In 2015, approximately 105,000 Volkswagen vehicles were sold in Canada that were capable of emitting up to 35 times the legal level of nitrogen oxides (NOx). The vehicles which did not comply with Canada’s emission standards were imported into the country with illegal software that would prevent emission testing devices from identifying the problem. The U.S. Environmental Protection Agency prosecuted Volkswagen, and the company agreed to pay a $15 billion settlement. In the same period of time, Canada has failed to conclude their investigation and no punitive measures have yet been taken.
“Volkswagen has already admitted that it perpetuated fraud against the public and put human health at risk by selling emissions-cheating vehicles,” said Amir Attaran, lawyer with Ecojustice’s law clinic at the University of Ottawa. “In taking zero enforcement action and levying no fines as other countries have, the Canadian government is leaving billions of dollars on the table – money that it could use to clean the environment.”
In 2008, the Canadian Medical Association estimated that 21,000 Canadians die every year from heart and lung diseases from polluted air. The Medical Officers of Health in the Greater Toronto and Hamilton Area (GTHA) have also estimated that traffic-related air pollution is responsible for 700 premature deaths and over 2800 hospital admissions for heart and lung conditions, per year, in the GTHA alone. The pollutant that Volkswagen’s illegal diesel vehicles were emitting – NOx – is one the major ingredients in smog. Once in the air, NOx are transformed into ground level ozone and fine particulate matter – the two air pollutants most clearly linked to hospital admissions, premature deaths, and chronic heart and lung diseases.
“Traffic-related air pollution is a huge problem in Canada. It is responsible for thousands of deaths and hospital admissions each year,” said Kim Perrotta, executive director of CAPE. “Volkswagen exceeded the legal standards and they tried to hide it with emissions-cheating devices. The federal government has to take action to demonstrate that companies cannot get away with this type of blatant disregard for Canada’s emission standards and human health.”
The federal government needs to put Canadian health interests first, and punish companies that do not follow emissions regulations. The inefficient investigation underway with Volkswagen sets the standard that Canada’s environment and health standards do not need to be upheld. Instead, a more transparent and proactive approach needs to be taken on by the Ministry of the Environment that will protect Canadians and their health for years to come.
On June 1, 2017, CAPE participated in the National Bike Summit organized by Canada Bikes where we declared our support for the development of a National Cycling Strategy. Here is why.
A National Cycling Strategy would be a triple win for public health.It would help us to reduce the rate of chronic diseases in Canada. Chronic diseases such as diabetes and heart disease are escalating at alarming rates across the country. They place a heavy burden on the health care system while also producing pain, disability, and premature deaths for hundreds of thousands of Canadians each year. For example, cardiovascular disease alone costs $12 billion each year in Canada.
Physical activity is one of the most effective “treatments” for chronic diseases. We know that one hour of moderate to vigorous activity per week can reduce the risk of premature death by 4 to 9%. And yet, most Canadian do not get the 2.5 hours of physical activity required to maintain good health. Time—or the lack of it—has been identified as the number one barrier to physical activity.
Active modes of transportation—such as cycling—overcome this barrier. They allow people to get the “exercise” they need while travelling to work or school. One study found that people who cycle or walk to work reduce their risk of developing a chronic disease by 11%. But we know that most people, particularly women and children, will not ride to school or work unless cycling routes feel safe. Experience in other jurisdictions has demonstrated that many people will cycle for travel if they have protected bike lanes that look and feel safe.
A National Cycling Strategy would reduce acute and chronic health impacts associated with air pollution. In 2008, the CMA estimated that air pollution produces 21,000 premature deaths each year in Canada. We know these deaths are the tip of the iceberg. They represent a broad array of adverse health impacts including lung cancer, asthma, stroke, and heart disease. The CMA estimated that air pollution costs Canadians $10 billion per year in direct health care costs and lost time, and that was based on a limited number of health impacts for which the evidence was the strongest.
The transportation sector is one of the most significant sources of air pollution in Canada, particularly in large urban centres and along major traffic corridors. Modelling studies have demonstrated that we can significantly reduce air pollution, adverse health impacts, and health care costs by getting residents to use their bikes, instead of their cars, for short trips.
A National Cycling Strategy would also reduce greenhouse gases that contribute to climate change. The World Health Organization (WHO) has called climate change the most significant public health threat of the 21st century. It has estimated that 250,000 people will die prematurely each year by 2030 from climate change unless dramatic action is taken to significantly reduce our carbon emissions. Climate change is already claiming the lives of tens of thousands of people each year from heat stress, diarrhea, malaria, and malnutrition. Many of the victims are children and the elderly living in some of the poorest countries in the world. While Canadians will not experience the worst of these impacts, we are not be immune to the impacts of climate change.
Already, in Canada, we are experiencing health impacts from wild fires, floods droughts, heat waves, and severe storms that are increasing in frequency and intensity; from insect-borne diseases such as West Nile Virus and Lyme Disease that are spreading as the climate warms; and from injuries and deaths resulting from melting permafrost and shifting snow cover. The transportation sector in Canada is responsible for about one quarter of all greenhouse gas emissions. Modelling studies have demonstrated that we can significantly reduce these emissions by getting people to replace short car trips with bike trips.
A National Cycling Strategy is the holy grail of public health; the public policy the serves many public health goals with one investment. It is an investment that will pay for itself many times over in health care savings alone.
Prepared by Kim Perrotta, CAPE Executive Director, June 2017
On May 29th, the newly created Coalition for Action on Toxics held an event on Parliament Hill to draw attention to the changes needed to the Canadian Environmental Protection Act (CEPA) to ensure that it protects Canadians from highly toxic substances.
This new coalition—which is housed by Tides Canada, and includes EcoJustice, Environmental Defence, Équiterre, and CAPE—wants decision-makers to understand what changes are needed and how important they are.
“As a palliative care physician, I have spent too much of my career caring for people who are dying prematurely from diseases caused by toxic substances,” offered Dr. Jean Zigby, President of CAPE. “Our environmental regulations must be strengthened to prevent these avoidable deaths and diseases.”
These toxic exposures are costly to society in financial terms as well as human terms. One study published in The Lancet in 2016 estimated that toxic substances that disrupt the endocrine system alone cost the United States $340 billion per year in health care costs and lost wages (Attina et al., 2016). This figure represents 2.33% of the GDP!
CEPA, the backbone of environmental laws federally, has not been revised since 1999. The Standing Committee on Environment and Sustainable Development, which has been consulting the public on the revisions needed to CEPA since the fall of 2016, is expected to release its report in the coming weeks.
The coalition has identified a number of key priorities that must be addressed if human health and the environment are to be properly protected from toxics in the environment and in consumer products. We believe that CEPA should be revised to:
Reverse the burden of proof for substances for highly toxic substances so that industry must prove that they are safe to use;
Require assessment of alternatives and make it mandatory to substitute highly toxic substances with less hazardous substances;
Increase protection for populations that are particularly vulnerable to toxic substances such as children;
Require risk assessments that consider exposures from different sources and from different substances and products;
Create national air quality standards that are health protective, legally binding, and enforceable;
Strengthen timelines to ensure that risk management options are assessed and implemented in an expeditious manner;
Improve enforcement and provide the funds needed to properly enforce;
Extend the right to know to consumers with mandatory labelling of toxic substances;
Ensure that the chemicals are re-assessed in response to new scientific evidence, regulatory action in other jurisdictions, or public concerns; and
Improve the review and approval process for new substances to make it truly protective of human health and the environment and transparent.
This is a once-in-a-generation opportunity to prevent chronic diseases in Canada, reduce health care costs, and protect the environment. Click here and let your Member of Parliament (MP) know that this is an important issue to you.
Prepared by Kim Perrotta, May 30, 2017
Attina, Teresa M et al. “Exposure to endocrine-disrupting chemicals in the USA: a population-based disease burden and cost analysis.” The Lancet Disease and Endocrinology. Vol. 4. No. 12. December 2016.
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
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.