Two approaches, one shared learning journey to support climate-health adaptation planning
Adapting to a changing climate
Canada’s climate is changing. On average, Canada is warming at about twice the global rate, with the north warming even more.
Public health authorities have a responsibility to respond to emerging threats to health in their community. Climate change is one of them. In 2016, the Ontario government released its Ontario Climate Change and Health Vulnerability and Adaptation Assessment Guidelines. This framework aims to foster “an adaptive and resilient public health system that anticipates, addresses and mitigates the emerging risks and impacts of climate change.” Once risks are identified, the next question is, what do we do? This is where adaptation planning comes in.
[A]daptation—ensuring human and natural systems can adjust to the spectrum of effects of climate change—will have a critical impact on the well-being and prosperity of all who live in Canada in the decades ahead.
Indigenous Peoples have a high capacity to adapt to change. At the same time, many already experience disproportionate impacts of climate change, which is exacerbated by ongoing colonialism and marginalization that undermines their determinants of health and perpetuates health inequities. Indigenous Peoples’ close connection to the land is an important component of their vulnerability to climate change. The ecological conditions support Indigenous cultures, identities, health, self-determination and economies and are central to their adaptive capacity. Because the Western conceptualization of science undervalues Indigenous experiences, their perspective is not fully incorporated into climate change assessments. Indigenous world views need to be actively sought out and meaningfully incorporated so that climate adaptation plans reflect on-the-ground realities holistically.
Climate-related risks of concern
The Public Health Agency of Canada, Ontario Region and Simcoe Muskoka District Health Unit undertook a review of the literature to identify characteristics of interventions that public health authorities could use to reduce health impacts associated with a warming climate in Ontario. The review identified interventions that public health authorities can tailor to their local context. Six climate-sensitive categories are most relevant to Ontario and also important for other regions of Canada: extreme weather; extreme temperature; air quality; vector-borne disease; ultraviolet radiation; and water and food quality/quantity (Figure 1).
Figure 1: Climate-sensitive categories relevant to Ontario
Public health interventions aim to promote and protect health, prevent or reduce illness, or reduce exposure to risks. They come in many forms, and many occur outside the health sector. Climate-health approaches identified in the review include:
- Alerts/advisories/warnings used to increase awareness of potential health risks from extreme weather events such as extreme heat or from vector-borne diseases and encourage actions to reduce them.
- Guidelines/frameworks that support or guide responses to food and water-borne illness, vector-borne diseases, extreme heat, extreme weather events, and air quality.
- Health communication and health promotion are standard public health interventions, which are relevant to all the climate-sensitive categories noted above.
- Planning/decision-making includes activities such as the development of contingency plans for public health emergencies, smoke forecasting models, and planning guidance that contribute to improved management of run-off and water quality.
- Policy is an overarching instrument that outlines rules, principles, roles, responsibilities, values/beliefs, and/or an intention for actions that support public health. This can include planning rules that reduce risk of flooding, minimum and maximum temperature standards, pollution controls, disease reporting, requirements for provision of shade, and measures to ensure food and water quality.
- Surveillance is the systematic collection, analysis, interpretation, and dissemination of health data on an ongoing basis to control and prevent disease. It encompasses a variety of initiatives including surveillance of vector-borne diseases, emergency room syndromic surveillance, and monitoring of environmental conditions such as extreme weather and temperature.
- Environmental Adaptations are interventions that change, modify, or improve structural environmental elements, for example: interventions that reduce the risk of flooding, preservation and enhancement of green spaces that mitigates flooding, promotes cooling of urban spaces, improves air quality, or reduces exposure to UV radiation.
Addressing Mental Health
Available evidence indicates that there are widespread psychological impacts from climate-related events. Crisis counselling, cognitive interventions, and suicide prevention are examples of interventions used to reduce the adverse mental health impacts related to emergencies such as floods and wildfires. In addition, adaptation interventions can reduce exposure, and enhance adaptive capacity to climate change making individuals and communities better able to cope, which reduces psychosocial health risk of climate change.
Including an Indigenous lens
To be effective at incorporating an Indigenous perspective into climate change adaptation planning it is first essential to be mindful of how the interaction with settlers, both past and present, have left their mark. Canadians, especially those working in public health, have the responsibility to learn about this history and the Indigenous Peoples of Turtle Island. Kerry Ann Charles-Norris of Cambium Indigenous Professional Services (CIPS) outlines how public health authorities can work with, and learn from, Indigenous Peoples in culturally competent ways. Knowing and understanding this history is imperative to being able to recognize inequities as well as the wisdom held by Indigenous Peoples. Only then will it be possible to build relationships and engage in actions that decolonize public health activities.
The True History of Canada, the many unethical events that occurred and the relationship that the government has had with the Indigenous Peoples since contact is unknown to most. This history has not been voluntarily disclosed in the past, and even in the present, the disclosure is not a priority in our society. These events have had a profound effect on Indigenous People’s health and wellbeing, have left important knowledge and wisdom out of decision-making, and the non-Indigenous Peoples of today have gained privilege from them.
Interconnectedness to the Land
Indigenous Peoples have an intimate connection to the land and were gifted the knowledge and tools to learn from those who make their home in the natural environment. This gift was given by the Creator so that people understood how to survive and flourish in a sustainable way and maintain balance within the ecosystem, including being able to identify specific species to aid and cure sickness and observing nature to be proactive in preparing for environmental changes.
Truth and Reconciliation
In 2007, the National Centre for Truth and Reconciliation was established as part of the Indian Residential Schools Settlement Agreement, the largest class-action settlement in Canadian history. The Truth and Reconciliation Commission (TRC) was formed. As part of this journey of understanding Indigenous Peoples and including them in the discussions and planning about our collective future in preparing for our changing climate, it is essential to understand the need for healing. An understanding and acknowledgement of the effects of Residential Schools are required so that healing can occur and Indigenous Peoples can be encouraged and supported in their journey of reconnecting and re-learning their language, culture, and traditions that were not just once forbidden but forcibly taken from both adults and children.
Including Indigenous Voices
Although we would like to think that we can speak in the past tense about events that have led to the inequalities and exclusion of Indigenous Peoples today, the reality is that the past actions have seriously affected the present and will continue to do so in the future. We can ensure that from this point forward, we create a better future through the use of the best practices and critical concepts that have been identified that must be taken into consideration when pursuing the inclusion of Indigenous Peoples’ voices and that those voices be meaningfully supported and incorporated.
- Trust is the foundation of meaningful engagement with Indigenous Peoples.
- Research is necessary to have an understanding of the community that public health authorities want to engage.
- Respect is vital to ensure that trust will be earned.
- Recognition of the rights of Indigenous Peoples and its representation in legislation.
- Remember, colonialism has an impact and that it will take time for those impacts to be rectified.
- Responsibility is on the public health professionals to ensure that they are educated so that they can appropriately and adequately provide climate change adaptation health services to the Indigenous Peoples.
- Nothing About Us Without Us: No policy or action should be decided by any representative without the inclusion of the group in which the policy/action is affecting.
- Ethical Space: Respecting the views of others and ensuring a cooperative spirit between Indigenous Peoples and Western institutions.
- Two-Eyed Seeing: Being able to see the importance of Western Science and Indigenous Knowledge and bring the best of both together.
- Seven Generations: Considering and ensuring that the decisions made today do not harm those yet to be born.
- Creators Law: All Beings have a purpose and must work together in harmony – including human beings.
- Seven Grandfather Teachings: Encompass the morals, values, structures, ceremonial practices, and spiritual beliefs of the Aanishnabe People.
Improving public health practice
Public health authorities can include a climate-health lens into existing interventions to enhance the understanding of how climate change is connected to various health outcomes and use this knowledge to develop climate-health adaptation interventions. The public health community could benefit from increased knowledge exchange efforts that provide information on processes and outcomes of the development, implementation and evaluation of climate-health adaptation interventions.
In addition, the public health sector needs to strengthen its efforts to include Indigenous voices. The TRC’s Call to Action invites Canadians to enter into a new relationship with Indigenous Peoples. The Climate Change Health Adaptation Program (CCHAP), which includes Indigenous communities as equal partners, is an example of this approach. By working together and incorporating the wisdom of Indigenous Peoples into Western science public health practitioners can improve health, decrease inequities and make Canadians more resilient in a changing climate.
Ronald Macfarlane (Public Health Agency of Canada), Sarah Warren (Simcoe Muskoka District Health Unit), and Kerry Ann Charles-Norris (Cambium Indigenous Professional Services)