Climate Change And Health And Well-Being In Canada's North: Report On A Public Health Planning Workshop On Climate Change And Health And Well-Being In The North - July 6-7, 2002, Yellowknife, NWT

July 6, 2002

Welcome and Objectives of the Workshop

• André Corriveau,
  Chief Medical Officer of Health,
  Northwest Territories

Opening the workshop, Dr. Corriveau welcomed the participants to Yellowknife. He reviewed the main objectives of the workshop which included:

• To increase awareness in the health community of the vulnerabilities and potential impacts from climate change on the health of citizens in the North.
• To identify current vulnerabilities, anticipated and already occurring climate change impacts, and the need for public health adaptation measures.
• To identify opportunities for collaboration between Northern health partners, and to define Health Canada's role in supporting the collaboration.

Dr. Corriveau then highlighted why public health groups in the North need to begin planning for adapting to climate change. He suggested that climate change is occurring and will continue for some time into the future. As well, climate scientists have indicated that of all regions in Canada, the North will be most affected by climate change. Climate change also may occur more rapidly than currently predicted. For all of these reasons, we therefore need to be better prepared for the impacts of climate change, and we need to be anticipatory rather than reactive in our public health response.

Presentations

Climate Change and Health: International to Local Action

• Michael Sharpe, Acting/Manager,
  Climate Change and Health Office,
  Health Canada

Mr. Sharpe began his presentation by highlighting the need to organize the health sector in the North to plan for the effects of climate change, given that it is such a broad issue. The Climate Change and Health Office at Health Canada is facilitating this coordination by linking the partners that deliver key health and social programs and services, including community health.

The Inter-governmental Panel on Climate Change (IPCC) has concluded that climate change is occurring now and will increase in the future. Climate Change is a truly global issue that will impact local communities in very different ways. It is quite clear from current scientific studies and observations based on traditional knowledge that the impacts of climate change are being felt in the North already. In responding to these impacts, we need to take a preventative approach to limit the effects of climate change on health and well-being. The focus of CCHO's work is on adaptation. At present, only about one tenth of CCHO activities are aimed at addressing greenhouse gas (GHG) mitigation issues. But CCHO has responsibilities under both climate change related issues.

Mr. Sharpe then reviewed the health story in climate change by discussing the Health Issues Table included in the workshop entry document "Climate Change and Health & Well-being: A Policy Primer for Canada's North". He noted that climate change is not a new issue, but is simply an important and significant stress that will add pressure to existing public health priorities in the North. We need to complete more assessments of the potential impacts on health from climate change in local communities to fully understand the policy implications. Traditional knowledge experts and policy research partners cannot perform all of the needed work; we need to include the scientists developing climate scenarios to identify likely future impacts.

CCHO does not advocate that a climate change and health program be developed in each jurisdiction in the North. Rather, the hope is that public health officials in the North will begin integrating climate change considerations into their existing work so as to address the possible impacts on health. CCHO facilitates this process, but ultimately, action must be taken at the local and community levels because this is where much of the mandate for protecting the health and well-being of people exists.

Questions:

During the discussion, one participant noted that because global cycles and patterns of weather change exist, it is never quite clear that the climatic changes to ecosystems in the North are actually due to climate change. Another participant remarked that even if this is the case, it is necessary to implement no-regrets policies to adapt to the health effects of climate change. Another commented that, in fact, the Inter-governmental Panel on Climate Change (IPCC), which includes over 1000 scientists, has concluded that climate change is occurring, and is at least partly due to human activities. In addition, regardless of the cause of climate change, the public health sector must take actions now to prepare and respond to these environmental changes.

One participant noted that climate change partnerships will be very important. A joint meeting between Health and Environment federal, provincial and territorial Deputy Ministers is being considered for this fall. This may offer an opportunity to build partnerships on climate change and health issues. Mr. Sharpe responded to this point by indicating that we need to be clear on what actions are requested from the Environment and Health Deputy Ministers before this is put on the agenda.

A participant shared some information on efforts to highlight the importance of the Arctic as an indicator region for climate change at the World Summit on Sustainable Development (WSSD), which is to occur this August in South Africa.

Regarding partnerships, a concern was raised because of the general focus on scientific research. It was noted that partnerships developed by the Inuit Tapiriit Kanatami (ITK) are very community- based and include traditional knowledge experts. The question was raised about how Aboriginal groups were going to be integrated into these processes, including those focussing on policy and adaptation. Mr. Sharpe responded by indicating that this meeting is an example of how Aboriginal groups are to be consulted and integrated on climate change and health issues. This is a policy meeting with public health decision makers and we are here to learn about how public health networks are organized in the North.

Climate Change in the North

• Chris Furgal, Unité de recherche en santé publique,
  CHUQ, Québec

Dr. Furgal began his presentation by reviewing what is known and what is not known about climate change - its causes and impacts. He indicated that we are already observing some warming outside what are considered normal measurements. As well, indigenous observations of climate change are showing a wide variety of impacts, and changes to ecosystems and climate that people have never seen in their lifetimes, nor heard of in stories.

With respect to human health, Dr. Furgal noted that we currently do not have sufficient climate scenario data to inform health impacts activities at the local level. A wide range of factors influence health, such as lifestyle, public health infrastructure, ecosystems, diet, and garbage disposal. These must be considered when discussing the impacts of climate change on health.

Dr. Furgal then provided an overview of the objectives, methods and results of a study on climate change and health in which he was recently involved, namely "Climate Change and Health in Nunavik and Labrador: What We Know from Science and Inuit Knowledge". This study indicated that using traditional knowledge is valuable because it shows us the complex relationships between northern ecosystems, human behaviour, local communities and human health. These are considerations which scientists sometimes overlook or do not capture fully enough.

The study focussed on possible impacts from climate change, as well as the burden of disease on the communities in the North. Impacts of greatest concern include extreme weather events, changes in ice distribution and ice stability, along with health effects, while the issue of least concern, is increased UV exposure. It was also noted that some adaptation initiatives are already underway, such as changes in food handling and preparation, changes in travel plans for hunting trips and increased emergency preparedness.

Climate change may strain our ability to meet sustainable development goals in Canada, including an equitable standard of living for this and future generations, safe food and water, clean energy sources, safe shelter, and a healthy environment. The Arctic Climate Impact Assessment (ACIA) attempts to understand in what ways climate change will influence sustainable development goals in the Arctic. The ACIA involves an inter-governmental panel assessing the impacts of climate variability and change, and increased UV radiation, on the Arctic Region. The Assessment will look at human health impacts, as well as environmental, social and economic impacts in the context of other developments and pressures on the Arctic Region. The Panel will produce a scientific document that includes a series of assessment reviews. It will also include a policy document with recommendations for adaptation strategies. There is a chapter on human health, and there is a separate chapter on climate change related vulnerabilities, sensitivities and capacity issues. The final document will also include a policy summary with recommendations regarding adaptation strategies. More information can be found at Welcome to ACIA www.acia.uaf.edu/. Drafts of the various chapters will be released this fall, and Dr. Furgal is looking for a suitable group of national public health experts to review the chapter on human health.

Questions

An inquiry was made as to whether the workshop participants could act as a group to receive and review the ACIA report which is to be released shortly. This may provide an opportunity to input into the contents of the report.

One participant suggested the need for caution in making generalizations about research results on the impacts of climate change from one region or area. Dr. Furgal agreed that there are significant differences between regions that should not be generalized. The project in which he was involved attempted to standardize the methods and analyse further approaches so that valid comparisons could be made between communities.

Opportunities for Action: Northern Adaptation Policy Directions

• Mark Buell, Inuvialuit Regional Corporation

Mr. Buell began his presentation by highlighting the importance of partnerships in a project that looked at observations of climate change in the Inuvialuit Settlement Region. A number of organizations were involved in the project, including the Inuvialuit Regional Corporation, International Institute for Sustainable Development (IISD), Inuit Tapiriit Kanatami (ITK), Northern Ecosystem Initiative (NEI) - Environment Canada, Health Canada, Joint Secretariat, the communities of Tuktoyaktuk, Aklavik and Inuvik and others. Mr. Buell outlined the methodology behind the study and highlighted that it was shaped through close consultations with members of the local communities.

A number of important findings were made in the discussions with the people in the three communities. For example, it became clear that many adaptation strategies to cope with the effects of climate change are already being implemented in the community (e.g., taking bottled water when hunting to cope with the increasing heat). Also, it was noted that some of the effects of climate change will be positive, such as an increase in shipping seasons for much of the North due to the earlier break-up of winter ice.

A number of challenges face the three communities because of climate change. For example, Tuktoyaktuk may, at some future time, need to be relocated because of extensive erosion of the shoreline. As well, low quality animal skins and furs mean that people are not able to make as many craft products to sell, nor clothing for personal use (e.g., moccasins etc). The community is looking for money to reopen community freezers which are needed to ensure that food does not spoil in the warmer temperatures. In this regard, warmer surface waters mean that fish now spoil quickly and sometimes cannot be eaten. As well, a growing mental health problem is related to the fact that elders cannot go hunting. Spiritual well-being of the community is also threatened due to erosion, as some graves are falling into the ocean.

Mr. Buell concluded his presentation by outlining the next steps for the project and indicating the importance of public health workers in northern communities input, as well as the need to get them engaged on this issue.

The Public Health Response to Climate Change in Canada's North: Future Directions and Considerations

• Peter Berry, Senior Policy Advisor,
  Climate Change and Health Office,
  Health Canada

Dr. Berry began his presentation by indicating that the Climate Change and Health Office (CCHO) was seeking input from public health partners in the North about how it can best support them in their efforts to address the impacts on health and well-being from climate change. He highlighted that climate change has implications for a wide range of public health programs, such as mental health, nutrition, water and air quality, disease monitoring and surveillance, disaster preparedness and relief, search and rescue, housing and shelter, education and awareness, and children's environmental health.

Northern communities are already adapting to the health effects of climate change. The key question that Dr. Berry suggested was whether this adaptation is anticipatory - planned, coordinated, collaborative and based on the latest scientific findings, or whether it is passive -less coordinated, and possibly less well-informed. Anticipatory planning provides greater effectiveness, and reduces health-related costs. These costs may include illnesses, deaths, economic impacts on health care systems and public health "infrastructure", as well as broader social impacts. It also provides opportunities to capitalize on climate change benefits (e.g. greater diversity or abundance of plants and animals in some areas), and would address growing concerns in local communities about the health impacts of climate change.

Dr. Berry outlined key requirements for planned adaptation, including sound knowledge to guide adaptation efforts, appropriate capacity to take action, which requires financial resources, institutional stability, information, skills and other resources, as well as collaboration between health partners, and between the health sector and other sectors. The key message was that public health decision makers in Canada's North will need to begin considering how they will obtain the information and other resources which they will need for their adaptation efforts, and how they may strengthen linkages with key partners in these efforts. Public health networks in the North may need to identify a suitable mechanism for collaboration, to ensure linkages are made with key climate change and health research & policy activities.

Dr. Berry closed his presentation by highlighting the services provided by CCHO to facilitate the development of climate change and health adaptation strategies in Canada. Currently, the CCHO website is being updated to include health issue and policy fact sheets, lists of funding sources, potential adaptation strategies, and a bibliography of public health adaptation information sources. CCHO is also in the process of developing a climate change and health information toolkit for public health decision makers. Dr. Berry ended his presentation by indicating that CCHO is seeki ng input about the types of information and services which health partners would find useful for addressing the health effects of climate change in the North.

Facilitated Discussion

What health issues are of most concern in the North?

• Diabetes is a big problem for northern communities. We need to put more effort into nutrition counselling.
• A lot of healthy people are starting to get strokes. Cancer and sexually transmitted diseases are also on the rise.
• There is currently a public health problem related to tobacco use.
• Children have asthma in record numbers.
• The lack of quality health care for almost all Aboriginal communities in the North is a big problem.
• There is a poor housing situation in Nunavut. Approximately, 1000 people out of a population of 30, 000 are waiting for suitable housing.

What are the similarities/differences between regions on the health issues of concern?

• Tobacco use and its health effects are pervasive.
• Obesity is a problem in the North, but is not limited to northern populations.
• Dene and Métis communities inland in the boreal forest will have different experiences than communities living on the coast. Métis communities eat caribou and moose, and this could be a problem if these species migrate.
• Focussing on the change in the ecological niches is therefore needed.
• Quality of drinking water is important, as there are now skin rashes caused by algae blooms.
• The Inuit and Cree view of the environment is very complex due to cultural relationships to the environment, and is different from region to region.
• The stratification within the community is important. Elders may live closer to the environment than children.
• It is difficult to identify similarities/differences of health issues because of a lack of research.

What health issues related to climate change are of concern?

• Many people have poor ventilation in their houses which will be a problem if temperatures rise. Housing is an issue across all northern regions.
• Earlier, there was a concern with contaminants and a structure was set up to manage it, and now the North is looking at the effects of climate change which could be quite serious (e.g., vector-borne diseases, food sources).
• Communities depend on ice roads, but as seasons get shorter, some communities might not be able to get resupplied with fuel and food.
• Food security will be an important issue for northern communities due to climate change.
• There is despair among northern people at some of the changes already seen. Ice safety is a big issue. It is getting harder to get traditional foods.
• With seasons changing, food preparation becomes more hazardous. We need to change our food preparation activities.
• There are concerns over mental health issues due to climate change.

What research and public health interventions are occurring in the North that are related to climate change and health?

• The Council of Yukon First Nations is quite active on climate change issues. Elders are indicating that health is important, and they can bring people together.
• Northern Ecosystem Initiative (NEI) - Environment Canada programs are ongoing. NEI has provided funding for an Inuit roundtable on climate change.
• There was a recent call for proposals from the Climate Change Action Fund (CCAF) on health and climate change which may address problems in the North.
• Making sure that regional and provincial/territorial governments have a health annex in their disaster preparedness plans (e.g., pandemic planning).
• One community in Labrador has developed a food safety project.
• The Centre for Indigenous People's Nutrition and Environment (CINE) at McGill University is looking at climate change issues.
• The Arctic Borderlands Program includes a climate change theme.

What are the steps needed to address these climate change and health issues?

• As a first step, we must start at the community level to find out what people are observing and feeling.
• The National Contaminants Program (NCP) is up for renewal next year, and climate change might be included as a component. It would be helpful to examine the success of the NCP in bringing together research and policy partners. The approach on climate change so far has been more fragmented, and consequently very different in different regions and communities.
• The NCP model could be taken to the upcoming meeting of Deputy Ministers of Health and Environment to be showcased and proposed for adoption to address climate change and health issues.
• On the issue of climate change and health, the problem is that there is no national assessment occurring or being funded. We therefore do not know what the community needs are.
• A big problem is that climate change has been an issue in Aboriginal communities for the last 50 years but nobody really took notice.

What existing public health mechanisms can be used to address these issues? Do new forms of cooperation need to be developed?

• Communities want to be involved, and they have much of the needed information on impacts and adaptation strategies. Next steps include the development of more indicators of climate change impacts, and communication of results. However, local communities need money for this.
• There is the difficult issue of jurisdiction. Provincial and Territorial governments have the responsibility for health, and the Federal government provides transfer payments to territorial governments. Many of the determinants of health are also outside of the jurisdiction of the health authorities.
• There are some fundamental issues about Aboriginal rights and jurisdiction that need to be addressed.
• Most of the needed health interventions would not be done simply for climate change but for other reasons (e.g., surveillance for West Nile Virus).
• There is a Health Canada online learning program for epidemiologists for specific issues, which can be very helpful.
• Environmental health programs in the North exist and are valued. But if we are to increase our activities in food safety and security issues, then we will need environmental health officers with strong mandates and adequate funding.
• We also have programs related to sunscreen education and nutrition counselling.
• We may need to increase our knowledge about heat stroke and the needed adaptation skills (e.g, getting out of the heat, hydration).
• There is a need to increase advocacy for the things we cannot influence directly (e.g, improving social housing, improving indoor air quality).
• It is important to use both qualitative information and quantitative information (e.g., using photography and actual measurements of shorelines receding).

How can Health Canada support your work in this area?

• Information materials provided by Health Canada such as the CCHO website are quite useful, even if not community specific. The ideas can be borrowed.
• Need to have materials that are designed by the northern communities, for people in the North with their own images and information.
• There is a need for surveillance and research initiatives. What role does the CCHO have if not a funding one?
• Health Canada, through CCHO, is making scientific and public health adaptation information accessible to all. In addition, CCHO will identify these resource-type needs at the federal level and there may be an opportunity to do it through federal/provincial/territorial mechanisms as well. Health Canada will also coordinate the national climate change and health impact assessment, to be done by federal and territorial partners.