THE INTERVIEW: Dr Pierre Gosselin, physician and climate-change scientist

Two months ago, we reported on a new study by a group of Quebec researchers that predicted a steep rise in climate change-related mortality.

If carbon dioxide emissions aren't drastically cut in the coming years, their study showed, global warming will begin taking its toll not just on polar bears and Antarctic icebergs, but on humans as well.

To learn more, we decided to follow-up with the Laval University physician who co-authored the study, Pierre Gosselin (above), a National Public Health Institute of Quebec researcher and the head of the World Heath Organization Collaborating Centre for Environmental and Occupational Health Impact Assessment and Surveillance, who answered our questions by email.

You trained as a physician. How did you first become interested in studying the connection between health and climate change?

I have always been interested in nature and the outdoors before my medicine. So I began family practice in pristine Eastern Quebec, then changed to public health (mostly environmental health since 1984), and also got involved in environmental NGOs. Climate change issues were already discussed in those circles in the 90s, so it raised my interest for research in the area and I was involved in the first Canadian climate change assessment in 1996-1997. It has just became more important ever since.

Do you still see patients?

I don’t see patients anymore, except some risk-taking members of my family. :-)

At a time when the environment and carbon emissions controls have taken centre stage in Canadian politics, why has the medical community largely remained apolitical? There seems to be some frustration among the few physician-environmentalists in Canada about the lack of medical leadership in public on climate change.

That’s a tough question! On the health policy stage, there are plenty of other real and immediate problems that need to be addressed. I always say that most of the supporters of my work in environment health come from other sectors than health, and my fiercest competitors (for grants, program money) are my colleagues from the health sector working in infectious diseases or fighting cancer, for instance. On a more personal level, I guess many of my colleagues are too busy with their practices and when they’re off, they just want to indulge in gas-guzzling BMWs or far-away vacations! So they possibly aren’t yet ready to support a societal change that implies reducing one’s emissions drastically. But I’m a physician, not a sociologist!

Your research hasn’t been ignored exactly, but it also hasn’t really made a lot of national news. Why do you think that is?

Most of my studies were funded by the Quebec government to focus on the province, so it’s more difficult to make an impact on the national news with such a focus, even if the conclusions and results are most of the time fully transferable. But they’re very well received in the international scientific literature, at the World Health Organization and, of course, in Quebec. I was the lead author of one chapter in the coming Health and Climate Change National Assessment to be published this summer by Health Canada, so there’ll be lots of interesting material in there for journalists.

What’s your take on Liberal leader Stéphane Dion’s “Green Shift” plan? What do you think of the Conservative government’s work on the environment portfolio?

I’m not too familiar with Dion’s plan or with the respective benefits of the cap-and-trade approach versus other ones as I’m more involved in impacts and adaptation than greenhouse gas (GHG) reduction. One thing is sure though: we do need to reduce GHG in absolute terms, not reduce the intensity of an ever-increasing consumption of fossil fuels as the Harper government proposes. The amount of GHG already present in the atmosphere now will impact our climate for 150 years before stabilizing, so we’re just turning the faucet off at the same time we begin adapting. Most experts believe it’s doable to adapt to two times the current CO2 levels, but not much beyond, and we can stop the warming train around 2080 if we stop emitting now, according to the Intergovernmental Panel on Climate Change (IPCC). The former World Bank economist-in-chief Sir Nicholas Stern said the costs of inaction were immense compared to the 1% or 1.5% of the GNP that active measures to reduce GHG would cost the economy. Mr Harper accepts similar levels of impact on the economy when they are decided by greedy Wall Street subprimers, or to fight against terrorists, but apparently not when they concern the environment we live in.

Do you ever get angry letters from climate change nonbelievers?

Not so far -- maybe after this chat. :-) Anyway, an immense majority of people sense the climate is changing. It’s mostly their life habits they’re more reluctant to change.

Your research seems to indicate that unless climate change is somehow miraculously reversed in the next few years, identifying and protecting patients at high risk of heat-related mortality will be an increasingly important part of public health work. Should medical schools train students on that subject specifically? Should this become a focus of continuing medical education offered by groups like the CMA or the Canadian Association of Physicians for the Environment?

Most cities in Canada will see a doubling of their number of summer hot days in the coming decades. On top of it, we often forget that climate change is also, and maybe even more, about increased variability in climate events, with more frequent and severe extremes. This means more rain overall in some regions, more tropical-like rain, winter thawing of rivers, more hurricanes in the East, more landslides in some areas with roads and infrastructure destroyed, etc. Indirect effects on food availability and price will affect the poor. Environmental migration (some 400,000 New Orleans inhabitants never returned to their hometown since Katrina in 2005) can impact not only the migrants but the communities where they finally move. So this will require adapted and updated emergency plans, preventative measures and training of medical personnel, including at the initial university level. That’s exactly what we’re doing currently in the 2006-2012 Quebec Action Plan on Climate Change (Health component).

What should the healthcare system be doing to help protect the elderly and at-risk patients from climate change-related mortality?

For the protection of elderly or at-risk patients, there are basic recommendations that are posted on most public health departments websites, but a recent study by my colleague Tom Kosatsky showed that there are several inconsistencies and contradictions throughout the world on this, and that very often we refer to the easy “Go see your doctor.” The poor doctor very often doesn’t know what to do exactly. Again, we are currently working on this: for instance, trying to evaluate the clinical significance of the interaction between some prescription drugs and heat in order to offer clinicians more robust recommendations for clinical practice.

Here’s a paradox. Air conditioning protects patients at-risk of climate change-related mortality. But the energy demands of all those air conditioners cause carbon emissions, which cause more climate change and therefore higher mortality risks for at-risk patients. What’s the solution?

The solution is in a mix of measures such as better-built homes with natural ventilation and better insulation, more shade in cities (which helps reduce the heat island effect), through various greening measures, and reducing car use through better urban design. In the end we’ll need air conditioning nonetheless for high-risk groups, though hopefully we’ll need it less often and for shorter periods. Some regions of the world are blessed with plenty of hydro power which is a very low GHG emitter, so Manitoba, Quebec and Norway (all have 97%-plus hydro) can enjoy air conditioning with less remorse...

You and your coauthors suggested in a recent paper, “The potential impact of climate change on annual and seasonal mortality for three cities in Quebec, Canada,” (PDF) that Quebecers won’t enjoy reduced winter mortality rates caused by global warming, as European studies have predicted on the other side of the Atlantic, because Quebecers are already adapted to the cold and because heating prices are lower here. Unfortunately, as gas prices rise so too do heating prices across Canada. Do you think higher heating prices therefore mean higher winter mortality rates?

Actually there should be a slight reduction in winter mortality with a huge increase in summer deaths. But you’re right, higher heating prices can mean higher winter mortality rates, as is seen in several developed countries, for instance the UK. Our study showed that we’re well adapted to winter, but this is not genetic and needs maintenance on a regular basis. Some management measures can also mitigate this: After the death, some 15-20 years ago, of two Montrealers who had seen their power cut by Hydro Quebec in the midst of winter for unpaid bills, a regulation was put in place to allow any such power cuts only from April to October. Public funding for social housing is another attractive avenue for low-income groups, and Quebec is very active there too. This is primary prevention at its best!


Photo: Health and Environment Group, Centre hospitalier universitaire du Québec

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