The goal of this study was to investigate how people across Canada understand and perceive the link between climate change and health. The study provides a baseline understanding of public perceptions on these intersecting issues, at a time of complex and compounding public health challenges with the COVID-19 pandemic and worsening climate health impacts. The survey was conducted in the winter of 2020, prior to the record setting heatwaves and wildfires that transpired across Canada in the summer of 2021, and set an important national baseline for climate and health opinion moving forward. These results offer insight that can be useful for public engagement and communications, which will allow for targeted interventions that are mindful of pre-existing climate concerns and how this affects attendant perceptions and behaviours associated with health impacts.
Concern about health impacts of climate change
Overall, the results find that levels of concern about health impacts are similar to levels of concern about biophysical, economic, and national security impacts of climate change among people in Canada. Within climate opinion classes, health impacts are of higher concern among the alarmed and lower concern among the disengaged compared to other categories of climate impact. Water- and food-related impacts are of highest concern across classes and most common in response to the open-ended question. This differs from a previous Canadian survey in which air quality impacts were the most commonly named in response to an open-ended question [12]. Somewhat surprisingly, given recent discussion on these matters (e.g. [33]), mental health concerns ranked the lowest; although there was high “worry about future generations”, there was low concern about “personal climate anxiety” and “stress from evacuation during extreme weather events.” The low concern about mental health impacts is interesting considering that climate change poses a serious threat to mental health in Canada [34], with some projecting mental health impacts to be among the costliest of all health impacts [35]. At the same time, mental health has been underrepresented in research on climate change and health historically [36, 37] and a recent survey found that only 44% of Canadian public health organizations report working on climate-related mental health risks [38]. This suggests that perhaps less information has been mobilized to the public regarding this pressing health issue and its linkage with climate change. Low concern about climate anxiety may also be due in part to the lack of widespread understanding and a common operational definition of the term [39, 40].
On the whole, these results illustrate the well-documented phenomenon of psychological distancing, which describes how people are more likely to believe the worst impacts of climate change are far away temporally, socially, and geographically [41, 42], and thus more likely to be concerned for the future generations than their own personal well-being. This distancing is consistent with previous research on public perceptions of climate impacts in Manitoba [14] and Ontario [13]. Recent research in the US shows that the spatial and temporal distribution of climate-related health impacts are far more immediate, localized, and costly than currently understood [43], which speaks to the need to carefully consider risk communications that take into account psychological distancing that may actually run counter to the best available climate and health sciences.
In some cases, concern about the health impacts of climate change parallels indicators of vulnerability across sociodemographic characteristics. Interestingly, people with low income, older people (55+), and women consistently have higher concern regarding health impacts. Given that income, age, and gender are indicators of vulnerability to climate impacts generally [44], it is increasingly clear that those who are most affected by climate change are also more likely to be concerned about the impacts, and speaks to the larger health equity issues climate change poses for Canadians. People with higher incomes, for example, likely have more resources available to them to adapt and insulate themselves from the effects of climate change on their personal health, and thus may be less concerned because they are less likely to be affected. These results are consistent with previous research in other parts of the world which has found a similar relationship between indicators of vulnerability and risk perception on climate change (e.g. [45–47]).
Awareness and affective assessment of health impacts
Respondents reported considerable awareness of climate change health impacts, with just over half of Canadians responding high or very high on the question of how much they had thought about the connection between climate change and health, and only one fifth of respondents answered low or very low. By comparison, research in the US in 2014 found that only a third of Americans had thought about the health impacts of climate change “a great deal” or a “moderate amount” [3], while in 2020 significantly more Americans thought that climate change health effects would become more common [48]. While a substantial amount of Canadians report having thought about the link between climate change and health, the results show that this awareness is not evenly distributed across the population. The alarmed have thought about climate change health impacts about two to three times as much as the concerned and disengaged, respectively. Though perhaps unsurprising, this correlation between climate opinion and climate-health link indicates that there is a significant gap in awareness for half of the population, namely the concerned and disengaged, perhaps in part due to a lack of exposure to information on health impacts. At a global level, despite increasing public and scientific work on climate change and health [49], “in absolute terms, climate change continues to be framed in ways that pay little attention to its health dimensions” [50]. Public health agencies and units are poised as effective messengers on climate change health risks [3, 51, 52], and in some jurisdictions are mandated to communicate this information, such as the Canadian province of Ontario [53]. However, a recent survey of Canadian public health organizations found that only 48% of organizations had engaged in climate change and health education and outreach with the public, and only 36% had undertaken education or training on climate change and health risks and adaptation among staff or professionals [38]. Further health-focused climate communications campaigns (e.g. [54]) are needed to target those less engaged on climate change if we hope to reach widespread understanding of and participation in adaptive health behaviours, and the results of this Canada-wide study are helpful in this regard.
The results also found that about sixty percent of people, particularly women, perceive climate change as bad or very bad for human health. This suggests that the majority of the public perceive climate change as harmful to health, or are inclined to answer as such when prompted, despite half of people not having thought a significant amount about health impacts in particular. Similarly, a 2015 survey of Americans found that while only 10% of people had previously thought about climate change and health “a great deal,” 31% responded that climate change is “very bad” for health [3]. As Maibach et al. [3] suggest, this discrepancy could be in part due to people making inferences or momentary judgements about the negative impacts of climate change on health due to their general understanding of the issue, the context of the survey, and/or their suppositions about what the “right” answer is.
Unprompted knowledge of health impacts
More than half of Canadians can name one or more health impacts of climate change when unprompted, with the most common impacts related to food security and agriculture, air quality, temperature related morbidity and mortality, and extreme events. Answers to open-ended questions such as this are likely more realistic representations of peoples true understandings of climate change and health as compared with close-ended questions that may prompt certain responses [3, 55]. Results here show a slight decline compared to previous surveys which found 69% of climate change believers in 2017 and 63% of Canadians in 2008 were able to identify one or more health impacts of climate change in response to an open-ended question [10, 12]. On the other hand, the results are significantly higher than a survey of US adults in 2015 which found that only 27% of respondents could name at least one health impact of climate change unprompted. The different coding schemes used to classify open-ended responses in these different surveys may be responsible for some of the variation in results. In general, however, the results here suggest that there has not been a notable increase in public knowledge on the health impacts of climate change over the past decade. The fact that only about half of the concerned and less than a third of the disengaged can correctly name one health impact of climate change indicates that levels of knowledge on health and climate remain low among these groups. This speaks to the importance of strategic and ongoing health-focused climate communications
Opportunities and challenges for health framing within climate communications
The results of this study can help researchers and policymakers as they seek to engage the public with more focused, effective, and audience-specific communications on health-related climate issues. While some recent literature points to a health framing as a potentially effective way to engage people across political and ideological divides [17, 18, 56], the results of this study find relatively low concern regarding climate health impacts among the disengaged, and suggests this may not hold true for this audience in Canada. In other studies testing climate health framing, one found that public health framing in climate communications was effective at a local scale, but “backfired” for discussing impacts at a distance, and increased polarization across the climate concern spectrum [23]. Another study in Manitoba looking at climate change and Lyme disease similarly found a lack of resonance of climate health impacts with more skeptical audiences, and suggested that health messages might be ‘strategically decoupled’ to best engage these audiences depending on the goal of the communicator [14, 21]. Results here suggest that for those less concerned about climate change, discussing the health impacts of climate change may not be more effective for engaging them than other climate change frames such as the economy. On the other hand, for communicating with the alarmed, health frames may be particularly beneficial, as this group is more concerned about impacts on health than impacts on national security and the economy. A summary of key findings and implications for health and climate communications are found in Table 2. Specific written and visual materials with health and non-health related frames were tested in the latter part of this survey study and the results will be published in a subsequent paper.
Table 2
Key findings and implications for health and climate communications
Key findings of public perceptions | Implications for health and climate communications |
When prompted, most Canadians perceive climate change as harmful to human health. | - There is some resonance of the health harms of climate change, which suggests that a public health framing in climate communications may resonate to some extent with Canadians but not a panacea. - The majority of people are likely open to information about the health risks of climate change, given that they accept that it is harmful. |
The alarmed have thought more about, and are relatively more concerned about, climate health impacts than the rest of the Canadian population. | - Variable levels of concern suggest that a health frame is not equally resonant across audiences in Canada and may not be effective to bridge the political divide on climate change. Health framing in climate communications is likely to be more successful in reaching those already worried about climate change (i.e. the alarmed and concerned). |
Canadians have different levels of concern about specific health impacts, with highest concern for future generations, food and water security, and respiratory impacts from air quality, and lowest for mental health and heat stroke impacts. | - Communicators seeking to operationalize targeted public health framings in climate change communications may choose to focus on specific health impacts of high or low concern, depending on their objectives. - Climate communicators hoping to reach the largest audiences with messages that resonate might use the areas of highest concern in their messaging. - On the other hand, if a communicator is aiming to increase awareness and concern on climate health impacts of lower concern, they must be aware of the specific audiences that may (or may not) resonate with this message. |
Unprompted knowledge of climate change health impacts is high among the alarmed, but remains low among the concerned and disengaged. | - More targeted education on the health impacts of climate change is needed to reach those less concerned and engaged on the issue. |
Limitations and areas for future research
A significant limitation of the study was the sample size from Indigenous and racialized communities which was not sufficient for analysis according to ethnicity. This is an important limitation, given that racialized communities are disproportionately impacted by climate change now and into the future, including the health impacts of climate change, due to systemic marginalization and racism [49, 57]. In this way, the survey overlooked a large and potentially significantly at-risk portion of the population. Sufficient sample representation for comparison by race is also important considering previous research in the United States which has found that People of Colour are more often concerned about climate change impacts than white people [58]. Future surveys should ensure sufficient representation from Indigenous and racialized communities through more targeted recruitment and sampling, in order for the results to be applicable and useful to these communities.
Finally, the survey is limited in its scope given a finite number of variables that could be explored and the limitations inherent with measuring evaluative judgments. As Maibach et al [3] explains, “evaluative judgments are not necessarily comprehensive representations of an individual’s “true” attitudes, but rather are based on momentarily accessible, salient information”. The context of the questions within the survey focused on climate change could have influenced participants’ responses. Additionally, the measures here (i.e. concern, awareness, affective assessment, and unprompted knowledge) do not necessarily fully capture issue value or importance. It is possible that people are not overly concerned about the climate health impacts presented, yet they do significantly value health, which may mean that we are underestimating the effectiveness of a health frame. The conclusions drawn with respect to applications in communications framings are limited given that these results just deal with perceptions and do not directly test health frames in communications materials. Test of health framing materials was done in a subsequent part of the survey and will be published in a future article.
Future research should seek further resolution of climate health perceptions and knowledge in Canada and the efficacy of health framing between demographics, geographic regions, and locally germane climate impacts. Studies testing the effects of specific climate and health communication campaigns on uptake of adaptive behaviours and support for policy change are also needed, as an alternative measure of the efficacy of these frames, and would contribute to the evolving literature on climate/health indicators [49]. Additionally, further exploration into the relationship between people’s personal health attitudes, experiences of climate impacts, and perceptions of climate health risks may shed more light on what informs and underlies the different perceptions found here.