As health professionals, we know how important it is for our patients to be physically active. After all, physical activity is known to reduce the risk of chronic diseases such heart disease and diabetes. It also improves mental health and provides some relief from arthritis. But we also know that many people have difficulty finding the time to get the levels of physically activity needed to maintain good health. Studies bear this out; the number one barrier to physical activity is time. This is particularly true for women with young children. This is where active modes of transportation (such as walking and cycling) and transit use come in. Research has demonstrated that many people can fold physical activity into their lives if they combine it with other activities such as errands, commuting to work, or taking the kids to school.
As health professionals, we are well positioned to encourage our patients to think about active transportation as a way to get the physical activity they need to stay healthy. When we use the phrase “active transportation”, we mean any activity used to get people from one destination to another that involves physical activity. It can include skate boarding or in-line skating, but usually involves walking or cycling. When we use the phrase “active travel”, we are referring to transit use as well as active transportation because many trips on transit begin or end with walking or cycling.
Unfortunately, many communities across Canada have not been designed to encourage and foster active modes of transportation or transit. Many were built during a time when it was considered wise to separate homes and schools from workplaces and amenities. This led to communities designed around cars; sprawling neighbourhoods with winding roads and cul-de-sacs separated from shopping malls that grouped all amenities into one place. Experience and research has demonstrated the problem with this thinking. We now understand the need for compact neighbourhoods that have enough people in them to support efficient transit service and attract restaurants, stores, and other services. We know that streets built on a grid encourage people to walk and cycle to nearby amenities. We know that streets lined with sidewalks encourage walking by making it safer and easier to do. And we know that busy streets with separated bike lanes are safer for cyclists and encourage more people to ride their bicycles.
But changing the design of communities and streets can be difficult. Resistance can come from a number of different sources. As health professionals, we can play an important role in community decisions. We can help educate the public and decision-makers about the many health benefits of community and street designs that support and foster a healthy lifestyle.
CAPE has produced a new toolkit—PrescribingActive Travel for Healthy People and a Healthy Planet: A Toolkit for Health Professionals—to help health professionals become advocates of active transportation and transit with their patients and in their communities. The toolkit is designed with five stand-alone modules so people can focus on the ones of most interest to them. Module 1 describes the health, environmental and social benefits of active travel. Module 2 provides strategies to motivate patients to use active travel. Module 3 explains the links between active transportation and community design. Module 4, designed for health professionals in southern Ontario, focuses on Ontario’s Growth Plan and how it impacts active travel. Module 5 provides strategies for promoting change in one’s community. The toolkit also includes two factsheets and brochures that health professionals can give to their patients, two backgrounders that can be used in meetings with the public or decision-makers, and a series of memes that can be used on Twitter or Facebook to make people think about the many benefits of walking, cycling, and transit for society as a whole.
Kindzierski maintains that coal plants are not a major contributor of fine particulate matter (PM2.5), the air pollutant that has been most clearly and consistently linked to chronic heart and lung diseases as well as acute health impacts. Kindzierski refers readers to several of his own studies, one of which contains a graph (posted above) that identifies coal combustion (the mustard yellow bar) as a small contributor of ultra fine particles in Alberta’s air (Md. Anul Bari et al., 2015). He fails to explain however, that coal plants are one the most significant sources of sulphur dioxide (SO2), the gaseous air pollutant that is transformed in the air into secondary sulphate (the large brown bar).
Secondary sulphate, as illustrated by the author’s own graph, is the most significant source of ultra fine particles, the most worrisome portion of PM2.5. In 2014, coal-fired power plants were responsible for 40% of the SO2 emitted in all of Alberta and 60% of the SO2 emitted in the Edmonton Region (Pembina 2016a). In other words, coal plants were the largest source of SO2 that is transformed into the secondary sulphates that contribute most significantly to air levels of ultra fine particles and PM2.5 in Alberta.
Air Pollution and Human Health
Kindzierski then goes on to challenge the view that air pollutants other than PM2.5 and ground level ozone are harmful to human health, and even calls into question the health evidence associated with PM2.5. Thousands of studies have been directed at the acute and chronic health impacts associated with air pollution over several decades. In 2013, the World Health Organization (WHO) reassessed the health literature on air pollution and found, among many other things, stronger evidence that short- and long-term exposure to PM2.5 increases the risk of mortality and morbidity particularly for cardiovascular effects; stronger evidence that short-term exposures to ozone can have negative effects on a range of pulmonary and vascular health-relevant end-points; new evidence that short- and long-term exposure to nitrogen dioxide (NO2) can increase the risk of morbidity and mortality, mainly for respiratory outcomes; and additional evidence that exposure to SO2 may contribute to cardiovascular and respiratory mortality and morbidity and asthma symptoms in children (WHO, 2013). These findings are well known and well accepted by public health, environmental, and medical professionals around the world.
Coal Plants, Air Pollution and Human Health
In 2012, using the Air Quality Benefits Assessment Tool (AQBAT) developed by Health Canada, Environment Canada estimated that improved air quality resulting from the current coal regulations would prevent approximately 994 premature deaths and 860 hospital admissions or emergency room visits between 2015 and 2035 (Environment Canada, 2013). These avoided health outcomes were valued at $4.9 billion. In 2016, the Pembina Institute extrapolated these results to determine the additional health benefits associated with a 2030 coal plant phase-out in Canada. It found that a 2030 phase-out date would nearly double the health benefits associated with the existing coal regulations, preventing an additional 1,008 premature deaths and 871 hospital admissions or emergency room visits between 2015 and 2035. These additional health benefits were valued at nearly $5 billion (Pembina 2016b).
It is clear to us: a 2030 Canada-wide phase-out of coal-fired power plants is a public policy that will produce many direct public health benefits for Canadian while simultaneously helping us to meet our commitments under the Paris Climate Change Agreement.
Prepared by Kim Perrotta, Executive Director, CAPE, March 7, 2017
Neonicotinoid pesticides or “neonics” are the group of pesticides that came to public attention several years ago when beekeepers began reporting alarmingly high rates of bee colony losses. Ontario beekeepers, for example, reported losing 58% of their bee colonies over the winter of 2013 and 38% over the winter of 2014 (1). While there is ample evidence linking neonics to bee colony losses, this issue is bigger than the bees.
When an international group of independent scientists, the Task Force on Systemic Pesticides, reviewed over 1100 peer reviewed scientific articles, they found that neonics are extremely toxic to most insects, spiders and crustaceans; moderately toxic to birds and fish; persistent so they can accumulate to hazardous levels in the soil; water soluble so they can run off into streams and lakes and leach into ground water; linked to large-scale acute losses of domestic honeybee colonies; and associated with impaired learning, increased mortality, reduced fecundity, and increased susceptibility to disease in bees. The Task Force concluded that neonics are potentially harmful to ecosystem services, such as pollination, that are vital to food security and sustainable development (3).
When public health researchers conducted a study to determine how people around the world might be affected by the total loss of animal pollinators, such as bees, they estimated that global fruit supplies would decrease by 23%, vegetables by 16%, and nuts and seeds by 22%. They predicted that these changes in food supplies could increase global deaths from chronic and nutrition-related diseases by 1.42 million people per year (4).
Moved by the threat that neonics pose to the honey industry in Ontario, which is worth about $26 million per year, and to agricultural crops in Ontario that depend upon pollination, which is worth about $897 million per year, the Ontario Government moved decisively (2). In July 2015, Ontario passed regulations that aimed to reduce the number of acres planted with neonic-treated corn or soybean seed by 80% by 2017 (2). In so doing, Ontario became the first jurisdiction in North America to restrict the use of neonics. The regulations targeted the three neonic pesticides used most extensively in Ontario: imidacloprid, thiamethoxam, and clothianidin. Newly released data indicates that neonic-treated corn and soybean seeds were used on about 3 million acres of crop land in Ontario in 2016—down by almost 1 million acres from 2014 (6). While this is substantial reduction—about 24%—it is long way from the 80% reduction that will be required by the regulations by the end of this year.
In November 2016, Health Canada proposed a new decision for the neonic pesticide imidacloprid based on a reevaluation of the science. This decision, which is open for public consultation until March 23, 2017, proposes the phase-out of all the agricultural and the majority of outdoor uses of imidacloprid over three to five years. This decision was based on Health Canada’s findings that this pesticide is being measured in aquatic environments at levels that are harmful to aquatic insects that are a food source for fish, birds, and other animals. Let Health Canada know that you support the phase-out of imidacloprid, but want to see them move faster to protect the ecosystem from neonics. You can review the consultation document here and provide feedback here.
On January 17, 2017, industry think-tank the Fraser Institute released a new report, Did the Coal Phase-out Reduce Ontario Air Pollution? which suggests that coal plants across Canada should not be phased out based on its assertion that Ontario’s phase-out did not significantly reduce air pollution (Fraser Institute, 2017). This report includes a number of statements about pollution, health care benefits, and coal plants that are incorrect or misleading.
The Fraser report focuses on the air pollution benefits of the Ontario coal plant phase-out while ignoring the many co-benefits associated with this action. In 2002, the five coal-fired power plants in Ontario were responsible for
nearly one quarter (23%) of the sulphur dioxide (SO2) emissions and one seventh (14%) of the nitrogen oxide (NOx) emissions in Ontario that contributed to air pollution and acid rain,
nearly one quarter (23%) of the airborne mercury emissions which contributed to the contamination of fish with a persistent toxic that is harmful to the brains of humans, and
one fifth (20%) of Ontario’s greenhouse gases emissions that were contributing to climate change (OPHA, 2002).
Over the last 20 years, the public health sector, the Ontario Medical Association, environmental organizations, cottagers’ associations, and labour organizations have been outspoken advocates for the phase-out of coal plants in Ontario. All of these groups shared the common view that many health and environmental benefits could be gained simultaneously by closing Ontario’s coal plants.
While there were technologies that could be applied to reduce emissions of sulphur dioxide, nitrogen oxides, and mercury from these plants, there was no technology at that time that could eliminate emissions of greenhouse gases. Given the age of Ontario’s coal plants, the availability of combined cycle natural gas plants, the promise of energy efficiency, and renewable technologies, it made more sense economically to accelerate the closure of coal plants than to re-invest in them.
The Fraser report and press release suggest that coal plants are not a major contributor of fine particulate matter (PM2.5)—the air pollutant that has been mostly clearly linked to chronic health impacts such as heart disease and lung cancer, and one of two air pollutants responsible for most of the smog alerts that used to be common in Ontario. This is simply not true.
Coal plants emit significant quantities of SO2 and substantial quantities of NOx. Both are gaseous air pollutants that can harm human health directly. When they enter the atmosphere, they can be transformed into sulphates and nitrates—acid particles that contribute to air levels of PM2.5. In fact, this secondary PM2.5 is the major culprit behind high levels of PM2.5 measured in many airsheds and is often more hazardous for human health than other forms of PM2.5 (RIAS, 2011). This PM2.5 does not, however, show up in emission inventories for PM2.5.
The Fraser Institute suggests that Ontario’s coal phase-out had little impact on emissions and air quality. This is misleading. Between 2003 and 2012, SO2 emissions from coal plants were reduced by about 140,000 tonnes (see Figure 1). During that same period, annual air levels of SO2 across Ontario declined by nearly 50% (see Figure 2) and annual air levels of PM2.5 declined by about 25% (see Figure 3) (OMOECC, 2014). While the improvements in air levels of SO2 and PM2.5 cannot be attributed solely to the closure of coal plants, their closure was an important contributor to reductions in air levels.
Air quality is impacted by multiple sources of pollution. The actions to reduce air pollution are intentionally broad-based because the improvements are cumulative. Coal plants are an efficient target for emission reductions because they are stationary sources that emit large volumes of air pollutants. They are also a significant source of air toxics such as mercury and greenhouse gases.
Air pollution is also a transboundary issue. Emissions of SO2 and NOx from coal plants in the U.S. have a significant impact on Ontario’s air quality, while emissions from Ontario’s coal plants have a substantial impact on air quality in Quebec, Vermont and New York (Yap et al., 2005). In recognition of this reality, Canada and the United States committed in 1991 to take action on both sides of the border with the Canada-US Air Quality Agreement. This agreement has proven very successful. Emissions and air quality on both sides of the border have improved because of cooperation between the two countries (Canada-US, 2014).
In 2005, Ontario estimated the contribution of coal plants to air pollution across Ontario and the adverse health impacts associated with that contribution. Because coal plants release air pollutants so high in the air, the pollutants are dispersed over long distances. The impact, therefore, on any one airshed is relatively small, but the impact overall on human health can be significant because so many people can be affected. Using methodologies that were well-accepted in other jurisdictions, Ontario estimated that air pollution from its coal plants were responsible for over 600 premature deaths, 900 hospital admissions, and 1000 emergency room visits, each year, in Ontario. These health impacts were valued at $3 billion per year (OMOE, 2005).
The Fraser report suggests that the $3 billion in health benefits estimated cannot be accurate because it represents too great a percentage of Ontario’s health care budget. This statement reflects a misunderstanding about the health benefits estimated in 2005. The $3 billion per year in health benefits reflect the value of the many lives that are shortened by air pollution, as well as health care costs. They do not reflect health care costs alone. The 2005 report is clear about this point.
An independent assessment conducted by Toronto Public Health in 2014 suggests that improvements in Ontario’s air quality have translated into significant health benefits for Ontario residents. Toronto Public Health found that improvements in Toronto’s air quality from 2000 to 2011 have reduced air pollution-related premature deaths by 23% (from 1,700 to 1,300 per year) and hospital admissions by 41% (from 6,000 to 3,550 per year) in Toronto alone. It attributes the improvements in air quality to a variety of policies implemented by different levels of government including the phase-out of coal plants by Ontario (TPH, 2014).
With the evidence of catastrophic climate change mounting daily, the need to modernize Canada’s electricity sector has never been more clear. With the costs of renewable technologies dropping, the opportunity to transform our economy has never been greater. CAPE stands by its position. We believe that the phase-out of coal plants in Alberta and across Canada is an economically prudent decision that will improve the health of Canadians while taking the steps needed to address climate change.
Prepared by Kim Perrotta, MHSc, Executive Director, CAPE
Canada-US, 2014. Canada-U.S. Air Quality Agreement Progress
Fraser Institute. (2017). Did the Coal Phase-out Reduce Ontario Air Pollution? Prepared by Ross McKitrick and Elmira Aliakbari.
Ontario Ministry of Energy (OMOE). 2005. Cost Benefit Analysis: Replacing Ontario’s Coal-Fired Electricity Generation. Prepared by DSS Management Consultants Inc. RWDI Air Inc. April, 2005
Ontario Ministry of the Environment and Climate Change (OMOECC). 2014. Air Quality in Ontario 2013 Report.
Ontario Public Health Association (OPHA). 2002. Beyond Coal: Power, Public Health and the Environment
Regulatory Impact Assessment Study (RIAS). 2011. Reduction of Carbon Dioxide Emissions from Coal-Fired Generation of Electricity Regulations.
Toronto Public Health (TPH). 2014. Path to Healthier Air: Toronto Air Pollution Burden of Illness Update. Technical Report.
World Health Organization (WHO). 2013. Review of evidence on health aspects of air pollution – REVIHAAP Project.
Yap, David, Neville Reid, Gary De Brou, and Robert Bloxam. 2005. Transboundary Air Pollution in Ontario 2005. Queen’s Printer.
Perhaps because we mostly work inside boxes—hospitals, clinics, universities, and office buildings—it has taken the world’s health community far too long to realize that human health belongs in the same box as what we call “the environment.”
These ideas have been part of other thought systems, including Aboriginal concepts of wellness, for generations—but until recently they have been largely neglected within Western medical thought, other than in the realm of public health and environmental medicine.
As health professionals, it is not actually easy to admit that what happens outside our clinics and hospitals has a greater impact on overall health status than what happens inside them. We have put a lot of time and effort into learning what to do in our boxes. But as professionals who have committed a lifetime to the pursuit of optimal health for the people and populations we serve, we recognize that when the evidence demands it, we must peek over the edges of our boxes, open the windows, and let in new ideas and collaborations.
In response, a Planetary Health Alliance has been launched out of Harvard, funded by the Rockefeller Foundation, the world’s first Chair in Planetary Health has been established at the University of Sydney, and health professionals are mobilizing worldwide to ensure that our growing understanding of the linkage between human health and the natural environment is integrated into policy.
Comprehensive human health impact assessments include an assessment of the impact of a project on the social determinants of health such as housing and income, as well as the ecological determinants of health including greenhouse gas emissions. This will allow health authorities to recognize and consider potential positive and negative health impacts of projects on their communities, to plan and fund healthcare provision services to address those impacts, and, to suggest modifications to plans in order to mitigate negative health impacts.
This integration has the potential to save not only lives but also money as it is well-recognized that preventative medicine is cheaper than acute care.
Prepared by Dr. Courtney Howard, Dr. Trevor Hancock, and Robert Rattle
The full letter to the MoECC calling for the integration of health impact assessments into federal environmental impact assessment processes and a list of signatories can be found here.
It has been a good week for people and the planet. Last Monday, November 21st, 2016, the federal government announced that it will take steps to phase out pollution from coal-fired power plants across the country by 2030. And on Thursday, November 24th, the Government of Alberta announced that it has signed an agreement with three major power generators to ensure a phase-out of coal plants in Alberta by 2030.
There will be time in the coming days to examine and critique the details surrounding these two new announcements but today we want to acknowledge what they can mean for human health in Alberta, across Canada, and around the world.
A new report endorsed by 15 health and environmental organizations—including the Canadian Association of Physicians for the Environment, the Asthma Society of Canada, and the Lung Association—estimates that a Canada-wide phase-out of coal power by 2030 would prevent more than 1000 premature deaths, 900 hospital admissions or emergency room visits and nearly $5 billion in health care costs by improving local air quality. In fact, most of these national health benefits will be realized in the Prairies—about $3 billion in Alberta and up to $1.3 billion in Saskatchewan. While the lion’s share of the benefits will happen in the Prairies, there will still be important benefits realized in the Atlantic provinces and in central Canada, making a Canada-wide coal-phase out truly in the country’s national interest.
The 2030 phase-out will also significantly reduce mercury emissions. Mercury is the reason that pregnant women are warned not to eat certain types of fish during pregnancy. It is a persistent substance that accumulates in the aquatic food chain that can harm the brains of children exposed during pregnancy. Reducing this pollution will mean that these harmful effects can be minimized; that we can reclaim fish as a healthy protein source for all.
In addition, the 2030 phase-out will help Canada’s fight against climate change. Renowned medical journal The Lancet estimates that climate change is already responsible for approximately 150,000 deaths each year. People are dying from malnutrition, malaria, infectious disease and extreme heat; conditions made worse by a climate characterized by more frequent and more intense storms, heat waves, and droughts. People in countries that are already struggling to feed their people will experience many of these health impacts, but Canada will not be immune. Over the last 10 years, Canada has experienced an increase in droughts, wildfires, extreme rain and ice storms, floods and extreme heat. We have seen the spread of insect- and tick-borne diseases such as West Nile virus and Lyme disease. And we have seen permafrost and ice roads melting in the far north. Canadians are already being affected by climate change, both in economic and health terms.
By accelerating the closure of coal plants across the country, we will cut Canada’s greenhouse gas emissions by about 8%. This will help Canada to meet its commitments under the Paris Agreement on Climate Change and put us in a stronger position to ask the same of other countries. But more importantly, we will be acting decisively to improve the health of Albertans, Canadians and other people around the world from the ravages of uncontrolled climate change.
We congratulate the governments of Alberta and Canada in their decisions to phase out coal-fired power, and to reap the important health benefits for Albertans and all Canadians. Now the hard work begins: designing plans to ensure this transition happens quickly, in partnership and collaboration with communities most impacted. We look forward to working with all levels of governments throughout this process.
Prepared by Kim Perrotta, MHSc, Executive Director of Canadian Association of Physicians for the Environment (CAPE), on November 25, 2016
In collaboration with CAPE and nine other health organizations, energy think tank the Pembina Institute has released a new report titled “Out with the coal, in with the new: National benefits of an accelerated phase-out of coal-fired power”. This report estimates the air pollution-related health benefits associated with a Canada-wide phase-out of coal-fired power plants by 2030.
There are currently 14 coal plants operating in Canada: six in Alberta, three in Saskatchewan, four in Nova Scotia, and one in New Brunswick. These plants are significant emitters of air pollutants, mercury that contaminates fish, and greenhouse gases that contribute to climate change.
In 2012, Environment Canada found that coal regulations, which limit carbon dioxide emissions from these plants or require their closure after 50 years of operation, would produce $4.9 billion in health benefits over a 20-year period by improving air quality in several provinces.
When the Pembina Institute extrapolated those health benefits to a 2030 phase-out date, it found that the health benefits would be doubled producing an additional $5 billion in health benefits over a 20-year period by further improving air quality.
In 2014 alone, the study found that these 14 coal-fired power plants were responsible for approximately 163 premature deaths and 141 hospital admissions or emergency room visits. These health impacts, along with other related impacts, were valued at approximately $816,000,000.
While these health benefits would be realized in the four provinces that operate coal-fired power plants, the provinces downwind of them – Manitoba, Ontario, Quebec and Prince Edward Island – would also experience improved air quality and reduced health impacts. The report notes that greatest health benefits would be realized in the prairies because of the heavy use of coal plants in Alberta and Saskatchewan.
The report notes that substantial health benefits would also result from the elimination of mercury emissions from these coal plants. The 2030 phase-out would also cut Canada’s greenhouse gas emissions by up to 8.5% and make Canada a role model for other countries around the world.
Click here to read the full report or download a two-page summary factsheet.