Planetary Health, Planetary Safety . . . and Your Vote

In the early 1990s, we humans decided it would be a good idea to prevent “dangerous” interference with the planet’s climate. In 2005, our scientists got together and agreed that “dangerous” meant a global temperature rise of 2C or more. Then in 2018, the IPCC warned us that anything more than 1.5C of heating would be neither safe nor healthy, and not just for polar bears, but for us humans. That prediction is proving true, as the surviving citizens of British Columbia can testify after the many disasters of 2021.  

As I mentioned in a previous column, health care systems have learned a great deal about how to keep patients safe in hospitals. Strategies that put the onus on fallible humans are the least effective. Policies and procedures, while annoying, can work somewhat better. Pre-printed order sets. Mandatory checking. Double checking. Pre-op checklists. All this checking and redundancy helps protect patients from human and system errors.

But whether we humans (and especially we physicians) like it or not, what works most effectively to keep patients safe are strategies that may feel like constraints to our “freedom”. Computer automation. Rules. A range of other unavoidable mechanisms designed to jar us out of autopilot and into active thinking mode. In other words, forcing functions.

The problem with “forcing” people is that it tends to bring out that almost universal human tendency towards a condition well-known to pediatricians: oppositional defiant disorder. Since Health Sciences North issued a safety edict against many of the traditional short forms used in order writing, I’ve been tempted to feel personally affronted every time I’m required to write out the word “Discharge” instead of D/C. Sounds like a small thing, right? But that’s the way we humans are.

In the 21st century, we’re facing many threats to our health and safety. The pandemic is an obvious one. But festering in the backdrop are the slower-moving and ever more dire threats of climate change and other global environmental issues of our own making. Every day, there are news reports on how global heating is sickening and killing people, either directly through floods, storms, and heat waves, or indirectly through impacts on food security, fresh water supplies, and political stability. Just this morning, I read that extreme heat waves are now 100 times more likely in already-very-hot India.

Given the threats, you’d think we’d all be taking urgent action to reduce greenhouse gas emissions, for the sake of our own health and safety. You’d think individuals, small businesses, large corporations, and governments the world around would educate themselves, recognize the dangers, and do everything possible to reduce their environmental impact. And you’d think that health professionals, whose very vocation is health, would be at the forefront of action. And yet, despite the ongoing pandemic, global emissions in 2021 were the highest ever in (human) history, and our health care systems keep pumping out between 4 and 10 percent of those emissions.

If we’re going to turn this around, we can’t just rely on good will and education. We need forcing mechanisms. Action has to start at the top, with gutsy governments willing to not only proclaim long term targets, but also to set legally binding, short term emissions budgets, then put in place the required policies and procedures. This actually happened in the UK. As a result of their 2008 Climate Change Act, UK emissions in 2019 were 45 percent below 1990 levels. Between 2007 and 2017, the National Health Service reduced its carbon footprint by 18.5 percent.

Meanwhile, here in Canada, our national emissions remain substantially higher than in 1990, and our health care systems are only just beginning to think about sustainability. Our provincial leaders do battle over the carbon “tax”. And the planet gets hotter. Less safe. Less healthy.

Keep all this in mind when you vote.