Strengthening Canada’s focus on mitigation: Reflections on the COP28 and climate and health

Ed. note: This is the third in a series on COP28. Parts 1 and 2 can be read here and here.

The health sector is an economic giant. Thus, it must play a significant role in strengthening Canada’s focus on climate change mitigation, including reducing its own contributions to climate change and urging the provinces and territories to commit to both the COP28 UAE Declaration on Climate and Health and the World Health Organization’s (WHO) high-ambition net zero commitment.

There are a number of ways in which it can strengthen Canada’s actions at the societal and community level as well as within the health sector itself to mitigate climate change, in particular by taking action to reduce greenhouse gas (GHG) emissions and reach a net-zero emissions status as soon as possible.

First, the countries signing the COP28 declaration – and that includes Canada – committed themselves to “pursuing the better integration of health considerations into our climate policy processes, and of climate considerations across our health policy agendas.” This provides the basis for demanding that the federal and provincial governments follow through on those commitments.

We should expect that health be explicitly and specifically incorporated into Canada’s climate policies – including, where relevant, provincial climate policies – and that climate change mitigation and adaptation be integrated into health policy, especially at the provincial level.

Consistent with the WHO’s position, this means that fossil fuels will be phased out and all forms of fossil fuel subsidies and supports, including tax concessions, should cease. Since some provinces also provide subsidies and supports, provincial health sector organizations also should make these demands of their provincial governments.

Second, the health sector should demand that the federal and provincial governments follow through on the declaration’s acknowledgement of the health co-benefits of “deep, rapid and sustained reductions in greenhouse gas emissions . . . just transitions, lower air pollution, active mobility and shifts to sustainable healthy diets,” as well as the “common objective” of pursuing health-enhancing adaptation policies “across a range of sectors – including food and agriculture, water and sanitation, housing, urban planning, health care, transport and energy.”

To do this, the federal government must conduct health impact assessments of current policies in these and other relevant areas and identify the positive (and negative, if any) health impacts of pursuing climate-friendly/net-zero policies. This would be consistent with Recommendation 5 in the 2022 Lancet Countdown on Health and Climate Change Policy brief for Canada, which calls for “including health benefits in cost analyses of adaptation and mitigation policies.” Then, the federal and provincial governments must “develop healthy public policies for the common good,” a first step to the well-being society that the WHO proposes and the subject of an open letter to Canada’s First Ministers on World Health Day 2022.

Third, the health sector should also demand that the private sector commit to a healthy future free of fossil fuels and implement what amounts to “healthy private policy.” The obvious places to begin are with the food and agriculture, water and sanitation, housing, urban planning, transport and energy sectors and their impacts on GHGs, energy and resource efficiency, just transitions, lower air pollution, active mobility and the shift to sustainable healthy diets (the last is the focus of Recommendation 3 in the 2023 Lancet Countdown on Health and Climate Change Policy brief for Canada).

Fourth, another area of private sector activity that the health sector should target is the investment portfolios of banks and pension funds. Health sector organizations, including health authorities, should join the fossil fuel divestment movement and demand that both public pension funds such as the Canada Pension Plan and provincial and private plans fully divest from fossil fuels. A helpful report can be found here. In addition, they should remove their banking services from banks that are major investors in fossil fuels.

Fifth, the health sector must insist that all this occur within the context of the “common objective” in the declaration related to maximizing health gains for disadvantaged and vulnerable groups.

Sixth, the health sector itself must “walk the talk” and honour its ethical duty to do no harm by adopting and implementing measures to reduce GHGs and achieve net zero as soon as possible. This has been an important part of the work of the Canadian Coalition for Green Health Care for almost a quarter of a century, and it has a wealth of resources and experience. It is also the focus of one of the Coalition’s partners, CASCADES, which is a university-based initiative.

Canada can usefully learn from the NHS in England, which has a comprehensive and ambitious plan “to be the world’s first net zero national health service.” An important part of its strategy is “a roadmap to help suppliers align with our net zero ambition,” which has the added benefit of creating demand for and strengthening the green innovation economy.

When Canada’s health ministers next meet and address both the WHO net-zero commitment and the COP28 UAE Climate and Health Declaration, they should also collectively pledge to make our health system net-zero well before 2050 and create a national “net-zero/green procurement” strategy.

Finally, Canada’s health ministers and health systems will need to go beyond net zero, which is after all just a climate change issue, and address the other elements of the health systems’ overall ecological footprint, aiming to become a “One Planet” health system as soon as possible.

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Trevor Hancock


Dr. Trevor Hancock is a public health physician, a retired Professor of Public Health at UVic, and was a co-founder of both the Canadian Association of Physicians for the Environment and the Canadian Coalition for Green Health Care.

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