Sometimes the tiniest of things can embody the largest of problems – in this case, a blacklegged arachnid that's smaller than an apple seed. It's the deer tick, and its bite can carry Lyme disease. The bugs are creeping into Canada as warmer temperatures boost their survival rates at more northern latitudes. And that means doctors like Cathy Vakil are seeing more cases.
Last summer, for the first time since Vakil began practising in 1985, she saw a patient with the full-blown bull's-eye rash and flu-like symptoms that the disease is known to cause. “There's no question there are more ticks," says Vakil, family physician in Kingston, Ontario, and assistant professor in the department of family medicine at Queen's University. "This didn't exist 20 years ago."
Lyme disease is on the rise in Canada, with the Public Health Agency of Canada noting new risk areas emerging in provinces from Nova Scotia to Manitoba and advising health professionals to learn about diagnosis and treatment. Global warming, it says, is expected to speed up the expansion of Lyme disease into Canada.
Climate change has already triggered an increase in average annual temperatures in Canada in recent decades, along with rising sea levels. It is expected to trigger more extremes of weather, from higher rainfall to more intense storms and floods and more periods of drought, particularly in the Prairies.
That has myriad implications for Canada's health care system. It means more people suffering from heat waves, poor air quality and floods, as well as the spread of diseases – and the pests that cause them – to new areas. (Kingston isn’t the only place ticks are showing up; further north, Sudbury's health unit recorded its first case in 2008.)
Globally, the World Health Organization pegs climate-related deaths at 150,000 a year, and calls climate change "the defining issue for public health during this century."
In Canada, worsening air quality and higher temperatures will result in more emergency room visits and rising hospital admissions, which will come at great cost to the public health care system, according to the now-defunct National Round Table on the Environment and the Economy. (The round table was dismantled in 2012 after the federal government stopped funding it; 25 years of research is no longer publicly available on its website.
A need to adapt
Having a resilient health care system in the face of climate change requires a willingness and determination to adapt, experts say. One of the best places to start is to introduce the health impacts of climate change into the curriculum of medical schools, something Vakil and others have been pressing for. She would also like to see public health units across the country do more education and help the public connect the dots between climate and health – both physical and mental.
"It's scary and overwhelming, but climate change is a public health issue that should be dealt with," says Vakil, who sits on the board of the Canadian Association of Physicians for the Environment.
Change is afoot. Last year, the Canadian Coalition for Green Health Care published a toolkit for health care facilities on "climate change resiliency." It was based on a pilot of six facilities in Canada, and included a checklist of what institutions should do, from emergency management to boosting energy efficiency to how to maintain patient care during a weather-related disaster.
Such disasters – wildfires, extreme thunderstorms, droughts and tornadoes – all have implications for health care facilities, and Canadians will be increasingly vulnerable to such events as the population grows and ages. They’re already happening with greater frequency and health professionals are seeing the impacts first hand, said Linda Varangu, the coalition's executive director.
Some hospitals in northern Ontario, for example, are seeing their cooling systems over-taxed while others are rethinking their design after major flooding events nearby. "There's growing awareness, especially in those facilities that have been impacted already. They're having to do things differently now,” says Varangu.
It’s not like authorities haven’t seen it coming. Expected population growth and chronic disease trends "indicate that the proportion of Canadians highly sensitive to climate-related health impacts will grow over the coming decades," a Health Canada report made clear six years ago.
An additional risk is the potential for diseases, such as dengue fever and malaria, to become more prevalent as places Canadians typically visit on holiday, such as the Caribbean, see warmer temperatures that boost the survival rates of disease-spreading mosquitoes and parasites.
The Public Health Agency of Canada has $12 million in funding over five years – 2011 to 2016 – to bolster its “preventative public health systems and adaptation to climate change” program. The agency is boosting its risk assessment methods, particularly around vulnerable populations (such as the elderly, children and northern populations) and ramping up research in areas such as Lyme disease and gastrointestinal illnesses.
Focus on resilience
Real change will require longer-term thinking. Infrastructure, for example, will need to be planned around new weather patterns and risks from now on, says Sanjay Khanna, resident futurist at University of Toronto's Massey College, who focuses on how global risks such as climate change may impact public, private and not-for-profit sectors.
For now, Khanna says efforts to make Canada's health care system more climate resilient have been "fragmented," underscoring the need for coordinated efforts to build system-wide adaptive capacity. Planners will have to consider granular details of likely risks, such as how extreme weather could disrupt transportation routes and thus slow delivery of crucial medical supplies.
Doctors and nurses, too, will have to consider the potential mid- to long-term impact of extreme weather. These include more frequent disruptions to health care delivery with implications for patient care. "Health care professionals should take the time to develop scenarios that help them touch, taste and feel the future so they can prepare for it," says Khanna. He adds, however, that fiscal restraints on health care spending mean it will be difficult to boost investments unless longer-term costs and benefits are weighed.
Many shifts are under way at the local level, as risks for each community vary considerably. For Victoria or Halifax, rising sea levels are a threat, while in Windsor, a principal concern is heat waves.
Windsor, Canada's southern-most city, estimates its number of hot days could almost quadruple later this century, with the risk that heat-related illnesses will strain health care services. Its climate change adaptation plan proposes more public education on heat waves and their effects, and mapping "hot spots" in the city of populations most vulnerable to these illnesses.
City staff planners have met with the medical officer of health to assess risks from heat and vector-borne diseases. The city is now boosting its tree canopy for more shade and exploring how to better keep its public parks cool, says Karina Richters, the city's environmental coordinator. "We're trying to put this on the radar."
Pursuing self-sufficiency
Some facilities are bolstering self-sufficiency. In London, Ontario, the goal is simple: creating a "bullet-proof infrastructure to keep the buildings operating regardless of external operating conditions," says Phil Renaud, director of engineering services at London Health Sciences Centre, which includes two large hospitals.
It uses cogeneration to power one hospital and has added backup generators at the other. The benefits are manifold – cogeneration has led to cost savings pegged at more than $3 million a year in reduced hydro bills. Its turbines are more efficient and cleaner than traditional sources, and at maximum capacity produce enough energy "to power a medium-sized town." And the system is now more resilient to power outages from natural or man-made disasters.
Some facilities are being built in new ways. In Boston, the Spaulding Rehabilitation Hospital was recently "future-proofed." That involved ensuring its ground floor was 30 inches above the 500-year flood level lines. It has windows that can be manually opened in case the air conditioning conks out so patients don't overheat. And it placed its electrical equipment on the roof, instead of the basement, in case of flooding.
Across the United States, momentum is growing to rethink how climate change will affect the health care system, says Colleen Funkhouser, program coordinator at Reston, Virginia-based Health Care Without Harm.
Funkhouser says the sector was previously reluctant to engage on the issue, at least until climate change was reframed as a public health concern. When Superstorm Sandy directly affected several hospitals and exposed their vulnerability to extreme weather events, the conversation shifted. More attention was focused on preparedness, she says. At the same time, health care institutions explored opportunities to reduce their own impacts on the climate.
Research is underway to examine potential costs to health care systems. In the first study of its kind in the U.S., scientists from the Natural Resources Defense Council and economists studied the health costs of six climate-related disasters that occurred in recent years, and which are likely to worsen as atmospheric CO2 levels climb. They pegged total costs at more than $14 billion. It’s just an “indication” of what to expect in the coming years, the study warned.
Are we fully aware of what’s to come? Are Canadians prepared? Change in Canada has been slow to come, in part because the federal government has not prioritized the issue, says Trevor Hancock, professor and senior scholar at the University of Victoria's School of Public Health and Social Policy.
Still, given the size of Canada's health care system, its moral obligation to do no harm and the costs – both economic and social – associated with climate change, "the sector should be setting an example for the rest of society," he says. "There's a lot more it could and should be doing.
