required to address the
disease; 10 11 will be affected by climate
health and health care chal-
change, with some groups
lenges that will come with it. • Cardiorespiratory
distress from air pollu- facing more detrimental
As the Canadian health tion due to wildfires; 12 effects than others. Global
care system confronts the and local actions are needed
challenges of an aging • Increased respira- to reduce climate change-
population, constrained tory ailments due to causing emissions and to
intensifying ground-
budgets and resource-inten- build resilience and adapta-
level ozone and air
sive infrastructure, climate tion strategies.
pollution; 13
change will bring an added
The goal of this report, link-
layer of grave and distinct • Decreased access to,
ing climate change to health
challenges for nurses and and availability of, food
due to fluctuations in and nursing, is to provide a
others working in the health
agricultural yields and resource for CFNU’s nearly
care system. Researchers
food prices. 200,000 nurses and nursing
predict that climate
II CLIMATE CHANGE AND HEALTH
student members, along between climate change Meanwhile, powerful politi-
with members of the public, and health through three cal forces are campaigning
as we learn about the links case studies of extreme to deny the science of
between climate change weather events in 2018 climate change and prevent
and health. This report first from Western, Central, meaningful actions. It is
provides an overview of and Atlantic Canada. The our duty as nurses, as
the climate change science, report concludes with seven community members and
describing who is likely recommendations for nurses as parents to use our full
to be most affected. The that can be supported by toolkit, including our ability
report also summarizes the their institutions, work- to move quickly in the face
health impacts of climate places, associations and of fast-moving threats to
change within the four unions. health, to work towards a
elements framework of response to climate change
Children are going on strike
earth, air, fire and water. for today’s patients and
worldwide because they
We conclude by elaborating those of tomorrow. Working
fear the consequences that
on the emerging mental together we can build resil-
climate change will bring
health issue of ‘ecoanxi- ience toward a healthier
to their health and well-
ety’. The report focuses on future.
ness within their lifetimes.
the concrete connections
RECOMMENDATIONS TO NURSES
1. Work with your employers, unions and associations to
reduce emissions and to “green” your workplace.
2. Know about climate change science, and help educate
patients and the general public about it.
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 obli-
gations under the UN Framework Convention on Climate
Change (The Paris Accord).
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.
5. Be prepared for extreme weather events.
6. Promote active transportation and local healthy agricul-
ture and food systems to reduce emissions.
CANADIAN FEDERATION OF NURSES UNIONS III
Photo credit: Martin Péchy
Photo credit: USGS IV CLIMATE CHANGE AND HEALTH
KEY MESSAGES
• Canada is warming at twice the global rate
(with the North warming at three times the
global rate). It will continue to warm in the
future.
• Canada is warming at a faster rate because
we have a larger land mass and a larger cryo-
sphere (parts of the earth where water is
frozen) in comparison to other countries.
• Because most of the warming in Canada is due
to human activity, how much it continues to
warm will depend on what Canadians do now.
• Unless we take real and meaningful actions on
climate change at every level – in our everyday
lives, workplaces, cities, provinces and our
nation – Canada’s temperatures will continue
to rise to catastrophic levels that will include
extreme temperatures over extended periods
of time, more droughts, more flooding, threats
to coastal communities from high water-level
events, potential water supply shortages
during summer months and more severe
wildfires.
• Projected public health impacts include
increases in heatstroke and stress, allergens,
respiratory conditions (such as COPD, lung
cancer and asthma), increases in the spread of
insect-borne diseases (such as Lyme disease
and West Nile virus), reduced access to and
availability of food and fresh water, and the
destruction of infrastructure and human
displacement due to climate change-related
events.
CANADIAN FEDERATION OF NURSES UNIONS V
INTRODUCTION
Climate change is a global increase in temperatures of in our atmosphere. This
challenge that will affect at least 2 degrees Celsius.16 has affected the balance
how we live and how we Given the scale of the threat between the incoming solar
manage our health care that climate change poses rays and the outgoing infra-
system. The repercussions to the health of humans and red radiation. The end result
of climate change on health the environment for current is that our atmosphere
are just beginning to enter and future generations, retains more heat, causing
the public consciousness, nurses have a role to play as our planet to warm.18 The
and nurses need to be leading voices demanding science can no longer be
prepared for changes that action. ignored: the human burning
will affect their practice, of fossil fuels (oil, coal,
In this report, we describe
their lives, and the lives of gasoline, natural gas, etc.)
climate change and then
their patients and families. is driving up temperatures
outline the anticipated
in our atmosphere, causing
Rising global temperatures health issues, recommend-
climate disruption and
put everyone’s health at ing what nurses can do to
changing the livability and
risk.15 As nurses, we have a advocate for a transition to
the health of the world
moral duty to prepare for a green economy and health
around us. This is the story
the effects of a changing care system to prepare
of climate change.
climate so we can work for this new era of public
alongside our patients, health. If we are able to reduce our
clients and communities greenhouse gas emissions
to build resilience. Nurses and to capture some of the
also have a moral duty to WHAT IS CLIMATE carbon that is in the atmo-
advocate for meaningful CHANGE? sphere, we could keep the
action on climate change by average rise in temperatures
Humans are having a
governments, to call for a below 2 degrees Celsius
massive impact on the
solid plan to lower emissions from pre-industrial levels.
environment.17 This has been
and build a healthier and This is the target that
occurring at an accelerated
more sustainable society for Canada agreed to, along-
pace since the Industrial
our future. side 194 other countries,
Revolution. As a result
in the 2015 Paris Accord.19
According to leading of modern conveniences
Nevertheless, even under
international scientists, the and easy access to energy
this scenario, there would be
world’s nations have only derived from burning
considerable ecological and
12 years left to dramatically fossil fuels, humans have
economic damage affect-
reduce climate change-caus- increased the concentration
ing the health of people
ing emissions if we hope to of greenhouse gases, in
in Canada and around the
prevent a devastating global particular carbon dioxide,
world.
1 CLIMATE CHANGE AND HEALTHThe world’s nations have only
12 years left to dramatically
reduce climate change-causing
emissions.
Photo credit: Pixabay
Given the challenge ahead extreme weather as demon- also took nearly 100 lives in
of us, there is a sense of strated in March 2019 by Quebec. 26 Floods and once-
urgency to reduce our Cyclone Idai in Mozambique. in-a-century storms are also
society’s climate change In Canada, we are presently becoming more frequent.
footprint and to prepare experiencing more severe In 2018, New Brunswick
for the challenges ahead. In forest fires and localized experienced the worst
2018, the Intergovernmental flooding, along with extreme flood in decades, causing
Panel on Climate Change seasonal temperatures and many people to lose their
(IPCC) recommended a noticeably higher food homes. 27 As carbon dioxide
global target of no more prices. I 22 Health Canada accumulates in the atmo-
than 1.5 degrees Celsius rise estimated in 2017 that 9,500 sphere, Canada’s oceans
in temperature to reduce deaths per year in Canada are also becoming more
the severity of the risks to were attributable to poor acidic because of chemical
our health and survival. 20 21 air quality. 23 In that same reactions at the surface.
Regardless of what we are year, British Columbia had This acidification is nega-
able to achieve in reversing the worst wildfire season on tively affecting the ability of
the trend, we are already record (only to be surpassed shellfish to build their shells,
seeing the health effects of by 2018), and in northern threatening vast fisheries
a changing climate today. Alberta the fire that burned across Canada. 28
for three months released
Globally and domesti- These are just a few exam-
over 77 megatons of carbon.
cally, erratic and extreme ples of how climate change
This is nearly half of the
weather patterns are having is currently directly impact-
emissions that Canada
a profound impact on ing Canadian communities.
needs to reduce to reach its
communities. Low-income
targets. 24 Ragweed season
countries, where people has increased by 25 days in
are already living in Winnipeg and by 24 days
precarious situations, are in Saskatoon. 25 Extreme
being affected the most heatwaves globally in 2018
from droughts, floods and
I Canada’s food cost for the average Canadian family is expected to increase by $411 in 2019, rising
to $12,157 per year, with the increasing cost of vegetables continuing to be an important factor
(Canada Food Prices Report 2019).
CANADIAN FEDERATION OF NURSES UNIONS 2WHO WILL BE fires. 29 Children, people with care system. Furthermore,
chronic disease, people there will continue to be
MOST AFFECTED?
living in inadequate housing, significant impacts on those
Climate change will affect those who struggle to pay living in the north, as they
everyone because extreme their energy bills and those are already experiencing
climactic events and a who are already suffering landscape changes that
changing environment will from food insecurity will be affect their sense of self
be experienced everywhere. most affected. Indigenous and their traditional way of
Nevertheless, our changing peoples, disproportionately life. 31 Vulnerable groups in
climate will dispropor- more vulnerable than other Canadian society are already
tionately impact the most Canadians, will also face in the greatest need of nurs-
vulnerable groups in Canada unique adaptation chal- ing care, and now nurses will
(those who are socially, lenges. 30 As parts of the need to direct their skills
culturally or economically planet become increasingly to help build more resilient
disadvantaged) as they unlivable, there will be communities, and to become
have the least resources climate refugees arriving strong advocates demanding
to prepare and respond in Canada. This will place action on climate change to
to exposures and shock additional pressure on reset- ensure a healthy future.
events such as erratic tlement agencies, our social
weather, floods or forest safety nets and the health
Vector
Howard, C., Rose, C., & Rivers, N. (2018). Lancet Countdown 2018 Report: Briefing for Canadian
Policy Makers. The Lancet.
3 CLIMATE CHANGE AND HEALTHClimate change will affect
everyone because extreme
climactic events and a
changing environment will be
experienced everywhere.
Photo credit: Pixabay
FINDINGS
The health of planet Earth, we consider the effects of and has the potential to
humanity and the natural forest fires and heatwaves. undermine food security
world are central to the And finally, within “water ” in Canada and around the
issue of climate change. Our we cover floods, waterborne world.
understanding of the health illness, warming and acidify-
Climate change is causing
effects of climate change ing oceans, rising sea levels
extreme weather events,
are informed by a growing and droughts. We conclude
droughts and heat stress,
global planetary health with a discussion on the
which are undermining
movement, 32 which provides mental health challenges
harvests. 35 Extreme weather
research to improve our surfacing in response to our
understanding of the future changing climate. events have reduced yields
in Canadian agriculture
implications of climate
change. In recognition of the EARTH by up to 50%. Agricultural
producers in Saskatchewan
natural world in which we Much of the world’s food recently faced a second
live, this report categorizes production is traded on consecutive dry year,
the environmental threats global markets, so Canada making 2017 and 2018 the
of climate change into the depends on many regions driest growing seasons in
classic elements’ frame- around the world for food 135 years. 36 In Val Marie,
work of earth, air, fire and production, just as other Saskatchewan, producers
water. 33 Within “earth” we regions depend on us. 34 This received a third of their
include food systems, land global interconnectedness normal rainfall, meaning
use, vectors and infectious of food supply systems production was reduced
agents. “Air ” includes smog, means that climate change to 32 bales per acre, a far
particulate matter, cardio- affecting one part of the cry from the 210 bales per
vascular disease, asthma world will affect food supply acre farmers were able to
and allergies. Under “fire” and prices in another part
CANADIAN FEDERATION OF NURSES UNIO NS 4Projections for the future climate
in the Canadian prairies include
hotter summers and longer
droughts, which is expected to
contribute to growing stress
to agriculture.
Photo credit: Jackson Jorvan
store the previous year. 37 dairy producers selling off of farming, according to a
Projections for the future their cows prematurely. 40 recent report. It concludes
climate in the Canadian prai- However, existing agricul- reducing meat and dairy
ries include hotter summers tural practices around cattle product consumption is
and longer droughts, which and dairy are significant “the single biggest way” to
are expected to contrib- contributors to climate reduce your environmental
ute to growing stress to change, contributing impact on the planet. 43
agriculture. When there is about 20% of greenhouse Transitioning to more
precipitation, heavier down- gas emissions globally. 41 sustainable agriculture
pours caused by a warmer Livestock and meat produc- by shifting towards more
atmosphere will further tion are considerably more vegetable protein sources
contribute to erosion of the energy-intensive forms of also means a better diet
vulnerable topsoil. 38 This agriculture than non-meat- for your health as recom-
trend towards droughts and based options, and generate mended by the Canada Food
deficits in soil moisture are greater amounts of green- Guide 44 and the EAT-Lancet
also expected to intensify in house gas emissions per unit Commission Summary
British Columbia’s interior in of food. Methane, in partic- Report. 45
a high-emissions scenario. 39 ular, is a major by-product
There is also a link between
of meat production and has
Heat stress can also have climate change, pollina-
a greater warming effect
a detrimental impact on tors and food security. 46
on the atmosphere than
livestock, poultry and dairy In addition to the impact
carbon dioxide. 42 In addition
production. Extreme heat, of changing weather
to land use, deforestation,
resulting in shortages of patterns, a changing
water shortages and agri-
feed grain, and rising prices, climate is contributing to a
cultural pollution are part
have led to cattle and decline in pollinator insect
of the ecological impacts
5 CLIMATE CHANGE AND HEALTHpopulations so vital to our in Canada as their vectors hantavirus, salmonellosis,
agricultural systems. Bees (mosquitos and ticks) cholera and giardiasis. 50
are not able to collect the spread into new regions of As vector populations and
required pollen to survive Canada and increase their weather patterns change
because of the disruption populations. 47 Lyme disease because of a warming
of the seasonal timing of cases in Canada more than climate, these threats may
flowering plants, which doubled between 2016 spread outside their known
is tied to climate change. and 2017, with 2,025 cases endemic areas.
Without insect pollinators, in 2017 (88% of the cases
human production of fruits were in Ontario, Quebec AIR
and many vegetable plants and Nova Scotia). 48 There Climate change and air
would be severely impacted. were 367 cases of West pollution, although not
Nile virus in 2018 (primarily the same, have a common
While insect pollinators in Quebec and Ontario), origin and are aggravated
suffer, some insect species up from 200 cases in 2017, by the burning of fossil
are thriving in the warmer and many more cases go fuels. Air pollution is caused
climates. Earlier springs, unreported and potentially by atmospheric increases
longer and hotter summers, undiagnosed. 49 in carbon dioxide, nitrous
and milder winters are ideal
conditions for the spread There are other infectious oxide, ground ozone and
of disease-transmitting agents that may proliferate particulate matter, as well as
mosquitoes and ticks. West globally due to increased increased pollen counts for
Nile virus and Lyme disease temperature and flooding, those with allergies. Ground
are two growing concerns such as dengue, malaria, ozone reacts with sunlight
radiation to create smog, a
Lyme disease cases in Canada
more than doubled between
2016 and 2017, with 2,025 cases
in 2017 (88% of the cases were
in Ontario, Quebec and Nova
Scotia).
Photo credit: Pixabay
CANADIAN FEDERATION OF NURSES UNIONS 6Among the 194 countries
analyzed, Canada has the
third highest rate of new
traffic-related asthma cases.
Photo credit: Life of Pix
familiar sight for many city is projected to have the lungs. Prolonged expo-
dwellers, especially during greatest change in ozone-re- sure can cause serious
the summer. 51 Air pollution is lated premature deaths chronic and acute health
often aggravated by hotter from 2000 to 2030. 53 With effects, including lung
climates. Toronto Public Ontario and Manitoba just cancer, chronic obstructive
Health predicts that climate across the border from the pulmonary disease (COPD),
change will cause a 20% Midwestern states, millions cardiovascular disease, and
increase in air pollution-re- of Canadians are implicated. the development and exac-
lated deaths in the city by erbation of asthma 55 56 Four
Fine particulate matter
2050. 52 million children develop
(PM) is another component asthma every year as a
Ground ozone II is a color- of air pollution that can result of air pollution from
less and irritating gas that be seriously damaging to cars and trucks, equivalent
forms just above the earth’s human health. Comprised to 11,000 new cases a day,
surface and looks like smog of aerosols, smoke, fumes, a recent landmark study
at ground level. Smog will dust, ash and pollen, 54 fine has found. Among the 194
likely increase with higher PM material is, by definition, countries analyzed, Canada
temperatures and with smaller than 2.5 microns has the third highest rate of
frequent stagnate air condi- in diameter, allowing it to new traffic-related asthma
tions. In the US, the Midwest penetrate deep into our cases. 57
II Ground-level ozone is a “secondary” pollutant produced when two primary pollutants, nitrogen
oxides and volatile organic compounds, react in sunlight and stagnant air. Nitrogen oxide comes
from human activities like burning of oil, gasoline and coal, and volatile organic compounds
derive from both human and non-human sources such as wildfires (Government of Canada).
7 CLIMATE CHANGE AND HEALTHRATE OF NEW TRAFFIC-RELATED ASTHMA CASES
(194 NATIONS ANALYSED)
Fine PM is of particular 2000. 62 Airborne allergens in disasters that devastate
concern for the health of may also be exacerbated communities (e.g., Fort
the elderly. 58 Generated when ground ozone and McMurray fire). Climate
primarily from the burning particulate matter levels change is causing hotter
of fuels, PM pollution is are high, as those affected and drier summers in
interlinked with carbon diox- by allergy-induced asthma western Canada, sparking
ide pollution causing climate are already struggling record-breaking forest fire
change. According to Health to breathe. In Canada, seasons in recent years. 65
Canada, 59 reducing air pollu- Saskatchewan has seen the The resulting evacuations
tion from human activities greatest increase in the increase the pressure on
to acceptable levels would number of days for ragweed local health care services
result in about 14,400 fewer season from 1995 to 2011. 63 and hospitals.
annual deaths in Canada.
FIRE In 2017 and 2018, tens
Almost 7% of Canadians of thousands of British
Extreme heat and droughts
suffer from respiratory Columbians in the interior
cause loss of life and live-
allergies. 60 And a warming of the province were forced
lihoods, and trigger severe
climate will likely cause to evacuate, sometimes
wildfires. High temperatures
airborne allergens to spending weeks away from
can cause heatstroke and
increase in certain regions. 61 home. The Fort McMurray
worsen many pre-existing
Allergens include tree, grass fire in 2016 resulted in a
conditions such as cardio-
and weed pollen. Reports major evacuation, including
vascular and respiratory
indicate that birch peak the local hospital. The Fort
pollen season could be diseases. 64 More intense McMurray hospital building
forest fires put communi-
extended by two to four had to be evacuated, moving
ties at risk and can result
weeks by 2020, compared to 106 patients by bus, with
CANADIAN FEDERATION OF NURSES UNIONS 8The science predicts a future
with more frequent and intense
heatwaves in Canada, without
the reprieve of cooler nights.
Photo credit: Pixabay
nurses and physicians on lead to decreased produc- WATER
board to provide care. 66 tivity amongst outdoor
workers, negatively affect Warming air temperatures
Extreme heat is damaging and increased carbon
the learning of students
to people’s health and live- dioxide in the atmosphere,
and disrupt transportation,
lihoods. During heatwaves, caused by climate change,
including flight cancella-
the body struggles to are creating significant
tions. 69 The science predicts
remain cool and maintain its changes to weather
a future with more frequent
normal temperature. Serious patterns, the availability of
and intense heatwaves in
health symptoms can fresh water and the health
Canada, without the reprieve
manifest after prolonged of our oceans.
of cooler nights. 70
exposure to heat, physical
effort and the dehydra- Most of the costs related Warmer temperatures
tion caused by sweating. to extreme heat are human will cause more intense
Children, the elderly and the costs – lost lives, but cities short-term precipitation
chronically ill and low-in- are beginning to recognize in some regions, causing
come people are the most the challenges ahead as they flash flooding and erosion.
vulnerable to temperature struggle to keep residents The melting glaciers, rapid
regulation challenges during cool in heatwaves, which are snow melts and more
a heatwave. Symptoms of more acute in urban land- frequent downpours could
heatstroke, often exacer- scapes. Some cities are even have devastating effects in
bated by high humidity, taking action to hold fossil Canada. We are seeing the
begin with headaches and fuel companies to account. 71 impacts already. In 2013, the
muscular cramps, and can The urban heat island effect floods in Alberta displaced
quickly intensify into diffi- makes cities much warmer over 100,000 people and
culty breathing, convulsions, than surrounding rural areas caused an estimated
and deteriorated, or loss of, by as much as 12 degrees $1.7 billion in damages. It
consciousness. Heatstroke difference because of the was the most damaging
can quickly occur and, if heat trapped in pavement flood ever recorded in the
left untreated, can result in and buildings. 72 With well province. 73 Floods can also
death. 67 over 80% of Canadians living spread disease by increasing
in cities, the health effects waterborne pathogens by up
In 2017, it was estimated to 70%, 74 spreading bacteria,
of urban heat islands during
that 157 million people protozoa and viruses, along
heatwaves will become more
exposed to heatwaves with agricultural waste,
severe.
missed 3.4 billion weeks of raw sewage and chemi-
work. 68 Extreme heat can cals. 75 Increases in water
9 CLIMATE CHANGE AND HEALTHtemperatures also increase rising water is unknown, but dissolving and reacting
algae growth and produce the effect is not something with water. 82 The resulting
higher concentrations of that will change quickly chemical reaction creates
toxic blue-green algae 76 even if we do meet the carbonic acid which acidi-
killing off aquatic life. global targets for reducing fies the ocean, jeopardizing
emissions. The rising sea sea life and food supplies.
Other regions of the globe
level will result in a higher Ocean acidity reduces
will experience worsening
storm surge, causing more the availability of calcium
droughts, water scarcity
frequent inland flooding carbonate for shell forma-
and desertification. Climate
as more severe weather tion and affects organisms
change will impact our
occurs, particularly on the that are essential to support
global drinking water supply
East Coast of Canada. 78 The the marine food chain. 83
in many ways, depleting coast of southern Atlantic While some marine life may
this finite resource. Rising Canada will experience the adapt overtime, others may
sea levels will increase the largest local sea level rise decline or disappear.
salinity of our fresh water in Canada because of the
supplies. 77 Over the medium Researchers report that
added effect of sinking land
term, shrinking glaciers will areas. 79 Inland flooding will changing water tempera-
deplete fresh water reserves tures, deoxygenation, and
displace people and cause a
for significant regions of increasing amounts of plas-
loss of valuable land, includ-
the planet, in particular tics and ocean pollution are
ing fertile agricultural lands.
drier regions such as the putting marine ecosystems
In cities like Vancouver, with
Canadian Prairies. under severe stress. 84 The
high-density populations,
unpredictability of ocean
The Canadian coastal prov- municipalities may find it
food stock and current
inces face an additional difficult to respond to a
declines in the shellfish
challenge – rising sea levels. disaster event as the sea
market on the Pacific
Canada’s urban waterfronts level could rise by more than
coast leaves the aquacul-
may face a 20-centimeter 50 cm. 80 81
ture industry bracing for
rise by 2050, and potential In addition, ocean acidifica- change. 85
predictions are up to one
tion results from greenhouse
meter by 2100. The rate
gas emissions entering,
and extent of damage from
Canada’s urban waterfronts may
face a 20-centimeter rise by
2050, and potential predictions
are up to one meter by 2100.
Photo credit: Pixabay
CANADIAN FEDERATION OF NURSES UNIONS 10The world is struggling to
visualize a hopeful future... there
is a renewed sense of urgency
about the need to do something
- to act now.
Photo credit: David Holt
THE EMERGING the complex and threatening Thunberg before world
problems associated with leaders during the 24 th UN
ISSUE OF
climate change. Ecoparalysis Framework Conference on
ECOANXIETY is the feeling of hopeless- Climate Change in 2018, is
Under the looming threats ness – of being incapable of an expression of ecoanxiety.
of climate change, an effective action to mitigate There have been multiple
emerging sense of imminent climate change. Solastalgia student protests around
and inescapable crisis is refers to the feelings of the world, and there is a
gripping the emotional distress and isolation renewed sense of urgency
and social well-being because of the gradual loss in news stories about the
of our communities. 86 of one’s home environment, need to do something – to
Environmental philoso- which sometimes includes act now. Society is in a
pher Glenn Albrecht and climate change-related precarious position as we
colleagues have started to displacement. 87 88 This realize the full cost of indus-
document the psychological vocabulary provides a trialization, rapid growth
burden of climate change on way of articulating human and extended life span. The
the mental health of people, emotional, spiritual and world is struggling to visu-
manifesting in a number psychological reactions to alize a hopeful future. As
of syndromes such as the current climate crisis. a society we must face the
‘ecoanxiety’, ‘ecoparalysis’ fact that we have created a
The growing climate kids’
and ‘solastalgia’. Ecoanxiety public health emergency.
movement, which was
is the anxiety experienced
highlighted in a famous
from being surrounded by
speech by 14-year-old Greta
11 CLIMATE CHANGE AND HEALTHMAKING THE LINK ACROSS
CANADA
The effects of climate annual summer tradition. Those with underlying respi-
change are a global From the hundreds of ratory conditions – the very
challenge. Canada will face, forest fires burning in the young and older adults – are
and is already experiencing, Northwest Territories in 2014 the most vulnerable. Fires
some serious challenges to the swaths of smoke from put an increased demand on
such as forest fires, floods British Columbian infernos emergency departments and
and extreme heat. The which reached across west- hospital services, as well as
following three case studies ern Canada over the past on evacuation protocols.
illustrate the widespread few years, forest fires are
societal and health In 2018, Vancouver was
becoming all too familiar for
outcomes across Canada, listed as having the fifth-
Canadians and for hospitals
resulting from recent natural worst air quality in the
coping with respiratory
disasters caused by climate world because of wide-
distress. As temperatures
change. spread wildfires in British
rise and droughts worsen,
Columbia. 89 In some regions
it is likely that we will
of BC the air quality was
see more intense, and
CASE STUDY 1: longer-lasting, forest fires.
double what is considered
WESTERN CANADA The immediate health
to be hazardous to human
health. 90 During the 2003
FOREST FIRES AND effects of forest fire smoke
catastrophic fire season in
SMOKE are well known: shortness
BC, communities in south-
of breath, headaches,
Extreme forest fire seasons ern BC recorded a 46% to
increased coughing and eye
in Canada are becoming an 78% increase in physician
irritation, to name a few.
Photo credit: Sebastian Ronderos-Morgan
CANADIAN FEDERATION OF NURSES UNIONS 12Photo credit: Sebastian Ronderos-Morgan
visits for respiratory-related forced hundreds to flee from Indigenous population
conditions. 91 In 2018 – a their homes. Communities, and those who engage
record-breaking year for like Southend, had to evac- in land-based activities,
air quality advisories in the uate their homes and begin experienced disrupted
province – local authori- the 600-kilometre journey livelihoods which impact
ties in the Vancouver area to Saskatchewan’s largest their economic stability and
reported a 120% increase city, Saskatoon. While heli- spiritual well-being.
in daily physician visits copters and ground crews
Wildfires are becoming a
and an 80% increase in the fought the flames, families
normal summer event in
number of asthma prescrip- were placed in temporary
Western Canada. There are
tions dispensed. 92 Choking shelters in a soccer centre.
children growing up today
forest fire smoke has been The Red Cross, Ministry
who will associate summer
responsible for an increasing of Social Services, health
with smoke and restricted
number of emergency room and justice officials as well
outdoor activity because
visits, primary care provider as the City of Saskatoon
of lengthening air quality
visits and respiratory hospi- collaborated to coordinate
advisories.
talizations for conditions services and provide basic
such as asthma and COPD. 93 amenities. 94
The widespread and worsen-
For rural Canadians, separa-
ing effects of forest fires are
tion from the land and from
obvious to anyone living in
land-based food systems
the Western provinces over
can also contribute to
the past few years.
mental and emotional stress.
In 2018 in Saskatchewan, Southend Saskatchewan,
a 3,000-hectare wildfire a community with a large
13 CLIMATE CHANGE AND HEALTHIn 2018, Vancouver was
listed as having the
fifth-worst air quality
in the world because of
widespread wildfires in
British Columbia.
Photo credit: Sebastian Ronderos-Morgan
CANADIAN FEDERATION OF NURSES UNIONS 14Climate change will cause
a 10-20% increase in the
intensity of flooding in New
Brunswick.
Photo credit: Bill Lapp
CASE STUDY 2: a thousand people were sustainable livelihoods, and
evacuated from their homes a cultural loss for those
ATLANTIC CANADA
as waters rose to over 5.5 who have a spring tradition
FLOODING meters above their normal of gathering fiddleheads.
Since 2011, New Brunswick level in the Saint John It also represents a threat
has experienced a three-fold region. 97 The Department of that flooding events pose to
increase in the number of Justice and Public Safety agriculture and local jobs.
disaster financial assistance estimated recovery costs at
Regrettably, Canadian
programs triggered by $9.6 million because of the
scientists forecast that
flooding. 95 extensive damage to private
climate change will cause
and public infrastructure. 98
In January 2018, a mixture a 10-20% increase in the
Water damage leads to mold
of rain, unseasonably warm intensity of flooding in New
in homes, psychological
temperatures and melting Brunswick over the course
distress, loss of income
snow combined to increase of this century.100 This will
and property. The physical,
water levels to record highs be exacerbated by rising sea
mental and financial distress
across New Brunswick, caus- levels in Atlantic Canada,
is often overwhelming.
ing widespread flooding and contributing to more inland
power outages. Thousands Fiddleheads are a seasonal flooding of rivers. Rising sea
of New Brunswickers were favourite, harvested each levels in Atlantic Canada
without power, some were year from the riverbeds in are being hastened by
isolated due to destroyed New Brunswick. The spring the waterbed effect, land
bridges, and residents of following the flooding, the levels slowly sink into the
the Musquash area were Regional Medical Health Atlantic Ocean because of
evacuated from their Officer declared that post-glaciation shifts in
homes because of threats fiddleheads were unfit for the earth’s crust. For the
to the stability of a nearby consumptions because of Halifax waterfront, it means
dam. 96 In the immediate the risk of contamination a quadrupling in the number
aftermath of the flooding, from raw sewage, fuels of floods as sea levels rise
the Government of New and chemicals leaked into 20 centimetres over current
Brunswick mobilized emer- rivers. 99 This resulted in levels by mid-century.101
gency assistance to test an economic loss to many
water and restore power to local pickers who depend
20,000 residents. Nearly on seasonal work for
15 CLIMATE CHANGE AND HEALTHCASE STUDY 3: hot summer beginning in worsen, such as cardiovas-
May persisted relentlessly cular disease and respiratory
CENTRAL CANADA
into September.103 disease, and can cause
EXTREME heatstroke.107 Excessive heat
HEATWAVE Southeastern Ontario and can lead to edema, heat
southern Quebec expe-
The summer of 2018 was the rash, cramps, fainting and
rienced the most intense
third warmest on record.102 exhaustion.108 Left untreated,
heatwave in years between
Scorching heat spanned the heatstroke can even damage
late June and the first week
globe, from Japan to Russia internal organs. The people
of July 2018. In Quebec, in
and the United States. most at risk are older, live in
the first week of July more
Canada was no exception. poverty, lack education and
than 90 people died from
In southern Canada an early live in high population-den-
heat-related health issues sity urban neighbourhoods
as average temperatures with low incomes.109
soared to 45 degrees Celsius
with the humidex.104 105 With In 1995, the Chicago heat-
a humidex of 47 degrees wave claimed more than
in Ottawa, it was the 700 people, requiring
second-warmest Canada refrigerated trucks to handle
Day on record. In Montreal the overflow of bodies.110 In
authorities reported a 30% 2003, European heatwaves
increase in emergency calls resulted in thousands of
during that blistering week deaths.111 These natural
of heat.106 disasters provide lessons
for us as we move into an
Photo credit: Exposure to heat can cause uncertain future.
Staff Sgt. Sheila deVera existing conditions to
In Quebec in the first week of
July more than 90 people died
from heat-related health issues.
Photo credit: rawpixel
CANADIAN FEDERATION OF NURSES UNIONS 16REGIONAL CHARTS 112 – HIGH-CARBON FUTURE
Average hottest temperature of Average number of +30°C days
the year per year
Recent past High-carbon Recent past High-carbon
future future
2051-2080 2051-2080
Vancouver 29.3 34.0 1.2 13
Calgary 31.8 36.5 4 27
Regina 35.3 40.7 16 50
Winnipeg 34.5 39.3 11 47
Toronto 33.5 38.4 12 55
Ottawa 33.1 37.7 10 49
Fredericton 33.0 37.0 7 36
Halifax 29.8 33.4 0.6 8.1
Charlottetown 29.8 34.1 1 16.2
St. John’s 28.1 31.0 0.1 1.7
Yellowknife 28.7 32.2 0.3 3.8
Average coldest temperature of Average number of days with
the year frost per year
Recent past High-carbon Recent past High-carbon
future future
2051-2080 2051-2080
Vancouver -7.9 -3.1 32 6
Calgary -33.1 -26.6 194 145
Regina -37.3 -30.9 196 158
Winnipeg -36.0 -29.8 189 149
Toronto -22.6 -16.7 132 78
Ottawa -30.7 -24.9 160 114
Fredericton -29.5 -24.6 173 118
Halifax -22.0 -17.6 145 91
Charlottetown -24.1 -18.4 156 97
St. John’s -17.9 -13.4 154 92
Yellowknife -43.6 -37.3 227 192
17 CLIMATE CHANGE AND HEALTHMAKING THE CASE FOR CHANGE
WHY NURSES AND in addition to mental health, inaction cannot be options.
socioeconomic status and Just as nurses advocate
THEIR NURSES
the built environment. While for vaccinations to reduce
UNIONS SHOULD nurses are increasingly the spread of infectious
TAKE ACTION aware of the importance of diseases, so too must nurses
the social determinants of advocate for meaningful
health, we must now go one action by governments and
The three case studies
layer deeper to consider corporations to transition
presented here are just the
the ecological determi- our economy into a healthier
beginning of a potentially
nants of health. Above all, and more sustainable future.
devastating tale of the
nurses must be equipped to
health effects of climate Working alongside different
educate patients and clients
change in Canada. There stakeholders, Canada’s
about the health risks of
are numerous other exam- nurses can engage in
climate change and work
ples of the broad health feasible, actionable and
upstream to prevent health
impacts of climate change committed strategies to
crises before they occur.113
from coast to coast to build pathways towards a
Our community is only as
coast, as well as globally. better and healthier future
healthy as the ecological
Canada’s nurses can expect for our communities, country
system upon which life
to witness increasing illness and planet.
depends.
across Canada, directly and
indirectly linked to climate As previously noted, ecoanx-
change. All body systems iety can be a paralyzing
are predicted to be affected, force, however, despair and
Canada’s nurses can engage in
feasible, actionable and committed
strategies to build pathways towards
a better and healthier future.
Photo credit: Skitterphoto
CANADIAN FEDERATION OF NURSES UNIONS 18HOW NURSES 1.1. Work with your employers, unions and associations to
CAN TAKE reduce emissions and to ‘green’ your workplace.
ACTION 1.1. Join the Canadian Coalition for Green Health Care
(http://greenhealthcare.ca/). The website provides
Below we outline several
recommendations for numerous resources for workplace action.
what nurses and nurses 1.2. Form ‘green teams’ in your workplaces to petition
unions can do to tackle for green procurement. Green procurement involves
climate change and demanding better purchasing decisions that reduce
prepare for this new era carbon footprints and encourage sustainable sourc-
of health care. Nursing ing in contracts and tendering processes.
educational institutions,
unions, associations and 1.3. Learn about environmental impact assessments
health care workplaces and other resources which you can find from the
have a role and respon- National Collaborating Centre for Environmental
sibility in facilitating and Health and how they can be deployed in your
supporting these recom- workplaces (http://www.ncceh.ca/content/
mendations. The following health-impact-assessment-environmen-
recommendations are tal-health-methods-tools-and-policy-change).
non-exhaustive and
1.4. Promote the divestment of pension plans from
provide nurses and nurses
high-emission sectors and the investment in clean
unions with a starting-off
technologies and low-emission sectors.
point for meaningful
actions to take in their
lives, their practice, their 2.
2. Know about climate change science, and help educate
workplaces, their commu- patients and the general public about it.
nities and their country.
2.1. Individual nurses can learn how to counsel patients
and clients about climate change and the corre-
sponding health impacts so that patients and clients
can take concrete information about climate change
and apply it to daily life. Specifically, nurses can
emphasize prevention of, and preparation for, the
effects of climate events. Nurses can educate clients
in individual counseling sessions, through social
and traditional media and with patient educational
material.114 This includes preparation for patient
experiences of ecoanxiety by being equipped to
offer local ways for patients to take action and
provide hope.
2.2. Campaign for the ecological determinants of health
to be included in nursing education to prepare
future generations of nurses, who will see the great-
est effects of climate change. Nursing education
should support a basic level of climate change
literacy. Specific links between climate change and
human health should be included in curricula as this
education will assist nurses in their clinical practice.
19 CLIMATE CHANGE AND HEALTH3.
3. Call for meaningful federal and provincial actions
to reduce and eliminate climate change-causing
emissions to ensure Canada leads the world in imple-
menting its obligations under the UN Framework
Convention on Climate Change (the Paris Accord).
3.1. Nurses can use their trusted and privileged posi-
tions to mobilize the public and other health
professionals to tackle the climate crisis. Using real-
world examples from their experience brings forth
concrete examples of the health impacts of climate
change.
3.2. Advocate for serious climate action from politicians
of all political parties within the frame of climate
change and health.
3.3. Advocate to ensure that any plan to reduce or elim-
inate emissions in high-emission industrial sectors
includes and requires a just transition and equitable
treatment for workers in those sectors to maintain
quality of life and good job opportunities.
3.4. Support the coal phase-out target for Canada by
2030. Coal-powered electricity can be replaced by
non-emitting sources, and any gap can be made
up by lowest-emitting natural gas technology in a
system designed to minimize methane emissions.
3.5. Support carbon pricing as a means to encourage
behaviour change across society and the economy,
recognizing the true economic and health cost of air
pollution and climate change emissions.
3.6. Promote transitioning away from fossil fuels towards
renewable energy. Though lucrative, investing
now in the fossil fuel industry will have serious
downstream costs that we, our children and our
grandchildren will have to bear. By investing in
renewal energy rather than in fossil fuels we are
committing to a healthier future.
CANADIAN FEDERATION OF NURSES UNIONS 204.
4. Be aware and plan for the emerging patient needs
resulting from climate change and help them take
action to support a healthy planet.
4.1. In conjunction with local health and government
officials and affiliated organizations, nurses can
play a key role in identifying the most vulnerable
demographic and geographic areas in relation to the
changing climate. Nurses can collaborate with other
professionals and experts to promote monitoring
of current and future threats, with special attention
given to targeted populations.115
4.2. As nurses, become knowledgeable about climate
change, and remember to assess patients and
clients for influences outside of the domain of
biological health. Be aware and factor in the impacts
of upstream climate change-related determinants of
health.
4.3. Nurses can assess their clients for the psychological
burden of climate change. This includes the effects
of ecoanxiety, ecoparalysis and solastalgia.116 117 118
Nurses can validate their patient’s experiences by
naming and acknowledging their patient’s mental
health burdens and providing them with hope. This
includes creating a toolkit of strategies that nurses
can provide patients with to help them mitigate and
adapt to climate change.
4.4. 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.
Photo credit: Pixabay
21 CLIMATE CHANGE AND HEALTH5.
5. Be prepared for extreme weather events.
5.1. Ensure your health care workplace has evacuation
and emergency response protocols in place. Is your
facility ready in the case of extreme weather events?
Check on the policies and inform your colleagues.
Be prepared for calling in support workers, when
needed. Preparing for surge capacity begins with
education and awareness about the most likely
climate change risks in the region and workplace,
and who those risks will mostly impact.119
6.
6. Promote active transportation and local healthy agri-
culture and food systems that reduce emissions.
6.1. Promote workplace infrastructure that allows for
active transportation like cycling or public transpor-
tation which are both beneficial for your own health,
and also reduce carbon use.120
6.2. Working with dietitian colleagues, nurses can advo-
cate and promote healthy eating literacy, including
more vegetables and whole fruit, less red meat and
processed foods, and less packaging.121 Both the new
Canada Food Guide and the EAT-Lancet Commission
Summary Report encourage more plant-based
protein, which is good for our health and for a
healthy planet.
6.3. Advocate for local suppliers of food and other
products that contribute to a reduction in carbon
demands and pollution, and benefit the local
economy.122
Photo credit: Sebastian Voortman
CANADIAN FEDERATION OF NURSES UNIONS 22CONCLUSION We have 12 years to take meaningful action to prevent global warming from reaching 2 o C. The IPCC (2018) stated that we need to cut climate emissions by 45% by 2030, moving to zero emissions by 2050. Our governments have a tremendous responsibility; we have an obligation to support them in the policies for a healthy planet and healthy commu- nities. Canada is warming at twice the rate of the rest of world, and we must be prepared.123 The Canadian Federation of Nurses Unions and its Member Organizations recognize the journey to mitigate the effects of climate change and prepare for the health consequences won’t be an easy one. However, as trusted advocates in our communities and workplaces, Canada’s nurses have the power to make a meaningful difference that will last generations. Working together we can build a resilient and healthy future for everyone. 23 CLIMATE CHANGE AND HEALTH
IT’S TIME FOR NURSES TO TAKE ACTION ON CLIMATE CHANGE. CANADIAN FEDERATION OF NURSES UNIONS 24
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