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Courtney Howard is an emergency physician in Yellowknife and the vice-chair of the Global Climate and Health Alliance. Nicole Redvers (Deninu K’ue First Nation) is an associate professor at Western University. Sarah Cook is a family physician in Yellowknife whose family has been evacuated to Alberta, where she is helping co-ordinate care for pregnant evacuees.

People across Canada often get a dreamy look when they think about the North, and smile as they speak of the wildlife, the vast landscapes and the Aurora. Those lights indeed invoke a sense of wisdom and awe. But there is often a richness of life that gets lost in the light.

Too many Canadians are unaware of the Peoples who have made this place their home for millennia. With high rates of health inequities, a significant absence of affordable food and housing, and an underresourced health system with a lack of widespread available cultural supports, Indigenous Peoples in the North have been forced to be creative on their own.

This summer, a more fiery light is being cast across the Northern landscape. Extreme wildfires linked to human-caused changes in temperature and precipitation patterns are increasing, with profound consequences for health and health systems. The communities that have been our long-time homes have been evacuated, forcing approximately 68 per cent of the majority-Indigenous population out of their homes. Our families and colleagues are now scattered across Canada, and likely won’t be able to return for weeks. Some people who were forced to flee the capital of Yellowknife last Wednesday had just arrived there from other Northwest Territories communities that were themselves evacuated. Stanton Territorial, a 100-bed hospital that serves a remote area larger than France, Portugal and Spain combined, in a part of the world that is warming at triple the global rate, had to move its patients to safety; the hospital, which is located 1000 kilometres by air north of its customary referral centre in Edmonton, transferred them to British Columbia and Alberta in what was an epic logistical feat.

But we believe that this light also has wisdom to offer to people in Southern Canada who are considering how to build a healthy future. This summer of smoke must be considered an SOS from Mother Nature: a moment where we stop, re-evaluate our practices and plan how we will keep her – and each other – safer and healthier.

Direct human health effects of wildfires can include death, major burns, injury incurred while fleeing fires, as well as anxiety and post-traumatic stress disorder. Wildfire smoke can travel long distances, resulting in exacerbations of asthma and chronic obstructive pulmonary disease, with studies now indicating elevated levels of heart attacks and increased overall mortality. The long-term effects of smoke are relatively unknown, however. Canada is one of the few G7 countries to not have a dedicated environmental health institute.

Feelings of irritability are common in response to wildfire events, and can be accompanied by eco-anxiety, ecological grief, eco-anger and sometimes guilt as people become aware of the impact that climate change will have for them. It is normal to need to process these emotions – to grieve the future we thought we had. The next step is to replace uncertainty and fear with a plan for our collective health response. Action feels better than anxiety.

Extreme wildfires threaten the ability of health systems to deliver care. In recent years, surgeries have been cancelled because of overly smoky operating rooms, and multiple health care structures have had to be evacuated. What’s more, there is a direct connection between health care and climate change. Canada’s health care system accounts for about 5 per cent of our greenhouse gas emissions, and globally, health care emits more than the shipping or aviation industries.

Canadian health care workers are grossly unprepared for climate change. Surveys reveal that only a minority of medical students are taught about climate change in a health context, and that practising physicians believe it is important, but don’t know what to do. To that end, this year the Association of Faculties of Medicine of Canada led a Declaration on Planetary Health, which was signed by most medical schools in Canada. Health Canada funding is now required to implement those calls to action, which include the immediate implementation of planetary health education and research, and a transition to climate-resilient, low-carbon health systems.

Canada has also committed to the World Health Organization’s Resilient, Low-carbon Healthcare Initiative, which was reaffirmed in a recent Group of 20 communiqué. However, while Britain’s National Health Service has a quantitative plan and a large, well-structured nationwide team of people with legislated targets to drive delivery on this commitment, for example, it appears that only a handful of Health Canada staff are doing similar work. It is time to produce a serious plan with near-term targets that lay out what net-zero health care in Canada looks like, and to resource it appropriately. Such work has been found to save money by maximizing efficiency in use of ecological, economic and human resources. In this context, hospitals can become anchor institutions of sustainability and climate resilience, sheltering community members and demonstrating the best practices required to urgently decrease greenhouse gas emissions.

This kind of health care with a universal lens must be designed in partnership with Indigenous Peoples. They have weathered intergenerational health effects related to broken treaty promises, residential schools, colonial health care systems, and extractivist resource projects which have devastated access to land-based foods and long-standing cultural activities. Climate change is another issue layered on top for Indigenous communities globally, including those in the North, which have to contend with disproportionate consequences – as the wildfires made clear – despite contributing little toward emissions themselves. With cultural cabins burning down, changes to animal and plant availability as their forest homes burn, risks to cultural artifacts and traditional knowledge repositories housed within communities, and evacuations that force families apart, the well-being effects on Indigenous communities are compounded and vastly underappreciated.

Indigenous Peoples’ knowledge has also been grossly ignored and marginalized in climate-change mitigation and adaptation responses, despite centuries of stewarding the lands and waters. Ecocentric, community-centred, land-based and holistic approaches build resilience and inform wise practices that can better prepare our communities in a changing world. While the Arctic Indigenous Wellness Foundation helps people reconnect to the land and build community, skills and strength, and Indigenous leaders such as Elder François Paulette have been world leaders in sounding the alarm about climate change, their teachings have often not been incorporated into planning at home. Respect and recognition of Northern Indigenous leadership combined with the support needed to scale and spread practices around community and land-based care benefits us all.

Canada’s health care structure – with 13 provinces and territories each administering their own systems – requires more integration to perform well through climate-change disasters. Though the Canada Health Act protects free access to health care across jurisdictions, crossing one border means that just about everything else changes. When a NWT-based evacuee arrives in Alberta seeking health care, for instance, their new providers cannot access their health records, and NWT physicians cannot provide care there either, as they are not licensed to practise in that province. Even remote video-call appointments are not possible, as this technology is not widely approved. National licensure for health care professionals, portable and accessible health care records, and secure virtual-care platforms are absolutely crucial if we hope to provide health care in a world marked by climate change.

We all need to work together to move our climate reality – that Canada will continue to warm until at least mid-century – into our common vision of the future. A disaster is something that overwhelms local systems, so to prevent that, everyone from decision makers to community members must make themselves familiar with the temperature and precipitation projections for their area, and have a plan to help through floods, fires and heat-related emergencies.

It is daunting, but we have an advantage that many places outside of Canada do not: access to the best of Western health expertise, as well as to the lived experience, stories and Traditional Knowledges of Indigenous Peoples. Clear acknowledgment and respect for the Indigenous rights holders of the lands and waters can lead to conversations that bridge multiple ways of knowing and being, and set the stage for transforming agendas. Gathering the full richness of insight from across the North will help us see a path through the smoke to a safer future.

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