How can the health sector support Canada’s net-zero ambition?

Fiona A. Miller, Professor & Director at the Centre for Sustainable Health Systems, University of Toronto in Canada, explores how the health sector supports Canada’s net-zero ambition

As the Honourable Steven Guilbeault has clarified, if Canada is to achieve net-zero emissions by 2050, we will need “all-hands-on-deck.” (1,2) The Government of Canada has a plan to work across sectors, engage businesses, drive market change, and secure critical co-benefits from climate action. However, Canada’s net-zero ambition for the health sector is largely restricted to climate adaptation. Minister, the health sector can do so much more. We need these “hands” too. (1,2)

How is Canada’s net-zero ambition going so far?

Achieving Canada’s net-zero ambition of neutral greenhouse gas emissions by 2050 is a complex and challenging goal that requires a whole-of-society approach. The Honourable Steven Guilbeault fully acknowledges this, noting that the Federal Government “cannot achieve this alone.” (1, 2)

The “Net-Zero Challenge,” which targets businesses across Canada, is a clear example of this collaborative approach. The initiative calls for all companies operating in Canada to voluntarily commit to developing and implementing a plan to achieve Canada’s net-zero ambition, supported by clear technical standards and public reporting requirements. (3) Canada’s climate strategy also aims to secure ‘co-benefits’ – that is, those positive effects that a measure aimed at one objective might have on other objectives, thereby increasing the total benefit for society. By way of example, the 2030 emissions reduction plan aims at “clean air and good jobs, a healthy environment and a strong economy.” (4)

What’s missing from Canada’s Net-Zero Plan?

But where is the health sector in these plans? At 12.2% of Canada’s GDP, (5) more than 10% of all employed Canadians, (6) and almost 5% of the country’s greenhouse gas emissions, (7) surely the health sector is a critical business that warrants focused attention? And as a sector that is both challenged by climate change and will benefit from climate action, and which plays a crucial role in supporting individual and community health and health equity, (8) surely the health sector should be a key partner in efforts to secure the co-benefits of climate action?

Though Minister Guilbeault was a signatory to the COP26 Health Programme at the United Nations Climate Change Conference of the Parties in November 2021, thus committing Canada to deliver a climate-resilient and low-carbon sustainable health system, (9) Canada is behind other countries in defining a strategy to engage the health sector in the transition to a low carbon and sustainable economy.

The health sector’s role in climate adaptation

Of course, the health sector is not absent from the editorial by the Minister (2) and the Canadian Government’s plans – or Canada’s net-zero ambition. The health sector is correctly seen as having a critical role to play in climate adaptation. Health systems must respond to the health impacts of climate change and help prepare communities and health services to withstand and recover from extreme and compounding weather events and other climate-related hazards. In doing so, the health sector can support vulnerable populations, such as the elderly and low-income communities, who are often most at risk from the health impacts of climate change or most challenged in responding to these threats.

In this area, Canada’s Federal Government has displayed considerable leadership. As the Minister notes, the Chief Public Health Officer of Canada, Dr Theresa Tam, devoted her most recent annual report to the issue of climate change in Canada. (10) As well, the Federal Department of Health Canada houses world-leading expertise on health adaptation and health system resilience. (11)

The health sector’s role in climate mitigation

Yet there is a significant gap in the Federal Government’s plans: the health sector’s direct contribution to the net-zero transition. Healthcare is a highly resource-intensive and polluting industry, estimated at 5.2% of global emissions and increasing. Moreover, Canada’s health sector is estimated to be the second most carbon-intensive in the world after that of the U.S. (12). There is clearly work to do.

Meanwhile, a growing number of countries such, as the English National Health Service (13) and multi-national health networks, such as Aga Khan Health Services (which has national service companies in nine countries, such as Tanzania, Pakistan and Kenya), (14) have ambitious decarbonization plans. Nevertheless, while Canada is participating in the World Health Organization Alliance for Transformative Action on Climate and Health, which comprises more than 60 countries that are signatories to the COP26 Health Programme, (15) the Federal Government has not identified a strategy to support coherent and coordinated healthcare climate action across the country.

Critically, efforts to deliver a more sustainable health system are not solely motivated by the imperative to ‘clean up healthcare’s own backyard.’ Systems of care that are less environmentally harmful cannot be realized simply by swapping out one highly polluting product for one that is less polluting. They must also shift the kinds of care provided. This involves removing the estimated 30% of care that is low value and wasteful and reimagining care delivery to be higher touch and lower impact – through improved management of chronic diseases, more robust primary healthcare capacity, more integrated systems of person-centred health and social care, and more attention to the social and structural determinants of health. (16) As large and informed buyers of products and services, as community-embedded service delivery systems, and as promoters of high-quality and equitable access and outcomes, the health sector has a critical role to play in more equitable and sustainable development.

What’s the Canadian Government to do?

The Canadian Government’s reticence to engage the health sector in the transition to a sustainable economy is, in some respects, understandable.

In Canada, healthcare is largely the constitutional responsibility of the provinces, and provincial sovereignty is closely guarded. Yet there is a long and vital tradition of federal engagement in pan-Canadian health policy. The federal engagement has proved critical in efforts to build and sustain a nationally consistent system of universal healthcare – a system that is deeply valued across the country. The challenge of climate change and the imperative of sustainability must surely warrant similar federal engagement.

There is already much innovation within and across provinces and territories in Canada. The Federal Government’s role for Canada’s net-zero ambition is to support this innovation and improvement, including through funding, support for standards- and guidance development, support for research and education, and by enabling pan-Canadian coordination and collaboration.

There is no shortage of enthusiasm across the health sector. Expertise and change-making capacity is growing, some of which has been seeded by the Federal Government itself. Relatively small but smart investments could accomplish a great deal.

You are correct, Minister, we need “all-hands-on-deck”. (1,2)

References

1. https://www.canada.ca/en/environment-climate-change/news/2023/01/minister-guilbeault-welcomes-the-2022-annual-report-from-the-net-zero-advisory-body.html
2. https://www.openaccessgovernment.org/reach-canadas-net-zero-targets-by-2050/155183/
3. https://www.canada.ca/en/services/environment/weather/climatechange/climate-plan/net-zero-emissions-2050/challenge/how-to-join.html
4. https://www.canada.ca/en/services/environment/weather/climatechange/climate-plan/climate-plan-overview/emissions-reduction-2030.html
5. https://www.cihi.ca/en/national-health-expenditure-trends
6. https://doi.org/10.11575/sppp.v14i1.74064
7. https://doi.org/10.1371/journal.pmed.1002623
8. https://doi.org/10.4095/329522
9. https://twitter.com/GovCanHealth/status/145824157 5612567552?s=20
10. https://www.canada.ca/en/public-health/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/state-public-health-canada-2022.html
11. https://www.canada.ca/en/health-canada/services/climate-change-health.html
12. https://www.lancetcountdown.org/data-platform/mitigation-actions-and-health-co-benefits/3-6-mitigation-in-the-healthcare-sector
13. https://www.england.nhs.uk/greenernhs/
14. https://the.akdn/en/resources-media/whats-new/our-stories/achieving-net-zero-how-our-health-operations-are-slashing-carbon-emissions-while-saving
15. https://www.who.int/initiatives/alliance-for-transformative-action-on-climate-and-health
16. https://doi.org/10.1016/S2542-5196(21)00005-X

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