Dear Prime Minister Justin Trudeau and Canadian Delegation at the COP21 Climate Change Negotiations,

As you begin work in Paris, please know that you carry the hopes of the Canadian medical profession with you.

Dr Margaret Chan, World Health Organization (WHO) Director General has stated that COP21 “may be the most important health agreement of the century, an opportunity not only to reduce climate change and its consequences, but to promote actions that can yield large and immediate health benefits, and reduce costs to health systems and communities.” Indeed, doing so in a manner that enhances health can make Canadians and human communities everywhere more resilient, and more capable of absorbing, adapting and reshaping in response to climate change.

Therefore, we, the undersigned physicians and medical students of Canada, call on the Government of Canada to:

1. Adopt a strong, universal and ambitious global climate agreement at COP21 in which the protection and promotion of health is a central principle.

2. Integrate health considerations into all national planning processes regarding climate mitigation and adaptation.

3. Phase out fossil fuel subsidies and instead use this public money to accelerate the transition to renewable energy, protect fresh water and support climate-friendly agriculture.

4. Prioritize actions that both reduce climate change and improve health, including reducing the number of deaths from cancer, respiratory and cardiovascular diseases that are caused by air pollution (approximately 1/8 worldwide) through actions such as creating a 10-year timeline to the phase-out of coal-powered electricity in Canada.

According to the World Health Organization: “Climate change is the greatest threat to global health in the 21st Century.” What patients have we already seen affected in Canada? A little girl in the Saskatoon ER with an asthma exacerbation from wildfire smoke, tearful after being evacuated from her house in Northern Saskatchewan. An 80-year-old woman dying of heat stroke after sweltering through another heat wave in her Toronto apartment. A family in a fly-in community in Canada’s North eating less high-quality lean protein and more empty calories as caribou become more scarce and travel on ice becomes more dangerous. And many more, including people affected by the emergence and spread of infectious diseases like Lyme Disease, as climate change shifts the probability curve of a variety of illnesses, making them more common, and more severe.

Indirect effects of the changing climate such as drought are also critical as they can lead to failed crops, as was seen in Alberta this summer. In less resilient areas, this can lead to malnutrition, which may contribute to conflict and refugee flows, as is the case in Syria.

To leave our children a livable world we must keep global surface temperature warming below two degrees Celsius. To do this, 80 per cent of economic fossil fuel reserves must be left in the ground. Fortunately, we have developed the technology to make this possible: studies show that Canada can achieve 100 per cent low-carbon electricity by 2035 and decrease emissions by 80 per cent by 2050. We can do no less.

The good news is that many measures that decrease emissions also improve health. For that reason, the Canadian Medical Association promotes a 10-year timeline to a Canadian coal-power phase-out, endorses physician involvement in active transport initiatives, and supports lending a health rationale to carbon pricing initiatives. CMA policy also encourages MDs to work as part of multidisciplinary teams to provide the unifying voice of health to achieve climate goals. This is an effort well-spent for physicians: the Lancet states that “tackling climate change could be the greatest global health opportunity of the 21st century.”

Presenting climate change in a health frame has been shown to be the best way to motivate a population to action. Yet, climate change is just starting to be covered in medical schools and medical conferences. Changing this will be our profession’s first step towards integrating climate care into health care.

Dr Rudolf Virchow, a prominent 19th century MD, said that “Medicine is a social science, and politics nothing but medicine at a larger scale.” Never has that been more true than in the work the Government of Canada will do at COP21 and subsequently in Canada to optimize climate-health.

As the physicians and medical students of this country we pledge to lend our skill-sets and energy to the shared goal of promoting health by protecting the planet. And we call on you to fully integrate health into your climate policy, and to show the utmost courage and resolve in the business of saving lives.

Signed,

Dr. Courtney Howard, MD, CCFP(EM), Climate-Health Lead Board Member, Canadian Association of Physicians for the Environment, Canadian liaison to Global Climate and Health Alliance, Emergency Physician, Yellowknife

Ms. Kelly Lau, BASc, MDCM Candidate 2017, McGill University

Dr. James Orbinski OC, MSC, Bsc, MD, MA, CIGI Research Chair & Professor in Global Health | Balsillie School of International Affairs, Professor, School of International Policy and Governance | Wilfrid Laurier University, Professor, Dalla Lana School of Public Health, University of Toronto

Dr. Curtis Lavoie, MD, CCFP EM, Assistant Professor, Pediatric Emergency Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada.

Dr. Cathy Vakil MD, CCFP, FCFP, Assistant Professor, Department of Family Medicine, Queen's University, Kingston, ON

Dr. Ryan Meili MD, CCFP, Family Physician, West Side Community Clinic, Assistant Professor, College of Medicine, University of Saskatchewan, Founder, Upstream: Institute for A Healthy Society

Dr. Warren Bell MD, Family Physician, Salmon Arm, British Columbia, Past- Founding President of Canadian Association of Physicians for the Environment

Dr. Melissa Lem, MD, CCFP, Lecturer, Department of Family and Community Medicine, University of Toronto

Ms Claudel P-Desrosiers, MDCM Candidate, National Officer for Global Health, IFMSA-Quebec

Dr. Paul Dhillon, CCFP, The Review Course in Family Medicine

Dr. Anne Gillies, MD FRCP(C), Paediatrician, Mental Health Outpatient Services, Children's Hospital of Eastern Ontario

Dr. Sarah Giles, MD, CCFP(EM), DTMH, Family/emergency physician, Fort Smith, NWT, Assistant Clinical Professor, Faculty of Medicine, University of Alberta. Field doctor, MSF

Dr. Dhenuka Radhakrishnan, University of Ottawa, Assistant Professor, Department of Pediatrics

Dr. Brigitte Lemyre MD FRCPC, Associate Professor of Pediatrics, University of Ottawa

Dr. Mike Benusic, MD, Resident Physician, University of Toronto

Dr. Darcy Scott, MD, FRCPC, Pediatrician, Stanton Territorial Health Authority, Clinical Lecturer, University of Alberta

Dr. Mary Jean Duncan,MD, FRCS(C), Assistant Professor,U of Ottawa, Paediatric Plastic Surgeon

Mr. David Galiano, MDCM candidate, President, IFMSA-Québec

Ms. Cheryl Young, BHSc, MD Candidate, University of Toronto

Dr. Elizabeth Shouldice, Assistant Professor , Emergency Medicine, University of Ottawa, Emergency Physician, Queensway Carleton Hospital

Dr. Chris Mackie, Department of Epidemiology and Biostatistics, McMaster University

Dr. Jean Zigby, MD, CM, CCFP, President, Canadian Association of Physicians for the Environment; Faculty Lecturer, McGill University

Dr. Belle Song, MD, Resident in Family Medicine, Queen's University

Dr. Sian Tsuei, Resident Physician, University of British Columbia

Dr. Julie Hurteau-Miller, Pediatric radiologist, Assistant professor, University of Ottawa

Mr. Beau Frigault, MSc, University of Queensland, Medical Student

Dr. Justin Bell, MD, PGY1

Dr. Ritika Goel, MD, MPH, CCFP, Family Physician, Inner City Health Associates, Lecturer, Department of Family and Community Medicine, University of Toronto

Dr. Lucy Barker, MD

Dr. Monika Dutt, MD, CCFP, FRCPC, Cape Breton University

Dr. Matthew Bromwich, MD, FRCSC, Assistant Professor, University of Ottawa, Department of Surgery, Division of Pediatric Otolaryngology.

Mr. Koray Demir, MDCM Candidate, National Officer of Human Rights and Peace, Canadian Federation of Medical Students

Dr. Benjamin Langer, MD, Family Medicine Resident, University of Toronto Department of Family and Community Medicine

Ms. Sharon Wang, BSc, Medical Student, McGill University

Dr. Carolina Jimenez, University of Ottawa

Ms. Kaylynn Purdy, Northern Ontario School of Medicine, MD Candidate 2018

Dr. Mark Scott, MD, CCFP(EM), Emergency Physician, Rockyview General Hospital, Clinical Lecturer, Faculty of Medicine, University of Calgary

Dr. Daniel Myran MD, Family Medicine Resident University of Ottawa

Dr. Alanna Fitzgerald-Husek, MD MPH CCFP, Resident Physician, Public Health & Preventive Medicine, Dalla Lana School of Public Health, University of Toronto

Dr. Catherine Pound, MD, FRCPC

Ms. Emily Deane, MDCM candidate, MSc, BSc, McGill University Faculty of Medicine

Mr. Bing Yu Chen, Local Officer for IFMSA Quebec Public Health

Ms. Cecilia Alvarez Veronesi, MASc, Med Student, University of Toronto

Dr. Ewan Affleck, CM, BSc, MDCM, CCFP, Chief Medical Information Officer, DHSS, GNWT, Faculty, University of Calgary, Department of Family Medicine

Ms. Joanna Afghani

Dr. Alex Hoechsmann MD, CCFP-EM, UBC, Clinical faculty

Dr. Thomas Piggott, MD, Resident Physician

Dr. Catherine Gray MD, MSc, FRCPC, Assistant Professor, University of Ottawa Department of Medicine

Ms. Ananthavalli Kumarappah, MD Candidate 1T8, University of Toronto

Dr. Amanda Murdoch PGY1 Queen's University

Dr. Margaret Boland, MD, FRCP(C), Pediatric Gastroenterologist, Associate Professor of Pediatrics, University of Ottawa

Dr. Nicholas Brandon MD, CCFP, Resident, Public Health and Preventive Medicine University of Toronto

Dr. James Truong MD, Callander Lakeside Medical Clinic, North Bay Regional Health Centre ER, Northern Ontario School of Medicine

Dr. Christine Lamontagne, MDCM, FRCPC, Staff anesthesiologist, Assistant professor, University of Ottawa

Dr. Danyaal Raza, MD MPG CCFP, Staff Physician, St. Michael's Hospital, Toronto ON, Lecturer, Dept. of Family & Community Medicine, University of Toronto

Dr. Shelly Xu, MD, Family Medicine Resident, Memorial University of Newfoundland

Dr. Katherine Kohle, MD CCFP, Family Physician, Yellowknife; MSc Epidemiology Student, London School of Hygiene and Tropical Medicine

Dr. Rachel McGhee, Family Physician - Northern Health, UHNBC, UBC

Dr. Wendy Lai MD CCFP(EM), Staff, Department of Emergency Medicine, Humber River Hospital, Lecturer, Department of Family and Community Medicine, University of Toronto

Dr. Mahli Brindamour, MD, FRCPC, Pediatrician, Assistant Professor, College of Medicine, University of Saskatchewan

Dr. Sarah Sawyer MD PhD

Dr. Marcos Bettolli, MD, FRCSC, University of Ottawa, Children's Hospital of Eastern Ontario, Associate professor, Department of Pediatric Surgery

Dr. Philip Miller, MD, CCFP(EM), Clinical Instructor, UBC Faculty of Medicine

Ms. Steph A. Pang, MDCM Candidate at Faculty of Medicine, McGill University

Ms. Eunice You, Medical student, McGill University, Faculty of Medicine

Dr. Annelise Miller, MDCM, Resident physician, University of Ottawa

Mr. Adam Burgess, student, Medical Student, University of Calgary

Dr. Larry Barzelai MD,CCFP, Family Physician, Assistant Professor UBC, Member of CAPE

Dr. Trevor Hancock MB,BS, MHSC, Hon FFPH (UK), Professor and Senior Scholar, School of Public Health and Social Policy, University of Victoria

Dr. Dayna Bell, MD, FRCPC, Pediatric Emergentologist, Assistant Professor, Pediatric Emergency Medicine, University of Ottawa

Dr. Tom Kovesi, Pediatric Respirologist, Professor of Pediatrics, Children’s Hospital of Eastern Ontario and the University of Ottawa

Dr. Tandi Wilkinson, MD, CCFP-(EM), Clinical Associate Professor, UBC, Emergency Physician, Yellowknife NT, Associate Medical Director, UBC CPD

Dr. Gail Graham, FRCPC, FCCMG, Chief, Department of Genetics, Children's Hospital of Eastern Ontario

Saleha Munawar, BHSc, MD candidate, Queen's University School of medicine

Ms. Anne-Lou McNeil, MD candidate

Mrs. Aline D. Khatchikian, Laval University medical student, Regional Assistant of the Americas for the International Federation of Medical Students' Associations' Standing Committee of Public Health

Ms. Djamila Saad, MDCM Candidate, Vice-president for External Affairs, IFMSA-Québec

Ms. Sonya Krause, MCC Candidate, Masters of Climate Change, Candidate, University of Waterloo, Faculty of the Environment.

Dr. Tally Mogus

Dr. Tara Somerville MD CCFP, Family Physician, Port Elgin Ontario

Ms. Olena Zotova, McGill University, Medicine Preparatory Program Student

Dr. Leah Genge, MD, CCFP, DTMH, MSc, Family Physician - Calgary Urban Project Society (CUPS), Elbow River Healing Lodge, Clinical Lecturer, University of Calgary

Dr. Carolyn Nowry MD,CCFP

Dr. Maria Pelova, MD, CCFP, Professor assistant, University of Calgary

Dr. AnneMarie PEGG, MD, CCFP(EM), Emergency Coordinator, MSF France, Emergency Physician, Yellowknife Northwest Territories

Dr. Margaret McGregor, University of British Columbia, Faculty of Medicine, Clinical Associate Professor

Dr. Sam Wong, MD, FRCPC, University of Alberta, Associate Clinical Professor

Ms. Synthia Meilleur, MDCM Candidate, Laval University

Mr. Charles-Antoine Barbeau-Meunier, Medical Student, Université de Sherbrooke; IFMSA-Québec

Dr. Susan Comay MD, Clinical instructor, UBC

Dr. Julie Martz MD CCFP

Ms. Sabrina Provost, MD Candidate, University of Montreal

Dr. Anna Stratis, MD CCFP

Dr. Kristina Krmpotic MD FRCPC

Mr. Kit Moran, Medical Student, Dalhousie University, Halifax NS

Ms. Marilie Samson, Medical student, Laval University, IFMSA

Dr. Robert James, MD, FCFP, Associate Clinical Professor (retired), Department of Family Medicine, McMaster University, Adjunct Professor, School of Health Policy and Administration, York University

Mr. Steve Lee, Foundation for Environmental Stewardship

Mr. Dylan Ginter, BSc, Student - University of Saskatchewan, College of Medicine

Ms. Nina Nguyen, MD Candidate, University of Sherbrooke, Quebec

Dr. Ashley Riskin, MD, CCFP, Founder/Director, Connect Health Centre for Integrative and Functional Medicine, Vancouver, BC, Emergency Medicine, Fraser Health

Dr. Suzanne Watters, Family physician, Comox, Bc

Dr. Kelly Gallins MD CCFP(EM), Hospitalist and Emergency Physician, Sidney BC

Dr. Joel Lexchin MD CCFP(EM), Professor, School of Health Policy & Management, York University, Emergency medicine doctor, University Health Network, Associate Professor, Department of Family and Community Medicine, University of Toronto

Dr. Danielle Froese MD, CCFP, FCFP

Dr. Saideh Khadir, MD, University of Montreal

Dr. Maja Stachura, MD, FRCPC, UBC

Mr. Jeremy Cygler, McGill University, MCDM Candidate, class of 2017

Jennifer Cortez, MD, CCFP, Partner, Highland Family Practice, Comox BC

Dr. Joe Vipond, MD, FCFP, CCFP(EM), Clinical Lecturer, University of Calgary, Member, Canadian Association of Physicians for the Environment, Ms. Sarah Tremaine, MPH, Medical Student, Dalhousie University

Mr. Scott Haslam, RPh

Ms. Sarah Bryson, MSc

Ms. Ashley Robinson, Medical Student, Dalhousie University, Faculty of Medicine, First Year Medical Student

Dr. Riyad B. Abu-Laban, MD, MHSc, FRCPC, Associate Professor, Department of Emergency Medicine, University of British Columbia

Ms. Laurie Dolcé, Medical student, Université Laval

Ms. Jessica MacIntyre, MSc, MD Candidate, Dalhousie University, Faculty of Medicine

Ms. Rebecca Psutka, MSc, BSc, Medical Student, University of Calgary class of 2016

Ms. Nicole Jedrzejko, MD Candidate 2017, McMaster University Michael G DeGroote School of Medicine

Mr. Christopher Letke, MD Candidate, McMaster University

Ms. Erin Budd, MD Candidate, Michael G Degroote School of Medicine, McMaster University

Dr. Terence Wuerz, MD, FRCPC, Assistant Professor, University of Manitoba

Dr Mélissa Langevin, MD, FRCPC (PEM), Assistant Professor, Emergency Physician, Children's Hospital of Eastern Ontario

Dr. Claudia Kraft, MD, CCFP(EM), MSc, University of Ottawa, Faculty of Health Sciences, Associate Clinical Instructor & Northwest Territories Physician

Dr. Jennifer Cram MD, CCFP, Family Physician, Annapolis Royal, NS, Resident Physician, Public Health and Preventive Medicine, University of Toronto

Mr. William Enlow, IFMSA-Québec, Université Laval

Dr. David-Martin Milot, MDCM, MSc, Medical Resident in Public Health and Preventive Medicine, University of Sherbrooke

Dr. Lisa J. Jing Mu, MD, FRCPC, CCFP, Public Health and Preventive Medicine Specialist, Family Physician

Dr. Michel Welt, MC, CSPO, FRCS(c)

Dr. Louise Koclas, MD, FRCPC, Pediatrician, Clinical Faculty, McGill University

Patrick Steadman, MSc, MD/PhD Student, University of Toronto, PhD Student, Hospital for Sick Children, Junior Fellow, Massey College

Dr. Steve Kraus, MD, CCFP(EM), Stanton Regional Hospital, Yellowknife

Mr. Austin Yan, MSc, BArtsSc, MD/PhD Candidate, University of Ottawa

Dr. Margaret Becklake, Prof Emeritus of Medicine. McGill University

Dr. Sue Turgeon

Megan Schlorff, BHSc, McMaster University medical student

Ms. Xin Mei Liu, M.D., C.M. candidate of 2019, McGill University, Faculty of Medicine

Dr. Ewurabena Simpson, MD, MPH, FRCPC, Staff Physician, Division of Hematology/Oncology, Children’s Hospital of Eastern Ontario, Assistant Professor of Pediatrics, University of Ottawa

Dr. Laara Banner, MD, CCFP, UBC Clinical teaching faculty for rural students and residents at Kootenay Boundary Regional Hospital in Trail, BC.

Dr. Peter Moosbrugger, MD, CCFP (COE), FCFP, Medical Director - The Views Residential Care, Physician Lead - Health Connections Clinic, Clinical Assistant Professor - UBC Strathcona Site

Dr. Richard Denton, BSc, MD, MClSc, CCFP, FCFP, FRRM, Northern Ontario School of Medicine, Assoc. Prof. in Clinical Science, Family Medicine, Int'l Co-Chair, North America of International Physicians for the Prevention of Nuclear War

Mr. Antoine Mercier-Linteau, Étudiant en médecine, Université Laval

Dr. Gary Bota MD FRCP, Section Chair, Emergency Medicine, NOSM

To learn more about climate-health, please consider attending the Lancet session within COP21 'Sustainable Energy for All: Marrying climate change, development imperatives,' on Monday December 7th at 15.00-16.30 in Observer room 2. It is presented jointly with the UN Foundation and HELIO International.

This is an initiative of the Canadian Association of Physicians for the Environment (CAPE), Canadian Affiliate of the Global Climate and Health Alliance.

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