Canadian medical student climate advocacy during the COVID-19 pandemic
Authors: Alanna Jane, Gillian Forster, Colin Faulkner
Journal: The Lancet Planetary Health (2022)

When asked what is the most effective long-term approach to protecting human health and preventing chronic disease, our solution as medical students is clear: prioritising a healthy planet for the health of our future patients. The relationship between climate change and health is well-documented, with known effects on vector-borne diseases, drought and water insecurity, food insecurity, wildfires, and air pollution.1The Lancet CountdownClimate change impacts, exposure and vulnerability.https://www.lancetcountdown.org/data-platform/climate-change-impacts-exposures-and-vulnerabilityDate: 2019Date accessed: December 24, 2021Google Scholar In March of 2020, a timely article written by colleagues from Queen's University in Kingston, Ontario and the University of Toronto about how medical students can combat climate change was published.2Cohen A Letourneau S Climate change advocacy: a growing movement.Univ Tor Med J. 2020; 97: e34-e35Google Scholar Inspired, we joined the Queen's Environmental Advocacy In Medicine (EAIM) interest group to advocate for planetary health, but were met with the challenges of COVID-19.Although our advocacy work with EAIM began pre-pandemic with in-person activities, the focus of our work shifted to hosting events and raising awareness in a safe and virtual manner. The new public health guidelines elicited us to create novel strategies which strengthened our overall impact. In this Comment, we describe our climate advocacy experiences in EAIM and the challenges we overcame with COVID-19, as well as three key learning points discovered.The first learning point is that virtual climate advocacy offers a strengthened and multifaceted approach to tackling climate change. COVID-19 has warranted a transition from in-person to virtual activities, permeating many domains of life. This shift revealed both advantages and disadvantages. Regarding the latter, the lack of physically sharing a space with fellow EAIM members during team meetings caused a temporary loss of morale. However, attending virtual meetings proved helpful from a time-management, pollution-reduction, and cost-savings perspective as the need to travel was reduced. Furthermore, hosting events online allowed for a much wider catchment area and diversity of attendees, greater accessibility for attendees with disabilities, and the ability to record and watch sessions at a later time. Virtual platforms also allowed for heightened climate advocacy collaboration on a national scale. For example, members of the Canadian Federation of Medical Students' Health and Environment Adaptive Response Task force (HEART) gathered virtually every month to share ideas and support each other's work. HEART includes Project Green Healthcare (PGH), an initiative to carry out local climate advocacy projects at participating Canadian medical schools.3Luo O Carson J Sanderson V Vincent R Training future healthcare sustainability leaders: lessons learned from a Canadian-wide medical student community of practice.J Clim Change Health. 2021; 4100066Google Scholar Queen's PGH team created infographics for an active transportation campaign to promote biking and walking to and from Kingston hospitals. Our virtual experiences with HEART and PGH allowed us to expand our networks and converge with fellow activists in a way that would not have been possible before COVID-19. Another success was fellow medical students championing the Canadian Residency Matching Service to move to online interviews, saving 1·44 tonnes of carbon dioxide equivalents per student.4Liang K Dawson J Stoian M Clark D Wynes S Donner S A carbon footprint study of the Canadian medical residency interview tour.Med Teach. 2021; 43: 1302-1308Crossref PubMed Scopus (5) Google Scholar The move to online advocacy precipitated many changes that were positive and helpful for our work.The second learning point is the importance of addressing inequities in climate change and environmental racism. A key emerging topic in climate advocacy, especially in the Canadian context, is intersectionality and combating environmental racism. Racialised communities living in Canada, such as Indigenous and Black peoples, have long been exposed to environmental pollutants and hazards. There is not enough space in this piece to properly highlight all the injustices these communities have faced and are currently facing, but a few examples include decades of mercury poisoning in the Grassy Narrows First Nation of Ontario, the placement of a dump releasing toxic substances in Nova Scotia's historically Black community of Africville, the abhorrent number of over 100 Indigenous communities facing boil water advisories, and the ongoing destructive efforts of the federal government and oil industry who continue to accelerate the extraction of resources from unceded territories.5MacDonald E Environmental racism in Canada: what is it and what can we do about it? Ecojustice.https://ecojustice.ca/environmental-racism-in-canada/Date: Sept 1, 2020Date accessed: December 24, 2021Google Scholar, 6Black K Swampy M Tip of the iceberg: the true state of drinking water advisories in First Nations. University of Calgary, May 7, 2021https://ucalgary.ca/news/tip-iceberg-true-state-drinking-water-advisories-first-nationsDate accessed: December 24, 2021Google Scholar Extractive projects notoriously evade public health restrictions, further exacerbating COVID-19 outbreaks for the surrounding Indigenous communities.7Désilets C Jiménez G Lorimer B Large-scale resource extraction exacerbates the threat of COVID-19 across the American hemisphere, especially for Indigenous peoples. KAIROS Canada.https://www.kairoscanada.org/large-scale-resource-extraction-exacerbates-the-threat-of-COVID-19-across-the-american-hemisphere-especially-for-indigenous-peoplesDate: May 4, 2020Date accessed: December 24, 2021Google Scholar Furthermore, the Royal Canadian Mounted Police have arrested members of the Wet'suwet'en First Nation in British Columbia for their actions opposing pipelines.8Barrera J RCMP arrest 14, clear road on Wet'suwet'en territory in ongoing dispute over land rights, pipeline. CBC News.https://www.cbc.ca/news/canada/british-columbia/rcmp-wet-suwet-en-pipeline-resistance-1.6254245Date: Nov 18, 2021Date accessed: December 24, 2021Google Scholar These examples prompted EAIM to educate ourselves and fellow settler students on environmental racism. We held a collaborative event between EAIM and the Queen's Indigenous Health Standing Committee featuring Beze Gray, an Anishinaabe Water Protector and Land Defender. Beze spoke about their experiences growing up in the "Chemical Valley" area of Ontario and their work to hold the Canadian Government accountable for the deleterious health effects seen in local Indigenous populations due to toxic pollution. Also, educational social media campaigns and virtual screening events were valuable tools to increase awareness at Queen's of environmental racism in Canada. Learning from individuals' lived experiences facilitated a deeper understanding of these complex issues.The third learning point is that we should acknowledge the benefits of accessible nature and time spent outdoors. COVID-19 has had a tremendous impact on the value medical students place on access to natural spaces. With increased stress on medical students to attend daily virtual lectures, many students flocked to personal wellness activities centred around spending time outdoors. Not only is access to nature therapeutic for medical students and health-care providers, but the "PaRx: A Prescription for Nature" national nature prescription programme encourages physicians to prescribe time outdoors to their patients for a variety of health benefits.9Cooper Reed A Haldane V Mincer J McDermott E Rawlyk B Nature prescribing in Canada: a trainee led discussion on implementation and educational opportunities.J Clim Change Health. 2021; 4100040Google Scholar EAIM co-hosted a virtual event in April, 2021, where the current PaRx Director spoke on the importance of prescribing and protecting nature for ourselves and our future patients. Spending time outside improves mental and physical health, including lowering cortisol levels, reducing inflammation and stress in adults with chronic obstructive pulmonary disease, and increasing concentration in children with attention-deficit hyperactivity disorder.10BC Parks FoundationPaRx: why nature?.https://www.parkprescriptions.ca/en/whynatureDate: 2021Date accessed: December 24, 2021Google Scholar Furthermore, outdoor active transportation including walking and biking is associated with reductions in greenhouse gas emissions and air pollution, and health advantages of increased physical activity.1The Lancet CountdownClimate change impacts, exposure and vulnerability.https://www.lancetcountdown.org/data-platform/climate-change-impacts-exposures-and-vulnerabilityDate: 2019Date accessed: December 24, 2021Google ScholarIn conclusion, we recognise that physicians have a unique role in climate advocacy, and as we continue to improve our understanding of environmental advocacy, we propose the following three calls to action for Canadian medical students, residents, and physicians to become more engaged in efforts at their local institutions. We call on medical learners and physicians to (1) prioritise educating themselves and their peers on issues of environmental racism through learning from Indigenous and Black scholars, (2) continue utilising virtual connections to act on a unified, national climate front, and (3) challenge policy makers on issues of divestment, greening health care, and system-wide changes. When asked what is the most effective long-term approach to protecting human health and preventing chronic disease, our solution as medical students is clear: prioritising a healthy planet for the health of our future patients. The relationship between climate change and health is well-documented, with known effects on vector-borne diseases, drought and water insecurity, food insecurity, wildfires, and air pollution.1The Lancet CountdownClimate change impacts, exposure and vulnerability.https://www.lancetcountdown.org/data-platform/climate-change-impacts-exposures-and-vulnerabilityDate: 2019Date accessed: December 24, 2021Google Scholar In March of 2020, a timely article written by colleagues from Queen's University in Kingston, Ontario and the University of Toronto about how medical students can combat climate change was published.2Cohen A Letourneau S Climate change advocacy: a growing movement.Univ Tor Med J. 2020; 97: e34-e35Google Scholar Inspired, we joined the Queen's Environmental Advocacy In Medicine (EAIM) interest group to advocate for planetary health, but were met with the challenges of COVID-19. Although our advocacy work with EAIM began pre-pandemic with in-person activities, the focus of our work shifted to hosting events and raising awareness in a safe and virtual manner. The new public health guidelines elicited us to create novel strategies which strengthened our overall impact. In this Comment, we describe our climate advocacy experiences in EAIM and the challenges we overcame with COVID-19, as well as three key learning points discovered. The first learning point is that virtual climate advocacy offers a strengthened and multifaceted approach to tackling climate change. COVID-19 has warranted a transition from in-person to virtual activities, permeating many domains of life. This shift revealed both advantages and disadvantages. Regarding the latter, the lack of physically sharing a space with fellow EAIM members during team meetings caused a temporary loss of morale. However, attending virtual meetings proved helpful from a time-management, pollution-reduction, and cost-savings perspective as the need to travel was reduced. Furthermore, hosting events online allowed for a much wider catchment area and diversity of attendees, greater accessibility for attendees with disabilities, and the ability to record and watch sessions at a later time. Virtual platforms also allowed for heightened climate advocacy collaboration on a national scale. For example, members of the Canadian Federation of Medical Students' Health and Environment Adaptive Response Task force (HEART) gathered virtually every month to share ideas and support each other's work. HEART includes Project Green Healthcare (PGH), an initiative to carry out local climate advocacy projects at participating Canadian medical schools.3Luo O Carson J Sanderson V Vincent R Training future healthcare sustainability leaders: lessons learned from a Canadian-wide medical student community of practice.J Clim Change Health. 2021; 4100066Google Scholar Queen's PGH team created infographics for an active transportation campaign to promote biking and walking to and from Kingston hospitals. Our virtual experiences with HEART and PGH allowed us to expand our networks and converge with fellow activists in a way that would not have been possible before COVID-19. Another success was fellow medical students championing the Canadian Residency Matching Service to move to online interviews, saving 1·44 tonnes of carbon dioxide equivalents per student.4Liang K Dawson J Stoian M Clark D Wynes S Donner S A carbon footprint study of the Canadian medical residency interview tour.Med Teach. 2021; 43: 1302-1308Crossref PubMed Scopus (5) Google Scholar The move to online advocacy precipitated many changes that were positive and helpful for our work. The second learning point is the importance of addressing inequities in climate change and environmental racism. A key emerging topic in climate advocacy, especially in the Canadian context, is intersectionality and combating environmental racism. Racialised communities living in Canada, such as Indigenous and Black peoples, have long been exposed to environmental pollutants and hazards. There is not enough space in this piece to properly highlight all the injustices these communities have faced and are currently facing, but a few examples include decades of mercury poisoning in the Grassy Narrows First Nation of Ontario, the placement of a dump releasing toxic substances in Nova Scotia's historically Black community of Africville, the abhorrent number of over 100 Indigenous communities facing boil water advisories, and the ongoing destructive efforts of the federal government and oil industry who continue to accelerate the extraction of resources from unceded territories.5MacDonald E Environmental racism in Canada: what is it and what can we do about it? Ecojustice.https://ecojustice.ca/environmental-racism-in-canada/Date: Sept 1, 2020Date accessed: December 24, 2021Google Scholar, 6Black K Swampy M Tip of the iceberg: the true state of drinking water advisories in First Nations. University of Calgary, May 7, 2021https://ucalgary.ca/news/tip-iceberg-true-state-drinking-water-advisories-first-nationsDate accessed: December 24, 2021Google Scholar Extractive projects notoriously evade public health restrictions, further exacerbating COVID-19 outbreaks for the surrounding Indigenous communities.7Désilets C Jiménez G Lorimer B Large-scale resource extraction exacerbates the threat of COVID-19 across the American hemisphere, especially for Indigenous peoples. KAIROS Canada.https://www.kairoscanada.org/large-scale-resource-extraction-exacerbates-the-threat-of-COVID-19-across-the-american-hemisphere-especially-for-indigenous-peoplesDate: May 4, 2020Date accessed: December 24, 2021Google Scholar Furthermore, the Royal Canadian Mounted Police have arrested members of the Wet'suwet'en First Nation in British Columbia for their actions opposing pipelines.8Barrera J RCMP arrest 14, clear road on Wet'suwet'en territory in ongoing dispute over land rights, pipeline. CBC News.https://www.cbc.ca/news/canada/british-columbia/rcmp-wet-suwet-en-pipeline-resistance-1.6254245Date: Nov 18, 2021Date accessed: December 24, 2021Google Scholar These examples prompted EAIM to educate ourselves and fellow settler students on environmental racism. We held a collaborative event between EAIM and the Queen's Indigenous Health Standing Committee featuring Beze Gray, an Anishinaabe Water Protector and Land Defender. Beze spoke about their experiences growing up in the "Chemical Valley" area of Ontario and their work to hold the Canadian Government accountable for the deleterious health effects seen in local Indigenous populations due to toxic pollution. Also, educational social media campaigns and virtual screening events were valuable tools to increase awareness at Queen's of environmental racism in Canada. Learning from individuals' lived experiences facilitated a deeper understanding of these complex issues. The third learning point is that we should acknowledge the benefits of accessible nature and time spent outdoors. COVID-19 has had a tremendous impact on the value medical students place on access to natural spaces. With increased stress on medical students to attend daily virtual lectures, many students flocked to personal wellness activities centred around spending time outdoors. Not only is access to nature therapeutic for medical students and health-care providers, but the "PaRx: A Prescription for Nature" national nature prescription programme encourages physicians to prescribe time outdoors to their patients for a variety of health benefits.9Cooper Reed A Haldane V Mincer J McDermott E Rawlyk B Nature prescribing in Canada: a trainee led discussion on implementation and educational opportunities.J Clim Change Health. 2021; 4100040Google Scholar EAIM co-hosted a virtual event in April, 2021, where the current PaRx Director spoke on the importance of prescribing and protecting nature for ourselves and our future patients. Spending time outside improves mental and physical health, including lowering cortisol levels, reducing inflammation and stress in adults with chronic obstructive pulmonary disease, and increasing concentration in children with attention-deficit hyperactivity disorder.10BC Parks FoundationPaRx: why nature?.https://www.parkprescriptions.ca/en/whynatureDate: 2021Date accessed: December 24, 2021Google Scholar Furthermore, outdoor active transportation including walking and biking is associated with reductions in greenhouse gas emissions and air pollution, and health advantages of increased physical activity.1The Lancet CountdownClimate change impacts, exposure and vulnerability.https://www.lancetcountdown.org/data-platform/climate-change-impacts-exposures-and-vulnerabilityDate: 2019Date accessed: December 24, 2021Google Scholar In conclusion, we recognise that physicians have a unique role in climate advocacy, and as we continue to improve our understanding of environmental advocacy, we propose the following three calls to action for Canadian medical students, residents, and physicians to become more engaged in efforts at their local institutions. We call on medical learners and physicians to (1) prioritise educating themselves and their peers on issues of environmental racism through learning from Indigenous and Black scholars, (2) continue utilising virtual connections to act on a unified, national climate front, and (3) challenge policy makers on issues of divestment, greening health care, and system-wide changes. We declare no competing interests. We would like to thank Cathy Vakil for reviewing this article and for her encouragement and support, and Andrew Stevens for reviewing this article. We would also like to thank and acknowledge the work of the Queen's University Indigenous Health Standing Committee for their time and expertise reviewing this article. As settlers on the traditional territories of the Anishinaabe, Haudenosaunee, and Huron-Wendat Peoples, we acknowledge our positionality and privilege within the climate advocacy movement, and are committed to lifelong learning and unlearning. Finally, we would like to thank the entire Queen's Environmental Advocacy in Medicine (EAIM) 2019–2020 and 2020–2021 executive teams for their leadership and help in organising events, as well as the Queen's Aesculapian Society for their support in funding these events.