Doctors say political activism part of their jobs on issues affecting health

As a child growing up in Toronto, Dr. Melissa Lem was dubbed a tree hugger thanks to her passion for the environment. It's a label she fully embraces as a family physician pushing for political action when it comes to the link between health and climate change, a major issue during the federal election campaign.

Lem, who now works in Vancouver and is a board member with the Canadian Association of Physicians for the Environment, said the group garnered support from the Canadian Medical Association and four other large health organizations before meeting with representatives of three major federal political parties in February as it called for a commitment to limit global warming.

Since then, the physicians' association has bolstered its position and will be joined on Thursday by 19 more groups representing hundreds of thousands of health-care professionals advocating for action, said Kim Perrotta, the association's senior director of climate, health and policy, adding only the Conservative party has formally declined discussions with the group.

Lem said momentum for bold activism by doctors has built steadily, especially after warnings that climate change is the biggest threat to health in the 21st century, based on a major study published in 2018 in the journal The Lancet.

It's hard to ignore recent marches around the world, with youth who fear for their future demanding politicians take decisive steps on climate change, she said.

"We have definitely stepped up our efforts to communicate with our members of Parliament," said Lem, who carried a placard saying "Climate change harms our health" when she recently joined other doctors and medical students from the University of British Columbia to march among an estimated 100,000 people in Vancouver.

Climate change has been associated with harms to physical and mental health through issues including pollution, floods, wildfires and insect-borne diseases.

Lem said more doctors have become social activists in recent years because their patients' health is affected by what's going on around them.

Last week, some Toronto-area health-care professionals and trauma-care doctors called for a national ban on handguns after meeting with Liberal Leader Justin Trudeau, who later said he would give municipalities the authority to ban the guns in their communities.

Dr. Gary Bloch, a family physician at St. Michael's Hospital in Toronto, said doctors who see the often terrifying impacts of social policies are increasingly choosing to get politically involved.

He joined Lem in denouncing a recent tweet by the Journal of the American Medical Association, which asked people to agree or disagree with the statement: "Medical school should produce physician scientists, not physician social justice activists." Many other health professionals also disagreed with the tweet's premise in their comments online, however the tweet's poll showed 31 per cent agreed with the statement, and 69 per cent disagreed.

"I thought it was ridiculous," Bloch said. "It comes from an extremely antiquated view of what medicine and being a physician is, one that somehow places a barrier between the idea of science and the idea of society. I do not see the divide. We cannot even begin to think about improving health without using the full context of how people live."

Greater activism by physicians is "coming out of all corners right now," Bloch said. "Doctors, on the one hand, sense their limits. But they are very aware that if they only use their traditional tool boxes they will only get so far in improving people's health. And I think the other piece is that doctors are quite aware of their privileged voice and many physicians feel some responsibility to use that privileged voice for social good."

Bloch said he wanted a career addressing poverty-related issues before deciding to go to medical school and has linked his scientific knowledge with intervention, often by connecting patients with a social worker so they can apply for disability or child-tax benefits, for example, or file their income-tax forms. His team also connects patients to a no-fee lawyer if necessary.

His work is based on a "tool" he developed 10 years ago to screen all patients for poverty by asking about their living and employment situation as well as social supports, educating them about resources and linking them to services. It was initially used in Ontario but the College of Family Physicians of Canada has produced a version for doctors in every province and territory.

Children from low-income families are more likely to develop a condition that requires treatment later in life, even if their economic status improves, Bloch said, adding deprivation of food and housing are just some of the reasons poverty has such a high impact on health, Bloch said.

Countless studies have linked poverty as a risk factor for cancer, diabetes, cardiovascular disease and mental health problems and that has a direct hit on health-care costs that governments must consider in making policy decisions, he said.

Dr. Victor Do, president of the Canadian Federation of Medical Students, said social issues have become a greater part of the curricula across Canada, often through advocacy from students aiming for more awareness about a range of topics including health of Indigenous and LGBTQ patients, for example.

"Sometimes it's been discussed that all physicians, and medical trainees for that matter, should stay in their lane but we know that social determinants make such a huge impact, probably more than the medical treatment that we give to our patients. So if we see things like climate change issues or gun violence they matter to us because they affect the patients that we care for and they affect our ability to do our jobs," said Do, a fourth-year medical student at the University of Alberta.

"For me, being an advocate and a leader is core to being a physician."

This story by The Canadian Press was originally published Oct. 7.