Canada's Dec. 10 decision to ratify the Kyoto protocol and reduce greenhouse emissions (www.climatechange.gc.ca/) has attracted its share of critics, but they're hard to find within the medical profession.
The exception appears to be Alberta's physicians, who are being forced to weigh the health impact of global warming against the economic impact Kyoto may have on the province's energy-based economy — and on their patients. “The accord may influence the ability of governments to fund health care,” says Ron Kustra, assistant executive director of the Alberta Medical Association (AMA). “And if there is a significant drain on the provincial economy, it will impact government revenue. We know too that unemployment is not good for an individual or family's health care, so dire predictions of job losses certainly raise concerns for us.”
And those predictions have been dire. The Canadian Manufacturers Association puts the job-loss total at between 200 000 and 450 000 jobs, with Alberta at particular risk because of huge projects such as the tar sands. Ottawa says the economy will generate 1.26 million new jobs by 2010, about 60 000 fewer than if we had not ratified the protocol.
Most CMA divisions contacted by CMAJ say Kyoto has not emerged as a major issue. Three divisions — British Columbia, the Yukon and Ontario — have produced their own resolutions supporting the protocol, and almost all have adopted the position taken by the CMA's General Council last August, “that CMA urge the federal government to ratify the Kyoto Protocol and adopt a strategy that will reduce Canada's greenhouse gas emissions by at least 6% below 1990 levels by 2012.”
“The MMA has not issued its own position on Kyoto, nor do we intend to,” said Manitoba Medical Association spokesperson Debbie Bride. “We lack time and resources to pursue [an issue like this] on our own — we see that as an appropriate role for the CMA, and there's no point in duplicating its efforts.”
The Newfoundland and Labrador Medical Association has also adopted the CMA position, although spokesperson Lynn Barter says the issue “has not received a lot of comment or attention from the executive or members.”
The CMA has been aggressive in its support. President Dana Hanson sent a strong letter of support to Prime Minister Jean Chrétien last September and a congratulatory letter following the recent ratification.
But Hanson is not surprised that there is some opposition within medical circles. “Anyone who attended GC [CMA's General Council] knows this, because our resolution [on Kyoto] certainly didn't slide through — 75% supported it — and the Alberta delegates ensured that their economic concerns were heard. In the end, health issues had primacy, and that's why the motion passed.
“What's important with Kyoto, I think, is that we've shone a light on this entire area [global warming] and been forced to ask ourselves: ‘What’s going on in the environment?' And if nothing else, Kyoto may drive an innovation agenda. If that happens, it will all have been worth while.”
Some divisions have been actively supporting the protocol. President Wayne MacNicol says the Yukon Medical Association (YMA) asked its local MP to take YMA members' support to Ottawa. “We met with MP Larry Bagnall twice, and he brought our concerns to the minister of the environment,” he says.
The Ontario Medical Association has also been a strong proponent — it brought forward the pro-Kyoto resolution that was passed during the CMA's 2002 annual meeting.
But some physicians have strong anti-Kyoto views. Dennis Modry, director of the University of Alberta's Heart Transplant Program, protested the protocol in a strongly worded letter to the National Post in which he claimed the agreement will increase the crime rate because of rising Kyoto-related unemployment. “Please do not mistake my anti-Kyoto comments for ‘anti-climate control,’ ” Modry told CMAJ. “Some [Alberta physicians] support Kyoto. [However], many do not, and many have told me that they find it unconscionable that we would risk damaging the socio- economic well-being of Canadians consequent to Kyoto.”
He called for a national poll of physicians to “gauge their sentiment.”
But despite its concerns about the protocol's economic impact, the AMA rushed to defend a public health physician who was fired for criticizing the Alberta government's anti-Kyoto stance (CMAJ 2002;167[10]:1156). President Steve Chambers responded immediately with a letter supporting the physician, Dr. David Swann. It was sent to all AMA members. — Patrick Sullivan, CMAJ; Louise Gagnon, Ottawa