Earth Day Feature: Sustainability and Physicians

“Climate change is a health issue” – Doug Courtemanche

As we celebrate Earth Day it’s important to remember that physicians have a critical role to play in fighting for sustainability and climate justice. Simple but effective measures can help us decrease the carbon footprint of our practices significantly. Furthermore, by advocating for sustainability and engaging in activism, we’re able to leverage our platform, spread awareness, and lead by example.

Why Earth Day Matters

“Health is one of the public’s top concerns in every political poll,” says surgeon and clinical professor Douglas Courtemanche. “Looking at the climate crisis through the lens of health is a good way for doctors to show people that it’s not just a political issue, but a personal one.”1

Jay Slater, Family Physician and former Chair of the Vancouver Division of Family Practice, also believes that physicians should use the observance as an opportunity to reflect on the link between climate, nature, and health.

“Earth Day is a time to remember and appreciate the health benefits of spending time outdoors,” he says. “It’s also an opportunity to understand our collective responsibility to protect our fragile environment. We should take advantage of the opportunity to talk to our patients about these issues.”2

Dr. Courtemanche begins our interview by reciting an acknowledgement he wrote and first shared publicly at a meeting of the Canadian Association of Physicians for the Environment (CAPE), an organization in which he’s very active.

“The land is a living, breathing, life-sustaining organism. It’s a flux of air, water and soil that generates life, recycles life, and sustains life. We have a relationship to the Land with a capital L. We all live on land that was once part of someone else’s territory and they had a relationship with that land. Colonialism stole the land and stole the relationship of those people with the land. Extraction and exploitation have brought us to the point that we now understand that we need a fundamentally different relationship with the land. Not a colonial relationship. We need an indigenous relationship.

I acknowledge that I live on historic xʷməθkwəy̓əm (Musqueam) territory, shared with the  Sḵwx̱wú7mesh (Squamish), and Səl̓ílwətaʔ (Tsleil-Waututh) Nations. I lived two blocks from the Camosun Bog, which is home of sʔi:ɬqəy̓, the two-headed serpent, a creature of lore, stories of which were used to teach children respect for the land or there might be consequences. I am grateful for the place that I live in.”

Easy Ways to ‘Green Your Practice’

Whether running a medical practice or a home, small steps toward sustainability can have a large cumulative impact. Dr. Slater believes that physicians are in a unique position to lead by example.

“You wouldn’t expect to see your family doctor smoking,” he reasons. “Likewise, if family doctors can be encouraged to green their offices and take steps toward creating a healthier environment, patients will probably notice.”

Dr. Courtemanche points to everyday situations that can be improved in order to cut down on waste.

“If you have 15 people working in your office and everybody has a garbage bag under the desk with one thing in it, that’s 15 plastic bags to be hauled away at the end of the day,” he says. “Something as simple as reducing that to one office garbage can is a step in the right direction.”

He believes that medical supplies are often used wastefully as well.

“Paper gowns and paper on benches are proven to be unnecessary. Speculums can be cleaned, sterilized, and reused. Cloth drapes have a much smaller carbon footprint than disposable ones.”

Dr. Courtemanche points to readily available resources that can help physicians make positive change. These include Ilona Hale’s ‘Planetary Health for Primary Care’ and Trevor Hancock’s ‘Green Office Toolkit’ (links to resources are below).

Why do so many clinics feel that disposable materials are necessary? Dr. Courtemanche points to marketing, but says that the alternative is not only better for the environment but economically advantageous as well.

“Being green, safe, and economically sensible are not competing priorities,” he says. “They can go together.”

Dr. Slater notes that there’s emerging evidence challenging many of the practices that have been in place for decades. Reusable, sterilizable office equipment, for example, is considered safe in terms of infection risk.

Doctors Add Gravitas to Environmental Activism

In addition to advocating for good practices in the workplace, Dr. Courtemanche has a strong history of involvement in environmental activism. He says that he sees the world through a “climate trauma lens” and admits that he can be the “pointy end of the stick”. He believes that it’s his duty as a member of the medical community.

“Physicians have a lot of social credibility and street credibility,” he says. “If people drive by a protest outside the Royal Bank and see a group of physicians in white coats and stethoscopes chanting ‘down with big oil’, they may begin to think more seriously about it.”

Dr. Slater agrees.

“I’ve been to the Climate Protests in which tens of thousands of people walk en masse between City Hall and the Art Gallery to show their concern about the planet,” he recalls. “Doctors, residents and medical students wearing medical scrubs and white coats draw significant attention. It shows people that this is a health issue and that health care providers are concerned. Imagine thousands of doctors dressed in white and scrubs? It adds gravitas.”

Environmental Education Key for Physicians 

Dr. Courtemanche teaches his third year medical students that change can be made at the personal, institutional, and political levels. This means cutting down on waste in the clinic, advocating for better laws, and practicing what you preach at home. He would like to see more education for physicians on the matter throughout undergrad, post grad, and CME studies.

Every Day Should Be Earth Day

Ultimately Dr. Courtemanche believes that physicians should be involved, because climate change is a health issue.

“There are health concerns directly related to climate change,” he says. “The more I read and learn about the severity of the crisis, the more apparent it becomes that this must be dealt with urgently.”

“The natural environment has tremendous value,” says Dr. Slater. “Every day should be Earth Day.”

He reminds us of PaRx, a program that enables doctors to write a prescription for health,  allowing patients to access BC parks.

On a final note, Dr. Slater says the Vancouver Division of Family Practice has incorporated Climate and planetary health in our strategic priorities. Over the coming months information, links to partner agencies and advocacy groups, and supports for greening our members practices will be emerging. “The time to act is now.”

Resources and Organizations

The following resources and organizations provide excellent opportunities for physicians to become more involved in sustainability.

• Green Office Toolkit
• Planetary Health for Primary Care Toolkit
• Canadian Association of Physicians for the Environment (CAPE) BC Committee
• Doctors for Planetary Health West Coast Website
• CASCADES Canada: Creating a Sustainable Canadian Health System in a Climate Crisis
• College of Family Physicians Guide to integrating planetary health in family physician training 

Cited Sources

1 Direct communication with Dr. Douglas Courtemanche

2 Direct communication with Dr. Jay Slater