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Climate change is the most pressing health issue facing Canadians but there hasn't been enough dialogue within health circles and among decision-makers on how to deal with it, public-health officers say.

"This is probably the biggest societal issue we should be having a conversation around," said Dr. Robert Strang, chief public-health officer for Nova Scotia. "There's been lots of focus on environmental sustainability; I'm not sure we're having the robust dialogue around what the health implications are today and in the future."

While Prime Minister Stephen Harper stands firm in protecting jobs ahead of reducing emissions, the health-related costs of climate change are significant. In 2008, poor air quality alone, including from oil and gas production, cost Canada about $8-billion, according to a report by the Canadian Medical Association. By 2031, those costs are expected to rise to $250-billion, the CMA said.

Indeed, climate change is on the minds of Canadians: Ottawa is set to announce its long-awaited decision on the Northern Gateway pipeline, following a caution from International Monetary Fund managing director Christine Lagarde that new energy infrastructure should not come at the expense of the environment.

Public-health experts say the effects of climate change – from poor air quality to severe weather events to new vector-born diseases – are harming Canadians' health. Dr. Eilish Cleary, the chief medical health officer for New Brunswick, said that the health system is set up to treat people once they're sick, as opposed to putting money toward addressing climate change now to prevent health problems in the future.

"Generally, prevention is cheaper than the cure," she said.

Poor air quality – which Canadians can expect more of with increased traffic congestion, forest fires and pollen production – results in more symptoms of respiratory and cardiovascular disease, increased rates of emergency-room visits and hospitalizations, and deaths from asthma and chronic obstructive lung disease.

As more frequent and severe storms become the norm with rising temperatures, flooding can reduce water quality, prolonged power outages can create risks around food safety and storms that displace people from their homes increase risk for infectious disease.

Changing insect habitat patterns also leads to the migration of diseases, another concern among public-health officers. Instances of Lyme disease, for example, have been steadily increasing in Canada as ticks have moved north along with warmer temperatures.

Cleary said that although there's an increasing awareness within health circles that climate change is an important environmental health issue, the conversation on how to prevent it has barely started.

"There hasn't been adequate recognition by all levels of policy-makers and decision-makers that it is really a problem that we have to do something about. I think that that has to be the first step," she said.

What's more, she said, decisions about emissions can't be taken in isolation of health.

Strang agreed, adding that most of the discussion in public health has been around adaptation to climate change, and better preparing people for disasters. Not enough has focused on prevention, which requires minimizing greenhouse-gas emissions, he said.

In the meantime, Dr. Perry Kendall, provincial health officer for British Columbia, said Canada needs to map its vulnerabilities and put plans in place to adapt to climate hazards like floods, ice storms and wild fires, which all impact people's health.

"We're not going to be able to change the weather, stop tornadoes, or stop ice storms, or stop major snowstorms, or stop droughts – but what do we do to make our cities or our communities more resilient?," he asked.

Toronto has made concerted efforts in the last decade to improve the region's air quality, said Dr. David McKeown, medical officer of health for the city of Toronto. Deaths in the city related to poor air quality are down to 1,300 from 1,700 a decade ago. While cleaner vehicle emissions, heightened interest in transit and Ontario's phase-out of coal are all likely contributors to improved air quality in Canada's biggest city, he said, there is still progress to be made.

"We have work to do of our own in order to reduce emissions and improve the impact on health."

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