Hon. Stan Kutcher: Honourable senators, I rise today to speak to Senator Coyle’s inquiry on climate. I will focus on the impact of climate change on human health, and how health care systems could respond.

To begin, let us acknowledge the leadership and hard work that Senator Coyle has demonstrated in creating and advancing Senators for Climate Solutions.

Climate change is not only a threat to our global environment and economy, but it is also an existential threat to human health and our health care systems. In 2009, the medical journal The Lancet identified climate change as the most significant global health threat of the 21st century. These impacts are both direct and indirect. In terms of direct impacts, frequent extreme weather events, such as floods, hurricanes, heat waves and wildfires, impact both health and our ability to provide health care. Various water-borne diseases occur in flooded areas, and access to timely, critical care becomes extremely difficult due to damages to infrastructure, such as roads and bridges. Wildfires disrupt access to acute care sites, while concurrently increasing demand for care due to their impact on respiratory conditions. We are all aware of the impact of hurricanes on health care infrastructure, and how heat waves lead to increased deaths.

Perhaps less appreciated, however, is the indirect impact of climate change on the geographical spread of disease, or the emergence of new diseases — especially infectious diseases. For example, in my home province, there has been an increase in tick-borne infections that can lead to Lyme disease. This is due to an increase in the numbers and longevity of blacklegged ticks as a result of warmer winters. Their biting spreads the bacterium Borrelia burgdorferi, the cause of Lyme disease, resulting in increased numbers of people who have contracted the disease. According to the Canadian Public Health Association, this outcome — of indirect climate change impacts on human health — is driven by numerous complex changes in the pathways of disease transmission that are sensitive to climate changes. For example, the West Nile virus arrived in Ontario in 2013, and has since spread across that province.

I want us to be aware — now — of some of the nasty tick‑borne and mosquito-borne illnesses that seem to be spreading into Canada due to our changing climate. They have impressive names, such as human granulocytic anaplasmosis, babesiosis and La Crosse encephalitis. Trust me; none of us wants to have a severe case of any of these diseases, even if we could pronounce their names. Their impacts are most severely felt in populations that are already at risk of poor health, and face barriers to appropriate affordable housing, food security and quality health care. The impact of climate change will make those inequalities worse. Addressing this issue requires dealing with the social determinants of health, as well as undertaking actions needed to protect health care settings from severe weather events, such as moving them away from flood plains.

We need to be ready. There are two key areas where preparation within our health systems is needed now: These are treatment readiness and risks to health infrastructure.

The first area is treatment readiness. As we all remember, when COVID-19 arrived, we were not prepared. We had insufficient stockpiles of personal protective equipment; we had insufficient surge capacity in our emergency rooms and intensive care units; our surveillance, reporting and tracking systems were inadequate; we lacked national coordination in our response; and much more. This must not happen again. We need a coordinated national disease surveillance capacity with single-point national accountability. This includes a national health database that can provide real-time information to guide policy decisions, and help direct resources and interventions where and when they are needed.

We also need to be able to rapidly provide treatments that we expect may be required. For example, to treat many various tick‑vector bacterium diseases, effective antibiotic treatments are available; there are medications such as doxycycline, clindamycin and azithromycin. They are not exotic drugs; they are commonly used medications.

But as we have learned, we can’t expect that just because they are commonly used that they will be there when they are needed. We are now experiencing challenges obtaining other types of common medications, such as paediatric fever and pain medication. I recently went to Shoppers Drug Mart stores all over Ottawa to try to find specific medications for sinus congestion and found only empty shelves. We can’t let ourselves get into the same situation again.

In conjunction with this is the preparation of our health care providers. I know there are a number of excellent physicians in this chamber. I do wonder, however, how many of us, if faced with a person who presented with persistent and severe malaise, sweats, headaches, nausea and fatigue, would consider a diagnosis of babesiosis? If our basic workup identified the presence of a hemolytic anemia, which is a condition where red blood cells are being destroyed, we would certainly look at all possible causes, but we might not think of asking for a microscopic parasite analysis or ordering a babesia IFA antibody test.

To be clear, this is not pandemic preparation I am talking about. We might indeed experience pandemic disease outbreaks due to climate change, but we might more likely see a gradual increase in various types of infectious diseases. They will slowly sneak up on us unless we are keeping a close eye out.

In September 2020, The Lancet published “A pledge for planetary health to unite health professionals in the Anthropocene,” which proposed an interprofessional planetary health pledge. The pledge adds protecting planetary health to the fundamental commitments health practitioners make when they enter their profession.

Recognizing that, the Canadian Medical Association’s 2020 strategic plan mentions environmental well-being. The Canadian Federation of Medical Students, through its Health and Environment Adaptive Response Task Force, has been working on developing educational materials that could be embedded in medical curricula.

While much more needs to be done, initiatives across all of Canada’s medical schools are under way, and I am pleased to say that the Faculty of Medicine at Dalhousie University is one of the early leaders in this work.

I have great faith in our infectious disease colleagues. I know they are up to this challenge. I would also like to acknowledge and thank our colleague Senator Osler for her exemplary national work on this file.

I am hopeful that this necessary work will be done well and expeditiously.

The second is the risks to health infrastructure. Health infrastructure is something that many of us, especially in large urban areas, take for granted. The hospital? Yes, just down the road. Ambulance station? There is one about 15 minutes away. Drug store? There is one in the Rideau Centre.

Health care settings are subject to extreme weather events that can damage or destroy anything from roads, making it difficult to access a hospital in an emergency, to damage to ports and, thus, to the smooth functioning of the medical products supply chains. This reality raises the uncomfortable possibility that when this critical infrastructure is most needed, it can be unavailable.

Let’s take the issue of floods, for example. In a study of the impacts of floods on health infrastructure, it was noted that health care facilities faced both diminished capacity and increased demands. Regarding the recent floods in Bangladesh, UNICEF noted that:

The flooding damaged water points and sanitation facilities increasing risk of waterborne diseases . . . . Access to healthcare and nutrition services was reduced due to the damage of 90 per cent of health care facilities.

Closer to home, during the recent British Columbia floods, numerous patients had to be evacuated from hospitals and long‑term care facilities, and access to acute-care settings in flood‑ravaged areas became problematic.

A recent flood mapping exercise of Canadian health care centres at risk of flooding concluded:

There are a surprising number of facilities at risk of flooding in most provinces and territories. Manitoba and Yukon have the largest percentage at risk of flooding. . . . Yukon’s high percentage of facilities in the floodplain and small total number of facilities illustrate how weather-related disasters driven by climate change could disrupt and damage important health infrastructure when it is most needed.

So, in the face of our climate change reality, what is to be done? Thankfully, many things. We can consider opportunities for action in two complementary categories: developing environmentally sustainable health care facilities and creating climate-resilient health care facilities.

Health care systems account for about 4% of total global carbon emissions, and health care facilities can act to substantially reduce their carbon footprint. At COP 27, the World Economic Forum produced an article entitled “Here’s how healthcare can reduce its carbon footprint,” which addresses this important issue. For example, hospitals have the highest energy intensity of all publicly funded buildings and emit 2.5 times more greenhouse gases than commercial buildings. Therefore, switching from fossil fuels to renewable energy can have a major impact.

Other innovative solutions can also help.

Another direction is shifting outpatient care away from hospitals into more energy-efficient community settings and by increasing the use of high-quality virtual care with less environmental impact, such as home-based health monitoring systems and telehealth care. A secondary gain will be the avoidance of travel from home to hospital, thus decreasing the carbon footprint of transportation.

Health care facilities also need to become more climate resilient. In this domain, some good initiatives are under way. I will briefly touch upon a few of them here.

The World Health Organization has created the WHO Guidance for Climate Resilient and Environmentally Sustainable Health Care Facilities. More recently, the WHO report, Measuring the Climate Resilience of Health Systems, has provided substantial guidance on how to mitigate climate-change impacts on human health and health care.

Our federal government has created the Climate change and health vulnerability and adaptation assessments: Workbook for the Canadian health sector. This is designed to help health care facilities evaluate and then address their climate-change preparedness.

The Canadian Coalition for Green Health Care, in partnership with the Province of Nova Scotia, has created The Health Care Facility Climate Change Resiliency Toolkit that can be used by health care settings to assist them in their climate preparedness work.

As we can see, honourable senators, much work is being done, but much more is needed.

Canada’s health systems, collectively, have the third-largest per capita carbon footprint in the world. Our health care systems were responsible for about 5% of Canada’s annual greenhouse gas emissions prior to the pandemic. Per-capita GHG emissions in our health sector actually increased from 2018 to 2019.

In 2021, Canada committed to the WHO COP 26 Health Program initiative directions, which include building climate‑resilient health systems, developing low-carbon sustainable health systems, adaptation research for health, the inclusion of health priorities in nationally determined contributions and raising the voices of health professionals as advocates for stronger ambition on climate change. To those, I would add this: ensuring that our Indigenous, Inuit and Métis communities are fully integrated into the creation, development, deployment and evaluation of all the work that needs to be done.

We need a cohesive national initiative to set directions, coordinate efforts across jurisdictions and support legislation and implementation of sustainable changes to health systems. That will require collaboration amongst federal-provincial-territorial partners; input from Canadian expertise, such as Health Canada, the Public Health Agency of Canada, l’Institut national de santé publique du Québec, our universities and granting agencies; and international expertise, such as the WHO and the U.S. Centers for Disease Control and Prevention. The National Adaptation Strategy currently under way is an ideal place to address this need. We must not let this adaptation strategy get stranded on the rocks of inactivity.

This is a tall order — an existential challenge — but it is our challenge. As we Canadians have shown time and time again in our history, we are up to any challenge. Wela’lioq, thank you.