Warm Climate,
Variable Health,
Storm Warning
Pierre Gosselin, MD, MPH
Institut national de santé publique du Québec
and Université Laval
CAPE Montreal Conference
26 septembre 2009
Greenhouse Gas Emissions
Density-Equalling Cartogram. Borders have been adjusted according to the countries’
cumulative CO2-equivalent emissions (1970-2000). Source: Gibbs et al. (2007).
Mortality caused by Climate Change, 2000
Density-equalling Cartogram – WHO Regions scaled according to estimated
mortality (per million people) in the year 2000, attributable to the climate
change that occurred from 1970 to 2000. Source: Gibbs et al., 2007.
Quebec Data (1960-2003)
Projet #4
Source: Ouranos, 2005.
Projet #4
RIMOUSKI ?
MONTRÉAL ?
NASHVILLE
??
PITTSBURGH
Source: Ouranos, 2005.
Quebec Data
Figure 2 : Nombre de catastrophes naturelles au Canada, de 1900 à 2002
Figure 2 shows the number of climate-related and other natural
disasters recorded in Canada between 1900 and 2002. According to
the estimates published in the World Disasters Report, 2004, the total
number of Canadians affected by natural disasters has increased from
79,066
1984hydrométéorologiques
and 1993, to 578,238
betweenau1994
Note
: Seulesbetween
les catastrophes
sont associées
climat.and 2003.
Source : D. Etkin et coll., 200417.
Note : Only hydrometeorological disasters are associated with the
climate.
Source : D. Etkin et coll., 2004.
In: Évaluation nationale
santé et CC 2008
Question, 2002-2003:
What health impacts
were there in Quebec?
In: Évaluation
nationale santé et CC
2008
Several studies conducted in Quebec since 2003
Researchers:
 Diane Bélanger PhD (INSPQ, CHUQ)
 Bernard Doyon PhD (CHUQ)
 Pierre Gosselin MD MPH (INSPQ, CHUQ, U.Laval, Ouranos)
Contributors:
Belkacem Abdous PhD, Pierre Valois PhD (U.Laval), Philippe
Poitras MSc (CHUQ), Mélissa Giguère MSc (INSPQ), Marie-France
Sottile MSc (Ouranos), Luc Vescovi PhD (Ouranos), Philippe
Gachon PhD (Ouranos), Daniel Martin PhD (CHUQ).
Sponsors:
Health Canada, Ouranos, MSSS, INSPQ
Public Health Agency of Canada, IRSC, GEOIDE, Arcticnet.
Several studies conducted in Quebec since 2003
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Other studies:
Kosatsky et al. of the Montreal Public Health
Directorate (urban heat islands);
Garneau et al. of UQAM (pollens and asthma);
Nunavuk studies by Furgal et al. (various topics);
Other Canadian studies including Quebecrelated data.
2005 Assessment
Studies conducted by INSPQ (Quebec’s
National Public Health Institute), 2003-2007

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4 sectoral assessments (water,
zoonotic/vectorial diseases, temperature,
EMEs)
General population perceptions, behaviour
Public health and municipal managers’
perceptions
Mortality modelling and simulation
14 reports available on-line at:
http://www.inspq.qc.ca/publications/liste.asp?E=p&Theme=8
2005 Assessment
Température en
degrés Celsius
18.3 - 20.9
21.4 - 23.0
23.5 - 26.0
26.5 - 28.0
28.5 - 30.4
30.9 - 32.3
32.8 - 33.8
34.2 - 37.4
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Heat wave alert systems (health network) have
existed since 2004-2005 for southern
Quebec.(93% of the population). Few tests
performed.
No systematic review of air conditioning in existing
hospitals and shelters, but new standards for new
buildings and renovations.
No specific training or recommendations for
medical staff regarding health care or medication.
No public awareness/outreach programme.
No real prevention or remediation programme for
urban heat islands.
2005 Assessment
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Lack of public health emergency training
Very good environmental monitoring system
(storms, flooding, dams, rivers, forest fires,
etc.)
No follow-up of EME consequences; some
short-term psychological follow-up
Some preventive actions regarding flooding
and road network, Northern housing and
infrastructure.
2005 Assessment
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Very good drinking water monitoring system, but
infrequent investigation of epidemics
Same for commercial and traditional foodstuffs
Poor beach and swimming pool monitoring –
even though Quebec has 50% of Canadian
pools!
Preventive watershed-based approach in place
but poorly financed.
2005 Assessment

Quantitative water management
is poorly implemented (outdated
infrastructure, standards,
swimming pools…)

No quality control for small water
sytems and private wells (20% of
population)

Poorly organized public
awareness/outreach
Public Perceptions and Behaviour
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75% of adults take action to protect themselves
from the heat
The proportion of air-conditioned dwellings has
doubled since 1997; now at 35,8%.
The most significant factor limiting access to air
conditioning is household income.
Projet #2
Pourcentage des ménages possédant un
climatiseur
40
35
30
25
20
15
10
5
0
1972
1976
1980
1984
1988
1992
1996
2000
2004
Année
Percentage of households with air conditioning in Quebec, 1972 to 2005
Source: ISQ (2005b) and Bélanger et al. (2006a).
Access to air conditioning in 2005, in relation to the mean temperature
warming trend (1960-2003) in southern Quebec
Source: Bélanger et al. (2006a), Yagouti et al. (2006)
Public Perceptions and Behaviour

“Living alone” is an excellent predictor
for low income, chronic health
problems and “age over 65”; these are
the people who are most at risk in case
of an Extreme Meteorological Event

Two-thirds of people using walking
aids or wheelchairs are unable to go
shopping for groceries during a heat
wave.
Public Perceptions and Behaviour
Public Perceptions and Behaviour

Apartment dwellers and low-income people make
great use of public parks and beaches during
heat waves.
tous les jours
pas tous les jours
s ans chauffage au bois
100%
Projet #2
90%
80%
Pourcentage
70%
60%
50%
40%
30%
20%
10%
0%
Est du
Québec
Nord du
Québec
Région de
Québec
Centre du
Québec
Sud de
Montréal
Nord de
Montréal
Région de résidence
Percentage of domestic wood heating, per region
Source: Bélanger et al. (2006)
Montréal et
Laval
Link Between Mortality And
Climate
Mortality and Climate – Relative to Tº
Other questions, 2005:
Where does the public stand?
What changes are people ready for?
Study of Public Health /
Municipal Managers
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Very high recognition of environmental problems
(water, air); some linkage to CC
Same recognition level regarding existing
vulnerabilities (poverty, unemployment, aging
population) and their link with health conditions
Most managers consider that CC adaptation will be
a regional and provincial priority for the next 10
years, with varying importance depending on the
region.
Results
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Both manager categories
(public health and municipal)
are very aware of the negative
impacts on infrastructure and
economy, and on physical and
mental health.
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Collectively, their appreciation
of these impacts is clear,
detailed and balanced.
Results
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Most managers believe that their regional
institutions, in partnership, share the responsibility
for CC adaptation.
However, there is little field work, mostly limited to
heat wave emergency plans.
Most managers say they need (in this order):
• More practical information;
• Regional climate data;
• More political and institutional support; and
• Financial and human resources to move ahead.
Discussion
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Municipalities rely more on government
information sources, less on scientific sources
(Ippersiel & Morissette, 2004)
More municipal (6+) than public health (1+)
laws and regulations
Little money tagged for prevention at the
municipal level.
Discussion

There is no unanimous certainty that a period of
climate change has started, notably because of
the media-peddled controversy on the causes of
the warming trend – natural vs anthropic.
Public’s Intentions
Regarding Certain Actions (2005)
Figure X: TRANSPORT : Solutions pour réduire les effets nuisibles des CC
sur la santé et le bien-être des Québécois
Augmenter le transport en
commun (covoiturage, autobus)
69,5
24,4
3,5
2,3
Diminuer l'utilisation de l'auto
dans les grandes villes
58,4
29,5
7,6
4,0
Rendre obligatoire l'inspection
des automobiles (> 7 ans)
57,9
Aider financièrement l'achat
d'automobiles "vertes"
59,5
Augmenter le nombre d'abribus
58,0
24,5
25,2
9,7
6,7
6,9
7,7
6,8
30,5
2,7
Taxer davantage l'achat des
automobiles
18,2
0%
19,3
20%
Tout à fait d'accord
26,6
40%
Plutôt d'accord
60%
Plutôt en désaccord
19,7
80%
100%
Tout à fait en désaccord
Figure XX: LOGEMENT : Solutions pour réduire les effets nuisibles des CC sur la
santé et le bien-être des Québécois
Améliorer les exigences sur
l'isolation des maisons et des
logements
63,1
30,6
4,2
1,7
Empêcher la construction des
maisons, chalets ou logements
dans les zones à risque (e.g.
inondations)
62,5
Empêcher le chauffage au bois
lorsqu'il y a du smog, l'hiver
21,6
37,1
0%
10%
20%
Tout à fait d'accord
27,4
30%
40%
Plutôt d'accord
50%
9,6
19,6
60%
70%
Plutôt en désaccord
5,8
14,1
80%
90%
100%
Tout à fait en désaccord
Assessment Summary
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Action on housing and infrastructure
will be crucial;
standards must take CC into account
Availability of shaded and cool areas in
cities will have to increase; trees
planted today will be useful around
2040…
Not cutting them is a lot smarter.
Supporting the poor, handicapped or
chronically ill will be decisive to avoid
social disasters…
Neighbourhood solidarity.
Assessment Summary
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The ground is fertile but it is
necessary to continue tirelessly
explaining the links between the
actions that need to be taken, their
causes and the climate…
Our major information effort: 22
reports, summaries, articles and book
chapters (several thousand copies
distributed); some 100 conferences
and media events; hyperlinks on 6
websites…
Assessment
Summary
Chapter 6 deals
with Quebec; it
summarizes all
studies conducted
in Quebec and
includes
recommendations.
See http://www.hc-sc.gc.ca/ahcasc/media/nr-cp/_2008/2008_122-fra.php
and for the online version:
http://www.sindark.com/2008/08/03/humanhealth-in-a-changing-climate/
Ouranos
Health Research Programme
2006-2009
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Several applied health research projects
are being concluded within Ouranos
(cyanobacteria, rural gastroenteritis, atlas of
vulnerabilities, links between heat and air
pollution, historical and future
hospitalization modelling)
Advice on guidelines being prepared for
doctors and healthcare workers.
Température en
degrés Celsius
18.3 - 20.9
21.4 - 23.0
23.5 - 26.0
26.5 - 28.0
28.5 - 30.4
30.9 - 32.3
32.8 - 33.8
34.2 - 37.4
Ouranos
Health Research Programme
2009-2014
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In development
Important support for adaptation work
New issues: urban heat islands and
mortality, UV, zoonotic and vectorial
diseases, strokes, high risk group
characterization, housing, health impacts of
Extreme Climatic Events, geosimulation of
Lyme’s Disease…
Température en
degrés Celsius
18.3 - 20.9
21.4 - 23.0
23.5 - 26.0
26.5 - 28.0
28.5 - 30.4
30.9 - 32.3
32.8 - 33.8
34.2 - 37.4
Health Action Plan 2007-2013
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Reinforced health monitoring (for ECEs, infectious
zoonotic and vectorial diseases, real time mortality)
will be in place by 2012
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Platform in development
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There will be studies, recommendations and
demonstration projects on how to improve climaterelated health care and services (institutional and
home-delivered)
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Adaptation of health care–related buildings and lands
(1,700 buildings) according to new standards
(demonstration projects)
Health Action Plan 2007-2013
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Support demonstration projects for the
creation of «cool islands» and for the
prevention of EME risks to vulnerable, nonhealth care clients (schools, day care
facilities, low cost housing, etc.)
Training programme planned for network and
non-network staff (pending needs
identification)
Health Action Plan 2007-2013
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First health programme of this kind in Canada
– yet incomplete and imperfect
Not much done yet on behaviour and its
follow-up (and continuing reinforcement)
Links need to be established with other
existing health-related initiatives (UV, physical
conditioning, sustainable development,
transportation, etc.)
Planned funding: $30 million, including 50%
for demonstration projects – initiated last year.
LESSONS LEARNED
LESSONS LEARNED
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Need to start to change our thinking and words on
the need for innovation for CC adaptation. The
necessary technologies have been around for more
than a century: bicycles (1817), railways (1804),
tramways (1832), planning (~10,000 years), boats
(~10,000 years), tax (~1,600 years) and walking
(~2,000,000 years)
What is needed instead is a strenghtening of public
institution mandates, infrastructure and legal
requirements.
LESSONS LEARNED
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It took 10 years to get ready to act, so we might
as well start now, because…
When the money comes, we’d better be ready to
spend it wisely;
It is essential to broadcast, explain and repeat
the concepts, solutions, impacts and avoided
costs, since human behaviour remains…
human.
LESSONS LEARNED
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What will be lacking is the few billion
dollars needed to offset the advertising
drive to consume and emit GHGs
Last year, the world automobile industry
alone spent $70 billion on advertising and
incentives… out of a total world advertising
budget of $450 billion
Reducing GHG emissions remains the
Number 1 adaptation measure, one which
we owe our descendants.
Thank you for your attention