The Meaning of Do No Harm in a Planetary Health Crisis

By Dr. Courtney Howard
Board President, CAPE

Three things happened yesterday which are saddening and enraging – and which are critical to our understanding of this pandemic. Today, there is an encouraging sign we are moving in the right direction.

First, the Canadian community lost our first physician to what is understood to be COVID-19 related illness. Dr. Huy-Hao Dao was a 44 year old public health physician in Montreal. The CAPE community mourns the loss of our colleague, as well as all those who have passed away across the country and around the world. We honour our comrades-at-arms in health who continue to leave their families and go to work in the face of demonstrably life-threatening risk.

Second, the Squamish-Lillouet Regional District declared a state of emergency and has ordered the evacuation of multiple homes as a result of forest fires. This is happening as flood waters rise in other provinces, meaning multiple Canadians are now having to manage overlapping crises.

Third, CAPE became aware of a confidential memo sent by the Canadian Association of Petroleum Producers (CAPP) to the federal Cabinet in late March which, under the cover of a “public health response” to the pandemic, makes a long list of demands that include the suspension of regulations that protect human and ecological health, and the delay or cancellation of climate change policies.

As Canadian families and healthcare workers have been doing their best to rearrange their lives to keep each other safe, CAPP has been maximally working its influence with our decision makers, with the memo referencing two previous meetings with the cabinet, and the establishment of a task force.

What is most egregious is that CAPP has co-opted the language of health, with the theme of the memo being “do no harm.” One section quite literally recommends the federal cabinet “postpone the development and consideration of any additional measures related to climate to support the do no harm principle.” This is reprehensible: both the Lancet and the WHO have called climate change the biggest health threat of the 21st century. The recent UNICEF-World Health Organization-Lancet report ranked Canada 170th out of 180 nations in terms of sustainability, making us one of the wealthy countries that “threaten every child’s future through climate change.”

It is unacceptable to use the central ethical tenet of the medical profession at a moment of crisis to justify more catastrophic harm to health.

At the hospital and in our clinics, we are entirely occupied with new procedures, with personal protective equipment, with keeping each other and our patients safe. However, our decision-makers are under pressure to create a plan to help Canada emerge from this crisis, and it is imperative that the voice of health weighs in to ensure these solutions benefit the many instead of the few.
In the scarce moments we have away from the bedside, it is important to take a step back and consider the broader picture for health: the coronavirus is a zoonotic virus which made its leap from animals into humans as a result of a lack of attention at the interface between humanity, animals, and disease vectors. It is now illustrating the tragic consequences to both health and the economy of minimizing the importance of our intersection with the natural world.

The World Economic Forum’s 2020 Global Risks Report makes clear that the major risks facing the world in terms of both impact and probability are climate-related. It is clear that if we want to protect the health of a child born today from a lifetime of escalating, climate-related health crises related to wildfires, floods, extreme heat, weather-related disasters, and changes in infectious disease patterns, we have both an adaptation and a mitigation-related sprint ahead of us.

The coronavirus crisis is the biggest wakeup call we have ever had; that by failing to take nature into account we are putting our health in danger.

The principle Do No Harm provides, even now, essential guidance at the bedside, reminding clinicians to put the best interests of the patient first, to carefully consider the risks and benefits of procedures, to avoid arrogance and overtreatment.

In the planetary health context, Do No Harm is equally a call to humility. It means recognizing that natural systems are incredibly complex and that the wisest course of action is to increase respect for their feedback loops and unpredictable elements, and to intervene in them less.

In the context of our overlapping planetary health emergencies, it means recognizing that the ecological determinants of health, such as biodiversity, climate, air, and water, not only influence human health directly, but also form the foundation of human society – including of our healthcare systems. We are seeing cracks appear in this foundation. We need to pay deep attention to these, and seek to shore them up.

Do No Harm means maintaining or strengthening current policies designed to protect environmental health—not rolling them back.

Do No Harm means envisioning a world aligned with our national commitment to net zero by 2050 and ensuring that every public dollar spent helps to solve the economic fallout from the coronavirus crisis and the climate crisis, providing funds for the infrastructure and human skills required to build that world.

Do No Harm means putting the wellbeing of our population first and being willing to work through complex solutions even if the quick and familiar bandaid solution gets us home and into bed sooner. It means immediate support for the social determinants of health through income supplements or similar mechanisms. It means including all Canadians in our vision of the future, creating the educational programs and opportunities required for us to rebuild society safer and healthier than before.

Do No Harm means treating others as you would wish to be treated.

It means recognizing that in 2020, health is planetary, and what happens to other Canadians or on the other side of the world has deep consequences for all of us. It means honouring the health of our children as much as we honour that of our elders. It means providing support for the entire human family by maintaining or increasing financial support for middle-and-low income countries both through direct nation-to-nation financial transfers and via coordinating institutions like the World Health Organization.

Crises don’t just happen to “other people” – they happen to us all.

We have shown that when pressed, we prioritize health, and can change the world fast to save lives. This is new information, and because of it, I have never been so hopeful that we will prevent further crises. I believe that Canadian families and healthcare workers understand the true meaning of “Do No Harm.” I believe we will work together in a focused way to ensure our decision makers understand that saving lives and keeping one another safe comes first. We will rebuild our world – for the better.

The public stimulus funds being spent now provide us with that opportunity. We will not have a second chance at this within the time window remaining to us to provide a healthy future for our children. We must get it right this time.

There are signs this morning that the federal government is seeking a path that does support both the social and ecological determinants of health. We are pleased to see $1.7 billion announced to clean up orphan wells in Alberta, Saskatchewan, and British Columbia—aid which is expected to help maintain 5,200 jobs in Alberta alone, as well as the establishment of a $750 million emission-reduction fund, with a focus on methane, to create jobs while decreasing air pollution.

Please let your decision makers know — with phone calls, emails, texts, photos of your kids’ pictures of a healthy Earth, and by any other creative virtual means available to you—to use our public dollars for supporting people through a healthy, safe recovery—not by bailing out fossil fuel corporations.

In the time it has taken me to write this, my six and eight year old daughters retrieved their belongings from school. My laptop is now accompanied on our kitchen table by pencils, glue, and rainbow-coloured gym shoes. The eldest has facetimed her friend, one of her first-ever solo calls, yelping, “I miss you SO MUCH!!” My husband, our hospital’s medical director, having left before the kids woke up, returned, bringing me the new ER laptop for my first virtual shift today. He grabbed dinner, headed back to check on a patient.  There is a small human tugging on my arm. I must go

Before I do, I’m taking a deep breath here on Yellowknife’s Dene Territory, and am sending love and energy from coast to coast to coast. Thank you for taking such good care of one another. We would not have asked for this disruption, but we can be proud of the first steps we have taken in response. If we keep our eyes fixed firmly on a vision of a cleaner, kinder, healthier, and safer world, and move towards it step by step—that is the destination that awaits us.


Dr. Courtney Howard
Board President, CAPE

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