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On this page, we will share insights and wisdom from some of our experts on climate change and sustainability.


By Patrick O’Connor.

This story originally appeared in EMPOWER, the Canadian Heart Function (CHF) Alliance Network Patient-Focused newsletter.

My name is Pat O’Connor, and I am writing this to save lives.

In 2007 at age 55, I had a quadruple bypass followed by three stents in 2009. I passed the stress test before the surgery and before the stents. I was diagnosed with chronic kidney disease, macular degeneration[KL1] , and psoriasis. After the stents, I had angina for three years requiring a nitro patch, nitro spray and two naps a day.

I knew I was going downhill fast and had to do something different. My quality of life was suffering.

A nursing friend who had worked in the office of the head of cardiology at UBC gave me a copy of the documentary, Forks Over Knives. The film and book were based on the China Study sponsored by Oxford University, Cornell University, and the Chinese government which found that chronic diseases are strongly correlated with animal consumption. The more animals consumed, the more chronic disease.

Given my lifestyle, I knew then what I had to do to improve my health.

I became a vegan 11 years ago and quickly noticed many positive changes to my health. My scans over the last 3 years have shown significant improvement in my heart health, including almost no evidence of heart disease.

In Canada, we are facing a health crisis because we primarily operate as an acute care system that treats symptoms rather than focusing on the prevention of health issues. We need to promote health by training our health professionals and Canadians generally that it is not necessarily their genetics causing poor health outcomes, but their poor understanding of nutrition and lifestyle.

Overall, there is a major gap in our healthcare system which focuses on treatment rather than prevention; more progress needs to be made toward preventive medicine. I also encourage a holistic approach to heart health through a healthcare team that includes folks such as a nutritionist and naturopath, in addition to traditional healthcare workers.

We need to change what is on our plates for personal and planetary health.

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Peter Menikefs, MDCM, FRCPC. Anita Rao, MDCM, FRCPC.

To the Editor,

We commend the Canadian Anesthesiologists’ Society for introducing environmental sustainability to this year’s Guidelines to the Practice of Anesthesia. As citizens of the planet, we must be mindful of the current climate crisis. As medical practitioners, to provide thoroughly holistic care, we are obliged to consider the environmental impact of the choices we make in our provision of care. To do so would be in keeping with the World Health Organization’s declaration that climate change is the single biggest threat facing humanity. Perioperative services contribute significantly to the health care sector’s environmental footprint. In recent years, our centers have taken many steps to green surgical and anesthesia practice. Some of these initiatives include the abolition of the use of desflurane, the reclamation and reprocessing of energy devices, and the recycling of polyvinyl chlorides (PVCs).

In our operating rooms, the introduction of new green initiatives is accelerating. Further, as teaching centers, we see significant turnover in our team membership given the

rotation of trainees. To provide focus to team members regarding these initiatives, we have recently introduced The Sustainability Moment.

Immediately following completion of the first phase of the Surgical Safety Checklist, a brief overview of green initiatives is provided to all team members by the anesthesiologist,

generally taking no more than fifteen seconds to complete. With the recent introduction of The Sustainability Moment to our operating rooms, feedback for its use has

been very positive. Observations would suggest that more complete separation of waste products (recyclables, biohazard waste, PVCs) occurs following the reminder

provided by The Sustainability Moment. Further, surgeons have verbalized that they are more mindful of equipment choices, such as selecting reusable over disposable

equipment, once they have been primed by The Sustainability Moment. And with trainees omnipresent in our operating rooms, it is hoped that they will take their

learnings and disseminate them to other facilities and individuals throughout their careers.

At a cost of no more than fifteen seconds per case, we recommend that operating rooms adopt the use of The Sustainability Moment.

Can J Anesth/J Can Anesth

Received: 26 January 2023 / Revised: 26 January 2023 / Accepted: 27 January 2023

Canadian Anesthesiologists’ Society 2023

P. Menikefs, MDCM, FRCPC (&)

Environmental Sustainability Working Group, Ontario’s

Anesthesiologists, Ontario, Canada


Department of Anesthesia, Unity Health, St. Joseph’s Health

Centre, University of Toronto, Toronto, ON, Canada


Department of Anesthesia, Trillium Health Partners, University

of Toronto, Mississauga, ON, Canada

Disclosures: None.

Funding statement: None.

Editorial responsibility This submission was handled by Dr.

Stephan K. W. Schwarz, Editor-in-Chief, Canadian Journal of

Anesthesia/Journal canadien d’anesthe ́sie.


1. Dobson G, Chau A, Denomme J, et al. Guidelines to the Practice of

Anesthesia: Revised Edition 2023. Can J Anesth 2023; https://doi.


2. World Health Organization. Climate change and health, 2021.

Available from URL:

detail/climate-change-and-health (accessed January 2023).

3. Kagoma Y, Stall N, Rubinstein E, Naudie D. People, planet and

profits: the case for greening operating rooms. CMAJ 2012; 184:


4. Hanna M, Bryson GL. A long way to go: minimizing the carbon

footprint from anesthetic gases. Can J Anesth 2019; 66: 838–9.

5. University of Calgary. Sample sustainability movements.

Available from URL:


offices.pdf (accessed January 2023).

Publisher’s Note Springer Nature remains neutral with regard to

jurisdictional claims in published maps and institutional affiliations.

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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 ( and, 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 or call 647-776-6740.

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

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