Climate Change and Health Adaptation in the Vancouver Coastal Health and Fraser Health Authority Health Regions

The project, “Climate Change and Health Adaptation in the Vancouver Coastal Health and Fraser Health Authority Health Regions,” was funded by Health Canada’s HealthADAPT program until March 2022.

Vancouver Coastal Health (VCH) and Fraser Health Authority (FH) are the two largest public health authorities in British Columbia (BC), representing 60% of the BC population. The two public health authorities launched this project within VCH and FH jurisdictions, including Vancouver, Richmond, North and West Vancouver, along the Sunshine Coast and Central Coast, and from Burnaby to Fraser Canyon. VCH/FH Facilities Management (FM) and Health Emergency Management British Columbia (HEMBC) collaborated with VCH and FH as project partners over the course of the project.

The project began in September 2019 with an assessment of the degree to which communities, populations, facilities, and some health services are susceptible to and prepared for the effects of climate change. The assessment described current and future climate conditions for the VCH and FH health regions as well as the climate-related health-related impacts and risks. This collaborative preliminary work led to the creation of a Climate Change and Health Adaptation Framework that outlined project partners’ roles in climate change and health adaptation and presents recommendations that correspond to the risks identified in the vulnerability and capacity assessment as well as during engagement with VCH collaborators and advisors. The framework is meant to communicate health authority priorities to internal and external audiences and enable action planning at the program level within and between each of the four partner organizations.  

Understanding and Assessing Impacts

The connection between climate change and negative impacts to human health and the health system is strong, as evident during recent extreme heat, smoke, and flooding events. Climate change and health vulnerability assessments assess the degree to which individuals, communities, facilities, and the services delivered by the health system, are susceptible to, and prepared for, the effects of climate change. In the first of two phases of this HealthADAPT project, a vulnerability and capacity assessment was produced that assessed the degree to which population health, health care facilities, and certain health services are susceptible to, and prepared for, the effects of various hazards, including heat, air quality, storms and flooding, and changing ecosystems.

The vulnerability and capacity assessment used environmental scans, literature review, primary data collection, internal and external engagement, and input from many advisors to assess current vulnerabilities and capacities. Engagement with communities in both the VCH and FH health regions was essential to creating community vulnerability maps, which were shared with local and regional governments in VCH and FH jurisdictions. These maps put local and regional governments in a better position for developing adaptation actions as it provided current climate data that helped refine understandings of community vulnerability. These findings, including the maps, provided the foundational knowledge required to create a coordinated, integrated, and multi-agency Climate Change and Health Adaptation Framework for VCH and FH.

Here are the key findings of the assessment:

  • Extreme heat events, like the one that occurred in June 2021, will become much more common as the global climate warms, intensifying impacts to population health and the health system.
  • Wildfire risk is expected to increase in BC as the climate changes.
  • In addition to direct impacts from fire, the smoke from wildfire events contributes to poor air quality, in addition to other climate related air quality impacts of increased ground-level ozone, and longer pollen seasons.
  • Flooding from extreme precipitation and coastal storm surge will intensify as climate change alters hydrological regimes and sea levels rise.
  • Changes to the climate will contribute to conditions favourable to the spread of infectious disease, including water- and food-borne diseases (e.g., Vibrio), Legionellosis from contaminated water, Lyme Disease, and other less prevalent diseases including those acquired outside of Canada. Not enough is known about the changing epidemiology and ecology of many of these diseases and precautions should be taken to avoid minimizing the risks.

Identifying Actions

Building on the results from the Vulnerability and Capacity Assessment, this project included the creation of a climate change and health adaptation framework. The framework outlined the project partners’ roles in climate change and health adaptation and presented recommendations that correspond to the risks identified in the vulnerability and capacity assessment as well as during engagement with VCH and FH collaborators and advisors. This framework is meant to communicate health authority priorities to internal and external audiences and enable action planning at the program level within and between each of the four partner organizations.

Recommendations are organized across six pillars:

  • Emergency preparedness and response
  • Risk assessment, epidemiology, and research
  • Communications
  • Leadership and advocacy
  • Health equity
  • Facilities

The framework is motivated by the project’s vision: to collaboratively maintain healthy communities and a resilient health system as the climate changes. The framework supports collaboration within and between the four project partners, and with the many allied organizations, to share a vision for healthy and resilient communities. The framework is focused on the 2022-2026 period in order to align with adaptation planning cycles at the provincial level.

Through the framework process, the following actions were completed:

  • A long list of potential actions was developed using input from internal and external engagement during the vulnerability and capacity assessment process, as well as from desktop research that included scholarly and grey literature and findings from other internal and external planning processes.
  • This list was then evaluated by an expert committee to prepare a shorter list that could be used during subsequent engagement. This exercise used impact and feasibility as the two primary criteria, with additional criteria (e.g. cost) considered as needed.
  • The list of recommendations and actions was further refined through internal external engagement.


Even before the HealthADAPT project officially ended, staff had begun to implement projects of various sizes and focuses. Actions that have been recently completed at VCH include:

  • Hiring a Climate Change and Health Lead
  • Developing a Heat Check-In Guide for Non-Governmental Organizations
  • Developing seasonal readiness planning across the Office of the Chief Medical Health Officer and other VCH program areas like home health
  • Engagement with Central Coast communities focused on climate resilience
  • The completion of a local air quality monitoring project funded by the Port of Vancouver in collaboration with the Strathcona Residents Association in response to concerns regarding the Centrum expansion project, truck traffic and other port activities. Technical advisory support for this project was provided by VCH, the University of British Columbia (UBC), and Metro Vancouver (MetroVan).
  • VCH’s executive leadership has also named planetary health as a strategic priority, which has resulted in the establishment of a planetary health portfolio in 2021-2022 that includes mitigation actions to improve air quality and food and water quality and engage with Indigenous communities. FH is also exploring similar adaptation and resilience work, including work related to planetary health.

Outcomes and Monitoring Progress

Determining the precise impact of such a broad program of work is difficult. Public health and climate change adaptation share a similar feature whereby success is often the absence of an undesirable thing happening. This makes demonstrating the impact of various interventions, and of a program generally, quite difficult. However, efforts are underway to report on the work, relying on process and outcome indicators, and other best practices from the evolving literature on monitoring and evaluation strategies for low carbon resilience and public health.

Anecdotally, the project continues to attract international attention and staff from VCH have been involved in several different communities of practice as a result of their participation in the HealthADAPT project. Community partners have stated that VCH’s commitment to supporting climate resilience is welcomed, and is contributing to a more robust field of practice.

Another way that efforts will be monitored in the future is through GreenCare – an environmental sustainability network made up of four public health authorities in Vancouver, including VCH and FH. GreenCare’s Environmental Performance Accountability Report highlights environmental sustainability successes, challenges and future opportunities, and both VCH and FH have previously published Reports within this network to demonstrate accountability in their programming.

Next Steps

In terms of next steps, the following measures are currently underway:

  • A joint citizen science survey of self-reported indoor temperatures and building factors during summer 2022 with City of Vancouver and the British Columbia Centre for Disease Control (BCCDC)
  • A study to deploy indoor real-time smart thermostats to measure indoor temperatures in BC housing buildings in collaboration with BC Housing and the University of Waterloo
  • Supporting the Sunshine Coast Regional District in developing their Community Climate Adaptation Plan
  • Collaborating with Metro Vancouver on developing a hyperlocal air quality monitoring network with low-cost sensors in a selected neighborhood
  • Catalyzing and informing adaptation activities in all VCH communities, including collaborating with various governments and community-based organizations
  • Pilot project to offer one-time grants to non-profit organizations to support the creation of plans and/or action on community climate resiliency

VCH has also adopted a portfolio and project management software solution to facilitate strategic planning, action, and reporting. Capacity continues to be built at both health authorities.