World Family Doctor Day 2024: Healthy Planet, Healthy People

World Family Doctor Day is on May 19, a time to celebrate and acknowledge family physicians. The World Organization of Family Doctors has announced “Healthy Planet, Healthy People” as this year’s theme.

As such, PEACH is highlighting family physicians making a difference in our communities. From inspiring patients to adopt plant-based diets to helping hospitals reduce their carbon, family doctors are making an enormous impact in environmental sustainability.

Dr. Rebecca Douglass: Taking climate action through inhalers

A family physician for more than 15 years, Dr. Rebecca Douglass says one of the first things that made her realize the impact primary care providers can have on climate change was learning about inhalers.

“It never occurred to me that the propellent in inhalers is such a potent greenhouse gas,” she says. “And often, these inhalers are not in keeping in best care for the patients themselves, and better alternatives are available.”

In primary care, one of the largest sources of greenhouse gases are from pressurized metered-dose inhalers (pMDIs). These inhalers use a propellant called hydrofluoroalkane, a powerful greenhouse gas, to deliver the medication. While pMDIs are effective, many patients can be switched to dry powder inhalers (DPIs) which have a much lower carbon burden. Learn more with the Green Office Toolkit for Clinicians and Office Managers (PDF).

While recognizing that it does take some effort to learn about DPIs and prescribe differently, Rebecca says, “many patients would opt for these options if they knew about them. They are beneficial for their health and it’s fairly easy to implement and make a big impact.”

In the future, Rebecca said she would like to see more of a shift to providing holistic care, including
social prescribing and improving access to healthy food and exercise– advocating for interventions that prevent disease in addition to those that treat it.

“The impact of diet and exercise can’t be overstated. That’s one area where we are making progress – for example, kids are learning about these issues in school now,” she says. “I hope to motivate people to move towards a plant-based diet and increase their exercise. When you look at the data on it, if these interventions were medications, they would be considered wonder drugs.”

Dr. Teela Johnson: Plant-based diets for patients

A hospitalist at Unity Health, Dr. Teela Johson is working to introduce more patients to plant-based diets – at home and through the hospital inpatient menu.

Working in a unit providing care to people with metabolic disease, Teela makes sure she is always talking to patients about healthy eating habits. While helping to improve patient health, she considers it an important part of climate activism. “I talk to everyone about increasing their fiber intake and I show them the Canada Food Guide. Patients are interested in it, but a few of them don’t always connect plant-based eating with their health,” she says.

A volunteer with the Agrifood Working Group with the Canadian Association of Physicians for the Environment (CAPE), Teela notes that the impacts of plant-based diets go beyond individual health. Agriculture, and the food supply chain, is a significant driver of carbon emissions.

Looking to further expand plant-based diets beyond her patients, Teela is working to introduce a new menu to her hospital next year. She has been inspired by New York City Mayor Eric Adams who pledged to reduce the city’s food-based emissions by a third by 2030. As part of that commitment, New York hospitals have adopted plant-based menus. Meat is only provided on request.

“I would love for that to be offered at my hospital,” Teela says. “If introducing plant-based menus in my hospital goes well, it will also demonstrate that this is one way to help the hospital reach its carbon goals.”

Ultimately, Teela would like for people to understand how connected climate and diet are. She’d like people to eat more plant-based foods and then have their health improve. “If people were healthier and focused on prevention, the healthcare system would save so many dollars as well.” It’s also good for the environment.

Emma Ko: Creating healthier, sustainable communities

Through medical school, Emma Ko, a third year medical student at McMaster University, has been inspired to volunteer time to help advance efforts to ensure environmental sustainability is part of primary care. As a PEACH volunteer, she has helped develop sustainability guidebooks for hospitals, long-term care facilities and outpatient offices. Through this work, she has learned about sustainability practices within healthcare that contribute to making clinical work environments greener and more climate resilient.

“Our responsibility as healthcare professionals is not only to care for our patients but also to safeguard the environment,” she says. “Climate change affects us all, and by engaging in green initiatives, we not only mitigate its effects but also create healthier, more sustainable and resilient communities for everyone.”

Emma, who begins her residency in July, believes there are many opportunities for growth when it comes to making healthcare more environmentally friendly. “I hope to continue this work in residency and use it in practice,” she says. “I am eager to continue championing green initiatives and making a positive impact on both the health of individuals and our planet.”

Emma is also involved with Trees for Hamilton, a volunteer group with a mission to help green medical spaces by planting trees nearby.

“I remember planting trees at Hamilton General Hospital when I first came to Hamilton three years ago. Seeing them grow over time brings me so much joy every time I return to my clinical placements at that site,” she says. “It’s a great way to enjoy the outdoors with friends, while also offering a tangible reminder of our impact on our environment.”

Dr. Curtis Lavoie: Promoting a green emergency department

Leading the Green Team at the Children’s Hospital of Eastern Ontario (CHEO), Dr. Curtis Lavoie always has always been mindful of the ‘low-hanging fruit’ – the things that can easily be done to promote environmental sustainability in healthcare.

An emergency department physician, Curtis says there were two obvious things causing a lot of waste: paper on exam beds and bottled water. “For a high-volume emergency department, the exam paper on beds was creating a high volume of garbage for limited benefit,” he says. “We were able to get rid of that.”

The emergency department was also using bottled water for certain procedures – that meant the water was being shipped in one-time-use bottles, creating carbon and waste. “It took some time to phase out, but there was enough evidence to show that tap water is better, so we stopped using bottled water.”

As part of the hospital’s commitment to ‘Kick the Carbon’, CHEO hired an energy manager about six years ago, responsible for reducing energy consumption. Addressing aging infrastructure and inefficiency in the hospital’s heating and cooling systems has been paramount to reducing the hospital’s carbon emissions. Already, carbon is down 30 per cent.

“How heating and cooling is maintained in every facility is important. It’s something anyone can tweak,” Curtis says. “You might have to invest in it, but you get a really great payback as it can also save you money to ensure your system is energy efficient.”

When it comes to the future of green initiatives in healthcare, Curtis would like to see planetary health prioritized. “I want people to bring planetary health into the decision-making process. It needs to be part of the discussion points and ingrained in every important practice decision,” he says. “There has to be more consideration or our future generations.”

Refer to PEACH’s Guidebook for Sustainable Hospitals (PDF) to learn more.

Olivia Ly: Making a difference one step at a time

When it comes to environmental sustainability, Olivia Ly recognizes how significant and overwhelming the global challenge is, so she focuses on the areas that she can control. For the second-year family medicine resident at McMaster University, that means prescribing dry powder inhalers (DPI), emailing instead of printing where possible, monitoring for opportunities to deprescribe and encouraging patients to adopt plant-based diets.

“I think change happens on every level, from micro interactions to macro policy changes, and I believe that the small decisions we make in clinic multiplied over hundreds of patient encounters do make a big difference,” she says.

While she has always been interested in environmental sustainability, Olivia truly began to understand the intersections between healthcare and climate work while conducting quality improvement research. She’s been part of several environmental initiatives throughout her training, include co-leading the Greener Gases initiative within the Hamilton Health Sciences Anesthesia Department, organizing a local quality improvement project to improve DPI prescriptions among family medicine residents and researching the environmental impact of unnecessary end-of-life interventions with the PEACH team.

When asked what her hope is for sustainability in healthcare, Olivia would like for ‘green teams’ become the norm.

“I hope for new buildings and institutional policies to be designed with sustainability in mind so that the green choice is easy and automatic. On a personal level, I would love to work on a tool or calculator for primary care to make improving sustainability in an outpatient practice easy and attractive – something that highlights the easiest, most effective changes while also showing potential cost and time savings.