The impacts from extreme climate events (and related impacts such as food security, working conditions) will be a key driver of increasing global and local health inequities.

Recognized as the greatest threat to public health1, the climate/ecological crisis was brought home this summer in BC through wildfires, heat emergencies and air quality issues. The exacerbation of heat and smoke are health risks to all but particularly affect children, the elderly and those with chronic health conditions. The impacts from extreme climate events (and related impacts such as food security, working conditions) will be a key driver of increasing global and local health inequities.

Physicians within the Fraser region, including primary care providers, have unique opportunities to be both a health voice on climate/ecological issues and simultaneously promote climate change mitigating measures in their service delivery. We know that health care contributes 4.6% of the total national greenhouse gas emissions2 and there are numerous opportunities for change that have population health co-benefits. Ideas include:

Greener Prescribing: Data indicates that metered dose inhalers (MDIs) are the single largest contributor to pharmaceutical-related greenhouse gases3. Substituting just one MDI with a propellant-free dry powder inhaler (DPI) could save between 150-400kg of carbon emissions (equivalent to up to 170 litres of gasoline). Options include prescribing alternatives to MDIs (where clinically appropriate) with equivalent dry powder inhalers (DPIs) or soft mist inhalers (SMIs), which can cut greenhouse gases from inhalers by 97%4. MDIs also vary significantly in greenhouse gases5. Further, the GPAC’s BC Guidelines identify that nearly 1 in 3 asthma patients are misdiagnosed and as many as 90% of asthma patients use their inhaler incorrectly, so there are also concurrent opportunities to improve patient care and reduce health inequities6.

Nature Prescriptions: To encourage co-benefits for both the environment and patient health7, consider the opportunities for nature prescribing. Park Prescriptions is an evidence-based Canadian program guiding and supporting the prescription of nature. Research has shown that people who feel more connected to nature do more to protect it8.

Workforce Training: Consider training to be a Fraser Health climate champion, take a CPD session or encourage/develop opportunities for trainees to develop and implement projects to improve the environment while improving population health.

Creating a more sustainable medical practice: There are a number of resources that are being adapted to help practices become a more environmentally and socially sustainable practice. Doctors of BC has committed to supporting BC physicians to improve sustainability in their practices through quality improvement projects, and to spread and scale up successful quality initiatives that generate outcomes such as limiting waste, improving the use of resources, and limiting the carbon footprint of the workplace. Fraser Health has previously outlined its commitment to sustainability including the need to implement sustainable workplace services and programs.

By acting now and helping to reduce healthcare-derived greenhouse, family physicians and primary care providers can become a large part of the climate change solution. For more information, please contact


1. The Lancet (2021). The Lancet Countdown on health and climate change. Available:

2. Eckelman MJ, Sherman JD, MacNeill AJ (2018) Life cycle environmental emissions and health damages from the Canadian healthcare system: An economic-environmental-epidemiological analysis. PLOS Medicine 15(7): e1002623.

3. Brooks, S., Cheung, A & Wintemute, K. 2020. Low carbon inhalers: Choosing wisely for patients and the environment. Canadian Family Physician.

4. University of Toronto: Family and Community Medicine (2021). Climate change and health – what can family doctors do? Available:

5. Janson C, Henderson R, Löfdahl M, et al. Carbon footprint impact of the choice of inhalers for asthma and COPD. Thorax 2020;75:82-84.

6. BC Ministry of Health (2015). Asthma in Adults – Recognition, Diagnosis and Management. Available:

7. Twohig-Bennett C, Jones A. The health benefits of the great outdoors: A systematic review and meta-analysis of greenspace exposure and health outcomes. Environ Res. 2018 Oct;166:628-637. doi: 10.1016/j.envres.2018.06.030. Epub 2018 Jul 5. PMID: 29982151; PMCID: PMC6562165.

8. Caroline, ML, Mackay, MT. (2019). Do people who feel connected to nature do more to protect it? A meta-analysis. Journal of Environmental Psychology,65.

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