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Our health systems are part of our Canadian identity. Health systems contribute almost 12% to Canada’s total GDP, consume more than a third of many provincial healthcare budgets and employ more than 2 million people. Most people would agree that access to high quality healthcare is key to protecting our health. However, the healthcare sector accounts for about 5% of Canada’s greenhouse gas emissions that have been linked to climate change.

“In an effort to treat disease and illness the healthcare system is creating new health problems linked to climate change and environmental pollution”, says Dr. Sean Christie, a neurosurgeon and professor in the Division of Neurosurgery at Dalhousie University.

“It seemed absurd to me that almost every surgical case we did generated more garbage than what I typically see in a week at home. The more I began to look into the issue, the more I realized the extent of environmental impacts arising from the delivery of healthcare.”

Gillian Ritcey, Managing Director of the Dalhousie Healthy Populations Institute (HPI) was already familiar with this critical issue. She had returned to Halifax after working with Dr. Fiona Miller at the University of Toronto’s Centre for Sustainable Health Systems with an expertise in healthcare and environmental sustainability. Ritcey’s vision led to the creation of the Creating Sustainable Health Systems in a Climate Crisis Flagship Project with HPI.

“We recognized the impending threat of climate change on human health and the exacerbation of health inequality and decided that HPI needed to bring together an interdisciplinary, cross-sectoral team with the skills and capacity to support the creation of a hub of sustainable health system research excellence at Dalhousie,” says Ritcey.

HPI’s Flagship Project team is co-led by Dr. Christie and Dr. Daniel Rainham, professor in Health Promotion in the School of Health and Human Performance and includes Dr. Peter Tyedmers from the School of Resource and Environmental Studies, and Dr. Nathan Ayer, director of analytic services with EarthShift Global. Several research activities have been initiated including a series of surveys of clinicians, medical students, patients and healthcare leadership to gauge their understanding and interest in pursing high-quality, low-carbon health care.

Recently the Flagship Project was successful in obtaining just over $500,000 in research support from the Department of Surgery and NSERC’s Alliance Missions grants competition. The funds will support research to estimate greenhouse gas emissions and related environmental impacts from surgical procedures and hospital operations using life- cycle assessment (LCA) methodologies. According to the team it may be the first LCA completed of an entire surgical procedure from the moment of referral to the completion of rehabilitation.

At the national level, HPI represents Atlantic Canada as one of four partners in CASCADES, a multi-year capacity building initiative funded by Environment and Climate Change Canada to address healthcare’s contribution to the climate crisis. The other partners include the Centre for Sustainable Health Systems at the University of Toronto, the Planetary Healthcare Lab at the University of British Columbia, and the Canadian Coalition for Green Health Care.

Collaboration is an important part of the Flagship’s work, as seen with the recent launch of HealthcareLCA, which brings together environmental assessments of health systems, hospitals, healthcare services, surgical procedures, medical equipment, and pharmaceuticals into an open-access database. HealthcareLCA can be used to educate health professionals about the environmental impacts of healthcare, provide researchers with data points from existing studies, and improve access to evidence for developing policies and procedures to improve environmental performance. HealthcareLCA is a collaboration between HPI (which hosts the online platform), CASCADES and Brighton and Sussex Medical School.

Interest in sustainable healthcare is growing. In January 2023, HPI teamed up with Dalhousie's Global Health Office and CASCADES to offer an IPE Mini-Course on Sustainable Health Systems. The course was oversubscribed with 40 trainees from Medicine and Health Faculties at Dalhousie.

According to Dr. Rainham, “students in medical school and in other health disciplines realize that the climate crisis is making us unwell. Climate-informed clinicians will not only be able to provide better care but will be far more likely to lead climate innovations and reduce the environmental impacts of healthcare delivery.”