At-a-glance – Climate change impacts on health and wellbeing in rural and remote regions across Canada: a synthesis of the literature

Amy Kipp, MAAuthor reference 1; Ashlee Cunsolo, PhDAuthor reference 2; Kelly Vodden, PhDAuthor reference 3; Nia King, BScAuthor reference 4; Sean Manners, BAAuthor reference 3; Sherilee L. Harper, PhDAuthor reference 1

https://doi.org/10.24095/hpcdp.39.4.02

Author references:

Author reference 1

School of Public Health, University of Alberta, Edmonton, Alberta, Canada

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Author reference 2

Labrador Institute, Memorial University, Happy Valley-Goose Bay, Labrador, Canada

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Author reference 3

Environmental Policy Institute, Grenfell Campus, Memorial University, Corner Brook, Newfoundland and Labrador, Canada

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Author reference 4

School of Medicine, Queen’s University, Kingston, Ontario, Canada

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Correspondence:

Amy Kipp, University of Alberta, 11405 87 Avenue NW, Edmonton, AB  T6G 1C9; Email: kipp@ualberta.ca

Ashlee Cunsolo, Labrador Institute of Memorial University, P. O. Box 490, Station B, Happy Valley-Goose Bay, NL  A0P 1E0; Tel: 709-896-4702; Email: ashlee.cunsolo@mun.ca

Sherilee L. Harper, School of Public Health, University of Alberta, 11405 87 Avenue NW, Edmonton, AB  T6G 1C9; Tel: 780-492-7766; Email: sherilee.harper@ualberta.ca

Abstract

This article provides a synthesis of the forthcoming first order draft of the Canadian Government’s National Assessment on Climate Change ‘Rural and Remote’ chapter, highlighting key health concerns from the literature associated with climate change in rural and remote regions, as well as existing and future adaptation strategies. To support the health and wellbeing of those experiencing the negative effects of climate change, and utilizing systematic search processes, this synthesis article highlights the importance of considering the specific socio-cultural, economic, and geographic elements and existing expertise of individuals and communities in rural and remote regions.

Keywords: climate change, health, wellbeing, rural, remote, adaptation, Canada

Highlights

  • Climate change negatively impacts the health and wellbeing of individuals and communities in rural and remote regions in Canada.
  • Key health concerns from the National Assessment on Climate Change ‘Rural and Remote’ include the exacerbation of issues associated with food and water security, chronic illness, infectious disease, unintentional injury and death, and mental health.
  • Although specific characteristics increase climate change vulnerability of rural and remote regions, many strengths within these regions support resilience to climate change.
  • Focusing on climate change adaptation, as well as realizing co-benefits from climate change mitigation, presents important opportunities for the health sector.

Introduction

In rural and remote regions (see Box 1) across Canada, human health and wellbeing are often influenced by the close connection individuals and communities have to their social, cultural, and physical environments.Footnote 1Footnote 2Footnote 3Footnote 4Footnote 5 These communities often rely closely on the environment for their sustenance, livelihoods, and cultural practices, influencing the social determinants of health and wellbeing.Footnote 1Footnote 2Footnote 3Footnote 5Footnote 6 As a result, climate change is directly and indirectly impacting the health and wellbeing of individuals and communities.Footnote 1Footnote 2Footnote 5Footnote 7Footnote 8

Box 1. Definition of rural and remote regions

Building from the PHAC definition,Footnote 31 rural and remote regions are defined as areas with less than 10 000 people, in which rural regions have less than 50% of the population that commute to an urban location for work, and remote communities have no residents that commute to an urban location for work or the community is located in one of the Canadian territories.

This article synthesizes the health content from the first order draft of the ‘Rural and Remote’ chapter of the Canadian government’s forthcoming National Assessment on Climate Change, Canada in a Changing Climate: Advancing Our Knowledge for Action.Footnote 9 The Rural and Remote Chapter is one of several national issues chapters of The National Assessment, including chapters focused on Our Natural Capital, International Dimensions, and Resilience of Our People and Society, for example, as well as regional chapters, such as Northern Canada, British Columbia, the Prairies, Ontario, Quebec, and Atlantic Canada.Footnote * This assessment will serve as an important resource for communities, policy-makers, and academics to support climate change adaptation decisions and actions and explores how Canada’s climate is changing, the impacts of these changes on Canadians, and the adaptation strategies being used to reduce climate related risks.Footnote 9 The Rural and Remote Chapter, and by extension this article, is based on a scoping reviewFootnote of gray and peer-reviewed literature; ongoing engagement with researchers, governments, communities, organizations, and Indigenous knowledge-keepers and leaders; and collaboration with other Chapters in the National Assessment. The scoping review characterized the nature, range, and extent of literature on climate change impacts and adaptation in rural and remote Canadian communities, and included literature published since the last national assessment (2013). Based on quantitative and qualitative analysis of the scoping review, as well as input from engagement and collaboration, key health concerns associated with climate change and adaptation strategies in rural and remote regions throughout Canada were identified. This article provides a brief overview of these key health concerns.

Climate change, health, and wellbeing in rural and remote regions

Many changing climate conditions and resultant environmental impacts negatively affect individual and community health and wellbeing in rural and remote regions, including: increased prevalence and severity of extreme weather events;Footnote 1Footnote 2Footnote 5Footnote 10Footnote 11Footnote 12 changes to sea ice, vegetation, fish, wildlife, and water;Footnote 1Footnote 2Footnote 5Footnote 12Footnote 13 and weather and environmental uncertainties.Footnote 1Footnote 2Footnote 6Footnote 14

Negative health outcomes associated with these changes include an increased prevalence of poor nutrition, obesity, and diabetes;Footnote 5Footnote 15Footnote 16 vector-borne, waterborne, and foodborne disease;Footnote 5Footnote 12Footnote 16Footnote 17 cardiovascular disease;Footnote 15Footnote 16 respiratory issues;Footnote 18 injury and mortality;Footnote 12Footnote 13Footnote 14 and mental health issues.Footnote 3Footnote 6Footnote 18Footnote 19Footnote 20 Characteristics of rural and remote regions may increase the sensitivity to these health risks, such as remote geography and limited transportation infrastructure, reliance on natural resources, and under-resourced social and physical infrastructure.Footnote 2Footnote 5 Additionally, vulnerability to climate change is influenced by the intersection of social, cultural, and political factors in rural and remote regions as well as individual characteristics and circumstances.Footnote 2Footnote 5Footnote 21Footnote 22 Based on a synthesis of the literature from this scoping review, key health concerns in rural and remote areas include: 1) challenges with access to and quality of food and water; 2) exacerbation of chronic illness and infectious disease; 3) potential unintentional injury and death; and 4) intensified challenges with mental health and wellbeing. Furthermore, the literature highlights Indigeneity, age, gender, and socioeconomic status as key factors influencing individual and community vulnerability to climate change in rural and remote regions.

Changing access and availability of nourishing, accessible, and preferred food and water

Many rural and remote regions have experienced changing access to, and quality of, food and water systems, linked to environmental changes such as rising temperatures,Footnote 7Footnote 16Footnote 20Footnote 23 changing precipitation patterns, and increasing incidents of extreme weather events.Footnote 7Footnote 18Footnote 23 For example, in many Northern remote First Nations and Inuit communities, climate-change-related disruptions to sea ice, wildlife, and vegetation impacts the ability of individuals to hunt, fish, and forage, leading to decreased consumption of healthy and culturally-preferred local food and increased reliance on retail food.Footnote 7Footnote 16Footnote 18Footnote 19Footnote 23 Water security, including access, availability and quality, may also be challenging in rural and remote regions, where rising temperatures and more frequent extreme weather events can overwhelm fragile water treatment systems, interrupting the provision of safe drinking water.Footnote 7Footnote 23 Across Northern Canada, where many communities rely on surface water sources, changes to water levels, run-off, flow regimes, and sediment accumulation can drastically affect drinking water availability and quality.Footnote 23Footnote 24 Both food and water insecurity have been linked to negative health outcomes, including poor nutrition, obesity, diabetes, cardiovascular disease, acute gastrointestinal illness, and mental health concerns.Footnote 7Footnote 12Footnote 16Footnote 25

Exacerbation of chronic illness and infectious disease

Changing precipitation patterns, rising temperatures, and increased frequency and severity of extreme weather conditions can also exacerbate chronic illnesses and infectious diseases in rural and remote regions by increasing exposure to environmental contaminants, and vector-borne, foodborne, and waterborne diseases;Footnote 16 putting enhanced stress on underlying chronic conditions (e.g. cardiovascular and respiratory illness);Footnote 4Footnote 18 and disrupting healthcare provision and chronic disease management.Footnote 6 Further, research has documented increased risk of waterborne disease in rural and remote areas, due to weather-related contamination events.Footnote 5Footnote 25 Additionally, changing winds, ocean currents, and rivers, carrying environmental contaminants North, may lead to increased levels of persistent organic pollutants and toxic heavy metals in local food and water sources in remote polar regions;Footnote 7Footnote 16Footnote 23 the consumption of contaminants can result in many health concerns.Footnote 7

Changing climate conditions resulting in increased injury and mortality

Extreme and rapidly changing weather conditions, including heat waves, storms, droughts, flooding, and changing sea ice conditions, have had significant negative effects on the health of individuals in rural and remote regions.  For example, an increase in the number of heat waves experienced in rural regions was associated with increased heat stroke and respiratory related emergency room visits.Footnote 26 Additionally, wild fires and associated health challenges, such as respiratory issues, mental health stressors, and damage to critical health infrastructure, have been identified in forest communities across Canada as a threat to safety and wellbeing.Footnote 11Footnote 18Footnote 19

Changing and uncertain environmental conditions impacting mental health and wellbeing

As environments change and people adapt to new and often fewer desirable conditions, the mental health and wellbeing of individuals in rural and remote regions is also affected. For example, in Indigenous communities in rural and remote regions of Canada, individuals are often deeply connected to the land for their wellbeing; as climatic changes alter the environment, access to places and practices of cultural significance are often disrupted.Footnote 3Footnote 6Footnote 12Footnote 27 For Nunatsiavut Inuit, for example, these changes have led to increased anxiety, fear, distress, anger, grief, and depression related to changes to land-based activities, connection to land, and cultural identity.Footnote 3Footnote 25Footnote 27 In regional plans in Manitoba, the potential loss of livelihoods associated with drought was identified as a climate-sensitive mental health concern.Footnote 28 In Atlantic Canada, individuals have connected an increase in the prevalence and severity of storms in rural coastal communities and the subsequent damage to important mental health infrastructure,Footnote 29 which often differs by gender.Footnote 30

Climate change adaptation responses and opportunities in rural and remote regions

Despite these challenges, focusing on climate change adaptation, as well as realizing co-benefits from climate change mitigation, presents an important opportunity for the health sector. Already many Canadian rural and remote communities have begun to develop and implement health-related adaptation strategies (Table 1). To support adaptation to the health effects of climate change, a number of changes to existing adaptation strategies are needed, including: using multiple knowledge systems, specific to sociocultural contexts; addressing non-climatic factors impacting adaptation; utilizing innovative forms of technology; improving and integrating health surveillance with environmental monitoring; supporting sustainable development practices; enhancing awareness of risks and response; expanding knowledge of climate change impacts; and developing the capacity of the health sector to respond to climate change (Table 1). Ultimately, for rural and remote communities to continue to adapt to the health impacts of climate change, it is important to consider the specific local and regional socio-cultural, economic, and geographic elements; support and draw upon existing expertise of individuals and communities in rural and remote areas in Canada; and continue to view human health within the social-cultural and physical environments of rural and remote regions (Figure 1).

Table 1. Examples of existing and potential adaptation strategies to the negative health effects of climate change in rural and remote communities in Canada
Examples of existing adaptation strategies References
Introducing local food production systems 15,16,19
Using experience-based Knowledge of local communities to support community resilience 3,6,12
Developing community-based monitoring programs and research to gather data about environment and health to inform decision making 5-7,18,25
Using Indigenous Knowledge and Local Knowledge regarding the physical environment, to support hazard avoidance and emergency preparedness 12-14
Utilizing a social development approach, which involves health professionals, social workers, and those in caring professions supporting those directly impacted by climate change to strengthen community capacity 22
Fostering protective factors for physical and mental health through connection to land-based activities, cultural arts and crafts, and opportunities for bringing community together 27
Examples of potential adaptation strategies References
Using local knowledge, Indigenous Knowledge, and/or western knowledge to respond to specific local sociocultural contexts 7,12,19,22
Eliminating social barriers to adaptation (e.g. poverty, inequality, housing concerns, etc.) and reducing non-climatic factors (e.g. chronic disease) 5,22
Utilizing innovative forms of technology (e.g. telehealth, mobile monitoring applications; satellite imagery) 5,19
Improving public health surveillance and furthering monitoring programs 5,7,8,12,14,15,23,24,29
Supporting sustainable development practices (e.g. clean energy programs) 12,19,22,29
Enhancing communication and awareness of risks and responses (e.g. lists of safe spaces, pamphlets regarding disease outbreaks; developing outreach strategy) 5,12,18,19,29
Expanding knowledge of climate change impacts on health through research and investment, and sharing best practices for public health adaptation 5,19,29
Developing the capacity of health systems and emergency response to withstand and respond to climate risks (e.g. creating technical guidance and training courses; integrating climate change into medical and public health training) 14,19

Figure 1. Visual summary of key health challenges and adaptation strategies in the context of climate change in rural and remote regions in Canada

Figure 1

Text Description

This figure illustrates the environmental impacts of climate change that are influencing the health and wellbeing of rural and remote communities and lists key health concerns and adaptation strategies. The strengths identified are: strong social capital and social networks; place-based knowledge systems; and high-rates of community participation and involvement. The challenges identified are: reliance on natural resources; geographic remoteness; under-resourced social and physical infrastructure; and limited institutional capacity (e.g. healthcare systems).

The environmental impacts are:

  • Increase in extreme weather events
  • Changes to sea ice, weather, precipitation, flora, fauna, land and water.

The key health challenges are:

  • Food and water security
  • Exacerbation of chronic and infectious illness
  • Increased injury and mortality
  • Impacts on mental health and wellbeing.

The Adaptation strategies identified are:

  • using multiple knowledge systems, specific to sociocultural contexts
  • addressing socio-cultural barriers
  • using innovative technology
  • improving and integrate public health and environmental surveillance
  • supporting sustainable development practices
  • enhancing risk communication and knowledge of climate change, and
  • developing capacity of health systems.

Acknowledgements

Thanks to Don Lemmen, Fiona Warren, and the managing team of the Natural Resources Canada (NRCan) National Assessment, Canada in a Changing Climate: Advancing Our Knowledge for Action, whose permission was obtained to publish this article. We would also like to thank the rural and remote communities, researchers, and policy-makers whose knowledge and expertise helped to inform the writing of this overview.

Conflicts of interest

The authors have no conflicts of interest to declare.

Authors’ contributions and statement

AC, SLH, and KV contributed to conceptualizing the literature review and search string to identify peer-reviewed and gray literature. NK and SM conducted the literature review search and extracted quantitative information from articles. AK, AC, and SLH analyzed articles qualitatively and synthesized information, including identifying emergent themes related to health concerns and adaptation strategies, as well as drafted the article. All authors contributed to revising the article.

The content and views expressed in this article are those of the authors and do not necessarily reflect those of the Government of Canada.

References

Footnotes

Footnote 1

Intergovernmental Panel on Climate Change. Climate Change 2014: Impacts, Adaptation, and Vulnerability. Part B: Regional Aspects. Contribution of Working Group II to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change. In: Barros VR, Field CB, Dokke JD, et al., editors. Cambridge (UK), New York (USA): Cambridge University Press; 2014. 688 p.

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Footnote 2

Intergovernmental Panel on Climate Change. Climate Change 2014: Impacts, Adaptation, and Vulnerability. Part A: Global and Sectoral Aspects. Contribution of Working Group II to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change. In: Field CB, Barros VR, Dokken DJ, et al., editors. Cambridge (UK), New York (USA): Cambridge University Press; 2014. 1132 p.

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Footnote 3

Cunsolo A, Ellis NR. Ecological grief as a mental health response to climate change-related loss. Nat Clim Chang. 2018;8(4):275-81. doi: 10.1038/s41558-018-0092-2.

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Footnote 4

Public Health Agency of Canada. Climate change impacts on the health of Canadians [Internet]. Ottawa (ON): Public Health Agency of Canada; 2017. Available from: http://publications.gc.ca/collections/collection_2017/aspc-phac/HP5-122-2017-eng.pdf

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Footnote 5

Expert Panel on Climate Change Adaptation and Resilience. Measuring progress on adaptation and climate resilience: recommendations to the Government of Canada [Internet]. Gatineau (QC): Environment and Climate Change Canada; 2018. 188 p. Available from: http://publications.gc.ca/collections/collection_2018/eccc/En4-329-2018-eng.pdf

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Footnote 6

Cunsolo Willox A, Stephenson E, Allen J, et al. Examining relationships between climate change and mental health in the Circumpolar North. Reg Environ Chang. 2015;15(1):169-82.

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Footnote 7

Berner J, Brubaker M, Revitch B, Kreummel E, Tcheripanoff M, Bell J. Adaptation in Arctic circumpolar communities: food and water security in a changing climate. 2016;1:1-8.

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Footnote 8

Durkalec A, Furgal C, Skinner MW, Sheldon T. Climate change influences on environment as a determinant of Indigenous health: relationships to place, sea ice, and health in an Inuit community. Soc Sci Med. 2015;136-137:17-26.

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Footnote 9

Natural Resources Canada. Canada in a Changing Climate [Internet]. Ottawa (ON): Natural Resources Canada; 2018 [cited 2018 Nov 26]. Available from: https://www.nrcan.gc.ca/environment/impacts-adaptation/19918

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Footnote 10

Rapaport E, Manuel P, Krawchenko T, Keefe J. How can aging communities adapt to coastal climate change? Planning for both social and place vulnerability. Can Public Policy. 2015;41(2):166-77.

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Footnote 11

Government of Saskatchewan. Prairie resilience: a made-in-Saskatchewan climate change strategy [Internet]. Government of Saskatchewan; 2017. Available from: http://publications.gov.sk.ca/documents/66/104890-2017 Climate Change Strategy.pdf

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Footnote 12

Ford JD, Willox AC, Chatwood S, et al. Adapting to the effects of climate change on Inuit health. Am J Public Health. 2014;104(Suppl. 3):e9-17.

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Footnote 13

Clark DG, Ford JD. Emergency response in a rapidly changing Arctic. Can Med Assoc J. 2017;189:e135–6.

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Footnote 14

Young SK, Tabish TB, Pollock NJ, Kue Young T. Backcountry travel emergencies in arctic Canada: a pilot study in public health surveillance. Int J Environ Res Public Health. 2016;13(3):276.

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Footnote 15

Barbeau CD, Oelbermann M, Karagatzides JD, Tsuji LJS. Sustainable agriculture and climate change: producing potatoes (Solanum tuberosum L.) and bush beans (phaseolus vulgaris L.) for improved food security and resilience in a Canadian subarctic first nations community. Sustain. 2015;7(5):5664-81.

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Footnote 16

Loring PA, Gerlach SC. Searching for progress on food security in the North American North: a research synthesis and meta-analysis of the peer-reviewed literature. Arctic. 2015;68(3):380-92.

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Footnote 17

Harper SL, Edge VL, Schuster-Wallace CJ, Berke O, McEwen SA. Weather, water quality and infectious gastrointestinal illness in two Inuit communities in Nunatsiavut, Canada: potential implications for climate change. Ecohealth. 2011;8(1):93-108.

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Footnote 18

Dodd W, Scott P, Howard C, et al. Lived experience of a record wildfire season in the Northwest Territories, Canada. Can J Public Heal. 2018;109(3):327-37.

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Footnote 19

Government of Northwest Territories. Northwest Territories Climate Change Strategic Framework 2018-2030 [Internet]. Government of Northwest Territories; 2017. Available from: https://www.enr.gov.nt.ca/sites/enr/files/resources/128-climate_change_strategic_framework_web.pdf

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Footnote 20

Statham S, Ford J, Berrang-Ford L, Lardeau MP, Gough W, Siewierski R. Anomalous climatic conditions during winter 2010-2011 and vulnerability of the traditional Inuit food system in Iqaluit, Nunavut. Polar Rec (Gr Brit). 2015;51(3):301-17.

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Footnote 21

Krawchenko T, Keefe J, Manuel P, Rapaport E. Coastal climate change, vulnerability and age friendly communities: linking planning for climate change to the age-friendly communities’ agenda. J Rural Stud. 2016;44:55-62. doi: 10.1016/j.jrurstud.2015.12.013.

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Footnote 22

Drolet JL, Sampson T. Addressing climate change from a social development approach: small cities and rural communities’ adaptation and response to climate change in British Columbia, Canada. Int Soc Work. 2017;60(1):61-73.

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Footnote 23

Medeiros AS, Wood P, Wesche SD, Bakaic M, Peters JF. Water security for northern peoples: review of threats to Arctic freshwater systems in Nunavut, Canada. Reg Environ Chang. 2017;17(3):635-47.

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Footnote 24

Bakaic M, Medeiros AS. Vulnerability of northern water supply lakes to changing climate and demand [Internet]. Arct Sci. 2017;3(1):1-16. Available from: http://www.nrcresearchpress.com/doi/10.1139/as-2016-0029

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Footnote 25

Harper SL, Edge VL, Ford J, et al. Climate-sensitive health priorities in Nunatsiavut, Canada. BMC Public Health. 2015;15(1):605.

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Footnote 26

Bishop-Williams KE, Berke O, Pearl DL, Kelton DF. A spatial analysis of heat stress related emergency room visits in rural Southern Ontario during heat waves. BMC Emerg Med. 2015;15(1):1-9. doi: 10.1186/s12873-015-0043-4.

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Footnote 27

Cunsolo A, Shiwak I, Wood M. “You Need to Be a Well-Rounded Cultural Person”: youth mentorship programs for cultural preservation, promotion, and sustainability in the Nunatsiavut Region of Labrador. In: Fondahl G, Wilson G, editors. Northern Sustainabilities: Understanding and Addressing Change in the Circumpolar World. Springer Polar Sciences. 2017:285-303.

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Footnote 28

Government of Manitoba. A made-in-Manitoba climate and green plan. Hearing from Manitobans [Internet]. Government of Manitoba; 2017. Available from: http://www.gov.mb.ca/asset_library/en/climatechange/climategreenplandiscussionpaper.pdf

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Footnote 29

Province of New Brunswick. Transitioning to a low-carbon economy: New Brunswick’s climate change action plan. Fredericton (NB): Province of New Brunswick; 2016. Available from: https://www2.gnb.ca/content/dam/gnb/Departments/env/pdf/Climate-Climatiques/TransitioningToALowCarbonEconomy.pdf

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Footnote 30

Vasseur L, Thornbush M, Plante S. Gender-based experiences and perceptions after the 2010 winter storms in Atlantic Canada. Int J Environ Res Public Health. 2015;12(10):12518-29.

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Footnote 31

Public Health Agency of Canada. The Rural Think Tank 2005 - Understanding issues families face living in rural and remote communities [Internet]. Ottawa (ON): Public Health Agency of Canada; 2007. Available at: http://www.phac-aspc.gc.ca/hp-ps/dca-dea/publications/rtt-grr-2005/2-eng.php

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Footnotes

Footnote 1

For a complete list of Chapters and more information on the National Assessment on Climate Change visit: https://www.nrcan.gc.ca/environment/impacts-adaptation/19926

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Footnote 2

The search approach utilized for the Rural and Remote chapter followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Full details of the search methods will be available in Natural Resource Canada’s National Assessment, Canada in a Changing Climate: Advancing Our Knowledge for Action, Rural and Remote Chapter (forthcoming 2020).

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