C L I M A T E O F C H A N G E

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Taking Our
Breath Away
The Health Effects
of Air Pollution
and Climate Change
October 1998 The Authors

Dr. John Last has been a professor of epidemiology and community medicine
at the University of Ottawa since 1969. He is past president of the American
College of Preventive Medicine, past Canadian vice-president of the American
Public Health Association, and has worked extensively with the World Health
Organization and other agencies in developing nations. Dr. Last was also editor-
in-chief for three editions of Public Health and Preventive Medicine, the author
of chapters in 36 books and more than 200 articles in journals of medicine.
He is an honorary life member of the International Epidemiology Association.
Dr. Konia Trouton is a family doctor and medical epidemiologist with Health
Canada’s Bureau of Reproductive and Child Health in Ottawa. She holds a
medical degree from the University of Calgary and a Master’s degree in Public
Health from the Harvard School of Public Health. Dr. Trouton also co-directs
a fellowship year for family physicians in population health at the University
of Ottawa, and is president of Physicians for Global Survival, a Canadian
non-governmental organization.
Dr. David Pengelly is an Associate Clinical Professor in the Department of
Medicine at McMaster University and an Associate Professor in the Department
of Medicine at the University of Toronto. He holds a Master’s degree in
Experimental Medicine and a Ph.D. in Physiology from McGill University.
Dr. Pengelly is a member and former Acting Director of the McMaster Institute
of Environment and Health, and has served on many government and NGO
committees in the area of environmental health.
Acknowledgements
The following individuals reviewed earlier drafts of the report, offering many useful comments
and suggestions:
Karen Asp
Dr. David V. Bates, Professor Emertius of Medicine, University of British Columbia
Melanie Fitzpatrick, University of Seattle
Dr. Trevor Hancock, Public Health Physician, Chair Canadian Association of Physicians
for the Environment
Dr. Tee. L. Guidotti, Professor of Occupational and Environmental Medicine, University of
Alberta Faculty of Medicine
Dr. Tord Kfellstrom, Director, New Zealand Environmental and Occupational Health
Research Centre, New Zealand
Joan M. Masterton, Atmospheric Environment Service, Environment Canada
Dr. Tony McMichael, Professor of Epidemiology, London School of Hygiene and Tropical
Medicine, United Kingdom
Dr. Douw Steyne, Professor, Atmospheric Science Programme, Department of Geography,
University of British Columbia
Dr. Alistair Woodward, Professor of Public Health, University of Otago, New Zealand
David Suzuki Foundation The David Suzuki Foundation would like to thank all those who helped in the preparation of
2211 West 4th Ave., Suite 219 this report, particularly Dr. Devra Davis from the World Resources Institute, who provided the
Vancouver, BC, Canada V6K 4S2 initial inspiration.
Tel: (604) 732-4228
Fax: (604) 732-0752 Photographs courtesy of Al Harvey and The Slide Farm. All photographs ©1998.
email: [email protected]
www.davidsuzuki.org ISBN 1-55054-680-5
Taking Our
Breath Away
Human activities are changing the composition
of the air we breathe. Unfortunately, this new
atmosphere is a less healthy one for Canadians.
While historically, natural events like volcanic eruptions played the
dominant role in altering the atmosphere, today it is the combustion
of fossil fuels on a massive scale that is increasingly responsible for
atmospheric changes.
In this report, atmospheric damage is classified in two ways
according to how it affects humans. First, at the ground level, a
number of substances directly damage health by entering the body
when we breathe. Second, gases which have little or no direct adverse
effect on the human body accumulate in the upper surface layers of
the atmosphere, gradually destabilizing the climate, and disrupting
the delicate ecological balance which is critical for maintaining life.1
These two problems will have increasingly severe impacts on the
health of Canadians and the world’s peoples in the coming years.
The first problem, air pollution, already contributes to a signifi-
cant number of premature deaths and increased illness in Canada
and around the world. The second, climate change, or global warm-
ing, ultimately may pose a more serious threat to human health.
The effects of global climate change include heat waves, disruption
of previously stable weather systems, more frequent violent weather
events, increased risks of infectious diseases, and threats to food
supplies. Over time, additional and far-reaching impacts are likely
to arise from rising sea-levels caused by the melting of polar ice-caps
and alpine glaciers, and thermal expansion of the sea-water mass.
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A critical point that is often lost in discussions about climate change and air
pollution is that the same human activities, namely the excessive combustion of
fossil fuels (gasoline, oil, coal, etc.) for energy, are the major cause of both prob-
lems. Climate change has an additional local impact in that as the global climate
changes and the atmosphere warms, air pollution in cities will likely worsen
because heat and sunlight are critical factors in the production of urban smog.
Since the combustion of fossil fuels is the largest contributor to both air
pollution and climate change, the most prudent measures to reduce the health
impacts of these problems involve significant reductions in fossil fuel consump-
tion. A small but important step was made at the 1997 Kyoto Conference when
Canada agreed to reduce greenhouse gas emissions to six per cent below 1990
levels by 2012. However, this is far less than the 60-80 per cent reductions that
international scientific studies indicate are required to effectively slow the rate of
climate change.
The scientific and medical evidence is compelling. To prevent further harm,
and to promote immediate and long-term improvements in health, we must
initiate and implement effective strategies to reduce the rate of fossil fuel com-
bustion, greenhouse gas emissions, and air pollution. Implementing solutions
today will reduce the burden of serious health problems tomorrow, especially
the burden on our children and the generations to follow. In a nutshell, the
challenge of curbing global warming also presents a positive opportunity to re-
duce air pollution and to improve human health. This paper explores the links
between air pollution, human health and climate change, regulatory and policy
alternatives, and the potential health benefits from reduced use of fossil fuels.

Fossil fuel
consumption
Air
pollutants

CO 2
8 million avoidable
deaths between
2000 and 2020*

Concentrations of
par ticulate matter
FIGURE 1. GLOBAL IMPACT
ON PUBLIC HEALTH
FROM CURRENT TRENDS Public health
impacts
IN FOSSIL FUEL USE
: World Resources Institute
*Assumes an 18 per cent cut in projected
levels of fossil fuel use in developed
nations by 2020 and a 10 per cent cut Human
in developing nations exposures
 C L I M A T E O F C H A N G E

Fossil fuel emissions, global warming

and human health
S     I R,  ’
consumption of fossil fuels has increased by a factor of 30. In 1860 we used the
equivalent of 300 million tonnes of oil; today we use the equivalent of 8,730
million tonnes.2 These fuels are an immensely useful energy source, storing
a large amount of recoverable energy into a small volume. Their combustion
8 powers the engines used to transport people and
goods in cars, trucks, trains, planes and ships. They
BILLION TONNES CARBON/YR

6 heat our homes, work places and institutions. They

are also extensively used to generate electricity,
4 to power industrial processes and to support the
Fossil Fuel
agricultural industry.
Carbon 2 Unfortunately, fossil fuel combustion also results
Carbon from in the release of numerous air pollutants. For exam-
Forests/Soils 0 ple, the combustion of coal in thermal power plants
1800 1850 1900 1950 2000 releases sulphur dioxide, oxides of nitrogen,
particulate matter, and mercury – all of which have direct and indirect impacts
FIGURE 2. ANNUAL RELEASE
OF CARBON TO THE
on health. Moreover, the most significant undesirable by-product of fossil fuel
ATMOSPHERE, 1800-2000 combustion is carbon dioxide, the primary cause of the greenhouse effect.
: R.E. Munn, Policy Making Global
Change
What is the greenhouse effect?
The greenhouse effect is a complex process by which some of the sun’s energy
being reflected by the earth is absorbed and retained as heat in the lower atmos-
phere. Carbon dioxide, water vapour, and several other gases help to retain this
heat, thereby stabilizing the planet’s ambient temperature. Without some green-
house effect, much of the heat would be dispersed into space, and the earth’s
average surface temperature would fall from 15 degrees Celsius to minus 6 de-
grees Celsius.3 However, due to the rapid increase in fossil fuel consumption
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during the past 100 years, atmospheric concentrations of carbon dioxide have
increased by almost 30 per cent, rising from 280 parts per million by volume
(ppmv) to 360 ppmv.
Scientific authorities, reporting through the United Nations-sponsored Inter-
governmental Panel on Climate Change, have concluded that the buildup of
CO2 in the atmosphere is accentuating the greenhouse effect, trapping more
heat, and increasing global warming and climate change.4 Other atmospheric
gases, although they occur in minute quantities, also contribute to the green-
house effect. These include naturally occurring gases such as methane and ni-
trous oxide, and specific halogenated compounds including hydrofluorocarbons,
perfluorocarbon and sulphur hexafluoride, which are manufactured by humans.
Each greenhouse gas has unique sources and characteristics. Carbon dioxide
(CO2), the primary greenhouse gas, is produced by living organisms and by
human activities, particularly through the combustion of fossil fuels. In 1996,
activities by Canadians caused the release of 508 million tonnes of CO2 into the
atmosphere, accounting for 75 per cent of the country’s contribution to global
warming. Another greenhouse gas, methane, is produced in much smaller
amounts by decomposing plant and animal material, and is the primary con-
stituent of natural gas. Although its amount is relatively small, methane has 21
times as much global warming potential as CO2. This means that Canada’s meth-
ane emissions are equal to 83 million tonnes of CO2. Nitrous oxide (N2O) is
another greenhouse gas produced from the combustion of fossil fuels. It is re-
leased through the production and application of nitrogen fertilizers, and from
natural sources. With a global warming potential 310 times greater then CO2,
Canada’s N2O emissions are equal to 72 million tonnes of CO2 annually. See
Figure 3.
Halogens Other greenhouse gases include hydrofluorocarbons (HFCs), perfluoro-
1%
N 2O carbons (PFCs) and sulphur hexafluoride (SF6). HFCs were developed as a sub-
11%
stitute for chlorofluorocarbons (CFCs) and are used in refrigeration and in the
Methane
12%
manufacture of semi-conductors. Depending on the type of HFC and its life-
time in the atmosphere, HFCs have a global warming potential which ranges
from 140 to 11,700 times greater than CO2. The annual output of HFCs in
CO2
Canada is equivalent to 500,000 tonnes of CO2. PFCs are released during the
76% aluminum refining process and have a global warming potential 7,400 times
greater than CO2. In 1996, emissions of PFCs in Canada were equivalent to the
release of 6 million tonnes of CO2. SF6 is used in heavy industry to insulate
FIGURE 3. CANADA’S 1996
high-voltage equipment and in the production of magnesium. SF6 has a global
GREENHOUSE GAS EMISSIONS warming potential 25,000 times greater than CO2 and, in 1996, resulted in the
EXPRESSED AS CARBON equivalent of 1 million tonnes of CO2 emissions in Canada.5 HFCs, PFCs, and
DIOXIDE EQUIVALENTS 5 SF6 together accounted for 1.14 per cent of Canada’s greenhouse gas emissions
: Environment Canada expressed as CO2.
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Greenhouse gas emissions and global temperature

TRENDS IN CO2 EMISSIONS
Annual worldwide carbon emissions from all industrial and commercial
sources were estimated to be about 2 million tonnes in the middle of the 19th
century. By 1900, carbon emissions were almost 1 billion tonnes, and by 1995
they had surpassed 6 billion tonnes per annum.6 The release of 6 billion tonnes
of carbon through combustion
adds approximately 22 billion 0.6
tonnes of carbon dioxide to the
GLOBAL MEAN TEMPERATURE ( °C)*
atmosphere. In the past, most of 0.4

these CO2 emissions were ab-

0.2
sorbed by plants, soils and the
oceans, collectively known as
0.0
“carbon sinks.” These carbon
sinks act as CO2 reservoirs, each -0.2
finding a natural balance be-
tween absorbing and releasing -0.4

CO2. Today, however, the an-

-0.6
nual output of CO2 emissions
1860 1880 1900 1920 1940 1960 1980 2000
exceeds the capacity for absorp-
tion by plants and other natural FIGURE 4. GLOBAL AVERAGE
“sinks” where carbon is stored. This problem has intensified with widespread TEMPERATURE CHANGES,
destruction of forests during the past half-century. Further, pollution and in- 1860-1997
creased ultra-violet radiation (caused by stratospheric ozone depletion) has led : Hadley Centre for Climate
to a declining ocean plankton population. Because ocean plankton acts as an- Prediction and Research
other carbon sink, this has tilted the carbon imbalance as well. Global warming
itself also weakens the ability of some of these sinks to store carbon, creating a
reinforcing feedback loop which again accelerates warming.

S I G N I F I C A N T G L O B A L T E M P E R AT U R E I N C R E A S E
Since the beginning of systematic record-keeping in the 1860s, the world’s aver- According to
age temperature has been found to fluctuate in response to natural processes.
These processes include: variations in output of solar radiation associated with Environment
sunspots and solar flares; variations in oceanic and atmospheric currents; and Canada, in all
variations in the extent to which incoming solar radiation is blocked by atmos-
pheric dust and gases, associated mainly with large volcanic eruptions. likelihood 1998
Within these temperature variations, however, an inexorable upward trend will be the
in temperature readings can be observed during the period from 1860 to 1998.
Based on direct measurements, the world’s average temperature has risen by warmest year
almost 1 degree Celsius over the past 138 years, and the 11 hottest years on
in recorded
history.
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10ºC
record have occurred since 1982. The US National Oceanic and
8ºC
6ºC
Atmospheric Administration reports that so far, 1998 has been
4ºC the hottest year since systematic records were first kept7 and other
analyses indicate that it has been the warmest year of the past
600. Canada is in step with this trend. The national average
temperature for the first eight months of 1998 was 2.7 degrees
Celsius above normal, with northern parts of the Northwest
Territories experiencing temperature increases of greater than
5 degrees.8

I S T H E WA R M I N G T R E N D AT T R I B U TA B L E
T O AT M O S P H E R I C G R E E N H O U S E G A S
FIGURE 5. PROJECTED
TEMPERATURE INCREASES AC C U M U L AT I O N ?
IN CANADA The Intergovernmental Panel on Climate Change (IPCC), involving more than
Projected temperature increases 2,000 of the world’s top scientific experts, was established by the World Mete-
during December, January and orological Organization and the United Nations Environment Programme in
February, assuming twice current 1988. The IPCC was given the task of assessing all available scientific informa-
levels of CO2. tion on climate change, its environmental and socio-economic impacts, and
: The Pembina Institute for possible response strategies. The IPCC established three working groups
Appropriate Development
consisting of the world’s leading experts in climatology, atmospheric physics,
meteorology, energy, and economics. The 1995 IPCC Report on the Science of
Climate Change states,
Our ability to quantify the human influence on global climate is currently
limited because the expected signal is still emerging from the noise of
natural variability, and because there are uncertainties in key factors.
These include the magnitude and patterns of long term natural variability
and the time evolving pattern of forcing by, and response to, changes in
concentrations of greenhouse gases and aerosols, and land surface changes.
Nevertheless the balance of evidence suggests that there is a discernible
The balance of human influence on global climate. 9

evidence suggests Since 1995, there has been a great deal of research which substantiates this
scientific analysis. In addition to empirical scientific evidence of global tempera-
that there is ture increase, there is much direct observational evidence of some of the conse-
a discernible quences, such as the retreat of alpine glaciers and snow lines, and the melting of
polar icecaps and permafrost. Further observational evidence comes from changes
human influence in the pattern of vegetation in many parts of the world such as plants growing
on global and birds nesting at higher altitudes and higher latitudes than in previous years.
In Canada, the MacKenzie Basin Impact Study found that many parts of the
climate. north had already experienced a 1.5 degree Celsius average temperature increase
this century.10 Another recent study indicated that spring arrives a week earlier
in the Arctic than it did only a decade ago.11
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There is also indirect supporting evidence of climate change. Models predict “The climate
unstable weather patterns, and the past few years have witnessed frequent
dramatic weather anomalies, which seem to be becoming the norm. These anoma- system is
lies have had some dramatic and devastating effects. Heat waves, storms, hurri- an angry beast
canes, and floods of unprecedented severity have occurred throughout the world
during the past 15 years. Climatologists are now saying that the increasing and we are
severity and frequency of El Niños in the 20th century may be attributable to poking it with
global warming. D. James Baker, U.S. Undersecretary of Commerce for the
National Oceans and Atmosphere Administration (a U.S. government agency) sticks.”
describes the 1998 El Niño as, Professor Wallace Broeker,
Columbia University
...[O]ne of the major climatic events of this century. The country [U.S.]
as a whole saw the warmest and wettest January and February in the past
104 years. This record-breaking El Niño is consistent with a worldwide
warming trend over the last 40 years toward a warmer and wetter world.
We can’t draw a causal link between El Niño and global warming but our
modeling tells us that global warming may first manifest itself in changes
in weather patterns; in other words this winter’s El Niño is a taste of what
we might expect if the earth warms as we now project.12

Dr. J. P. Bruce, the former director of meteorology for Environment Canada

and a scientific editor of the IPCC 1995 Report confirms this trend:
The temperatures in 1998 are more than just unusual, they are unprec-
edented. Last year was, on world-wide average, the hottest ever recorded.
Now 1998 has become the new benchmark. In the first half of the year,
large parts of Canada experienced temperatures an astonishing 4 to 7
degrees C above normal. A strong El Niño is partly to blame, but there is
growing evidence that greenhouse gas emissions are making El Niño events
increasingly intense.
... [It] is not possible to attribute individual severe weather events to
climate change. Instead one must examine overall decadal or longer trends.
For example, in Canada, forest fires, insects and diseases have affected twice
as much area of the boreal zone in the 1980s and 90s, as in previous
decades. And in Calgary, the average frequency of large hail storms (hail
stones greater than 20 mm) has increased from one every four years in the
1980s to two every year in the 1990s.
Meanwhile, the frequency of heavy one-day rains has increased by
20 per cent in the United States this century, resulting in more flash
flooding. Sea levels also continue to rise, with more frequent flooding of
low-lying islands. On a global basis, the annual losses from natural disasters
have risen from about $1 billion per year in the 1960s to more than On a global basis, the annual
$40 billion per year in the 1990s. And climate change appears to have losses from natural disasters
have risen from about $1 billion
per year in the 1960s to more than
$40 billion per year in the 1990s.
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played a part, since the frequency of severe climate-related disasters

(storms, floods, droughts, etc.) has increased three times as rapidly as
50 for other natural disasters (earthquakes, volcanoes etc.).13

The weight of observational evidence supporting the theoretical models of

global warming associated with greenhouse gas accumulation is persuasive. In
the absence of absolute certainty, it is prudent to apply the precautionary princi-
ple, that is, to adopt policies that do not further exacerbate a potentially devas-
tating problem – in this case increasing the atmospheric burden of human-pro-
40
duced greenhouse gases. Given the potential harm to the earth’s climatic systems
and to human health, it would be unwise to require absolute proof, beyond any
shadow of a doubt, that fossil fuel emissions are causing global warming. This
degree of scientific certainty about any complex problem is rarely possible.

30
Health effects of global warming
The IPCC has stated that, “Climate change is likely to have wide-ranging and
mostly adverse impacts on human health, with significant loss of life.”14 The
principal direct effect of global warming is excessively hot weather. Heat can
aggravate existing medical problems, particularly with the old, the young and
the ill. In 1995, a heat wave killed several hundred people in Chicago, and
20 several thousand people in Uttar Pradesh, India, and parts of central China.15 In
the northern hemisphere during the summer of 1998, unprecedented severe
heat waves struck North America, Europe, India and China, accompanied by
forest fires, death and property loss. As temperatures continue to climb due to
global warming, many Canadian cities can expect to experience a significant
increase in the average annual number of very hot days, with more and longer
10 heat waves (Figure 6). Currently, there are approximately 70 heat-related deaths
in Montreal, and 20 in Toronto every year. It is estimated that by 2020 annual
heat-related deaths could increase to 460 in Montreal and 290 in Toronto.16
Preparedness and provision of adequate refuge for those at risk can mitigate,
to a small degree, the impact of heat waves on humans. For example, in 1995,
the health department in Philadelphia provided those at high risk with access to
0
air-conditioned shopping malls and other cool places. Similar plans may be nec-
Victoria Winnipeg Quebec essary in Toronto, Montreal, and other Canadian cities at risk of severe heat
Calgary London Fredericton
waves. Unfortunately, people in developing nations do not have this luxury. It
> 30 C (1950-80) > 30 C (2 x CO2) > 35 C (2 x CO2)
was estimated that more than 2,500 people died in India during the summer of
FIGURE 6. NUMBER OF DAYS 1998 due to excessively hot weather.17
ABOVE 30ºC IN CANADIAN Moving high-risk individuals to air-conditioned locations may save lives in
CITIES, CURRENT AND UNDER the short term, but relying on such measures is counter-productive in the long
2XCO 2 SCENARIO term. Increased dependence on air conditioners, refrigerators and freezers dur-
: H. Hengeveld, Environment Canada ing hot weather periods intensifies air pollution by increasing demand for
 TAKING OUR BREATH A WAY 9
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electricity, which in many parts of Canada is supplied by fossil fuel-burning In Toronto, between 1951 and
power plants. The combination of pollutant emissions and heat leads to more 1980, there were on average 10
urban smog, already a significant problem in and around Canadian cities. Smog days each summer when the tem-
gets worse during heat waves because increased atmospheric temperatures and/ perature was above 30 degrees.
or ultraviolet radiation levels enhance the photochemical reaction that produces With a doubling of carbon dioxide
ground-level ozone and secondary organic particulates. levels, this wouald increase to 53
At ground-level, ozone is a toxic and irritant gas which, even in very minimal days per summer.
quantities, has adverse human health effects.18 Secondary particulates are respir- Source: Climate Variability, Atmospheric
Change and Human Health Conference,
able air pollutants which are formed when acidic air emissions, such as oxides of Ontario, November, 1996
sulfur and nitrogen, and volatile organic compounds (VOCs) are transformed
into nitrates, sulfates and organic aerosols. Ozone and particulates affect the
respiratory system and decrease lung function, leading to increased mortality
from respiratory and cardiovascular disease.19 These pollutants accumulate in
the air of industrial regions and those heavily affected by automobile exhaust
fumes. Some pollutants can travel great distances, and others, like ozone, take
time to form. As a result, the areas most affected by smog are often suburban or
rural regions some distance from major pollution sources.
Environment Canada predicts that parts of Canada will likely experience
greater health effects from smog as a result of global climate change since warm,
dry summer weather and periods of hot, stagnant weather result in more fre-
quent smog episodes. As noted in a 1997 study on the impacts of climate change
on Canadians,
[H]igher temperatures would enhance the production of various secondary
air pollutants (for example, ozone and particulates). As a consequence,
there would be an increase in the frequency of allergic and cardio-vascular
disorders caused by these air pollutants.20

Clearly, warmer temperatures will lead to direct and indirect impacts on the
health of Canadians.

E F F E C T S R E L AT E D T O E X T R E M E W E AT H E R E V E N T S
There are many other complex effects of climate change besides increasingly hot
weather. Undoubtedly, they will significantly impact human societies and the
ecosystems upon which our lives and well-being depend. For example, climate
models predict that global warming will cause unstable weather patterns. The
floods in Manitoba, Minnesota, North Dakota, and Germany in 1997, and the
ice storm in Eastern Ontario and Western Quebec in 1998 are examples of the
types of extreme weather events predicted by climate change models that can
occur when weather patterns change. Similarly, the unprecedented floods in
China during the summer of 1998 demonstrate the magnitude of human suf-
fering climate change will bring. These floods killed thousands, left millions
homeless and without adequate food, and resulted in billions of dollars in
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The Saguenay Flood economic losses. Similar flooding occurred in India and in Bangladesh,21 one of
The devastating effect of severe the world’s poorest nations, where high ocean and river levels have claimed more
rainstorms is vividly seen in the than 900 lives and displaced 35 million people.22 Since developing nations lack
Saguenay flood of 1996. Over 245 the resources and infrastructure needed to help reduce their impacts, and
millimetres of rain fell in 36 hours. because much of their populations are at or near sea-level, they will suffer
Approximately 500 houses were the brunt of increasingly-frequent severe weather events due to climate change.
destroyed, 3,000 were damaged We can expect more frequent extreme events in the future, but we cannot yet
and 1,000 families were perma- reliably predict where and when they will occur.
nently relocated. Losses totaled in These severe weather events disrupt ecosystems and destroy productive agri-
excess of $1 billion. cultural land. Floods and droughts not only lead to increased plant, animal and
Source: Climate Variability, Atmospheric human disease, they can also reduce biodiversity and cause species extinction.23
Change and Human Health Conference,
Ontario, November, 1996 Species loss may also affect human health since future discoveries of plants and
animals which produce substances that have medicinal uses, including cancer
treatments, will be compromised. Ultimately, such losses could have far-reach-
ing, unexpected consequences throughout the complex chains of life that make
up all ecosystems.
Alterations in established rainfall patterns are another expected effect of glo-
bal warming. Model results predict that for every increase of 1 degree Celsius,
there will be a 2 per cent increase in average precipitation.24 Climate change is
also expected to cause alterations in the timing, regional patterns and intensity
of precipitation events, particularly in the number of days when heavy precipita-
tion occurs.25 While some regions will get warmer and wetter, others will get
warmer and drier. Among those likely to become drier, the grain belt of the
Prairies may be the most vulnerable. The magnitude of change is best illustrated
by a recent study by the Geological Survey of Canada. It found that 4,000-
7,000 years ago, when the mean temperature was 1-2 degrees Celsius warmer,
the prairie water table was more than 4 metres lower than present levels and
there was an increase in the salinity of remaining surface and near-surface
waters.26 Climate models indicate that global temperatures may increase up to
3.5 degrees Celsius by the end of the next century. Environment Canada’s Envi-
ronmental Adaptation Research Group further predicts that water levels in the
Great Lakes will drop by as much as 2.5 metres. The resulting decline in soil
moisture in the Prairies and around the Great Lakes is likely to lead to reduced
agricultural productivity and could ultimately jeopardize food security in Canada;
both surface and ground water sources could be compromised on a large scale,
limiting the potential for irrigation. According to the Canada Country Study, a
10-30 per cent reduction in average crop yields from the Prairies may occur.
Throughout Canada, the effects of climate change pose a particular threat to
the health and well-being of First Nations. Many aboriginal communities are
still very much involved in hunting, fishing and other resource-based activities
 TAKING OUR BREATH A WAY 11
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for subsistence and ceremonial purposes. Climate change will likely alter dra- “Economic losses
matically the abundance and distribution of wildlife, fish, and vegetation, putting
food supplies, economic livelihoods, and cultural traditions of many First caused by natural
Nations in jeopardy.27 catastrophes are
S E A - L E V E L R I S E A N D E N V I R O N M E N TA L C H A N G E S likely to bring
The combination of the melting of polar and alpine ice-caps and thermal expan- home the effects
sion of the sea-water mass has probably contributed to a sea-level rise of 10-25
centimetres since the beginning of the 20th century.28 This combination is of climate change
expected to raise sea levels by one-third to one-half metre in the next 50 years.
Some models predict an even greater rise in sea levels, and if large parts of the
more and more
Antarctic ice shelf should break up and melt, the sea level could rise several dramatically as
metres. However, even a one-third metre rise in sea level (the most conservative
prediction) would likely displace many millions of people now living at or near
time goes by.”
sea level. Their homes and productive land would be inundated, and seepage of Munich Reinsurance Corporation
sea water would salinate agriculturally productive land, rendering it infertile. of Canada, Annual Review of
Tidal zones, a vital part of marine ecosystems, would be disrupted by rising seas, Catastrophes, Munich, 1998.
leading to a further reduction of already-depleted coastal and ocean fish stocks.
A one-third metre rise in sea level would also inundate large parts of small
island states like the Maldives and densely populated atolls in Pacific archipela-
goes. It would displace many millions of people from low-lying regions in Bang-
ladesh, South China, parts of the Indonesian archipelago, and from cities at
sea-level like Lagos, Calcutta, Shanghai, Jakarta and others, many with
populations of more than 10 million. The Asian Development Bank has
estimated that 140 million people in Bangladesh and China alone could be
displaced by rising sea levels.29 Storms and high tidal surges are a serious threat
to large numbers of people in all of these areas. Should the oceans rise by one
metre, 17 per cent of Bangladesh, which produces just 0.3 per cent of the world’s
greenhouse gases, could be submerged.
Many parts of the eastern seaboard of the USA and some large cities (Boston,
New York, Philadelphia, Washington, Miami) are also at or near sea level and
risk inundation unless protected by levees. In Atlantic Canada, accelerated sea
level rise and increased storm activity is expected to lead to increased coastal
erosion, flood hazards, storm damage and property loss.30 In British Columbia,
sea level rise could threaten low-lying areas such as Greater Vancouver, particu-
larly Richmond and Delta, where existing dykes and other infrastructures will
need to be upgraded and new projects undertaken. These projects may cost
hundreds of millions of dollars, and would not protect all areas. In addition,
ground water contamination by sea water intrusion may affect many residents
of the Lower Fraser Valley.31
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COMMUNICABLE DISEASES
An increase in average ambient temperature predicted by climate models would
likely extend the territorial range and increase the abundance of insects like
mosquitoes, which carry diseases such as malaria, dengue, and several kinds of
virus encephalitis. Some animals that can carry dangerous diseases, including
rodents and bats, could also expand their range and become more abundant.
For example, in western North America in 1998, drought followed by heavy
rains led to a sharp increase in the population of deermice.32 Many pathogenic
organisms and diseases could pose an increased risk to Canadians because
of climate change and associated ecosystem changes. These diseases include:
toxoplasmosis; western and eastern equine encephalitis; snowshoe hare virus;
dengue; yellow fever; malaria; Lyme disease; Rocky Mountain spotted fever;
Malaria — in Canada hantavirus pulmonary syndrome and seasonal respiratory infections that would
There were 744 confirmed cases of be exacerbated by climatic instability.33
malaria in Canada in 1996, and an The spread of dengue, eastern equine encephalitis, and similar diseases is
estimated 2,000 unreported cases. made more likely because of the recent arrival in North America of the Asian
Most of the cases are Canadians Tiger mosquito, which is hardier than anophelene mosquitoes and has already
returning from abroad. Toronto has spread as far north as Nebraska and Iowa.34
one of the highest rates of im- Climate model projections indicate that the geographical zone of potential
ported malaria in the industrial- malaria transmission could expand in response to global mean temperature
ized world. Researchers point to a increases. This would increase the affected proportion of the world’s population
hotter climate as a significant fac- from approximately 45 per cent to approximately 60 per cent by the latter half
tor. In 1998 a woman in Toronto of the next century.35 At present malaria infects more than 250 million people a
contracted malaria from a local year, killing almost 2 million.
mosquito. This is the first such in- Warmer weather caused by El Niño episodes has already been linked to
fection found in Canada in mod- increased incidence of tropical disease. An examination of historic data regard-
ern time.36 ing malaria outbreaks in Venezuela revealed that malaria increases by an average
of one-third in the year following an El Niño event.37 Climate change may result
in conditions similar to those of El Niño events, which will increase the risk of
further outbreaks of diseases such as cholera and malaria. This does not mean
that more people will necessarily get these diseases, but it does mean that many
more people would be exposed to the risk of contracting them. Protecting the
health of Canadians will require significant new expenditures, increased vigi-
lance, and new methods of monitoring and surveillance that are now either
non-existent or have fallen into disuse.
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The costs of global warming

ECONOMIC COSTS
Economists and climate scientists argue that by continuing our current pattern
of fossil fuel consumption, the resulting costs could have a significant impact on
national economies. The IPCC reports that the costs of damage due to climate The costs of
change could range from one to two per cent of gross domestic product for
developed countries and four to eight per cent for developing countries.38 These
damage due to
costs will arise from national declines in agricultural productivity, forestry, climate change
fisheries, and water availability. At the same time, governments would be re-
quired to spend more money on coastline protection, flood control, infrastruc- could range from
ture and health care. Other economic effects could arise due to increasing one to two
transglobal economic interconnections. Today, an economic crisis in one part
of the world can have far-reaching global economic consequences. The stock percent of gross
market and international currency crisis of 1998 illustrates this clearly.
domestic product
M I G R AT I O N S A N D D I S P L AC E M E N T O F P E O P L E for developed
Climate change and sea level rise are likely to make some places uninhabitable,
leading to major increases in migration. For example, any large influx of countries and
environmental refugees fleeing floodwaters will enormously strain the receiving four to eight
country or region’s ability to cope with direct environmental problems caused
by global warming. Moreover, environmental refugees may bring new health percent for
problems linked to climate change that differ from those of established resi- developing
dents, and this too can strain health resources. Many major migrations of people
in the past two to three decades have been associated with the declining ability countries.
of environments, especially in subsistence economies, to sustain an expanding
population. Often environmental stress has led to violent conflict,39 which then
forces many people to migrate as political rather than environmental refugees.

FOOD SECURITY
Disruptions of long-established weather patterns can have drastic consequences
for agricultural productivity. Floods and droughts, as have occurred in North
Korea for several successive years, can lead to famine. Prolonged periods of
drought, as in the West African Sahel, produce an annual sequence of crop fail-
ures and death of livestock, leading to depopulation of the region. In the grain-
growing regions of the upper-midwestern U.S.A. and the Canadian prairies,
declining soil moisture levels in the dry seasons which may be associated with
the El Niño southern oscillation of the late 1980s and early 1990s, caused a
decline in agricultural productivity. The same phenomenon has been repeated
in the late 1990s. This time, agricultural productivity was adversely affected by
floods in parts of the region from previous years. Such changes of established
seasonal cycles could lead to enough crop losses to threaten food security.
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A G R I C U LT U R A L P E S T S
In a warmer, wetter environment, weed species of plants and many pests and
parasites (insects, fungus, etc.) that affect food crops proliferate at the expense of
food crops. Predation and spoilage of stored food supplies also tends to increase.
These factors further threaten food security.

INFRASTRUCTURE
Climatic stress leads to pressures on many aspects of society, notably
sociodemographic, economic, and political stability. If budgets are required to
battle the direct impacts of climate change, there will be less money available for
the maintenance of public health services and other infrastructure such as roads
and public transportation. It is unlikely that essential public health services would
escape unscathed. For example, these services could be left inadequately
prepared for emergencies or even for the provision of routine health care.
Epidemics of cryptosporidiosis, a bowel infection that affected about one-half
million people in Wisconsin in 1995, were partly attributable to a decline in the
effectiveness of local public health services, including routine surveillance of
public water supplies.40

ALLERGIC DISEASES
Global warming may also increase the risk of respiratory diseases. Grasses and
allergenic pollens grow more profusely in a warmer environment than a cool
one. This result, in combination with heat-intensified smog episodes and higher
levels of atmospheric particulate matter, could increase the risk of allergic respi-
ratory diseases, particularly asthma. The prevalence of asthma has risen by about
30 per cent in Canada during the past 20 to 30 years for reasons that are far from
In Canada asthma is one of the clear. This increase may soon be eclipsed by further and greater increases in the
most prevalent childhood respira- frequency of allergic respiratory diseases as a result of climate change.41
tory diseases making it the number
one cause of school absenteeism. INTERCONNECTIONS
Source: “The Air Children Breathe: The The climate isn’t the only part of the world that is changing. Many other
Effects on their Health” Conference, Toronto,
January 1998 significant changes are also occurring that are likely to affect human health.
These include: depletion of the stratospheric ozone layer; species extinction and
reduced biodiversity; desertification of previously productive agricultural lands
due to overgrazing; overcultivation and population pressure; air, water and soil
pollution; demographic changes including population growth, rural to urban
migration and aging populations; and increases in global trade and travel. All of
these changes are interconnected, many reinforce each other, and all relate to
climate change, some directly, others indirectly.42
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The cholera epidemics that struck the Pacific coast of South America in the
early 1990s illustrate some of these complex interconnections. The bacterium
responsible for the disease, cholera vibrio, probably reached the region in the
ballast or bilge water of ships trading from the Indian subcontinent, and were
released into coastal sea waters off Peru and Ecuador. At the time, the El Niño
southern oscillation made these waters warmer than usual. Zooplankton flour-
ished in the warmer waters, providing a rich medium for cholera vibrio, which
forms a symbiotic relationship with zooplankton, to proliferate and spread
the disease.43
It is evident from studies examined in this section that climate change has By reducing the
the potential to seriously degrade the health and well-being of people around
the world. In fact, the scope of expected health effects could go beyond anything rate of fossil fuel
previously faced in the history of humanity. By reducing the rate of fossil fuel combustion we
combustion we can counter global warming and prevent many of these effects.
In addition, as the following section details, we can improve the health and well can counter
being of tens of thousands of Canadians. climate change
and prevent
many of the
adverse health
effects.
 C L I M A T E O F C H A N G E

Air pollution and human health

W         

occur gradually, other byproducts of burning fossil fuels, air pollutants, are
already causing premature mortality for thousands of Canadians annually and
making tens of thousands sick. All indications are that these statistics will likely
worsen with global warming. As it currently stands, recent studies have shown
that close to 8 per cent of all non-traumatic mortality in Canadian cities is
attributable to air pollution caused by the burning of fossil fuels.44 Developing
Recent studies an understanding of the processes that lead to contamination of the atmosphere
will help us focus on the components that cause the most harm to human health
have shown that and enact effective strategies to reduce that harm.
close to 8 per Scientists use several research methods to analyze the relationship between
human health and air pollutants. These include: epidemiological studies, which
cent of all identify statistical associations between atmospheric levels of pollutants and ob-
non-traumatic served health effects; clinical studies, which expose people to limited amounts of
pollutants and measure reversible effects; and toxicology studies, which expose
mortality in human or animal tissue to pollutants and examine the results. The health effects
measured by these studies include acute (short-term) changes and chronic (long-
Canadian cities is term) effects. The following section, based mainly on epidemiological studies,
attributable to details current knowledge on the detrimental health effects caused by increases
in air pollution.
air pollution
THE CHEMISTRY OF AIR
caused by
Air is a mixture of water vapour and gases, some of which – oxygen, nitrogen
the burning of and carbon dioxide – are necessary for all forms of life. Carbon dioxide makes
fossil fuels. up just 0.03 per cent of the air we breathe, but, as discussed in previous sections,
its role is far more important than this small proportion might suggest. In addi-
tion to these gases, air can be contaminated by pollutants, such as undesirable
gases and suspended particles, also known as aerosols, leading to adverse human
health effects.
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Where do these pollutants come from?

Air pollutants are derived from both natural sources and human activities. Natural
sources include: forest fires, which add particulates; volcanoes, which add acid
12
gases and particulates; biological processes in soil, which add oxides of nitrogen;
lightning; and dust due to soil erosion. However, a large proportion of air pol-
lutants are caused by human activities, primarily the combustion of fossil fuels.
When fossil fuel is burned, primary pollutants are created. These include:
carbon dioxide (CO2); carbon monoxide (CO); oxides of nitrogen (NOx); sulfur
dioxide (SO2); hydrocarbons (also known as Volatile Organic Compounds 10

[VOCs]); and airborne particulates. Fossil fuels may also contain contaminants
or additives in the form of heavy or toxic materials which are emitted as
suspended particles. In Canada, fossil fuel use accounts for about 55 per cent
of SO2 emissions, 90 per cent of NOx emissions and 55 per cent of VOC
emissions. In addition, about 70 per cent of total carbon monoxide emissions 8
in Canada are energy-related.45

T H E P R I M A R Y P O L L U TA N T S

Oxides of Nitrogen (NO x)

6
About 94 per cent of NOx gases are from vehicles, industry, production of elec-
trical power and home heating. NOx is a major constituent in the production of

P E R C E N TAG E
another pollutant, ground level ozone (O3), and is a source of acid precipitation
(acid rain). It is estimated that O3 and its precursors (NOx and VOCs) can travel

4
TABLE 1. PERCENTAGE INCREASED RISK OF DEATH ATTRIBUTABLE TO CITY-SPECIFIC CHANGE
IN AIR POLLUTION CONCENTRATIONS EXAMINED SIMULTANEOUSLY BY CITY, 1980-1991

CIT Y AMBIENT AIR POLLUTANTS

CO NO2 SO2 O3 ALL POLLUTANTS

Quebec 1.2 5.4 0.8 3.6 11.0

2
Montreal 2.1 0.0 2.9 3.4 8.4
Ottawa 0.2 3.1 0.8 0.7 4.8
Toronto 2.0 2.4 0.6 1.5 6.5
Hamilton 1.8 3.5 2.3 2.7 10.3
London -1.2 9.4 0.8 1.6 10.6 0
Calgary
Vancouver
Quebec
Montreal
Ottawa

Hamilton
Toronto

London
Windsor
Winnipeg
Edmonton

Windsor 1.5 0.0 0.2 1.9 3.6

Winnipeg 2.0 3.4 0.3 0.7 6.4
Edmonton 1.3 0.3 1.0 1.0 3.6
FIGURE 7. INCREASE IN
Calgary -0.1 7.7 1.4 0.7 9.7 MORTALITY ON HIGH AIR
Vancouver 0.0 7.2 -0.3 1.4 8.3 POLLUTION DAYS
: Burnett et al. : Burnett et al.
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up to 800 kilometres in the atmosphere.46 On average, the highest NOx concen-

trations in urban areas occur in the late afternoon and early evening. Although
catalytic converters and improved exhaust gas recirculation help to reduce some
vehicular emissions, there has been an overall increase in atmospheric burden
of NOx due to the increasing number of vehicles on the road and the rapidly
growing trend toward larger, less fuel-efficient vehicles.

Volatile Organic Compounds (VOCs)

VOCs come from both human and natural sources. Natural sources of VOCs
are almost exclusively vegetative and contribute more than five times as much
to the Canadian environment as do human sources. However, in urban areas,
where O3 is a problem, human-made sources are greater than natural sources.47
Human sources include gasoline and diesel emissions from transportation, par-
ticularly refueling stations, industrial fossil fuel use and incomplete combustion
of petroleum products at mobile and industrial sources. VOCs also result
from the use of various petroleum-based products such as solvents and surface
coatings in home and commercial settings.

Sulphur Dioxide (SO 2)

The principal source of SO2 is human activity, mainly from the industrial use of
fossil fuels in petroleum refineries, pulp and paper mills, and electrical generat-
ing plants and through the smelting process in metal refineries. SO2 is one of the
more persistent pollutants, combining with water molecules to form sulfuric
acid, leading to acid rain, snow and fog. SOx compounds also contribute to the
formation of secondary fine particulates under certain conditions.

Particulates
Particulate emissions, which consist of microscopic solid particles and minute
liquid droplets, also come from both human and natural sources. Natural sources
include fog, dust, smoke from forest fires, and volcanoes. Human sources of
primary particulates include the combustion of fossil fuel and biomass, dust
from mechanical processes such as mining and milling, and road dust from
vehicle travel. Secondary particulates are produced from the reaction of various
gaseous emissions (NOx, SOx and VOCs) in the atmosphere.
Particulates which have the most noticeable health effects are those which
are smaller than 10 micrometres (µm) in diameter. These are divided into two
fractions: fine particulates, which are less than 2.5 µm ( known as PM2.5), and
the coarse fraction, 2.5-10µm (known as PM10). Both PM2.5 and PM10 remain
suspended and dispersed in the air, with the potential to travel long distances
and cause cumulative effects. Other hazardous air pollutants may adhere to these
particles, increasing their toxicity.
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Carbon Monoxide (CO)

In Canada, about 70 per cent of CO emissions are energy-related, with more
than 60 per cent resulting from the combustion of hydrocarbons in the trans-
portation sector, particularly in gasoline-powered vehicles. The addition of
catalytic converters to automobiles and improved combustion at industrial sites
has reduced CO levels by more than 50 per cent since the 1970s.48 Unfortu-
nately, as in the case of NOx, increasing numbers of vehicles on the roads are
reducing the effectiveness of the reductions.

Secondary pollutants
In addition to the direct effects of the primary pollutants, some also contribute
to the formation of “secondary pollutants.” Secondary pollutants, including ozone
(O3), and acid aerosols (sulfuric and sulfurous, and nitrous and nitric acids), are Records show
produced when certain suspended atmospheric particles or gases undergo chemi-
cal reactions in the presence of water vapour and sunlight (photochemical reac-
that the most
tions). Complex compounds are also created from the reaction of VOCs with severe and
acid aerosols, creating secondary organic particles.
It is important to note that increased temperatures resulting from climate widespread
change will increase the amount of VOCs in the atmosphere, as higher tempera- episodes of ozone
tures lead to greater vapourization of solvents and gasoline, the principal manu-
factured sources of VOCs.49 It is also likely that increased temperatures will exceedences are
cause greater incidences of ground level O3 pollution since sunlight is an impor-
tant agent in O3 production. Records show that the most severe and widespread
associated with
episodes of O3 exceedences are associated with stagnant high-pressure systems stagnant high-
accompanied by high temperatures and intense solar radiation.50
pressure systems
How do these atmospheric contaminants accompanied
damage human health? by high
With pollutants in the air we breathe, our lungs are exposed to the risks these temperatures
contaminants pose to human health. The quantity and quality of the exposure,
and variations in the individual’s physical condition, influence the reaction. The and intense
exposure can be described by the type of pollutant(s), the concentration, the solar radiation.
duration and/or the quantity. Individuals also vary in the volume of air inhaled
and in factors such as age, sex, height, weight, activity level, and health status.51
Therefore, some groups in a population, such as children, may be at higher risk.
Many air contaminants have been studied to determine their effects on hu-
man health. Some of the mechanisms of injury are known, others are uncertain.
A comprehensive study of air pollution and health, referred to as the APHEA
project, provides a basis for part of our scientific evaluation of the health
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impacts associated with incremental changes in ambient air pollution. The study
began in 1991, when a group of European and American investigators designed
a large collaborative air pollution epidemiology study to examine the health
effects of air pollution in 15 different cities in 10 countries of eastern and west-
ern Europe. The population base was greater than 25 million people, and all
aspects of the design were agreed upon at the beginning, so the results could
appropriately be combined in a meta-analysis at the end of the study. A meta-
analysis is a research synthesis that compares, analyzes and combines numerical
results from many studies to arrive at a conclusion.52
The basic objective of the APHEA study was “to provide quantitative
estimates of the short term health effects (using the total and cause-
specific number of deaths and emergency hospital admissions) of air pollution,
taking into consideration interactions between different pollutants and other
environmental factors.”53 The association between specific levels of several
pollutants and the daily number of events (cause-specific deaths and hospital
admissions) were assessed using regression analysis adjusted for a number of
time-related factors.
All of the studies examined SO2 and some measure of particulates. In some
studies, other pollutants such as O3, CO, and NOx were also measured. The
outcomes, in most cases, were expressed as “risk ratios” for the events examined,
with respect to a “standard” increase in pollutant level. This means that they
were able to chart increases in hospital admissions and premature deaths in rela-
tion to increases in pollution levels. Because common methods and outcome
measurements were used, it is possible to compare directly the findings of the 11
studies and draw conclusions regarding pollution levels and expected health ef-
fects. In general, pollution levels which were well within regulatory limits were
found to impact on mortality and morbidity. In fact, the amount which is known
to trigger health impacts is minute. For example, the Canadian government has
determined that with regard to gound level O3 the maximum “desirable” level is
50 parts per billion (ppb.) which equals 100 micrograms per cubic metre
(µg/m3) while the maximum acceptable level is 82 ppb. To put this in perspec-
tive 50 ppb is approximately 5 tablespoons in an Olympic-sized swimming pool.
While these amounts may be very small, the human body is extremely sensitive,
and at these concentrations O3 can actually be smelled in the air. As we shall see,
these and lower levels of O3, have been found to be associated with increases in
both illness and death.
Other studies, such as the well-referenced and comprehensive review by the
American Thoracic Society Environmental and Occupational Health Assembly
also detail the health effects of air pollution. This review examines the effects of
many pollutants and pollutant classes.54
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What are the effects of different pollutants?

Ozone (O3) In Ontario,
Ground-level O3, a principal constituent of smog, has been recognized as a prob- 20% of hospital
lem pollutant with detrimental health effects in both developed and developing
countries throughout the world. Numerous health effects have been linked admissions for
to ground level O3, including damage to lung tissue, particularly among the bronchitis,
elderly and children, reduced breathing function, and sensitization of airways
to irritants and other allergens. It is also associated with increased emergency bronciolitis and
room attendances for asthma and respiratory disease, and hospital admissions pneumonia in
for acute respiratory disorders. In Ontario, 20 per cent of hospital admissions
for acute bronchitis, bronchiolitis and pneumonia in infants under the age of infants under
one can be attributed to the summer pollutants, ozone and sulphates.55
Fourteen per cent of all respiratory admissions in infants are associated with
the age of
air pollution. Relatively low levels of O3 can also cause healthy individuals to one can be
experience chest pain, coughing, nausea, and pulmonary congestion.56
A recent review of epidemiological literature conducted for the Canadian
attributed to
Council of Ministers of the Environment examined the health effects of ground- summer
level O3.57 The review concluded that there is a risk ratio for respiratory hospital
admissions of 1.045 associated with a 99 µg/m3 increase of O3. In other words, pollutants
when O3 levels are at 60 per cent of the maximum acceptable level as defined of ozone and
in the National Ambient Air Quality Objectives (above which official smog
warnings are issued), 4.5 per cent more people than average are admitted to sulphates.
hospital for respiratory illness than if no O3 was present. Moreover, the review
also concluded that this level of O3 was associated with a 1.35 per cent increase
in premature death. The previously-noted APHEA project found a greater
TABLE 2. MEAN VALUE OF POLLUTANTS, BY CITY, 1990-1994,
IN ORDER TO COMPARE TO LEVELS WHERE EFFECTS ON HEALTH HAVE BEEN OBSERVED

VANCOUVER EDMONTON WINNIPEG TORONTO MONTREAL SAINT JOHN HALIFAX

NUMBER OF SITES 6 3 2 7 8 2 3
PM10 (µg/m3) 20.7 23.2 27.2 27 27.6 15.3 17
PM2.5 (µg/m ) 3
13.1 9.9 8.6 16.1 14.9 9 10.5
SO4 (µg/m ) 3
2.1 1.6 1.8 4.4 4.2 3.2 4.1
CO (ppb) 1004 921.8 614.8 887.8 596.6 502.7 770.3
NOx (ppb) 57.6 51.7 25.3 47 48.7 23.7 36.7
NMHC (µg/m ) 3
236 249.2 78 100.4 138.9 140.4 104.4
SO2 (ppb) 5.1 2.9 1.4 4.5 5.2 10.3 10.7
SUM 03-40* 463 1109 551 1596 949 734 724
: Atmospheric Science Expert Panel Report, 1997
*The sum of daily maximum ozone for the year over “background” (40 ppb)
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increase in mortality associated with O3. In one APHEA study, which reviewed
data for Barcelona, a 4.8 per cent increase in premature deaths was associated
with a 93 µg/m3 increase in O3.58
The complex interrelationship between O3 formation, atmospheric tempera-
ture, and meteorological conditions has led to a serious concern that increasing
global temperatures will lead to increased production of O3 and increased
human health problems. As noted in the IPCC report:
Researchers also recognize that concurrent hot weather and air pollution
can have synergistic impacts on health. For example, warmer temperatures
can accelerate production and increase concentrations of photochemical
oxidants in urban and rural areas and thus exacerbate respiratory disor-
ders.59

The greatest technical difficulty with addressing O3, and to a lesser degree
fine particle pollutants, is that they are generated by reactions in the atmosphere
from other pollutants, as opposed to being directly emitted at a source. Only by
reducing the O3 precursors, NOx and VOCs, can O3 be reduced. However, since
these precursors result from the production, transportation, and burning of
fossil fuels (especially petroleum-based fuels), there is great resistance, on eco-
nomic grounds, to taking steps to control this pollutant in most jurisdictions.
The problem is compounded by the fact that O3 and its precursors can be
transported hundreds of kilometres, leaving control strategies in the hands of
extra-jurisdictional agencies.

Nitrogen Dioxide (NO 2)

Although there have been many studies of the effects of NO2 on health, many
of these have been cohort studies examining health outcomes, particularly in
children, measured in terms of respiratory symptoms or pulmonary function
change. Both NO2 and CO are pollutants which have major indoor sources
from gas cooking stoves, non-electric portable space heaters and cigarette smok-
ing. As a result, there are few studies in the literature which have shown a statis-
tically-significant association with hospital admissions or mortality. However, a
recent Canadian study found that an increase of 80 µg/m3 in NO2, lead to an
average increase in mortality of 4.6 per cent.60 The APHEA study in London
determined a 1.14 per cent increase in hospital admissions for respiratory illness
associated with a 92 µg/m3 increase in NO2.61 The study from Barcelona found
a 3.4 per cent increase in mortality when NO2 increased by 100 µg/m3.

Sulphur Dioxide (SO 2)

Exposure to SO2 leads to eye irritation, shortness of breath and impaired
lung function When inhaled, SO2 stays in the nose, mouth and trachea (upper
 TAKING OUR BREATH A WAY 23
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respiratory tract), but some penetrates deeper during physical activity. The Ontario Smog
Combined with water, SO2 converts to sulfuric acid, which is highly irritating
to the sensitive mucosal surface lining of the respiratory tract. Prolonged or Plan Workgroup
repeated exposure causes chronic inflammatory changes. Persons with asthma has estimated
experience attacks of wheezing (bronchoconstriction) from exposure over about
0.25 ppm (parts per million). that in Ontario,
Sulphur dioxide was identified as a hazardous air pollutant in 1952 after it approximately
was linked to a severe smog episode in London, England that resulted in 4,000
deaths. From the 1950s to the 1960s, there were many studies which explored 1,800 premature
the role of SO2 and particles in the air as air pollutants associated with adverse
health outcomes. Based on these studies, steps were taken to regulate emissions
deaths and
and reduce levels of these two pollutants. These steps were quite successful in 1,400 hospital
lowering the levels of both SO2 and the coarser fraction of suspended particles.
By the mid-1960s attention in North America was turning towards the grow-
admissions per
ing problem of O3, or “photochemical smog.” The growth of automobile traffic year are due
in North America, had increased concentrations of ground-level O3, especially
in the summer months, and it was clear that adverse health effects were also to the effects
attributable to this pollutant. Less attention was paid to the health effects of of inhalable
SO2, and there was no change in the SO2 standards from those based on 1950s
and 1960s research. Today, attention has once again focused on SO2, particu- particles.
larly because of its association with SO4 (particulate sulphate). Emitted from
fossil fuel combustion and formed when SO2 breaks down in the atmosphere,
SO4 has been shown in a number of studies to increase mortality and hospitali-
zation in persons with cardio-respiratory disease.
Although ambient concentrations of SO2 have greatly decreased during
the last 30 years in many regions, it is apparent from the APHEA project, and
others, that SO2 continues to be a problem. In 10 of the 11 APHEA studies,
SO2 at ambient levels was shown to have adverse health effects. In 7 of the 8
studies where premature mortality was examined, significant associations were
found with daily levels of SO2, and in all 5 studies where hospital admission was
examined, significant associations were found with SO2 levels. We may con-
clude from the APHEA studies that there is good evidence that a change in the
24 hr level of SO2 from 10 µg/m3 to 60 µg/m3 would be associated with a 3 per
cent increase in total daily mortality, a 4 per cent increase in cardiac and respira-
tory mortality, and a 2 per cent increase in daily respiratory hospital admissions.
The highest median levels of 24 hour SO2 observed in the APHEA project
were recorded in Milan, Italy and Cracow, Poland (66, and 74 µg/m3) and the
lowest was observed in Paris, France (23). It should be noted that the Canadian
Ambient Air Quality Objectives have set the maximum acceptable SO2 level at
220 µg/m3, far greater than the highest median levels observed in the cities
studied – levels which were associated with significant increases in hospital
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Hamilton Air Quality admissions and premature mortality. One can conclude that a more stringent
Over a year, if current levels of Canadian standard should be determined, as it is likely that SO2 from the burn-
particulate matter were slightly ing of fossil fuels is also having a negative impact on the health of Canadians.
increased, this would mean an ad-
ditional 92 deaths, 74 hospital Airborne Particulates
admissions, 3,128 emergency room Evidence from animal studies and occupational exposure to a variety of aerosols
admissions, 37,444 asthma days, have found that these small particles themselves may be toxic. In addition to
559,820 reduced activity days toxicity, the amount inhaled may overwhelm the natural human defense mecha-
and 1,735,488 acute respiratory nisms for clearing unwanted substances from the airways, causing breathlessness
symptoms. and in severe acute cases, death.
: Regional Municipality of Hamilton- Increases in particulate matter also correlate to increased time off work and
Wentworth
school, and increased emergency room visits. The health effects that are most
closely related to particulate levels are premature mortality, increased hospital
admissions for respiratory disease, asthma attacks and respiratory symptoms.62
It must also be noted that, while studies provide an understanding of the
specific impacts on respiratory systems due to high concentrations of particulate
matter, they do not explain the adverse effects which have been identified in
epidemiological studies where concentrations of particulate matter are orders of
magnitude lower. Although there are a number of hypotheses, there is no cur-
rently-accepted general understanding of the mechanisms of action by which
fine particles at ambient concentrations exert the health effects found in the
general population.
The strongest association, and that to which the greatest economic conse-
quences are ascribed, is between exposure to ambient fine particles (PM2.5) and
mortality, either total or cause-specific.63 While relatively few studies have
measured particulate pollution using the PM10 measurement system, with the
exception of the studies of Pope et al. in Utah, it is generally agreed that the “fine
fraction” of particles (PM2.5 and perhaps smaller) have the most harmful conse-
quences to health.64 Sulphate particles (SO4), for example, are typically smaller
than 1 µm in size and have been linked to increased hospital admissions and
deaths.65 In Canada, particulate sulfate levels correlated closely with urban
hospital admissions for both cardiac and respiratory disease during the period
1983-1988. For all age groups there was a statistically-significant increase in
respiratory admissions (of 3.7 per cent) and in cardiac admissions (of 2.8 per
cent) when a 13 µg/m3 increase in sulfates was recorded on the day prior
to admission.
A 1997 Canadian report attempted to link the associations between mortal-
ity and acute sulphate exposure, with those between mortality and chronic
sulphate exposure.66 This was possible in light of the very strong evidence put
forward by Pope et al., which developed a 7.5 per cent health outcome change
per 10 µg/m3 increase in SO4.67 While many studies focus on immediate meas-
urable health effects one day after episodes of high pollution, the Pope study
 TAKING OUR BREATH A WAY 25
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concentrated to long-term exposures. What was found was that there is a cumu- “Even for healthy
lative, chronic effect that is actually worse than acute, short-term effects, which
had already been found to cause considerable damage. There is also new people, long-term
evidence that current ambient levels of PM10 are associated with increases in exposure [to air
daily cardiorespiratory mortality and in total mortality.68
pollution] is
Carbon Monoxide (CO)
associated with
Carbon monoxide has long been recognized as a pollutant with adverse health
effects, and in moderate concentrations it is lethal. The toxic effect mechanism decreased lung
of carbon monoxide (CO) is well known. Carbon monoxide binds more tightly
to hemoglobin than oxygen, so when it is inhaled, it rather than oxygen is ab-
function and
sorbed by red blood cells. Consequently the body’s tissues are starved of oxygen. increased
Organs with the greatest oxygen demand, the heart and brain, are most affected.
The amount of carbon monoxide that has been absorbed can be measured by
mortality.”
the amount of bound hemoglobin (carboxyhemoglobin). Small amounts of Dr. John Gray, Past-President,
carboxyhemoglobin are associated with headache, drowsiness and cardiac Ontario Medical Association,
arrhythmias. Higher levels cause coma and death. Levels high enough to cause August, 1998
these effects usually occur indoors due to malfunctions in appliances such as
gas furnaces and non-electric space heaters. The long term effects of low level
exposures are not well documented.
Carbon monoxide can be measured in the exhaled air of heavy (2 pack per
day) smokers at concentrations from 58 to 87 mg/m3. The industrial threshold
limit value for an 8 hour day is 58 mg/m3. There are many indoor sources of
CO, such as gas cooking stoves, portable non-electric space heaters and cigarette
smoking. Since the introduction in the 1970s of catalytic converters on auto-
mobiles and light trucks, urban levels of CO have dropped substantially, and
until recently it was thought that CO was no longer a pollutant problem. This
has changed within the last two years.
There are three important recent papers relating exposure to CO to hospi-
talization for congestive heart failure in patients over 65 years of age: Morris
et al. (1995), Schwartz and Morris (1995), and Burnett et al.(1997). The Schwartz
and Morris paper (covering 7 cities) expanded on the earlier paper, which exam-
ined only Detroit, Michigan. The very recent Burnett paper is of particular
interest because the data was obtained from 10 Canadian cities, one of them
Hamilton, and in general, the burden of illness associated with CO estimated by
Burnett et al. for Hamilton is similar to that found by Morris and Schwartz in
several US cities.69 The studies found that, on average, an 11.6 mg/m3 increase
in CO was associated with a 25 per cent increase in hospitalization for elderly
patients with congestive heart disease.
Current data on premature mortality and CO exposure includes that from
the APHEA study in Athens, as well as the recent study on “pollutant mix” by
Burnett et al. (1998), referred to in the following section. In the Athens study,
26 C L I M A T E O F C H A N G E
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there was a 1 per cent increase in risk of premature mortality associated with a
CO increase of 1.16 mg/m3 .70

Synergistic effects
A recent study by Burnett et al. indicates that with the use of the appropriate
statistical tools, it is possible to show from data in Canadian cities that these
pollutants, have a substantial impact on non-traumatic mortality. Their analysis
of data from 1980-1991 in 11 Canadian cities showed the relative effect of dif-
ferent air pollutants on premature mortality. NO2 increased the risk the most
(5.3 per cent), followed by CO (2.5 per cent) SO2 (1.8 per cent) and O3 (1.4 per
cent). In total the study revealed that approximately 5,000 people per year died
prematurely as a result of air pollution in the 11 cities studied.
The Burnett paper demonstrates that when gaseous pollutants are consid-
ered in the analysis along with particulates, reductions in fossil-fuel emissions,
especially from sulphur-containing fuels, would lead to reductions in health ef-
fects an order of magnitude greater than previously estimated. They concluded
The number of that approximately 8 per cent of all non-traumatic mortality in Canadian cities
is attributable to ambient air pollution generated from the combustion of fossil
deaths will likely fuels.71 In other words, the combination of pollutants discussed in this section is
increase in the likely responsible for 1 of every 12 non-accidental deaths in Canada. Further,
the number of these deaths will likely increase in the future as air pollution
future as air worsens due to increased fossil fuel use and global warming.
pollution worsens In addition to synergistic effects, current evidence suggests that, for most of
the fossil fuel-related pollutants (O3, CO, SO2, NO2, PM10, PM2.5, sulphates,
due to increased etc.) there is no “safe” level or “threshold.” That is, there is no level below which
there are no adverse health outcomes. This implies that though there may be
fossil fuel use dramatic episodes of mortality and morbidity associated with “peaks” of bad
and global pollution, some people are quietly being admitted to hospital or dying when air
pollution is at lower levels as well. In fact, data suggest that the greatest public
warming. health impact in terms of numbers occurs on “non-alert” days. In terms of im-
provement, every little bit of reduction helps. Every litre of gasoline not used
and every tonne of coal not burned will help improve our health.
While this report has endeavored to explore the complex relationship
between air pollution, fossil fuel consumption and global warming, only a
sampling of the true associated health costs have been discussed. Fossil fuel
combustion also results in the emission of many other hazardous air pollutants
including heavy metals, complex organic compounds and radioactive material.
These materials accumulate in the environment and can be ingested through
breathing air, drinking water and eating food. Many have been linked to cancer.
Policies aimed at reducing fossil fuel use would also result in fewer emissions of
these hazardous air pollutants.
 TAKING OUR BREATH A WAY 27
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Populations at Risk
As with many other situations, the most vulnerable populations are children,
the elderly, and those with underlying illness, particularly heart and lung dis-
eases, like asthma. Between 5 and 8 per cent of Canadians are asthmatics. Across
the country, that translates roughly to the population of Vancouver, and the
number of people suffering from the disease is on the rise. In addition to these
physiological factors, there is an association between poverty and vulnerability
to air pollution. Some of the risks are demonstrated in the previously-mentioned
studies of cardio-respiratory disease and air pollution.

W H AT FAC T O R S M A K E C H I L D R E N
MORE VULNERABLE?
Children are physiologically and anatomically at greater risk to air pollution
than are adults.72 Children’s lungs are not fully developed at birth, and the sur-
face area grows rapidly from 3 square metres at birth to 75 square metres by
adulthood. Most of the branching into bronchioles is completed in early fetal
life, but the alveolar development continues into late childhood. This growing
tissue is more sensitive to noxious stimuli. Children breathe in and out more
rapidly than adults: every minute they exchange more air per kilogram of body
weight than most adults. The minute volume is 0.20 L/min/kg for a newborn,
0.39 L/min/kg for an infant of 1 year, 0.43 for a 10 year old. This compares to
0.36 for an adult woman, and 0.33 for an adult man.73 Children may also be
more active out of doors at times when the photochemical and acidic aerosol
pollution reaches a daily maximum.
Many studies indicate that exposures to both indoor and outdoor air pollu-
tion increase respiratory illness in children. Specifically, some research indicates
that the increase in hospital admissions for children with asthma in recent years Hospitalization
is directly related to worsening air pollution.74 Canadian children spend about
90 per cent of their time indoors, 5 per cent in vehicles and 5 per cent outdoors.
of young children
However, studies show that outdoor air pollutants, such as sulphate, readily in Canada for
penetrate indoors, increasing exposure times and elevating health risks.75
Children with diagnosed or suspected asthma are also considered to be at high- asthma increased
est risk of experiencing short term and/or longer term adverse health effects. by 28 per cent
Hospitalization of young children in Canada for asthma increased by 28 per
cent among boys and 18 per cent among girls between 1980-81 and 1989-90.76 among boys and
In other words, since 1980, either more children have experienced asthma
attacks requiring hospitalization, or those children with asthma had more
18 per cent
frequent hospitalizations for an exacerbation. among girls
Very young children are also not as able as adults to get rid of toxic
substances. Toxic substances that enter the body through the respiratory or between 1980-81
and 1989-90.
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digestive system, are excreted through the kidney and/or liver. In addition, the
body protects other organs, in particular the brain, from adverse effects. The
blood brain barrier begins to develop in the fetus but is only fully effective by
about age 5 to 6 months. Renal (kidney) excretion and hepatic (liver) excretion
reaches adult capacity at about 16 months.77

P OV E R T Y, A N D OT H E R S O C I A L FAC T O R S
T H AT I N C R E A S E R I S K
Canada has one of the highest child poverty rates in the developed world, and
the rate of child poverty has increased by 45 per cent in Canada since 1989.
Today, there are approximately 1.5 million children living in poverty in Canada,
and these children are at additional risk from the effects of air pollution and
other environmental contaminants.78 In the last 10 years, foodbanks have
The fact that increased their capacity by about 50 per cent, largely because of the needs of
Canadian children. Low income children are almost twice as likely to be born
children, with low birthweight, and to die within 30 days. Unfortunately, poor health
especially poor continues beyond early childhood, with a greater incidence of bronchitis and
asthma among other conditions.
children, are Related social factors add to the burden experienced by children living
often the most in poverty. They are more likely to grow up in neighbourhoods adjacent to
polluting industries, heavily used transportation corridors and sites previously
vulnerable to the used for toxic waste disposal. They are also more likely to be exposed to multiple
contaminants that make them more vulnerable to the adverse effects of air
risks posed by air pollution. These risks include: living in improperly designed and maintained
pollution should buildings; exposure to cigarette smoke; and poor nutritional status. There are
many barriers to improvement for people in high-risk groups. Poor parents
act as a strong often have little or no political or economic power and therefore are unable to
stimulus to those improve their environment or living conditions. They may also have reduced
access to information on the health impacts of environmental contaminants.
shaping public U.S. studies from the environmental justice movement have drawn many links
policy. of this nature between social economic and environmental issues. The fact
that children, especially poor children, are often the most vulnerable to the
risks posed by air pollution should act as a strong stimulus to those shaping
public policy.

W H O M O N I TO R S T H E S E P O L L U TA N TS ?
Several pollutants are routinely measured continuously by monitoring stations
operated by federal and provincial agencies. Since 1969 in Canada, the follow-
ing pollutants have been monitored systematically: sulphur dioxide; carbon
monoxide; nitrogen dioxide; total suspended particulates; ground level ozone;
and reduced sulphur compounds. Each province measures the pollutant over a
 TAKING OUR BREATH A WAY 29
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standard time, e.g., 1 hour, 8 hours, 24 hours. The Air Quality Index, a scale
from 0 to 100, is then used to translate each different readings to one of five
levels. Values over 50 exceed allowable safe concentrations.
Generally, air quality is regulated under federal and provincial legislation.
Federal legislation regulates the following vehicle emissions through the Motor
Vehicle Safety Act: CO, NOx, hydrocarbons, and diesel particulates. There
are National Ambient Air Quality Objectives for all the pollutants that are
monitored, except reduced sulphur compounds. These objectives establish the
maximum desirable level (long term goal), maximum acceptable levels and
maximum tolerable level. If measurements exceed the maximum tolerable level,
appropriate action may be undertaken by provincial and/or federal authorities.
The method, sampling time and frequency, and averaging time for pollut-
ants differ, depending on the type of pollutant and the purpose of monitoring.
In general, gaseous pollutants are measured continuously, and particulates are
measured intermittently, but at regular intervals. Most particulate measurements
(total suspended particulate and PM10) are measured with a 24 hour sampling
period every six days, on a cycle which is synchronous throughout North America
( North American Synoptic 6-day Cycle). In Ontario, coefficient of haze, a
particulate measure, is measured continuously using a 1 hour sampling period.
Continuous samplers can have their data transmitted from the sampling site to
a central location, but this cannot be done with the samplers operating on the
six day cycle.
Data may be reported directly as a concentration of the pollutant measured
(e.g. in parts per million or parts per billion, or as micrograms per cubic metre).
Alternatively, data from different pollutants can be combined as an Index,
such as the Federal Index of the Quality of the Air (IQUA), or the Ontario Air
Pollution Index (API) or the Air Quality Index (AQI). While the API is health-
based, neither the IQUA or AQI are based on health effects. Their purpose is to
communicate to the public which pollutant is worse with reference to its own
criterion at a given time, and to provide a basis for examination of trends.
 C L I M A T E O F C H A N G E

Trends for the future

O    , C        

world and the second largest producer of greenhouse gases. With a population
Wood waste,
of less than 30 million, we use as much energy as the entire continent of
pulp liquor
and firewood
Africa, home to 700 million people79, and contribute 2 per cent of overall
5.8% global emissions.
Electricity
20.9% Petroleum
Petroleum, natural gas and coal, which contain varying concentrations of
36.4% energy and carbon, are the major sources of Canada’s contribution to global
warming and climate change. In terms of fossil fuel use, Canada is second only
to the United States in per capita consumption.
Various rationales are put forward to explain Canada’s high level of fossil fuel
Coal
11%
use including: lifestyle choices; a cold climate; long distances between popula-
tion centres; and over-dependence on energy-intensive industries such as min-
Natural gas
25.9% eral smelting, natural gas processing, petroleum refining, and pulp and paper
Total energy consumption production. Even taking these factors into consideration, Canadians have a large
15,332 petajoules
appetite for energy and current projections indicate that our greenhouse gas
FIGURE 8. CANADIAN emissions will continue to increase.
PETAJOULE CONSUMPTION, In 1996, fossil fuels made up 73 per cent of Canada’s total energy consump-
1996 80 tion. Since 1990, Canada’s greenhouse gas emissions have increased by 12
: Natural Resouces Canada per cent, going from 599 megatonnes to 670 megatonnes. It is anticipated
that without significant changes in the production and consumption of energy,
Canada’s emissions will be 36 per cent higher by 2020.81 Projections for world-
wide fossil fuel use indicate that this level of growth is far greater than other
industrialized countries.
A number of credible organizations have completed international assessments
projecting world wide fossil fuel use over the next 30 years. These include the
Intergovernmental Panel on Climate Change, the U.S. Energy Information
Administration and the World Energy Council. In an effort to project the
impacts on public health, the World Resources Institute produced an average
forecast, based on these sources, and concluded that total fossil fuel use by
 TAKING OUR BREATH A WAY 31
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the developed nations is expected to continue to increase by 14 per cent from

1990 to 2020.82
Looking at these trends, we can only conclude that Canada will continue
to be one of the world’s largest per capita energy consumers. As a result, air
In spite of efforts
pollution will grow and become a far greater problem for the vast majority of to implement
Canadians.
pollution
Trends in Air Pollution reduction
As a result of increased automobile fuel efficiency and pollution control technol- technology in
ogy, there were significant improvements in air quality between 1970 and 1985. Canada, there
However, during the past decade, these improvements have begun to erode due
to increasing numbers of automobiles and a trend towards larger, less fuel-efficient is not expected
vehicles such as vans, trucks and Sport Utility Vehicles (SUVs). Automobile
ownership in Canada has increased from 310 vehicles per 1,000 people in 1970
to be any
to 484 per 1,000 in 1994.83 In 1980, purchases of vans, trucks, SUVs and improvement
commercial vehicles made up 26 per cent of new vehicle purchases. Today these
heavier vehicles comprise 48 per cent of new purchases.84 As a result of these in total NOx and
trends, during the past decade there have been little or no improvements in the VOC emissions,
ambient concentrations of O3 and fine particulate, and in some regions average
concentrations have increased. At the same time, CO2 emissions have risen the components
substantially. of smog which
In spite of efforts to implement pollution reduction technology in Canada,
there is not expected to be any improvement in total NOx and VOC emissions, create ground
the components of smog which create ground level ozone, by 2010. NOx emis-
sions are projected to remain constant at 2 million tonnes, while VOC emis-
level ozone,
sions will increase from 2.5 million tonnes in 1990 to 3 million tonnes in 2010.85 by 2010.
There are very few projections available for particulates in Canada; however,
forecasts for the Vancouver region indicate that, without significant interven-
tion, PM2.5 emissions will increase by 65 per cent and PM10 emissions will
increase by 57 per cent during the next 25 years.86 Due to the make up of the
inventory sources, similar results may be derived for other large urban areas
in Canada.
As noted earlier, in addition to more air pollution resulting from increased
use of fossil fuels, climate change itself will facilitate the formation of secondary
air pollutants, notably O3 and organic aerosols formed from evaporated hydro-
carbons (VOCs). The illness and death associated with these compounds will
continue to be significant since areas in Canada with the largest air pollution
problems are also the most populous. O3 and particulate levels are currently
highest in the Windsor-Quebec corridor, the Lower Fraser Valley, and several
parts of the Atlantic Provinces such as, St. John, New Brunswick, and Halifax
and Sydney, Nova Scotia.
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Trends in Morbidity and Mortality

Related to Air Quality
Air pollution has a significant impact on the health of Canadians. The Canadian
government estimates that up to 16,000 premature deaths per year are associ-
ated with ambient air pollution in Canada.87 Specific regional studies aimed at
The Canadian quantifying the benefits of reductions in air pollution provide a further indica-
tion of the scope of health effects arising from increased fossil fuel use. In the
government 1996 Smog Plan for Ontario, the Ontario Ministry of Energy and Environment
estimates that estimated that NOx would increase to 933,000 tonnes and VOCs would in-
crease to 1.2 million tonnes by 2015. By reducing these emissions by 45
up to 16,000 per cent, approximately 173 premature deaths would be avoided every year.
premature deaths Hospital admissions, adult chronic bronchitis and symptom days would be even
more dramatically affected. In 1994, the Greater Vancouver Regional District
per year are completed an analysis of its air quality initiatives and found that strategies to
reduce air emissions of particulate matter by 9,400 tonnes per year (from 37,431
associated with to 28,013 tonnes) averted 2,757 premature deaths over 30 years and avoided
ambient air over 33,000 emergency room visits.88
Further studies looking at global mortality trends indicate that by 2020,
pollution 700,000 premature deaths a year could be prevented as a result of decreased air
in Canada. pollution if climate change policies were implemented. Of these, 140,000 would
be in developed nations, and 563,000 would be in the developing nations.89
In Canada, several studies have estimated the financial value of reducing the
human health effects of specific air pollutants. One of the more recent estimates
looked at the health benefits arising from lowering the amount of sulphur found
in gasoline and diesel fuel to reduce ambient air pollution levels. By reducing
this one contaminant, pollutant levels of fine particulate matter and acid gases
would be reduced. Economists estimated that the health benefits due to improv-
ing the ambient air quality in Canada amount to $8 billion over 20 years.90
Another study completed for the Canadian Council of Ministers of the Envi-
ronment estimated that reductions in motor vehicle emissions of particles, NOx,
VOCs, air toxics, and benzene, could produce benefits ranging from $11 to $30
billion over a 24-year period.91
Even greater health and economic benefits would accrue to the public as a
result of greenhouse gas mitigation efforts aimed at reducing fossil fuel combus-
tion in Canada. By reducing the combustion of fossil fuel, emissions of SOx,
particulate, NOx, VOCs, air toxics and ozone and greenhouse gases are reduced.
Model simulations for the 1995 Climate Action Network greenhouse gas man-
agement plan estimated that as a result of reducing CO2 emissions by 147 MT
in 2010, emissions of SOx would be reduced by 376 kilotonnes (24 per cent),
VOCs by 135 kilotonnes (13 per cent )and NOx by 281 kilotonnes (16 per
 TAKING OUR BREATH A WAY 33
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cent) respectively by 2010.92 Since each of these emissions contributes to the

formation of fine particulate (PM2.5) in the form of acid and organic aerosols,
significant human health impacts would be avoided. In fact, some preliminary
U.S. analyses indicate that, in the short term, the health benefits arising out of
reduced air pollution, notably aerosol particulate and ground level ozone, may
be equal to or greater than those attributable to reduced greenhouse gas im-
pacts.93
The magnitude of these benefits is confirmed by the results of an economic
evaluation of the health impacts from fossil fuel combustion in China. The 1997
World Bank study, Clear Water, Blue Skies: China’s Environment in the New
Century, outlined the potential health costs related solely to particulate expo-
sure. If there is no change in the rates of consumption of fossil fuels, the costs are
expected to rise from $32 billion in 1995 to $390 billion in 2020 (adjusted for Economists
rise in income). This includes 600,000 premature deaths, 5.5 million cases of
chronic bronchitis, 5 billion restricted activity days and 20 million cases of estimated that
respiratory illness annually. In 2020, 20 per cent of the world’s people will live in the health
China, given mid range population projections.94 The World Bank study confirms
the theme of this paper and provides a perfect example of the true costs of fossil benefits due to
fuel combustion. When these costs are combined with the full potential costs of improving the
effects from climate change, the need for effective fossil fuel reduction policies
becomes even more urgent. ambient air
quality in Canada
amount to
$8 billion
over 20 years.
C L I M A T E O F C H A N G E

The need for action

T ,    ,     

combustion of fossil fuels must be addressed immediately so as to improve the
The decisions health of the current generation and reduce the impact of air pollution and
climate change on the health of those to follow.
taken by The World Health Organization has defined health as,
decision-makers The extent to which an individual or a group is able to realize aspirations
on fossil fuel and satisfy needs, and to change or cope with the environment. Health is
a resource for everyday life, not the objective of living; it is a positive
usage can have concept, emphasizing social and personal resources as well as physical
capabilities.
powerful effects
Health is often seen as the product of personal lifestyle choices, such as diet,
on personal exercise or smoking. In popular culture, advertising, and in posters on the walls
health, over and of doctors’ offices, we are challenged as individuals to make choices with our
long-term health in mind. However, this report has shown that the decisions
above lifestyle taken by decision-makers on fossil fuel usage can have powerful effects on per-
decisions. sonal health, over and above lifestyle decisions. To meet this challenge we must
act as a society in the same way we urge individuals to act. Past experience tells
us that if we act as a whole, we can overcome tremendous obstacles. For exam-
ple, two formidable challenges to public health have been the control of diseases
due to polluted water and due to cigarette smoking. The lessons learned from
the sanitary revolution in the second half of the 19th century, and tobacco con-
trol programs in the latter half of the 20th century, are salutary in this regard.
The tobacco story illustrates the nature of the challenge, and the responses it
has elicited. For generations, smoking had been accepted, even praised for its
apparent benefits. The tobacco industry aggressively promoted tobacco as a
fashionably benign, if not healthy, amenity. Our culture was permeated with
features designed to make life easier for smokers. Children were, at most, gently
 TAKING OUR BREATH A WAY 35
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discouraged from starting to smoke too early in life. Ashtrays were found every-
where, and offering and accepting a cigarette was regarded as the correct way to
show friendship when introduced to strangers. This is still the case in many
cultures where there is less awareness and less regulatory control of the tobacco
industry. When the first epidemiological studies demonstrating the relationship
of smoking to lung cancer were published in the early 1950s, the reaction from
politicians and the general public was mainly shock and disbelief. As the knowl-
edge of heart disease risks mounted, as well as many other harmful effects of
tobacco on health, including effects of second-hand and sidestream smoke, aware-
ness of the medical dangers became more widespread. It also became easier
for people to understand and accept the need to do something about this
major public health problem. As attitudes shifted, laws and regulations to
control smoking began to appear on statute books.

Essential steps
The lessons learned from an examination of the approach to tobacco control,
and to several other important health problems, led to the concept of five essen-
tial steps in the process of dealing with any serious public health problem.95
The five essential steps are as follows:
• Awareness that the problem exists
• Some understanding of what causes the problem
• Capability to deal with the cause(s)
• A set of values leading to the belief that the problem is important
• The political will to deal with the problem
The same five steps are necessary to deal with the health effects associated
with fossil fuel combustion. Some are already happening. As a society, we need
to move forward on others, for global climate change and regional air pollution
are probably the greatest health problems of our time.

A WA R E N E S S O F T H E P R O B L E M
A N D U N D E R S TA N D I N G T H E C AU S E
The first two steps of the process involve public education. Right now, there
is growing public awareness of the general problem of environmental deteriora-
tion, and specific aspects of it, including air pollution in some urban Canadian
centres. There is also a common belief that the rising incidence of respiratory
diseases like asthma is somehow related to air pollution. There is growing
but incomplete awareness of the atmospheric changes in concentrations of
greenhouse gases that are inducing climate change, and less understanding that
burning fossil fuels is the source of the problem. There is even less understand-
ing of the health impacts of climate change.
36 C L I M A T E O F C H A N G E
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“All human However, many Canadians are increasingly aware of another environmental
change that is occurring at a global level – stratospheric ozone depletion and the
health is resulting increased UV radiation flux that harms many living things, including
ultimately humans. Awareness of this planet-wide problem should make it a little easier to
explain the complex story of global climate change. The fact that rising tem-
dependent on peratures and the increasing frequency of extreme weather events are among
the health of the consequences of global warming needs to become more widely known.
What also needs to be emphasized in public education are the causes – the
the biosphere. combustion of increasing quantities of fossil fuels, the increase in emissions of
other greenhouse gases (besides CO2) and to a lesser extent, deforestation around
Scientists believe the globe.
that climate Awareness and understanding of climate change and air pollution issues is
increasing in many sectors of the Canadian community. In 1997, more than
change will have 50 major health care associations in Canada signed a Physicians’ Statement on
major, irreversible Climate Change. These groups included the Canadian Lung Association, the
Royal College of Physicians and Surgeons, the Canadian Public Health Associa-
effects on the tion, the Canadian Institute of Child Health and College of Family Physicians
environment of Canada. They publicly recognized that global climate change carries with it
significant health, environmental, economic and social risks, and that preven-
with secondary tive steps are justified. The Ontario Medical Association also added its voice to
the public debate on air pollution and health impacts by producing a compre-
consequences for hensive list of recommendations.96
human health The public’s understanding of the health effects of air pollution has grown
substantially in the last few years. One reason is the commencement of continu-
and well-being ous monitoring of air pollutants under the auspices of the federal National
that could occur Pollution Surveillance (NAPS) program. This program enabled public broad-
casting of smog advisories in cities, which has helped to educate the public on
within a matter the health effects associated with smoggy days. These advisories also include
of decades.” specific, but limited, measures that can be taken to protect oneself and one’s
family from the adverse effects of air pollution. Such advisories are an important
Physicians’ Statement
step, but much more public education and government action on air pollution
of Climate Change signed
and global warming is needed.
by more than 50 organizations
representing health professionals C A PA B I L I T Y T O D E A L W I T H T H E C A U S E S
across Canada OF THE PROBLEM
There are many different ways to deal with the problems of air pollution and
climate change. For example, some aspects of regional air pollution can be tack-
led at the source. Scrubbers in smelter stacks and coal-burning electric power
generators, and catalytic converters in automobile exhaust systems are all
designed to reduce atmospheric concentration of some pollutants.
However, these and similar measures do not attack the root cause – our reli-
ance on fossil fuel as our primary energy source. They also tend to be more
 TAKING OUR BREATH A WAY 37
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expensive and sometimes lead to other problems, such as higher emissions of

CO2. More comprehensive solutions would tackle these causes, steering us
toward lower energy consumption, and replacing fossil fuels with clean energy
sources. Change of this kind is more challenging and must involve all levels of
government, industry and the general public.

T H E B E L I E F, B A S E D O N VA L U E S ,
T H AT S O M E T H I N G H A S TO B E C H A N G E D
The fourth step requires individuals to already have some understanding of
the first three. This crisis is not so much a planetary crisis, as a human crisis.
Canadians must come to understand there is a problem, they must understand
that we are causing the problem, and they must learn that there are solutions
available. If these three conditions are met, then individuals can use their values
to decide if the problem is important enough to justify personal action. A simi-
lar process must take place at the government and industry level.
If individuals and institutions don’t have accurate and credible information
in the first three steps, it is unlikely that they will be able to believe the problem
is important. For example, many people, especially city-dwellers who experience
smog and haze, believe something must be changed, and are helping to generate
the political will that is required to implement the necessary changes. Fewer
people are aware of the extent to which climate change is a problem with very
serious health consequences.

POLITICAL WILL TO DEAL WITH THE PROBLEM “Humanity is

The final step is perhaps the most challenging. As mentioned previously, Canada conducting an
is not controlling its current and projected growth in greenhouse gas emissions.
Are the targets too ambitious? Are the costs of taking action too much for unintended,
Canadians to bear? On both counts the answer is ‘no’.
Canada’s commitments to the climate change issue began in 1988 when the
uncontrolled,
federal government sponsored the Toronto Conference on the changing atmos- globally
phere. Describing climate change as an “uncontrolled experiment” with unknown
consequences, more than 300 policymakers and scientists called for nations
pervasive
to reduce emissions of greenhouse gases to 20 per cent below their 1988 levels experiment
by 2005.97
In 1990, at a preparatory meeting for the Rio Earth Summit, then Environ- whose ultimate
ment Minister Lucien Bouchard committed Canada to stabilize its net emis- consequences
sions of greenhouse gases at 1990 levels by 2000. This political commitment is
the basis for Canada’s domestic National Action Program on Climate Change could be second
(NAPCC) and has been confirmed and re-affirmed at various federal-provincial
meetings of Environment and Energy Ministers since 1993. However, no
only to global
substantial action has taken place. In 1996, Ministers publicly stated for the first nuclear war.”
time that Canada would not be able to meet its commitment. “The Changing Atmosphere”
Conference, Toronto, 1988
38 C L I M A T E O F C H A N G E
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When the UN Framework Convention on Climate Change (UN FCCC)

was opened for signature at the 1992 Earth Summit in Rio, Canada was one of
the first countries to sign and ratify. The Convention required industrialized
countries to return greenhouse gas emissions to 1990 levels by the year 2000,
but was not a legally-binding agreement. In 1995, at the first meeting of the
Conference of the Parties to the Framework Convention in Berlin, it was agreed
An effective that these commitments were inadequate to meet the overall objectives of the
Convention to:
greenhouse gas
[S]tabilize greenhouse gas concentrations in the atmosphere at a level that
emissions would prevent dangerous anthropogenic (human made) interference with
reduction plan the climate system.98

would not only The parties to the Convention agreed to work towards negotiating a proto-
col that, not only specified targets, but was also legally-binding. In December
slow and reduce 1997, the Kyoto Protocol to the Framework Convention on Climate Change
was signed by Canada and adopted by more than 160 nations. This is the first
the damage from “legally-binding” international agreement that attempts to reduce the threat of
climate change, global climate change. It is an important first step in the decades-long interna-
tional effort to prevent serious global warming, but a number of issues must
it would also still be addressed if the Protocol is to produce real reductions in emissions. The
have other Protocol calls for an overall global reduction of 5.2 per cent below 1990 levels by
2012. Canada agreed to a target of a 6 per cent reduction from 1990 levels. In
positive comparison, the U.S. agreed to a 7 per cent reduction. This commitment is a
economic effects clear signal to provincial governments, industry and the public that Canada
must begin to implement measures to meet that target.
from an It must be kept in mind that these targets arise from political negotiations –
they do not reflect what the science is telling us. In order to reduce and stabilize
environmental atmospheric concentrations of greenhouse gases at 1990 levels, the IPCC scientific
and human panel has concluded that emission reductions of 60-80 per cent of current
global output are required.99 This reduction is necessary to avoid serious envi-
health ronmental, economic, and health consequences of climate change.
standpoint. There are many strategies and tactics that could start to accomplish the
necessary reductions today. An effective greenhouse gas emissions reduction plan
would not only slow and reduce the damage from climate change, it would also
have other positive economic effects from an environmental and human health
standpoint.
While it is clear that reduced fossil fuel usage will affect some sectors of the
economy, independent studies show that overall, there will be little overall eco-
nomic impact (see box below). Reduced growth in some areas will be offset by
gains in others. Many studies point out the benefits of “no regrets” options to
reduce greenhouse gas emissions. In other words, there are many options where
the economic benefits are equal to or greater than the costs of reduction.
 TAKING OUR BREATH A WAY 39
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Economic benefits
• The IPCC report says energy efficiency can be improved by 10 to 30
per cent at no net cost. Reductions of 50 to 60 per cent may be possible
if appropriate technologies and financing are available.100

• In 1997, over 2,800 North American economists, including 300

Canadians, signed a statement acknowledging that many potential
policies exist to reduce emissions for which the total benefits far
outweigh the total costs.101
• A recent report by the Union of Concerned Scientists (UCS) and the
Tellus Institute demonstrates the economic feasibility and affordability
of meeting the Kyoto target through the implementation of domestic
sustainable energy policies.102

In addition, the studies urging “business as usual” ignore the multiple benefits
of reducing emissions, including health improvements.
Clearly, logic supports action to reduce greenhouse gas emissions. But the
complexity of the issue, its long-term nature and strong resistance to change has
meant little action has taken place by governments and industry.

Following through on Canada’s international role

Once looked to as a leader in international environmental diplomacy, Canada’s
performance in recent years has brought into question its commitment to fol-
low through on the promises it has made. Canada has taken a world leadership
role in many important issues of our time, such as international peace-keeping
and eradication of land mines. Canadians were leading figures in the Rio
Summit, and the first international agreement to control ozone-depleting
substances was the Montreal Protocol.
Yet in Kyoto, and at subsequent climate change negotiating meetings, Canada
supported a position of unrestricted international trading of greenhouse gas
emissions. This would mean few reduction activities would occur in Canada,
with few of the benefits as well. These flexibility mechanisms included in the
Kyoto Protocol are poorly defined and still have the potential to be major loop-
holes that would allow industrialized countries like Canada to increase their
emissions of greenhouse gases without offsetting decreases in emissions else-
where in the world. There are many benefits to reducing emissions at home,
including reductions of other air pollutants, improving the health of Canadians
and their communities, ensuring Canada remains competitive in a more energy-
40 C L I M A T E O F C H A N G E
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efficient and less carbon-intensive international economy, providing incentives

for the development of new technologies that will help reduce Canada’s
emissions further, and regaining international credibility. This November,
parties to the Kyoto Protocol will meet in Argentina to continue negotiations.
Canada’s environmental reputation is suffering at home as well as at an inter-
national level due to our failure to keep our commitment to reduce greenhouse
gas emissions, the weakening of federal environmental and health protection
legislation, failure to enact endangered species legislation, and other recent policy
changes. In May, 1998, the federal Commissioner of the Environment and
Sustainable Development, Brian Emmett, tabled his second annual report.
“The government The report condemns the federal government’s failure to protect the environ-
ment, and is particularly critical of Ottawa’s record on climate change. The
is not keeping Commissioner noted:
the promises it The current approach, with its heavy emphasis on voluntary measures, is
makes both to not sufficient to deal with the problem...The government is not keeping
the promises it makes both to Canadians and to the world...To date, most
Canadians and to of the debate in Canada has been focused on the pace and on the costs of
action to reduce greenhouse gas emissions. Less effort has been directed
the world
toward taking advantage of the opportunities in responding to climate
... If the change and the admittedly more difficult question of the costs of not
taking action...Vision and leadership are two essential ingredients for
performance of tackling environmental challenges that face a government. If the perform-
the government ance of the government of Canada does not improve, the environment
and the health of Canadians will be damaged.
of Canada does
In the field of global environmental sustainability, Canada has had an inter-
not improve, the national image as a leader and trend-setter. We must return to this position of
environment and global leader. We have a long way to go to meet this challenge, but Canadians
expect and support actions to meet our international obligations. For this to
the health of change, governments have to learn to recognize the politically acceptable
win-win opportunities associated with a proactive stance on climate change,
Canadians will opportunities that work for the health of Canadians and the domestic economy,
be damaged.” as well as the global atmosphere.
Brian Emmett,
Federal Commissioner of the
Environment and Sustainable
Development, May 1998
C L I M A T E O F C H A N G E

Recommendations for change

M            .
The combustion of fossil fuels which threatens the earth’s climate also damages
human health today. Strategies to reduce all air pollutants at their source
will have a far greater impact on health than strategies targeting particulate
matter alone.
Following the Kyoto Climate Change Meeting, the David Suzuki Founda-
tion and the Pembina Institute for Appropriate Development created a plan of
action to allow Canada to close the widening gap between our Kyoto obliga-
tions and “business as usual” emission levels. Canadian Solutions – Meeting our
Kyoto Commitment: Climate Action Basics for Canada sets out practical and effec-
tive measures that governments and industries can and should take to reduce
Much of the Canada’s greenhouse gas emissions. The plan contains detailed implementation
strategies and estimates of the economic and environmental benefits of taking
debate over action. It is the first Canadian study to show how Canada can meet its Kyoto
target.
global climate To reduce Canada’s greenhouse gas emissions requires three major types of
policy is missing action:
• improving energy efficiency, including conservation, in order to reduce
one basic point. fossil fuel usage;
The combustion • shifting from high carbon fossil fuels (e.g., coal) to less carbon intensive
fossil fuels (e.g., natural gas) as a transition strategy, and
of fossil fuels • increasing our use of renewable energy sources (e.g., wind, solar,
which threatens biomass).103
Actions to reduce greenhouse gas emissions do more than help in the fight
the earth’s against climate change. Significant public health benefits would include fewer
premature deaths due to poor air quality and a decrease in the aggravation of
climate also respiratory diseases like asthma. Associated health care costs would also be greatly
damages human reduced. Reducing greenhouse gas emissions would also reduce economic losses
health today.
42 C L I M A T E O F C H A N G E
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15 practical and effective steps to begin

reduction of greenhouse gas emissions in
Canada

• Improved and mandatory fuel economy standards for new vehicles

sold in Canada

• Phased increases in gasoline and diesel taxes matched by equal

reductions in other taxes

• Actions to increase urban public transit availability and use

• Mandatory renewable energy content in gasoline

• Ensuring a level playing field for electricity generation, which would

mean a gradual reduction in coal-fired generation

• Adopting a mandatory 8.0 per cent renewable energy quota for

electricity retailers by 2010

• Providing incentives to produce electricity from waste solution gas

in fossil fuel production

• Taking actions to improve energy efficiency in industry

• Mandating the capture of landfill methane gas

• Reducing greenhouse gas emissions from the agricultural sector

• Cost-effective retrofit of residences

• Mandating R-2000 building codes for new homes

• Cost-effective retrofit of commercial buildings

• Providing federal support for localized energy systems particularly

district heating and cooling projects

• Using the Kyoto Protocol’s flexibility mechanisms such as

international emissions trading as supplements to domestic actions
 TAKING OUR BREATH A WAY 43
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in the forest and agricultural sectors, which would result from associated pollu-
tion. Studies indicate that a staggering $11-$30 billion would be saved with
reductions in motor vehicle emissions of particles, NOx, VOCs, air toxics
and benzene.104
Reducing fossil fuel combustion and other emissions of greenhouse gases Studies indicate
also brings more direct economic benefits. Increasing the efficiency of energy
use decreases energy costs for consumers and improves the competitiveness of
that a staggering
Canadian business and industry. In addition, the longer we delay in our efforts $11-$30 billion
to meet the Kyoto commitment, the more dramatic and expensive it will be for
us to take the actions required. Finally, delay means falling behind countries that would be saved
are already taking the necessary steps to become less dependent on fossil fuels with reductions
and more efficient in energy use. Those nations will have greater economic
opportunities as a result. in motor vehicle
Measures such as those included in Canadian Solutions, backed by consistent
and clear policy-making at all levels of Canadian government, will be required if
emissions of
Canada is to meet its environmental, economic and health objectives. These particles, NOx,
15 measures are not a comprehensive list of the actions required to reduce green-
house gas emissions, but, taken together, they constitute a practical, affordable VOCs, air toxics
and effective beginning. and benzene.
At present, federal, provincial and territorial ministers of energy and envi-
ronment meet twice a year to discuss greenhouse gas reduction strategies. This
committee, the Joint Ministers of Energy and Environment (JMM), has the
primary responsibility for implementing the Kyoto Protocol nationally and
provincially. As climate change has the potential to impact all ministries and
responsibilities, other ministers should also be involved. Governments have not
fully appreciated that environmental problems have major health implications.
Health Ministers, responsible for the health of Canadians, must therefore be
involved at the decision-making level on this issue.
Health professionals are also in the front-lines of this issue. They see the
impact of environmental degradation on people’s well-being every day. When
global ecosystems become ill, people become ill. This is not a new concept.
Early in the last century, doctors recognized that contamination of the environ-
ment, in this case drinking water, was causing wide-ranging health problems in
the community. Today, the scale of environmental contamination of air, soil and
water has reached unprecedented global levels, and it is having serious effects
on the health of communities.105 In 1992, the World Health Organization’s
Commission on Health and Environment released a report to world leaders
at the Rio Earth Summit describing how global environmental issues are inextri-
cably linked to the health of the community. The report, Our Planet, Our Health
prescribed that health professionals and organizations must take an active role
in environmental policy to ensure that:
44 C L I M A T E O F C H A N G E
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One of the • governments and institutions develop an awareness of the health implica-
tions of policy decisions
problems climate • health impacts are considered fully when decisions are made
change poses • greater urgency is given to preventing or limiting environmental health
risks in all sectors
from a • governments give higher priority to forming an international consensus on
public health environmental, economic and health issues
• and in the case of climate change, governments give priority to strategies
perspective is that target the energy sector, the main source of greenhouse gases, in order
to control CO2 emissions, focusing particularly on energy efficiency
that some of its measures and the development and use of renewable energy sources.
health hazards One of the problems climate change poses from a public health perspective
is that some of its health hazards entail a scale and time-frame with which the
entail a scale and health sector has had little experience. The conventional concepts of prevention
time-frame with will therefore require some modification. Some effects will not only be more
geographically widespread, but likely to arise indirectly via complex ecosystem
which the health changes. Detecting ecosystem changes that may negatively affect health (for
sector has had example, via vector-borne diseases) will be important.
A further challenge is posed by the time-scale. Many of the adverse health
little experience. impacts of climate change will likely occur gradually over decades. However, it is
also possible that, as a result of “climate surprises,” these impacts could arise
quite suddenly.
Given these considerations, a strong argument can be made for the use of the
precautionary approach. Even if scientists were to obtain full empirical data in
the medium-term future about the health impacts of climate change, this could
be too late for timely and effective intervention. Policy decisions in relation to
climate change need to be taken on the basis of reasonable anticipation based on
the best current scientific evidence. As climate change will affect all sectors of
Canadian society, solutions too must involve each of those sectors. There are
encouraging signs that this issue is being taken seriously by some sectors such
as the insurance industry, the religious community, medical and health care
organizations. All sectors of the business community must recognize that healthy
communities and ecosystems translate to healthy businesses.
As individuals, we also need to take personal responsibility for our own con-
tributions to the problem. Many of the initial actions Canadians can take do not
require radical lifestyle changes. Nonetheless, we also need to start examining
how changing our lifestyle can improve environmental and economic
sustainability, as well as the attractiveness and livability of our communities. We
can use our power as consumers and citizens to send a strong message to corpo-
rations, and to federal, provincial and local governments to do the same.
Another report in the David Suzuki Foundation climate change series Taking
Charge: Personal Initiatives looks in depth at the types of actions individuals and
local communities can take to reduce climate change.
 TAKING OUR BREATH A WAY 45
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Protecting the next generation

As this report has detailed, reducing our dependence on fossil fuels will improve
health and reduce mortality today. In terms of taking action and averting the
serious health effects of climate change, we have a collective responsibility for
the state of our children’s health. Canadian children must not be held ransom to
the environmental, social and economic woes for which they are not responsible
but will inherit unless assertive and strong actions are taken now.
In April, 1998, ministers of environment from the G7 nations, plus Russia,
agreed on a declaration on children’s health. They declared that pollution was
among the most important environmental health threats to children worldwide.
Some specific recommendations stated that:
1 Air pollution must be reduced, particularly pollutants that exacerbate
asthma and other respiratory ailments. Canada and the United States
agreed in January 1998 to work towards a new Annex on transboundary
ozone under the Canada-U.S. Air Quality Agreement.
2 Global climate change negotiations should take into account the special
vulnerability of children, so decisive international action must be taken to
confront the problem of global warming.
3 Environmental threats to children’s health must be set in a larger context
of poverty alleviation and economic and social development.
4 Protection of children’s environmental health should be a high environ-
mental priority and international financial institutions, WHO, UNEP
and other international bodies should continue ongoing activities and give
further attention to children’s environmental health.106
Recent changes in Canadian environmental regulation, and delegation of
authority from federal to provincial departments of the environment is an
unfortunate development from the perspective of health protection. Lowering
environmental standards is in nobody’s long-term interests if it leads, as is likely,
to the deterioration of population health. In striving for and achieving these
goals, Canadian adults and their children will benefit greatly.
 C L I M A T E O F C H A N G E

Conclusion

T         

serious health problems associated with reliance on fossil fuels as the world’s
primary energy source. This reliance is changing our atmosphere and the very
air we breathe. Whether it is through deteriorating air quality at the local or
regional level, or through climate change, humans and ecosystems are at risk.
The evidence cannot be ignored. In order to minimize threats, and reduce present
day health effects, we must act now to curb emissions of pollutants and green-
house gases. This simply will not be possible in any meaningful way without
a reduction in fossil fuel use and a shift to cleaner energy sources and to energy
conservation.
Unfortunately, what should be a medical and scientific challenge has now
become very politicized, obscuring empirical evidence. The key challenge for
Canada to avoid further deterioration in both human health and the stability of
our atmosphere is to accept the scientific and medical evidence, and then to
The key accept the need for immediate changes.
Political efforts to delay or sidetrack that empirical, analytical process will
challenge is to not alter what scientific and medical communities are saying about what the
accept the future will hold if present levels and trends in emissions continue. More people
will suffer from respiratory illness and premature death, more of our communi-
scientific and ties will face the difficulties and damage caused by severe weather episodes, more
medical evidence, Canadians will face substantial alterations of the lands and waters that deter-
mine their economic livelihoods, and more humans throughout the world will
and then to face new and quite substantial health risks associated with the altered climate.
The evidence shows that our societies face a serious and concrete threat.
accept the need Denial or delay will only serve to waste valuable time and resources. Action is
for immediate required and required now.
changes.
 TAKING OUR BREATH A WAY 47
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NOTES
1. This does not include CFCs that accumulate in the upper atmosphere, depleting
the ozone layer. Although ozone depletion is a serious aspect of global change, this
report does not address this issue at any length.
2. John Houghton, Global Warming: The Complete Briefing (Cambridge: Cambridge
University Press, 1997), p. 189.
3. Ibid., p. 12.
4. J.T. Houghton et al., eds., Climate Change 1995 – The Science of Climate Change
(Cambridge: Cambridge University Press, 1996). (Volume 1 of the Report of the
Intergovernmental Panel on Climate Change)
5. Environment Canada, Canada’s 1996 Greenhouse Gas Emission Summary – Draft,
Pollution Data Branch, September 1998.
6. R.T. Watson et al., eds., Climate Change 1995 – Impacts, Adaptations and
Mitigation of Climate Change: Scientific-Technical Analysis, Cambridge: Cambridge
University Press, 1996. (Volume 2, Contributions of Working Group II to the
Second Assessment Report of IPCC)
7. “NOAA’s El Nino Weather Summary,” National Oceanic and Atmospheric
Administration, 7 April 1998, hhtp://www.publicaffairsnoaa.gov.
8. Environment Canada News Release, 24 August 1998.
9. Houghton et al., Climate Change 1995-The Science of Climate Change, p. 39.
10. Stewart J. Cohen, Mackenzie Basin Impact Study Final Report (Environment
Canada and University of British Columbia, 1997), p. 1.
11. R. Myneni et al., “Increased plant growth in the northern high latitudes from 1981
to 1991.” Nature 396 (1997): p. 698.
12. “Special El Nino Weather Summary Issued”, News Statement, National Oceanic
and Atmospheric Administration, 7 April 1998, hhtp://www.publicaffairsnoaa.gov.
13. J. Bruce, Montreal Gazette, 29 August 1998, p. B-6.
14. Houghton et al., Climate Change 1995-The Science of Climate Change.
15. L.S. Kalkstein, “Lessons from a very hot summer.” Lancet 346 (1995): pp. 857-859.
16. A.J. McMichael et al., eds., Climate Change and Human Health (Geneva: World
Health Organization, 1996). Table 3.5 attributed to Kalkstein et al.
17. “Waiting for the rain to resign,” Edmonton Journal, 12 June 1998.
18. Canadian 1996 NOx/VOC Science Assessment, Environment Canada, 1997, p. 2.
19. D.S. Shprentz, Breathtaking: Premature Mortality Due to Particulate Air Pollution in
239 American Cities (Natural Resources Defense Council, May 1996), p. 13.
See also R.T. Burnett, R.E. Dales, M.E. Raizenne, D. Krewski, P.W. Summers, G.R.
Roberts, M. Raad-Young, T. Dann, J. Brooke, Effects of Low Ambient Levels of
Ozone And Sulphates on the Frequency of Respiratory Admissions to Ontario Hospitals,
Environ Research 65, 172-194, 1994.
20. Environment Canada, The Canada Country Study: Climate Impacts and Adaptation,
1997, p. 6.
21. The floods in India, Bangladesh and China are the result of a number of factors,
climate change being one. Deforestation is also a significant contributing factor.
22. Vancouver Sun, 16 September 1998, p. A1.
23. V.H. Heywood and R.T. Watson, eds., United Nations Environmental Programme:
Global Biodiversity Assessment. Cambridge: Cambridge University Press, 1995; see
chapter 11, J.A. McNeely et al., “Human influences on biodiversity,” pp. 711-821.
48 C L I M A T E O F C H A N G E
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24. McMichael et al., eds., Climate Change and Human Health, p. 33.
25. N. Arnell et al., “Hydrology and freshwater ecology,” in R.T. Watson et al., eds.,
Climate Change 1995: Impacts, Adaptations and Mitigation of Climate Change:
Scientific-Technical Analyses (Cambridge: Cambridge University Press, 1996)
pp. 325-363.
26. R.E. Vance and D.D. Lemon, “Geoscience and Climate Change in the Palliser
Triangle of the Southern Canadian Prairies,” Delta: Newsletter of the Canadian
Global Change Program 8.1 (1997).
27. R.T. Watson et al., The Regional Impacts of Climate Change: An Assessment of
Vulnerability (Cambridge: Cambridge University Press, 1998), p. 14.
28. Houghton et al., Climate Change 1995 – The Science of Climate Change, p. 363.
29. R. Watson et al., eds., Climate Change in Asia: The Thermatic Overview (Manila:
The Asian Development Bank, 1994).
30. D.J. Forbes et al., “Climate Change and Climate Variability in Atlantic Canada,”
Climate Change Impacts in the Coastal Zone of Atlantic Canada, p. 51.
31. L. Beckman et al., Responding to Global Climate Change, Effects of Climate change
on Coastal Systems in British Columbia and Yukon (Environment Canada, 1997),
pp. 8-18.
32. P. Epstein, “Climate, Ecology, and Human Health”, Consequences – The Naure and
Implications of Environmental Change, Vol 3, No.2, 1997 pp3-19,
33. Environment Canada, The Canada Country Study, op.cit.
34. McMichael et al., eds., op. cit. 1996
35. Watson et al., The Regional Impacts of Climate Change, op.cit.
36. “Malaria may be on the move to ‘tropical’ Canada,” Canadian Medical Association
Journal 158 (1998): p. 160.
37. M.J. Bouma and C. Dye, “Cycles of Malaria Associated with El Nino in Venezuela”
Journal of the American Medical Association, 278.21 (1997): pp. 1772-1774.
38. J.P. Bruce et al., Climate Change 1995: Economic and Social Dimensions of Climate
Change (Cambridge: Cambridge University Press, 1996), p. 205. (Contribution of
Working Group III to the IPCC)
39. T.F. Homer-Dixon and V. Percival, Environmental Scarcity and Violent Conflict:
Briefing Book. (Toronto: University of Toronto Press and AAAS, 1996).
40. “Cryptosporidiosis in Wisconsin,” MMWR 45 (1995): p. SS1.
41. R.E. Dales et al., “Prevalence of childhood asthma across Canada,” International
Journal of Epidemiology 23 (1994): pp. 775-81.
42. J.M. Last, “Human Health in a Changing World,” in J.M. Last, Public Health and
Human Ecology, 2nd Edition. Stanford, Connecticut: Appleton & Lange, 1997;
Chapter 11, pp. 395-425
43. R.R. Mouri–o-Pérez, “Oceanography and the Seventh Cholera Pandemic,”
Epidemiology 9.3 (1998).
44. R.T. Burnett et al., “The Effect of the Urban Ambient Air Pollution Mix on Daily
Mortality Rates in 11 Canadian Cities,” Canadian Journal of Public Health 89.3
(May-June 1998): pp. 152-156.
45. State of Canada’s Environment (Environment Canada, 1997).
46. Senes Consulting Ltd., Screening Level Valuation of Air Quality Impacts Due to
Particulates and Ozone in the Lower Fraser Valley (Vancouver, B.C.: March 1994).
 TAKING OUR BREATH A WAY 49
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47. Canadian 1996 NOx/VOC Scientific Assessment, Environment Canada, October

1997, p. 35.
48. State of Canada’s Environment, (Environment Canada, 1997).
49. J. Smith et al., Adapting to Climate Variability and Change in Ontario, March 1998,
p. 71.
50. Canadian 1996 NOx/VOC Science Assessment, Environment Canada, October
1997, p. 31.
51. Committee of the Environmental and Occupation Health Assembly of the
American Thoracic Society, “State of the Art: Health Effects of Outdoor Air
Pollution,” American Journal of Respiratory and Critical Care Medicine 153
(1996):3-50.
52. Electric Power Research Institute, Resource Papers: Meta-Analysis: An Introduction,
March 1994.
53. K. Katsouyanni et al., “Short Term Effects of Air Pollution on Health: A European
Approach Using Epidemiologic Time Series Data: The APHEA Protocol,” Journal
of Epidemiology and Communtity Health 50 (1996): pp. S12-S18.
54. R Bascom, P.A. Bromberg, D.A. Costa, R. Devlin, D.W. Dockery, M.W. Frampton,
W. Lambert, J.M. Samet, F.E. Speizer, M. Utell, State of the Art: Health Effects of
Outdoor Air Pollution, Am J Respir Crit Care Med 153, pp. 3-50, 477-498, 1996
55. R. Burnett et al.,Effects of Low Ambient Levels of Ozone and Sulfates on the Frequency
of Respiratory Admissions to Ontario Hospitals, op. cit.
56. R.T. Watson et al., eds., op. cit. p. 310
57. Hagler-Bailly Consulting, Environmental and Health Benefits of Cleaner Vehicles and
Fuels, Supplemental Report 2: Selected Concentration – Response Functions for
Human Health Effects, Canadian Council of Ministers of the Environment Task
Force on Cleaner Vehicles and Fuels.
58. J. Sunyer, J. Castellsague, M. Saez, A. Tobias and J.M. Anto, “Air Pollution and
Mortality in Barcelona,” Journal of Epidemiology and Community Health 50:
S76-80, 1996
59. R.T. Watson et al., eds., op.cit. p. 310.
60. R.T. Burnett et al., op.cit.
61. M. R. Anderson et al., “Air Pollution and Daily Mortality in London: 1987-92,”
British Medical Journal 312 (1996): pp. 665-669.
62. R.T. Burnett et al., op.cit.
63. Hagler-Bailly, op.cit.
64. C.A. Pope et al., “Respiratory Health and PM10 Pollution: A Daily Time Series
Analysis,” American Review of Respiratory Disease 144 (1991): pp. 668-674.
65. Ibid.
66. “Sulphur in Fuels,” Health and Environment Impact Assessment Report of the
Expert Panel, Environment Canada / Health Canada / Canadian Petroleum
Products Institute Study on Sulphur in Gasoline and Diesel Fuels, 31 March 1997,
pp. 4-11.
67. C.A. Pope et al., “Particulate Air Pollution as a Predictor of Mortality in a
Prospective Study of U.S. Adults,” American Journal of Respiratory and Critical Care
Medicine 151 (1995): pp. 669-674.
68. R. Bacsom et al., op. cit
50 C L I M A T E O F C H A N G E
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69. The three studies include:

i) R.T. Burnett et al., “Association Between Ambient Carbon Monoxide Levels and
Hospitalizations for Congestive Heart Failure in the Elderly in 10 Canadian Cities,”
Epidemiology 8 (1995): pp. 162-167;
ii) R.D. Morris et al., “Ambient Air Pollution and Hospitalization for Congestive
Heart Failure Among Elderly People in Seven Large U.S. Cities,” American Journal
of Public Health 85 (1995): pp. 1361-1365; and
iii) J. Schwartz and R. Morris, “Air Pollution and Hospital Admissions for
Cardiovascular Disease in Detroit, Michigan,” American Journal of Epidemiology
142 (1995): pp. 23-35.
70. G. Touloumi et al., “Daily Mortality and Winter Type Air Pollution in Athens,
Greece – A Time Series Analysis within the APHEA Project,” Journal of
Epidemiology and Community Health 50, pp. S47-S51.
71. R.T. Burnett et al., eds., op.cit. pp. 152-156.
72. G.W. Chance and E. Harmesen E, “Children are Different: Environmental
Contaminants and Children’s Health,” Canadian Journal of Public Health 89
(1998): Supp. 1.
73. Ibid.
74. M. Raizenne et al., “Air Pollution Exposures and Children’s Health,” Canadian
Journal of Public Health 89 (1998): Supp. 1.
75. “An Association Between Air Pollution and Mortality in Six U.S. Cities,” The New
England Journal of Medicine 329 (9 December 1993): p. 1758.
76. R.E. Dales et al., op. cit.
77. D.W. Dockery et al., “Health Effects of Acid Aerosols on North American
Children: Respiratory Symptoms,” Environmental Health Perspectives 104
(May 1996): pp. 504-505.
78. N. Chaudhuri, “Child Health, Poverty and the Environment: The Canadian
Context,” Canadian Journal of Public Health 89 (1998): Supp. 1.
79. M. Keating et al., Canada and the State of the Planet: Canadian Global Change
Program (Oxford: Oxford University Press, 1997), p. 29.
80. Natural Resource Fact Sheet, Natural Resources Canada, http://www.nrcan.gc.ca/
mms/nrcanstats/factsheet.htm.
81. Canada’s Energy Outlook 1996-2020, Natural Resources Canada, April 1997,
p. C-27.
82. Working Group on Public Health and Fossil-Fuel Combustion, “Short-term
improvements in public health from global-climate policies on fossil-fuel
combustion: an interim report,” The Lancet 350.9088 (1997): pp. 1341-1348.
83. The State of Canada’s Environment, Environment Canada, 1997.
84. New Motor Vehicle Sales, Statistics Canada Report No. 63-007-X1B, March 1998.
85. 1996 Progress Report, Canada-United States Air Quality Accord, pp. 25-26.
86. Forecast and Backcast of 1995 LFV (Lower Fraser Valley) Emission Inventory,
Levelton Engineering Ltd., prepared for the Greater Vancouver Regional District,
May 1998, pp. 109-110.
87. Canada’s Response to U.S. EPA Proposal on Transboundary Air Pollution,
Government of Canada, 16 March 1998.
88. Clean Air Benefits and Costs in the GVRD, ARA Consulting, April 1994.
89. Working Group on Public Health and Fossil-Fuel Combustion, op.cit.
90. Government Working Group on Sulphur in Gasoline and Diesel Fuels, Preliminary
 TAKING OUR BREATH A WAY 51
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Report, 27 March 1998, Table A.4.6: Health Benefits (2000-2020).

91. 1996 Progress Report, Canada-United States Air Quality Accord, p. 21.
92. Model Simulations of the Climate Action Network Program for Energy Demand,
GHG Emissions & Investment, Energy Sector, Natural Resources of Canada,
June 1995, Table 1.8, Appendix A.
93. O.L. Loucks, Estimating the Consequences of Greenhouse Gas Emissions: The Case of
Air Quality for the U.S., U.S. Global Change Program.
94. World Bank Report, Clear Water, Blue Skies: China’s Environment in the New
Century, Washington, D.C.
95. J.M. Last, “The Future of Public Health,” Japanese of Journal of Public Health 38.10
(1991): Supp. 1, pp. 58-95.
96. Ontario Medical Association, Health Effects of Ground-Level Ozone, Acid Aerosols
& Particulate Matter (Toronto, May 1998).
97. Conference Statement, “The Changing Atmosphere: Implications for Global
Security,” Toronto, June 1988.
98. United Nations Framework Convention on Climate Change: Article 2, Objective,
p. 6.
99. M. Keating et al., op.cit.
100. J.P. Bruce et al., op. cit.
101. Redefining Progress: Economists’ Statement on Climate Change, 1997.
102. Tellus Institute and Union of Concerned Scientists, A Small Price to Pay: US Action
to Curb Global Warming Is Feasible and Affordable, Union of Concerned Scientists,
July 1998.
103. David Suzuki Foundation, Pembina Institute, Canadian Solutions – Meeting Our
Kyoto Commitment: Climate Action Basics for Canada, Vancouver, 1998.
104. 1996 Progress Report, Canada-United States Air Quality Accord, p. 21
105. J. M. Last, Public Health and Human Ecology (Stanford, CN: Appleton and Lange,
1997).
106. 1997 Declaration of the Environment Leaders of the G8 on Children’s
Environmental Health, Canadian Journal of Public Health 89 (1998): Supp. 1.
 CLIMATE OF CHANGE:
THE DAVID SUZUKI FOUNDATION’S REPORT SERIES
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A Glimpse of Canada’s Future

Written by Ellen Battle and Bill Stipdonk of Metrix Consulting and by Dr. David
Suzuki, this report examines the ways Canada could and will be affected by climate
change. Some of the topics covered include: how the greenhouse effect works, and how
a warmer world will affect the social, economic and environmental fabric of Canada.
The Role of Government
A Briefing Paper to the Honourable Paul Martin, September 29, 1997
Canadian energy production and consumption are currently subject to taxation
rules and government programs which interfere with the nation’s ability to meet its
greenhouse gas reduction targets. In this report, Michael Margolick of ARA Consulting
Group shows how Canada’s economy is currently structured to encourage ever-greater
energy consumption, and therefore higher emissions of greenhouse gases. The report
also presents a rationale for a plan to reduce greenhouse gas emissions.
Taking Charge: Personal Initiatives
Written by Pembina Institute Climate Change Director Robert Hornung, this report
shows how the actions of individuals and communities can affect climate change.
Examining everything from personal purchasing habits, daily behaviour, and lifestyle
choices, to official community plans and growth strategies (development permits,
zoning bylaws, etc.), the authors show how local actions can significantly cut Canada’s
rate of greenhouse gas emission.
Keeping Canada Competitive
Since the 1992 Rio Earth Summit, few countries have lived up to the agreed goal
of stabilizing greenhouse gas emissions at 1990 levels. Here in Canada, it is estimated
that emissions are already 12% above 1990 levels – one of the worst records of any
developed nation. Canada’s former chief negotiator Doug Russell reviews how Canada’s
performance has compared with other countries, and examines the implications
of Canada’s failure to keep pace with international efforts to reduce greenhouse gas
emissions.
Taking our Breath Away
Epidemiologists Dr. John Last and Dr. Konia Trouton, and an air pollution expert,
Dr. David Pengelly, explore the links between air pollutants and changes in climate,
including present and future impacts on Canadian health. A critical point that is often
lost in discussions about climate change and air pollution is that the same human
activities, namely the combustion of fossil fuels for energy, is the major cause of both
problems. The report also looks at the opportunities available to reduce the use of
fossil fuels and to improve human health.
Canadian Solutions
This report is printed on Arbokem, which is
45% agri-pulp, 43% post-consumer waste This report examines the commitments Canada made in Kyoto at the United Nations
paper, and 12% calcium carbonate filler. Climate Change meeting and proposes an action plan to fulfill those commitments.
Arbokem is manufactured by a
totally chlorine and effluent free agri-pulp Written by the David Suzuki Foundation and the Pembina Institute, a series of
process. measures are detailed with a focus on implementation strategies and quantification
Design: Alaris Design, Victoria
of the potential environmental and economic benefits that would be generated
Printing: Western Printers through implementation.
Finding solutions in science and society
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The goal of the David Suzuki Foundation is to study the underlying structures
and systems which cause environmental crises and then work to bring about
fundamental change. We do this in four ways:
Research: The David Suzuki Foundation seeks out and commissions the best,
most up-to-date research to help reveal ways we can live with nature.
Application: We support the implementation of ecologically sustainable
models – from local projects, such as habitat restoration, to international
initiatives, such as better frameworks for economic decisions.
Education: We work to ensure the solutions developed through research
and application reach the widest possible audience, and help mobilize broadly
supported change.
Advocacy: We urge decision makers to adopt policies which encourage
and guide individuals and businesses, so their daily decisions reflect the need
to act within nature’s constraints.