June 4, 2021
By Alisa Kim
Dr. Fiona Miller, a professor at the Institute of Health Policy, Management and Evaluation (IHPME), has been awarded $6 million from Environment and Climate Change Canada to lead a collaborative project that aims to engage Canada’s health care community in climate action and awareness through a nationally coordinated network.
The project, titled CASCADES (Creating a Sustainable Canadian Health System in a Climate Crisis), will be led by Miller, a professor at IHPME at U of T’s Dalla Lana School of Public Health, and the founding director of the Centre for Sustainable Health Systems. She is partnering with with Dr. Sean Christie and Gillian Ritcey of the Healthy Populations Institute at Dalhousie University; Dr. Andrea MacNeill, who leads the Planetary Health Care Lab at the University of British Columbia; and Neil Ritchie and Linda Varangu of the Canadian Coalition for Green Health Care. The team members are in turn connected to diverse regional and national health associations, health care leaders, clinicians, administrators and sustainability researchers.
The broad network-building these partner organizations will undertake is key to addressing health system sustainability because, as Miller notes, “although there have been pockets of extraordinary excellence and effort, there’s just not the coordinated and consistent movement forward that will drive the health system toward the direction it needs to go, which is net-zero [emissions] at minimum.”
Getting to “net-zero” means reducing the greenhouse gas emissions from health care as close to zero as possible, and offsetting the small subset of remaining emissions in socially and environmentally sustainable ways. MacNeill, who is also a cancer surgeon at Vancouver Coastal Health Authority and one of the founding partners in the network says “the bar has been set” by England’s National Health Service, which has committed to a net-zero health system for both direct and indirect emissions by 2045. For Canada to follow suit, all stakeholders in the health care system must be engaged, she says. “This project is bottom-up change. We need a mandate from the health system—we need patients, communities, frontline providers, administrators and senior leaders to say that this is their business. That’s our job—to elevate that,” says MacNeill.
The project has two overarching goals. The first is to build the capacity of Canada’s health care community to achieve resilient, net-zero health care by increasing awareness and motivation, and by developing the skills, tools and networks to enable action. This will be achieved through professional development training to provide clinicians and administrators with the knowledge and skills to understand and support sustainable change, and via outreach and communications to foster awareness and attract new audiences.
The second goal is to cultivate and support sustainable health care innovations. This will be done by testing innovations using methods to assess whether they are improvements toward high-quality, low-greenhouse gas care. The most promising innovations will then be spread across Canada using “playbooks” to implement them so that they become best practice in sustainable health care. Examples of service delivery innovations include using alternative anesthetic gases and substituting standard asthma inhalers with dry powder inhalers or smaller volume inhalers.
Christie, who is also a neurosurgeon in the Nova Scotia Health Authority and one of the founding partners in the CASCADES network, argues that the health care community should play a major role in Canada’s pledge to achieve net-zero emissions by 2050 because of the sector’s greenhouse gas footprint and its social reach. Greenhouse gas emissions from health care account for five per cent of Canada’s total carbon footprint, notes Christie. Moreover, health care is the second largest employer nationally and represents the largest single provincial budget expense. “Climate action across Canada’s health care community, however, remains limited in scope and piecemeal owing to partial implementation of solutions, inconsistent measurement across settings and regions, and insufficient communication,” he says.
“Our team is ideally placed to overcome these limitations,” says Ritchie, Executive Director of the Canadian Coalition for Green Health Care and one of the founding partners of the CASCADES network. “We possess sustainability expertise and health care expertise, with deep connections with both sectors. We understand how to engage diverse members of the health care community on their own terms, and pursue national coordination while respecting local priorities, provincial and territorial jurisdiction, and differences across professions, practice settings and context.”
The federal government’s investment in the team’s proposal to harness efforts toward a sustainable health system is both encouraging and empowering, Miller says. “It puts an enormous amount of wind in your sails that the vision we’re articulating is appreciated and understood. There’s tremendous opportunity to move forward. You really do need to create a framework where people can pull together in a common direction. That is what this is about: leveraging the efforts of many towards a shared goal.”