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Climate activists should focus on public health to inspire action

When we talk about climate change it can often seem like something abstract, or like something that our grandchildren will have to deal with.

According to the World Health Organization climate change is the biggest global health threat in the 21st century, and it’s not just being felt by people with breathing problems. climate change means more heat stress, more injuries from extreme weather; more prevalent diseases such as West Nile and Lyme disease - which is on the rise. So we are going to explore the link between climate change and public health in the present and in our future.

Piya Chattopadhyay: To start things off we're joined by Dr. Ryan Meili. He is a family physician and an assistant professor at the University of Saskatchewan's college of Medicine, where he heads the division of social accountability. He is also the founding director of Upstream — an organization that brings attention to political issues through public health. We often talk about climate change as an environmental issue — how it affects our environment. How big of a problem will this become for our health, though? 

Ryan Meili: Well as you mentioned, the World Health Organization, the Lancet — a number of large international groups have declared this the biggest threat to human health of the next century, the century we're in. We've seen a lot of progress in global health. This has the potential to undo much of that progress. Just given that it's the greatest risk, it also means it's the greatest opportunity. If we take serious climate action to improve global health and improve equity even further. 

Piya Chattopadhyay: So, you're a doctor, you see patients all the time. We've heard about how smoke is exacerbating asthma. At the ground level, what other ways can we expect climate change to directly impact our health? 

Ryan Meili: We saw very similar things among patients here in Saskatchewan as we had the wildfires in recent weeks. One of my patients had very severe worsening of his COPD — difficulty breathing — we're likely to see lots of respiratory and cardiovascular illness — either from that exposure to smoke or the increased allergens and pollens that are released during heat waves. The heat stress itself can cause all kinds of illness, in particular exacerbating respiratory and cardiovascular illness. But then there are other types of illness such as injury when you have these extreme weather events such as hurricanes, et cetera, that can cause physical injury as well as emotional traumas. People see their homes and surrounding environment destroyed. And then there's infectious disease. 

Piya Chattopadhyay: When we talk about public health we often talk about infectious diseases... so how might they be impacted? 

Ryan Meili: You mentioned off the bat Lyme disease, West Nile virus — those are things we never used to see. I was taught in medical school that Lyme disease didn't exist in SK and now we see cases of it rather frequently. There's also the risk of water borne illnesses as you get floods and the possibility of mixing sewage lagoons with drinking water sources and in other parts of the world, changes in water mean outbreaks in cholera, changes in the distribution of malaria — all kinds of infectious diseases that could affect us. 

Piya Chattopadhyay: So when we look globally, which parts of the world are going to be hit hardest by these kinds of health impacts? 

Ryan Meili: It's been pretty well described that the places that will be hit the hardest are remote regions and marginalized people — people living in poverty — as well as the elderly, the very young, and the chronically ill. When we talk about Canada that means the North is going to be particularly affected as we've see again with the wildfires here — people in Northern Saskatchewan bearing the brunt of that. Courtney Howard one of my physician colleagues working in Yellowknife says there's no such thing as a climate change denier north of 60° as they're already seeing the effects there so clearly. That really compounds the health effects, because these are already populations dealing with higher levels of poverty and associated illness, so the climate change effects will just have even worse effects on their health outcomes. 

Piya Chattopadhyay: You got intimately involved in this work back in 2010 when you were in the Philippines you were working there. What kind of climate change health issues did you see there?

Ryan Meili: They'd had a recent typhoon and we were seeing people who had lost their homes in the typhoon and they were living in places where they didn't have access to clean water as a result, so we were seeing lots of diarrheal illnesses, et cetera, and we were also seeing as a result the way that the health system was set up there, there was a lot of private care, and not a great public system, so people were requiring greater medical attention, and not having the systems to set them up. So we have to think about what are the stresses that this will put on a public health system.

Piya Chattopadhyay: We contacted HC to ask them about that. They did send us a comment "the Public Health Agency of Canada is preparing to address potential health effects caused by climate change in much the same way that it prepares for the possibilities of bioterrorism and pandemic influenza. It does this by gathering information about the links between climate change and human health and creating strategies to prevent and adapt to threats". So Dr. Meili, from where you stand, as our health agency, do you think they're doing enough to prepare for the health effects of climate change? 

Ryan Meili: Health Canada does actually use some pretty clear language and talk about climate change as a real health issue and health risk and talk about the different ways it can harm us. However, when it comes to action, the actions page on their website is archived to 2013. There’s no updated information on what's being done, and certainly as a physician on the front lines, we're not seeing communication about this. The way we see communication about Ebola, and influenza or other threats - lots and lots of information coming to us — this the #1 health issue facing the world — we don't get any communication about this. 

Piya Chattopadhyay: What more would you like? Guidance? 

Ryan Meili: Yeah, some more guidance, and some more information on how to be prepared for these heat waves, or the results of forest fires. I think that would be really helpful. But then there's also the reality that some response from health Canada is important but it's not really their job, or the Public Health Agency of Canada's job. Many of the changes that are needed are really structural — infrastructure, Ag policy, changing industry policy to have action on climate change, which to me points to the need for a Health in all Policies approach. Moving beyond the silos where you can have Health Canada really clear on climate change and other ministries doing nothing, or taking us in a worse direction. We need to actually be addressing the question, what is the core mission of government if it's not to improve the health and well-being of the population? So having that Health in all Policies framework could actually use public health's leverage to create real momentum for change.

Piya Chattopadhyay: As you call for better policy, you're also on a regular basis seeing patients who come in and say, 'I'm having this', and you as their physician say, 'Listen, this is connected to climate change'. How is that message received — how are we doing at educating the public from people like you — the front lines? 

Ryan Meili: I think more and more people understand this — as your guest off the top was noting — this is starting to come home to people. But I feel like that's what we need to do more of, is actually tell those stories. Because we're human beings — we respond to story. Taking this abstract concept — the amount of PM2.5 particles in the air that can affect our health — maybe people will understand that a little bit, but when they hear the story of somebody watching their daughter struggling for air in the emergency room because the smoke in the air has made their asthma way worse, it brings it home, it makes it personal. Health is something as Canadians we care a lot about — healthcare always at the top of the list of what's important in polls — that's a good surrogate for how important health is and it points to a role for Health Canada, Public Health Agency of Canada, and care providers like me to be telling those stories so that we can actually be inspiring change among the public and among policy makers.




Ryan-Meili.jpegRyan Meili is founder and Executive Director of Upstream, a Family Doctor, author of A Healthy Society: How a Focus on Health can revive Canadian Democracy and Assistant Professor at the University of Saskatchewan. Ryan also serves as vice-chair of the national advocacy organization Canadian Doctors for Medicare, is a Broadbent Institute Fellow and an Evidence Network Expert.


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