Prioritization of climate change adaptation measures for all facilities of the Centre intégré de santé et de services sociaux (CISSS) de l'Outaouais

The project, “Prioritization of climate change adaptation measures for the facilities of the Outaouais Integrated Health and Social Services Center (CISSS)”, was funded by Health Canada’s HealthADAPT program until March 2022.

Extreme weather events can cause many health impacts, both physical and psychosocial, and impact the infrastructures of the health system. In the context of climate change, these events will be more frequent, longer, and more intense, potentially having a significant impact on the health system. The Outaouais is a region in western Quebec, made up of the city of Gatineau, the regional county municipalities of Vallée-de-la-Gatineau, Pontiac, Collines de l’Outaouais, and Papineau. Due to its geographical location, the Outaouais, particularly Gatineau, is likely to experience an increase in heat events, higher temperatures, and higher humidity levels due to climate change. The Outaouais Integrated Health and Social Services Center (CISSS) led this project by focusing on a number of climatic hazards, namely extreme heat, flooding, freeze-thaw, high winds, droughts and forest fires. The project benefited from the support of the National Institute of Public Health of Quebec (INSPQ), the Department of Infrastructure Conservation of the Ministry of Health and Social Services of Quebec (MSSS), the City of Gatineau, regional county municipalities and municipalities in the Outaouais, the Office de l’habitation de l’Outaouais (OHO), the Outaouais Development Observatory (ODO), the Regional Council on the Environment and Sustainable Development in the Outaouais (CREDDO), the Outaouais Regional Civil Security Organization (ORSCO), the University of Quebec in Montreal (UQAM), and Environment and Climate Change Canada (ECCC).

The project had two main stages:

  • Assessing the climate risks of the region, the vulnerabilities of the built environments and at-risk populations, and the emergency procedures of the establishments of the CISSS de l’Outaouais
  • Proposing an action plan to better prepare for extreme climate events, and thus reduce the effects of extreme climate change on the Outaouais population

These two actions were carried out with external partners. The project used demographic data, data on past climate risks, and climate projections of future risks to develop the action plan and a number of assessments.

Understanding and Assessing Impacts

The Outaouais has experienced several health emergencies due to extreme weather events, which have highlighted the need for the CISSS to adapt to climate change and increase the resilience of the local health and social services system in the region. According to the Canadian Assessment of Vulnerabilities and Adaptive Capacity, Gatineau will be one of the most vulnerable cities to heat events in Canada. This Assessment further indicates that the Outaouais region will be more exposed to extreme heat waves, flooding, torrential and intense rains, an increasing number of freezing and thawing episodes, windstorms, and wildfires. While the population is known to be extremely at-risk to heat waves based on data from previous heat events, there is a need to better project vulnerability to localized climate hazards to ensure that essential services and those responsible for emergency measures can respond appropriately. As such, the objectives of this project were to identify and analyze the risks of projected climate change by 2050 and design an action plan that would support the resilience of social and public health services in the Outaouais region. The project benefited from the support of several Quebec ministries and organizations, in particular the INSPQ and the Department of Infrastructure Conservation of the Ministry of Health and Social Services of Quebec (MSSS), as well as the expertise of the academic community and external consultants. These actors collaborated within several committees, which ensured the smooth running of the different stages of the project. The vulnerability assessment work included data collection, assessment of key vulnerabilities, and consultations with stakeholders.

The consultations were to be carried out in 2020 through in-person workshops with municipal stakeholders, but, due to the start of the COVID-19 pandemic, the workshops had to be postponed and adapted into virtual sessions that were carried out the following year. Nonetheless, 31 Outaouais municipalities were consulted to discuss the impacts of climate risks on local services and their health and wellbeing. CISSS used questionnaires to assess the population’s health risks to climate hazards. The information collected during these consultation sessions helped identify at-risk populations and provided more localized data on climatic hazards.

The data collected through this project used a health equity lens, which helped demonstrate the relevance of the work undertaken. A profile of climate risks was developed based on demographic data, data on past climate risks, and climate projections of expected future risks. The consultation workshops helped enrich this content, and it was also supplemented by internal publications and climate data provided by Ouranos, a research institute, and the federal and provincial governments. This portrait revealed the repercussions of climate change events and their consequences on health at the community level.

Identifying Actions

To develop this plan, it was essential to identify and prioritize climate change adaptation measures adapted to Outaouais needs, and therefore relevant to the territorial and CISSS operational reality. More specifically, this work consisted of:

  • Identifying the relevant documents and determining the operational framework;
  • Developing tools to identify and prioritize adaptation measures;
  • Identifying the adaptation measures and categorizing them according to the framework;
  • Determining the criteria to be used to prioritize adaptation measures;
  • Prioritizing the adaptation measures identified;
  • Drafting an action plan for adapting CISSS de l’Outaouais facilities to climate change.

Consequently, a working group made up of two representatives of the public health department’s environmental health team, with support from the project coordinator, worked on identifying climate change adaptation measures in view of the risk analyses that were carried out as part of the project. To identify adaptation measures, an inventory of the adaptation measures proposed in various documents was created to inform the project. WHO’s operational framework for strengthening the resilience of health systems was the main source to guide the project in identifying actions.

Following the identification of actions, a criterion was determined to establish an order of priority in the implementation of the adaptation measures. This encouraged the development of a reliable, relevant, and realistic action plan. The working group presented the tools and results to the project steering committee to obtain their feedback and suggestions for improvement. All the CISSS de l’Outaouais departments were also asked for their feedback in order to ensure that the measures are adapted to their operational realities.

The CISSS de l’Outaouais adaptation plan brings together the ten elements that make up the WHO’s operational framework for strengthening the resilience of health systems in the face of climate change, as well as the main links to the constituent elements of health systems adapted to the CISSS operational context.


During the workshops with municipalities, a lot of valuable information on adaptation measures, health risks, and at-risk populations was collected. This information was then categorized by climatic hazard, to be included in the Strategic Action Plan. For example, to adapt to extreme heat waves, a number of “greening campaigns” were recommended to raise awareness and promote certain urban amenities to improve community safety and resilience (e.g. Planting more deciduous trees). The portrait of climate risks in the Outaouais clearly illustrated that many CISSS facilities will be increasingly affected by extreme heat waves. This demonstrated the need to implement more greening projects, as enabled by the Vivre en vert program, and funded by CREDDO, which targets 18 communities in Gatineau that are particularly at-risk to the effects of heat islands.

The report also included a summary of climate projections. Particularly, the likelihood of future hazards, including extreme weather events such as flooding, was calculated based on current events and identified risks. As the majority of the municipalities in the workshops were affected by flooding in 2017 and 2019, for example, flooding is projected to constitute a greater risk in the future, especially due to freeze-thaw phenomena in the winter. Health risks and impacts were also calculated, with floods known to exacerbate cardiovascular and respiratory diseases. It was also noted that the most at-risk populations were also most exposed to each projected hazard. The conclusions of the workshop provide concrete recommendations on adaptation measures, including the development of sustainable and adaptable technologies and infrastructure, the promotion of a coordinated multi-sectoral response to address environmental and climate risks, and programs taking into account climate-related health risks.

Outcomes and Monitoring Progress

The observations made during the vulnerability assessment work of CISSSO facilities, which resulted in the development of the Strategic Action Plan, propose a number of adaptation measures and recommendations. The project revealed that the region will be more exposed to several climatic risks and that the local population will experience greater health risks to extreme climatic hazards, in particular heat waves. The work undertaken as part of this project demonstrated the need for CISSS de l’Outaouais to take climate change into consideration within its health and social services. This will support the CISSS to respond to the urgent health challenges related to climatic hazards. Indeed, the consequences of climate risks, as determined in this project, will have to be considered within existing programming and in emergency planning. Although the work in this project has been disrupted by the COVID-19 pandemic, which caused a delay in some aspects of the project and some limitations in consultation, the project has highlighted the need to prioritize climate issues within local government organizations, particularly within the context of operational activities. In particular, one example of an implementation relating to the project has been how CISSS de l’Outaouais was able to influence the choice of land for the relocation of a long-term care accommodation center.

By integrating a climate change perspective into existing operational activities as well as various large-scale projects, CISSS de l’Outaouais will be more mobilized and will be better able to contribute to the implementation of adaptation measures. A monitoring committee will be set up to oversee the implementation of the adaptation measures prioritized in the Climate Change Adaptation Plan to adapt CISSS de l’Outaouais facilities to climate change.

Next Steps

The Vulnerability and Adaptation Assessment and Action Plan provides a solid foundation for continuing climate change adaptation work in the Outaouais region. This is the first adaptation plan produced by a healthcare institution in Quebec. It is significant because it highlights the direct links between the impacts of climate change and the health system and will encourage other health institutions in in Quebec take similar measures.

The Strategic Action Plan demonstrates that the CISSS de l’Outaouais will have to anticipate and plan interventions to deal with many climatic risks. Due to issues related to COVID, consultations with the First Nations communities of Kitigan Zibi and Lac-Rapide in Outaouais have been limited. These consultations will likely be facilitated in the future in order to have a more comprehensive assessment of climate-related health vulnerability. It is also expected that, with the implementation of the Plan, additional information dissemination, awareness, and communication work will be carried out and will target the public, as well as internal teams and external partners, to promote adaptation to climate change. The governance structure of this project additionally demonstrated that a multidisciplinary team will be essential to achieve the objectives set out in the CISSS de l’Outaouais Climate Change Adaptation Plan.