The Green Gab
*Cross-posted on Emerging Leaders for Environmental Sustainability in Healthcare’s (ELESH) website as “The Green Gab: Dr. Edward Xie”
Dr. Edward Xie is an Assistant Professor and Faculty co-Lead of Climate Change and Health in the Department of Family and Community Medicine at the University of Toronto. He works as an emergency physician through University Health Network and partners with ELESH as a fellow of the Centre for Sustainable Health Systems.
Edward’s academic interests focus on health services and policy related to determinants of health and inter-sectoral problems, such as homelessness, poverty, addictions, and climate change. He completed an MSc at the LSE and LSHTM with a focus on economic analysis and social policy.
Green Gab: So, before we begin – congratulations to you and to Dr. Green for your new appointments as Faculty Leads of Climate Change and Health.
Edward Xie: Thanks a lot, I really appreciate it.
We’re still trying to feel out where we’re going to go, but we’re hoping to work with leaders in different fields within primary care, and more specifically within the Department of Family and Community Medicine within UofT. We’re looking for ways that we can enhance and improve sustainability within education, quality improvement, clinical practice, and operations of healthcare centres as well. And to do that, we’re working very closely with our social accountability leaders because we know that issues of climate change and health and other environmental issues are very closely tied to local communities and people who may be more marginalized.
GG: That’s really exciting. Could you tell us a little bit about who you are?
EX: I work partly as an emergency doctor and I did my training in family medicine and emergency medicine at UofT and then at McGill afterwards. And I practice a little bit of family medicine, mainly through some volunteer clinics – there’s one through UofT. And there was one serving uninsured populations and now I’m practicing a little bit of family medicine related to isolation centres for people who are experiencing homelessness during the pandemic. Most of the other time I’m doing emergency medicine at the University Health Network. And then the rest of my time is spent on research, teaching and advocacy work.
I have an interest in global health as well, however you want to define that. I work with an academic group that does faculty and learner exchanges with Addis Ababa University. I’ve worked with Doctors Without Borders – MSF – before as well. And then I work on the board of Toronto Environmental Alliance and Canadian Association of Physicians for the Environment. And then loosely with a few other advocacy organizations as well, including the Decent Work and Health Network and others.
GG: That’s wonderful, so you’re really at the heart of it all. So when were you initially attracted to the field of sustainability in healthcare?
EX: I had an interest in environmental degradation and environmental protection for a long time now. And then I started to think about its effects on health and how healthcare would have an influence on the environment probably more in the last four or five years. That’s been fairly recent for me. I did a master’s in health policy a few years ago and my thesis was around how to communicate the effects of climate change on health.
GG: Right. Extending from that point, what are your thoughts on how environmental sustainability impacts healthcare and even vice versa?
EX: That’s a really great and super complex question. The first part being how does environmental sustainability affect healthcare. We unfortunately don’t have a healthcare system if it’s unsustainable. So, the main questions for me are how can we maintain a healthcare system that undermines itself, for example through emitting pollution, either through air pollution or through greenhouse gas pollution. We know that in Canada, air pollution contributes to over 15 000 deaths each year alone, and so, if the healthcare system is not watching how it contributes to air pollution, that really undermines its own goals.
The same is true for greenhouse gases as well. The estimate is that the Canadian healthcare system contributes about five percent of Canada’s total greenhouse gas emissions, and that’s quite similar to and even rivals other major sectors such as air travel. And so when we think about the goal of healthcare to improve health, it’s really undermined if we’re contributing to air pollution and climate change because we know that both of these can damage health.
Climate change is also going to limit our resources and contribute to supply chain disruptions. A few years ago there was a very strong hurricane, called Hurricane Maria, and it was thought to have been made more intense and more likely because of climate change. It wiped out a major facility that was producing intravenous saline, which is used worldwide as a very common medication to replenish fluids to help with dehydration and low blood pressure. Because of that disruption, there was a shortage all across North America of this very common, very important medication. We can expect that through the many different effects of climate change – either through increasing intensity or frequency of storms, through an increase in wildfires, through sea level rise and other effects around the world where we get all of our medical and healthcare supplies from – that this situation will get worse. We need to think about sustainability as a core issue that’s related to environmental degradation.
Probably the most recent example that’s top of mind is COVID-19, where we’ve seen links between human industry pushing further into the environment, increasing exposure of human societies to new viruses. And there is a link between increased demands on the environment, increased push for resource utilization and this increased exposure to new health conditions that we’ve never had before and creating, unfortunately, new diseases that we’re not prepared for. It’s concerning.
GG: During your time in this field, is there a sustainability initiative or program that you were involved in or you headed that you could share with us?
EX: I haven’t done a lot yet. I’m still fairly new to it. If anything, I’m actually taking a lot of inspiration from ELESH that held a really cool event late last year which showcased some really interesting ideas from students from UofT of ways to improve health and reduce the impact on the environment. We also are looking to partners from around the world for inspiration. This includes the UK where they actually have a government mandate and a health system mandate to reduce greenhouse gas emissions. They have a lot of programs and a dedicated health unit that oversees reductions in emissions and sets standards for how healthcare facilities can actually reduce their environmental impact. We’re hoping to implement something like that here as well, where we can offer people a range of different options that they can introduce to reduce their environmental impact.
One of the things that we’re very excited about, and we’re kind of watching other groups being involved in, is this idea of social prescribing, or more broadly shifting healthcare behaviours and shifting models of care towards prevention. Alliance for Healthier Communities here and the National Health System in the UK have been working on this. Instead of focusing on prescribing medications or prescribing healthcare interventions, social prescribing means prescribing things that improve social isolation for people or improve the social and cultural environment for people that helps their health conditions, including mental health. To use social isolation as an example, that contributes to depression, worsening health, and health care utilization.
GG: What would be some challenges to implementing those initiatives you described from the UK?
EX: The UK actually has a legal mandate to achieve the goals they’ve set out. We don’t have that type of top down leadership to have a long-term vision of drastically reducing our emissions. There is less extrinsic motivation to achieve specific goals. And I think in the UK it’s really a major motivating force where it gets everybody on side with a particular objective. That lack of a mandate is probably the main barrier.
GG: What are some successes that you have encountered in the healthcare system with regards to sustainability?
For Toronto Environmental Alliance, part of those efforts include changes that on the face of it don’t seem like they relate to health but they actually have a major impact. One of the major initiatives is called Climate Hubs. It works with community groups in community centres or even community health centres to promote awareness of climate change and look for local resources that organically spring from the communities. That has included, for example, neighbourhood gardens, which have several benefits. They serve as a way to have better access to food in parts of the city that are not well served by mass market grocery stores and where past urban planning hasn’t been able to supply access to nutritious and affordable food. They are a way of improving neighbourhood cohesion and social inclusion within the community. They are also a way of increasing green space. So efforts like that are really cool, and it’s really great to see that within that organization. It’s a way of improving health, civic engagement, and neighbourhood cohesion.
GG: What impact has COVID-19 had on sustainability initiatives?
EX: It’s been good and bad. Obviously COVID-19 has been tragic in terms of its human toll, and its impact is just devastating to lower resource areas, especially outside of Canada, but also within Canada for remote and rural communities. It can be a lot more difficult to get healthcare, even within cities, when access to healthcare has been reduced. It’s also made it harder to reduce the amount of waste that healthcare is putting out because we find that we are using a lot more single-use masks and PPE. There are different options that healthcare organizations have looked into to improve that. There are certain ways of reusing PPE, of decontaminating it, cleaning it and repurposing it. We’re really hoping to see more of that happening. In some ways it’s been an opportunity to promote innovation along those lines, because with the pandemic there have been disruptions within supply chains. It’s important for us, especially the engineering folks, to look at how we can reduce our use of resources and deliver healthcare more efficiently, so that if there are more supply chain disruptions in the future, we’re not so reliant on having to bring in more resources from outside Canada.
Canada’s been quite slow at developing systems for virtual care and tele-medicine and we’ve seen COVID-19 drive a major push to establish those possibilities where they’re suited to the care that’s needed. So hopefully access to fast internet for communities in Canada improves, and that also improves the access to healthcare through virtual care and tele-medicine. I’m also hoping that it changes the way that we think about work, and in some ways whether it’s possible to do work virtually instead of having to be at work for people who would benefit from or would prefer to work from home. Flexible work hours may help getting around issues related to childcare or having to care for other family members at home. We can also ask if there are opportunities from the pandemic because of the unemployment level that we’re seeing, to have more employment in roles that are extremely beneficial for society but also reduce impact on the environment. Those would be a lot of the caring roles that are important, so not just childcare but also elder care and other social care roles.
GG: We’re really grateful for you taking the time to speak with us and explain your experience in healthcare and sustainability in healthcare.
EX: Thanks so much for doing this. What ELESH is doing is fantastic. I really love the energy that’s in your group, so I thank you for actually taking this initiative, it’s awesome. Sorry for my long rambling answers, I’m sure transcribing them will be challenging.
GG: No worries, we love it.
EX: Alright thanks guys, take care.
The Green Gab is an initiative led by the Emerging Leaders for Environmental Sustainability in Healthcare (ELESH) that engages health system leaders in conversations about the climate crisis, environmental sustainability, and their vision for the future of sustainable healthcare.
The initiative takes the form of a series of interviews that will be published on the ELESH website. Interview guests include clinicians, non-clinicians, academics, advocates and activists. ELESH hopes to generate public dialogue around the role of healthcare in responding to climate and environmental crisis, and shine a spotlight on leaders who are working to bring healthcare into a sustainable future.
The Green Gab is Paula Samaha, Yousef Safar, Alia Almneni, Cristian Santos, Nargol Salimi, Danielle Toccalino, and Colin Sue-Chue-Lam
All CSHS guest posts are published under the CreativeCommons Attribution Non-commercial Share Alike license. Guest Contributors are free to publish their guest posts elsewhere.