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"What's new is that the health professionals are starting to say, 'What can I do?'" said Levinson, also a professor of medicine at the University of Toronto.

Her group has released 40 recommendations from doctors in various specialties encouraging individual and collective action against climate change, including scaling back on lab tests where possible and meeting virtually to avoid excessive travel.

Similar initiatives, big and small, are underway across the country.

A "planetary health" food pilot that recently wrapped at Vancouver General Hospital loaded patient menus with plant-based meals and "climate-conscious proteins" including steelhead trout and turkey, said Dr. Annie Lalande, whose six-month project focused on hospital meals and food production.

The program introduced lunch and dinner options including coconut chicken curry, soy-based sloppy joes and a Korean-style gochujang bowl made with beans to incorporate sustainable and mostly locally sourced ingredients.

The recipes were developed with input from patients, and the programwas recently extended to Richmond General Hospital south of Vancouver.

Lalande, who is doing a PhD in environment and sustainability at the University of British Columbia whilecompleting her residency in surgery, said there are clear connections between human health and the environmental impacts of raising animals, especially cattle, for meat.

"People are understanding the role that food plays in both our health and the health of our planet. The main goal of the project was looking at it from a greenhouse gas emissions perspective," she said.

"We're trying to maintain choice for patients and we're certainly not trying to turn everyone vegan," said Lalande, adding that before the new menu was introduced, up to half the food on patients' plates was left uneaten.

Sustainability efforts by Choosing Wisely Canada, which also involves Toronto's St. Michael's Hospital, have focused on reducing "low value" lab tests, treatments and procedures.

Family doctors, pharmacists and nearly two dozen societies of specialists made the 40 evidence-based recommendations released this week. It's part of a campaign funded by the Canadian Medical Association Foundation, Health Canada and all provinces and territories except Quebec and Yukon. The former Quebec medical association contributes some funding.

The recommendations encourage doctors to order blood tests only as needed — instead of routinely scheduling them — to cut down on the use of single-use tubes and syringes. They also urge greater care in prescribing medications, noting antibiotics are often prescribed for viral infections despite evidence they do not work in those cases.

Many recommendations are simple and practical, including those offered by the Canadian Critical Care Society, which is calling on staff in intensive care units to not use gloves when proper handwashing is sufficient.

"In the ICU, they use 100 pairs of gloves per day, per patient. People put on gloves all the time, even to walk into the room and press a button on a machine," Levinson said.

"Of course, that transcends critical care. We throw away millions of gloves."

Recommendations by the Canadian Orthopaedic Association call on operating-room staff to separate uncontaminated waste from materials that are contaminated and must be incinerated, producing more greenhouse gas emissions.

There is also a recommendation against the prescribing of metered-dose inhalers whenever possible for patients with asthma or chronic obstructive pulmonary disease (COPD) because the device releases a greenhouse gas called hydrofluorocarbon (HFC) into the atmosphere.

Dr. Val Stoynova, an internal medicine specialist in Victoria who co-authoredrecommendations from the Canadian Society of Internal Medicine, said about 35 types of inhalers are available in Canada and several are the L-shaped metered-dose type.

"When you push on the canister, whatever comes out is the gas that propels the medication into the lung. That gas is extremely carbon intense and each metered dose inhaler, depending on the type and the volume of propellant, can actually have as much greenhouse gas as a standard vehicle driving up to 170 kilometres a day," she said.

Metered dose inhalers must also be incinerated as medical waste to neutralize leftover propellant.

Low-carbon, cheaper alternatives called dry powder inhalers do not have a propellant and their carbon footprint amounts to driving between two and five kilometres per day, Stoynova said.

When followed up with a standardized test, it turns out that about a third of Canadians diagnosed with asthma in a clinical exam do not actually have it, and nearly twice that many are incorrectly diagnosed with COPD, she said.

"They're being prescribed inhalers for a disease they potentially don't have and those are inhalers we don't really need to be using," said Stoynova, adding side-effects from the short-acting devices can include anxiety while some longer acting inhalers contain steroids that pose a risk of infection or voice hoarseness as well as fungal infection of the throat.

However, patients should not be made to feel guilty for needing an inhaler to manage a chronic illness, she said. Children under age six and those who are frail or have a disability lack the co-ordination to use a dry powder inhaler, she said.

Tony Leamons, one of four patient advisers who provided input on the Choosing Wisely recommendations, said the idea is for doctors and patients to collaboratively discuss the pros and cons of procedures that may not be necessary, not to dissuade anyone from getting the care they need.

"I think there's good value for the environment from these recommendations," Leamon said from Port aux Basque, N.L. "Patients should be involved because they are the users of the health-care system."

The recommendations also urge virtual appointments where possible, and Leamon said that isespecially good for rural residents like him because driving to a major medical centre 900 kilometres away in St. John's, N.L., would emit large amounts of carbon dioxide and other pollutants.

Many doctors, nurses and other health professionals have joined "green teams" at hospitals to be more mindful of waste.

General internist Dr. William Silverstein of Toronto's Sunnybrook Health ¹ú²úÓÕ»ó¸£Àûs Centre said a "green task force" that began there two years ago has focused on issues such as reducing waste.

Medical students are also learning about climate-change advocacy as part of Choosing Wisely Canada's program called STARS — Students and Trainees Advocating for Resource Stewardship — which Silverstein helped launch when he was in medical school in 2015.

It enrols two students from each of the country's 17 medical schools for a year, with a virtual meeting in the fall when students learn how to advocate for change. This year, they received information about the harms of metered dose inhalers and the prescribing of alternative options.

Three virtual meetings are held throughout the year so students can network and talk about projects they have started or ways that their curriculum can be improved, said Silverstein, adding participants receive Choosing Wisely Canada certificates at the end of the program.

Its goal is to train the next generation of doctors to "do the right thing," Silverstein said.

"Ultimately, this is a health-care system that they are going to be stewards of."

The STARS program has been duplicated in eight countries, including the United States, Brazil, Japan and New Zealand, with discussions currently underway with medical schools in Switzerland, Silverstein said.

This report by ¹ú²úÓÕ»ó¸£Àû was first published May 17, 2024.

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