Climate Change Health Impacts Demand Urgent Action

“The human symptoms of climate change are unequivocal and potentially irreversible – affecting the health of populations around the world, today. Whilst these effects will disproportionately impact the most vulnerable in society, every community will be affected.”

This is one of the conclusions expressed in the new report, The Lancet Countdown: Tracking Progress on Health and Climate Change, that was released on October 31, 2017.  Produced by the prestigious medical journal, The Lancet, with an interdisciplinary team of researchers from 24 academic institutions and inter-governmental organizations, the new report identifies 31 indicators that can be used to measure the impact, adaptation, mitigation, economics, and politics of climate change on a global scale.

The Countdown notes that global inaction to mitigate climate change is moving us towards a 2.6°C to 4.8°C increase in the global temperature by the end of the century – “a level which would be disastrous to health even with maximal adaptation efforts”.  It states that “adaptation has limits” and that action is needed to “prevent the potentially irreversible effects of climate change.”

The message delivered by the Countdown is urgent and dire, but not without hope.  It also reports that “Whilst progress has historically been slow, the last five years have seen an accelerated response, and the transition to low-carbon electricity generation now appears inevitable.”

In Canada, the Countdown was released along with The Lancet Briefing for Canadian Policymakers,  authored by CAPE President-Elect, Dr. Courtney Howard, the Canadian Public Health Association (CPHA), and the Lancet Countdown team. The policy brief examines several Countdown indicators that are particularly relevant to Canada.  For example, it reports that annual weather-related disasters in Canada have increased by 44% from 1994-2000 to 2000-2013, and notes that these events have affected hundreds of thousands of Canadians, if not more.

Canadians Impacted by Extreme Weather

  • 2013, Calgary flood – 100,000 people affected
  • 2014, Manitoba flood – 6,900 people affected
  • 2014, Yellowknife, Northwest Territories wildfires – poor air quality from smoke
  • 2015, La Ronge, Saskatchewan wildfires – 13,000 evacuated
  • 2016, Fort McMurray, Alberta wildfires – 88,000 people evacuated
  • 2017, Williams Lake, British Columbia wildfires – 24,000 people evacuated
  • 2017, Calgary and Vancouver – poor air quality from wildfire smoke

The policy brief reports that to meet the Paris Agreement, and keep global temperatures from exceeding a 2°C increase, global greenhouse gas (GHG) emissions must be reduced to nearly zero by 2050.  This will require halving emissions every decade between now and then.

Several global policy priorities, which have the potential to produce immediate health benefits as well as long-term climate benefits, are discussed in the policy brief with Canadian data.  These include:

  • the need to replace coal-fired power plants with low to zero emitting sources by 2030;
  • the need to dramatically reduce the use of private motorized vehicles with public transit use, active modes of transportation, and telecommuting; and
  • the need to increase low-meat and plant-rich diets.

For more information, read the Lancet Briefing for Canadian Policymakers and see the CBC interview with CAPE President-Elect Dr. Courtney Howard.

Prepared by Kim Perrotta, Executive Director, CAPE, November 3, 2017

Other Blogs on this topic:

https://physiciansfortheenvironment.wordpress.com/2017/06/06/a-national-cycling-strategy-a-triple-win-for-public-health/

https://physiciansfortheenvironment.wordpress.com/2017/03/08/coal-plants-have-a-significant-impact-on-air-quality-and-health-incomplete-facts-dont-change-the-truth/

https://physiciansfortheenvironment.wordpress.com/2017/01/18/ontarios-coal-plant-phase-out-produced-many-health-and-environmental-benefits/

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Bloor Street West Bike Lane shows need for National Active Transportation Strategy

Last week, Toronto’s Public Works and Infrastructure Committee decided to maintain the Bloor Street West Bike Lane.  The bike lane was installed on Bloor Street from Shaw Street to Avenue Road as a pilot project for one year.  It was a watershed moment for bike lanes in Toronto because Bloor Street is one of the busiest streets in the city.  But the debate also exemplifies the desperate need for evidence-based direction from the federal government.

Before the installation of the Bloor Street West Bike Lane, this stretch of road was used by approximately 24,000 vehicles and 3,300 cyclists per each weekday, and recorded, on average, 22 collisions involving cyclists each year.  After the installation of the bike lane, cycling increased by 49% to 5,220 cyclists per week day, while the number of vehicle/cyclist conflicts was decreased by 61% (Toronto 2017).

City staff recommended maintaining the Bloor West Bike Lane on the basis of several evaluation studies which found that: a significant number of drivers, cyclists, and pedestrians felt the road was safer with the bike lane; driving time along this stretch increased by only 2 to 4 minutes respectively during peak times; customer spending increased among local businesses; and strong support for the bike lane was expressed by cyclists, pedestrians, local residents, and drivers who ride a bicycle on occasion (Toronto, 2017).

Sixty people and organizations were registered for deputations at this Committee meeting. Despite the positive results from the evaluation studies and the passion of the testimonies, two of the six councillors still voted against maintaining the Bloor West Bike Lane.  Councillor Holyday and Councillor Mammoliti were fixated on the cost of installing the bike lanes, the risk of slowing vehicular traffic, and the loss of parking spots.  It was frustrating and disheartening.

Bike lanes reduce injuries and deaths among cyclists.  They increase levels of physical activity, which reduces chronic diseases, deaths from cardiovascular disease and cancer, and health care costs.  Bikes emit no air pollutants and no greenhouse gases.  Bike lanes make jobs, services, and recreational opportunities more accessible to people who cannot drive and to those who cannot afford their own vehicles.  With so many health, environmental, and social benefits, why is it so difficult to get bike lanes installed?

We need to think  about bike lanes differently.  We have to think of them like sidewalks; essential infrastructure that protect people from vehicles while fostering healthy lifestyles.  We have to think of them like soccer fields and hockey arenas; community assets that promote physical activity and social cohesion.  We have to think of them like parks and greenspace; a land use use of land that improves air quality, mitigates climate change, and promotes mental health.

There is a role for the federal government to engage in this debate.  Chronic diseases cost Canada hundreds of billions of dollars each year in lost-time and health care costs.  Bike lanes are a public health priority; one that could be fostered and promoted with a national strategy that includes targets, design criteria, and policies.  Citizens need help getting municipal councillors on side.  The federal government needs to get health care costs under control.  It is time for a National Active Transportation Strategy.

Prepared by Kim Perrotta MHSc, Executive Director, CAPE, October 20, 2017

References:

Other Blogs on this topic:

CAPE helps take legal action against Minister McKenna over Volkswagen scandal

CAPE and Environmental Defence, with legal support from Ecojustice, are taking legal action against Federal Environment Minister McKenna, to force the federal government into investigating and punishing Volkswagen for their illegal importation and sales of emissions-cheating diesel vehicles in Canada.

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.

A National Cycling Strategy: A Triple Win for Public Health

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

Read more:

Canada Bike’s National Cycling Strategy

Prescribing Active Travel for Healthy People and a Healthy Planet: A Toolkit for Health Professionals

CEPA Review: A Chance to Reduce Human Suffering & Health Care Costs

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

Reference:

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.

Prescribing Active Travel for Healthy People and a Healthy Planet: A Toolkit for Health Professionals

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 toolkitPrescribing Active 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.

The toolkit and its various supporting documents can be found at https://cape.ca/active-travel-toolkit/

Prepared by Kim Perrotta, Executive Director, CAPE, March 20, 2017

Coal Plants have a Significant Impact on Air Quality and Health: Incomplete Facts Don’t Change the Truth

It is a sad statement of our times that in the middle of an important public health debate, the National Post has printed a commentary that muddies the water with incomplete facts and misleading information about coal plants, air pollution and human health (Warren Kindzierski, They keep saying shutting down coal will make us healthier, so how come there’s no evidence of it? February 24, 2017).

Coal Plants and Air Pollution

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