Climate Change is a Health Care Issue

A lack of progress in reducing emissions and building adaptive capacity threatens both human lives and the viability of the national health systems they depend on, with the potential to disrupt core public health infrastructure and overwhelm health services.

This is not a quote from Greenpeace, Al Gore, or David Suzuki. It is from The Lancet, one of the most prestigious medical journals in the world. More and more health organizations are recognizing climate change as the biggest global health threat of the 21st century. Canadian health organizations, such as the Canadian Medical Association, Canadian Association of Physicians for the Environment, Registered Nurses’ Association of Ontario, and others are urging decisive action from political and business leaders, institutions, and individuals to reign in CO2 emissions that are causing climate change.

The following are some of the major health care impacts of climate change as identified by The Lancet, IPCC, numerous academic institutions, and intergovernmental agencies spanning the continents:

• Exposure to warmer temperatures and more heat waves increases population risk for heat related illnesses, including heat stress, cardiovascular disease, and renal disease.

• Higher temperatures are a risk factor for occupational health, particularly for outdoor workers. Heat associated health issues have led to significant loss of labour productivity and will continue to do so if temperatures keep rising unabated.
• Extreme precipitation (flood and drought) events are becoming more frequent as a result of climate change (See IPCC SR1.5). These events lead to acute loss of life by flood waters and longer term mortality caused by water-borne illnesses and mental health issues associated with loss of infrastructure, property, livelihoods, etc.
• Increased incidence of wildfires, leading to immediate risk to life as well as disease associated with inhalation of fine particles.
• Shifting climate zones are increasing the range of certain climate sensitive illnesses, and increasing the ranges of key disease vectors. Lyme disease is a key issue in Ontario as the range of ticks carrying the disease expands.
• Food security and undernutrition. Global food systems are dependent on a stable climate and crop yield potential is decreasing as global warming advances.
• Combustion of fossil fuel that causes global warming also leads to significant air pollution. Ambient air pollution is the cause of an estimated 4.2 million deaths per year globally. Therefore, mitigating climate change by limiting the combustion of fossil fuels would lead to direct health benefits and reduction in costs to healthcare systems. In Toronto, where UHN facilities are located, air pollution is estimated to give rise to 1,300 premature deaths and 3,550 hospitalizations each year (see Toronto Air Pollution Burden of Illness Update 2014).

Even though impacts in Canada may not be as severe as in more vulnerable parts of the world, the healthcare impacts listed above will be felt to varying degrees of severity by UHN and other Canadian hospitals. It is clear that climate change mitigation is one of the top issues facing health care providers worldwide. It is also worth noting that Canada is warming at DOUBLE THE RATE of the global average.

For many people and organizations including myself, an alarm bell sounded when the IPCC released the 2018 Special Report on Global Warming of 1.5C. Previously, the most frequently discussed target to prevent catastrophic climate change was 2 degrees C of warming above pre-industrial averages. This report draws stark contrasts between the projections for Earth under 1.5C and 2C warming scenarios.

Because of the severe impacts of a 2C warming scenario, the IPCC identifies 1.5C warming as a more realistic goal for a livable planet with a climate adaptable to future human populations. However, having already blown past 1 degree C of greenhouse gas induced warming, this target leaves a very small window in which drastic action must be taken to reduce emissions of greenhouse gases. In order to achieve the 1.5C target, greenhouse gas emissions reductions of 45% over 2010 levels must be achieved by 2030 (11 years away!!) and net-zero emissions must be achieved by 2050. This means that any new building construction project must be capable of net zero performance as that building will definitely still be in operation in 2050. Think about this: if you have a young child, they will barely be 30 years old in 2050. The climate crisis will impact current generations.

So What is UHN Doing About it?

Due to the success of UHN’s energy management program, we may have a little bit of a head start in tackling this issue. The chart below shows that our energy savings initiatives have also led to significant greenhouse gas savings.

This chart includes scope 1 emissions (gas/fuel burned on UHN sites) and scope 2 emissions (emissions from production of steam and electricity that is purchased by UHN  from utilities). Our absolute emissions in 2018 are down almost 19% compared to 2010 levels. This is despite adding over 52,000 square meters of new floor space during that time. Our 2018 emissions were 10% lower when compared to our weather adjusted baseline. Major emissions savings were achieved at our research sites through the implementation of demand controlled ventilation (see more info here and here). A significant portion of these savings can be attributed to the elimination of coal fired electricity generation in the province of Ontario.

Over the coming year, the Energy and Environment team will be undertaking a study to understand projects that need to be prioritized in order to meet the greenhouse gas reduction targets laid out by the IPCC. We are also implementing a process to incorporate the societal cost of carbon emissions into business case development and analysis.

At the same time, we are working closely with infrastructure project implementation teams to ensure climate resilience is part of the decision making process for major projects. For example, by adding extremely efficient cooling capacity and redundancy to hospital sites. Check out the blogs for the redevelopment of the cooling plants and TGH, Bickle, and Lyndhurst.

The climate crisis is an incredible challenge to face. Aggressive greenhouse gas reduction targets will be very difficult to meet in the critical care, 24-7 spaces that are common at UHN. But ultimately, we must solve these problems. The risks posed to human health by further inaction are far beyond the capacity of global healthcare systems. These are the types of problems energy managers get up in the morning to try to solve and we truly must be successful in responding to this challenge. The consequences of failing are too great.