From Nepal to Canada: Placing Green Principles for Chronic Disease Prevention at the Centre of the Post-COVID-19 Recovery

By: Eliza Thapa, MBBS, MPH, Volunteer PLACE Research Lab

January 27, 2021

“The decisions we make today should result in a sustainable world seven generations into the future”- The Seventh Generation Principle by Haudenosaunee
-Quoted from “Indigenous Canada” (Faculty of Native Studies, University of Alberta)

When I first moved to Canada in March 2020, I was caught off guard by the news that a new strain of coronavirus (SARS-CoV-2) had emerged in the Hubei province of China. I could not have anticipated the infectious respiratory disease now known as COVID-19 would generate a worldwide health crisis, devastate economies, and change our way of life. Nevertheless, I could see then that recovery from this global pandemic might offer Canada (and the world) the opportunity for a new path forward - putting sustainable, health-promoting policies at the centre of our recovery plan.

As a former Medical Officer of Health in Nepal, I made chronic disease prevention and mental health promotion two central themes in my work. Many chronic diseases such as type 2 diabetes, hypertension, chronic respiratory illnesses, cardiovascular diseases, and mental health conditions have risk factors like low air quality, lack of physical activity, and poor access to nature.

These risk factors are shifting their prevalence as society adapts to COVID-19. Air quality and traffic congestion have improved with remote working and social distancing. Physical activity and access to nature have increased, as we seek to spend more of our recreation and leisure time outdoors. In Kathmandu, for example, the lack of vehicle traffic and its dust and air pollution means residents can now clearly see Mount Everest on the horizon, for the first time in many decades.

Given the widespread socio-economic impacts of COVID-19, many health professionals are reconsidering their roles in the pandemic crisis, beyond providing crucial preventive and clinical care.

As both a medical doctor and health promotion educator, I would argue it is our role and responsibility to join in efforts to seek solutions by meaningfully contributing to conversations about a sustainable pandemic recovery. Many health organizations have done so, including the World Health Organization, with its WHO Manifesto for a healthy recovery from COVID-19, and the Canadian Association of Physicians for the Environment, with its Healthy Recovery Report. A recent opinion editorial in the Edmonton Journal describes how some of these efforts could translate to Alberta's renewable energy generation.

For my part, I see air quality, physical activity, and access to nature as key factors for a pandemic recovery in Alberta, and throughout Canada. More than ever, now is the right time to focus on long-term sustainability.

With Canada facing environmental issues much earlier than the onset of COVID-19 (and projections that it might not meet its Paris Agreement 2030 emissions reduction target) this could be an opportunity for Canada to re-evaluate strategies for creating a sustainable and healthy future. I believe that prioritizing and fulfilling commitments to develop green spaces, increasing active transportation, and reducing emissions are steps forward in the right direction.

When I arrived in Edmonton, I learned about its rich history, and long-lasting ties with the oil and gas industry. I discovered that the Athabasca oil sands were a significant contributor to the national economy at their peak, bringing financial prosperity to Alberta and the rest of Canada. However, I was astounded to learn that while the oil sands emit 70 megatonnes of greenhouse gases per year, Alberta is planning to legislate a limit of 100 megatonnes per year, rather than actually reducing emissions.

In combination with greenhouse gases that have already been emitted, these new emissions will contribute to climate change. For Alberta, this is predicted to mean warmer, drier conditions, increased frequency and intensity of wildfires, and enhanced conditions for air pollution. Climate change will increase exposure to fine particulate matter and ground-level ozone, with the most significant impacts felt by vulnerable populations like children, the elderly, outdoor workers, and people with chronic respiratory and heart conditions. 

As a Medical Officer of Health and health educator, I have always believed in preventive health care, and have been a staunch advocate and promoter of maintaining an active lifestyle. Previous studies have shown that access to green spaces like parks, trails, and gardens is associated with cleaner air, more physical activity, reduced stress, better mental health, reduced cardiovascular diseases, and boosted immunity. Short walks in the park, moderate hikes on trails, and sometimes even more strenuous exercises were some of the activities I recommended to patients suffering from various chronic conditions and mental health disorders.

As part of the post-pandemic recovery, ensuring equitable access to parks and green spaces, updating and expanding active transportation infrastructure for walking and biking, and policies to promote cleaner transportation modes like zero-emission vehicles and safe public transit can make a strong contribution to economic and environmental sustainability.

Canada, a place I have decided to call home, should take appropriate steps in response to this pandemic to adopt green principles, promote cleaner and more efficient energy forms, and develop smarter cities with long lasting resilience and sustainability. As we move forward into a post-COVID-19 world, I call upon healthcare professionals, and other stakeholders, to understand and speak up about the benefits of a balanced and sustainable environment, especially its influence on preserving our population health.