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#72 Burning Up: The Health Impacts of Climate Change

Dr. Edward Xie is an Emergency Physician and Clinician Investigator at University Health Network, Assistant Professor at the University of Toronto, and Board Member of Canadian Association of Physicians for the Environment (CAPE).

January 15, 2020

Climate change has been called the defining issue of our time. Its scope, complexity, and impact pose an enormous challenge to humanity. Political, economic, ecological, agricultural, and health systems are already being affected in unprecedented ways. In this episode, we sat down with climate experts and activists to discuss these issues. First, we heard from George Kourounis, renowned global adventurer, storm chaser, and host of Angry Planet, who clarified the difference between climate and weather, and described the impacts of climate change we're already feeling. Next, we listened in on a talk by Gideon Forman, a Policy Analyst at the David Suzuki Foundation and former Executive Director of the Canadian Association of Physicians for the Environment (CAPE). He discussed the magnitude of climate change in the context of health. Dr. Chung-Wai Chow, a lung transplant physician and leading research scientist at the University Health Network, whom we heard from in episode 38, elaborated on the effects of wildfires and pollution on respiratory health, based on her research in Fort McMurray. You'll also hear from Dr. Edward Xie and learn more about how other vulnerable populations are being impacted by climate change, from Indigenous communities in Canada to climate refugees across the globe. Dr Xie helped us understand how increased flooding, droughts, and spread of infectious diseases are further stressing fragile health systems based on his work as an emergency and family physician at the University of Toronto and board member of CAPE. While the situation is serious, there's much we can do to help fight climate change, from personal lifestyle changes to community activism to international accountability. Along with our other guests, Carol Devine, Humanitarian Advisor for Doctors Without Borders and Community Scholar in the Dahdaleh Institute for Global Health Research at York University, shared her insights and recommendations on how we can tackle the climate challenge together.

Written by: Stephanie Nishi

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TEA: Toronto Environmental Alliance
CAPE: Canadian Association of Physicians for the Environment
CAPE Toolkit for Health Professionals
David Suzuki Foundation
Angry Planet, with George Kourounis
A crisis in the making: MSF and the global health impact of climate change (Article)
Lancet Climate Change Countdown 2019 Report
Meatless Mondays
Climate-induced migration and displacement: closing the policy gap
The UN Refugee Agency: The 1951 Convention

Yagnesh Ladumor [0:00] Hey listeners, we want to hear from you. So don't forget to fill out our listener survey. And if you do, you can enter our giveaway to win a Muse headset, or one of three $50 gift cards to RYU apparel. You can find the link to the survey in the show notes or on any of our social media accounts.

Greta Thunberg [0:17] We are right now in the beginning of a climate and ecological crisis. And we need to call it what it is: an emergency.

News Anchors [0:30] The Amazon Rainforest is burning at record rates. New Delhi air pollution is putting the health of millions of people at risk there. ...cyclone that has swept across Southern Africa... Kerala for a second consecutive year is battling floods in some districts... Hurricane Dorian devastated the Bahamas... What we are witnessing right now, in the form of these unprecedented bushfires in Australia, is the impact of human caused climate change.

Al Gore [0:57] I am extremely optimistic. As I said before, we are going to win this. When any great moral challenge is ultimately resolved into a binary choice between what is right and what is wrong, the outcome is foreordained, because of who we are as human beings. 99% of us, that is where we are now, and it is why we are going to win this. We have everything we need. Some still doubt that we have the will to act, but I say the will to act is itself a renewable resource.

Jesse Knight [1:32] Climate change, perhaps the greatest challenge humanity has ever faced, and an enormously complex issue. Politics, economics, ecology, chemistry, fluid dynamics - the climate models literally take weeks run on our most advanced supercomputers. In this episode of Raw Talk Podcast, we take a look at some of the impacts of climate change on human health, from forest fires in Canada and Australia, to hurricanes in Puerto Rico, and droughts in South Sudan. It's a serious situation, and it can be heavy to confront the realities of, but we'll also talk about some of the solutions, and some of the progress we've made so far, including some of the things you can do right now to help fight climate change. I'm Jesse,

Yagnesh Ladumor [2:09] and I'm Yagnesh,

Jesse Knight [2:11] and welcome to Episode 72 of Raw Talk.

Yagnesh Ladumor [2:22] First off, we sat down with explorer, adventure, and storm chaser George Kourounis. To help us understand the state of the crisis and a little bit about climate science.

George Kourounis [2:31] I'm George Kourounis, I'm a Explorer in Residence for the Royal Canadian Geographical Society, and my job is to basically travel the world and document the most extreme forces of nature and wild weather. Anytime like Mother Nature is angry and, and wants to harm you. I'm usually there with a camera rolling in some capacity, documenting it, so that we can, so that we can see how bad bad really is.

Yagnesh Ladumor [2:56] So it's January in Toronto, minus five, snow on the ground. A lot of people might be thinking, well, it's not that bad. But what's really happening is people are confusing climate and weather. We'll let George explain.

George Kourounis [3:10] Here's the thing. people confuse weather and climate all the time. They'll say, "Oh, it's, it's cold today. All you climate change, people don't know what you're talking about." No, it's you that don't know what you're talking about. Because, sort of the way I like to describe it is, weather is what you get, whereas climate is what you expect. And think of each day or each storm or each weather event as a single pixel. Right? That pixel doesn't show you the whole picture, you have to step back and all these individual pixels together start to tell you the big picture of what's really going on. What we're, what we're able to do now, is because we have all this data over a long period of time, we can now say, "Okay, this Cyclone, wherever this, this hurricane, was likely 20 or maybe 30% worse than it would have been due to climate change." So you can never pinpoint one particular event and say that was caused by climate change, right? But you can look, like you said, look at that bigger picture and say, okay, we're seeing more of these forest fires, we're seeing more of these droughts in these places, we're seeing more floods in these places that are uncharacteristic. Venice, just the other day, or just, whatever, a week or so ago, had some of the worst flooding in 40 or 50 years, right? That was an event, that was one pixel, right? But, these one in 50 year events are now becoming one in five year events. So it's the ends of the bell curve. The extreme events at the very, very end, they're becoming normalized so the normal is changing.

Yagnesh Ladumor [4:42] We also heard from Gideon Forman, Policy Analyst at the David Suzuki Foundation, and former Executive Director of Canadian Association of Physicians for the Environment. Gideon recently gave a talk to a group of medical students at U of T, discussing the magnitude of climate change in the context of health.

Gideon Forman [5:00] The climate modeling suggests very significant rise in ocean levels as the glaciers melt. Now in the Antarctic as you know, there are massive, massive glaciers, and if they crumble, the scientists are predicting a very significant increase in ocean levels. This is from a few months back in Scientific American, where the prediction is over three meters. Now that is at the extreme end and it could be less than that, it depends on the massive glaciers crumbling, but this is the gives you some sense of the order of magnitude that the scientists are thinking in terms of if those glaciers go. And you can imagine the impacts on our, on our coastal cities with flooding in that at that range. Whether it's a Halifax, a Vancouver, bigger cities like New York, or London, or Cape Town, or Miami. And of course with the flooding comes typically things like sewer backups, and with the obvious health effects connected to that. So a very clear nexus between flooding and health impacts.

Yagnesh Ladumor [5:59] Rising ocean levels are a key part of climate change. And we often hear about, or think of the impacts on major cities. But what are some less discussed impacts? We asked George.

George Kourounis [6:09] Yeah, here's a, here's a great example that I never have. I can talk about examples of this all day long, but I was in the island nation of Tuvalu. It's one of the least visited countries on planet Earth. They have one runway. There's two flights that arrive every week, one on Tuesday, and another one on Thursday. That's it. From Fiji. And it's a very low lying island nation. And when I was there, I talked to some of the government officials and they were literally genuinely concerned about the need to have to relocate their entire population, move the country because of sea level rise. And you don't have to have the sea level rise so much that it covers the entire island. It only has to get high enough so that it pollutes the drinking water supply. And basically they're worried about their water supply and food security because the salt water inundates their crops and they already depend on like too much imported food as it is. So they're living on this precarious balance right now. And they're not the only ones. There's Tuvalu, there's Kiribati, there's parts of Fiji, these very low lying islands, Maldives. And these islanders don't contribute to greenhouse gas emissions very much. But these people are the ones who are on the front lines. So thousands of miles away from all of these coal burning plants and the crowded streets of Beijing or Los Angeles, we're all these cars are burning up their fuel. There's these islanders who are genuinely concerned that they're going to have to leave their country and never ever go back. And the same thing is happening in places like Bangladesh. In southern Bangladesh, we met with people that are leaving because they would point out to the ocean and say that's where my farm used to be. It's just eroding into the sea. Every year, half a million people are relocating to the capital of Dhaka. We have climate change refugees right now. And thousands, and thousands, and thousands of them. They're just happening in places you don't hear about.

Yagnesh Ladumor [8:09] In addition to climate change impacting humans, there's also tremendous impact on ocean wildlife.

George Kourounis [8:15] So I've been diving in lots of places all over the world, including the Great Barrier Reef. And it is appalling to see what has happened there. And it comes down to quite a few different factors, mismanagement of tourism, there's been pollutants and runoff, agricultural runoff has been poisoning the corals, the sea temperatures going up is one thing. They have a very narrow range of temperatures where they're able to survive the coral and the associated life forms that live amongst the coral. But also, with all this carbon dioxide going into the atmosphere, a lot of it is being absorbed by the ocean. And when you add carbon dioxide to water, you create carbonic acid. And what's happening is the pH level of the ocean is dropping, so it's getting more acidic. That is a big contributor to coral bleaching. And it's hard to find a pristine coral reef anywhere on planet Earth. Like the Great Barrier Reef has lost somewhere in the order of half of its coral, if not more. Like it is appalling what has been going on. I don't want to scare people and say that we're that we're doomed, but what I do want, the point I do want to get across is that this requires urgent attention.

Yagnesh Ladumor [9:25] Another highly visible aspect of climate change is an increasing number and intensity of forest fires across the world, as we've seen with Australia and California. Occasionally, fires are a natural occurrence, and an important part of forests health. They redistribute nutrients and clear clutter to improve fertility of the soil. However, they can also be extremely damaging to ecosystems, as George tells us.

Yagnesh Ladumor [9:49] Could you talk about forest fires and how they're impacted by climate change?

George Kourounis [9:53] Right now we have tremendous forest fires in Australia. This past fire season in California was absolutely devastating, as was the year before, as was the year before that. So California burns every year, it seems, and the fire seasons are getting longer. One big problem that we're seeing, and we're predicting is going to get worse, is the movement of the jet stream in North America. So the jet stream is a high altitude river of air. And that's why it takes you less time to fly from California to New York than it does to fly from New York to California, because that high altitude river of air is flowing from west to east. But it's not a straight line, it undulates and dips up and down. When we have the polar vortex, that dreaded polar vortex, that's a dip in that jet stream that pulls all this cold air down from the Arctic. Well, as it raises and dips, it also can cause these droughts in places, these these really intense heat waves as well. So it's pulling this air up from from the equator. And in California, when you get hot, dry air, what does it do to all the foliage? Dries it out, turns it into a tinderbox, right. And over the past decade or so, California has been having these terrible, terrible droughts. Not a lot of rain, lots of heat, you get the Santa Ana winds, which are these very particular winds that you get in California that are very hot and very dry. And they are like taking a leaf blower to your campfire. Like it's just just pumping energy into it, right. So I really expect there to be more of these fires in places where we're seeing them now in Australia, in Alberta, in BC, and California as well, in particular.

Yagnesh Ladumor [11:41] Forest fires, droughts, flooding, and extreme weather. These are some of the most devastating impacts predicted by leading climate scientists and models. What's worse, many of these effects contribute to positive feedback loops, accelerating climate change and making it harder to stop. For example, burning trees releases more carbon dioxide, while melting permafrost releases methane into the atmosphere. And as sea ice melts in the Arctic, the white of the ice and snow is being replaced by the blue of the ocean. It turns out, that color changes significant, since the white ice tends to reflect sunlight back into space, while the deep blue ocean tends to absorb heat.

Jesse Knight [12:18] Clearly, the impacts of climate change on our environment are already serious. But both Gideon and George have also suggested that climate change could have major impacts on human health. In fact, the Lancet academic journal and the World Health Organization have both described climate change as "the greatest global threat to health in the 21st century". Next we'll look at some of the reasons why.

Jesse Knight [12:38] We heard from Dr. Chung-Wai Chow in Episode 38, where she discussed the effects of air pollution on respiratory health. Dr. Chow and her team have been studying the health impacts of the 2016 Fort McMurray wildfires a remote community in Alberta, Canada. We're excited to welcome back Dr. Chow and learn more about what she's discovered about the impacts of forest fires on respiratory health.

Dr. Chung-Wai Chow [12:57] So when we last spoke I had just begun the study in Fort McMurray. For the listeners who may not be aware, you know, Fort McMurray is 450 kilometers north of Edmonton. It is a town of about 80,000 people, and there are really no other communities around. So when you drive south of Fort McMurray as you go past the Fort McMurray airport, the road sign says that there is no service for the next 350 kilometers. So it's very remote. And so my research was focused on measuring lung function, doing health surveys and then collecting bio samples from participants. The specific research question that we wanted to answer was, what was the prevalence of abnormal lung function, post fires, and whether or not this changes over time? And the second question that we wanted to ask was, you know, could we correlate this with specific biomarkers in the blood and urine. The symptoms that most people complain of are cough and increase in sputum production, but it's been clearly shown that there is an increased risk of developing asthma or exacerbation of asthma and COPD as a result of the wildfires and wldfire smoke.

Jesse Knight [14:16] Dr. Chow explained that forest fires are not isolated events and affect both local and surrounding areas.

Dr. Chung-Wai Chow [14:21] The air knows no borders and the pollutants that come from one geographic region go to the other. The Fort McMurray fires began in northern Alberta, but then several weeks downstream, there was clearly an increase in respiratory symptoms and hospitalizations and hospital visits that actually affected the eastern seaboard. And so the fires that begin in one area will track downwind and will directly affect those people and communities that live there. And forest fires that are now occurring in Sydney, Australia probably will affect downstream as the air moves and circulates to regions of the world far away. And I think what has also changed in the last couple of years is a realization that forest fires is not an isolated problem, that it only affects very specific regions of the world. But in the last couple of years, and particularly in the summer of 2019, we have seen huge forest fires in many parts of the world where it has impacted communities. I mean, forest fires are in many respects, part of a natural ecological evolution, but I think what has changed in the last couple of years is the fact that forest fires are occurring in communities where people live. And it is very much affecting not just the members of that community but also the health and the economy of those regions. And I hope that it is dawning onto people that we share the global air.

Jesse Knight [15:59] Dr. Chow's work is still ongoing. Her plan is to continue follow up with the individuals who've enrolled in her work over the next two years and continue her efforts to engage the community at Fort McMurray. Although this work is still in the early stages, we asked Dr. Chow what types of impacts she expects this research will have.

Dr. Chung-Wai Chow [16:15] I think that there is a lot of this information that can be used for communities, particularly to communities that are very prone to wildfires and to recurrent wildfires, in terms of how do you mitigate some of these changes, when do you decide that we should have school closures, when do you put out advisories for people to stay indoors. But I think what I hope that this will do is it will actually allow policymakers to look at how communities are built, how close can we allow communities to be built, and housing to be built into into a forested regions, and how do we mitigate some of the changes. The other thing that I hope that will help, and this is not within my area, but I think that the big difference in Fort McMurray was that it wasn't just wildfires, it wasn't just a forest, but there was a huge amount of buildings and structures that were burnt. And that, you know, this may allow people to think about the different types of building materials that are used in areas that are fire prone. But in terms of the results for my study, which is looking at lung function, I think that, what I hope is, that once we publish this is that it allows people to, on a very individual basis, look at their own risk, looking at their, you know, what are their risks of lung disease or that if you have actually had lung disease, asthma, or allergies, that you may think a little bit about how you can sort of mitigate that.

Jesse Knight [17:51] We also spoke with Dr. Edward Xie, an emergency and family physician at the University of Toronto and a board member of CAPE: Canadian Association of Physicians for Environment.

Dr. Edward Xie [18:01] My name is Edward Xie, I work part time as an emergency doctor at University Health Network, and I'm also an Assistant Professor at University of Toronto in the Department of Family and Community Medicine. Most of my work centers around, or at least the academic work, centers and health equity and structural determinants of health.

Jesse Knight [18:16] We asked Dr. Xie if climate change had begun to impact any of his patients here in Canada.

Dr. Edward Xie [18:20] Yeah, so this is one of the questions I get asked most often, which is my own personal opinion as as a health care provider. And it's a bit tricky to answer. You know, there is this strange dichotomy between very large, slow onset, global scale weather pattern changes, and you know, what we see day to day. So, you know, from what I see in the emergency department, I can say that there are certain health outcomes that are going to become more likely, but whether anything in particular I can attribute to climate change is much more difficult to say. So like, one of the stories that really stands out for me is, you know, last summer during one of the heat waves, we had an elderly woman come in and she had actually collapsed at home due to heat exhaustion. When she came into the hospital, she was really struggling to breathe. And there were a lot of contributing factors to that. So part of it was, she was, you know, had lower income, she was elderly, so she had a fixed income. She couldn't afford air conditioning. She also had some chronic diseases. So she was, you know, had difficulty getting out of the home had some social isolation. So it was hard for her to move about, to seek cooling centers, or to go see her family doctor to get care when she was feeling worse. And so she ended up in dire straits because of the high heat and also contributing to our medical conditions. So this is one of the main reasons I became interested in climate change. And it came out of this interest in in trying to help marginalized and disadvantaged populations to improve their health outcomes. We know that for example, elderly people are more susceptible to heat, especially in Canada. There was a devastating heat wave in Quebec quite recently, and there were dozens of people who had premature deaths related to that. We also know that children are more vulnerable, just because of their physiology, and they may be in situations where they're not able to protect themselves.

Dr. Edward Xie [20:10] There are, you know, in terms of looking at global health issues, there are themes that are cross cutting across the entire world, including areas of Canada. And one of the main ones that I touched on a little bit earlier, was poverty. And so, you know, the patient in my case had a fixed income, they couldn't afford air conditioning. It wasn't an option to them. And that's, that's a major factor in people not being able to adapt to climate change. And I would say that there are a lot of communities in Canada that are resource poor in terms of financial resources, for example, but they are resource rich in terms of human resources and human potential. And that's making me think of Indigenous communities in Canada, who will be disproportionately affected and that that also goes Indigenous populations everywhere. There was actually a United Nations report on Indigenous issues that examine this and how dispossession of lands for example, and institutional and structural barriers are causing greater effects on Indigenous people. So I would say that they're not inherently vulnerable, they've actually been extremely resilient to not only climate change, but also a lot of the structural violence that's happened, but they, because of the position that a lot of people have been put in, they are more sensitive, they have had a lot of their ability to adapt taken away from them. So I would say I guess you know, they are resource rich in offering a lot of things for people to learn and I certainly have a lot to learn myself. You know, one of the best examples I have is I guess that we are on Dish With One Spoon territory. And so, you know, this this treaty between Anishinaabe and Haudenosaunee and Mississauga peoples was built around this idea that actually aligns really well with sustainable development. That, you know, we are here to share the land, and we need to be able to protect it so that future generations can thrive. And I think those are really important lessons that come from marginalized groups.

Jesse Knight [22:17] Dr. Xie also described how vulnerable groups may be disproportionately impacted in their ability to access health care.

Dr. Edward Xie [22:23] Some of the effects we're expecting in Canada are drier summers, which could contribute to more droughts and forest fires. But also, again, paradoxically, we may see wetter winters and springs and warmer temperatures that cause floods. So on the one hand, more fires, on the other hand, also more floods. And those can endanger, obviously, you know, large populations across Canada, but also their access to health systems. You know, one of the the examples that I've heard is in a northern community where their access to health care is actually dependent on ice roads. And when those are melting or the the ice conditions are uncertain, it makes it much more difficult to access health care. And we are also, for example, seeing that in areas where there's large scale flooding, it can be more difficult to access health care, it can lead to more health issues related to the flooding itself, like water and food contamination. And it reduces the resiliency of our health infrastructure if there's potentially damaging storms. And it makes it harder for hospitals, for example, to keep themselves open. So if there is a major storm that cuts off electricity, hospitals then have to rely on generators to keep the electricity going. And if you know a hospital needs more electricity, using the generator is less efficient. And so there are many different effects on the health system, not just within Canada but also otherwise. We know that the the Canadian health system relies a lot on resources that come from other parts of the world. So a lot of our medicines, for example, come from other parts of the world. You know, one of the examples where we saw that there was a global impact that was felt locally was with Hurricane Maria, which happened a couple years ago. Hurricane Maria was an extremely intense storm. It hit Puerto Rico, where there was a major facility that produced saline. And in the weeks following that, there was actually a saline shortage across North America. And that was felt in many hospitals across Canada. And it's one of these things where, you know, we can't say climate change cause that. We can say that the types of storms that that cause this problem are going to be more likely because of climate change. And so we may have issues related to supply chain. I'm interested in these structural determinants of health. And they said that climate change threatens to undo the last 50 years of progress that we've made in development, poverty and global health. And so this, you know, people think of it as an environmental issue, but it is extremely pervasive in our lives. You know, as I've talked about, it affects food prices, it can affect national security in terms of conflict, it can affect our health, obviously, as well, and so it will touch on every aspect of our lives.

Jesse Knight [25:24] Gideon Forman, from the David Suzuki foundation, further describe the impacts of climate change on larger economic and human systems.

Gideon Forman [25:31] Lesser known in terms of health impacts is the loss of productivity. The Lancet had an article in December of last year where they estimated the number of hours in 2017 lost to productivity because of the climate crisis, and they came up with this number that I still find staggering: 150 billion hours in lost productivity in 2017 alone. This is days when the scientists estimated that people weren't able to go outside because of the heat. Most of those hours lost, were in the south, the global south, and many of them in agriculture. You can imagine the impact on our ability to feed ourselves if the heat is so severe that people are not able to go outside to plant crops or to harvest them. So the loss in productivity is also a health impact. It's a lesser known one, but also one that we need to be mindful of to understand this crisis. The other aspect of climate change, or the climate crisis, as we call it now, is that it's also a humanitarian challenge. And the scientists have been saying this for a number of years now, because of climate crisis, people are going to be on the move from things like flooding and drought, and many of them will become refugees. And so it could become the defining or most significant humanitarian challenge of the 21st century because of the refugees that it produces.

Jesse Knight [26:52] Back to Dr. Xie, who's also worked as a physician with Médecins Sans Frontières, or Doctors Without Borders. We asked him whether he'd witnessed any first hand effects of climate change as part of his work around the world.

Dr. Edward Xie [27:03] So when I was working with Doctors Without Borders, it was in a conflict zone. And you know, obviously the the medicine itself was heartbreaking. Like it was a population that was war torn, didn't have health care access for a long time. The hospital that I'd been working in had been damaged in the fighting, and didn't have regular medical staff. So Doctors Without Borders was trying to rehabilitate the hospital and build trust with the local population. And one of the contributors that came out of some evidence, some research that was done around that conflict was that there was a severe drought, one of the worst ones for a very long time. And it led to crop failures. And that led to large scale population migration in the in the country and then to political unrest and then conflict. So in that case, you know, climate change could have been one of the contributing factors to it.

Jesse Knight [27:56] He also described the complexities involved for refugee camps created because of changes in climate.

Dr. Edward Xie [28:01] It's a, it's a complex issue. So I'll try to pick apart some of the pieces. I have not personally worked in one. I was working close to one. So we would see refugees every once in a while. And I guess the first thing I would say is, you know, one of the reasons why it's a complex issue is that climate induced migration is not covered under most of the the international conventions on on the rights of refugees. So the 1951 convention, for example, and some of the protocols that came afterwards, don't recognize this type of threat in terms of climate. So there are potentially fewer protections for people who are forced to leave because of climate changes. The second thing is, you know, the reason why we have camps to begin with, you know, part of the reason is for protection of people to have people in one place where they can be provided services, where there can be enhanced security, but one of the issues with with having camps, or one of the reasons why there are overcrowded camps is that we don't have these international mechanisms in place, such as conventions that allow movement of climate migrants, but also that we we don't allow free movement of refugees. We don't have great systems of helping to integrate refugees into host populations, and ways of allowing people who are refugees to easily gain livelihoods in the places that they end up. And so all of those factors contribute. And also we are going to run into this question more and more in the coming years because there are large areas of the world that will be affected by extreme weather events, mainly in terms of droughts, in terms of coastal flooding, in terms of more severe storms, that could send many more people into situations where they are forced to flee or they're, pushed into situations where they've lost their homes or livelihoods and they need to move.

Yagnesh Ladumor [30:05] Climate change is expected to exacerbate a number of existing vulnerabilities on a global scale, especially security of income, housing and food. But what about disease? The World Health Organization has reported recent rises and infectious diseases worldwide despite major advances in our treatment and prevention technologies. This is due to a combination of rapid changes in demographics, social and environmental factors, including climate change. Gideon tells us more about how this works.

Gideon Forman [30:33] The chance of those microbes, those dangerous microbe surviving is greater because of the because of the temperature being hotter. Health impacts from mosquitoes and ticks: the mosquitoes and ticks are becoming something of a poster child for the health impacts of climate change. You've probably seen these before, but the models do suggest with more grassland in Canada and greater heat we're more likely to see mosquito populations increasing and with that increases in West Nile. And of course, with the black legged tick now better able to survive our winters we're more likely to see increased Lyme disease. I gave a talk just last week actually the University of Ottawa medical school chatting with some doctors there, and they were saying until recently, they hadn't seen Lyme disease at all in Canada. So it's really quite a new phenomenon. The trajectory the vector, of course, is the is the black legged tick, and our winters used to be more punishing, they're now warmer, more moderate. And so the tick is more able to survive our winters,

Yagnesh Ladumor [31:32] Dr. Shear spoke more about how Canada is being impacted.

Dr. Edward Xie [31:35] So speaking from a Canadian perspective, there are certain disease vectors that are climate sensitive, and by that I mean some of the changes that are going to happen with climate change are going to make Canada more favorable or more suitable for them. So Lyme disease would be a big one. The black legged tick, it has a hard time surviving cold winters, but as Canada warms more and more we know that Canada is already warming twice as fast as the global average, we know that that tick that its territory can move north by about 50 kilometers a year. So we're starting to see in the last several years that the number of Lyme disease cases has increased several fold. And that's because the the conditions for them to survive are much better. It's actually a problem in a lot of Canada, Ontario is one of the worst affected. Also Nova Scotia has a large tick problem. We also are seeing more mosquito vectors in Canada. And in the last few years for the first time there's a mosquito that can transmit dengue and Zika and chikungunya, and it's being detected in Canada in Windsor as one of the southernmost points. So it's a major concern in Canada because we're going to potentially be exposed to diseases that we haven't been before. In the rest of the world, it's a huge problem, especially for lower middle income countries that have health systems that have yet to be strengthened. We will see potentially hundreds of millions of people exposed to dengue, we are potentially going to see also millions of people who will be exposed to malaria in areas where there wasn't malaria before. So for example, areas at high altitude where the mosquito generally wouldn't be able to survive we're seeing that the mosquito territory also spread as well.

Yagnesh Ladumor [33:32] Could you tell us a little more about how those mosquito ranges are affected?

Dr. Edward Xie [33:36] I'm gonna just qualify that by saying I'm certainly not an expert in this. So the reason why they might be able to spread more is that the mosquito territory expands. So some of the conditions that make it easier for the mosquito to grow and breed are warmer temperatures, higher humidity, and so we're seeing in certain parts of the world that the weather conditions are becoming more suitable for them. So we know that below certain temperatures, the mosquitoes really are not very active, or it's harder for the virus to replicate. So that's one of the reasons. The other reason is an interaction with human behavior and the way human systems works. So, if you know this is this is almost a contrary example, or it's paradoxical in that if you have a region with drought, and you no longer, for example, have piped water sources, people are more likely to store water in containers. And, if those containers are open, they become mosquito breeding grounds.

Jesse Knight [34:38] Okay, that's it for the doom and gloom. Hopefully, it's not overwhelming, but motivating. Next, we'll look at some of the ways we as individuals and health practitioners can help the fight against climate change.

Dr. Edward Xie [34:50] This can be it can be anxiety provoking for people you know. There's this term I've heard of climate paralysis where the scale of the problem can be it can be be so big that it's hard to know what to do. And that's where I really liked your question about focusing on, you know, some personal things that that we can do to make an impact. And I'm going to reframe it a little bit as well, because, you know, sometimes there can be a bit too much of a focus on personal responsibility. And we do offer personal responsibility, but we also have to put that in the context of these structural factors that really mold our architecture of choice. And we have to look at both so personally, what I would say is, and this is work that's actually been done through the Government of Ontario, they looked at what was the biggest carbon footprint for Ontarians. And they found it was four things. Let me see if I can remember them. So I think the first one was driving, it was transportation that way, there was also flying, household heating, and meat based diets. And so those four things made up more than half of the contribution, like the carbon footprint of Ontarians. And so I would say, you know, for people looking to make a big impact, those would be the four that I would target. So, you know, eating a healthier diet, so having less meat in the diet would be something that people could do and something that I've done myself. And then in terms of transportation, looking at what trips can be avoided. And so I found that there was a lot of travel that was something that I didn't need to do. So for example, I personally found that it was much easier to rent a car when I needed a car rather than owning one. So I don't own a car, but that is that's a choice that can be more difficult for people, for example, in rural communities where there are long distances to get around. So I would say in those cases, it's not a hard and fast rule, for example, but to cut out the trips that are not necessary, and that includes flying as well. You know, I am actually reflecting on something I read recently in Healthy Debate, and I believe this was Andreas Laupacis, who wrote about this culture and academia of flying to go to international conferences. And this is seen as something that's very prestigious and it leads to academic advancement, that you're able to go speak or attend an international conference. And unfortunately, you know, all this flying around contributes quite a bit to some of the problems that we're trying to solve in terms of health and global health. And so we need to look at ways that we can connect with with each other that don't require consuming more fossil fuels and contributing to the problem. And so for example, I'm trying to have a lot more meetings through teleconference. And I know the medical community is moving that way as well in terms of things like telemedicine and virtual care. And I think, you know, as that type of technology gets better, we can connect with each other in ways that don't involve having to travel as much. Yeah, so that's what I would say in terms of the top things.

George Kourounis [38:08] Well, get involved politically, that is a really important thing, right? We all know single raindrop believes that they are responsible for the flood, but all the raindrops together make a big difference. So getting involved politically, putting pressure on your local politicians, your provincial politicians, your federal politicians to take action. Unfortunately, we have a government in the United States right now, that is certainly not playing the global game. They, you know, literally, Trump is a climate denier who thinks this is a Chinese conspiracy, he has stated this, right. But, on a more personal level, there's lots of little things that people can do to make a big difference. So I've talked to lots of climate experts and and climatologists and ask them what's the one thing that's easy to do and makes the biggest impact, most bang for your buck that you can do today, eat less meat.

Dr. Chung-Wai Chow [39:08] And, if we can actually all make a decision that, you know, we would rather take public transit and we advocate for better public transit, better rail lines so that people don't have to drive to work, that would make a huge difference.

Jesse Knight [39:24] To dive deeper into actions that can be taken to help combat climate change, we also spoke with Carol Devine. Humanitarian advisor for Doctors Without Borders, and community scholar at the Dahdaleh Institute for Global Health Research at York University. She told us about her work on climate change and some of the things she's doing to help reduce her personal carbon footprint.

Carol Devine [39:41] I work for Doctors Without Borders/Medecins Sans Frontieres Canada. I'm a social scientist, and I think all people should have access to medicine. So I'm an Humanitarian Affairs advisor, which means I you know, MSF works on the basis of independent medical care based on need. So whatever I do, is helping with that. And then in particular on climate change, I'm helping us frame, with other colleagues, you know, how do we talk about climate change? How do we prepare? But, also how do we reduce our own footprint? I've been a vegetarian since I was 18, except for the time I ate lard and Byelorussia by mistake, but and then I'm flying less. I'm flying more consciously. And you know, when I think about humanitarians, oh, yes, they're working hard to fly less, but then big corporations are still flying in private jets. Like, come on. This is where I think the advocacy matters and where we're looking at the big impacts. The small actions add up. So in Toronto in Canada, we should take the actions that we know are out there to reduce our footprint cycle more, fly less, then I think we can also use our voices. I think that matters too, and to say what kind of local community we want to live in, because that impacts on what kind of world we want to live in. I think what we can help do is talk about who's suffering and understand a bit more about, you know, why that's happening and contribute to that conversation. So keep doing our medical humanitarian work, but Doctors Without Borders has a dual mandate to do this independent medical assistance, and also to speak out. And we spoke out about genocide, we spoke out about famine, and now can we talk about vulnerable people who stand to become more vulnerable.

Jesse Knight [41:20] Carol also told us about some of the things that MSF, Doctors Without Borders, is doing as an organization to minimize their environmental impact.

Carol Devine [41:28] So we did this rapid diagnosis in Canada, Switzerland, Honduras, Mexico and Kenya. Now that's not representative of the 72 countries where MSF works, but it gives an idea it's a mix, and we look mostly at carbon, and then we have to look at, we're going to go deeper into waste and waste management and that whole supply chain cycle because that's going to be massive, but what we wanted to do is this quick diagnosis so we could get going based on data. And unsurprisingly, what do you think our was biggest footprint?

Jesse Knight [41:56] Flights.

Carol Devine [41:56] Yeah, flights, but supply. So cargo, air cargo and personnel. So it doesn't mean we're going to immediately stop flying. No, we're going to really, you know, I like the analogy a colleague said was, let's walk when we can walk and we'll run when we have to run. So where can we cut back? Where can we have guidance to say, do I really need to go? Do I? Do all of us need to go? Where is it urgent and where isn't it? So we have this incubator where we're we're working on this called "Climate Smart MSF". And it's just beginning and I'm going to be super humble about it. We have a long way to go, but ICRC (International Committee of the Red Cross), and others working on this have been extremely generous sharing how they do it. And likewise, when people ask I say, okay, we're at the beginning, but here's how we do it. We need to share best practices,

Jesse Knight [42:43] Dr. Xie expanded on how greener lifestyles are often healthier lifestyles, and how sustainable approaches to medicine have a variety of benefits.

Dr. Edward Xie [42:50] What we had focused on were a lot of the health co-benefits that come out of primary care, and those would be the I guess this comes around to the issue of, you know, sometimes people say that the healthcare system doesn't really have a role in mitigating or preventing climate change, it should be focused on adapting. What we miss when we focus on that is all these opportunities to improve people's health at the same time as being more sustainable. So for example, you know, if we follow Canada's food guide that can lead to healthier diets, but it also reduces the environmental impact through a focus on plant based proteins, and on eating habits that could potentially reduce waste, food waste, as well. Other health co-benefits that are really obvious would be things like active lifestyles and exercise that could potentially reduce fossil fuel use in terms of transportation and also make people healthier in terms of the chronic conditions that they're living with. We also see of really key importance to primary care, this rule of preventive care. We know that if we keep someone or if we help someone to stay healthy in the community, they use much fewer resources, their health care is much less intensive than if we have to treat them in the hospital. And that translates into reduced emissions and also means that people are living healthier lives and they're enjoying more of that wellness than if they end up in a hospital because of worse health. I want to point out one other thing which I thought was very interesting and this was when I was looking through the choosing wisely guidelines, the recommendations, and there was a submission from family doctors. And what they really do is they focus on reducing unnecessary testing, unnecessary resource use, unnecessary treatments. And I want to bring that back to the health co-benefits aspect where you know, we are by lessening this unnecessary healthcare, we're actually reducing the burden on patients on the healthcare system. We're spending less money on these tests that are not needed, but it also reduces our impact on the environment because we know that the health care system in Canada contributes about 5 or 6% of the greenhouse gas emissions of Canada as a whole. So it's a fairly significant contribution. And if we can reduce that by cutting out some of the waste, it really fulfills a lot of the social goals and the social accountability of the healthcare system.

Yagnesh Ladumor [45:30] Dr. Xie also told us about some of the organizations he's gotten involved with to help advocate for greener lifestyles and health care, including Toronto environmental Alliance and CAPE, the Canadian Association of Physicians for the Environment.

Dr. Edward Xie [45:43] It's a non-governmental, academic organization that's been running for decades now, I believe. And it is a group of concerned healthcare providers, not just physicians. It also includes public health professionals, nurses and many other people who are concerned about the health effects of environmental damage, environmental harms, including climate change. And so it's a group that provides education, provides practical tools and provides advocacy on improving environmental standards and looking at environmental issues with a health lens. And so our current President, who is Courtney Howard, has been extremely outspoken on an international scale. She was actually at COP 25 quite recently talking about health issues. And our current Senior Director of climate change in health, Kim Perrotta, who's a public health professional has done amazing work earlier this year. We we actually released a set of modules in this tool kit that was sponsored by the Canadian government that looks at the health impacts of climate change and ways that the health system can actually improve that.

Yagnesh Ladumor [46:52] Dr. Xie is a board member on the Toronto Environmental Alliance we asked him how they help

Dr. Edward Xie [46:58] So Toronto Environmental Alliance is more of a local group and I really appreciate being able to work in these two organizations because CAPE is more national. And then TEA (Toronto Environmental Alliance) can focus in on local issues. So what they do is, you know, the main focus is building a vision for a sustainable, inclusive and healthy city of Toronto. And it does it by trying to advocate and work towards designing the city and bringing people together in a way that furthers all of those goals. And so for example, one of the major projects that they're working on is called zero waste buildings. And so they work in these large apartment buildings that may rely on private services to take away their waste, and they work with the the residents there, and also the building managers are themselves to reduce the amount of waste which actually can save money, but also allows the residents to share some of the resources that they would have otherwise thrown out. And so it can build a cyclical economy and help people out that way. And TEA also advocates for municipal policies. So for example, you know, whenever the city's engaging in these large infrastructure projects, such as efficiency retrofits to Toronto community housing buildings, TEA is advocating to build in fair and equitable work plans so that there is decent work for local people as well.

Carol Devine [48:32] I got involved with my local kind of green group to think about in our community when there is flooding, how are we going to respond and help each other. And I liked that, that was meaningful for me. I connected with neighbors more and you know, I believe in the smaller actions like there's been a lot of conversation like why do you focus on the paper straws or steel straws over plastic straws and I think there's even been some science now saying those smaller actions can lead to bigger ones.

George Kourounis [49:02] Be active in your community do clean-ups and get involved with grassroots political movements and things like that because the big changes are the ones that are really important, these sweeping policy changes, and individuals can't help make those, well, they can't make the policy changes, but they can help influence, right. And here's the thing, as a business owner, as someone who's looking for companies to invest in, for example, the way I like to phrase it is if we can make saving the world profitable, then everybody will be on board.

Yagnesh Ladumor [49:35] In Alberta, Dr. Chow's team has worked to engage the Fort McMurray community to share their findings and bring together diverse perspectives.

Dr. Chung-Wai Chow [49:42] The first time we actually got together was in October of this year, and at this point many of us had already, you know, we are at two years into this study and so many of us now have had data to share. We invited members of the community, from people who were in the leadership roles in the school district, to emergency services, to the community health services of Fort McMurray to attend. And as we shared the information, there was a lot of very practical things in terms of how do we move forward? And how do we address these issues that come up? One of the advantages of working in a remote community in an isolated community that you have the ability to actually bring the group together and to share that information, and then to actually think about developing solutions.

Yagnesh Ladumor [50:33] Of course, a major part of these solutions, are governments, as Dr. Chow explained.

Dr. Chung-Wai Chow [50:38] I think, first of all, I think the governments need to acknowledge that climate change is a problem and to really collectively do something about it. I think, you know, it's, I appreciate that governments often times, like all of us, look at things that is beneficial to their catchment population, sometimes a lot of it is very much driven by economics. And clearly things that we do that improves climate may have some negative impacts. But I think the first action is that for some of the leading nations around the world to acknowledge that this is in fact a problem, and that we need to actually act on it.

Dr. Edward Xie [51:22] I think policy makers do understand at some level that climate change is a major issue. You can tell him choosing my words a little bit carefully here. But I, you know, I do get the sense that a lot of policymakers are choosing to ignore certain aspects of it, or are taking a more short term focus. So I think there's a lot of focus on, for example, what's happening with the economy right now, but we know with a lot of the science that's come out that once you factor in the social costs, the health costs, and the economic costs of climate change, those will far outweigh any short term costs that we're experiencing now. And so if we are trying to make sure that Canada, you know, as a country is able to grow sustainably that, you know, we're not giving up our future potential, there needs to be a more of a long term focus. But, that's also where it's important to have these decision architectures, structural choices that we need, so that we don't have to bear this cognitive burden of having to continuously make choices. So carbon pricing, for example, is something that I think is extremely important. What it does is it allows this background mechanism to operate in a way that shifts decision making in a way that's better for Canadian societies that's more environmentally sustainable, but also helps people out. So, for example, you know, we we are seeing that food prices are going up by, I think it was 17% for vegetables in the last year, and then projected to be a few hundred dollars in the next year. The rebates and the incentives from carbon pricing will help people and lower incomes be able to manage that. Some of the other, you know, things that that need to be built into these larger structural programs is helping people who the way our economy is structured now, may end up being losers. So for example, you know, smallholder farmers, people who are involved in extractive industries, we need to have some form of a just transition that helps people out in those those fields. And what I would say for people personally, to take away from this is, you know, there are these large scale issues to think about going from day to day, I think it's important to remember and keep in mind the reasons why we're doing this, you know that the children born today are going to be the people who will be disproportionately affected, who may not be able to live the same lives that were able to live because of the climate change that we are continuing to perpetuate. And that, you know, health is the most important thing to ourselves and our families. And because of the risks to health and climate change, it's one of the most important things that we need to be working on right now.

Gideon Forman [54:28] I think what we've seen in the last few months, last year with Greta Thunberg and the Friday's for Future movement is, at least for me, extremely heartening. If you come away with only one thing today, it's that you should never underestimate the power that you have.

Yagnesh Ladumor [54:42] As predicted by the climate models, human induced climate changes already contributed to changing patterns of extreme weather across the globe. In this episode, we've learned that if unmitigated, these changes have the potential to be one of the deadliest challenges humans have ever faced. Reversing the exponential feedback underpinning climate change would require us to change our way of life. There's much that we can do on an international, national, organizational, and individual level. We must build on the momentum of the past year and keep holding politicians and corporations accountable regarding climate change policy, while also making impactful personal changes. Tackling this challenge together has a potential to unite us globally in a way we've never seen before. Speaking of which, we'd love to hear about how you're reducing your carbon footprint or fighting climate change. Send us a message on social media and we'll share your stories along with our own.

Jesse Knight [55:37] This episode was hosted by Jesse and Yagnesh. Zeynep, Maria and Stephanie helped conduct the interviews and developed content. Grace was our executive editor, Nathan was our photographer and Alex was our audio engineer. A very special thanks to our guests, George Kourounis. Gideon Forman, Dr. Chung-Wai Chow, Dr. Edward Xie, and Carol Devine for speaking with us and sharing their insights. And of course thank you for listening. Be sure to check out our next episode in two weeks where we explore the phenomenon of biohacking. Until next time, #keepitraw.

Yagnesh Ladumor [56:11] Raw Talk Podcast is a student presentation of Institute of Medical Science and the Faculty of Medicine at the University of Toronto. The opinions expressed in the show are not necessarily those of the IMS, the Faculty of Medicine, or the university. To learn more about the show, visit our website rawtalkpodcast.com and stay up to date by following us on Twitter, Instagram, and Facebook: @RawTalkPodcast. Support the show by using our affiliate link on our website, or when you shop on Amazon. Also, don't subscribe on iTunes, Spotify, or wherever else you listen to podcasts, and rate us five stars. Until next time, #keepitraw.

Jesse Knight [56:47] of biohacking until ... so close