Planetary Health in Emergency Medicine

Speaker: Dr. Melody Porlier

Integrating Planetary Health in the Medical Curriculum: a Framework

As the impacts of climate change accelerate, there is growing recognition that medical education must evolve to meet the health challenges of an unstable planet. In this timely session, Dr. Melody Porlier—a resident in Emergency Medicine and planetary health advocate—shared a powerful roadmap for integrating climate change and planetary health into the core of medical training.

Why It Matters

A multinational survey of 4,600+ health professionals found:

• 77% agree that climate change adversely affects patients

• 86% believe clinicians have a responsibility to educate on these impacts

• Yet 41% feel they lack the knowledge to do so (Kotcher et al., 2021)

This gap is not just academic—it’s clinical. As planetary health becomes a frontline issue, future physicians must be equipped to recognize and manage climate-related health effects.

A Student-Led Revolution: The Montréal Model

The University of Montréal’s planetary health curriculum began as a student-led initiative in 2019. With faculty collaboration and institutional support, it has since evolved into a comprehensive, longitudinal curriculum that includes:

• Lectures, workshops, and case studies

• A dedicated Climate Crisis and Planetary Health Group

• Integration into both pre-clerkship and clerkship training

• New continuing professional development (CPD) modules for practicing clinicians

Topics covered include:

• Air pollution and respiratory health

• Extreme climate events

• Cardiovascular, neurological, and infectious diseases

• Mental health and reproductive health

• Health equity, vulnerable populations, and Indigenous perspectives

• Sustainable healthcare practices

Lessons from Implementation

A survey of 156 faculty physicians revealed:

• 84% are concerned about climate change

• 51% have seen patients with climate-related health issues

• 93% support including this content in medical education

  Yet key barriers persist:

• Time constraints

• Limited faculty expertise

• Lack of institutional mandate

Dr. Porlier and her colleagues tackled this with targeted faculty development, strong student-faculty collaboration, and active involvement in curriculum renewal processes.

The Way Forward

The Montréal experience demonstrates that meaningful change is possible—quickly and collaboratively—when learners and educators work together. Their model now includes:

• Formal representation in curriculum committees

• Residency integration pathways

• CPD and interprofessional engagement

• Exploration of a potential fellowship track in planetary health

Key Takeaways

• Medical education must evolve to address the climate emergency as a health emergency

• Leverage existing curricular spaces and adapt international frameworks to local needs

• Prioritize sustainability, equity, and community engagement in training the next generation

“Planetary health education is not optional. It’s the foundation for responsible, future-facing medical practice.”

Speaker: Dr. Stephanie Burelle

Carbon Footprint Scope 1-2-3 of a Healthcare Establishment

Healthcare heals—but it also harms. In this data-driven and solutions-oriented session, Dr. Stéphanie Burelle from Hôpital de Cité de la Santé de Laval unveiled Québec’s first comprehensive carbon footprint analysis of a healthcare system, laying bare the emissions cost of clinical care.

The Scope: Healthcare’s Global Emissions

Globally, healthcare accounts for 4.4% of all greenhouse gas (GHG) emissions. Canada ranks among the highest emitters per capita, alongside Australia and the United States, despite having just 2% of the world’s population.

The Study: CISSS de Laval Carbon Audit

Dr. Burelle led a carbon audit of seven representative healthcare facilities across Laval, Québec—including hospitals, rehab centers, and clinics—extrapolated to estimate emissions for the entire regional health system (CISSS de Laval) for the year 2019–2020.

Key findings:

• 90,000 tons CO₂e emitted annually across the CISSS

• Hospital Cité de la Santé alone emitted 41,000 tons CO₂e

• The top three sources of emissions:

  
  

  • Commuting: 18,400 tons CO₂e (34%)

  • Medical supplies: 18,200 tons CO₂e (34%)

  • Waste management: 3,300 tons CO₂e (6%)

That’s the equivalent of more than 9,000 round-trip flights between Montreal and Paris—just for commuting and supplies.

Regional Realities

Québec’s reliance on hydroelectric power reduces energy-related emissions, but other issues compound the problem:

• Heavy reliance on single-occupancy vehicles

• Larger cars compared to Europe

• Greater use of landfill waste disposal

• Aging infrastructure across many facilities

What Clinicians Can Do

Dr. Burelle emphasized that solutions exist at every level—individual, institutional, and systemic.

✅ At the bedside:

• Ensure tests and treatments align with patient values and prognosis

• Avoid unnecessary prescribing, scanning, and PPE use

✅ In your workplace:

• Champion eco-responsible clinical teams

• Lead glove use awareness campaigns and other source reduction initiatives

✅ In society:

• Engage in advocacy with professional bodies and governments

• Support policies that align healthcare with planetary health

“We must treat the patient without harming the environment they depend on to survive.”

Final Thought

Dr. Burelle’s presentation was both a wake-up call and a roadmap. Carbon audits like this offer a quantitative foundation for real change—highlighting not just the cost of care, but the cost of inaction. It’s time to act.

Speaker: Dr. John Bonning

Climate Impact of Healthcare

As emergency physicians, we are trained to respond urgently in the face of crisis. But as Dr. John Bonning reminded us in his sobering plenary, one of the greatest threats to health is unfolding not in a trauma bay, but all around us—through the accelerating impact of climate change.

The Healthcare Paradox: A System That Heals Yet Harms

Globally, the healthcare sector is responsible for approximately 5% of all greenhouse gas emissions, making it the fifth largest emitter if it were a country. The bulk of this footprint comes from:

• Supply chains (66%)

• Delivery of care (25%)

• Energy use, transportation, construction, and medical waste

Ironically, many harms stem from unnecessary or low-value care—interventions that provide little or no benefit, yet contribute heavily to emissions, waste, and patient harm.

Examples include:

• Excessive IV cannulation, unnecessary lab tests, and “just-in-case” CT scans

• Overuse of antibiotics, driving resistance and adverse events

• Routine use of pressurized MDIs and nitrous oxide, both potent greenhouse gases

• Widespread and often excessive PPE and glove use

• Futile interventions at end-of-life that prolong suffering and resource use

“Our ability to help the sick and injured may soon be outstripped by our propensity to harm the healthy.”— Dr. Ray Moynihan, BMJ

From Awareness to Action

Dr. Bonning challenged clinicians to recognize how biases, outdated practices, and unquestioned norms contribute to waste and harm. The crisis is not just environmental—it’s ethical. The principle of Primum non nocere (first, do no harm) must now apply to both patients and the planet.

The Path Forward: Choose Wisely, Act Urgently

Borrowing Greta Thunberg’s famous call to action—“Act as if our house is on fire. Because it is.”—Dr. Bonning issued an urgent appeal:

• STOP unnecessary care

• PRIORITIZE resource stewardship

• SAVE:

  
  

  • People – through equitable care

  • Profit – by reducing cost and inefficiency

  • Planet – by reducing our environmental footprint

This is not just about clinical choices, but transformational action—redefining what good care looks like in the face of a planetary emergency.

Final Words

Healthcare must shift from being a passive contributor to climate harm to becoming an active force for planetary health. Emergency medicine has always responded in times of need. Now, we must recognize the climate crisis as a medical emergency—and act accordingly.

Speaker: Dr. Eric Notebaert

Active Transportation, Health, and Global Climate Change

As the climate crisis intensifies, emergency physicians are not just witnesses to its health impacts—we are called to be part of the solution. In this compelling session, Dr. Éric Notebaert, emergency physician and sustainability advocate, explored how active transportation—walking and cycling—can yield profound benefits for both planetary and public health.

The Problem with Cars: A Public Health Hazard

Transportation accounts for nearly 40% of urban greenhouse gas emissions, with private cars among the worst offenders. Beyond emissions, cars contribute to:

• Air pollution (PM2.5, NO₂, black carbon)

• Noise pollution

• Urban sprawl and sedentarism

• Traffic-related morbidity and mortality

“Cars are among the greatest public health threats in our cities.” — World Health Organization

Active Transport: Health Benefits > Risks

Dr. Notebaert reviewed multiple international studies confirming that cycling and walking significantly reduce individual exposure to pollutants compared to sitting in a car. Even modest distancing—just 1–2 meters away from vehicle traffic—markedly lowers particulate exposure for cyclists.

Key takeaways:

• People in cars experience up to 90% more carbon monoxide exposure than those walking

• Active commuters gain up to +1 year in life expectancy

• Health benefits (reduced cardiovascular disease, diabetes, cancer, cognitive decline) far outweigh the risks from air pollution or road accidents

Urban Design and Inequity

Walkability matters. Data from Ontario’s CANHEART study showed that individuals living in low-walkability neighborhoods had higher rates of hypertension and diabetes, and greater harm from pollution exposure.

In contrast, cities designed for active transport (like Copenhagen or Amsterdam) report:

• Lower GHG emissions

• Fewer DALYs lost (Disability-Adjusted Life Years)

• Improved mental and physical health across the population

Modeling the Future: The Auckland Scenario

A simulation from New Zealand estimated that if active transport reached 40% of trips (like in Europe’s top cycling cities), outcomes would include:

• 50% drop in per capita GHG emissions

• Hundreds of lives saved annually

• Billions in healthcare and fuel savings

• $6–$20 return for every $1 invested in bike infrastructure

Your Role: What Health Professionals Can Do

Dr. Notebaert concluded with a call to advocacy and action, emphasizing that clinicians are uniquely positioned to lead on this issue:

• Educate patients on pollution and active commuting

• Engage with urban planners and public health officials

• Advocate for safer bike infrastructure in your cities

• Model change by using active or public transport to commute

“We must act like the climate crisis is a public health emergency—because it is.”

Final Word

Active transport isn’t just a personal lifestyle choice—it’s a prescription for healthier people and a healthier planet. As emergency physicians, we see the effects of urban health inequities every day. Now, we can be part of redesigning our cities—and our systems—for good.