10. Climate Action

Sustainable Development Goal 13: Climate Action, focuses on taking urgent action to combat climate change and its impacts.

Dr. Paula Braitstein is an epidemiologist living and working in Kenya since 2007. Most of her research has been oriented around major health and social issues in East Africa including HIV prevention, treatment, and the cascade of HIV care, and high risk children and youth including those who have been orphaned (from HIV and other causes), separated, abandoned, and those who are street-connected. Dr. Braitstein is a CIHR Chair of Applied Public Health Research, and won the 2017 CIHR Institute of Public and Population Health Mid-Career Trail Blazer Award for her work with street-connected and homeless youth in East Africa. In addition to doing her own research, Paula is Co-Field Director of Research for the Academic Model Providing Access to Healthcare (AMPATH) Consortium in which the University of Toronto (Faculty of Medicine and the Dalla Lana School of Public Health) is a partner. Dr. Braitstein is a passionate environmentalist in Kenya and leads a graduate seminar course on planetary health for the DLSPH and Moi University, School of Public Health (Kenya).

Victoria Haldane is a PhD candidate at the Institute of Health Policy, Management and Evaluation, she is also a student in the collaborative specialization in global health at the DLSPH. She is co-founder of Emerging Leaders for Environmental Sustainability in Healthcare (ELESH) and a junior fellow with the Centre for Sustainable Health Systems. Her research interests include implementation science to improve quality of care, health systems resilience, and making our health systems better for people and the planet.

CREDITS: This podcast is co-hosted by Dr. Erica Di Ruggiero, Director of the Centre for Global Health, and Ophelia Michaelides, Manager of the Centre for Global Health, at the DLSPH, U of T, and produced by Elizabeth Loftus. Audio editing is by Sylvia Lorico. Music is produced by Julien Fortier and Patrick May. It is made with the support of the School of Cities at U of T. 

Transcript

Ophelia Michaelides [00:00:07] I'm Ophelia Michealides. And this is healthy cities in the SDG era, a podcast about the Sustainable Development Goals and how research conducted by faculty and students at the University of Toronto is helping to achieve them. We're recording from Toronto or Tekaronto, which for thousands of years has been the traditional land of the Huron-Wendat, the Seneca and the Mississaugas of the Credit. Today, this meeting place is still the home to many indigenous people from across Turtle Island and we are grateful to have the opportunity to work on this land. In this episode, we'll look into SDG 13, which focuses on taking urgent action to combat climate change and its impacts. SDG 13 targets include strengthening resilience to climate related disasters, integrating climate change measures into national policies and strategies, and on improving education, awareness and capacity. On climate change mitigation, adaptation and impact reduction. Climate change is widely regarded as the most significant global threat to human life and biodiversity that the world faces in the 21st century. A landmark report released by the Intergovernmental Panel on Climate Change, or the IPCC in 2019 titled Global Warming of 1.5 degrees Celsius, clearly stated that in order to prevent catastrophic outcomes of climate change, rapid and drastic transitions are needed in the production and utilization of energy, land, infrastructure and industrial systems, all of which currently very heavily rely on fossil fuels. Current global efforts to address the climate crisis, including international treaties like the 2015 Paris Agreement, are insufficient to reduce carbon output at the rate and magnitude needed. In this episode, we'll speak with Dr. Paula Braitstein about the environmental and health effects of climate change with an urban environment and in particular in East African country contexts. Then we'll speak with Victoria Haldane, where we will focus on the role of integrating climate change related content and competences into public health, education, and some of the exciting student led initiatives that exist at the University of Toronto. 

Ophelia Michaelides [00:02:27] Dr. Paula. Braitstein is an epidemiologist living and working in Kenya since 2007. Most of her research has been oriented around major health and social issues in East Africa, including HIV prevention, treatment and the cascade of HIV care and high risk children and youth, including those who have been orphaned from HIV and other causes separated, abandoned, and those who are street connected. Dr. Braitstein is the chair of Applied Public Health Research and won the 2017 CIHR Institute of Public and Population Health Mid-career Trailblazer Award for her work with street connected and Homeless Youth in East Africa. In addition to doing her own research, Paula is Cofield, director of Research for the Academic Model Providing Access to Health Care or AM PATH Consortium in which the University of Toronto is a partner. Dr. Braitstein is a passionate environmentalist in Kenya and leads a graduate seminar course on planetary health for the DLSPH and Moi University's School of Public Health. Welcome, Paula. Thank you so much for being with us today. 

Paula Braitstein [00:03:34] Thank you so much. I'm happy to be here. Thanks for the invitation. 

Ophelia Michaelides [00:03:37] I'm really looking forward to exploring some very important questions around planetary health with you. As many of us are acutely aware, we are experiencing a climate crisis the world over, and many have described climate change as the principal global health threat of the 21st century. My question to you is, what do we know about the relationship between climate change and health, and how is this relationship experienced, particularly within cities? 

Paula Braitstein [00:04:08] Mm hmm. Very good question. So climate change is actually pretty well documented at this point to cause a wide range of health effects. It causes direct health effects, such as floods and heat waves, water shortages and landslides. It causes ecosystem mediated health effects, such as an altered infectious disease risk. So, for example, COVID 19, that causes reduced food yields because of these ecosystem mediated effects, you know, and a lot of mental health effects as well. It also causes a lot of indirect deferred or what we call displaced health effects, meaning such things as livelihood loss, population displacement. So migration, for example, and urbanization because of climate change. And so all of these are are examples of health effects as a result of climate and environmental change, really. In fact, climate change is one of only several environmental changes and ecosystem impairments that we're currently experiencing. Other ones are, for example, land degradation and deserts, location, biodiversity loss, freshwater depletion and contamination. And actually, urbanization and its effects have a very, very specific kind of a a role and an impact to be felt in all of us. So in terms of cities, you know, over half of the world's population today actually live in cities, and that's expected to double by 2050. So cities are magnets, really, for for people searching to make their lives better, you know, to serve in search of employment and prosperity. And North America, for example, has some of the most urbanized human landscapes in the world. You know, we estimate about 80% of the population in Canada. US is living in an urban environment. So what's happening, though, is that population growth, combined with economic growth fueling recent urban land expansion in North America and many other places, what's happening is that this is forcing the conversion of wild land and rich agricultural land into urban settlements. So while cities really help people to lift themselves out of poverty and cities generate 80% of the global GDP, in fact, they have a lot of they have a lot of health impacts as a result of poor air and water quality, insufficient water availability, waste disposal problems, and then things related to high energy consumption. And, you know, so in in a place like Toronto, you don't necessarily feel the health effects of high energy consumption. But in a place like India or Africa, you really do because the majority of people are dependent on bio char fuels like dung or wood or, you know, this kind of thing, things that you burn for cooking and heating and so on and so forth. So, you know, of course, people living in cities experience some things worse than others. So, for example, you know, the urban heat island effect is probably like a classic example. So what happens is that, you know, the sun is hot and and a city heats up. Like, just imagine in the summer, right? It's always hotter in a city than it is in the country. And it's because the city heats up, the concrete absorbs the heat, and then it's not able to cool down at night, usually because there's not a lot of green space. And so what happens is that heat builds and builds and accumulates. And so, you know, it creates this thing we call the urban heat island effect. Now, one thing to really note about climate change, climate and environmental change, is that the impacts of it are not experienced equally by everybody. There are really, really serious inequities and and ways in which people who are already vulnerable, people living in poverty, for example, the elderly, you know, they are more likely to experience those those negative health effects. So, for example, you know, if you're living in in an urban center like, say, wherever, Toronto, it really doesn't matter where. And there's a heat wave going on. Right. Hopefully you have air conditioning and hopefully you have a pretty spacious apartment with like a good breeze growing, going through it or whatever. But like people who are living in poverty or low income housing or, you know, even if they're homeless, you know, they have no option to do that. So like, you know, the classic thing is elderly people in small apartments, in urban centers. Without air conditioning. You know, they they die literally of heat exhaustion becaus... because it just gets too hot and they don't have the money to be able to buy the things that would help to cool them down. And of course, it is worth mentioning that air conditioners actually contribute to global warming. Right. Because they consume a huge amount of energy. So there are there are trade offs all the way around. Now, what's also very interesting is that, in fact, you know, urban environments are also vulnerable to issues around food and security and water and security. So classically, we think of people living in rural areas as being the ones most vulnerable to the food insecurity effects of climate change, like drought, for example, or extreme flooding. But in truth, you know, like urban environments are are are equally at risk, but in a very different way. So imagine that there's some kind of, God forbid, natural disaster that happens like that affects northeastern North America. Okay. And transport systems are down. Communications are down. There's you know, what is that going to do that's going to affect supply chains? And supply chains are the lifelines of cities, because without those supply chains. Right, the stores don't get replenished. So, you know, people will be able to survive probably a few days with what they have in their cupboards pretty soon. I mean, as we saw with COVID, they're going to go to the stores and hoard large amounts of of of essentials. But, you know, if they don't get replenished and people are running out of things and getting hungry, you know what's going to happen. People are going to start rioting and looting. And, you know, it's like it could be really disastrous really, really quickly. So we were lucky with COVID that supply chains, especially of food, were maintained. But, you know, that was a different kind of of a natural disaster that resulted from climate and environmental change. But, you know, something like I don't know. You know, rising ocean levels, for example. And a billion people are going to be living in urban centers around the world. I mean, in coastal areas and cities around the world, like within the next 20 or 30 years, a billion people. And and and as the water levels rise, which they are doing right. And we can see the effects already in South Asia right now with all these cyclones happening. Well, I mean, this we're talking about a billion people to be displaced. And again, of course, the people with who are well resourced. Right. Like, you know, the Donald Trumps of the world. I hate to say it, but they can always go somewhere else. They have like another place to go. But it's the people who don't have anything to fall back on. Right? Who lose their livelihoods, their homes. They're the ones who are going to be forcibly displaced, become climate refugees. And and and then, you know, it affects it affects everything. And all of those people who are displaced, of course, need to eat and drink water and wash their hands and defecate every day. And, you know, I mean, these are these are some very, very serious problems that we're already facing. And, of course, you know, we just experience them and in different kinds of ways. 

Ophelia Michaelides [00:12:51] Mm hmm. I mean, it's certainly a very, very complex relationship. And, you know, just struck me, I was I heard last week, actually. So some of the small, small Polynesian island Vanuatu is having conversations as of late with New Zealand as I last heard around the expectation that the whole entire island will be underwater, you know, in X amount of years. And so they're talking on a national level around relocating an actual nation, which blows my mind, really, and speaks to a lot of what you were saying. You know, clearly that there are so many layers to the to the types of environmental and health effects that we experience as our environments experience change and impairment, as you mentioned. And one of the things that particularly struck a chord with me is the disproportionate effect of climate change on the health of underserved populations. As you mentioned, the elderly and people who are[..] do not have access to resources to be able to mitigate these effects. I'm wondering if this phenomenon can be extrapolated to a different scale, and I think you alluded to this as well. On a regional scale, perhaps, you know, how do low and middle income settings experience climate change in different ways? And how does climate change impact health for those living in low and middle income settings? 

Paula Braitstein [00:14:21] Well, yeah. So as I said, you know, we call climate change a risk multiplier. So whatever either an individual or a country's vulnerabilities are in general, you know, weak infrastructure or rain dependent agriculture. Right. You know, all kinds of things, really. Like with climate change, their risks become multiplied many times, you know. So, for example, take Kenya, for example, where where I live, you know, we have we are experiencing presently all kinds of ways that climate change is is affecting us here differently from higher income countries. But we have both severe drought. And this is actually typical of all of these to Africa, we have severe drought and then we have extreme floods. And of course, a lot of these are are driven by climate change. But then we also are not prepared to deal with them and experience worse effects of them, because, for example, the city of Nairobi is built on a swamp. And so whenever it rains, the streets become totally flooded. 

Ophelia Michaelides [00:15:39] Mm hmm. 

[00:15:39] And the other piece of this. Okay, so that that causes chaos, of course, all over the city. And especially poor people are living in the more low lying areas. You know, their places get flooded out routinely there. Their their housing becomes either destroyed or uninhabitable. And, you know, these are often temporary dwellings made of whatever people can find iron sheets, mud sticks, you know, that kind of thing, plastic sheeting. And so extreme droughts, extreme flooding, locust invasions. And, you know, people here are highly dependent on subsistence farming, right. To be able to eat and which, interestingly, in some ways actually makes them more food secure because they're not dependent on supply chains. Hmm. Okay. Just going back to what I said earlier, but they are very dependent on the weather. So like right now in western Kenya, this time of year, it should be raining quite a lot. And it's not all the farmers have planted their wheat, their maize, and there's no rain. And people are starting to really worry because this could this could cause crops to fail. And if they do, then that has like massive consequences, right, for nutrition and food security of of people in Kenya and and especially people in Kenya without without a lot of money who really depend on the produce that they that they produce themselves from agriculture to to feed themselves and their families for the year. So, you know, the drought and, you know, causes a lot of livestock deaths. And livestock is a major source of capital for a lot of communities and families here. And and what happens is that as as people are kind of driven out of their agricultural areas because because there's no food and there's no money. And so they they move to urban centers, right? They move to the cities. But you have to have money to live in the city, right? To be able to rent or rent a place to live and purchase food. You can't really grow most of your own food in the city, at least not the way cities are set up today. And um...and what this is doing is creating like, you know, we have urban sprawl in Canada and and that has, you know, as I mentioned earlier, it's got a lot of issues right it... Right. It increases like commuting, usually with cars because public transport doesn't go out there. It's eating up rich agricultural land. It's eating up wild land that should be preserved as wild, you know. But urban sprawl here is mostly unplanned. And so, you know, settlements are developed that are like extremely temporary and vulnerable to the effects of storms or winds or floods or whatever it is. And and there's a lot of homeless people. Right. And a lot of homeless children and youth specifically who are the are the focus of of a lot of my research, actually. And, you know, and so what what happens is that climate change drives these these other issues and kind of multiplies their... multiplies their magnitude and multiplies their impact. And so it's you know, like I said, it affects us in in direct and indirect ways. And, you know, and and the way people experience it in different places is usually different depending on their context. But we all experience the effects of climate and environmental change. It's just that we we tend to experience that a bit differently depending on where we are geographically and depending on our wealth and depending on our health, our baseline health. And so yeah, so these are all these are all part of it. It's, it's a kind of a complex issue in a way. But even though they're like so many different, it's almost like the, you know, the story of the eight blind man or whatever around the elephant. And everyone touches a different part. It's the way we experience it is different in different places, but it all kind of amounts to the same problem. Yes. Yeah. 

Ophelia Michaelides [00:20:20] Yes. I know that story of the the elephant and the and the blind man well...I love that one, actually. And I wonder and thinking of that analogy, you know, touching of the elephant and, you know, describing an elephant and what what you feel underneath your hand, that must be the elephant. And, you know, you described many ways that people are trying to individually mitigate against climate change, whether be, you know, around subsistence farming and and other other mitigating factors that people find for themselves. But, you know, you also mentioned a lot about the way, you know, where cities are located and how how they are designed. I'm wondering if you could you know, if we can think about and if you could tell us a little bit more about the environmental impacts of cities and in terms of their design and infrastructure. And, you know, what can we do to have some more sustainable alternatives, perhaps? 

Paula Braitstein [00:21:16] Mm hmm. That's a great question. You know, as it turns out, I only learned this relatively recently. But as it turns out, the construction sector accounts for, like almost 40% of greenhouse gas emissions. It's really pretty incredible, actually. 

Ophelia Michaelides [00:21:35] Wow. 

Paula Braitstein [00:21:35] You know, our cities, our streets, all of our urban infrastructure is basically built with concrete and steel. Right. And and so concrete, like is composed of cement, aggregate and water. And and it constitutes actually the most energy intensive manufacturing industry, in part because it relies on coal and petroleum, coke. And and then it all has to be transported. And usually the transport is is done by heavy duty, often diesel fueled vehicles, rail or ship. And and so it contributes enormously to our our greenhouse gas emissions. You know, the construction sector also accounts for a lot of emissions through production of steel. Steel also is very highly energy intensive, requires a lot of mining and destruction of land. And and, you know, the construction sector also generates 25% of waste globally and consumes 40% of natural materials and energy and uses 15% of fresh water resources. So, like, if we're ever going to get to net zero emissions, we really, really need to do things quite a bit differently. So so what does that look like? I mean, you know, there's there's a lot of ways to think about it. And I think there are a lot of lessons to be learned from indigenous communities worldwide because they've been creating dwellings and fostering ways of living that promote regeneration for thousands of years. Right. And so we really have to kind of think in a more quote unquote, "all my relations" kind of a way where everything is recognized to be interrelated, interconnected, and and we have to recognize also the relationship between ourselves as humans and nature and how this relationship also needs to change quite radically. Like right now, we have a very kind of extractive philosophy like, you know, let's USE our natural resources as opposed to recognizing that that we need to live. We depend on these things and we need to, like, you know, really try to live in some kind of, you know, harmony with nature. And I can talk about that Now, sustainable housing is generally used to describe the process as it applies to the housing industry. Basically less waste, more reuse and recycling of local resources, lower life cycle, environmental impacts and costs, etc.. But, you know, I think it's important to start thinking about sustainable housing as a as a broader concept that kind of touches on the sustainable development goals together. Okay. So for example, in the Brundtland report from 1987, Sustainable Housing, Sustainable Development was defined as housing that meets the needs of the current residents without compromising the ability of future generations of residents to meet their own needs. So this includes not only ensuring minimal negative environmental impacts, but also actively preserving the air, water, soil and biodiversity of the land where the housing is. It involves environmental stewardship, risk mitigation, integration of, you know, climate change mitigation techniques kind of into the technology. But it also incorporates the social aspects of things. And this is very important, you know, because we have a tendency to forget that housing is fundamentally a social ah..a social construct in a way, because housing is is so critical to human survival. And we are fundamentally social beings. And and so where we live is like it is crucial to how we live. And so, you know, we need to start to rethink how we live like these, you know, 50 storey apartment complexes, for example, that have, you know, hundreds and hundreds of apartments in them. They're basically like giant blocks of concrete and steel where people I mean, I've lived in enough of them. You feel like a rat in a maze going into it. And then you close your door and you don't really want to talk to anyone. You don't want to hear from anyone. If you hear noise, you're like, I call the police. 

Ophelia Michaelides [00:26:30] You know, you call the super [superintendent]

Paula Braitstein [00:26:33] Exactly. And really, when it comes down to it, that is not good for us. That is not good for us as a human species. Mm hmm. So, you know, we need to really think about, you know, how we incorporate issues around our interactions with each other, our relationships with each other, our sense of community. You know, the the whole where we work live and play concept and try and integrate it in a way that, you know, that is also environmentally sustainable. Right. So, you know, I didn't really talk about this much, but the mental health effects of climate change are also very, very serious and a lot of people. Have reported all kinds of mental health issues that are specific to living in cities. And there was a very interesting systematic review done that found that when you compared a natural environment to a synthetic environment, meaning like being in nature versus being in a concrete jungle, right? That the people and this is in a systematic review that people experience less anger, less fatigue, and were less depressed than people living in inner cities without a lot of green space. So, you know, we have to we have to make room for nature in our lives, first of all. And we have to change our relationship with nature so that we we recognize the sort of it's not even a symbiotic relationship. Nature will somehow manage to go on, even if we're not around. But if we are going to survive as a human civilization, you know, we need to we need to up our game as far as our relationship with nature. You know, if you look around when you're in a city and this is something I get my students to do in our planetary health class, it's called it's an adaptation from land based learning, which is an indigenous approach to learning. Okay. And so you look around, you go to some natural place where you are like your local park, and you ask yourself the question, what ecosystem services is this place providing? Is it, you know, is it even feeding a squirrel? You know, are we getting a bit of oxygen? What is it doing about water? Is it a does it have enough space to absorb any water or is it all just like running off, you know, and accumulating in our sewers and so on? And, you know, we just we need to we really need to rethink our relationship with nature, because right now, it's unsustainable. It's highly extractive. It's it's it's financialized. It's all about money. And we really need to like we really need to decouple our our use and management of our of our finite natural resources from our global economy. Because that's part of the problem, is that because we're we're so rooted in this global, you know, neoliberal, capitalist economy that monetizes that monetizes lumber and minerals and water and, you know, all these things that all of us all of us need and all of us, frankly, have a right to. You know, and and so we really need to separate those things and that that separation of how we manage and use natural resources from how we manage and use our global economy. Right. That's what we start trying to, like, create in terms of achieving a sustainable, circular economy where the where the products of what we're doing, you know, of natural resource use or whatever, go back into the system so that there is no waste. You know, there should be no waste in anything and. Yeah. So we need to stop thinking of ourselves as like at the, at the top of the food chain in a very kind of anthropocentric way, and start thinking of ourselves as part of an ecosystem that we are presently destroying. And frankly, you know, urbanization is is responsible for a lot of it, even though it only accounts for a small like 2% of global landmass or something like that. Cities account for like the lion's share by a long shot of greenhouse gas emissions, production of waste, energy consumption, all of these things and fresh water use. You know, we need to we need to change that because certainly the trends around urbanization are not going to change. And that's maybe not a bad thing. You know, we need to probably like like take 50% of our planet's like nature and say, okay, no more. This is the limit for us as humans. We have to protect that 50% of nature. We need to protect it for for for nature, right. For biodiversity. But we also need to protect it for food production. And so we need to figure out how we live in urban centers in a way that is sustainable, sustainable, environmentally, sustainable, economically and sustainable socially and equitable. Right. And it's really you know, it's a tough nut to crack, but we've we've got to figure it out. We've got to do it. And I have a lot of confidence that we can. Mm hmm. 

Ophelia Michaelides [00:32:29] So many things to consider and undoubtedly so fundamental to our survival as a species. And that's why is coming through loud and clear. And, Paul, I really I really love the way you frame our relationship to nature and and and how we need to consider how we live[...]We live. And like you mentioned and so I know you mentioned, you know, some small things that we can do as individuals. You know, when when you go to a park, what do you see? You know, how what is the lens that we apply? You know, do you have any, you know, maybe parting words around, you know, what can we do moving forward? Where do we go from here? We know where we are right now. We know what we need to do. But as an individual, is there any one particular action that we can take to revive and revisit and and strengthen our relationship with with Mother Nature? 

Paula Braitstein [00:33:30] Yes, that's a good question, too. You know, there's there's a lot we can do at an individual level and. You know the expression. It's a bit trite at this point, but think globally, act locally. I mean, it's incumbent upon all of us to make some changes in our lives. Yeah. So, for example, one one thing people living in cities can do is, is to pay attention to their food shopping and to try and buy food that is local and preferably sustainably produced. You know, the more we can kind of cultivate our own food consumption and food food production locally, that can make a big difference. So, you know, even even like a bit of gardening on your patio or getting involved with a community garden or, you know, honestly even just getting involved kind of socially with people that actually can begin to change how we see the world and how we see each other and how we see ourselves in all of that. But ya, to pay attention to nature, you know, to look around and notice like, my God, there is not a tree around here. You know, like, what sign of nature is there? You know, or if you see a bird, you recognize that the bird exists, like acknowledge it, you know, and and think about, think about what your relationship with nature is. Do you have one? A lot of people at this point, you know, who have grown up in cities virtually have no relationship with nature. They, you know, they might go out for a picnic or a nice nature walk or something like that, but effectively do not see nature as a part of their lives. And that's something that we that we really need to change. And we really need to teach our children the value of nature and not the value of nature in a monetary way. The value of nature for its for its beauty, for its ecosystem services, for its gift of life, because we are fundamentally dependent on nature for giving us life. And, you know, so if you think about biodiversity, wherever it is that you live and start noticing, noticing it, you know, that's a good place to start because it's it's it's actually kind of a way of a mindfulness approach, if you will. If, if there are some listeners, right. Who do mindfulness meditation, it's about kind of recognizing, becoming aware, watching and listening for, you know, signs of nature and indications of our relationship to it so that we can we can start to have a more sustainable relationship with it, as opposed to this kind of top down extractive relationship with it. Right. And, you know, nature is not just another pretty face. People, you know. 

Ophelia Michaelides [00:36:44] It's truly awe inspiring. That's for sure. 

Paula Braitstein [00:36:49] It is. 

Ophelia Michaelides [00:36:49] Yeah. Yeah, it really is. 

Ophelia Michaelides [00:36:52] Paula, I want to thank you so much for. For laying out what is an incredibly intricate and extremely important topic. And for, above all, for reminding us to revisit our own personal relationship with nature. Thank you so, so much for being on today's show. 

Paula Braitstein [00:37:10] Absolutely. My pleasure, Ophelia. Thanks too. 

Ophelia Michaelides [00:37:21] Victoria Haldane is a Ph.D. candidate at the Institute of Health Policy Management and Evaluation at the DLSPH. She is also a student in the Collaborative Specialization in Global Health. She's a co-founder of Emerging Leaders for Environmental Sustainability in Health Care and a junior fellow with the Center for Sustainable Health Systems. Her research interests include implementation science to improve quality of care, health system resilience and making our health systems better for people and the planet. Hi, Victoria. Thank you for joining us. It's wonderful to have you on our podcast. 

Victoria Haldane [00:37:57] Thank you so much for having me, Ophelia. 

Ophelia Michaelides [00:37:59] I am looking forward to exploring some very important questions around climate change with you. But before we begin, I'd love to know a little bit more about your involvement with the Center for Sustainable Health Systems, as well as the Group for Emerging Leaders for Environmental Sustainability in Health Care. What led you to becoming involved with these groups? 

Victoria Haldane [00:38:21] I'll start with emerging leaders for environmental sustainability in health care, or ELUSH, as we call it. And that was a group that emerged from a small committee at the Institute of Health Policy Management and Evaluation, or IHPME. And really, it began with a group of students hearing Dr. Fiona miller speak on environmental sustainability in the health system in her introduction to the Canadian Health Systems class. From there it was just this lightbulb moment of Yes, this is hugely important and the importance is only increasing. So if the health care sector were a country, it would be the fifth largest source of emissions globally. And as a trainee, we're always told that we're future health systems leaders. And the truth is, we will be leading health systems that both contribute to emissions and are also at the front lines of responding to the crisis that they're contributing to. So that idea really inspired us to create ELUSH, and it was really Anna Cooper Reid who is such a superstar. And together with Danielle Tockolino and Collin Su-Chu Lam and Anson Chung and many others, that we've grown it to be this interdisciplinary and pan-Canadian network of trainees and early career researchers who are leading the call for transformative change. And while ELUSH was beginning, I was also an intern at the Center for Sustainable Health Systems, where I'm now a junior fellow, and the center is a really great hub for this work in Canada. And it connects to the many other organizations and individuals across the country who are focused on improving the environmental sustainability of health systems and services and driving change for low carbon, high quality care. And then just to go on a little bit further, what really led me personally to get involved, it was that initial spark from Dr. Miller's class, partially as well as Anna's inspiring energy. And a large chunk was my own relationship with nature. So I grew up in British Columbia in an area really prone to forest fires. So I've seen both the beauty of nature, its healing powers, but I've also seen its destruction and its impact on health and wellbeing. So I think that's more of my personal call to action for this. 

Ophelia Michaelides [00:40:23] Mm hmm. Fascinating. And I'm really very glad to hear that these groups exist and are advocating for environmental sustainability efforts within the field of health care specifically. From what I'm picking up on what you've been describing, there seems to be a need for emerging leaders to be equipped with the awareness and skills to drive change in the field. From your experience in... in founding and participating in these student led groups, what have students, you know, in the health or public health arenas, what have they been doing to draw attention to the climate crisis? 

Victoria Haldane [00:41:00] It's a really great space to be a student in, actually, largely because it is such a youth driven movement. And of course, I'm being generous and calling myself a youth when compared to the amazing champions we have, like Autumn Peltier and Greta Thunberg. But when it comes to environmentally sustainable health systems, it's really a nascent area. So there's a lot of learning together that is happening and working collaboratively between students and faculty to both learn about this and teach others at the same time. So, for example, at HP, CME, a group of us from us, we worked with Dr. Miller to create a reading course specifically on environmentally sustainable health systems, because there was this gap in our curricula that we'd noticed. We had just had the introduction in a lecture in Dr. Miller's class, but then elsewhere it was absent. So we thought, okay, there's a gap, let's create something to kind of fill that need. And medical students globally and here in Canada have done amazing work to embed planetary health into their curricula. And we work closely with students to champion these ideas and kind of organize towards our common goals. So it's an interesting mix of advocacy and really getting buy in from our institutions and funders that, a), this is something we need to be learning about now, b) We have the tools to teach people about this and c) it's absolutely a competency that we need to have across the many disciplines that make up the health system, as well as linking it to all the social determinants of health and other public health crises that we're facing right now. 

Ophelia Michaelides [00:42:34] Victoria, as you've made the case, obviously the health impacts of the climate crisis demands that individuals and institutions adapt and mitigate the effects of climate change. I wonder if you could tell us a little bit more about our collective responsibility as a health care system towards climate change. You know, how can public health and health systems as well as, you know, education programs in these areas, how can they reduce their environmental footprint and improve resilience to climate change? 

Victoria Haldane [00:43:05] I think the first task is to get the idea out that our health system both contributes to and must respond to the accelerating impacts of climate change. And that's a bit of a tough tension to sit with. But we need to be aware that climate change is the greatest threat to health and wellbeing of the 21st century. And once we face that head on and recognize that, well, there will always be important competing demands for finite resources in health care. We can't ignore the climate crisis, and it's in our best interests and the interests of the communities that we serve to act and to be ambitious. And more so because the impacts of the climate crisis will disproportionately impact those communities that are already oppressed and underserved. So it's really a matter of social justice that we act ambitiously towards these goals and that we set these goals in the first place. So I think that's the first thing: recognition and awareness. And then of course, action. And this has to happen now and it has to be multi-pronged and interdisciplinary. So there's no one path to decarbonize the health system. And there's some amazing work being done to set and achieve goals to decrease emissions. And a lot of people talk about how the National Health Service in the United Kingdom, they've aimed to decarbonize by 2040. And I think Canada should be equally ambitious in our goals. And I was speaking as a trainee and as a researcher, really my lane is pushing at our academic institutions and more recently our funders to see how seriously we as trainees take the climate crisis and to ask them to be equally committed to funding and equipping emerging leaders with the competencies we'll need to lead these future health systems that are facing the climate crisis, because our future health systems will be even under greater pressure to decarbonize. And part of what we need to do, really, is permeate our training and permeate our research ecosystem with the idea with the idea that the ecological determinants of health are deeply important. And I always think about how not long ago a sex and gender analysis and training that we take it would have been unthinkable. And now it's mandatory. And you see the absolute critical importance of a sex and gender lens to research. And that's something that that's a change. That's something we've collectively agreed is of deep importance. And I'd really love to see a similar ecological lens, a social determinants lens, an indigenous health lens. As trainees and as researchers, we have to be ever expanding our worldviews and really embracing the complexities of the communities and the ecologies that we serve. It's really not enough to accept the status quo anymore because we see how harmful the status quo is to public health. 

Ophelia Michaelides [00:45:48] Thanks for these incredibly important perspectives and framings for what is a very complex issue as well. As with most things, it sounds like there's no single prescription but rather many ways to move the dial on a more environmentally sustainable health system for the public health students or early career practitioners listening to our podcast. What advice would you give them in acting to combat climate change and its impacts? 

Victoria Haldane [00:46:17] Well, they can certainly reach out and join ELUSH or get involved some way in our collective. But beyond that, I really think the most important thing we can do is to start to view things through an environmental lens. I think a lot of people are environmentally minded and care deeply about the planet already. But what I see is a lot of boundaries between personal beliefs and habits and bringing those into the professional realm. So there is this gap of how do I translate biking and using reusable bags and eating a plant based diet? How do I bring that energy into my research? And to me, it's really a lens you apply. And this can be done on many scales, so we can think about how we conduct the research. I do a lot of work in global health, so thinking about when I get on a plane to fly, why am I flying for how long? What is the impact of that? Is it a quick trip or am I going for a longer period of time to capacity build, build up resources and what's the net benefit of my travel? We can also think if we work with colleagues in labs, you can start to think about lab processes. Are they highly polluting? What's the waste going on? There's a lot of emerging work at U of T on environmentally friendly labs, and we can also think about the content of our research. So how does the environment or ecology factor in to the research questions that we're asking or the communities that we're partnering with? Of course, there's our curricula, so there's really a lot of room to bring this into the classroom and into our training because it's not always an obvious connection. So I think as emerging leaders, we really need to keep being vocal about the climate crisis and keep capacity building ourselves. A lot of this isn't going to be handed to us. We have to develop the competencies. The training is what we need. We have to partner, work with faculty, work with other health system leaders and other stakeholders, patients, their families, communities to build up this body of work. And I think only by working together and by really plowing ahead is the way we're going to make effective change. 

Ophelia Michaelides [00:48:26] Excellent and very practical and real tips, certainly for for many of us. Victoria, I want to thank you for your insights and for illuminating our individual and collective responsibilities in the health care space towards towards our planet. Thank you for your incredible efforts and for taking the time to speak with us today. 

Victoria Haldane [00:48:48] Thank you so much for having me. It's been great. 

Ophelia Michaelides [00:48:58] The conversations with our guests today have shed light on the urgency of the climate crisis and its implications for public health and equity. Dr. Braitstein highlighted the myriad ways in which urban development is unsustainable from the environmental toll of current infrastructure materials to the reliance on delicate supply chains to secure drinking water and food, to the vulnerability of coastal cities to rising sea levels. More action and innovation is needed in order to improve the sustainability, resilience and adaptability of urban settings. Our discussion also focused on thinking of the climate crisis as a risk multiplier which exacerbates individual or country level vulnerabilities, meaning that those with the least resources are most at risk of experiencing the worst impacts of climate change. As highlighted by Victoria Haldane, there are many ways to improve the sustainability and adaptability of health and public health sectors. These range from advocating for transformative change within health care systems to integrating planetary health related competencies into health and public health curricula. Our conversation with Victoria also highlighted the opportunities for public health students and early career professionals to make positive change in combating climate change and its impacts. Notably, students and early career professionals can build capacity to address the climate crisis by integrating an environmental lens into academic and professional practices. For example, in the content and processes of one's research. 

Ophelia Michaelides [00:50:32] Healthy cities in the SDG era is made with the support of the School of Cities at the University of Toronto, whose mission is to bring urban focused researchers, educators, students, practitioners and the public together to explore and address complex urban challenges. We would love to hear your thoughts on Healthy Cities and the SDG era. If you enjoyed this episode, please rate, subscribe and share. To help others find this series, you can find healthy cities in the SDG era on Spotify, Apple Podcasts and the Dalla Lana School of Public Health's YouTube page, as well as our Center for Global Health's website. Join us for our next episode where we'll look at SDG 15 Life on Land. Thank you for tuning in and we look forward to speaking soon. Take care.