Environmental health podcast

Moderator: Breathing is the most natural thing, right? And yet every day with every breath, air pollution affects our health. We provide a forum for health and research experts to discuss air pollution and its impact on their health and on possible solution to address this issue. Now, take a deep breath and enjoy.

Dr. Scott Weichenthal: My name is Scott Weichenthal. I'm an Assistant Professor in the Department of Epidemiology, Biostatistics and Occupational Health at McGill University and my research is in the area of air pollution health effects.

Fiona Hanley: My name is Fiona Hanley, I am a nurse. I teach in the Faculty of Nursing at two different places in Montreal. One is a college, a cégep called Dawson College, and I also teach at McGill University in the Ingram School of Nursing.

Dr. Claudel Pétrin-Desrosiers: My name is Claudel Pétrin-Desrosiers, I'm trained as a family doctor and currently doing a master in environment and sustainable development at the University of Montreal. I am the current president of the Quebec Association of Physicians for the Environment.

Dr. Scott Weichenthal: So air pollution is caused by a number of sources, primarily combustion sources. So any time you're burning fossil fuels or any kinds of materials, there's a range of pollutants that are emitted into the atmosphere, these can be very small particles, so they can be different kinds of different types of gases.

Air pollution also includes sort of vapors that are released from indoor materials, so painting, glues, adhesives, things that are used on things we have in our homes. So air pollution is really just a mixture of chemicals that are in our environment.

Dr. Claudel Pétrin-Desrosiers: I think overall, we don't know enough about air pollution being medical student or being the general population. Air pollution is a big burden on our health. We recently estimated that it was responsible of the death of one in five people around the world, and it's not something we often discuss, be it in the medical curriculum or overall in the news.

Fiona Hanley: It should be from the very beginning of education for all health professionals, whether they're medical students, nursing students, respiratory therapy students, physiotherapy students, occupational therapy, etcetera, everybody needs to know the connection between our health and the environment. After all, I mean it's fundamental, we all need to have clean air to breathe, we all need to drink fresh water and have water to bathe in, we all need to eat food that is going to be good for our health.

Dr. Scott Weichenthal: So in Canada there are a range of important sources, so obviously traffic is an important one. In terms of traffic in addition to combustion sources, there's also things like brake and tire wear that contribute to air pollution. So these brake wear for instance is, contributes to metals in our environment. Also, we call biomass burning, so residential wood burning, forest fires, these are also really important sources of air pollution in Canada.

Dr. Claudel Pétrin-Desrosiers: Well, I worry about air pollution because it's an invisible killer and it, I mean as a doctor, as a health professional I think we should be worried about the fact that there's something out there that kills one in five people around the world.

Dr. Scott Weichenthal: We know that around the world air pollution kills millions of people on an annual basis. And when people think about air pollution, they often think of very polluted locations in the world.

And one of the interesting things about air pollution is that we haven't really identified a level that is known to not cause effects. So even in a place like Canada where we have relatively, well not relatively, we have excellent air quality in general, even at the levels we experience, there are around 15,000 people that are killed every year by long term exposures to air pollution. This includes things like cardiovascular mortality, respiratory mortality, lung cancer.

Dr. Claudel Pétrin-Desrosiers: And that costs like $120 billion a year to the system, that's massive.

Dr. Scott Weichenthal: So air pollution is not a concern because the risks are very large at an individual level. They are a concern because everyone is exposed, and any time you have an exposure that has even a small risk, but that loss of people experience, this can give rise to a large number of cases.

And so early on, of course, researchers focussed on the respiratory health effects of air pollution, so we know that it contributes to things like lung cancer and exacerbation of respiratory illnesses like asthma. And then the research sort of moved on to cardiovascular effects and now we know that the cardiovascular effects of air pollution are probably more important than the respiratory effects.

So we know that there's contributing to things like myocardial infarction, cardiovascular mortality. We know that people with existing cardiovascular diseases, so things like diabetes make you more susceptible to air pollution.

And now research is really moving into looking at the neurological effects of air pollution, so impacts on the brain, things like dementia, recent studies of brain tumors, and this has really been motivated by the fact that we know that that certain kinds of particles can actually reach the human brain. So we know they're getting there.

Fiona Hanley: Well, if we want to consider people who are more vulnerable to air pollution, children are the first ones that come to mind.

Dr. Scott Weichenthal: Obviously, younger, younger children who, whose lungs are still developing.

Fiona Hanley: For a variety of different reasons, and one is physiologically they tend to breathe more, they breathe faster, more air per kilogram if you like, as well too they have a faster rate of breathing.

Dr. Scott Weichenthal: Also pregnant women of course, because you want to limit their exposures to any harmful pollutants to protect both them and the developing fetus. Older people who may have underlying diseases that make them more susceptible to air pollution health effects.

So people who live in say a low income area that's very close to a highway might experience say, a higher exposure to air pollution then a higher income area that's very green and away from busy roadways.

Fiona Hanley: Some of the air pollution particles are even found in the placenta, and so children are exposed even in the womb.

Dr. Scott Weichenthal: So those are the populations that we sort of generally target when it comes to public health messaging around air pollution health effects.

Dr. Claudel Pétrin-Desrosiers: Well we can have an impact on our patients life just by raising our voice and making sure that when I see my patient at the clinic, I can provide them with solutions or ideas to make sure that you know, they have better health. I could say, you know you could go take a walk in a green space in the park in nature.

Dr. Scott Weichenthal: For physicians, I think the challenge is to, they're so much focused on individual level patient care, right, that it's easy to maybe overlook sort of these exposures that have a smaller risk at the individual level but are more important on a population level. They can play an important role by raising awareness of these environmental exposures and how they're relevant to cardiovascular health or to cancer and maybe telling their patients about them as well.

Dr. Claudel Pétrin-Desrosiers: There's a growing interest in the social determinants of health and I think now the movement is to consider the environmental determinants of health.

Fiona Hanley: In many ways we have to be opportunistic, because I think that there are many occasions that present themselves to us where we can have a conversation about environmental health, whatever the subject happens to be. If we're talking about a condition like a cardiovascular condition, for example, or we're talking about heart disease or we're talking about pregnancy and how to promote health in pregnancy, for example, there are many, many different occasions to be able to have that conversation about what are the influences of the environment on health.

Dr. Claudel Pétrin-Desrosiers: I don't want to put the burden on them. So there's something there in terms of this problem needs to be addressed by society as a whole. So I think we need to make sure that we sort of do a catch up work for every physicians that were trained in the last years or in the last decades because this is something that were not known as well as we know today.

Fiona Hanley: It shouldn't depend on one's individual interest. It should be part of the formalized curriculum for all students in the field of health.

Dr. Claudel Pétrin-Desrosiers: There's obviously a lot of training and raising awareness that need to be done to make sure that it's integrated perfectly or better in our practices. But I think we're heading in that direction.

Fiona Hanley: That very rarely do we ask, well, what are you using to clean yourself or to clean your house, or what is the state of carpets in your home, or do you live by a high traffic area, or do you know about the air quality health index? Do you know how to check whether today is a good day to go and do exercise outside or is it maybe something that we should do as an exercise inside today because that the air quality is not very good.

Dr. Claudel Pétrin-Desrosiers: Medical professionals and medical students are given an enormous trust by the population. We're trusted people. When we, usually when we say something to a patient it has an impact on their life, on their habits, on their choices. And I think we have to honour this trust when it comes to problems that are beyond the walls of our clinics, then I think we have to make sure that we, that our voices are heard but that we make sure that we are able to also amplify the voices of people who may not have this chance.

Dr. Scott Weichenthal: The solutions are sometimes source specific or pollutant specific. Generally decreasing large combustion sources in heavily populated areas is a good idea, right. So one of the, one of the actions that Montreal has done I think that was a good idea was to limit residential wood burning. Because wood, residential wood burning can produce a lot of air pollution which might not be a concern if you live in the country with not a lot of neighbors around.

But when you're in a major, a major city and everyone's burning wood that means millions of people are now exposed to these harmful pollutants. Reducing fossil fuel combustion is a good one. And I think, you know cities have made an effort to try and promote sort of active transportation. So things like cycling and walking.

I think governments around the world are really recognizing the health and economic impacts of air quality. And I think you know places like China have made really incredible strides to improve their air pollution, improve their air pollution levels.

Most Canadians, not just physicians, but most Canadians don't know is what a leader Canada is in air pollution research. We have some of the best researchers in the world here in Canada. But yeah, generally I think I am optimistic.

Dr. Claudel Pétrin-Desrosiers: If I had to summarize the situation of air pollution in Canada, I would say opportunity, because we have now the opportunity to improve the life of people and to save 14, over 15,000 deaths a year. And I don't think we've been giving any other opportunities as big as this.

Fiona Hanley: I think I'm very inspired by the passion that I see in the students around me. People go into nursing because they care about other people, and there's a huge passion that I see that is carrying them forward and that has a huge potential for influencing. It's like a stone in a pond. Despite everything, I do feel optimistic and now I think there's a whole community of people out there that is, that have caught fire with this idea as well too. So yes, it's inspirational.

Moderator: You listened to a podcast produced collaboratively by Health Canada, University La Rue(ph) and IFMSA Quebec which is the international and community affair division of the Quebec Medical Student Federation.

Concerned about air quality and its impact on health? Do you have a solution in mind? We invite you to take the floor to share your experiences or your opinion on this subject.

Write to us on the University La Rue Facebook page with the hashtag environment and health. If you want to learn more, search the Health Canada website for the keyword air and health.

Unidentified Speaker: (Music playing) Depuis des semaines et des semaines que cette inondation était député sans savoir qu’est-ce qu’elle deviendrait là, ni de notre maison, ni de l’indemnisation puis vers où on s’en irait.

Unidentified Speaker: (Music playing) En 2022, les changements climatiques ça reste la plus grande menace à la santé pour les Canadiens au 21ième siècle.

Unidentified Speaker: (Music playing) Canada is warming twice as fast as (inaudible) place in the world.

Unidentified Speaker: (Music playing) The climate emergency is when humans have emitted gases and (inaudible) impacts on the earth is causing our meteorological systems to shift and having impacts on all aspects of (inaudible).

Unidentified Speaker: (Music playing) Lorsqu’on réfère aux impacts psycho-sociaux des crises ou des événements extrêmes il faut vraiment penser à examiner l’ensemble des facteurs de stress, (inaudible) ce qu’on appelle les stresseurs.

Unidentified Speaker: (Music playing) Tous les intervenants étaient pris au dépourvu et on avait sous-estimé tout l’impact humain auprès des gens.

Unidentified Speaker: (Music playing) The important variations that we can see occurring in terms of seasonal.

Unidentified Speaker: (Music playing) (Inaudible) changement climatique (inaudible) la fréquence, l’intensité, la (inaudible) de (inaudible) les inondations, la chaleur (inaudible)

Moderator #1: (Music playing) Vous écoutez un balado propulsé par l’Université de la Rue, produit par la Coop les Affranchis et rendus possible grâce au soutien de Radio-Canada et de (inaudible) Québec.

(Music stops)

Natalie Epnetere: Ça c’est le 16 avril 2017, et ça c’est derrière la maison où on commence à voir autour du cabanon, de l’eau qui (inaudible) parce que derrière ce n’est pas la rivière. La rivière est beaucoup plus loin. Elle est à peut-être 300 mètres de là. On est dans une péninsule donc on a de l’eau en arrière, on a de l’eau en avant, mais nous ne sommes pas riverais. Mon nom c’est Natalie Epnetere. Moi j’habitais à Rigaud en 2017 et j’ai vécu ces inondations du début jusqu’à la fin. On était sorti de notre maison parce qu’on nous avait demandé d’évacuer. On a réintégré par la suite parce que l’eau c’était stabilisé. Ce qui est arrivé c’est que l’eau se rapprochait tellement de la maison (music playing) il mouillait, il mouillait, il mouillait, il y avait tellement d’eau. On s’est fait un muret mais deux personnes sans aide c’était essoufflant.

Unidentified Speaker: (Music playing) More frequent and intense extreme heat, increased risk of draught and forest fires, fine (ph) permafrost and the reduction of (inaudible) extent are direct consequences of global warming. In 2017 93% of Canadians who believed in climate change believed that it is a risk to their health or will be in the near future. They feel vulnerable to it. Economic security and food and water shortages can cause ongoing stress, anxiety and even depression. The issues of depression and anxiety are very real in Canada. More and more we are hearing about ecoanxiety, psychological health and climate change are interconnected. Though we have the knowledge to understand how these causes are interconnected, will we be able to adapt?

Joe Vipond: We are interconnected beings on this planet. You know, we’ve evolved as a civilization for a pretty narrow set of parameters of temperature and humidity and sea level. And so, as all of those parameters are changing and rapidly changing. My name is Joe Vipond I’m an emergency physician at the Rockyview Hospital in Calgary Alberta, the Co-Founder of the Calgary Climate Hub and the current president of the Canadian Association of Physicians for the Environment. And so, as all of that parameters are changing and rapidly changing it’s very difficult for our civilization to, to adapt, to have a functional civilization and through these different changes.

(Music playing)

Unidentified Speaker: (Music playing) D’ici 2050 on s’attend à ce que la hausse des températures devance d’un mois les pointes de (inaudible) printanières et la fonte des neiges. Au Canada un grand nombre de municipalité pourrait être gravement affecté par ce qui constitue le risque naturel le plus répandu au pays, les inondations. De 1900 à 2005 260 inondations majeures ont (inaudible) la vie de 235 personnes et occasionnées plusieurs milliards de dollars de dommage. Par exemple, l’inondation de 2013 en Alberta à entrainer le décès de quatre personnes, les dommages s’élèvent à environ $6 milliards de dollars. Au Québec depuis 1990 27 inondations qualifiées de catastrophique ont coûtées la vie de dizaine de personnes et ont encourues l’évacuation de dizaine de milliers de citoyens.

Ces inondations représentent un danger pour l’économie, la vie communautaire et affecte également la santé des populations touchées.

(Music stops)

Philippe Gachon: Les températures, oui, ils sont en train de se réchauffer, on le sait, on le sait tous, on a vu les hivers moins froid ces dernières années que d’habitude mais les régimes de précipitation sont en train de changer et ce cocktail, cette combinaison changement de précipitation, de température, génère des inondations, non seulement qui sont plus sévère en termes de volume d’eau, mais en termes de durée. Philippe Gachon, professeur d’hydro climatologie au département de Géographie ici à l’Université du Québec à Montréal. Je suis également directeur général du Réseau Risque, Réseau Inondation Intersectoriel du Québec. Il n’y a pas beaucoup de région dans le monde qui ont des inondations qui durent pas loin de deux mois.

(Music playing)

Natalie Epnetere:  Nous on était quand même à 5 kilomètres dans une presqu’île donc le souci qu’on avait c’était de se rendre au village. Et là quand j’ai téléphoné pour avoir accès à des sacs de sable on m’a dit, ben, il faut venir. Ben, j’ai dit, comment on fait pour traverser déjà deux à trois pieds d’eau?

(Music playing)

Unidentified Speaker: (Music stops) C’est pas juste une question de sac de sable mais aussi tout aspect psycho-social. On l’a vu en 2017, on l’a vu en 2019. On sait que même si on a l’incertitude, quand ça va se produire – (inaudible) situation (inaudible) anticiper la prévention, l’éducation, sensibilisation, être mieux capable d’intervenir notamment d’un point de vue social, psycho-social et en termes de santé.

(Music playing)

Natalie Epnetere: Donc là j’ai commencé à sentir qu’on aurait aucun soutien, sachant que l’eau continuait de monter, puis de monter sur le chemin.

(Music playing)

Philippe Gachon: Puis une fois que l’événement s’est produit être capable de tirer les leçons apprises, qu’est-ce qu’on a bien fait, qu’est-ce qu’on a mal fait, comment s’améliorer la prochaine fois? C’est ça une (music playing) gestion proactive des risques.

(Music playing)

Unidentified Speaker: Flooding causes mold growth and thus an increase in health problems related to the respiratory system. In the aftermath of floods accidental carbon monoxide poisoning is an increased health risk especially during clean-up activities. In the United-States following the 1997 North Dakota flood nearly half of the 33 cases of carbon monoxide poisoning that were reported involved cleaning professionals. The carbon monoxide poisonings reported were also associated with other causes such as the use of pressure washers, auxiliary heaters or a combustion pump.

(Music stops)

Claudel Pétrin-Desrosiers: (Technical difficulties) les autres effets des changements climatiques qu’on doit considérer toute la famille des maladies infectieuses et surtout les maladies vectorielles transmises par des, des pathogènes vivants comme des insectes ou des animaux. Dans cette longue liste là parce qu’il y en n’a plein à travers le monde-là, le Zika, l’Ebola sont des maladies influencées par les facteurs climatiques mais aussi la fameuse maladie de Lyme. Claudel Pétrin- Desrosiers. Je suis médecin de famille au CLSC Hochelaga-Maisonneuve. Je suis présidente de l’Association québécoise des médecins pour l’environnement puis je suis aussi responsable de santé planétaire pour le Département de médecine familiale, médecine d’urgence de l’Université de Montréal.

L’enjeu avec la maladie de Lyme en fait c’est un tic qui vie où il y a des bonnes conditions, puis avec le réchauffement climatique ben, on a agrandi son territoire de jeu. Fait que d’ici 2050 il va y avoir la maladie de Lyme au Saguenay, en Gaspésie, fait que ça sera pas juste dans le sud, sud de la province-là. En ce moment il comment à en n’avoir quand même pas mal en Estrie-Montérégie mais ça monte dans le nord vu qui fait de plus en plus chaud.

(Music playing)

Unidentified Speaker: Les impacts de la hausse de la température planétaire sont multiples. Depuis le début des années 1980 on remarque que le réchauffement s’accentue nettement. La fonte des glaces en région polaire s’accélère depuis les années 2000. La couche d’ozone a été fortement endommagée par le gaz carbonique. Environ 30% de l’élévation du niveau des mers est associée à l’augmentation de la température de l’eau et à l’augmentation des précipitations qui ont un impact important sur la propagation des maladies transmises de l’animal à l’humain. La grippe aviaire, la salmonellose, le virus du Nil et la maladie de Lyme ne sont que quelques exemples parmi tant d’autres. Si cette hausse provoque la transmission de virus et favorise la prolifération d’espèces invasive, affecte t’elle la population à d’autre niveau?

Unidentified Speaker: There are many impacts, economic, physical, architectural, but there’s also health as well and those health impacts can be a broad spectrum of things. It can be illnesses like (inaudible), it can be because of these recurrent disasters forcing internally to displace people to move elsewhere, it could be impacts on food security and all the way through to mental health and, and the impacts of watching this rapid evolution occur right in front of our eyes and anticipating what’s, what’s to come.

Unidentified Speaker: Dans le domaine de la santé et des changements climatiques on fait face à un double défis parce que d’un côté on pourrait être tenter de vouloir mettre de l’avant tout les impacts négatifs qui ont été documentés, qui sont bien réels, des changements climatiques sur la santé, d’un autre côté si on met l’accent de manière trop prononcé là-dessus et pas assez sur les moyens d’agir, les solutions, on peut poser un autre problème qui est l’éco-anxiété donc un peu le sentiment de peur, d’impuissance devant toute – la dégradation de l’environnement puis les impacts que ça peut avoir sur notre bien-être. Et cette éco-anxiété-là peut vraiment paralyser les gens, les rendent vraiment inconfortable et même nuire à l’action qu’on souhaiterait qu’il, qu’il soit modifié chez ces personnes-là. Donc, il va falloir trouver un juste équilibre, entre d’une part les gens qui sont un peu dans le déni ou dans l’inaction et d’autres part les gens qui pourraient en devenir paralysés tellement qu’ils sont conscients des impacts négatifs sur notre santé.

Natalie Epnetere:  On est à deux pieds du sol de la maison et puis là on se disait, ça va peut-être tenir. Mais une fameuse nuit en début mai on a pris la peine de dormir en haut, habituellement on avait notre chambre en bas, se disant, au cas où.
(Technical difficulties).

Scott Weichenthal: We don’t need any studies to answer that question, right. I mean, when people’s homes are being burnt or are being flooded, people are dying (technical difficulties) (inaudible) Vancouver, I mean it’s killing people. So, I’m Scott Weichenthal, I’m an associate professor at McGill University at the Department of Epidemiology Biostats and Occupational Health. The aim of our work is really to develop some new models of high-resolution temperature variations across both Montreal and Toronto. The effects have been pretty obvious, right, there were a lot of people that were – that died last summer in Vancouver because of a heat emergency. Obviously, we’re seeing increasing forest fires every year, primarily out West but you know, other places as well.

Unidentified Speaker: On le sait au Québec d’ici 2065 on attend au moins 20,000 décès en excès liés à la chaleur. On n’a pas de chiffre pour l’ensemble du Canada mais définitivement ce qu’on a vu à Vancouver l’été dernier c’était pas une anecdote-là, c’est un avant-goût des prochaines années puis ça m’étonnerait qu’on voie un phénomène similaire à Montréal ou à Toronto dans les prochains étés. La chaleur c’est un stress sur tout le corps. Fait que quand on est déjà un petit peu en situation vulnérable puis on a des problèmes cardiaques, des problèmes pulmonaires, des problèmes rénaux, des problèmes métaboliques, la chaleur ça peut être mortel. Puis dans les villes la chaleur elle tue. Elle tue où? Particulièrement les personnes âgées, les personnes qui vivent dans des îlots de chaleur, les quartiers défavorisés (music playing), les personnes qui ont une ou plusieurs maladies chroniques.

Unidentified Speaker: (Music playing) Variations in temperature, precipitation and extreme weather events have an impact on the introduction of pathogens and the food we eat. In additional unstable harvests increase the instability of prices of basic food products on international markets, resulting in price variations that are harmful to both producers and consumers. Therefore, climate change amplifies existing threats to our means of subsistence and to food security.

Sébastien Nobert: If you think the eastern township (ph) for example in Canada, last summer it was extremely dry. (Music stops) Sébastien Nobert, I’m a geographer, assistant professor, University of Montréal, I’m also an associate researcher at the Terrarium (ph). Farmers will now find water maybe in the water table to irrigate their land and not being very using rainwater as a form of insurance that they could always produce the kind of agriculture they do now. I think all this is related.

Unidentified Speaker: Les autres impacts des changements climatiques qu’on voit beaucoup au Canada, il y a les allergies, les infections, la malnutrition, l’insécurité alimentaire, déplacement de population, toute la composante de feux de forêt.

Unidentified Speaker: We currently hear fire chiefs saying, “I’ve never seen anything like this before. These fires are behaving not like anything we’ve previously experienced.” And when they get so out of control, it’s even hard to have targeted protection of living spaces like a town. And so, that’s why we’re seeing, you know, Fort McMurray (inaudible) high level, Slave Lake, you know, big portions of major towns disappearing.

Unidentified Speaker: Les feux de forêts c’est un double problème parce que ça augmente la pollution de l’air et en plus ça augmente les émissions de gaz à effet de serre parce que les arbres relâchent des gaz à effet de serre. Mais ça dégrade la qualité de l’air de façon assez importante, ça engendre des déplacements, ça peut engendrer des bris de services en santé, fermeture d’hôpitaux. On dit qu’on a une belle qualité de l’air de façon générale au Canada, au Québec, mais ça reste que dans le pays il y a 15,000 personnes qui décèdent prématurément à chaque année de la pollution.

(Music playing)

Natalie Epnetere: On est vers une heure du matin, toute la maison a bougée, ça l’a été comme un tsunami qui a passé sous la maison et c’est l’eau qui est rentrée avec une force là extraordinaire. La (inaudible) est tombée, le frigo – on avait un gros congélateur. Ça l’a fait un bruit incroyable. J’ai téléphoné au 911 pour savoir quoi faire et c’est là qu’on m’a dit, « Ben, madame, il n’y a personne qui va risquer sa vie pour vous donc vous devez attendre l’armée canadienne qui va arriver seulement demain matin. » Et là je vous dirais que c’est tout un choc. Donc, on est allé, on était dehors, on a réintégré dans un cadre de porte parce qu’on savait pas si la maison allait résistée.

Mélissa Généreux: En Estrie on a développé une expertise quand même assez unique sur les impacts des crises. Je m’appelle Mélissa Généreux. Je suis médecin spécialiste en santé publique, également comme professeur agrégé à la Faculté de médecine et des sciences de la santé à l’Université de Sherbrooke. Lorsque les inondations printanières de 2017 et de 2019 sont survenues au Québec on s’est dit ben, si ça l’a été observée dans la communauté de Lac Mégantic il y a quand même des bonnes raisons de croire que dans les communautés riveraines qui ont été inondées à la suite des ces événements-là qu’on peut s’attendre à observer un peu le même titre d’impact. Toute forme de perturbation peut amener son lot d’enjeu sur la santé psychologique.

Natalie Epnetere: Mais la maison a bien résisté finalement puis le lendemain matin on est – là l’armée est arrivée vers huit heures. On nous a dit prenez une petite valise puis on nous a fait signe à peu près deux pieds et pis dite, dite aurevoir à votre maison peut-être que vous ne la reverrai pu.

Unidentified Speaker: Donc, on a conduit notre étude dans les huit à 10 mois suivant les inondations de 2019 auprès de quand même 3,500 personnes qui vivent dans les quartiers qui ont été inondés dans six régions du Québec et les impacts étaient majeures. On a remarqué que les gens qui avaient été directement inondés là, qui ont eu de l’eau dans les pièces habitables de leur maison, chez 44% d’entre eux on observait des manifestations modérées à sévère de stress post-traumatique. Ceci a été mesuré presqu’un ans après la survenue des événements.

Natalie Epnetere:  Bien je dirais qu’il y a un avant, il y a un avant où on se sent dans – en sécurité, notre maison c’est notre havre de paix, c’est là où on va se sentir le plus en sécurité puis c’est tsunami en dessous de la maison puis toute bouge pis, pis qu’après ça on peut même plus y intégrer puis qu’on sait même pas où aller, c’est sûr que ça change par rapport à notre sécurité.

Unidentified Speaker: Enfin les symptômes de stress post-traumatique sont très diversifiés, puis c’est pas parce qu’on a certain des symptômes qu’on ait forcément atteint d’un trouble de stress post-traumatique.

Natalie Epnetere: Mon mari a perdu beaucoup d’ouïe puis le médecin l’a vraiment diagnostiqué pour un choc post-traumatique.

Unidentified Speaker : Donc, on parle de symptômes entre autres de pensées envahissantes. Donc, vous savez quand vous fait tout pour arrêter de penser à l’événement mais que ça vous envahi le cerveau, que ce soit par, bon, des pensés intrusives, des rêves récurrents sur le sujet, ou même des cauchemars, à ça on va avoir aussi des symptômes d’évitement, donc, des gens qui, qui ne sont plus capable à tout ce qui pourrait leur faire penser aux événements douloureux, qui vont carrément éviter les situations, les images qui pourraient leur raviver les souvenirs parce que ça fait trop mal. Et on peut avoir aussi des symptômes je dirais un peu plus de d’hyper activité, donc on, on fait le saut à rien, on peut vraiment devenir irritable facilement. Donc, c’est un cumul un petit peu de tout ces symptômes-là qui comme on peut l’imaginer peuvent devenir rapidement envahissants et nuire au fonctionnement et à la qualité de vie des gens.

Natalie Epnetere: Mais on était vraiment aux désarrois parce qu’on savait pas la suite des choses, où on irait passer la nuit, qu’est-ce qui arrivait avec nos effets personnels, notre maison. On était dans le néant complètement. Mais heureusement il y a eu la Croix Rouge qui nous a rapidement dit, ben, là il nous reste pu beaucoup d’hôtel parce que ça fait quand même plusieurs semaines que les gens évacuaient et puis il nous on quand même trouvé un endroit pour se loger, pour se nourrir, voir même s’habiller parce que là on n’avait pas de vêtements, on n’avait rien, puis nous on avait pas d’information. On savait pas ça serait quoi les suites, ça serait quoi – on était vraiment laissé à nous-même de ce côté-là.

Unidentified Speaker: That happens with any disaster whether it’s flood or fire. And when you evacuate a place, of course that’s going to have health impacts because suddenly those people are outside their normal living sphere. Sometimes they have to be in congregate living and, and the infectious diseases that go along with that, and of course, they all lose their primary health care because they’re no longer in their place of living.

(Music playing)

Natalie Epnetere: (Music stops) On était là sans réponses, sans savoir qu’est-ce qui adviendrait là, ni de notre maison, ni de l’indemnisation puis vers où on s’en irait. Donc, ça, ç’a l’a été des moments je dirais les plus angoissants même que l’inondation comme telle, tant avec la municipalité, qu’avec la sécurité publique, qu’avec tous les intervenants finalement.

Unidentified Speaker: Cette notion-là de ne pas savoir où on s’en va exactement, ce qui s’en vient, à qui on doit parler, c’est extrêmement stressant chez les gens et malheureusement ces stressants secondaires-là arrivent souvent dans un moment où l’aide, le moral, le, le soutien moral, le soutien très concret, l’attention des médias et de toute la population, tout ça est en décrescendo donc, vous comprenez que le stress continue à augmenter et l’appui de la population lui commence à diminuer et c’est exactement à ce moment-là que les gens commencent à ressentir le stress, la fatigue et la déprime.

(Music playing)

Unidentified Speaker: Quels sont les gestes et engagements à valoriser pour participer à réduire la courbe des changements environnementaux et ses répercussions sur la santé physique et psychologique? La lutte contre la pollution de l’air, le verdissement urbain à proximité des citoyens, l’amélioration des transports en commun, l’aménagement des réseaux cyclables et piétonniers, la lutte contre l’exposition aux pesticides, la protection de l’autonomie alimentaire ou la réduction de gaz à effet de serre, sont des exemples d’engagements qui peuvent être portés à tous les niveaux. L’engagement citoyen lui n’est pas à négliger dans l’équation. Comme la famille qui choisie de consommer des aliments en vrac et d’aller travailler à vélo, on sait que c’est la force des actions individuelles qui pourra nous garder en santé et en harmonie avec notre environnement. (Music stops)

Unidentified Speaker: Quand on parle de solution face aux changements climatiques ont à souvent deux volets d’action, la mitigation qui est la réduction des émissions de gaz à effet de serre puis l’adaptation aux changements climatiques. Qu’est-ce qu’on fait pour y faire face? (Inaudible) la question de l’adaptation climatique c’est une adaptation qui peut être fait à un niveau individuel puis à un niveau collectif. Puis l’utilisation de la nature est un facteur qui pourrait favorisée l’adaptation individuelle aux changements climatiques, mais aussi collective. Parce que si tu veux que tout le monde ait accès à la nature, faut que tu permettre la nature dans tes milieux de vie.

Unidentified Speaker: The reduction of heat created by green spaces within a city are tremendous. This should be something on which (inaudible) should invest a bit more.

Unidentified Speaker: La végétation a aussi un impact extrêmement important pour garder l’eau. L’eau va très rapidement se rendre dans les égouts lorsqu’on a de forte précipitation sur les surfaces asphaltées, les zones humides, ou les forêts vont absorber (inaudible) qui va garder dans le sol, donc ralentir le, on va dire le cycle hydrologique.

Natalie Epnetere: Mon mari qui allait à la pêche à chaque année depuis plus de 30 ans à arrêté d’aller à la pêche. On voit l’eau différemment maintenant.

(Technical difficulties) (Music playing)

Unidentified Speaker: Hundreds of studies show that reconnecting with nature is one of the best things you can do to improve your health. These studies show that in addition to making people happier and significantly lowering stress hormone levels, nature therapy improves the psychological well-being of cancer patients by reactivating fighting cells. It has been found that a 20-minute walk in a park can improve concentration in children with ADHD, similar to prescription-stimulant medications for the same condition. Also, children who spend more time in nature are more likely to develop environmental awareness and similarly adults who spend more time in nature are more likely to have a desire to protect it. Could simply immersing oneself in nature help to heal it and, in the process, secure our future on earth?

Unidentified Speaker: The Parks Prescription Program is actually developed and headed by the president elect of (inaudible) which is Melissa Lamb (ph) based out of B.C. And so, the idea is that overall, as a society we have a nature deficit. We’re spending too much time indoors, looking at screens, and we need to get out there and soak ourselves in nature, you know, let that green wash over us. And that has physical benefits because generally when you’re in nature you’re not sitting down just watching, you’re actually being active, hiking, biking, but it also has a lot of mental health benefits as well.

Unidentified Speaker: On sait aussi qu’après 15 minutes en nature, ou d’exposition à la nature, le taux sanguin de cortisone qui est l’hormone du stress diminue, la fréquence cardiaque diminue, puis la tension artérielle diminue. Tu sais on se fait dire depuis qu’on rentre à l’école en médecine, les piliers de bonne santé, pas fumer, faire attention à sa consommation d’alcool, bouger, puis bien manger. Nous on veut qu’il y ait un cinquième pilier qui se rajoute, ou un sixième là si on rajoute le sommeil, mais (inaudible) ça soit dire, est-ce que tu passe du temps dans la nature à chaque semaine?

Unidentified Speaker: And so, this is a program that physicians can actually write a prescription for nature for, for individuals and with that prescription they can actually go, and access park passes. And I believe there’s programs in, in provinces that allow them to access provincial park passes as well. (Technical difficulties)

Unidentified Speaker: (Inaudible) prescription nature qu’une politique innovante d’adaptation aux changements climatiques qui devrait être employée à plus large échelle et qui peut permettre finalement aux gens de reconnecter avec l’environnement et puis de peut-être même nourrir un désir encore plus grand de, de protéger cet environnement naturel là.

(Technical difficulties)

Unidentified Speaker: La fatigue pandémique on en n’a beaucoup entendu parler. Le concept de fatigue climatique existe aussi. Donc, à force de se faire bombarder d’information sur les problèmes mais pas assez sur les solutions, le sentiment d'impuissance qu'on vient nourrir peut tranquillement nous amener à une fatigue climatique qui nous amène un peu à baiser les bras à dire, tout ça c'est comme trop gros finalement donc, je vais un peu jouer à l’autruche.

Unidentified Speaker: The health care system in Canada emits about 4.6% of our country’s emission which is not insignificant. It’s about the same amount as our airline industry. So, we do have a responsibility as providers within the system to, to deal with that.

Unidentified Speaker: Une échelle de l’hôpital (inaudible) disait, qu’est-ce qu’on fait pour réduire nos déchets? Est-ce qu’on a des chaînes d’approvisionnement responsables? Est-ce qu’on utilise des médicaments qui sont vraiment nocifs pour l’environnement? Et, et encore une fois ça devrait être intégré dans l’ensemble des échelles de l’organisation du PDG jusqu’à l’échelle du conseiller en hygiène de salubrité, au préposé aux bénéficiaires, puis, puis aux médecins.

Unidentified Speaker: As physicians and nurses and, and other health care professionals we want to work within a system that is healthy for the environment, that we can be proud of and —

(Music playing)

Unidentified Speaker: Qu’est-ce que la santé planétaire? On défini la santé planétaire comme suit; « Parvenir au niveau de santé, de bien-être et d’équité le plus élevé possible à l’échelle mondiale en portant une attention soutenue au système humain, politique, économique, et sociaux qui façonne l’avenir de l’humanité. Porter attention aux systèmes naturels de la terre qui eux fixent les limites environnementales dans laquelle l’humanité peut s’épanouir en toute sécurité. En termes simple, la santé planétaire et la santé de l’humain en harmonie avec l’état des systèmes naturels d’ont-elles dépend.

Unidentified Speaker: Dans l’idée de la santé planétaire c’est justement c’est de reconnaitre que l’action ne peut qu’être transdisciplinaire puis qu’on a besoin de l’expertise et des savoirs de différents champs, que ça soit en ingénierie, en science social, en entrepôt, puis mais qu’on devrait reconnaitre les savoirs qu’ont dit non-traditionnels, les savoirs ancestraux, les connaissances qu’ont développées plusieurs Premières Nations sur leurs territoires, sur la nature qui habite leurs territoires, la vie qui habite leurs territoires puis ce, ce mouvement (inaudible) planétaire cherche à reconnaitre ces différentes formes de savoir-là.

Unidentified Speaker: (Inaudible) level (inaudible) we’re all going to be dealing with for – I mean, most certainly the rest of our lives.

Unidentified Speaker: (Inaudible) une capacité d’action collective (inaudible) la coopération comme jamais dans (inaudible).

Unidentified Speaker: C’est mieux se gouverner collectivement dans un esprit de, de bienveillance, tant pour la planète que pour les humains qui nous entourent.

Unidentified Speaker: If you’re concerned about these issues, the way to deal with that, an all-hands-on deck situation where if we just let it slide, we will all suffer. And it is very easy to feel hopeless when you’re just looking at it as an individual facing an entire system, but when we organize, when we work together towards a common goal, suddenly the impossible can become merely difficult and that’s when we start to win, and that’s really how we turn the ship around.

(Music playing)

Moderator #2: This episode was powered by Université de la Rue, produced by Coop les Affranchis and made possible by the support of Health Canada and IFMSA Québec.

Unidentified Speaker: (Voice of Translator) This flooding has been going on for weeks, we didn’t know what would happen to our house nor if we would get an indemnity. We did not know where we would go. In 2022 climate change remains the greatest health threat to Canadians in the 21st century.

Unidentified Speaker: Canada is warming twice as fast as the other place in the world.

Unidentified Speaker: The climate emergency is when humans have emitted gases and had other impacts on the earth, it’s causing our meteorological systems to shift and having impacts on all aspects of (inaudible).

Unidentified Speaker: (Voice of Translator) When it comes to the psycho social consequences of crises or extreme events we really need to think about the whole range of stress factors also known as stressors. Everyone involved was caught off guard and humanitarian impact was underestimated.

Unidentified Speaker: The important variations that we could see occurring in term of seasonal.

Unidentified Speaker: We know that climate change will increase the frequency, intensity and severity of such phenomena as floods, heat waves, forest fires, tornadoes and eventually hurricanes worldwide.

Moderator: You’re listening to a podcast powered by Université de la Rue produced by Coop les Affranchis and made possible by the support of Health Canada and IFMSA Quebec.

Natalie Epnetère:   (Voice of Translator) This is from April 16th, 2017 and this is behind the house, you can see around the shed that the water is rising but it's coming from the land because that's not where the river is located, it is much further away, it’s about 300 metres away. We live on a peninsula so we have water in the back, we have water in the front but we do not live on the shore. My name is Natalie Epnetère, I was living in Rigaud in 2017 and I lived through the floods the whole way through.

We got out of our house because we were asked to evacuate. We later returned because the water level had stabilized. What happened was that the water got very close to the house. It kept raining, there was so much water, we built a barrier but since we were only the two of us and without any help it was really exhausting.

Unidentified Speaker: More frequent and intense extreme heat, increased risk of drought and forest fires, thawing permafrost and the reduction of sea ice extent our direct consequences of global warming.

In 2017 93% of Canadians who believed in climate change believed that it is a risk to their health or will be in the near future. They feel vulnerable to it. Economic insecurity and food and water shortages can cause ongoing stress, anxiety and even depression. The issues of depression and anxiety are very real in Canada. More and more we are hearing about eco anxiety, psychological health and climate change are interconnected.

Will we have the knowledge to understand how these causes are interconnected? Will we be able to adapt?

Joe Vipond:   We are interconnected beings on this planet. You know we've evolved as a civilization for a pretty narrow set of parameters of temperature and humidity and sea level. And so as all of those parameters are changing and rapidly changing.

My name is Joe Vipond. I'm an emergency physician at the Rockyview Hospital in Calgary, Alberta, the co founder of the Calgary Climate Hub and the current president of the Canadian Association of Physicians for the Environment.

And so as all of those parameters are changing and rapidly changing, it's very difficult for our civilization to adapt, have a functional civilization and through these different changes.

Moderator: By 2050 spring flood peaks and snow melt are expected to occur one month earlier than normally because of rising temperatures. In Canada many towns and cities could be severely affected by flooding which is the most common natural hazard in the country.
The numbers speak for themselves, from 1900 to 2005 260 major floods claimed the lives of 235 people and caused billions of dollars in damages. For example the 2013 flood in Alberta resulted in the death of four people. The damage amounted to approximately $6 billion. In Quebec since 1990 27 floods qualified as catastrophic have resulted in the death of dozens of people and in the evacuation of tens of thousands of citizens. These floods represent a danger for the economy, community life and affect the health of the population.

Philippe Gachon:   (Voice of Translator) Temperatures are warming up, we all know it. We have seen milder winters than usual in recent years but precipitation patterns are changing and it is that combination of changes in precipitation and in temperatures that generates floods that are not only more severe in terms of volume of water but also in terms of duration.

Philippe Gachon, Professor of Hydro Climatology in the Department of Geography here at L'Université du Québec à Montréal, I'm also Director General of the RIISQ - Réseau Inondations InterSectoriel du Québec. There are not many places in the world that has flood that last for nearly two months.

Unidentified Speaker: (Voice of Translator) We were kind of far, about five kilometres away in a peninsula so the concern we had was to get to the village. When I called to get some sandbags I was told I had to go there, I asked them, how do you want me to get through three feet of water?

Unidentified Speaker: (Voice of Translator) This is not only about sandbags, there's also the whole psychosocial aspect. This is fundamental, we saw it in 2017 and now 2019. Even if we know for sure when it's going to happen we want to anticipate and do prevention, education, awareness to be able to intervene more efficiently, especially in terms of social, psychosocial and health issues.

Unidentified Speaker: (Voice of Translator) So at this point I'm starting to feel like we wouldn't have any help knowing that the water kept rising on the road.

Unidentified Speaker: (Voice of Translator) Then once the event has occurred one must be able to learn from what happened, did we do right? What did we do wrong? How can we do better next time? This is what proactive risk management is all about.

Moderator: Flooding causes mold growth and thus an increase in health problems related to the respiratory system. In the aftermath of floods, accidental carbon monoxide poisoning is an increased health risk, especially during cleanup activities.

In the United States following the 1997 North Dakota flood nearly half of the 33 cases of carbon monoxide poisoning that were reported involved cleaning professionals. The carbon monoxide poisonings reported were also associated with other causes such as the use of pressure washers, auxiliary heaters or a combustion pump.

Claudel Pétrin-Desrosiers: (Voice of Translator) Among the other effects of climate change we must consider the whole range of infectious diseases and especially vector borne diseases transmitted by living pathogens such as insects or animals. There are plenty of them around the globe. There's Zika and Ebola which are diseases influenced by climatic factors. There's also the notorious Lyme disease.

My name is Claudel Pétrin-Desrosiers, I’m a family physician at CLSC Hochelaga-Maisonneuve, I’m president of the Association québécoise des médecins pour l’environnement, and I'm also responsible for global health for the Department of Family Medicine and emergency medicine at the Université de Montréal. The issue with Lyme disease is that it consists of a tick that lives where there are suitable conditions for its survival. With global warming we're expanding the territory suitable for it. By 2050 Lyme disease will be seen in the Saguenay and Gaspé regions, it will not only happened in the south of the province anymore. Cases are rising as we speak in the Estrie-Montérégie regions but it's going up north as the climate is getting hotter.

Moderator: The impacts of the rise in global temperatures are multiple. Since the beginning of the 1980s we noticed that global warming is clearly accelerating. The melting of the polar ice caps has accelerated since the 2000s and the ozone layer has been strongly damaged by carbon dioxide

Approximately 30% of the sea level rise is due to the increasing water temperature to increase temperature in general and to precipitation which all have a significant impact on the transmission of diseases from animals to humans. Avian Influenza, Salmonellosis, West Nile virus and Lyme disease are just a few examples.

If this rise causes the spread of viruses and promotes a proliferation of invasive species, can it also affect the population in other ways?

Unidentified Speaker: There are many impacts, you know economic, physical, architectural, but there's also health as well and those health impacts can be a broad spectrum of things. It can be illnesses like as vectors change, it can be because of these recurrent disasters forcing internally displaced people to move elsewhere. It could be impacts on food security and all the way through to mental health and the impacts of watching this rapid evolution occur right in front of our eyes and anticipating what's to come.

Unidentified Speaker: (Voice of Translator) In the fields of health and climate change we face a double challenge because on the one hand we might be tempted to put forward all the negative impacts that have been documented and that are real of climate change on health.

On the other hand if we put too much emphasis on this and not enough on the solutions we can cause another problem which is eco anxiety, that feeling of fear, of powerlessness in the face of the deterioration of the environment and the impact that this can have on our well being.
Eco anxiety can really paralyze people, make them really uncomfortable and even hinder the change that we would like to see in these people. So we really need to strike a balance between people who are somewhat in denial or inaction and people who might become paralyzed because they are so aware of the negative impacts on our health.

Unidentified Speaker: (Voice of Translator) We were two feet from the ground of the house and we were thinking that maybe the barrier would be enough. But one particular night at the beginning of May we decided to sleep upstairs. Normally we had our room downstairs but we thought just in case.

Unidentified Speaker: We don't need any studies to answer that question, right? I mean when people's homes are being burned, are being flooded, when people are dying (inaudible) in Vancouver I mean it's killing people.

Scott Weichenthal: So I'm Scott Weichenthal, I'm an associate professor at McGill University in the Department of Epidemiology, Biostats and Occupational Health. The aim of our work is really to develop some new models of high resolution temperature variations across both Montreal and Toronto. The effects have been pretty obvious, right? There were a lot of people that were – that died last summer in Vancouver because of a heat emergency. Obviously we're seeing increasing forest fires every year primarily out west but you know other places as well.

Unidentified Speaker: (Voice of Translator) It is known that in Quebec by 2065 at least 20,000 heat related deaths are expected. We don't have Canada wide statistics but definitely what we saw in Vancouver last summer was not an isolated event, it was a foretaste of the years to come. I wouldn't be surprised to see something similar happen in Montreal or Toronto in the coming summers.

Heat is a strain on the whole body. When you're already somewhat in a vulnerable condition it can be cardiac, pulmonary, renal or metabolic problems heat can be deadly. In urban areas high temperatures are deadly. And who does it kill? Especially the elderly, people who live in heat islands, people who live in low income neighbourhoods and people who have one or more chronic diseases.

Moderator: Variations in temperature, precipitation and extreme weather events have an impact on the introduction of pathogens into the food we eat. In addition, unstable harvests increase the instability of prices of basic food products on international markets resulting in price variations that are harmful to both producers and consumers. Therefore climate change amplifies existing threats to our means of subsistence and to food security.

Sébastien Nobert:  If you think the Eastern Township, for example, in Canada last summer was extremely dry. Sébastien Nobert, I'm a geographer, assistant professor at University of Montreal. I'm also an associate researcher at the stadium(sic).
Farmers will now find water maybe in the water table to irrigate their land and not being they’re using rainwater as a form of insurance that they could always produce the kind of agriculture they do. I think all this related.

Unidentified Speaker: (Voice of Translator) Other impacts of climate change that we see a lot of in Canada are allergies, infections, malnutrition, food insecurity, population displacement and forest fires.

Unidentified Speaker: We currently hear fire chiefs saying I've never seen anything like this before, these fires are behaving unlike anything we've previously experienced. And when they get so out of control it's even hard to have targeted protection living spaces like a town. And so that's why we're seeing you know Fort McMurray, Lytton, High Level, Slave Lake, you know big portions of major towns disappearing.

Unidentified Speaker: (Voice of Translator) Forest fires are a dual problem because they increase air pollution and also increase greenhouse gas emissions. Because trees release greenhouse gases it degrades air quality quite significantly. This leads to displacements and sometimes health service disruptions and hospital closures. It is said that we have a good air quality in general in Quebec and in Canada but it remains that in the country each year there are 15,000 people who die prematurely because of pollution.

Unidentified Speaker: (Voice of Translator) Around 1:00 a.m. the whole house moved, it was as if a tsunami had passed under the house. The water came in with an extraordinary force, everything fell, even the fridge. We had a big freezer, it made an astounding noise. I called 911 to ask for advice and was told ma’am, there is no one who will risk their life for you. You have to wait for the Canadian Army tomorrow morning. I was in shock. We were outside, we went back into the doorframe because we didn't know if the house was going to hold up.

Millie Sagenereu (ph): (Voice of Translator) In Estrie we have developed a unique expertise regarding the impact of crises. My name is Millie Sagenereu (ph), I'm a physician specializing in public health and I'm also an associate professor in the Faculty of Medicine and Health Sciences at the Université de Sherbrooke. When the spring floods of 2017 and 2019 happened in Quebec we thought that if something was observed in the community of Lac Mégantic, there are good reasons to believe that in the riverside communities that were flooded following these events we can expect to observe the same types of impacts. Any form of disruption can bring its own set of psychological health issues.

Unidentified Speaker: (Voice of Translator) In the end the house held together. The next morning the army arrived around 8:00 a.m., we were told take a small suitcase of about two feet, then they told us to say goodbye to our home saying that maybe we would never see it again.

Unidentified Speaker: (Voice of Translator) We conducted our study in the eight to 10 months following the 2019 floods involving 3,500 people living in the neighbourhoods that were flooded in six regions of Quebec. The impacts were enormous. We noticed that people who had been confronted with the flood directly and had water in the habitable rooms of their house, while moderate to severe manifestations of post traumatic stress were observed in 44% of them, this was assessed almost one year after the events occurred.

Unidentified Speaker: (Voice of Translator) I would say that there's a before, a before where you feel safe, a home is a haven, this is where we feel the safest. When water is sweeping through the house like a tsunami, everything is moving and after that you can't even get in and you don't even know where to go, for sure it changes how we feel about our safety

Unidentified Speaker: (Voice of Translator) In fact the symptoms of post traumatic stress are very diverse and having some of the symptoms doesn't necessarily mean that you're affected by a post traumatic stress disorder.

Unidentified Speaker: (Voice of Translator) My husband experienced a lot of hearing loss and the doctor diagnosed him with post traumatic shock.

Unidentified Speaker: (Voice of Translator) These symptoms can include intrusive thoughts, you know when you do everything you can to try to stop thinking about an event but it overwhelms your brain whether through intrusive thoughts, recurring dreams about the event or even nightmares, there are also avoidance symptoms. In other words people who are no longer able to be exposed to anything that it might remind them of painful events, these people will avoid situations or images that can bring back memories because it hurts them too much. Other symptoms I would say are more akin to hyperactivity, being frightened without reason, becoming easily irritable so it's an accumulation of all these symptoms which as one can imagine can quickly become invasive and affect people's functioning and quality of life.

Unidentified Speaker: (Voice of Translator) We were really in disarray because we didn't know where we were going to spend the night, what happened to our belongings, our house, we felt like we were in the dark completely.

But fortunately the Red Cross was quick to tell us we don't have many hotel rooms left because people have been evacuating for several weeks. But they still found us a place to stay, to eat and even to get dressed because we had no clothes. We had nothing. And then we didn't have any information, we didn't know what would happen next. We were really left to ourselves in that respect.

Unidentified Speaker: Now that happens with any disaster whether it's flood or fire, and when you evacuate a place of course that's going to have health impacts because suddenly those people are outside their normal living sphere, sometimes they have to be in congregate living and the infectious diseases that go along with that and of course they all lose their primary health care because they're no longer in their place of living.

Unidentified Speaker: (Voice of Translator) We were left with no answer without knowing what would happen to our house nor if we would get an indemnity or where we would go. Those were some of the most distressing moments I would say, even more than the flood itself both with the municipality and with public security. Well with all the parties involved.

Unidentified Speaker: (Voice of Translator) This notion of not knowing exactly where you're going, what is coming, who you should talk to, it's extremely stressful for people and unfortunately these secondary stressors often come at a time when the help, the moral support, the very tangible support, the attention of the media and of the whole population are all in decrescendo. So you understand that the stress continues to increase as the support of the population starts to decrease, this is exactly when people start to feel stressed, tired and depressed.

Moderator: What are the actions and commitments that should be taken in order to reduce the impact of environmental changes and its repercussions on physical and psychological health? The effort to reduce air pollution, urban greening near where citizens live, improving public transportation, developing cycling and pedestrian networks, limiting exposure to pesticides, protecting food self sufficiency and reducing greenhouse gas emissions are just a few examples of commitments that can be made on all levels.

Citizen involvement is not to be neglected in the equation. Like the family that chooses to shop in bulk food stores and commute to work by bike, we know that it is the strength of individual actions that will keep us healthy and in harmony with our environment.

Unidentified Speaker: (Voice of Translator) When we talk about solutions to climate change we often have two streams of action, medication which consists of reducing greenhouse gas emissions and adaptation to climate change. What do we do about it? And within the question of climate adaptation you have adaptation that can be done at an individual level but also at a collective level, the use of nature is a factor that could promote individual adaptation to climate change, but also collective adaptation because if you want everyone to have access to nature, you put nature where people live.

Unidentified Speaker: The reduction of heat created by the green spaces within a city are tremendous. This should be something on which cities should invest a bit more.

Unidentified Speaker: (Voice of Translator) Vegetation also has an extremely important impact in retaining water. Water will flow very swiftly into the sewers when there's heavy rainfall on asphalt surfaces but wetlands and forests will absorb the rainwater and keep it in the soil, hence slowing down the hydrological cycle.

Unidentified Speaker: (Voice of Translator) My husband who used to go fishing every year for over 30 years stopped going. We see water differently now.

Moderator: Hundreds of studies show that reconnecting with nature is one of the best things you can do to improve your health. These studies show that in addition to making people happier and significantly lowering stress hormone levels, nature therapy improves the psychological well being of cancer patients by reactivating fighting cells.

It has been found that a 20 minute walk in a park can improve concentration in children with ADHD, similar to prescription stimulant medications for the same condition. Also children who spend more time in nature are more likely to develop environmental awareness, and similarly adults who spend more time in nature are more likely to have a desire to protect it. Could simply immersing oneself in nature help to heal it and in the process secure our future on Earth?

Unidentified Speaker: The parks prescription program is actually developed and headed by the president elect of CAPE which is Melissa Lem based out of BC. And so the idea is is that overall as a society we have a nature deficit, we're spending too much time indoors looking at screens and we need to get out there and soak ourselves in nature, you know let that green wash over us. And that has physical benefits because generally when you're in nature not sitting down just watching, you're actually being active hiking, biking, but it also has a lot of mental health benefits as well.

Unidentified Speaker: (Voice of Translator) It’s also known that after 15 minutes in nature or being exposed to nature the blood level of cortisol which is the hormone of stress, the heart rate and the blood pressure all decrease. We have been told since we entered medical school about the pillars of good health, not smoking, watching your alcohol consumption, being active and eating well. We want a fifth pillar to be added or a sixth if we're adding sleep. You should ask yourself, do you spend time in nature every week.

Unidentified Speaker: And so this is a program that physicians can actually write a prescription for nature for individuals and they – and with that prescription they can actually go and access park passes and I believe there's programs in provinces that allow them to access provincial park passes as well.

Unidentified Speaker: (Voice of Translator) I really see nature prescriptions as an innovative climate change adaptation policy that should be used on a wider scale and that can ultimately allow people to reconnect with the natural environment and perhaps even nurture an even greater desire to protect that same environment.

Unidentified Speaker: (Voice of Translator) We've heard a lot about pandemic fatigue, the concept of a climate fatigue also exists. So by being bombarded with information on the problems and not enough about solutions the feeling of powerlessness can grow and slowly lead us to a climate fatigue that causes us to give up in a way, you end up thinking this is too much, I'd rather not think about it.
Unidentified Speaker: The healthcare system in Canada emits about 4.6% of our country's emissions which is not insignificant, it's about the same amount as our airline industry. So we do have a responsibility as providers within the system to deal with that.

Unidentified Speaker: (Voice of Translator) We have to ask ourselves, hospital wide or clinic wide what are we doing to reduce the amount of waste we produce? Do we have sustainable supply chains? Are we using medicines that are actually harmful to the environment? And once again it should be integrated across the organizational ladder from the CEO down to the hygiene and cleanliness advisor to the beneficiary attendants and physicians.

Unidentified Speaker: As physicians and nurses and other health care professionals we want to work within a system that is healthy for the environment, that we can be proud of and…

Moderator: What is planetary health? Planetary health is defined as the attainment of the highest possible level of worldwide health, wellbeing and equity through sustained attention to the human, political, economic and social systems that shape humanity's future, attention to the earth's natural systems which set the environmental limits within which humanity can safely thrive. Simply put, planetary health is human health in harmony with the state of the natural systems upon which it depends.

Unidentified Speaker: (Voice of Translator) The concept of global health is to acknowledge that action can only be transdisciplinary and that we need the expertise and knowledge of different fields, whether in engineering, social sciences, anthropology, etcetera. We should even recognize the so called non traditional knowledge or ancestral knowledge. The understanding that several First Nations have developed about their territory and the nature that inhabits it, the life that inhabits their territory, this worldwide movement seeks to recognize these different forms of knowledge.

Unidentified Speaker: It’s a vital level issue, right, we're all going to be dealing with for certainly I mean the rest of our lives.

Unidentified Speaker: (Voice of Translator) We need to develop a capacity for collective action, inter relationship and cooperation as never before in history. To govern ourselves collectively in a spirit of benevolence both for the planet and for the people around us.

Unidentified Speaker: If you're concerned about these issues the way to deal with that, an all hands on deck situation where if we just let it slide we will all suffer and it is very easy to feel hopeless when you're just looking at it as an individual facing an entire system. But when we organize, when we work together towards a common goal suddenly the impossible can become merely difficult and that's when we start to win and that's really how we turn the ship around.
Moderator: This episode was powered by Université de la Rue, produced by Coop les Affranchis and made possible by the support of Health Canada and IFMSA Quebec.