June 2025 Edition — COA BulletinAdvocacy in Action

Chelsea Patriquin
Director, Strategic Initiatives
Canadian Orthopaedic Association
policy@canorth.org

In alignment with the 2022-2025 Strategic Plan, advocacy—particularly government relations—remains a top priority for COA members. Recognizing the need for greater representation and engagement with government officials, the COA has worked diligently to create formal opportunities for dialogue. Over the past three years, the COA Staff and Executive Committee have collaborated with outstanding members from across Canada to facilitate discussions at the federal, provincial, and local levels. In total, 38 membership-led meetings were conducted in Prince Edward Island, Nova Scotia, New Brunswick, Ontario, Manitoba, Alberta, and British Columbia.

In Spring 2025, we relied on the expertise of local COA members in Manitoba—Drs. Brad Pilkey, Greg Stranges, and Heather Barske—who led key discussions with the Department of Health and the Department of Environment and Climate Change. Additionally, our meetings benefited from valuable intra-provincial perspectives, with contributions from Drs. Bhavini Gohel (AB), Pierre Guy (BC), and Choosing Wisely Canada representative, Dr. AbdulRazak Sokoro. Discussions with the Department of Environment and Climate Change centered on hospital-based initiatives to mitigate the impact of climate change, particularly within operating rooms. Meanwhile, the Department of Health engaged with COA members to address the growing strain on trauma care resources in Manitoba.

As part of broader advocacy efforts, the COA joined 13 other organizations in supporting the Arthritis Society’s 2025 federal election campaign. This initiative aimed to highlight the devastating effects of delayed care on individuals living with arthritis. Additionally, partnerships with organizations such as the Canadian Physiotherapy Association and the Arthritis Society have strengthened our collective messaging and expanded our reach.

The COA remains committed to a membership-led approach in government relations, ensuring real, day-to-day challenges are met with solution-based discussions at the policy level. We will continue this model in future meetings, striving for meaningful change in orthopaedic care and health system sustainability.

At the 2024 COA Annual Meeting in Halifax, sustainability took center stage with a dedicated session titled “Environmental Stewardship in the OR” — a vital conversation about climate action in surgical care. This session laid the groundwork for orthopaedic surgeons to lead climate-conscious change through practical, evidence-based solutions. Below is a summary of that session, followed by an expanded reflection on the broader climate crisis, its impact on health care, and the role orthopaedic surgeons can play at work and at home.

Session Summary: “Environmental Stewardship in the OR”

This COA session brought together orthopaedic surgeons and sustainability leaders to address the climate impact of surgical practice and identify actionable solutions for making operating rooms (ORs) more environmentally responsible. The message was clear: climate change is not only a planetary crisis — it is a health crisis. Surgeons have the credibility and agency to drive measurable change.

Key Themes and Takeaways

1. The Climate Crisis is a Health Crisis
   • Health care contributes ~5% of Canada’s national carbon footprint — more than the airline industry.
   • ORs are disproportionately wasteful, producing about 30% of hospital waste.
   • Climate change disproportionately affects vulnerable populations and future generations.
2. Levels of Action
   Surgeons can contribute at three levels:
   • Micro: Personal habits (e.g. reducing single-use items, dietary changes).
   • Meso: Institutional practices (e.g. OR waste audits, reusable gowns).
   • Macro: Policy influence, procurement, advocacy, and voting.
3. Tools and Frameworks for Action
   • PEACH and the Canadian Coalition for Green Health Care offer tools, life-cycle analyses, and guidebooks.
   • Focus areas include leadership, supply chain, anesthetic gas reduction, food, energy use, and culture change.
   • “Refuse” — avoiding unnecessary items altogether — was highlighted as a core strategy.
4. Real-World Interventions
   • Dr. Marcia Clark (Calgary) launched a recycling program, analyzed metal waste, and co-developed a Choosing Wisely recommendation to reduce OR biohazard waste.
   • Dr. Doug Naudie (Western) led student waste audits, reduced plastic in arthroplasty care, and championed sustainable procurement.
   • Dr. Myles Sergeant (McMaster) emphasized the role of interdisciplinary collaboration and practical strategies for sustainability integration within OR teams.
5. Barriers & Opportunities
   • Many surgeons are unaware of existing sustainability efforts at their institutions.
   • Major emissions sources remain packaging and single-use practices.
   • Reverse mentoring (students teaching faculty) has spurred innovation.
   • Skepticism about recycling underscores the need for traceable, system-level solutions.
6. Call to Action
   • Surgeons were invited to join a new COA workgroup on sustainability.
   • Future goals include creating an orthopaedic-specific sustainability guide, influencing procurement, and advocating for systemic change.
   • A new COA Climate Action Committee will officially launch later this year, with its members to be announced during the AGM Business Meeting. Stay tuned for how to get involved.

Zooming Out: Climate Action in Orthopaedics and Beyond

While the Halifax session focused on actionable change in surgical care, it’s important to understand the broader context of the climate crisis — and how orthopaedic surgeons are uniquely positioned to lead both at work and in everyday life.

What’s the Problem?

We are living through a triple environmental emergency, as defined by the UN:
• Biodiversity loss
• Pollution (air, water, soil)
• Climate change — increasingly referred to as the climate crisis

In Canada, the crisis is tangible: floods, droughts, atmospheric rivers, wildfires — all amplified by rising temperatures. Scientifically, the root cause is an excess of greenhouse gases (GHG), which trap heat and destabilize the earth’s climate systems. The global target is to limit warming to 1.5⁰C above pre-industrial levels. Today, we’re nearing 1.2⁰C globally — and Northern Canada is already at +2.3⁰C.

What Can I Do?

As physicians grounded in science, we understand data — and the data is clear. A 2021 survey showed:
• 95% of physicians believe climate change is real
• 85% believe it is mostly caused by human activity

Governments have pledged targets and passed policies, but temperatures continue to rise. The change must come from us. The barriers — inertia, fear of change, cost, lack of time — are real, but so is the threat.

Surgeons are inherently action-oriented. You don’t need permission to start.

Workplace Action You Can Take

• Start small — bring your OR team together and begin with a waste audit or review supply use.
  • Present the Choosing Wisely Canada statement co-created by COA and Alberta Health to your leadership.
  • Watch COA’s webinar series, including one in French, on peri-operative sustainability (links available on the COA site).
  • Join the COA Climate Action Committee, which will begin its work this year.

At Home

• Review the United Nations’ “10 Things You Can Do to Fight Climate Change”: https://www.un.org/en/actnow/ten-actions
  • Bring your family into the conversation — use these actions as talking points around the dinner table.

Final Word: A Call to Lead

This isn’t about perfection — it’s about scalable, collaborative, science-based action. Orthopaedic surgeons, with their leadership, credibility, and influence, can spark real change.

“Effecting change toward a healthier planet will have us lead by example. As members of families, we can improve the lives of our grandchildren — and their grandchildren too.”

Let’s get to work.

Laurie A. Hiemstra, MD, PHD, FRCSC
Past President 2022-2023
Banff, AB

Treny M. Sasyniuk, MSc
Vancouver, BC

     “Where do we go from here’…… Evita

In 2018, 11.2% of orthopaedic surgeons in Canada were female, with provincial representation ranging from 0.0% to 18.1%. At that time, 26% of orthopaedic residents in Canadian training programs were women. Notably, no woman had served on the Executive or Board of the Canadian Orthopaedic Association (COA). Since then, the proportion of female orthopaedic surgeons and residents in Canada has increased to 13.6% (2020) and 38.5% (2022), respectively.

The shift toward a more inclusive orthopaedic community began in earnest in January 2018. Amid a snowstorm that delayed flights from the west, I arrived late to my first meeting of the COA Executive, having recently been appointed as the inaugural community surgeon Member-at-Large. In the final minutes of that meeting, the discussion turned to an issue that had long been discussed – how to implement a deliberate strategy to improve gender diversity within the COA and the broader Canadian orthopaedic community. With a woman now seated at the table, the conditions were in place to initiate meaningful action. The commitment of leaders such as Drs. Kevin Orrell and Peter MacDonald—as well as COA staff members Doug Thomson, Cynthia Vezina, and Trinity Wittman, helped propel this vision forward.

What are the key elements of a program that promotes gender equity in Canadian orthopaedics? Where does such an initiative begin – and where is it headed?

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