Intended for healthcare professionals


Communities in Northern Canada are feeling the health system implications of climate breakdown

BMJ 2023; 383 doi: (Published 05 October 2023) Cite this as: BMJ 2023;383:p2173
  1. Nicole Redvers, associate professor, western research chair and director of indigenous planetary health1 2
  1. 1Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
  2. 2Arctic Indigenous Wellness Foundation, Yellowknife, Northwest Territories, Canada

In the northern regions of Canada the climate emergency is not just some distant worry of something that may happen in the future. It has already had large multi-faceted impacts for years.1 The sub-Arctic and Arctic regions of Canada are warming at three to four times the global rate.2 For the many Indigenous communities that call the region home, the effects have been drastic. The “summer of smoke” in 2014 saw “two and a half months of unabating wildfire smoke exposure for residents within the city of Yellowknife and adjacent communities.”3 It led to double the number of emergency department visits for asthma and an increase of 48% in prescriptions for asthma medication, while cases of pneumonia increased by 57%.3 Spring forward to 2023, and we are seeing yet another unprecedented wildfire season. One community, Inuvik, did not have a day of reasonably healthy air quality from at least 26 July until 10 August. The city of Yellowknife did not have a full week of acceptable air to breathe between mid June and August. Some residents were able to start returning home only in September.4 Throughout the summer, multiple evacuations took place for entire communities, many of which have no year-round road access and required the transport of community members (including older people, patients, and young children) by plane or boat.5 People were often forced to leave their pets and belongings behind.

Often underappreciated is the impact on mental health and wellbeing that the climate emergency can have for Indigenous communities. In past wildfire years in Northern Canada, the prolonged smoke disrupted peoples’ livelihoods and limited land based activities that had “negative consequences for mental, emotional, and physical wellbeing.”6 The loss of cultural sites, cultural camps and homes, and the change in animal and plant availability for hunting and foraging caused by the wildfires have not yet been captured adequately from a health standpoint.

Health systems in the remote northern regions of Canada are often significantly under resourced and struggle to retain consistent healthcare providers, who often come in only on sparse travel rotations.7 Many communities rely on small nursing stations that offer very little culturally appropriate support for mental health, regardless of climate related events.8 In 2022, an unprecedented spring flood shut down water, sewerage, and power, and blocked the main airport into the community of Hay River.9 Without air transport for hospital inpatients, and the closest available hospital a five hour drive north, the need to find creative and safe ways to get patients out of the community was urgent. In 2023, the same community of Hay River had a wildfire burn through it, and several homes and Indigenous community buildings were lost.10 Repeated climate emergency events are creating an increasing burden on already overstretched healthcare systems in the north of Canada.

Despite the increase in climate-related events in the region, very little overarching planning for climate change mitigation and adaptation has taken place on a large scale within the health system, except for acute evacuation preparedness and response. This lack of response is not unique to Northern Canada. The healthcare sector alone makes up 5% of global greenhouse gas emissions, and has a carbon footprint equivalent to 514 coal fired power plants.11 Increasingly, national and international organisations must enter dialogue to create planetary health-informed and climate-resilient healthcare systems.1213

Permafrost melt is threatening the future of critical healthcare infrastructure. Worsening summer air quality is having disproportionate impacts on people living in poorly ventilated and often overcrowded housing conditions. Communities are facing the layered mental health impacts of increasingly having to stay indoors after the long winter, disrupting cultural practices. In light of this, healthcare system stakeholders in Northern Canada and elsewhere will be forced to carry out more strategic planning and investment to achieve a planet-friendly, sustainable, and climate resilient health system.14 More specifically, all health systems should be investing urgently in baseline assessments and monitoring of climate impacts, reducing known high-carbon care such as specific greenhouse gas-heavy asthma inhalers15 and anaesthetic gases.16 They should invest in primary care and care close to home, creating strategic partnerships with governments and suppliers to reduce the environmental footprint of supply chains.17 Furthermore, they should eliminate the use of fossil fuels18 while leveraging technology safely to reduce the need for medical and work related travel, revamp strategic plans to platform planetary health across all service delivery functions and operations, and ensure an equity based and culturally safe approach in all elements of system transformation. These health system changes require mobilisation of funding that is not currently available, deep courage from healthcare leadership, and the true and real embodiment of the urgency we face to create change. The earth can easily survive without us, but we cannot live without a habitable planet. We urgently need healthcare system transformation within Canada and abroad.


  • Competing interests: none declared.

  • Provenance and peer review: commissioned, not peer reviewed.