Psychology Month: Social Connection, Trust, and the Intersection of Climate and Health

In 2021, British Columbia spent late June suffering under a “heat dome”. Temperatures regularly reached 50 degrees Celsius, and by July 1^st almost 500 wildfires were burning across the province, including the one that destroyed the town of Lytton. In Nelson, in the Kootenay region, psychologist Dr. Todd Kettner was living with his wife and children in a new housing community with a small ecological footprint. The day after the final home in that community was occupied, a fire sprang up a kilometre away. These eco-friendly buildings were now occupied by anxious homeowners as embers from the nearby fire landed on their brand new roofs.

At the Kootenay Medical Centre in Nelson, Emergency Room department head Dr. Kyle Merritt was seeing patients come in presenting symptoms associated with the wildfire smoke and the heat dome. Acute cardiac events are more common when there is wildfire smoke in the area, and other health issues can become more severe with intense heat. The hospital was not overwhelmed, but there was enough of a concern for Dr. Merritt to take an additional step – and to make headlines doing so.

“I met a patient who had to be admitted because of the heat during the dome. So I made a note, the way all doctors do, indicating what’s going on when you see someone, and in my note I indicated climate change as the underlying cause. The same way you’d say a person was a smoker all their life and now they have lung cancer. You don’t diagnose someone with smoking cigarettes, you diagnose them with lung cancer – but you might write down use of tobacco as the underlying cause.”

This move caused something of a sensation, as newspapers both locally and globally picked up the story of a doctor who had diagnosed a patient with Climate Change. Of course, this was not really what Dr. Merritt had done. One cannot be “diagnosed” with Climate Change, and listing the underlying cause is not the same as the diagnosis. But a clickbait headline remains a powerful force in our society, and the story spread like mint in my garden.

Author’s note - it might be time for us to update our idioms when it comes to the speed with which something spreads. Right now, almost all of those sayings involve either pandemic-type diseases or wildfire. It seems like the wrong phrase to use given the fact that we are still dealing with a global pandemic that has killed millions, and in this case are talking about wildfires that displaced thousands and caused several deaths of their own. And so I humbly suggest “spreads like mint in my garden”. Let’s make it happen!

The heat, the fires, and the devastating problems they caused prompted Dr. Merritt  to join some colleagues in creating an organization called Doctors and Nurses for Planetary Health (DNPH). Health care professionals were seeing the direct effects of climate change on the health of the people they served, and thought they could do more. Since then the organization has expanded to include healthcare professionals of all kinds, including Dr. Kettner. They are a lobbying group, an advisory body, and a collective dedicated to making the fight against climate change a central part of their own practices in and around Nelson, B.C.

Nelson is a small city / large town in the Kootenays, with a population of about 10,000 and deep roots in the resource sector. Founded as a mining town 130 years ago, and maintaining strong ties to the forestry industry today, Nelson residents tend to feel a connection to the land around them in the way many small towns with picturesque surroundings do. Combine that with the influx of young, mostly liberal, Americans evading the Vietnam draft in the late sixties and you have the kind of town where establishing a collective like Doctors and Nurses for Planetary Health is a little easier than it might be elsewhere. As Dr. Kettner puts it, Nelson is going on “50 years of hippie-hood”.

Author’s second note – I really wanted to name this piece ’50 years of hippie-hood’ because I love the turn of phrase. I even promised, when I heard it, that I would do so. But I reconsidered at the last moment, because I am reticent to reinforce the harmful stereotype that climate action, and caring about environmental issues, is something ethereal that is solely the domain of aging hippies and young punk musicians. It is, of course, something that affects us all and something that people care about in all walks of life and across all cultural boundaries.

While the members of DNPH are environmental activists of one kind or another, it’s their position as healthcare providers that imbues their message with an authoritative tone. Dr. Kettner says “when we look at who people trust when it comes to the environment, it’s not politicians, or environmental activists or loggers or miners, it’s often healthcare professionals - nurses, or their family doctors.”

We’ve seen, over the past few years, an erosion in trust among the public when it comes to healthcare professionals. People protesting at hospitals, people disrupting life for everyone else over a false belief that the COVID vaccine is somehow responsible for people dying in greater numbers than COVID itself. While those people are the noisiest, they do not represent the majority of Canadians and doctors remain a profession that enjoys overall public trust.

This is especially true in Nelson. Another reason Dr. Merritt and Dr. Kettner and their group are able to produce results is that Nelson really is small. The people you play hockey with on Tuesday nights are the same people you see at the grocery store and the ones who reach out to you for professional help. In Dr. Merritt’s case, that means he has patients who have been under his care their entire lives. For Dr. Kettner, this means his practice and work is integrated into the community he has called home since he started his career as a psychologist nearly 25 years ago. Community connections create strong bonds, the kind that are tough to break. The kind that can weather the storm of online disinformation.

The DNPH group has been very effective in a number of ways (local infrastructure and transportation projects, reducing the footprint of their health system) but perhaps their biggest impact has been in making the connection between planetary health and human health. Recently they worked with the city to increase the delivery of electricity to homes while reducing the amount of fossil fuels in those homes. This not only benefits the environment, it improves the health of the people who are no longer living with emissions within their own walls.

Says Dr. Merritt, “you can’t have human health without a stable climate, healthy air, and healthy water. A lot of people aren’t making that connection all the time, and we try to think about it in everything we do”.

There are a lot of areas in every job where environmentally conscious and sustainable choices can be made. In healthcare-related settings, those choices almost always come with a health benefit as well. In Dr. Merritt’s case, it’s small things like ensuring the batteries used in the hospital are recycled, and bigger things like tackling the problem of anaesthetic gases and inhalers which include hydrofluorocarbons and chlorofluorocarbons that contribute a good deal to climate change.

“One of the advantages I have in working in primary care in a public system is that I get to interact with people from all walks of life, from cradle to grave within my community. It gives me a good opportunity to get to know what they’re going through. And in the emergency department, when events like wildfires or heat happen, it’s the most vulnerable people who are affected. And with mental health too – it’s people who have underlying mental health problems that get acutely exacerbated during these events, and they show up in the ER to compensate. Part of our role is doing advocacy for health, and climate change is now part of that.”

Author’s note number three. Dr. Kettner says that one of the things that keeps climate change top of mind for folks, and gets them to pay attention, is novel news and information. We’ve all heard a lot about polar bears and permafrost and the Great Barrier Reef for some time, and some have tuned out. Something new that might pique the interest of a person when you’re conversing could bring them back into the climate-aware headspace. Something like “hey did you know that anaesthetic gases are a significant contributor to ozone depletion and greenhouse warming?”

For Dr. Kettner, his involvement with organizations like DNPH allows him to share his expertise when it comes to the mental health effects of climate change. His work with the MIR Centre For Peace at Selkirk College has brought an additional lens of intersectionality with the climate crisis. Not only is there a crossover when it comes to health and mental health, there is a significant correlation between climate change and global peace, social justice, and inequality.

“I now feel like I’m focusing on the most important issues – the social determinants of health, greater access to mental health services for greater numbers of people, respect and reconciliation with Indigenous people. It’s where I want to focus a lot of my energy in the last 20 years of my professional career.”

Author’s note number four. While we were discussing Indigenous reconciliation, we spoke about the Haudenosaunee’s Seventh Generation Principle. It’s the philosophy they’ve abided by for hundreds of years, that states you are not only the steward of your environment for yourself and your offspring, but for their offspring and the generation after that and so on. Dr. Merritt shared what I think is an interesting thing to know – either for consideration in Canada or to one day help you win on Jeopardy! There is a new position that was created by the government of Wales in 2015. Sophie Howe completed the first term as Wales’ Future Generations Commissioner in 2023, the role is now held by Derek Walker.

There are several towns in the Kootenay region, and both Dr. Kettner and Dr. Merritt reference a sort of Springfield-Shelbyville type of rivalry between them. But this rivalry quickly disappears when it comes to achieving sustainable practices, and especially in the wake of the recent disastrous climate-related events. Dr. Kettner describes the situation as the wildfires of 2021 were abating.

“Teachers reached out to me from other towns around B.C. looking for resources to help their students with their anxiety when they returned to school after the raging forest fires that had sent them home for a month. That’s the kind of call I didn’t get as a one-on-one private practitioner seeing someone in my office for depression. Expanding our realm of influence to the public as well as to our patients is something I feel very strongly about.”

Stepping outside your immediate job always feels a little bit like a risk. It means doing something that may be outside your comfort zone, and risking a certain amount of venom from those inclined to oppose your initiative who demand you ‘stay in your lane’. It may feel a little less risky in a place like Nelson, B.C., but it still requires a little bit of daring. It’s a testament to the passion both Todd and Kyle feel, and to the immediate necessity of such action, that they have taken that step. And having done so has already made a significant impact.

Their DNPH group has been heavily involved with the city’s new Active Transportation plan, ensuring it is as sustainable and eco-friendly as possible. A number of their doctors and nurses present some of their advancements to neighbouring towns. The group is working with forestry experts on land adjacent to the city to decrease fire risk while increasing access for people to reap the mental health benefits of being able to go for a walk out in the woods. They are now being included in a lot of major decision-making, and their advice is sought on projects that have little to do with healthcare – except for the central thesis of Doctors and Nurses for Planetary Health. That is, that planetary health and human health are inextricably linked.

Author’s final note – while we were speaking, Dr. Kettner reminisced fondly about a series of TV commercials from his youth, which featured the Kokanee glacier in ads for Kokanee beer. He bemoaned the speed at which that glacier is now disappearing, an additional reminder of the devastating effects of climate change right there in their own backyard. In the course of this discussion, we discovered that Kokanee beer remains one of Canada’s best-selling brands to this day. Which surprised me, I didn’t think it was even being brewed any more, at least not since I was in high school and also saw those commercials. I thought that was interesting enough to add to this piece – Kokanee, it seems, has a great deal more staying power than I imagined it did!

Glaciers, sadly, may not have quite so much.