November 24, 2021
It may not be obvious how health and climate change are interrelated. Below, UBC nursing lecturer Raluca Radu answers a series of questions to help fill the gaps in our knowledge of the health impacts of forest fires in British Columbia.
Can you tell us more about your case study, what the impetus for this case study was and how it complements the nursing curriculum?
The case study is entitled, "Enriched Learning through an Interactive Case-Based Online Module: Nursing 290 Health Impacts of Climate Change". This case study will be implemented into the course in 2022, and its goal is to enable students to learn through a problem-based approach — in this instance, how a Canadian community is affected by climate change. The module will be designed as an online interactive tool that students can complete throughout the course. I was inspired by the Planetary Health Alliance Case Studies to build something that would focus on local Canadian examples. In this way, it can be showcased to students that climate change is here "in our backyard", and that it is essential to embrace the philosophy of "Think global, act local" when faced with such wicked problems.
With respect to the nursing curriculum, naturally I felt it was an incredible opportunity to improve the course I am teaching (Nursing 290) in order to create a higher level of engagement among the students enrolled in the class. As this is a non-nursing course, the students joining my class come from diverse academic backgrounds. Therefore, although this content is currently not taught in the Bachelor of Science in Nursing (BSN) program, a few of the students enrolled in my class have gone on to apply and successfully be admitted into the UBC School of Nursing Accelerated Program. Hence, it’s reassuring to know that future nurses and allied health care providers will have foundational knowledge of the health impacts of climate change, which they can carry throughout their practice. For further information on nursing in the realm of planetary health, check out my blog posting here.
Can you tell us more about forest fires, why you chose to focus on them and what impact they are having on health?
We decided to focus on wildfires in British Columbia because of their prevalence, especially given their increased incidence over the last 10 years. With climate change accelerating, we know wildfires are projected to increase in magnitude and we know how devastating their impacts are on communities and individual livelihood. Moreover, their power to disrupt ecosystems and permanently change the interface of how British Columbia’s known biodiversity will be affected are key considerations in how we move forward.
Exposure to wildfire smoke can have detrimental implications for human health. Specifically, short-term health effects can range from eye and throat irritation, headaches, difficulty concentrating, shortness of breath, wheezing and generalized chest discomfort — just to name a few. Long-term repeated exposure to wildfire smoke contributes to both respiratory and cardiovascular impairment. Granted, the length of time of being exposed to wildfire smoke and the concentration of particulate matter (PM) present, especially that of PM2.5 microns in size, also plays a role in how an individual experiences those health impacts.
Therefore, the picture is clear. The repercussions of being exposed to wildfire smoke require an urgent and holistic approach, which is why future health providers need to form a sound understanding of these implications.
What kinds of health impacts are you seeing in patients from wildfires?
While I do not work in the clinical setting, I undertake all efforts to stay up-to-date on all publications that are emerging. I equally try to stay involved in delivering webinars through various channels that allow for dissemination of knowledge to practicing nurses in diverse clinical settings.
Recent literature underlines that the immediate impacts of being exposed to wildfire smoke send individuals suffering from respiratory conditions such as asthma or chronic obstructive pulmonary disorder (COPD) to the emergency room. There, they are seeking treatment to relieve their symptoms of shortness of breath, wheezing and generalized chest discomfort that are associated with the exposure. Similarly, it is important to mention that while those who live in the closest proximity to a wildfire will have the most detrimental health impacts, people who are miles away may also still experience some of these health effects.
Many of you might recall that over the last four to five years alone, BC has experienced several wildfire seasons that were devastating in nature — ravaging entire communities and displacing many people to seek shelter and safety as their homes were burned to the ground. While provincial states of emergency were adopted throughout some of these wildfire seasons, we know that individuals throughout BC were cautioned to limit the time they spent outdoors and to make sure they sought medical help when recognizing a shift in their health status. While being inside can be looked as the safest measure, this may not apply to all individuals equally in our society. Particularly, keeping in mind individuals who are experiencing marginalization or homelessness, or who may depend on social housing. In some cases, this social housing may not be up to standards for properly sealed windows or will not have HEPA-based filters that can provide a layer of protection against poor indoor air quality. Therefore, when considering the intricate complexities that surround the issue of wildfire smoke exposure, it’s best to embrace an “equity and social determinants of health” lens.
How is nursing connected to and impacted by climate change? Do you think people readily make this connection?
As health care providers serving the frontlines in our health care systems, nurses meet individuals from all walks of life in a plethora of settings. When individuals in a community that has been disrupted by wildfires or other climate change-related events seek medical help, they may go to their nearest hospital, primary care clinic or public health unit that can address their symptoms and alleviate their suffering. Nursing as a profession is at the centre of this interaction with individuals. Hence, it is instrumental that nurses recognize when symptoms that are exacerbations of respiratory conditions are a result of wildfire smoke exposure or those related to dehydration due to extreme heat. Making the connection to these sorts of impacts is key.
I believe that people are starting to make a connection to this, and are becoming curious about how their role is related to the climate change emergency. Although I am not sure it is moving fast enough. I hope this is something that will change given the recent events we experienced here in BC this past summer of 2021, and the rising number of reports that are flooding the news.
What do you think can be done to spread awareness about how climate change is having an impact on health?
Nurses consistently rank among the world’s most trusted health professionals. Therefore, as a profession we have an opportunity to capitalize on this trust we have built with the public, and communicate the health impacts of climate change to our clients regardless of the settings where we practice. I believe that through education, or through continuing professional development opportunities offered by employers, nurses can be given a chance to familiarize themselves with the health impacts of climate change and understand their role in addressing these in their practice settings.
What are the costs that wildfires are taking on the health-care system? Is this something quantifiable?
As per the Global Climate and Health Alliance report published this year, I was astonished to look at figures comparing the impacts of wildfire smoke in three different regions, specifically Australia, Brazil and British Columbia, in the range of 2018-2020 years. Specifically, during the summer of 2018, BC saw the average cost of suppressing wildfires measured at C$615 million, and this was alongside increased prescriptions filled for respiratory medications. There were no estimates found for costs for hospital days, however based on information from the 2017 BC wildfires example, we learned that health systems saw a substantial amount of staff displaced to the affected communities to offer their assistance in evacuating patients and caring for them.
Therefore, I would argue that the costs that wildfires have on health care systems can be quantified and can be seen in how many health and human resources are necessary to be dispersed to affected areas within a short timeframe. In addition, this will be even more so aggravated by an ongoing pandemic which has already put a significant strain on all our health care workers and health systems.
What do you see in the future in terms of how climate change will impact the already strained health care system? Do you feel that spreading awareness will reduce some of these strains and the associated costs in the future?
If we do not invest in climate change adaptation and mitigation alongside emergency preparedness measures now, I am not sure how our health care systems will recover when faced with more climate change-related events. A recent and tragic example is that posed by the heat dome from this past summer of 2021. In this situation, not only did we see Lytton, BC completely eradicated, but we also saw among the highest mortality cases recorded in a given week due to extreme heat. I would only hope that the traumatic events that took place over this summer would have served as a sufficient warning and learning moment for those who may have been skeptical about climate change.
There are a myriad of reports published on a regular basis by outstanding researchers and scientists, both here in British Columbia and across the globe, with information that is pertinent to us and which requires being tailored to our context. If we fail to listen to the recommendations that stem from all these reports and not prepare ourselves for what may follow, I worry that our health systems will not be able to bounce back. Hence, I believe it is critical to focus on spreading awareness to all health care professionals and the public they interact with in their settings (whether it be a physiotherapist’s clinic or a community health centre, among many others). In this way, we can maximize the education provided with the hope of protecting the public against the detrimental health effects caused by climate change-related events.
Is the goal to include more case studies like this in order for the nursing curriculum to become more environmentally centered in general? Or is this case study more geared towards the curriculum of your particular Nursing 290 Health Impacts of Climate Change course?
This case study is currently focused on improving the curriculum for the Nursing 290 course. Over time, I am hopeful to inspire the Canadian Association of Schools of Nursing to integrate climate change and health alongside planetary health principles into the standardized curriculum that all schools of nursing across Canada generally follow. Therefore, my personal vision is to see this content embraced as a permanent component of nursing education, underpinning the intricate relationship between people and planet at the centre of what we do. Seeing our nursing colleagues in the US build coursework on climate change and planetary health in their nursing curricula gives me hope and inspires me to continue to think of innovative ways that can bring about similar exciting changes in a Canadian context.
Why do you feel that integrating environmental issues into the nursing curriculum is important, and how will this impact the learning for future nurses?
Learning about current and forecasted environmental issues as they relate to climate change is critical for nurses because of their position in society. Specifically, nurses are highly educated individuals who have a complex set of skills that enable them to provide holistic care to people on a wide spectrum. This rings even more true when individuals who seek care have been affected by climate change-related events. Hence, integrating such issues into the nursing curricula will equip nurses with the knowledge and skills they need to deliver care that is tailored to each individual’s context. This will empower them to anticipate climate change as a contributing factor to the aggravation of their patient’s health status.
The amount of didactic resources available to support the above gives me confidence that this process can be undertaken seamlessly. There is no need to reinvent any wheels, but rather complement the already existing courses that lay the foundation of promoting health and managing illness. The element to bring forward is how climate change impacts the people who nurses already care for in the most comprehensive ways. Another goal is to support them to see how their role is invaluable on the journey to healing and resilience-building in the face of the 21st century’s largest and shared global health crisis.
Raluca, would you like to leave us with any further questions to reflect upon?
I want to leave the audience with a question that still serves as a guiding compass for the work I undertake and I encourage others to reflect upon its meaning: How do we shift our values to live equitably in harmony with each other and with the millions of species we share this beautiful planet that we call home?
Ms. Radu would like to acknowledge the UBC Sustainability Initiative (USI), without which this work would not be possible. She was fortunate to be a successful recipient of a Climate Change Education Grant through USI in December 2020. The goal of this grant program is to support faculty members across UBC to integrate climate change-related content into their coursework. If any other UBC faculty are interested in applying for funding via this program, please visit the website for this initiative and apply by mid-December. Ms. Radu is equally grateful to have the privilege to work alongside her research assistant, Ms. Aubree McAtee, who has been instrumental in supporting this work.
Related links (for those seeking further information)
- Ms. Radu's graduate project
- UBC Nursing 290: Health Impacts of Climate Change course information
- Podcast episode where Ms. Radu was a guest (October 2019): "How climate change affects nursing"
- Blog authored by Ms. Radu (December 2019): "Nursing in the realm of planetary health"
- Blog co-authored by Ms. Radu with other nurses from BC (January 2020): "Nurses for planetary health: a call to action"
- Ms. Radu was fortunate to sit on the Executive Board of the Canadian Association of Nurses for the Environment from 2019 to 2021 – fabulous resource
- What inspired Ms. Radu for this case study: the Planetary Health Alliance Case Studies
- Blog co-authored with nursing colleague Helen Boyd and NNPBC (November 2021): "Climate Emergency: The Time to Act is Now"
- Ms. Radu’s Twitter Handle: @_Raluca_R
Global Climate and Health Alliance. (2021). The emerging threat of smoke impacts on health from forest fires and climate change.
Howard, C. et al. (2021). SOS! Summer of smoke: A retrospective cohort study examining the cardiorespiratory impacts of a severe and prolonged wildfire season in Canada’s high subarctic. BMJ Open 11, pp.1-10.