Urgent call to health professionals: Help save Patient M.E.

This post was originally published in the Sudbury Star as "A Life-threatening Case of Malignant Narcissism" on Aug. 21, 2021

Back in March of 1979, I was pretty sure I was flunking out of first year medical school. But that wasn’t even my worst fear. In second year, I would have to present patient cases in front of actual doctors, a requirement so daunting I considered dropping out. To my own surprise, I survived it all. And now, forty-two years later, I stand before you to present the tragic case of Patient M.E.

Ms. M.E. is a 4.5 billion-year-old planet of uncertain gender, who conventionally uses the female pronouns she/her due to her notable mothering capacities. She presented to the Emergency Department about 30 years ago, with gradual onset of fever and unstable vital signs. Since then, she’s deteriorated rapidly, and we’re increasingly concerned that her life support systems may fail if effective treatment isn’t started immediately. That’s unfortunately proving difficult, and we believe that help from the world’s health professionals is urgently required.

M.E.’s past medical history has been turbulent. She was born by happenstance, conceived by gravity from the sun’s leftover rocks and dust. Her early life and development were chaotic, egged on by volcanic eruptions and the impact of asteroids and meteors. Through all of this, M.E. proved remarkably resilient. She developed oceans, and within a billion years or so, she gave birth to life. That remarkable event certainly put some oxygen into her atmosphere and began to calm her worst impulses. Eventually her solid surfaces greened and her offspring began to walk and fly. At many points, M.E. must have thought the worst was over. But frankly, nothing in her history has been straightforward.

A full synopsis of M.E.’s lengthy life would take hours, so I’ll limit myself to a few illustrative examples. About 715 million years ago, her CO2 levels dropped, and M.E. suffered a severe biphasic bout of chills and hypothermia. She became entombed in ice, a state of affairs that persisted for much of the ensuing 120 million years. She almost lost her life during that time, but inevitably, life flourished again, only to be felled repeatedly by events we still can’t fully explain. Then, a mere 65 million years ago, M.E. was struck by a giant asteroid. The resulting dust obscured the sun, her main source of energy. It was a particularly dark time for our patient and resulted in the tragic and irrevocable loss of her most impressive offspring to date, the dinosaur.

M.E. eventually recovered from this incident and went on to have countless other children. Some came and went. Others discovered the right balance of competition and collaboration and learned to thrive.

Twelve thousand years ago, M.E. emerged from another lengthy bout of chills, and settled into a period of relative stability. Things seemed to be going well until quite recently, when it became apparent that one of her offspring, an intelligent and nimble two-footed creature, had put aside any pretense of cooperation with its mother and siblings, and was beginning to display traits consistent with a particularly malignant form of narcissism: lack of empathy; a grandiose sense of self-importance; rapid proliferation, invasion and destruction; voracious consumption of M.E.’s energy and resources; and a complete disregard for any consequences. As you can imagine, all of this has been hard on M.E. She’s really stressed, and at the end of her tether.

We’ve done a biopsy of the cancerous creature, and a complete genetic profile. We know what treatments are required, but the creature itself has been neither willing nor compliant. This is puzzling, and seems self-defeating, but there you have it.

At this point, we’re hoping for a concerted effort on the part of the world’s health professionals, whether surgeons or psychiatrists, nurses or therapists, to get this malignant condition under control, and help keep M.E. in a livable state.

What does the climate crisis require of health professionals??

Originally published in the Sudbury Star on Aug. 7, 2021 

Harvard physician Dr. Alexander Leaf was, by all accounts, an exemplary human being, quiet and humble, a man of wide-ranging interests and skills. Numerous obituaries published after his death in 2013 attest to his accomplishments as a physician, a leader, a teacher, a mentor, and a researcher.

In 1961, Leaf became a founding member of Physicians for Social Responsibility (PSR). In an era of profound Cold War tension, PSR warned Americans about the dangers of nuclear proliferation, and advocated for a nuclear-weapons-free world. Their work contributed to the signing of a Limited Test Ban Treaty in 1963.

The late 1960s yielded a Nuclear Weapons Non-Proliferation Treaty, which ushered in a decade of détente. The relative peace was shattered in 1979 by the Soviet invasion of Afghanistan.

A year later, one of history’s most unlikely medical meetings took place in Geneva: a get-together of six American and Soviet physicians. Across the divide imposed by the Iron Curtain, a meeting of minds took place, and two principles took shape:

• Physicians have a responsibility to protect life and preserve health

• Nuclear war is profoundly dangerous

Out of that meeting, International Physicians for the Prevention of Nuclear War (IPPNW) was born. Alexander Leaf became a prominent member. Four years later, IPPNW was awarded the Nobel Peace Prize "for spreading authoritative information and by creating an awareness of the catastrophic consequences of atomic warfare.”

In 1989, the Berlin Wall fell. That same year, Alexander Leaf penned the first significant medical paper on the potential health effects of climate change for the New England Journal of Medicine.  His conclusion: “The expense [of action] may be considerable, but the cost of doing nothing is incalculable.” Leaf later wrote in his 1996 memoir: “There are social and man-made hazards with possible disastrous consequences to human health.” No doubt he had nuclear weapons and greenhouse gases in mind.

Today, there’s a movement afoot to propel the world’s nations towards a Fossil-Fuel Non-Proliferation Treaty.

The parallels with anti-nuclear weapons activism should be apparent. I’m pleased to report that one hundred Nobel Laureates, including thirty winners of the prize in Physiology and Medicine, and countless other scientists, academics, and health professionals (including me), have joined the Dalai Lama to demand that fossil fuels be left in the ground.

The proposed treaty’s focus on fossil fuels highlights a perplexing point: although the 2015 Paris Agreement was a significant step forward, it neglects to actually mention coal, oil, or natural gas. That’s an odd oversight, when you think about it.

In contrast, proponents of a Fossil Fuel Non-Proliferation Treaty don’t mince words when it comes to the fossil fuel trio. Such a treaty would require a firm commitment from all the world’s nations to stop any further expansion of coal, oil, and natural gas production, phase out all existing production, and fund a peaceful, just transition to renewable energy for all people.

This year, a treaty to prohibit nuclear weapons came into force.

Sounds great, huh? The only problem is this: not one of the nuclear nations signed on. We can’t let that happen with fossil fuels. We must do better, because although humanity may yet avoid nuclear annihilation, there will be no escape from the laws of physics. The more fossil fuels we burn, the hotter things will get on this planet, and the worse it will be for us and our health.

I suggest it’s time to expand on the principles laid out by physicians like Alexander Leaf, and organizations like the PSW, and the IPPNW:

• Health Professionals have a responsibility to protect life and preserve health

• The burning of fossil fuels is profoundly dangerous to human health.                          

And it's time to ask ourselves: What then is required of us? 

Personally? Professionally? And above all, Politically? 

Will “Glasgow” mean we screwed up our last chance?

Since 1971, the Oxford English Dictionary (OED) has elected an annual word-of-the-year, based on its global analysis of how the English language adapts to changing times. Recent notable examples are “post-truth” (2016), “toxic” (2018), and “climate emergency” (2019). It’s not that such words didn’t exist before. It’s more about the altered meanings we give to words, and how often we use them.

It’s not news to say that 2020 was an unprecedented year. It brought us the Pandemic, just for starters. But 2020 was unprecedented in another way. For the first time ever, the OED concluded that no one word could represent the rapid evolution of the English language demanded by such a wealth of unprecedented events. And so it took the unprecedented step of creating a Words of an Unprecedented Year report.

Of the sixteen words selected, many were pandemic-induced: Coronavirus, for example, and  lockdown. Social distancing. Superspreader. Some achieved renown through social and political tumoil in the USA: mail-in(ballot), impeachment, Black Lives Matter, cancel culture.

But the very first word-of-the-year, bushfire, was brought to us by the unprecedented reality of climate change, which can no longer be denied because it’s upon us. What with the pandemic having consumed so much bandwidth, it’s easy to forget the unprecedented Australian bushfires that started in 2019, and burned through March of 2020, killing 34 humans and over a billion wild creatures.

The OED’s final word of the unprecedented year that was 2020 was also environmental in origin: net zero. Emissions, that is. An expression of human ambition to address our climate emergency. Net zero wasn’t brand new, of course, but its use was on the rise, prodded along by China’s unprecedented September announcement of its goal to be net zero by 2060. The term’s popularity has continued into 2021. There’s even talk of net zero health care in some circles, though probably not within the Ontario government.

But despite all the exuberance generated within the English language in 2020, the word unprecedented itself won Dictionary.com’s People’s Choice for 2020.

All of this leaves me wondering what word(s) we will find to see us through 2021, and how and why they will rise to fame. Afterall, US politics has become so much more boring with the orange guy removed from the helm. And we’re all just sick and tired of the pandemic. Even the Olympics feel remote.

The weather, however, does remain a potential source of candidate words. The month of July alone has already brought us unprecedented heat, drought, and fire out west, and unprecedented flooding in Europe, all with immense impacts on the lives (and deaths) of our fellow humans. Could such events trigger a whole new level of meaning for the word danger, one that signifies and encompasses the risks we bring upon ourselves with our continued burning of fossil fuels?

At the Rio Earth Summit, way back in 1994, one hundred and fifty-four nations agreed to combat “dangeroushuman interference with the climate system”. Since then, twenty-five years of COP meetings have generated new English language meanings for the names of key cities. Kyoto: A 1997 treaty with legally binding emissions reduction targets. (Canada failed and dropped out.) Copenhagen: a heartbreaking 2009 event derailed by powerful vested interests.  And Paris, a sort-of-breakthrough agreement that hasn’t yet but might still reduce global emissions of greenhouse gases.

This November, the city of Glasgow will have its chance, as host of COP26, to give new meaning to its own name. In this make-or-break climate decade, will Glasgow come to mean “we screwed up our last chance”? Or will it become synonymous with “together, we preserved a healthy, safe, and livable planet”?

Personally, I’m rooting for the words Glasgow and COP26 to soar in usage and positive meanings this fall. In fact, I want them in the running for 2021’s words-of-the-year because what happens in Glasgow just might determine the ongoing health of my little patients. And that is my business, as a pediatrician.

Elaine Blacklock M.D., F.R.C.P.(C)

That Heat Dome Could have Killed my Granny

Originally published in the Sudbury Star on July 10, 2021 as "That heat dome could have killed my Granny" https://www.thesudburystar.com/opinion/columnists/blacklock-that-heat-dome-could-have-killed-my-granny 

Back in the early ‘70s when I was a kid, my family would make a semi-annual August road trip to Summerland, B.C., in the heart of the Okanagan Valley. It’s where my dad grew up.

The Okanagan has always been a hot, dry place. The fruit trees and vineyards thrive only thanks to irrigation.

My grandmother lived in a little white stucco-coated bungalow at the north end of town. Though she had no AC, Granny Blacklock knew how to keep cool. She kept her room-darkening curtains and blinds closed throughout the day. A fan or two helped circulate cooler air from the north windows. Summer after summer for close to 92 years, she survived the Okanagan heat. I wonder if she would have survived the heat dome.

The local cherry crops didn’t. Farmers were expecting the first good harvest in three years, but extreme heat left the trees laden with clusters of shrunken, wilted, and burned fruit. In order to avoid a district-wide boil water advisory, the Town of Summerland announced water restrictions, and temporarily shut off some of the irrigation lines, putting the very trees at risk of dying.

On June 29th, Summerland’s temperature hit 42.8C, an all-time record. That record was shattered the very next day, as the temperature soared to 44.7C. Still, it could have been worse. Poor Lytton recorded Canada’s highest-ever temperature of 49.6C, before it burned to the ground, the victim of wildfire.

Meanwhile, SORCO, the Okanagan region’s only raptor rehabilitation centre, was overwhelmed by the demands of rescuing and reviving nests of starving, dehydrated baby birds of prey throughout the valley. Raptors and osprey. Eagles and hawks. Many of them already deceased. “The babies were literally hanging over the side of the nest and panting,” said SORCO manager Dale Belvedere, in an interview with Global News. The centre ran out of fish to feed the survivors, but thankfully received a 1000-pound donation from the Okanagan Nation Alliance.

Lake Okanagan’s fish, the dietary mainstay of many birds of prey, had been driven to the depths by water temperatures in the 28-30C range, six to eight degrees higher than usual. Recreational fishers (assuming they weren’t sensibly hunkered down near their air conditioners) were advised not to catch and release fish because water temperatures above 24C are generally lethal for salmon and rainbow trout. Still, it could have been worse. Out in Vancouver and all along the coast, more than one billion seashore animals ­— mussels, clams, sea stars, and snails — broiled on the hot rocks while awaiting the incoming tide. The putrid aroma of death was everywhere.

What’s lethal for cherries and raptors and fish and mussels is unlikely to be healthy for humans. Fortunately, people have a few more options than fish. After an estimated 70,000 people died during the European heat wave of 2003, the importance of early warning systems and public health measures became apparent. As a result, even before last week’s real heat hit, the B.C. news was rife with advice on how to safely avoid heat exhaustion and heat stroke, and portable AC units had sold out everywhere.

My Okanagan cousins all made it through the heat wave alive. Still, it could have been worse. And it was. Throughout B.C., there were 719 sudden deaths in one week, triple the usual number. Many of them were seniors who baked to death in their own homes.

My Granny Blacklock was above all a practical woman. She would have heeded the warnings and stayed indoors. She’d have put off walking to the supermarket and made do with leftovers. And she had family around to check on her. Still, her strategies for staying cool had serious limits, and it’s usually the most vulnerable among us who succumb. My Granny could have been one of them.

Why aren’t Medical Students Learning about Climate Change?

Originally published in the Sudbury Star on June 26, 2021 as "Climate change a health issue; medical students should be learning it"  https://www.thesudburystar.com/opinion/columnists/climate-change-a-health-issue-med-students-should-be-learning-it?

Fifteen months ago, when COVID-19 brought down the curtains on Broadway, on air travel, on eating out in restaurants, on getting together with family and friends, and even on being present with loved ones who were dying, everything changed.  Suddenly, we were forced to see all of life through the lens of a brutal and unrelenting virus, and to reckon with the consequences of our lack of preparation. Most of us understood that an unprecedented threat required an abundance of caution, and accepted the limits placed on our lives.

First year medical students took their classes on-line. No doubt, like generations before them, they learned about the influenza virus and its proclivity for genetic drifts and shifts. Drifts cause year-to-year variations in severity. Shifts can cause deadly global outbreaks, like the Spanish flu pandemic of 1918-19. No doubt it was all very real and relevant, given these COVID times.

On the whole though, pandemics don’t get much attention in med school, at least until one strikes. Then suddenly the topic becomes inescapable, infiltrating every nook and cranny of the curriculum.

Back in 2015, then-US President Obama convened a meeting at the White House to discuss how to squeeze coverage of what is arguably the 21st century’s most pervasive health issue into the curriculums of US medical and nursing schools. Presumably he thought it would be important for emerging health professionals to be educated about the dire health implications of climate change, the complicity of the American health care system (which produces 8-10 percent of US greenhouse gas emissions), and the tremendous health co-benefits of a rapid transition to clean, sustainable energy.

However, unlike the novel coronavirus, which quickly acquired its rightful place in medical education by dint of its obvious urgency and immediacy, climate change, and all the other planetary derangements that term has come to stand in for, have yet to be accorded more than token recognition within the curriculums of most medical schools in Canada. Somehow, our dangerous interference with the planet’s life support systems has not inspired the needed sense of urgency.

The teaching session I’ve personally started offering to 4th year medical students during their pediatric rotation is not actually part of the pediatric curriculum. It exists only because I’m willing and insistent. That isn’t how things should be. After all, our pediatric patients have by far the most at stake; they have many decades ahead of them on this planet. Their physical and mental health are already being impacted by the state of the planet, and unless things change drastically, their lives will increasingly be defined by dangerous global heating, melting ice and permafrost, sea level rise, unprecedented fires, droughts, and storms, acidified and deadened oceans, and the sixth great extinction of species.

You might think that teaching about the impact of planetary derangement on human health would have become an integral part of medical school curriculums by now. It’s not brand new knowledge, by any means. But there are obstacles. That seeming lack of “urgency”, for one thing. And lack of time. And a certain lack of expertise about the issue amongst those who teach.

Ironically, much of the impetus for change is coming from medical learners themselves. Several years ago, the Canadian Federation of Medical Students formed a subgroup called HEART, which conducted a national evaluation of medical school teaching about planetary health in 2019. Not surprisingly, they identified “clear opportunities” for improvement. They’ve also created an evidence-based set of “core competencies”, which provide a framework for developing curricula within medical schools nation-wide. We can only hope their efforts are taken seriously by those whose job it is to ensure that medical education remains accountable to the current and future needs of society. Afterall, neither societies nor people can remain healthy on a sick planet.

Sources:

Hackett F et al. Training Canadian doctors for the health challenges of climate change. The Lancet/Planetary Vol. 4, January 2020

https://blogs.bmj.com/bmj/2019/09/26/climate-change-is-impacting-population-health-and-our-future-patients-remaining-silent-is-not-an-option/

Xie E et al. Students help shape medical education to keep up with the times. CMAJ 2018; 190:E1486. doi: 10:1503/cmaj.70816

Wellbery C et al. It’s time for medical schools to introduce climate change into their curricula. Acad. Med.2018 December; 93(12):1774-1777.

And many more available on request.

The Unhealthy Tip of the Climate Change Iceberg

Originally published in the Sudbury Star on June 12, 2021 as "The tip of the climate change iceberg." https://www.thesudburystar.com/opinion/columnists/blacklock-the-tip-of-the-climate-change-iceberg

On April 15, 1912, the Titanic hit an iceberg and sunk. It wasn’t the exquisite blue-white peak of ice we see in photographs that doomed the supposedly unsinkable ship to a watery fate. The real danger in icebergs lurks below the surface, unknown and unmeasurable. Or at least that’s how things were before radar was invented.

We who live in 2021 are faced with a metaphoric iceberg of our own, and one of gargantuan proportions. This iceberg (yes, it’s a melting one) is a human creation called climate change, and we’re steaming straight towards it at full speed. We’ve studied our iceberg extensively, and we’ve made progress understanding the risks we face. We already know enough to compel any sensible ship’s captain to reverse course and make haste for a safe port. But such a manoeuvre would require courage, and a sense of urgency we still seem to lack.

Mostly, we’ve been busy scrutinizing the tip of our iceberg. And so, when the Canadian Institute for Climate Choices recently attempted to calculate the health costs we’re going to face as a result of climate change, they encountered some significant limitations. To date, most research has focused on the kinds of dangers we’re familiar with, on the impacts and risks that lend themselves to measuring and modeling. But other potential perils lurk beneath the surface.

The Institute’s report came out on June 2nd, just in time for this past week’s heat wave and spate of air quality alerts. As it happens, the well-studied tip of the climate iceberg features health threats like heat waves, air pollution in the form of ozone at ground level (where we generally do our breathing), and of course Lyme disease, which migrates further north with each passing year. 

Heat and ground level ozone are killers and they often keep company. Ozone is produced when sunlight ignites chemical reactions between air pollutants like nitrogen oxides and volatile organic compounds (VOCs), much of which arise from burning fossil fuels. Heat speeds up the process.

Now. . . assuming it’s actually possible to put a monetary value on a human life, the report calculates that deaths from ground level ozone could cost us $50-100 billion by 2050, depending on whether we turn the emissions ship around immediately, or keep barreling on at top speed. Throw in another $3-4 billion for heat-related deaths, and $7-15 billion for the loss of productivity that accompanies excess heat, and you have what we can predict with confidence.

What’s even more concerning, however, are the unknowns. Afterall, some 90 percent of an iceberg hides underwater, its dangers yet to be discovered, its costs yet to be reckoned. How, for example, will an unstable climate affect the economy, and our capacity to even provide health care? How will the ensuing destruction of much-loved ecosystems and rising species extinction rates affect our mental health, which is already in rough shape due to COVID.   

And whose health are we concerned with here anyway? Whose lives and deaths are we presuming to calculate? Probably not those of the rich and reasonably well-off. They will have access to air conditioners, and the option of staying indoors when it’s too hot or smoggy outside. As always, it will boil down to the usual risk factors, things like income, age, race, education, working conditions, internet access, and so on. And on.

So what does the Institute report recommend? It suggests we promptly change course and hightail it to new destination. Unfortunately, we’ve left it rather late. Big boats can’t turn around on a dime; we’re not going to escape giving the iceberg at least a serious glancing blow. Clearly it behooves us to make sure that everyone on board has a life preserver, and access to a lifeboat. Especially the most vulnerable among us.    

Sources:

https://climatechoices.ca/reports/the-health-costs-of-climate-change/ (accessed June 9, 2021)

Active Transportation: Good for You, Good for the Planet

Originally published in the Sudbury Star on May 29, 2021, as "Burning calories, not fossil fuels, should be our mantra." https://www.thesudburystar.com/opinion/columnists/blacklock-burning-calories-not-fossil-fuels-should-be-our-mantra

Back in the day, before the pandemic, it was common to visit places like New York City. While touring the Big Apple, you might have encountered a sign prompting you to:

                                                   “Burn Calories, Not Electricity

                                                                Take the Stairs”

And if the stairs were easy to find, appealing, and safe-looking, you’d have been tempted to use them. One of the people you could thank for your unexpected short burst of exercise would be Canadian public health physician Dr. Karen Lee, author of the 2020 book Fit Cities.

As Dr. Lee points out, we humans don’t like grimy, obscure stairwells with poor lighting and peeling grey paint. It’s no wonder we don’t use them. Instead, we let electricity do the work, while our bodies get heavier and our blood sugars and blood pressures soar.

Ditto for our transportation. We think of exercise as something we squeeze into our lives (or not) in the form of workouts; meanwhile, when we need to go somewhere, we'll probably take the SUV. Why is this? Are we just lazy? Do we no longer have legs? A wealth of research suggests it's much more complicated.

Over many decades, we've made some serious urban planning mistakes. We’ve designed and built our cities for the comfort and convenience of our cars and trucks. We live in sprawling, disconnected neighbourhoods. Multi-lane streets, big box stores, strip malls, parking lots, and retail-by-car have become our norm. Many of our intersections are ugly, intimidating, and potentially dangerous for people on foot, with traffic lights programmed not for the service of pedestrians but to ensure traffic flow. Riding a bike around town can be life threatening.

It could be different. Just the other day, I met a lucky guy who walks to work. His commute entails about 40 minutes of brisk walking each way. It takes him along shady, forested trails, through the university, and along Ramsay Lake Road, which has heavy traffic, but also features a rare dedicated walking/bike path with plenty of trees.

If this fellow walks to work regularly, he’ll accrue about 280 minutes of moderate aerobic exercise each week, almost twice the recommended minimum. He'll also save 80 bucks a month on hospital parking. He'll save on car insurance and gas. He'll avoid broken axles from hitting Sudbury potholes. He'll save on gym memberships. He'll burn calories. He’ll be healthier, both mentally and physically, with a lower risk of obesity, diabetes, high blood pressure, heart disease, strokes, and many kinds of cancer.

Regrettably, many people who might walk or bike to work face something quite different: poorly maintained sidewalks, long distances with nothing interesting or beautiful to look at, noisy cars and trucks rushing hither and thither, car exhaust, blazing sun with no trees or shade, not to mention risk to life and limb. It can seem too inconvenient, too unpleasant, or too dangerous to get around by burning calories. And so we burn fossil fuels instead.

But change is in the air. Dr. Karen Lee would undoubtedly applaud the construction of dedicated (and hopefully safe) bike lanes currently underway in Sudbury. She’d probably design prompt signs that say:

                                                “Burn Calories, not Fossil Fuels.

                                                            Bike to Work.”

 Elaine Blacklock M.D. F.R.C.P.(C)

Sources:

Lee, Dr. Karen. Fit Cities.  Doubleday Canada 2020. 

Put a Price on Carbon Pollution; It’s Good for our Health!

Originally published in the Sudbury Star on May 15, 2021, as "A price on pollution is good for our health." https://www.thesudburystar.com/opinion/columnists/blacklock-a-price-on-pollution-is-good-for-our-health

It turns out the current COVID-19 lockdown has a rare silver lining. With nothing much else to do, I’ve embarked on some spring cleaning. Like most people, I’ve accumulated way too much stuff, so I’ve been dumping miscellaneous items at the curbside, hoping they will disappear. (It’s amazing what people will haul away.) I hired my daughter to sell redundant clothes on-line. And though I hate throwing stuff out, the stuffed garbage bags have piled up in my already overstuffed garage.

These days, the City of Greater Sudbury only takes two bags every second week. So I ask Siri where extra garbage tags are sold. I drive to Shoppers and fork out the $2-per-tag user fee. The whole process is intentionally annoying and visible. It’s a nudge towards the three Rs: Reduce. Reuse. Recycle. It reminds me that consumption has consequences. The planet doesn’t dispose of my garbage-pollution for free. There’s a cost. A price we’ve been ignoring for too long.

In days gone by, we humans made our messes, and expected the planet to mop them up. But we’ve multiplied to almost 8 billion people, and the Earth can no longer absorb our impact. Collectively, we’re rapidly wrecking the place, crossing one planetary boundary after another. We’re even managing to change the climate. Things have reached the point where it can no longer be “free” to spew greenhouse gases, poisons, plastics, and waste of every conceivable sort into our air, water, and soil. Pricing pollution is an idea whose time has come. 

Truthfully, it never was free to pollute. It’s cost us dearly. The impact on human health alone has been enormous. There’s hardly an ecosystem left on Earth that isn’t contaminated with plastics and poisonous chemicals. Air pollution kills millions of people every year. And because the atmosphere has no boundaries, air pollutants don’t stay put. Some days, a significant proportion of the nastiness in California’s air is from China!

Greenhouse gases, however, are the consummate global pollutants. Whether they’re produced by a factory in Pittsburgh, a hospital in Saudi Arabia, a fire in the Amazon, or by my neighbour driving his SUV to work, they affect everyone everywhere, and will continue to do so, centuries after they reach the atmosphere. It’s going to get harder and harder for humans to stay healthy on a planet with a treacherous and unpredictable climate.  

Which brings me to a short paper I found recently in the British medical journal The Lancet, called “Health benefits of a carbon tax.” [883] We Canadians have a nicer name for such taxes: greenhouse gas pollution pricing.

A visible and rising price on pollution is a firm nudge. It helps us reckon with the true costs of burning fossil fuels on a finite planet. As coal, oil, and gas become less economical sources of energy, individuals and corporations will reconsider their options. And that could have huge and immediate benefits for our health. The air in our cities will be cleaner. We will rethink our dietary habits, our modes of transportation, and our consumer behaviours. Human energy might even become a “thing” again, as we rediscover our bicycles and our own two feet as modes of transportation. Chances are, we’ll all get more exercise. Our weights, our blood sugars, our blood pressures, and our health care costs will go down.

And here’s the best thing: each spring, we can look at our income tax statements, and see our rebate on the extra money we forked out to pay for our pollution. (not visible enough, Justin) 

Finally, since I’m a doctor, I’ll leave you with one last health tip: spring cleaning is an excellent form of exercise. It’s great for your physical (and mental) health, even if it does generate garbage. I racked up over 19,000 steps in a single day!

Sources:

https://www.sciencedirect.com/science/article/abs/pii/S0013935121000487

Haines A et al. The Imperative for Climate Action to Protect Health. NEJM 2019; 380;3:263-73.

Frumkin H and Haines A. Global Environmental Change and Noncommunicable Disease Risk. Annu. Rev. of Public Health 2019, 40:261-82

Not on the Peds Conference Agenda: The State of the Planet

Originally published in the Sudbury Star, on May 1, 2021, as "Climate Change, Human Health, and the State of the Planet" https://www.thesudburystar.com/opinion/columnists/blacklock-climate-change-human-health-and-the-state-of-the-planet

Last week, I attended a 3 ½-day medical conference, hosted by one of Canada’s great pediatric hospitals. The event was, of course, virtual. Through my laptop screen, I had access to some of the world’s top experts in children’s health from the comfort of my home. No drive to Toronto. No expensive hotel for four nights. No meeting up with old friends. No dining out. No hitting the theatre district to finally see Hamilton. There are a few pros and a great many cons to the limited life we currently live.

The conference featured a myriad of topics, but if I had to pick out an overall theme, it just might be this: there’s not much new under the sun. The social determinants of health still rule. They still predict how healthy or unhealthy we are.

Take a journey back in time to the great influenza pandemic of 1918-19. In Chicago, deaths from influenza and pneumonia correlated strikingly with neighbourhood literacy rates. Now fast forward back to the present. Right here in Canada, in 2020/21, rates of COVID-19 infections, admissions to hospital, and deaths correlate not only with our age, but also with our postal codes, our incomes and ethnicities, our employment and access to paid sick leave, and of course our general state of physical and mental health. Which correlates with our housing and food security, our education levels, our internet access, our transportation options, our ability to access health care and childcare, and so much more.

Of course, these social determinants of health have always been with us. Social workers are all too familiar with them. Medical and nursing students continue to write essays about them. But lest we forget, and we tend to, COVID-19 has thrust them right back in front of our faces.

Now you may be wondering, is this not an environment and health column you are reading? Indeed, it is. So, here’s the link: think about the determinants of human health as a big pyramid with a big round bottom. At the narrow top is the health care system. The fat middle is stuffed with all the social determinants of health. And the broad bottom undergirds and cradles all health.

 Or if you prefer, think about a bird’s nest. A sturdy frame built of sticks perched amidst the tree branches, enveloping and supporting the soft warm lining which shelters and protects the baby birds. Without the frame, nothing else thrives or grows. Everything falls apart.

In these analogies, the broad bottom of the pyramid, and the rigid structure of the nest, represent the ecologicaldeterminants of health: a stable climate with vibrant, functioning ecosystems, clean air and water, fertile soil, predictable temperatures, rainfall patterns, and sea levels, and the absence of poisons in the environment. This is the planet upon which we humans have created our civilizations, engineered the social determinants of our health, and built our health care systems.

The pediatric conference had record attendance this year, from all around the world. Alone together we cheered on the latest advances in medical care. We honed our skills in caring for some of the most challenging pediatric issues. We pondered the reality that in a country like Canada, one’s chances of dying from COVID-19 are melded to the colour of one’s skin. And yet, in three and a half days, there wasn’t a single mention of the other looming health threat of the 21st century: climate change and the critical state of the planet’s health.

So I’m going to mention it. Climate change is a health threat. And not just for polar bears. We humans had better stop covering our eyes with our masks and start paying attention to the ecological determinants of our health, lest they deteriorate irrevocably, right before our blinded eyes.

Sources:

Kyra H. Grantz et al. PNAS 2016;113:48:13839-13844

Burn Calories, not Fossil Fuels - Use Human-powered Transportation

Originally published in the Sudbury Star as "Human-Powered Transportation Benefits People and the Planet" on April 17, 2021. https://www.thesudburystar.com/opinion/columnists/blacklock-human-powered-transportation-benefits-people-and-the-planet

One possible way to look at human history goes like this: as the centuries and millennia rolled by, humans increasingly co-opted other energy sources to supplement their own blood, sweat, and tears. The combustion of wood, peat, dung. Oxen. Horses. Slaves. The energy of wind and flowing water. The stored chemical energy concentrated in coal, oil, and natural gas. Nuclear power. And finally, the energy of the sun, captured directly.

We’ve also helped ourselves along by mastering the use of the wheel, levers, and other principles of physics to reduce the effort required to do stuff. 

Things have gotten to the point where, what with electricity to power our washing machines and dryers, our stoves and fridges, our smart phones and computers; natural gas to heat our homes and our water tanks; gasoline and diesel to power our transportation, it takes precious little bodily exertion to get through most days. Meanwhile, many of us routinely take in way too much energy in the form of food. (Not everyone in the world is so lucky, of course. A good many people live in energy poverty.)

The plethora of energy available to us has improved our lives in many ways. On the other hand, it has also sickened us. It's led to unprecedented levels of inactivity, obesity, Type 2 diabetes, and all the complications thereof. And of course, it's also led to climate change and a general derangement of the planet.

Although some people's jobs do involve great physical exertion, most of us spend our days sitting. Our energy expenditure in day-today life has shrunk so much that, in order to stay healthy, we have resorted to taking up exercise regimens each New Year’s Day. We drive to the gym for our workouts, or at least we used to, before the pandemic. We have treadmills in our basements, on-line Pilates classes, and exercise bikes. Sometimes we even go out for walks in our neighbourhoods. We get a dog, so we'll have to walk. Our dog gets obese.

What we hardly ever do is use active transportation. Old-fashioned human-powered energy to get ourselves anywhere, especially places we actually need to go, like work, school, the grocery store, even the mailbox. Isn't that what our SUVs and trucks are for? And so we spew out air pollutants and greenhouse gases, even as we ourselves get fat and unhealthy. Our cities sprawl, acquiring more roads, more traffic congestion, more parking lots, and more potholes. Our lakes get more salt. Our forests are chopped down, our farmlands paved over.

There are exceptions to the rule, of course. Here’s one: health professionals Jim and Shannon Boland regularly bike to work at Health Sciences North Sudbury, saving money on cars, gas, parking, and transit. They also get free exercise. Jim gets stronger legs for his golf game. Shannon gets sheer joy and mental health benefits. And the planet gets a few less exhaust fumes, and maybe, eventually, a few more safe bike lanes.

The health co-benefits of serious action on climate change have been well-studied over the last decade. The two most obvious examples are the health impacts of reduced air pollution and  active transportation. Health professionals could turn the co-benefit logic around. We’re always recommending more exercise anyway. So let’s go further and promote not just mere exercise, but the use of human energy to get places, on foot or by bike, or with the help of e-bikes and e-scooters. The result would be fitter healthier people, cleaner air, and a considerable climate co-benefit. 

The voices of health professionals carry weight. In Toronto, a group of physicians has started an organization called Doctors for Safe Cycling, bringing their health expertise to the ongoing debate over bike lanes. Northern Ontario health professionals should not be left behind. Active transportation is a tremendous health opportunity, for both the planet and its people. 

 Elaine Blacklock M.D.F.R.C.P.(C)

Sources:

Haines, Andy. “Health co-benefits of climate action.” The Lancet Planetary-Health. Vol. 1: April 2017.

Assemi et al. “Transport-related walking among young adults: when and why? BMC Public Health (2020) 20:244. https://doi.org/10.1186/s12889-020-8338-0

Kelly P et al. “Walking on sunshine: scoping review of the evidence for walking and mental health. Br J Sports Med 2018; 52:800. https://doi:10:1136/bjsports-2017-098827

Pekka O et al. “Effects of frequency, intensity, duration and volume of walking interventions on CVD risk factors.” Br J Sports Med 2018; 52:769-775. https://doi10.1136/bjsports-2017-098558