Climate-Conscious Care in Action: How Hospitals Can Lead

Climate change now threatens both patient outcomes and the ability of health systems to deliver safe, reliable care. Its impacts are no longer distant or abstract. Across Canada, communities have seen skies darken and air quality deteriorate as wildfire smoke blankets neighbourhoods. According to the Lancet Countdown on Health and Climate Change, wildfire smoke contributed to an average of 1,400 deaths annually in Canada between 2020 and 2024.

Rising temperatures, extreme weather events and environmental degradation contribute to increased risk of respiratory disease, heat-related illness, mental health problems and changes in infectious disease patterns. These impacts will disproportionately affect older adults, children and marginalized communities.

In June 2021, a historic heat dome in British Columbia led to 619 heat-related deaths. Sixty-seven per cent of those who died were over age 70, according to the Report to the Chief Coroner of British Columbia. For many older adults, chronic illness, complex medication regimens and reduced mobility limit their ability to tolerate heat and air pollution. These physiological risks are often compounded by cognitive impairment, social isolation and structural inequities.

At the same time, Canada’s health system already faces significant strain from workforce shortages, access challenges and rising demand driven by an aging population. Climate change now adds further pressure, threatening system capacity and patient safety.

Extreme weather damages infrastructure, disrupts supply chains, compromises water quality and strains staffing and budgets. Rising energy costs and carbon pricing further intensify these pressures. Together, these realities demand stronger leadership in mitigation, adaptation and preparedness across the health sector.

Canada also ranks among the highest health care emitters globally. Health care accounts for 4.6 per cent of national greenhouse gas emissions according to the Canadian Medical Association, more than the aviation industry and the shipping industry. Hospitals therefore carry both a responsibility and an opportunity to lead.

Climate-conscious care begins with how, where and to whom care is delivered. By anticipating climate risks and redesigning care pathways, hospitals can protect system capacity while improving outcomes for vulnerable populations.

Health care use rises sharply in the final year of life, largely due to hospitalizations. Hospitals are more resource-intensive than other care settings such as long-term care or home and hospitalizations are not always aligned with patients’ wishes. While most Canadians prefer to die at home, only 13 per cent did so in 2021 and 2022, according to the Canadian Institute for Health Information. Advance care planning helps patients clarify goals and can reduce avoidable admissions, allowing more people to remain at home.

Clinicians can also reduce environmental impact by avoiding unnecessary tests, treatments and medications. This is particularly important for older adults, who face higher risks of polypharmacy, which can lead to negative outcomes such as medication non-adherence, falls and adverse drug events. Aligning care with patient goals can improve clinical outcomes while reducing waste and emissions.

Supporting aging in the right place offers another climate-conscious solution. According to March of Dimes Canada, 81 per cent of Canadian seniors prefer to age at home. Community-based care can preserve independence, enhance quality of life and reduce reliance on resource-intensive hospital and long-term care settings.

Integrated models such as the Neighbourhood Care Team (NCT) demonstrate how collaboration can advance these goals. Baycrest collaborated with partners in the North Toronto Ontario Health Team and North York Toronto Health Partners to develop the NCT model, designed to bring together local providers to function as one coordinated care team within the Toronto Seniors Housing Corporation buildings. The program has been able to successfully connect many tenants with primary care and aims to help older adults remain healthy and at home.

Virtual care can also play a role in reducing healthcare’s environmental footprint. Baycrest’s Virtual Behavioural Medicine (VBM) program delivers specialized dementia care to underserved communities while reducing travel-related emissions and hospital pressures. Co-created by Dr. Morris Freedman and Deb Galet, VBM supports patients experiencing neuropsychiatric symptoms, a leading cause of dementia-related hospitalization. The program combines pharmacological and non-pharmacological interventions to stabilize patients in their home environments and prevent unnecessary transfers.

Together, these approaches represent some of the most immediate and clinically grounded tools available to respond to climate change. They strengthen resilience by reducing avoidable demand, preserving capacity and improving continuity of care.

Climate-conscious care is not an abstract sustainability target. It is a core element of high-quality, equitable health care in a warming world. By aligning care with patient goals, reducing low-value interventions, supporting aging in place and expanding integrated and virtual models, health systems can protect vulnerable populations while easing pressure on hospitals and reducing emissions.

As climate change accelerates and Canada’s population ages, the health sector must lead. Doing so will deliver care that is better for patients, more resilient for the system and less harmful to the planet.

Dr. Jessica Cuppage is the Chief Medical Innovation Officer and Care of the Elderly Physician at Baycrest. She integrates technologies to enhance patient-centred care and co-leads Baycrest Hospital’s digital health strategy.