On World Health Day, let’s acknowledge that our hospitals – and the health care system as a whole – are very energy intensive, use large amounts of materials – including toxic substances – and produce large volumes of solid waste and toxic waste. But this is, in fact, counter to our ethical duty to do no harm, which must include not harming the environment and the health of people and communities.
But there is a lot of good news here, as well as lots of opportunity for further action. Nationally, the Canadian Coalition for Green Health Care (CCGHC) has been working for more than 20 years on these issues and has a wide range of helpful programs and resources.
In British Columbia, the four health authorities in the Lower Mainland have for some years been running a program called GreenCare; more recently, Vancouver Coastal Health has established a Planetary Health Office, while the University of British Columbia has created a Planetary Health Lab, which is also part of a national project, CASCADES, a multi-year capacity-building initiative to address health care’s contribution to the climate crisis. And through their Mandate Letters, B.C.’s health authorities have been tasked with “minimizing greenhouse gas emissions and managing climate change risk”.
Of course, many practitioners do not work in hospitals and health authorities but in private offices and clinics. But you too can help reduce your environmental impacts, using guides such as the Green Office Toolkit from the CCGHC. And wherever you work, you could start a Planetary Health Committee and bring forward a green agenda when you meet with your clinical, academic and administrative colleagues.
The first thing to remember is that advocacy is not a dirty word, in fact it’s a duty. The Canadian Medical Association’s Code of Ethics and Professionalism (2018) recognizes advocacy as a core activity of medicine. The commitment to professional excellence, one of the seven fundamental commitments of the profession, includes “advocacy on behalf of the profession or the public.” And the Canadian Nurses Association Code of Ethics for Registered Nurses (2017) mentions advocacy 34 times, has a focus on “how broad societal issues affect health and wellbeing” and considers advocacy to support “the need to improve systems and societal structures to create greater equity and better health for all” to be part of ethical practice.
Advocacy is not only about access to high quality treatment and care services, but also for what it takes to keep patients healthy. So, health professionals can and should keep the public informed about what is going on with respect to health in their community, the ecological and other factors that are contributing to those problems and what, from a health perspective, needs to be done about it.
If you identify ecological changes that threaten health, such as climate change, you have a duty to advocate for the remedies needed to protect the health of your patients.
As well as advocating as a health professional, there is much to do as citizens. First, as an individual, you can start to model the healthy and sustainable ways of life that we know are good for planetary health. These include eating a largely plant-based diet; switching from fossil fuels for vehicles, home heating and other uses; walking, biking/blading/rolling and using public transit wherever feasible; flying less and instead attending meetings and conferences virtually where appropriate; practicing the “5 Rs” (refuse, reduce, reuse, repurpose, recycle); going out in nature and hugging a tree; and much more.
We know that health professionals are respected and trusted in their communities, much more so than politicians and the media. So, use that to your advantage, working always from the base of evidence and your professional and ethical commitment to human wellbeing and planetary health.
As a citizen, you can and should speak out on these issues. Write to the local newspaper or be ready to do local radio and TV interviews; use social media to spread the word; write to and meet with municipal, provincial and federal politicians; join community organizations and NGOs; attend rallies and demonstrations, and if need be, be ready to initiate or support court action to protect human health and the planet.
Finally, if you need to learn about these issues prior to speaking out, or need the company and support of others, join groups such as the Canadian Association of Physicians for the Environment, the Canadian Association of Nurses for the Environment, the CCGHC and, of course Doctors for Planetary Health-West Coast.
If you don’t have the time to actively participate in these and other organizations, you can support them in other ways – financially, through showing up at events, by signing on to campaigns, petitions and letters. We are all fighting for the same cause – our planet and our health.
What you can do
Some ideas for ‘greening’ your office
- Use clean rather than sterile where appropriate e.g., tongue depressors.
- Use reusable rather than disposable, e.g., vaginal speculum.
- Stop using paper examine table covers; wiping down is good enough.
- Use cloth drapes and instrument pack wraps for sterile sets.
- Sort all your garbage into paper (it tears), soft plastic, hard plastic and metal. These can be recycled. Only contaminated items need to go in the garbage. We have recycling champions in our building.
Reducing energy consumption in radiology
Maura Brown is a radiologist in Vancouver. Concerned with the high energy consumption of CT/MRI machines, she has written about it with a colleague and has organized an on-site meeting in her Diagnostic Imaging department including stakeholders from engineering, facilities management, CT vendors and CT technologists. Not only did they find ways to lower energy use and emissions, but the idea is spreading across B.C. and has attracted international attention. The initiative is leading to broader actions within the Health Authority to address the system’s ecological footprint.
Opposing fossil fuel-friendly classroom education in B.C.
This was a CAPE campaign, spearheaded by Drs. Lori Adamson and Melissa Lem, lobbying to publicize the fact that Fortis BC “lesson plans” (biased toward putative benefits while largely ignoring health concerns and downplaying environmental damages resulting from natural gas extraction, distribution, and combustion) are being distributed in B.C. schools, and to demand their removal.
An open letter of concern to B.C. Education Minister Jennifer Whiteside was signed by almost 100 organizations, including the B.C. Teachers’ Federation, and Vancouver Island Health Authority. This campaign resulted in substantial coverage by media outlets, including CBC, CTV and Global TV News, CBC Radio, the Vancouver Sun, Victoria Times Colonist and the Globe and Mail, as well as social media news sites.
Advancing and advocating in B.C.
Doctors for Planetary Health (D4PH) has organized a number of events to take its message to B.C.’s politicians, including a “Code Red” Rally at the B.C. legislature in November 2021, and will be presenting its full “Code Red” policy brief to the B.C. government on World Health Day. In addition, D4PH members attend rallies and protests organized by other groups, ranging from protesting the Trans Mountain pipeline expansion to deforestation at Fairy Creek.