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In recent years, the UK medical establishment has come to take increasingly serious the warning of the Lancet-UCL commission that anthropogenic climate change may pose the “greatest threat to global health of the 21st century.” This has manifested not merely in rhetoric, but also in substantive action. Most recently the British Medical Association’s voted to form an alliance for action on climate and health, and to divest from the fossil fuel industry.

But it has long been recognised by environmental health workers and campaigners that environmental health threats do not respect national borders, and action to remediate them must consequently be similarly international in nature. It’s for this reason that the attention of many across the world will be directed towards the proceedings of the General Council meeting of the Canadian Medical Association (CMA), currently taking place in Ottawa, hoping that Canada’s doctors will engage with the threat to human and planetary health posed by our continuing dependence of fossil-fuel energy sources.

The General Council will vote on a series of motions brought forward by the Canadian Association of Physicians for the Environment, calling on the CMA to take a stronger leadership role in acting on the health effects of climate change. In particularly, they want the CMA to acknowledge the role played by fossil fuel dependence in driving climate change (as well as producing the air pollution responsible for 1 in 8 deaths worldwide in 2012), and to work towards the renewable energy transition by supporting a coal phase-out and offering a fossil-free investment fund to its members.

With the vast death toll of air pollution and the fossil fuel industry’s role in driving climate change and attempting to subvert both climate science and international climate change mitigation policy; and its continued commitment to exploiting newer and more-polluting fossil fuel resources in place of renewable energy investment, there is a substantive moral and medical case for Canada’s doctors to sever their ties with the industry.

The main opposition to this case, however, comes less on medical grounds than economic ones – this has been the case in the UK, and is likely to be the case in Canada. However, these economic arguments do not stand up to scrutiny – the fact is that, not only will concerted climate action be better for our health, it’s better for our pockets too.

One prominent concern is that the economic costs of breaking from fossil fuel dependence may hurt our health more than the gains from doing so. This is a favourite line pursued by fossil fuel industry-funded climate contrarian Bjorn Lomborg; however, it compares apples with oranges – the world now is not as it was before the Industrial Revolution, and renewable energy technology now provides a viable alternative. Recent estimates of the costs of all-renewable energy infrastructure predict that the additional investment required will be more than offset by longer-term savings (and that’s without even factoring in the economic impacts of climate change). And far from renewable energy holding them back, many emerging economies are finding it central to improving their energy infrastructure – in particular, the easy provision of off-grid renewable energy is making electricity supply to relatively inaccessible regions easier and cheaper – saving lives in the process. When it comes to exacerbating inequalities, then, the ways in which the health, social and economic impacts of climate change will hit the poorest hardest should be of far more concern. It is, of course, vital that the energy transition is brought about equitably – but that is not an argument against its necessity.

Furthermore such arguments neglect the ‘social cost of carbon’ – the fact that fossil fuels don’t just make us sick, this sickness costs. The health-related externalities of coal power alone are vast – recent estimates suggest that coal costs Albertans some $300m, while corresponding figures for the EU come to some €43bn, and across the USA it is thought to be a staggering $350bn. These costs add to the potentially huge health cobenefits of a renewable energy transition –a 30-40% reduction in all-cause mortality through increased cycling, two million premature deaths averted with more-efficient cookstoves, or any of the other range of health improvements arising from less air pollution, better transport, healthier diets and more green space. These benefits themselves have positive economic ramifications – for example, it has estimated that the UK’s health service could save £4 for every £1 invested in cycling infrastructure, or £17 billion within 20 years.

A second set of economic concerns comprises those rather closer to home, focusing on the impact of severing ties with the fossil fuel industry on the members of the CMA. If CMA members choose to make their investments fossil-free, will this hurt them financially? While such matters are beyond me – and most – to predict, available evidence shows fossil-free portfolios closely track, if not outperform, conventional benchmarks. Continued investment in fossil fuels, meanwhile, risks ex exposure to the ‘carbon bubble’ – the trillions of dollars the fossil fuel industry stands to lose if climate change mitigation legislation (which would make up to 80% of currently-listed fuel reserves worthless) is enacted.

While the actions of the CMA are for its members to decide, their decisions will influence not just them – indeed, not just Canadians – but affect the entire globe. Many health workers internationally will be following the events of the next few days with interest, and offering solidarity to CAPE and all CMA members willing to commit to the change we need. Leaving fossil fuels behind is not unaffordable – it is the alternative that is unaffordable.

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