CAPE Advocacy: A Reflection in Two Voices

Reflecting on the role of the Canadian Association of Physicians for the Environment (CAPE), Dr. Clarissa Wallace, M.D. and Jane McArthur, Ph.D. offer personal insights and discussion on addressing environmental health crises and advocating for policy change.

Illustrations: Dr. Clarissa Wallace

The Canadian Association of Physicians for the Environment (CAPE) was created in 1993 by physicians who envisioned advocacy based on evidence, the application of the precautionary principle, and a professional and public interest in protecting health and the environment. Through the years CAPE has achieved substantial policy victories in collaboration with many partners in the environmental movement.

What is it that makes CAPE influential and successful? There are a number of factors. Engagement of physicians and healthcare professionals in political action is powerful in part because of their effectiveness as storytellers. With a focus on health, CAPE physicians and the staff who facilitate their efforts, mobilize narratives to increase the understanding of decision-makers who can advance environmental protection in policy for improved human health outcomes.

The physicians and healthcare professionals who make up the CAPE community come to the organization with a mix of feelings, concerns, knowledge sets, and above all, a desire to take action. While the health of their patients, communities and family members generates awareness of external factors influencing health outcomes, their work as practitioners is not positioned to affect the factors or conditions that lead to the ill health they see. 

As advocates, however, healthcare practitioners are perceived as highly trustworthy on environmental health topics. This phenomenon has produced a community of actors – including volunteer healthcare professionals and paid staff – who strategically combine physician authority with campaign strategies aimed at improving environmental and human health.

What follows are reflections in two voices – these are personal reflections, alternating between the voice of physician Dr. Clarissa Wallace and toxics director Jane McArthur, Ph.D. –  in their ongoing discussion of finding the common ground on which to advance action on the ecological determinants of health within the wider context of current environmental health crises. 

January 2023: Repression and Disconnection

Clarissa: I’m like an ostrich with my head in the sand, except my eyes are open, and it burns.  The sand hurts.  All the time.  I used to be great at closing my eyes, or looking away, away from uncomfortable knowledge and emotion.  But even I am finding it hard to avoid knowing we are destroying the planet.  

Ostrich's head in the ground with speech bubble: "Still my eyes are burning!"

Jane: The challenge that lies before us is that toxic substances are everywhere. Every day, people in Canada are exposed to chemical pollution and toxic chemicals at home, school, and work, in the food we eat and products we use. It’s an intersecting problem of environment, health and social justice.

Scientists assert that chemical pollution has crossed a planetary health boundary, pushing the limits of nature to support human activity. The adverse health impacts of this activity are serious.

May 2023: Despair 

C: “Mom, what are we going to do about the world getting too hot?”  My new acquaintance on the bus is still reeling from conversation with her eleven year old daughter yesterday.  She shared this in response to my comment on medical student mental health.  “They’re much more anxious than when I went through, but the world wasn’t dying then.”  None of us is able to avoid seeing the threat.  It’s everywhere, especially now, with smoke over so much of the prairie already in May.

Earth disintegrating into a blood drop, with text around it: "Is the earth a blood diamond?"

J: Approximately 5.3% of deaths in Canada are attributable to pollution linked to exposure to carcinogens and particulate matter (PM2.5) in ambient air. Research shows that the top causes of death for people in Canada can be linked with pollutants on the Canadian Environmental Protection Act (CEPA) list of Toxic Substances including cancers, heart disease, and respiratory diseases.

The health effects of these toxic exposures are not felt equally, and those most vulnerable are the least responsible for the creation of the harms.

July: Grief and Guilt 

C: Moments of connection and compassion in clinic and in my personal life save me from despair.  Yet these too are tinged with grief over the daily damage I know is happening ‘outside’.  My own life feels pretty much the same so far, except for this awful knowledge.  And I know that it’s the way that I am leading my life, along with billions of others, which is at the heart of the problem.  We are killing ourselves along with sacred communities of plants and animals and the beauty of nature herself everywhere on our blue planet.  That’s almost the worst of it.  It’s my fault, our fault!

J: Plastics are embedded into all of our systems and our products. Food packaging, clothing and furniture, car parts such as tires and lights, children’s toys and dishes, and cosmetics contain plastics.

Plastics contribute significantly to the climate crisis. Plastics are made from fossil fuels and their processing emits an enormous amount of greenhouse gasses into the atmosphere. Research suggests that if plastics were a country, it would be the fifth-biggest global greenhouse gas emitter.

At every stage of its life cycle, plastics threaten human health. People are exposed to plastics and their toxic components in many ways, with varying effects and outcomes at different stages of life, from infancy to adulthood. 

September: Injustice

C: I understand that capitalism requires the seizure and possession of public and earthly ‘goods’, and of people themselves, mentally if not physically. 

So we all need to stop living the way we are!?  Right?  And right now!  We know it.  But how?  And when?  I love my life.  I love my family, our house, our yard, and I am thrilled to be becoming the doctor (and even the teacher) I always wanted to be, now that I’m almost retired. I am comfortable. . . well okay it is too hot and I know the smoke is coming, but somehow I still do nothing, or at least not much.  

In large text: "Anti-Socialism AKA Capitalism". In smaller text, pointing to an drawing of a pawn chess piece: "As pieces (objects) we move predictably. Positions cannot be shared. Many are 'sacrificed'". Text pointing to a drawing of a king chess piece: "Someone wins." Text at the bottom: "Losers are trapped. CHECKMATE!"

J: Nation-states are required by international human rights law to take active measures to prevent the exposure of individuals and communities to toxic substances. We must hold Canada accountable for its responsibilities to the people who live, work, learn and play here.

Personal risk assessments and individual responsibility for the prevention of exposures and ill health is not enough. Community engagement, coalition-building and meeting with decision-makers all help to create greater awareness about the concurrent environmental crises, environmental injustices, and pollution solutions for necessary improvements in law, regulation and policy.

October: What we suppress consumes us

C: Always as doctors we want to ‘fix it’.  And if we can’t we tend to turn away.  Everyone that is except our palliative care colleagues.  I shudder to think that might be the way, to be companions in death is a privilege but …..  Have we lost this fight?  That feels like giving up way too easily.  

How can we let our planet die, especially from abuse?  In some part of myself I understand that it is the way we live, all of our social understandings that need to change, and change fast.  

Dr. Clarissa Wallace holding an illustration of a scorched earth with text "Scorched earth, brought to you by LNG"

J: CAPE’s collaborations with coalitions, allied organizations and communities uses the data on pollution – and in particular in relation to health and justice impacts of pollution –  towards knowledge translation and mobilization and advocacy for policy, legislative and regulatory change. Often we are sought out as a powerful voice, persuasively making the health arguments.

The approach of leveraging the physician’s voice as an authority on health and the environment has allowed us to amplify the evidence on health and toxic pollution in a way that resonates with decision-makers, media and the public.

November: Connecting and Imagining 

C: Continuing to talk together and reading more, I am coming to understand that resistance can only go so far.  Yes, we must dismantle global systems of exploitation and oppression of ourselves and of the earth.  But we must also reimagine what could take their place.  Valarie Kaur leads us from resistance to ‘revolutionary love’ in See No Stranger.  We are all, every single one of us and all the creatures and life of the planet, on earth together, interdependent and ultimately indistinguishable. 

A web of circles of different sizes with text wrapping around the drawing: "Indra's Net. Every Jewel Connects"

J: We need a systems approach that is distinct from focusing solely on the level of individual behaviour modifications or personal responsibility for addressing environmental harms. CAPE advocates are working for greater societal action for health protection, illness prevention, equity and environmental justice.

December: Joining more fully, and giving thanks 

C: With the patience, faith, and companionship I found through CAPE this past year, I am beginning to see where I have mistaken the path that I might follow in my thoughts on the fate of the earth.  Wandering alone inside despair has been a fruitless and passive path to nowhere.  I am only manifesting the typical “inner devastation” of the disconnected highly individualistic western psyche, “which mirrors the outer devastation it has wrecked upon the planet” (Eisenstein).

But I am not alone.  We may not all be guilty, but we are all responsible.  (Heschel.)  I must do only my part, what falls to me to do, no more and no less.  And large within my responsibility is to recognize our connection and community, global community, not globalization and objectification, but rather infinite subjectification, our myriad uniqueness contained within the wholeness of life. 

CAPE and Rebecca Solnit have shown me “hope in the darkness”.  Bad actors on stage draw our attention, but each of us has a role to play, even if we are offstage in the darkness of the wings.  There is a rising global tide of connection.  This is compassion for each other, for all beings, for our companions past present and future, and for all the earth, our mother. 

Without knowing how I already know, I can stand in my place amid the cast of all of us.  However, cracked my voice, I know how to sing.  I know how to praise and wonder and long for love and survival, hope against hope, for the survival of us not me.

This year CAPE threw me a lifeline and I knew to close my fingers around the rope of our connection. You spoke to me and I heard myself unburden my fears and despair, enough to see the light in darkness, the beauty in the unknown which is ours to become.

At our BC meeting last night I heard that CAPE, which was started by just those four people in 1993, has grown to number hundreds, if not thousands.  The total count is unknown because we are ‘undocumented’, but we are here.  All of us in health care already belong, just as CAPE belongs within the global wave of movements which we hope will carry us toward a more sustainable future.

CAPE’s rope pulled me to remember that paradox is the product of our over-simplifying minds.  We will not see the earth restored to a pristine past perfection:  when and what would that have been?  There may or may not be an apocalypse, but we know we will  see both beauty and destruction.

May I release the intensity of my fear enough to be drawn into the lifeboat in which we find comfort together, and together work the oars of our journey toward an uncertain but more hopeful future. Thank you Jane!  Thank you CAPE.  And may each of us and the world find ways to knit and heal together. 

Two hands hold on to a life ring buoy

For more information about toxic exposures, human health and environmental justice, and the work being done at CAPE to address these, please visit our Preventing Toxic Exposures Program page.