The Lancet Countdown on Health and Climate Change
Policy Brief for Canada
Previously described as “the greatest threat to health of the 21st
century”, climate change is compounding existing health disparities
in Canada. Given this, addressing the current climate crisis offers what
is perhaps our biggest opportunity to improve the health outcomes
We see wildfires exacerbating respiratory illnesses and leading to
community displacement in Western Canada; heat-related illness in
urban areas; changes in the availability of traditional foods in the Arctic
region; mental health stresses; extreme weather events such as floods
and droughts; progression of infectious diseases such as Lyme disease
and emergence1. Moreover, climate change drives inequities: older
persons, those of low socioeconomic status, and racialized people
living in Canada face a greater burden of the impacts of climate change
on their health.
In particular, climate change disproportionately impacts Indigenous
peoples’ wellbeing. Colonialism has altered the ecological systems
that support Indigenous peoples’ health, economies, cultural practices
and self-determination. For First Nations, Métis and Inuit communities,
the current climate crisis is understood and experienced as an
intensification of the environmental changes imposed on Indigenous
people by historic and ongoing colonial processes. Their remarkable
and demonstrable resilience through these changes, however, reinforce
the opportunity for learning and collaborating on solutions that draw
on the ecological traditional knowledge, social and environmental
adaptability of Indigenous peoples in Canada.
This brief, written in collaboration with medical and public health
experts, as well as Indigenous and allied scholars, outlines opportunities
to address climate change. Based on data from the global Lancet
Countdown report, it looks at the impacts of extreme heat and air
pollution on the health of all people living in Canada. It also explores
how, by applying a justice lens to all policies, Canada’s leaders can
promote a healthy transition to a sustainable society in the dual crises
era of climate change and COVID-19, including developing a more
sustainable healthcare system and prioritizing health equity.
This policy brief presents updated information and recommendations
on two major clusters of indicators of climate-related health impacts in
Canada: extreme heat and air pollution. It provides six evidence-based
policy recommendations for a healthy response to climate change
through enhancing resilience and adaptability. We offer recommendations
that aim to reap co-benefits for physical, social, economic,
and environmental well-being. Additionally, as economies are slowly
recovering from the COVID-19 pandemic, this brief acknowledges the
unique opportunity to shift toward a carbon-neutral society, and these
policy recommendations enable progress towards this goal.*
*Additional recommendations can be found in the 2017, 2018 and 2019 briefs.
1 Retrofit existing built infrastructure, improve current social and natural
infrastructure, and better design novel urban and suburban communities to
improve resilience to heat, especially for groups at risk.
Turn down the heat
Clean our air
The way forward: healthy recovery
Promote and be guided by the resilience of land-based Indigenous-led
approaches that foster adaptation to rapid warming in Indigenous communities,
particularly in the north.
Increase support for sustainable housing, including flexible strategies that
financially and logistically support low emissions design and deployment of
technologies for improved insulation and energy efficiency at the community
and neighbourhood level.
Prioritise funding for low emissions transport and affordable public and
active transport initiatives, targeting communities who could benefit most
from access to healthy transportation and identifying examples of successful
Ensure a recovery from COVID-19 that is aligned with a just transition to a
carbon-neutral society, considering health and equity impacts of all proposed
policies to address the climate and COVID-19 dual crises, directly including and
prioritizing the disproportionately affected, including Indigenous peoples, older
persons, women, racialized people, and those with low income.
Strengthen health system resilience in the face of climate change and other
current and future health threats, prioritising decarbonisation, energy efficiency,
and improved waste management and supply chains, aiming at a
nation-wide “net-zero health service”.
Turn down the heat
Canada is warming at double the global average rate, and even more
rapidly in northern regions.2 The number, intensity and duration of
heatwaves are likely to increase, especially in southern Canada where
most of the population lives.
Extreme heat is associated with increases in all-cause mortality; risks
of being hospitalized for cardiovascular and respiratory diseases;3 and
congenital and birth complications.4,5 High temperatures also affect
psychological and emotional health.6 During extremely hot periods,
interpersonal and group violence tend to increase, especially in underprivileged
neighbourhoods. Domestic violence rises,
impacting the well-being of women.†,7 Additionally, extreme heat has
been linked to insomnia;8 higher suicide rates;9 and an increase in
mental health-related emergency department visits.10.
Canada’s aging population‡ is at higher risk of suffering from extreme
heat because of frequent social isolation, less access to energy-efficient
and heat-resilient housing, decreased ability to regulate body temperature,
and higher prevalence of pre-existing chronic conditions such as
hypertension, diabetes and heart disease. Between 2014-2018, rapid
warming in Canada led to a 58.4% increase in average annual heat-related
mortality for the over 65 population, compared to the 2000-2004
baseline, exceeding the global average of 53.7%.13 A record high of
over 2700 heat-related deaths in the over-65 population occurred
across the country in 2018.13 In the summer of 2018, two heat waves
affected Quebec, with 86 excess deaths resulting from the first of these
two heatwaves alone.14
Heat exposure also affects outdoor workers, including those in the
construction, service, manufacturing, and agriculture sectors. In
Canada, the work hours lost due to exposure to extreme heat was 81%
higher on average in 2015-2019 than in 1990-1994, with an average of
7.1 million extra work hours lost per year.§,13
In 2018, the monetised value of global heat-related mortality was
equivalent to 0.7% of Canada’s gross national income, compared to
0.2% in 2000.13 These costs are comparable to the average income of
263, 400 Canadians, or roughly the population of Gatineau, Québec’s
4th biggest city, or Saskatoon, Saskatchewan’s biggest city.
Physical, social and economic structures contribute to heat-related
death in people at risk. Older persons, outdoor workers, and those
living in low income neighbourhoods often have less access to green
spaces, public transport and proper insulation, or are more likely to be
socially isolated or to live on a low household income. For Indigenous
peoples, rising temperatures further exacerbate disparities attributable
to colonialism, such as food security, access to clean water, land use, ice
safety and housing stability.15 Addressing these inequitable structures
will support individuals’ and communities’ resilience and productivity
and decrease preventable health consequences as temperatures rise.
More sustainable infrastructure at community and household levels,
such as trees and urban vegetation (including parks, on streets and
‘green walls’), water features, and cooler buildings (which are lighter
in colour or better insulated to reduce heat absorption), can better
equip Canada to prevent these health consequences.16 However, infrastructure
changes to mitigate the above mentioned health impacts, if
only focused on design of new structures, may not be sufficient and
new buildings also can incur significant costs in resources and energy
demands. Retrofit of existing buildings offers an additional significant
opportunity to increase energy efficiency, reduce cooling costs, and
mitigate health risks, and has been studied in other countries.17,18,19
Policy responses to extreme heat can be tailored to the most effective
scales and be flexible to local realities, including scope for design of
new structures, greening, and improving ventilation and insulation of
† Gender-based violence increases in times of acute disaster and crisis, including climate-related events such as flooding and wildfires, while at the same time, the services available to women, such as shelters and
‡ According to Statistics Canada, the proportion of the population over 65 is 17.% and increasing to up to 30% in the next 50 years.
§ This data is calculated with the conservative assumption of work being undertaken in the shade.
FIGURE 1: THE HEALTH IMPACTS OF HEAT3,5,6,7,10,11,12
Clean our air
Air pollution has significant impacts on health, including exacerbating
respiratory conditions like asthma and chronic obstructive pulmonary
disease, and increasing risks of lung cancer, respiratory infections,
stroke and heart disease. However, the burden of air pollution is not
equally distributed across the population. Marginalized groups include
children, older persons, people with pre-existing conditions, outdoor
workers, racialized groups and low-income populations who are more
likely to live in neighborhoods near busy roads or industrial sites.20,21
In 2018 in Canada, there were a total of 8400 premature deaths related
to PM2.5 air pollution, of which 7200 were due to anthropogenic
sources.13 Total PM2.5 air pollution related deaths were more than 4.5
times higher than the number of deaths from transport accidents, and
almost double the number of deaths from all infectious diseases.22
While concerning, this number represents an opportunity to save over
8000 lives annually, and benefit the health of many others in Canada.
Transitioning rapidly to renewable, low-emissions energy can help
achieve this. The largest portion, over 30% of deaths from anthropogenic
air pollution, occurred due to emissions from households (e.g.
burning fuel for heating). 13,23 Notably, 17% of anthropogenic PM2.5 air
pollution related deaths were attributable to land-based transport,13
which in 2018 also accounted for 25% of Canada’s greenhouse gas
emissions (an increase of 53% since 1990).24 By reducing use of fossilfuel
based transport and home energy systems, including adapting
existing systems to incorporate energy-efficient technologies, it is
possible to decrease air pollution and improve health.
Total use of electricity for road transport increased 40% between 1990
and 2017.13 However, while Canada’s per capita use of electricity for
road transport remains the highest use worldwide, it has increased only
by 6.5% since 1990.13 Furthermore, electricity only accounts for 0.2% of
road transport energy in Canada, whereas fossil fuels still account for
over 95%.13 There remains large scope to increase uptake of sustainable
transport and by doing so, save health and economic costs
Active transportation has significant health co-benefits, including due
to physical activity, improvements in air quality, and social connection.
Studies have found reductions of approximately 20-30% in premature
mortality rates in those who regularly cycle or exercise for transportation.
25 Both active travel and public transit are associated with increased
physical activity and reduced rates of obesity compared to car use, and
when supported by infrastructures that prioritise safety and access, can
benefit the well-being of those with limited access to private vehicles.26
Transitioning to sustainable transport can avoid
preventable transport-related emissions and deaths, and modelling has
shown a cost-benefit ratio of more than 10 times in favour of integrating
active travel for health and emissions benefits.27
FIGURE 2: MORTALITY DUE TO PM2.5 AIR POLLUTION IN CANADA13,22
The way forward: healthy recovery**
The COVID-19 pandemic, subsequent crash in global energy prices, and
overall global economic downturn have cast doubt on the world’s ability
to prevent catastrophic and deadly effects of climate change. While
rates of emissions stalled early in 2020 due to COVID-19 lockdowns, the
total concentrations of major greenhouse gases have continued to rise.
This is in stark contrast to the 7.6% annual decrease in GHG emissions
necessary to limit global temperature increases to less than 1.5oC .28
An urgent transition to an environmentally sustainable, just and healthy
society is an essential part of recovery that Canada and other countries
must undergo. A just transition must include and prioritise groups most
affected by the current crises, including low-income groups, migrant
workers, older persons, and Indigenous peoples.
Furthermore, the COVID-19 pandemic has put immense strain on
Canada’s already overburdened healthcare system. Data from several
sources indicates that Canada’s healthcare sector was already responsible
for approximately 5%13,29,30 of annual greenhouse gas emissions
prior to the pandemic. Per capita, Canada’s healthcare is consistently
shown to have one of the largest carbon footprints in the world. In
England, the National Health Service has pledged to deliver a net zero
health service by 2040. Similarly, hospitals and health clinics in Canada
could realise health and financial gains by committing to and implementing
low-carbon, energy-efficient, reduced-waste health services.
Canada’s political and economic choices as it emerges from this
pandemic will determine whether it meets its commitment under
the Paris Agreement to contribute to limiting global temperature rise
well below 2oC. The country should lead by ambitiously updating its
Nationally Determined Contribution (NDC) to the Paris Agreement††.
Ultimately, governments and all sectors of society must make choices
that put human, environmental and economic well-being at the centre
of a sustainable recovery from COVID-19. These objectives are not
only mutually reinforcing, but mutually dependent. Crucially, Canada
must build resilience, equity and solidarity across groups, prioritising
Indigenous peoples and other communities most at risk.
Above all, through the pandemic, it is essential to prioritise a just
recovery: an equity lens must be applied to all policies. Those most
affected by climate change’s health impacts are those who currently
lack power and representation in economic and social hierarchies. For
Indigenous communities, addressing climate change is intimately tied
to the renewal of traditional knowledge systems, reconciliation, and
decolonizing approaches. All groups benefit when public and private
sector leaders work with Indigenous people and other disproportionately
impacted communities to ensure that historically underrepresented
groups are meaningfully engaged in all policy development
and recovery plans.
Working together, the lessons learned in responding to COVID-19 and
the increasing confidence in the power of collective action to care
for one another can be integrated into a collective response to the
climate emergency. This is an unprecedented opportunity to learn
and act together.
** There is a lack of data specific to impacts on health equity and on disproportionately affected groups, including Indigenous peoples. Furthermore, conventional scientific data collection and reporting methods do not align
with traditional ways of accumulating and sharing knowledge, thus it is difficult to use current indicators to capture the complex health impacts of climate change on Indigenous peoples.
†† As of October 2020, according to Climate Action Tracker, Canada’s NDC is consistent with a global temperature rise above 2oC and near 3oC. This is not compatible with the 1.5oC of the Paris Agreement. Despite several
promises to exceed the 2030 NDCs target (of 30% below 2005 emissions levels by 2030) and achieve net zero emissions by 2050, the federal government hasn’t adopted yet the policies required to respect these promises
and has continued to financially support the oil and gas industries. Source: https://climateactiontracker.org/countries/canada/.
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Organisations and acknowledgements
The concept of this brief was developed by the Lancet Countdown on
Health and Climate Change.
This brief was written by Dr. Claudel P-Desrosiers, MD; Dr. Finola
Hackett, MD; Dr. Deborah McGregor, PhD; and Dr. Krista Banasiak,
PhD. Guidance was provided by Dr. Céline Campagna, PhD, and Dr
Robert Woollard, MD, CCFP, FCFP, LM. Review on behalf of the
Canadian Medical Association was provided by Dr. Owen Adams, PhD,
Dr. Jeff Blackmer, MD, MHSc, FRCPC, CCPE, and Ashley Chisholm, MSc.
Contributions and review on behalf of the Lancet Countdown were
provided by Jessica Beagley and Dr Marina Romanello, PhD.
THE LANCET COUNTDOWN
The Lancet Countdown: Tracking Progress on Health and Climate
Change is an international, multi-disciplinary collaboration that exists
to monitor the links between public health and climate change. It
brings together 38 academic institutions and UN agencies from every
continent, drawing on the expertise of climate scientists, engineers,
economists, political scientists, public health professionals, and doctors.
Each year, the Lancet Countdown publishes an annual assessment
of the state of climate change and human health, seeking to provide
decision-makers with access to high-quality evidence-based policy
guidance. For the full 2020 assessment, visit www.lancet countdown.