It's a Win-Win (Co-Health/Environmental Benefits)
What we eat, and how that food is produced, affects our health but also the environment.
Food needs to be grown and processed, transported, distributed, prepared, consumed, and sometimes disposed of. Each of these steps creates greenhouse gases that trap the sun’s heat and contribute to climate change. About a third of all human-caused greenhouse gas emissions is linked to food.
What type of diet is associated with lower greenhouse gas emissions while also providing cardiovascular health benefits?
What is a plant-based diet?
Foods with the lowest greenhouse gas emissions are plant-based—such as vegetables, fruits, legumes, grains, tofu, and nuts—while red meats (especially beef and lamb) have the highest emissions.
Choosing Wisely Canada’s Recommendation #14 for Family Medicine is: “Don't conduct in-person visits where virtual assessment would provide equivalent clinical value and is preferred by the patient.”
In a United Kingdom, the National Health Services (NHS) evaluated its greenhouse gas emissions and discovered what % of emissions were attributed to travel to and from health facilities for staff, patients, and visitors?
a)<1%
b)5%
c)10%
d)20%
What is c) 10%?
When safe, feasible, and patient-acceptable Choosing Wisely recommends conducting virtual appointments as one strategy to reduce healthcare-related greenhouse gas emissions. Secondary benefits include cost and time-savings reported by patients when accessing appropriate virtual care.
Increases in temperature and changes to rainfall patterns due to the climate crisis threaten to change patterns of vector-borne disease transmission.
Modelling studies have estimated that child mortality (0-4 yo) will increase by up to 20% by the end of the 21st century due to which vector-borne disease?
What is malaria?
It’s all about trees.
In a recent study of urban landscape design in relation to four extreme heat events in Toronto, researchers found that higher tree canopy coverage was associated with a reduction in heat-related ambulance calls. At what % of canopy cover in an urban design will you see a significant reduction in heat-related ambulance calls?
a)5%
b)10%
c)20%
What is b)10%?
In addition to a reduction in heat-related ambulance calls, increasing the density of trees in an urban environment has been demonstrated to reduce air pollution (and associated respiratory complications), and improve mental health.
People who menstruate spent an average of 39 years experiencing menstrual cycles and using menstrual products. They may use between 10,000 and 15,000 disposable menstrual products in their lifetime.
Which menstrual product is the most cost effective AND has the lowest carbon footprint?
What is a re-usable menstrual cups?
Menstrual cups produce a markedly lower carbon footprint: 0.4% relative to pads; 6% relative to tampons
Consistent usage of reusable alternatives such as menstrual cups and menstrual underwear significantly reduces the amount of plastic waste generated (by 99.6% in comparison with pads; by 94% relative to tampons).
Menstrual cups also cost on average $30-50 and can last 5-10 years, making them one of the most affordable menstrual products available.
When prescribing puffers for asthma, which type of inhaler produces the most greenhouse gas emissions?
What are MDIs?
MDIs which contain hydrofluoroalkane (HFA) propellants known to contribute to climate change, account for 0.03% of global gas emissions annually. Instead, offer an alternative inhaler with a lower carbon footprint (e.g. dry powder inhaler (DPI), soft-mist inhaler, or MDI with a low greenhouse gas potential propellant) containing medications with comparable efficacy is available, and where the patient has demonstrated adequate technique and patient preference has been considered.
There’s something in the air!
There are nearly 900 premature deaths per year attributed to air pollution from traffic (gas and diesel fueled vehicles) in the Greater Toronto & Hamilton Area (GTHA) alone. Which of the interventions listed below could reduce premature deaths by 15% if implemented in the GTHA?
a)Public transit buses becoming 100% electric vehicles
b)Providing free air purifiers to all private residences within 100m of a highway
c)Having 20% electric cars and SUVs on the roads
What is a)Public transit buses becoming 100% electric vehicles?
Shifting to all-electric public transit buses in the GTHA would result in a reduction of 0.3 megatons (MTs) of greenhouse gas emissions and would reduce mortality attributed to traffic pollution by an estimated 143 lives/year. It is estimated to provide a net societal savings of $1.1 billion per year. It would also contribute to reduced cardiovascular and respiratory disease among people living in close proximity to high-traffic areas.
Amil is a 24yoM who works for the City of Hamilton doing landscaping over the summer months. It’s July and the temperature is 34C with the humidex. Amil was working outside all day and forgot to take breaks to hydrate and cool off.
Later that evening he presents to his family doctor’s office because his parents noted he appeared feverish and confused. You see that his skin is red and warm, his HR is 120, he is ++ sweaty, and his temperature is 40.4C. He seems a bit off balance and feels unwell.
What is the name of the medical condition Amil is likely experiencing?
What is heat stroke?
Unnecessary care has an enormous environmental cost given the energy and resources required to extract, process, manufacture, package, transport, and dispose of materials required for each medication, investigation, and healthcare visit.
Unnecessary care is defined as “care that provides minimal or no benefit, considering the harms, costs, alternatives, and preferences of the patient.
What % of investigations and treatments ordered in healthcare are considered “unnecessary care”?
What is 30%?
Reducing unnecessary care is one of the most important ways to reduce our environmental impact while continuing to provide high quality care to patients.
Choosing Wisely Canada recommends:
“Don’t prescribe intravenous (IV) antibiotics for patients who can safely be treated with an oral option, given that IV antibiotics have a higher carbon footprint.”
How much lower is the carbon footprint of oral antibiotics when compared to IV antibiotics?
a)20% lower
b)45% lower
c)75% lower
d)90% lower
What is d)90% lower?
Studies from the UK estimated that oral antibiotics have a carbon footprint up to 90% lower than the IV equivalent, depending on the antibiotic – a one-week course of oral ciprofloxacin is associated with 1.4kg CO2e (6.8km by car) of emissions versus 100.1kg CO2e (485.9km by car) for intravenous ciprofloxacin. The same group ran an early oral antimicrobial step-down project which saved 300,000 British pounds (or ~$450,000 CAD) annually.
Among patients on IV antibiotics, early transition to oral antibiotics has the additional co-benefits of reducing hospital length of stay, length of treatment, nursing care needs, in addition to lowering carbon footprint.
Canada experienced its most destructive wildfire season ever in 2023, with fires consuming 16.5 million hectares—more than double the previous record and nearly seven times more than the historical average (Natural Resources Canada 2024).
With the social determinants of health in mind, which subset of the population was found to have higher risk of emergency department visits due to exposure to wildfire particulate matter (PM)?
a)People living in urban high-rise buildings
b)People living in rural communities
c)People who were unhoused
d)People who lived in long-term care facilities
What is c)People who were unhoused?
In one San Diego study, the population of people who were unhoused had a higher exposure to wildfire-specific PM2·5 than people who were housed and that exposure was associated with higher odds of visiting hospital emergency departments 0–3 days after a wildfire event.
With extreme heat events increasing in frequency and severity, which sub-group of the population experienced a 58.4% increase in average heat-related mortality in Canada between 2014-2018?
What are people > 65 yo?
Green spaces or green infrastructure can include parks, trails, urban and rural forests, street trees, community gardens, and more. Green spaces can provide a multitude of benefits for both environmental health / climate change mitigation and human health.
Name one environmental / climate change mitigation benefit AND one human health benefit from increased access to green spaces?
What are...
Environmental Benefits:
- Air quality improvements
- Reduction in urban heat islands, shade provision
- Flooding mitigation through storm water storage
- Reduce outdoor air temperatures
Human Health Benefits:
- All-cause mortality reduction
- Cardiovascular disease benefits (improved blood pressure control, reduced risk of stroke)
- Lower risk of obesity
- Mental health benefits (reduced stress, lower rates of depression and anxiety)
- Reduced risk of diabetes
Inhaled anesthetic agents are one of the greatest contributors to operating room greenhouse gas emissions.
Which inhaled anesthetic agent has the highest greenhouse gas emissions?
What is Desflurane?
Using desflurane for one hour has the same carbon footprint as driving a car for 320km compared to only 6.5km for sevoflurane. Eliminating the use of desflurane is one of the most impactful changes we can make to green our profession.
Ontario’s Anesthesiologists, along with the American Society of Anesthesiologists and the World Federation of Societies of Anaesthesiologists, have all supported the restriction of high global warming potential anesthetics like desflurane through published statements. The European Union has planned a ban of desflurane by 2026.
Lower air quality is associated with a number of adverse health outcomes. People with existing cardiac and respiratory conditions are most affected.
Living in areas of poor air quality doubles mortality among people with which cardiac condition?
What is heart failure?
People with heart failure living in areas of poor air quality have nearly double the mortality risk.
Pathophysiology: Exposure to air pollution—especially particulate matter (PM)—induces oxidative stress and increases reactive oxygen species (ROS) in endothelial cells and cardiomyocytes, worsening the underlying ROS dysfunction already present in heart failure. This leads to endothelial dysfunction and impaired myocardial performance.
Blood Pressure: Long-term air pollution exposure is also associated with elevated blood pressure and blood pressure regulation dysfunction, which are commonly present in heart failure patients. By exacerbating hypertension and BP dysregulation, air pollution further increases cardiac workload and disease progression, contributing to higher hospitalization rates and mortality in this population.
Pregnant women are at increased risk of health complications due to climate change, including climate disasters, temperature changes, and other factors.
2023 was the warmest year on observational record. Exposure to extreme heat has been associated with a 25% increased risk of which adverse pregnancy outcome?
What is miscarriage?
In one study, women exposed to temperatures between 28°C and 32°C, had a risk of miscarriage 25% greater (adjusted OR 1.25, 95% CI 1.07–1.47) compared to those exposed to temperatures from 16°C to 21°C.