Dr. Kyle Merritt had never experienced this kind of heat.
A family doctor and emergency room physician in Vancouver, British Columbia, Merritt remained on the frontlines through the unprecedented June heat wave that broke temperature records across western North America.
Just 300 kms away in Lytton, temperatures reached a nationwide record high of 49.6 degrees Celsius.
Merritt is used to treating typical signs of high temperature exposure like heat exhaustion or heat stroke. But now, Merritt found himself treating patients exposed to prolonged heat, who couldn’t cool down, exacerbating their underlying health conditions.
That’s when a woman in her 70s came to see Merritt in the ER. She had diabetes as well as congestive heart failure, with symptoms worsening from her exposure to the oppressive heat.
Merritt provided a typical treatment of rehydration, but when it came time to discharge the patient, he hesitated. With no sign of the heat dome fading, he admitted the patient. On her chart, he wrote: “climate change.”
“Her diagnosis, of course, is not climate change,” Merritt explained. “But, the underlying factors affecting the diagnosis, certainly I did decide to document that in the charge as climate change.”
To Merritt, more attention should be paid to overnight temperatures that are hitting more records than the daytime highs. Between the week of June 24 and 30, 2021, the New York Times documented 1,238 daytime records broken across the United States. The overnight numbers were even starker: 1,503 records broken.
“In terms of homeostasis in your body, you need to be able to have these times where you can restore some processes,” Merritt explained. Without that restoration, other underlying health issues are likely to become exacerbated.
But with indoor temperatures reaching 40 degrees at night, Merritt said patients were getting dehydrated even while sleeping. Merritt said he spoke to patients who tried sleeping outside.
“Sometimes it’s hard to attribute specific weather events directly to climate change, but with the heat dome, it seemed pretty clear at that time…climate change was essentially required for that heat dome to happen,” Merritt explained. “So it seemed reasonable [for] me to record it as an underlying factor for the reason for admission.”
Canadian healthcare makes up five per cent of carbon emissions
Dr. Eugenie Waters, a family doctor in Ottawa, grew increasingly concerned about the climate crisis after having children. Waters worried about what kind of world her children would grow up in, as well as possible health impacts they may face from increased global heat.
Waters began connecting with other physicians who shared similar worries. She also became a member of the Canadian Association of Physicians for the Environment, an advocacy group that began in 1994.
“We need to start preparing the health system, physicians and other health care professionals for the effects of climate change,” Waters said, adding that “we need to not just adapt, but mitigate climate change in terms of reducing fossil fuel emissions.”
Waters warned of the wide variety of health ailments that could worsen in prolonged exposure to extreme heat, primarily older people with hypertension or blood pressure medications, those with chronic kidney disease, or chronic obstructive pulmonary disease (COPD).
Waters believes climate should be considered when it comes to the social determinants of health doctors recognize. With known health effects related to living in poverty, being racialized, or childhood trauma, Waters believes we need to treat climate change like a diagnosis in the same way.
One way doctors are failing to prepare for the climate crisis is through their education. Waters pointed out that medical schools across the country are lacking content about the health impacts of changing climates — a subject she believes should be brought into the curriculum.
“The pandemic has shown that our health systems are very fragile, and our health workforce is not inexhaustible,” Waters said.
In Canada, healthcare makes up nearly five per cent of all carbon emissions. These emissions “result in 23,000 years of life lost every year due to disability or early death.” Waters believes the country’s healthcare systems will need to figure out how to provide services while emitting fewer emissions.
Waters attributed the rise in tick-borne illnesses like Lyme disease over the last decade to the changing climate in Canada. She’s also treated more patients suffering from environmental allergies as well as asthma.
The climate crisis, Waters said, will trigger an increase in hospital visits as well as an increased need for healthcare providers.
Waters is also worried about climate change’s harms on mental health.
“Think of [being relocated] as a result of floods, wildfires — entire communities being lost. We’re talking [about] PTSD, increased suicidality, increased anxiety, and disruptions in terms of people being able to go through everyday life,” Waters explained.
Equity key to mitigating climate change
While thousands of temperature records were broken in 2020, it ranks the second warmest year on record, behind 2016. Most telling, the last seven years make up the seven warmest years on record.
NDP health critic Don Davies told rabble.ca in an interview that he expects to see more cases with the climate crisis listed as an underlying diagnosis.
Davies called the case in B.C. “as jarring as it is necessary.”
“If you look at the heat dome from last summer, the seniors who died as a direct or indirect result of it, were seniors that were living in places that didn’t have air conditioning,” Davies explained.
“They couldn’t escape the heat. Well, if you’re wealthy, you probably can,” he said.
Davies is calling on the federal government to recognize climate change as a social determinant of health. He also believes the Trudeau government should better support Canadians who face financial and social barriers to adapting to climate change.
In order to treat the climate crisis as both a physical and mental health issue, Davies believes universal coverage for all mental health needs must be implemented into Canada’s public healthcare system.
“I’m starting to see an intersection of the recognition that the climate crisis is not just going to affect our planet [or] our economy,” Davies said, noting it’s going to have ramifications all the way down to individual health.