How will climate change cause moral distress?

Moral distress is the psychological experience of knowing what the right thing to do is, but being unable to act (CMA, 2020, pg. 1). It is a common experience in healthcare, as patients lives and health outcomes are shaped by complex systems that are largely incomprehensible without insider knowledge. Nurses are in a unique position to experience moral distress due to the concept of “moral hazard” where the party making the decisions does not face the consequences (Morley, 2018, para 6). As the feet on the ground in healthcare, it is nurses who must bear witness to the outcomes of decisions made in government and management.

Nursing has the burden of a strong moral and ethical code that drives their decision making progress and forms the basis of their profession. Concepts like respect for life, fairness, client wellbeing, and client choice underpin how nurses structure their care and operate in their role (CNO, 2019, pg 1). While noble, it is when the healthcare system cannot operate optimally that these ethics and values become a source of psychological distress, like during public health emergencies, staffing crises, or simply unjust care.

An extreme example could be hospitals preparing to triage patients during the covid pandemic and refusing treatment to people who would not live enough healthy years to justify the resources. More commonly it could be a nurse prepping a patient for surgery who they do not believe will benefit from the treatment. It could also be allowing an infant who survived a medical abortion to die after they were accidentally born alive, or witnessing domestic violence and being unable to act. Every specialty in nursing has the potential to experience moral distress, because nurses witness intimate parts of people’s lives and often have the knowledge and tools to help but not the authority.

Climate change is expected to stretch the heathcare system to its limits through an increase in patients and a decrease in resources. We can expect surges in patients to become more common in conjunction with extreme weather events. The physical and human resources that healthcare relies on to operate will be disrupted due to natural disasters and global supply chain issues, leading to drug shortages, power outages,and poor staffing ratios. We know that surges in patients increases incidences of moral distress(CMA, 2020, pg. 1). As climate change intensifies, the nursing profession needs to be prepared for the psychological toll of working in a system in crisis.

Canadian Medical Association. (2020). Covid-19 and Moral Distress. RetrievedMarch 30th, 2022 from https://www.cma.ca/sites/default/files/pdf/Moral-Distress-E.pdf

College of Nurses of Ontario. (2019). Practice Standard: Ethics. Retrieved March 30th, 2022 from https://www.cno.org/globalassets/docs/prac/41034_ethics.pdf

Morley G. (2018). What is “moral distress” in nursing? How, can and should we respond to it?. Journal of clinical nursing, 27(19-20), 3443–3445. https://doi.org/10.1111/jocn.14332

3 Ways Climate Change Will Mirror the Pandemic

Climate change is predicted to seriously impact the ability of our healthcare system to provide care, but it has been difficult to illustrate how until now. The current pandemic has created conditions that could mirror what we see as extreme weather events and a changing climate intersect with staffing shortages and mass casualty.

Prioritization and redeployment

During the pandemic, hospitals were forced to cancel non-urgent care and redeploy staff to units with high demand, like ICUs, medicine floors, and specially created covid clinics and field hospitals.

In Canada, 560 000 fewer surgeries occurred during the first 16 months of the pandemic than in the previous year (CIHI, para 4). Emergency departments saw 9600 fewer visits every day during the pandemic than in 2019. Care was shifted virtually, and we prioritized the most urgent cases, covid patients, by shifting our staffing and resources. The impact of these decisions on population health will not be known for many years when we can compare long-term outcomes. Whom we saw as urgent also changed during the pandemic. Public health restrictions meant that many fewer people were treated for other infectious diseases, and accidents, but also that fewer people were diagnosed with time-sensitive illnesses like cancer.

Climate change will mirror these shifts but on a larger scale. We can expect more injuries and accidents as a result of extreme weather events and an increased burden of disease due to poor air quality, heat, and climate-driven communicable disease spread. While the pandemic stripped our healthcare system down to the basics, climate change will demand more robust treatment and care for more patients.

2. Staffing

Covid-19 showcased how the healthcare system was teetering on the edge of a staffing crisis. When the pandemic first hit, the immediate concern was that large numbers of healthcare workers would sicken at the same time, and be left unable to work. There was a lot of fear that waves of patients would hit understaffed hospitals and lead to crisis standards of care: treating patients not based on need, but on their likelihood of survival. This fear was realized in some places and patients died because of inadequate access to resources. However, this reality was quickly overshadowed by the large number of healthcare workers who, burnt out from poor staffing, moral distress, and problematic workplaces, quit in droves as the pandemic progressed.

This problem is one that we will see multiply as healthcare becomes harder to provide. Healthcare providers are educated with noble principles of their roles and responsibilities and when they are unable to provide the care they believe necessary, it is incredibly damaging to morale. Demoralized workforces, quit, compounding the problem for the remaining staff. Coupled with the likelihood that more healthcare providers will be sick, injured, or unable to reach their jobs as climate change progresses, what we saw in staffing crises during the pandemic could be a mere shadow of what is to come.

3. Inequity

At the beginning of the pandemic, there was a lot of talk about how we were all in this together. Sadly, this did not prove true. How covid impacted you and your community was largely determined by race and socioeconomic class, with the most vulnerable members of our society suffering the majority of death and disability. These people were also the most likely to suffer financially from pandemic restrictions, as businesses were forced to close. 57.3% of the poorest Americans experienced job or income loss during the pandemic, while the richest Americans gained 40% more wealth (HRW, 2021). Poor families lost access to not just education, but also food programs and childcare when schools closed while wealthy families could shift their education online and continue feeding their children. American states are cutting funding to children’s programs as part of their plan to bounce back from the pandemic, despite children losing out on two years of schooling. This is a problem that will deeply impact families who cannot afford to subsidize these funding cuts while leaving the wealthy untouched.

The social determinants of health show us how different aspects of our lives collide and interact to form health outcomes. Often, one risk factor, such as race, is tied to other risk factors, like socioeconomic class or environment. The pandemic brought this into sharp focus as the poorest and most racially diverse communities suffered the most. Climate chnage will have the same effect. Although it will end up affecting everyone, the wealthiest people live in safer places and have more tools to protect themselves. It is vulnerable people who will suffer first and suffer the most from climate disasters.

The pandemic illustrated what happens when our healthcare system is pressed too far: people die unnecessarily. One critical difference between covid and climate change, is that we can expect that one day covid will end. Extreme changes in weather and temperature are becoming a part of life that will worsen, not improve. As they do, we can expect that the problems showcased during the pandemic will rear their hands again, this time on a larger scale. Right now, this reality is fresh and present in the minds of not just health professionals, but also the general public. We need to take what we learned during this pandemic and make radical changes to prepare for the crisis that we know is coming. This will protect not just the public, but also the wellbeing of our healthcare workers and the future of universal healthcare.

CIHI. (2021). Overview: COVID-19’s impact on health care systems. Retrieved March 28th, 2022 from https://www.cihi.ca/en/covid-19-resources/impact-of-covid-19-on-canadas-health-care-systems/the-big-picture#:~:text=Hospitals%20retrained%20and%20shifted%20human,the%20pandemic%20compared%20with%202019.

Human Rights Watch. (2021), United States: Pandemic impact on people in poverty. Retrieved March 28th, 2022 from https://www.hrw.org/news/2021/03/02/united-states-pandemic-impact-people-poverty

Why Nurses Should Care About Climate Change

“Unprecedented, irreversible, crisis.” These are the words that headlines are relying on to communicate the risk that climate change is posing to humanity. Even so, it can be difficult to fathom how it will affect our everyday lives and society as a whole. How will climate change affect health care and why should nurses specifically care?

Increased burden of disease

Most obviously, climate change will increase respiratory illness, cancers, heat related illnesses, acute injuries, and communicable diseases, as well as compress available services for treatment.

Hotter weather and increased air pollution is predicted to cause greater rates of respiratory illnesses and cancers, as well as acute illness during extreme weather events. During the “heat dome” in Canada in June and July of 2021, 445 people died of heat related illness (HRW, para. 6) in a 2 week period. This type of weather event is becoming more common and is expected to routinely stress our healthcare system (Ebi et al, para 47). A longer wildfire season is expected to worsen air quality as well as cause more acute injuries. Outdoor air pollution is a known carcinogen. Public health agencies focus their campaigns on personal responsibility, yet air pollution is the second largest cause of lung cancer after smoking, at 14.1% of cases (Turner et al, para 23). This number could rise significantly as air quality worsens globally.

Rising temperatures are causing larger territories for pathogens that used to be contained by weather, climate, and infrastructure, like malaria. Malaria is already a leading cause of death, especially for children and babies. As we become less capable of handling the rapidly changing climate and weather, diseases like malaria are expected to come back in places that thye are believed to be eradicated, like the United States. There is also the issue of displaced persons. As we have seen in the recent refugee crisis out of Ukraine, different parts of the world have unique health challenges. Ukraine has one of the highest rates of drug resistant Tuberculosis in the world, and now millions of their citizens have been forced across borders (Holt, para 4). As we see more refugees and displaced people, we can expect that globally healthcare workers will be exposed to diseases that they may be susceptible to, and also may not be experienced in treating.

Permafrost holds pathogens like anthrax, influenza,and the bubonic plague that humans will be exposed to as melting ice delivers them into the environment. Siberia experienced an anthrax outbreak that was linked to melting glaciers in 2016, from a long frozen reindeer carcass (Doucleff, para 2). This led to at least one death, evacuations, culling of reindeer, and a large public health response. Increased temperatures also mean that vectors could expand their territories, and the territories of the diseases they carry.

Longer stretches of warm temperatures have already increased allergy season by up to 27 days, and poor air quality increases risks of severe asthma attacks (AAFA, para 2). These are diseases that can cause permanent lung damage and lead to greater need for healthcare services in old age.

Increased burden of disease means a greater strain on the healthcare system, and a greater strain on nurses. It can also mean ethical dilemmas and moral distress for nurses when the system is unable to adequately care for the volume of patients.

2. Civil unrest

Civil unrest is expected to increase as areas struggle to cope with famine and drought, as well as the pervasive effects of extreme weather such as economic difficulty, jeopardized housing and infrastructure, and increased burdens on still operational systems as they take on more displaced persons. We usually focus on the immediate health effects of pollution and heat waves, but these social issues are a serious threat to healthcare systems worldwide. This type of social upheaval and civil unrest affects every single social determinant of health, which already have the power to lower life expectancies by 18 years irrespective of climate change (WHO, para 6).

Nurses will see these challenges in healthcare as societies struggle to care for their most vulnerable citizens and the healthcare system as a whole manages an increased patient load with fewer resources.

3. Triaging society

We have made great strides recognizing how mental health and wellbeing impacts people’s lives. However, we must recognize that when push comes to shove, it will always be relegated below physiological and safety needs like housing, food, and clean water. Climate change and the associated stress it will place on society threatens to undo decades of progress in the mental health as we are forced to confront more direct threats to lives.

Climate change threatens the provision of universal healthcare, through lack of access and increased burden of disease (WHO, para 1). Additionally, it threatens to stress healthcare workers out of their professions. We saw this during our most recent global health crisis, as healthcare professionals quit in huge numbers, further stressing the ones that remained. We are also threatened with a lack of progress. During times of emergency, less time, resources, and brainpower can be put into issues that currently are heavily researched, like Alzheimers, autoimmune disease, and gene therapy. Climate emergencies and extreme weather events threaten lab equipment and supply chains, as well as energy usage for noncritical activities. Well these are all diseases that threaten and change lives, like mental health, they will be deprioritized as we face immediate existential threats.

For nurses, this means less time and energy to spend on patients who are not deemed critical, and more difficult decisions to make on how to spend time and resources.

Nursing is a role that meets people where their private lives intersect with public policy. This means that nurses need to be aware of how the world outside their workplace is impacting the lives of their patients and trends in healthcare. Climate change is like nursing in that it will bring people’s personal lives into conflict with global activities. As a profession, we need to be prepared to tackle the challenges that a changing climate is bringing us, through direct increases in illness and injury and the indirect consequences of destabilized societies and barriers in care. Additionally, we need to recognize that we ourselves will be impacted by the changing climate with our communities, and may ourselves be dealing with poor health, civil unrest, and lack of access to services. Nurses everywhere should recognize that their role will be challenged by the upheaval of climate change, and prepare to respond to this while upholding the values of their profession.

Asthma and Allergy Foundation of America. (2021). Extreme Allergies and Climate Change. Retrieved March 27th, 2022 from https://www.aafa.org/extreme-allergies-and-climate-change/#:~:text=Rising%20temperatures%20caused%20by%20climate,11%20to%2027%20days%20longer.

Ebi, K. L., Berry, P., Hayes, K., Boyer, C., Sellers, S., Enright, P. M., & Hess, J. J. (2018). Stress Testing the Capacity of Health Systems to Manage Climate Change-Related Shocks and Stresses. International journal of environmental research and public health, 15(11), 2370. https://doi.org/10.3390/ijerph15112370

Holt, E. (2022). Tuberculosis services disrupted by war in Ukraine. Retrieved March 27th, 2022 from https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00214-6/fulltext#articleInformation

Human Rights Watch. (2021). Canada: Disastrous Impact of Extreme Heat. Retrieved March 27th, 2022 from https://www.hrw.org/news/2021/10/05/canada-disastrous-impact-extreme-heat#

Turner, M. et al. (2020). Outdoor air pollution and cancer: An overview of the current evidence and public health recommendations. Retrieved March 27th, 2022 from https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21632

WHO. (2021). Social Determinants of Health: Health Equity. Retrieved March 27th, 2022 from https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1

WHO. (2021). Climate change and health. Retrieved March 27th, 2022 from https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health

Yarzábal, L.A., Salazar, L.M.B. & Batista-García, R.A. Climate change, melting cryosphere and frozen pathogens: Should we worry…?. Environmental Sustainability 4, 489–501 (2021). https://doi.org/10.1007/s42398-021-00184-8

5 Ways Nurses Can Help the Environment

Working in healthcare, it can be daunting how much energy and waste flows through our facilities in the day-to-day provision of care. Within such large and complex systems, it is difficult to know how you, one person, can reduce your impact.

This feeling of powerlessness intensifies when you consider the policies and procedures in place to maintain cleanliness and sterility and protect patients. How can a nurse really make a difference without compromising patient care or their employment?

I believe the answer to this question is by working to change the system from within. One person cannot single handedly change suppliers, introduce a lower waste cleaning system, or take control of the hospital waste stream. What they can do is:

Assess the situation

In facilities like hospitals, nurses are the feet on the ground. They and other HCPs are the ones who are providing the direct patient care that the rest of the hospital operates around. Look at your day and see where the waste is coming from, what processes use excess energy or water, and what rooms sit empty, heated, and well lit, or what windows have a permanent draft. This is the low hanging fruit, pain points that can be recognized by staff and need to be managed.

2. Treat your workplace the way you treat your home

You would never crank the shower to hot and then walk away for 10 minutes in your own home (I hope). Yet, you’d be hard pressed to find a nurse who had never run water down the drain at work. Workplace culture, stress, and a lack of accountability (like what you’d see on your water bill) are a huge driver of waste in healthcare. Start looking at your workplace and your work habits with the same critical eye you would have in your own home. Then, change your actions for the better.

3. Advocate

Climate change will affect all of us, and will put tremendous strain on our healthcare system as the effects lead to increased chronic disease and acute injury. Nurses are advocates, and need to take their role into the larger sphere from patient care. Advocate to management, and make it known that you see areas for improved resource use. Do it smartly, and make money part of your argument. Small changes can lead to large savings in these 24/7 facilities.

4. Get political

Nursing and healthcare is political. Every day you interact with patients directly affected by government policies and make choices that support or threaten the status quo. Get educated on who is impacted by pollution, carbon emissions, and a changing environment, and support policies, parties, and politicians that prioritize the environment. This does not mean that you need to vote for the Green party, but it should mean that you are paying attention and actively participating. Local and provincial governments play a large role in development and in your immediate environment. Who is prioritizing the health of your community? Who is threatening it?

5. Be an example

Nurses are well respected in the public. Consider how you represent your own views on the environment. Look at your home, your lifestyle, and your own biggest contributors of excess waste and energy usage. Bring that energy into the workplace and set an example for your peers. The best way to change others’ behaviours and beliefs is through a positive example. Choosing to turn off the lights during night shift, fully shut down the computers when you leave the office, and adjust the thermostat appropriately are all ways of quietly and positively changing your workplace culture without stepping on toes and offending others. It is much easier to alter your own behaviour than other people, and peer pressure is a huge motivator.

Climate change is scary, and can seem overwhelming to address. How can one nurse in a huge facility really have a positive impact? I hope that the 5 steps above give you an idea of how to start the ball rolling on small and big changes to improve sustainability within the healthcare system. Every movement starts with a few people who diligently pursue their cause, and nurses will have a big impact on how sustainable healthcare becomes.

Is Public Health failing Canadians?

A triage nurse I know once stated that you could perfectly track a patient’s health outcomes if you simply collected their income when they entered the ER; Supposedly, income directly determines your health and whether you will have a positive outcome. This is an interesting concept to me, because while you hear these things from people who are “in the know,” the research seems to tiptoe around the issue. We often look at the type of job a person has, their ethnicity, their marital status, and then determine from that what their health outcomes are more likely to lean towards. Public policy then acts on these ideas that widowers, or racial minorities, are more likely to suffer from adverse health outcomes and determines that health teaching and better screening is what we need to solve major health crises in our society like diabetes and hypertension. What if we are looking at the wrong variables? Perhaps the thing that links widowers, racial minorities, and single parents is not a personal disregard for health or poor dietary choices, but actually their income. This would fundamentally change the way we approach health in Canada. Currently, health teaching, education, and empowering Canadians to improve their health is our public health focus (Government of Canada, 2020, para. 1). Healthcare in Canada is universal, and therefore should have universal outcomes, unaffected by a person’s socioeconomic status (Government of Canada, 2017, p. 10). If it came to light that people’s personal choices are less relevant than their income then we would need to move our focus to economic equality for the good of the population. This topic is broad, and the solutions are complicated. In this paper, I will determine that income and health outcomes are directly related, as demonstrated through the connections between chronic, preventable diseases, life expectancy, and income.

To begin, I will explain some common terms used in healthcare. A health outcome is the impact that a healthcare intervention has on the individual seeking care (CIHI, 2020, para. 1). A positive health outcome could be staying alive, better quality of life, and functioning well, while negative health outcomes could be loss of life or function, decreased quality of life, or lack of wellbeing socially, mentally, or physically (Gibson Parrish, 2020, para. 1). Health related behaviours would be defined as actions that an individual takes in order to influence their physical and mental well being (Hassan & Tibret, 2016, p. 2). Chronic disease and health conditions would be diabetes, hypertension, COPD, depression, stroke, obesity, and any other long lasting health issue that requires consistent management, such as asthma or cancer (Oates et al, 2017, para. 2).

The concern with lower income individuals and health outcomes is centred on lower quality of life, due to chronic illness and loss of function. One study found that health disparities between higher and lower income Americans were most pronounced between income and chronic health conditions (Oates et al, 2017, para. 3). While there was a link between health related behaviours and education, it was income that determined the rate of chronic disease (Oates et al, 2017, para. 3). The concern with chronic health issues would be the impact they have on an individual’s quality of life, and the progression of the disease. Obesity, diabetes, and hypertension are chronic health issues that put individuals at risk of stroke and heart attack, health events that could significantly lower their quality of life if they survive. They are also largely manageable and preventable, which is why it is important to note that it is not an individuals health behaviours that determines their risk for these diseases but their income. A person’s education may impact their health behaviour, but it does not provide protection against chronic illness. This means that public health initiatives focusing on individual health behaviours and education, such as “move more, eat less” campaigns, are likely ineffective at protecting low income groups from chronic disease. Poor health also leads to reduced income, as does disability and age, putting those already at risk in a more compromising position (Kullar & Chokshi, 2018, para. 1).

As income disparity grows, as does health disparity. In the 1970s a man in the top half of the income spectrum could expect to live 1.2 years longer than his counterpart in the lower half of the spectrum, but as of 2000, he could expect to live 5.8 years longer (Kullar & Chokshi, 2018, para. 3). The difference in life expectancy between the top 1% and the bottom 1% of the income distribution is 10-15 years dependent on gender (Kullar & Chokshi, 2018, para. 4). Middle-aged Americans in the lowest quintile for wealth had a 48% chance of becoming disabled in the next decade, versus their wealthiest counterparts who only had a 17% chance. While there are endless reasons why this could be the case, a lack of income is what underpins it.

In this paper, I determined that while research focuses on many different variables, income underpins each of these things. Therefore, income is a strong factor for health outcomes and quality of life. In Canada, we are all supposed to be equal under the law and in government. Income inequality should not determine whether we end up with a chronic preventable disease, lowered quality of life, and early death. I consider the wealth of information available to be one of the things that prevents us from taking action against the link between poverty and poor health outcomes. The more research is done, the deeper the links and the more overwhelming the scale of this issue becomes. Genetics, marital status, mental health, income, childhood experiences, access to a grocery store, and health behaviours are just a few examples of the many ways that Canadians differ from one another. All of these issues can be separately linked to income, and maybe it is time that we moved our focus to resolving the underpinning issues in our society. Public economic policy needs to change to support all Canadians and their health.

References

Bushnik, T., Tjepkema, M., Martel, L. (2020, January 15). Socioeconomic disparities in life and health expectancy among the household population in Canada. Retrieved April 10, 2020 from https://www150.statcan.gc.ca/n1/en/pub/82-003-x/2020001/article/00001-eng.pdf?st=F1uJGNEl

Canadian Institute for Health Information. (2020). Outcomes. Retrieved April 13, 2020 from https://www.cihi.ca/en/outcomes

Foreman, K.J., et al. (2018, November 10). Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016-40 for 195 countries and territories. Retrieved April 10, 2020, from https://www.ncbi.nlm.nih.gov/pubmed/30340847

Gibson Parrish, R. (2010, July 10). Measuring Population Health Outcomes. Retrieved April 10, 2020 from https://www.cdc.gov/pcd/issues/2010/jul/10_0005.htm

Government of Canada. (2017, December 12). Canada Health Act. Retrieved April 10, 2020 from https://laws-lois.justice.gc.ca/PDF/C-6.pdf

Government of Canada. (2020). Public Health Agency of Canada. Retrieved April 10, 2020, from https://www.canada.ca/en/public-health.html

Hassan, G., & Tibret, B.T. (2016). Health-Related Behaviors, Health Consciousness and Psychological Wellbeing among Teaching Faculty in Jimma University, Ethiopia. Retrieved April 13, 2020 from https://www.iomcworld.org/open-access/healthrelated-behaviors-health-consciousness-and-psychologicalwellbeing-among-teaching-faculty-in-jimma-university-ethiopia-cep-1000113.pdf

Kullar, D. & Chokshi, D. (2018). Health, Income, & Poverty: Where We Are & What Could Help. Retrieved April 15, 2020 from https://www.healthaffairs.org/do/10.1377/hpb20180817.901935/full/

Oates, G., et al. (2017). Sociodemographic Patterns of Chronic Disease. Retrieved April 13, 202, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5171223/

Healthcare is eating itself

An unexpected benefit from the forced move to digitized healthcare has been an opportunity to address carbon emissions in healthcare. Mask mandates and fear of unwittingly transferring germs into one’s mouth caused a whole new form of garbage in the use of civilian disposable medical face masks. Fast food chains and restaurants everywhere reverted back to the use of exclusively disposable food packaging and drive-thru only food options. Many products began to be served in single use packaging. Airlines, a worst offender in the waste department, somehow managed to create more opportunities for trash on board through the addition of cleaning kits and single use hand sanitizer containers. Although surface transmission proved to be an insignificant contributor to the pandemic, a newfound fear of germs has permeated society resulting in more single use products and excessive wet wiping. However, the move to telehealth has opened up an opportunity to provide healthcare without the commute, space, and materials that traditional healthcare requires. This move has also opened up healthcare providers eyes to the many ways that CO2 emissions make their way into everyday care.

To begin to address carbon emissions in the healthcare sector, we need to understand the scope and where they are coming from. In the United States, 10% of carbon emissions come from the healthcare industry (Hays, 2019). Like all institutions, healthcare requires a physical building and with it water, heating, cooling, and electricity. The often sterile nature of healthcare has historically required the use of single use plastics and other petroleum based products such as syringes, gloves, catheters and IV ports, as well as vast quantities of cleaners and sanitizers. The constant flow of patients requires huge laundry capabilities, eating up water and energy. There is medication, carefully and wastefully packaged, which at some facilities is provided in single use plastic baggies. Additionally, there is the paper trail still required in many healthcare settings, or a similar computer based model of charting and all the technology that follows it. Most healthcare facilities are a complex and highly bureaucratic web, where direct patient care, medications, waste and laundry are all handled by different agents within a massive system. It is difficult for individual healthcare providers to understand how best to serve other departments to lower waste, and difficult for waste collection facilities to handle the sheer quantity of waste exiting a hospital. There is also the consideration of biomedical and toxic waste from bodily functions and medications.

While important to a nation’s overall wellbeing, healthcare offers many opportunities to lower carbon emissions through waste and excess. As increased carbon emissions are tied to increased hospitalizations, this should be prioritized by the healthcare system and the bodies that govern it. The alternative is that as climate change worsens health outcomes and pushes more patients into the system, the system creates more carbon emissions, feeding the problem.

The RNAO, an organization representing nurses in Ontario, has identified patient safety as a priority in providing optimal care (RNAO, 2004). They go so far as to illustrate that patient safety goes further than just physical safety and in fact includes psychological safety and safe environments, with the goal of moving to a culture of systemic changes that support patient safety. Given this, it is not unreasonable to extend the responsibility of multilevel healthcare providers, like hospitals and governments, to include preventing unnecessary injury, illness, and death resulting from CO2 emissions that the healthcare system itself is producing. However, these changes to lower emissions will need to be balanced with current patient safety initiatives. Many of the processes mentioned above have increased in waste as they have improved in safety, from medications being individually packaged, preventing errors, to the much more robust charting that is now expected.

The pandemic has demonstrated how fragile our systems are to a spike in need and how quickly they can be destabilized. This is a concern moving forward for how climate change will impact our ability to provide care and keep up with potentially large portions of the population suffering environment related chronic disease and injury. The concepts that govern healthcare from “do no harm,” to broader values like fairness, respect for life, and client well being need to move from the bedside into the larger sphere, providing cause for the healthcare system as a whole to address its role in climate change.

HAYS, B. (2019). Healthcare industry responsible for 10 percent of U.S. carbon emissions. UPI NewsTrack (Consumer Health).

RNAO. (2004). Position Statement: Patient safety. Retrieved March 24th, 2022 from https://rnao.ca/policy/position-statements/patient-safety

Why are young people so anxious?

Something struck me recently while reading the news. Somewhere under a headline about why we should not have children because of climate change and another one about how being a plant lover is destroying the environment, was yet another article concerning itself with the youth mental health crisis. Why is Gen Z so anxious and depressed? Is it social media? The death of religion? Or is it the spectre of impending death and destruction resulting from climate change that has plagued media headlines, elementary class presentations, and the backs of cereal boxes for their entire lives? As a borderline Gen Z/millenial, it took a long time for me to figure this out but now it is glaring.

I have felt hopeless and anxious at the state of the world basically since I learned to read and opened up Maclean’s magazine, the easy reading kept around my house. I don’t think I am alone in that. Usually I can (somewhat) dismiss these feelings with the thought that pendulum swings and everything will be okay. But as I have gotten older and the conversation has moved to ever worsening depictions of climate change, now the climate crisis, and social collapse, it has become harder and harder. The pendulum will not swing on positive feedback loops, or half a billion refugees in any length of time that is helpful to me. It is not like a bad housing market, poor economy, social trends. It’s not even like war, that eventually ends. The picture being painted is a world on fire with nowhere to hide. So, when we talk about climate change and irreversible decline or acceleration of these forces that shape the world, I find myself very anxious. Like many people, I seek solutions when I feel anxious.

For young people that solution searching looked like this:

It started at age 6 with turning off the taps when brushing our teeth, “trash free Tuesdays” at school, and Earth Day where we tried using as little electricity as possible. Then we got a little older and it turned out that those changes were inconsequential. Drive less, walk more, stop using disposable cups and bags. Still fairly doable, although I know I was wracked with guilt when I had to drive, forgot to bring a reusable bag, or worst of all, drove somewhere purely for pleasure. Then in my late teens, it was go vegetarian, or better yet, vegan, live in a city, and stay well informed on all social issues, which might as well be advice to stay anxious and plugged in. Ok, we are doing it and we are unhappy. But hey, with what we know now, planning a life completely different than what we expected or were raised with, the world is sure to be a better place, right? We can raise better kids in a better world? No. Actually, it’s corporate America’s fault. Your actions do not really have consequences but also everything you do from your period products to where you live and what you read is determined by what is best for the planet. Also, don’t have children, it is the number one way to minimize your impact. Minimize, minimize, minimize. Shrink your life and your future and then maybe, if you are lucky, things will get better when you are far too old and cynical to care.

Young people are told, in many different words and ways, every day, that they are going to die or worse in the climate crisis, and every facet of their life is the reason why. Even if they don’t die, some poor souls across the world will die because of them. What we have here is a recipe for guilt, shame, hopelessness, and dread, leading to anxiety, and depression. There is no other area of life where we have decided that thinking about the worst-case scenario all the time is going to bring positive results, yet with climate change that’s the path we have decided on for young people. And it is a dose they receive many times daily, from their toothbrush, deodorant, garbage cans at school, food wrappers, offhand comments from teachers, flyers, tampons, commercials, celebrities, presentations, clothing, bus ads, toilet paper, and now yes, social media. Everything is up for review, and looking forward to the future is worse than the present. The things we have been taught to value in the making of a meaningful life, like a partner, children, and a home, are now wasteful and wrong.

We are replacing children’s present-day lives with fear and guilt and their futures with a hollowed-out semblance of what life should be, then asking why they are so anxious and depressed. It is disgraceful. The intense fear that these articles elicit in people are one of the reasons that it is difficult to take action on climate change. Acknowledging the problem is necessary in order to act on it, and it is so hard to acknowledge climate change as a problem because it is so terrifying. Obviously, we need to address the climate. We need to do it in big ways and in small ways, and we all need to be on board. But we are not doing our children any favours by taking the approach of fear, and burdening them with costly and debilitating mental health issues.

Like the UN report said, it is not all bad. Things are looking better than they were. And we can take action on small and global fronts. Children, and people in general, should be aware of what IS happening as a result of climate change and what they can do NOW to help. And as adults, we should be building a world where what children can do to help is being taken care of for them.

These boots were made for walkin’

For the final dark month of winter, I decided that my challenge should be something to keep my spirits up and get me out of my yearly funk. Enter, walking.

It’s cheap, it’s easy, and if you’re lucky enough to have two functioning legs you probably do it all the time anyway.

I knew that this would be a good way to spend March, because I find it so dreary and difficult to get through, but I didn’t realize just how impactful walking everyday would be. This was the first winter in years that I can remember the end of it as something more than just one long, dark day after another. I’m not trying to be negative, but winter really wears me down and I have begun to dread it loooong before it arrives. This past year I began to think about it near the end of August and for the entire fall I kept thinking, “this will be the last nice day, enjoy it.”

I don’t know if it was the daily walk outside or just doing a monthly challenge that kept me flying high but either way, I couldn’t be happier. That dose of fresh air and exercise can’t be beat.

An unexpected bonus was that I got to see the seasons changing. While March seems like one dark hole, there is actually a lot of change in nature that I wouldn’t have noticed if I hadn’t been getting outside daily to see it. On more than a few snowy mornings I was the first person in my local conservation area, and seeing all the tiny footprints and hearing all the animals move around was amazing. I also came across a dead deer, but that’s the circle of life I guess. Like most things, winter has a lot of activity and beauty once you start looking for it.

Takeaway: Next winter I am challenging myself to walk every day, the entire season. It’s the type of thing that you need to get ahead of because once the winter funk takes you there is no going back.

Make it easy

This year I put a lot of thought and time into my New Year’s resolutions, until I realized I was over-complicating it. I wanted to be useful, happy, stimulated, active, and taking steps forward in my life. Really, one goal is not going to achieve those things as much as a change in mindset would. So, I created a little phrase that would keep me motivated and actually interested in what I was doing.

Move, do, create.

Everyday, I try to do 1 thing from each of these categories and a quarter of the year in, it’s going great! Basically not a day goes by where I don’t achieve these things in some way or another, and it doesn’t need to be difficult. Stretching before bed after a long day? Move! Added some new spices to a tried and true recipe? Create! Went to work? Did!

There’s a lot of flexibility here too. Going to the gym was a goal of mine for the year, but now all the gyms are closed and I’ve just pivoted to stretching, running, or walking without any difficulty because it’s doing what I need. At the beginning of the year, I loved stop motion. Now I haven’t done it in weeks but that’s okay because I’m creating other things to keep my brain feeling good. Sometimes the “productive” thing that I do is just to read. Not really that special, but still something that keeps my day from falling into bad habits that aren’t doing me any good. The concept that there are things I need to prioritize sticks with me and keeps me from falling into a funk.

I would recommend this little phrase to anyone looking to make some tweaks in their life, it’s low commitment and flexible enough not to be a burden on even the longest of days. Most importantly, it keeps the notion in your head that these things should be prioritized. Also, it’s easily modified. Maybe creativity isn’t important to you, but connection with loved ones is. Just switch out what isn’t relevant and give it a try.

Why I Journal and You Should Too

When I was a kid, I loved reading fictionalized journals and diaries and always wanted to be a little girl who journaled her days away. But I think I always liked the idea of being a journaler more than the act, I just didn’t have that much to write about. Now that I’m an adult however, I find journaling is an indispensable part of my life.

I first started journaling in a very basic way via list making. I am super disorganized and literally can’t keep track of tasks for more than a few minutes, which was fine when I didn’t have much to keep track of, but life is too busy for that now! It wasn’t long until I discovered that I could empty my brain of everything causing my stress and anxiety just by writing it down.

Journaling fulfils a few different needs for me:

1. To get out of my head

When I write things down, I no longer have to think about them except for when I want to. The thoughts and feelings are organized, and I can set them down and come back to look at them with a fresh mind and a different attitude.

Writing stuff down forces you to look at what you are actually thinking about outside your head, and it requires you to understand your thoughts and feelings enough that you can transcribe them. Personally, my thoughts are very abstract and a bit of a whirlwind sometimes. It is often hard for me to separate what I am actually thinking about from the many, many other concepts and ideas that accompany that thought. Being able to pick apart the feelings and actual realities behind my thoughts makes them much more manageable and actually allows me to find a solution. This brings me to my next point…

2. Sort through difficult thoughts

It used to be that when I had a problem I would be completely overwhelmed by it and spend literally weeks, if not longer, rethinking and feeling the exact same things. It was exhausting, paralyzing, and completely useless to helping me actually make a decision or come to a solution. Journaling means that I can put down what the actual issue is on paper. Once it’s on paper, it doesn’t need to be in my head anymore, and as silly as it sounds, I have the space for new thoughts. What is the actual problem here? Why am I upset? What is contributing to this? How can I fix it?

The magic question. Instead of mulling over the same overwhelming things for weeks, I can cut to the chase. What will actually resolve the bad thoughts and feelings?

3. Look back on my life

Starting in adulthood, I can literally track the peaks and valleys in my life by whether or not I was journaling. If I’m writing down what is going on in my life, it goes well. When I stop, it all hits the fan. That’s actually how I realized that this was the answer for me.

Apart from that nugget, looking back on what you’ve written down gives you a completely different window into your life. What was on my list for the day? Did I accomplish it? Is the same thing carrying through for weeks? What was good, what was bad, it’s all there, alongside random things that I don’t even recall writing down. It gives me an idea of how I was spending my time. Looking back at my journals always reminds me of a song I wanted to look up or a recipe I wanted to cook. It is where I have written down favourites that I have completely forgotten about. It even reminds me of people that I would never think about, like old teachers who for whatever reason made a cameo. It’s nice to have another record of your life that is more personal than a photo and showcases what was going on inside your head.

4. Keep track of things that are important to me

Life sometimes gets really busy and it’s easy to move on from something that at one point was a huge part of your life. Journals keep track of what is actually important to you and what you wanted to continue or stop. I spent all of last summer on my bike, but after a long winter and a job change where I need to commute, biking isn’t something I was even considering for this summer until I saw an old journal entry about how much I loved biking. A silly example maybe, but I don’t write down things that aren’t important to me in some way. The same goes for swimming, or growing a garden. I’ve been writing it down here and there for months and I remember that those are things I want to focus on this summer. Without writing down what I want to spend my time and money on, I forget and end up focusing on what is important in the absolute moment. All the things I love will pass me by if I don’t think about them and actually dedicate myself to them.

5. Practice self reflection

Finally, all these things add up to reflecting on your life and behaviours, so that you are actually heading in the direction you want to be. I find myself thinking about the same things again and again because they are either problems in my life or things I enjoy. If it’s a problem, I start to realize pretty quickly a) that it keeps on happening, and b) there is something that I am doing to drive that. I would never have realized what an impact my disorganization was having on my life if I hadn’t written 85 journal entries where the root cause of the problem was that I had forgotten to do something important. I was always in a state of emergency, and there was no time in the day to day mess of life to realize the mess was only there because I wasn’t thinking far enough ahead. If I always feel the need to write down how great I feel after a walk in the woods, it sends a pretty clear message. Also, just the act of journaling means that you put aside some time to actually think about what is going on in your life instead of just going through the motions and the time alone is a powerful tool.

And that’s that. I love journaling for the mental release, and it is the only way that I get anything done. I would challenge you to try it, even in the most basic way. Try writing down something or everything that makes you happy, or go the opposite route and write about what in your life is a problem. Having your thoughts on paper gives you a completely different perspective.