Cities, Climate and Inequalities

Climate change and social inequalities in health: The case of urban environments in Quebec

September 2022

Léa Ilardo, policy analyst (David Suzuki Foundation), contributor to the “Urgence climat” column (24heures.ca), master’s degree in applied political studies (Université de Sherbrooke)

Introduction

In Quebec, urban environments are set to experience more frequent and intense heat events in the future, as well as increased incidences of poor air quality due to climate change (Brown et al., 2021). The risks to people’s health are already significant and will only increase. But which segment of the population is most at risk? The health community uses various factors to characterize the state of health of an individual or a population, known as the determinants of health. Including personal, social, economic and environmental factors (Émond, 2010), they help us to understand that not everyone is equal in the face of climate change: some individuals and groups are more at risk of suffering the harms associated with climate change than others. These people are said to be more vulnerable. Vulnerability factors highlight a number of social inequalities in health, which correspond to differences in health between individuals linked to social factors or criteria of differentiation (social classes, socio-professional categories, income categories, levels of education, etc.) (Aïach, 2000). This research focuses on the amplifying role of social inequalities in health on the health impacts of climate change in urban environments, namely through two case studies: extreme heat and anthropogenic air pollution. 

Cases, methods and data from primary sources

The aim of this case study was first to place the issue of social inequalities in health linked to climate change in the Quebec context, and more specifically in urban environments. Does the literature confirm the presence of these inequalities in Quebec cities? Has it been studied, and to what extent? The goal was to bring together both general knowledge on the health impacts of heat waves and air pollution, and existing studies on related social inequalities in health (of which there are few). The health data come mainly from the Institut national de santé publique du Québec, which has expertise in environmental health and has been conducting research on the health impacts of climate change for several years. Data revealing inequities in terms of vulnerability to heat waves and air pollution were produced by researchers, notably in urban studies.

he three main studies I drew on were: Bélanger et al. (2015), Analyse multiniveau pour expliquer la prévalence d’impacts sanitaires néfastes autorapportés et l’adaptation lorsque il fait très chaud et humide en été dans les secteurs les plus défavorisés des neuf villes les plus populeuses du Québec en 2011 (Multilevel analysis to explain the prevalence of self-reported adverse health impacts and adaptation when it is very hot and humid in summer in the most disadvantaged areas of Quebec’s nine most populous cities in 2011); Carrier et al. (2014) The application of three methods to measure the statistical association between different social groups and the concentration of air pollutants in Montreal: A case of environmental equity; and Pham et al. (2012), Spatial distribution of vegetation in Montreal: An uneven distribution or environmental inequity? Adaptation perspectives aimed at improving equity are based on existing literature and on projects carried out in Quebec. The case study presented here highlights the inequitable impacts of climate change on the health of urban populations as well as the adaptation solutions that could promote equity or, conversely, lead to maladaptation. In this way, it provides a better understanding of the opportunities, constraints and conditions conducive to equitable climate action.

Results

With regard to the health impacts of heat waves, urban populations are more vulnerable, as surface temperatures are higher due to urban heat islands (UHIs). UHIs correspond to the difference in temperature observed between urban environments and surrounding rural areas, or between areas within an intra-urban perimeter. This difference can be as much as twelve degrees Celsius higher in UHIs than in adjacent areas (Drapeau et al., 2021). As a result, the risk of dying in hot summer weather is higher in UHIs, as the accentuated oppressive heat creates stress on the human body (Smargiassi et al., 2009).

People living in cities are also the biggest victims of air pollution, which is exacerbated by heat and the combustion of fossil fuels, mainly by road transport vehicles, which are more numerous in cities. Climate change is likely to influence levels of smog and fine particles in ambient air, pollutants that form more rapidly in the presence of high temperatures. Some ninety-five percent of smog-forming pollutants come from human activities, notably transportation, which has been growing steadily in Quebec since 1990. Reducing our greenhouse gas emissions would not only help combat climate change but also reduce air pollution, recognized worldwide as a major contributor to illness and premature death. Air pollution is responsible for 4,000 premature deaths in Quebec every year (Health Canada, 2021).

Heatwaves and air pollution are two examples of the health threat posed by climate change. However, even within urban environments, social determinants put certain populations at greater risk.

Extreme heat and air pollution are two cases that reveal an unequal distribution of health risks. Socially and economically disadvantaged people suffer much more from heat-related health impacts (Kovats and Hajat, 2008). They also have more limited access to vegetation, according to an analysis of the spatial distribution of vegetation in Montreal (Pham et al., 2012). They are more likely to live in UHIs and poorly insulated dwellings, where access to air conditioning is limited (not to mention people experiencing homelessness, whose ability to cool down is even more restricted). Other risk factors are also taken into account when identifying heat vulnerability profiles, such as living alone and having a severe disability, both of which are more common among the disadvantaged (INSPQ, n.d.). All these factors combine and reinforce each other: they are intersectional.

Social inequalities in health are also reflected in the identification of vulnerability profiles to air pollution. Neighbourhoods polluted due to high traffic density are also more asphalted (these are UHIs), have fewer green spaces and are therefore hotter. These areas generally correspond to where the most disadvantaged people live, according to a study carried out in the nine most populous cities in Quebec in 2011 (Bélanger et al., 2015). A study carried out specifically in Montreal showed that low-income people more frequently live near major roads and in areas with higher concentrations of pollutants (Carrier et al., 2014).

Thus, there is a direct link between social inequalities and vulnerability to health problems associated with climate change in urban environments, including Quebec. Adaptation measures must take this into account to avoid widening the inequality gap.

Analysis of the health impacts of heat reveals that adaptation could be greatly facilitated by improving greening measures (e.g., development of green spaces, greening of parking lots and building perimeters, green walls, green roofs) in the poorest sectors of major urban centres. For example, the creation of a downtown park to replace buildings would decrease the temperature of the surrounding air between two to six, or even more, degrees Celsius (Drapeau et al., 2021). The ILEAU campaign, which reduces UHIs in Montreal, is a concrete application of socially accepted policy that is carried out in collaboration with public health and community partners to transform the territory. The creation of community gardens is another example of a project that positively affects mental health and social relationships (Beaudoin and Levasseur, 2017). Indeed, green spaces jointly influence certain social determinants of health as well as health itself. Nevertheless, these strategies for creating islands of coolness have a negative side in that they can encourage what is commonly referred to as “green gentrification.” This is because they can cause gentrification that drives up rents, thereby driving out the populations for whom greening was intended. It is important to ensure that this does not neutralize efforts to reduce social inequalities in health when greening the most affected neighbourhoods.

The issue of air pollution must be treated with the same caution. Since it is largely linked to automobile traffic, solutions to reduce it may aim to redirect some of the traffic from local residential streets to the higher road network (arterial roads, freeways). However, this approach generally increases health inequalities by simply displacing the contaminants emitted by vehicles to areas where people with lower socioeconomic status are over-represented (Bellefleur and Gagnon, 2011). One solution is therefore to divert individuals from the automobile by developing an efficient public transport service and enabling the safe use of active transport, taking care to ensure that the presence of cycling infrastructure does not encourage gentrification, as studies have observed (Houde, 2018). In addition, the implementation of social pricing based on income, as developed in Quebec City (Accès transports viables et al., 2022), can improve accessibility to the public transit network and, by the same token, reduce certain health inequalities. Mobility improves access to employment, education, culture and healthcare while facilitating the fight against social exclusion (Schepper, 2017). Free public transit is a trend that is gaining ground in several Quebec cities, including Beauharnois and Saint-Jérôme (Tanguay, 2022).

Conclusion

This study confirms the importance of an approach that makes health, the environment and social inequalities inseparable, as well as of deepening our knowledge of health equity and how it could be undermined by the climate crisis. Working in isolation when developing policies to combat and adapt to climate change can have serious repercussions for the most disadvantaged populations. The creation of equity helps to increase adaptive capacity and well-being in cities, enabling them to become more resilient in the face of climate change (Brown et al., 2021). This research proposes courses of action for Quebec cities grappling with environmental inequities, which will only be exacerbated if ignored. As an example of good practice, Vancouver added an equity component to its climate change adaptation strategy in 2018, partnering with a non-profit organization to educate those residents who are most vulnerable to heat and poor air quality (Evergreen, 2020). It should be noted that the present research is based on a limited number of studies and is a first attempt at interdisciplinarity, which is essential if we are to respond adequately to the challenges posed by climate change. More in-depth research is needed to better define vulnerability profiles, as well as adaptation responses. In addition to socioeconomic disadvantage, the concept of environmental racism indicates that racialized populations are more affected by environmental damage. It would be interesting to study this relationship in the Quebec context, especially as the studies by Carrier et al. and Pham et al. reveal that visible minorities are, albeit to a lesser extent, likewise affected by the phenomena studied. 

^[1] Maladaptation is defined by the IPCC as inadequate adaptation measures that may lead to an increase in the risk of adverse climate-related consequences, an increase or shift in vulnerability to climate change, or a deterioration in living conditions, now or in the future.

To cite this article

Ilardo, L. (2022). Les changements climatiques comme inégalités sociales de santé : le cas des milieux urbains au Québec. In Cities, Climate and Inequalities Collection. VRM – Villes Régions Monde. https://www.vrm.ca/climate-change-and-social-inequalities-in-health-the-case-of-urban-environments-in-quebec/