Why every town and every hospital needs a forest

By Brian Baetz and Myles Sergeant

We're in a big pickle.

We're in the middle of a climate emergency. It's not a four-alarm fire kind of emergency, instead it's a long, slow emergency that keeps creeping up towards a very impactful climax. Some people still deny climate change, or that humans have ramped up the kinetics of the multidimensional puzzle we call modern life in western societies. But the vast majority of us feel it coming, and this has spawned the term "climate anxiety."

Just watch the Weather Channel on a regular basis and resist the urge to turn your head. The heat dome over Vancouver, the town of Lytton, B.C., burning to the ground, rampant flooding in Kentucky, heat and drought throughout Europe, the tarmac on Heathrow's runways melting the list goes on and on. It's like we're in an epic struggle against Mother Nature, and we were leading in the early going, but the last few innings have been kind of rough. And as the old saying goes, "Mother Nature bats last, and she bats 1.000." So we all know how this is going to end, most certainly for our kids and grandkids. But with the way things are going, maybe even for us.

But here's one solution.

As appealing as hand wringing and teeth gnashing and self-sedation may be, we all need to step up and take some positive action. There are a number of ways out of this climate emergency we find ourselves in, and many or all of these initiatives could and should be implemented concurrently. But the focus of this article is the multifaceted appeal of forested green space. Open spaces planted with trees have literally scores of benefits. Trees soak up carbon dioxide and a wide range of pollutants and emit a flux of life-sustaining oxygen and other healing compounds. They provide habitat for a range of wildlife, and they lower surface temperatures in summer heat waves. Medieval kings had their royal forests, and we are blessed with many treed areas provided by conservation authorities and local municipalities. But to effectively turn the tide against the climate emergency, we need to dramatically increase the acreage of treed spaces in our communities.

As part of the Trees for Health Initiative (www.treesforhamilton.ca and www.treesforlife.ca), we contend that every city and town across our great country needs a forest affiliated with their health- care facilities. This can be physically connected to a hospital or clinic, where greening up the related spaces around the facility will provide many benefits to on-site health care workers, patients and visitors. These spaces will be limited to the physical boundaries of the given health-care facility. However, somewhere down the street or along a river or on the edge of town will exist more space that could be conserved and planted out with trees to create a health forest that is conceptually aligned with the community's health-care facility.

The pandemic has shown us how important access to green space is for our physical and mental health, and this health forest will soon be viewed as an "upstream" health-care facility. As British Columbia's PaRx program has shown, where doctors write prescriptions for accessing nature, people using "upstream" preventive health-care spaces may have a substantially reduced need for "downstream" health-care facilities. All of these benefits are arrived at with minimal investment comparatively, and we can address climate resiliency and our public health needs in one stroke. Adding in the potential for integrating land-based wisdom from our Indigenous mentors is another huge bonus for a health forest in every community.

And here's how you can help.

As educated professionals and leaders within your communities, you can help bring the above vision into reality. Call the CEO of your local health network and suggest to them that a health forest is a necessary and vital component of providing health care to your community. Contact your alma mater and ask their development folks if they are working with local health-care leaders to catalyze a health forest in the community that the campus is a vibrant part of. And next time your firm is thinking about its own philanthropic endeavours, consider supporting Trees for Health - Ontario (via the registered charities Trees for Hamilton or Trees for Life).

The climate emergency bells are ringing, and it's our collective responsibility to do all that we can to turn the tide and mitigate the inevitable climate impacts in a sustainable and integrated manner.

Dr. Brian Baetz is a professor emeritus in the Department of Civil Engineering at McMaster University, and is the director of McMaster's W Booth School of Engineering Practice and Technology. Dr. Myles Sergeant is a family physician in Hamilton, the president of Trees for Hamilton, a co-founder of Trees for Health - Ontario and a co-lead of PEACH Health Ontario

The opinions expressed are those of the author(s) and do not necessarily reflect the views of the author's firm, its clients, The Lawyer's Daily, LexisNexis Canada, or any of its or their respective affiliates. This article is for general information purposes and is not intended to be and should not be taken as legal advice.

Interested in writing for us? To learn more about how you can add your voice to The Lawyer's Daily, contact Analysis Editor Peter Carter at peter.carter@lexisnexis.ca or call 647-776-6740.

This article was originally published by The Lawyer’s Daily, (www.thelawyersdaily.ca) a division of LexisNexis Canada.

Preventive Healthcare and Environmental Sustainability

Rini Dass, B.ScN., M.ScN., Adult-N.P.[1], Ana Hategan, M.D.[2]

Author information

[1] Assistant Clinical Professor, Adult-Nurse Practitioner, McMaster School of Nursing, McMaster University, St. Peter’s Hospital, Hamilton, ON, Canada.

[2] Clinical Professor, Geriatric Psychiatrist, Division of Geriatric Psychiatry, Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.

World Health Organization (WHO) defines health as a state of complete physical, mental, and social wellbeing (Government of Canada, 2010). It does not only represent the absence of disease or disability (Government of Canada, 2010). Health promotion and disease prevention and environmental sustainability are interconnected. An environmentally sustainable health system has the responsibility to conserve natural resources and protect global ecosystems to support health and wellbeing of current and future generations (WHO, 2017). Consumption of energy and other resources, production of greenhouse gas (GHG) emissions, use and disposal of toxic chemicals, and production of medical waste and wastewater are among the major impacts that healthcare can have on the environment (WHO, 2017). There appears to be a positive correlation between health and environment. Healthier the population, lesser disease burden, and lesser waste and impact on the environment. Vice versa, healthier the environment, healthier the population (Fuller et al., 2022).

It is well recognized that pollution is a planetary threat, with impacts on health that transcend local and national boundaries, and that it affects us worldwide (Fuller et al., 2022). Global action on all major modern pollutants including GHGs is needed. An all-hands-on-deck approach to transitioning away from fossil fuels to a clean, renewable energy is an effective strategy for mitigating pollution and slowing down climate change, while benefitting planetary health (Fuller et al., 2022). In this vein, active travel, such as walking and cycling, not only results in fewer GHG emissions that are warming the atmosphere but is increasingly recognized as an important source of physical activity (Pucher et al., 2010). Encouraging such health promotion activities has shown to improve management of many diseases such as diabetes mellitus and cardiovascular health, and decrease rates of premature death, among multiple other health benefits, while also contributing to reducing the environmental pollution (Fuller et al., 2022; Patterson et al., 2020; Pucher et al., 2010).

Personalized preventive healthcare delivering individualized care focused on lifestyle behaviour modification and disease prevention has been found to reduce cost of healthcare due to less disease burden, and subsequently reducing medical waste and improving equity in care (Hughes & Meadows, 2020; Musich et al., 2016). Preventive healthcare is essential at any stage of life. Measures should start as early as childhood. It should be integrated in day-to-day activities in environments such as schools and workplaces. Examples of such measures include adopting a healthy diet, encouraging physical activity, and implementing programs to promote good mental health and wellbeing and, eventually, integrating practices that affect both the overall health and the environment.

Support from government and healthcare leaders is needed to fund programs focused on health promotion and disease prevention, especially on preventable chronic diseases, with an eye on environmental sustainability. Support and funding is needed for more “green space activities” (e.g., walking, cycling, running, playing ball games) in communities, homes, schools, and workplaces. In 2021, hospitals (25%), pharmaceuticals (14%), and physicians (13%) were still the three largest shares of health dollars (over 50% of total health spending) (Canadian Institute for Health Information, 2021). Therefore, it is the hope that implementing programs for health promotion and disease prevention will hopefully decrease this healthcare spending while improving the environmental determinants of health (e.g., air pollution, chemical safety, lack of access to healthcare, poor water quality, climate change and natural disasters).

REFERENCES

Canadian Institute for Health Information. (2021). National Health Expenditure Trends, 2021 — Snapshot. https://www.cihi.ca/en/national-health-expenditure-trends-2021-snapshot. Accessed August 29, 2022.

Fuller, R., Landrigan, P. J., Balakrishnan, K., Bathan, G., Bose-O'Reilly, S., Brauer, M., Caravanos, J., Chiles, T., Cohen, A., Corra, L., Cropper, M., Ferraro, G., Hanna, J., Hanrahan, D., Hu, H., Hunter, D., Janata, G., Kupka, R., Lanphear, B., Lichtveld, M., … Yan, C. (2022). Pollution and health: a progress update. Lancet. Planetary health, 6(6), e535–e547. https://doi.org/10.1016/S2542-5196(22)00090-0

Government of Canada (2010). Creating a Healthier Canada: Making Prevention a Priority. https://www.canada.ca/en/public-health/services/health-promotion/healthy-living/creating-a-healthier-canada-making-prevention-a-priority.html. Accessed August 29, 2022.

Hughes, D. L., & Meadows, P. D. (2020). Reducing Medical Waste to Improve Equity in Care. American journal of public health, 110(12), 1749–1750. https://doi.org/10.2105/AJPH.2020.305962

Musich, S., Wang, S., Hawkins, K., & Klemes, A. (2016). The Impact of Personalized Preventive Care on Health Care Quality, Utilization, and Expenditures. Population Health Management, 19(6), 389–397. https://doi.org/10.1089/pop.2015.0171

Patterson, R., Panter, J., Vamos, E. P., Cummins, S., Millett, C., & Laverty, A. A. (2020). Associations between commute mode and cardiovascular disease, cancer, and all-cause mortality, and cancer incidence, using linked Census data over 25 years in England and Wales: a cohort study. Lancet. Planetary Health, 4(5), e186–e194. https://doi.org/10.1016/S2542-5196(20)30079-6

Pucher, J., Buehler, R., Bassett, D. R., & Dannenberg, A. L. (2010). Walking and cycling to health: a comparative analysis of city, state, and international data. American Journal of Public Health, 100(10), 1986–1992. https://doi.org/10.2105/AJPH.2009.189324

WHO (2017). Environmentally sustainable health systems: a strategic document. https://www.who.int/publications/i/item/WHO-EURO-2017-2241-41996-57723. Accessed August 29, 2022.

Healthcare Professionals Need to Unite For the Sustainability Cause And Share Information

As healthcare professionals, we tend to work in our own little silos, certainly attending to, and acquiring information that specifically impacts our particular profession. This mode of thinking is antiquated, not only in terms of healthcare delivery, but in terms of how we, as responsible healthcare professionals address the environmental impact of our professional activities.

Recently, my girlfriend in Wales, who happens to be a medical doctor, was diagnosed with breast cancer. An entire team of healthcare professionals was created and collaborated on the decision making process to create the best treatment outcome for her particular situation.

In a similar fashion, I believe we healthcare professionals need to collaborate and share our knowledge about best practices with respect to environmental sustainability in the healthcare sector. It is at this point, that I'll make you aware that I am not a medical doctor, but a dentist.

For a few years now, I have been experiencing “climate grief”, “the psychological response to ecological loss related to the changing climate. This grief can be experienced as profound sadness, helplessness, guilt, anxiety, or numbness related to the climate crisis” (https://www.psycom.net>anxiety). As a responsible global citizen, I felt the need to address my guilt and anxiety: guilt, because as a healthcare professional I felt the need to find out how I can implement and encourage positive change in my profession, and anxiety, because I am overwhelmed by the belief that our governments will do too little too late to address this global existential threat.

I have created a small group of like-minded dentists who actively search for companies that embrace environmentally responsible products/protocols. I held a three hour continuing education virtual event for my dental component society where twelve speakers (including Dr. Ali Abbass, anesthesiologist, and Linda Varangu (@greenhealthcare.ca) contributed content. I started a small pilot project to collect PPE from several dental offices which I personally transported to MEA Health.ca, a PPE recycling facility in Kitchener ( I live in Muskoka). This initiative has now grown, with the help of Rotarians/healthcare professionals in several regions of Ontario. Now, several family healthcare teams are also using this recycling initiative to responsibly collect and dispose of their PPE, and different Rotary clubs are helping to collect and recycle the PPE in their areas. The world disposes of 50,000 “blue masks” EVERY SECOND (https://blogs.worldbank.org).....this is unsustainable.

One of the speakers at that event was the VP of Dentec Safety, a company that makes reusable respirators without exhalation valves that are Health Canada approved. Yes, this respirator is perhaps slightly less comfortable than the ubiquitous N95 masks we continue to throw out; I view this as a minor inconvenience. Adopting this reusable respirator for my clinical activities mitigates my contribution to the PPE waste dilemma; it is a solution I am better able to live with.

My network of like-minded healthcare professionals continues to grow; it is why I'm writing this. We must share ideas/initiatives/products that make healthcare as a sector, more sustainable. In connecting with the creators of this website, we have shared information that has grown our armamentarium for environmentally responsible delivery of healthcare (I've provided all of my links for the website).

We must advocate inside and outside of our own professional spheres. This week I connected with executives within the two biggest companies that distribute oral care products; I encouraged them to provide and highlight samples of sustainable products for their booths at the upcoming Annual Spring Meeting of the Ontario Dental Association, and I questioned their overuse of packaging that is not recyclable. I indicated that I understood that marketability was important: “Let us dentists help you promote the sustainable options”. I asked the P and G rep to profile their recycling initiative; very few dentists are even aware of this program. Today I will do my best to connect with a 3M rep and ask why their company, which has greatly benefited from the pandemic, in the form of N95 mask sales, is not addressing the end stage of their products, and partnering with recycling companies. ESGs (Environmental/Social/Governance responsibility) are now on the radar of most forward thinking companies.

Request that your personal dentist takes part in the Terracycle initiative that allows dentists to collect (free of charge to them) used oral health products (toothpaste tubes, toothbrushes, dental floss and mouthwash containers) for recycling. We must approach the environmental issue in every way we can.....and that means sharing information and acting on it. I have discussions with my fellow local medical professionals about their choice with respect to inhalers and delivery systems for medications. (There is a low-waste pharmacy in Antigonish, Nova Scotia that has adopted reusable glass vials for prescriptions (https://www.cbc.ca>nova -scotia). These sorts of conversations need to multiply. Let's all be part of the environmental solution, and not just the problem. We cannot turn a blind eye and do nothing.

Dr. Laurie Houston