The Quebec winter, with its freezing temperatures, has consequences on people’s health. Beyond frostbite and hypothermia, the cold exacerbates chronic diseases, puts vulnerable populations at risk and widens inequalities. How can Quebec better prepare to deal with the impacts of cold winter temperatures on the health of its citizens?

The context in Quebec

Every year, extreme cold spells cause the death of over a hundred people in Canada. In Quebec, cold waves cause more premature deaths than heat waves. 

Despite rising average temperatures due to climate change, cold spells remain a challenge. Extreme cold spells could actually become more dangerous to the health and safety the public due to the gradual loss of acclimatization to cold weather.

That said, certain groups are more vulnerable to the cold due to socio-economic factors. Among those most at risk are:

• Outdoor workers  

• People experiencing homelessness  

• Disadvantaged people and/or those experiencing energy poverty  

• Elderly people, infants and young children

• People with pre-existing chronic conditions

• People who consume psychoactive substances (alcohol, drugs) or tobacco excessively 

Aggravation of health conditions

Winter weather conditions can exacerbate the symptoms and consequences of certain chronic diseases or comorbidities. In cold or very cold weather, there is an increase in hospitalizations and mortality among people with cardiovascular, cerebrovascular and respiratory diseases, particularly those aged 45 and over, with a more marked effect on the elderly. 

Other medical conditions such as diabetes, kidney disease, malnutrition and certain neurological disorders can also increase an individual’s vulnerability to cold. Lifestyle habits such as smoking and alcohol or drug use can increase sensitivity to the effects of cold weather.

Outdoor workers and the unhoused

Due to their prolonged exposure to the cold, outdoor workers and people experiencing homelessness are particularly vulnerable to cold weather. They are at greater risk of developing direct health problems (frostbite, chilblains, windburn and hypothermia), as well as indirect ones (respiratory and cardiovascular diseases). This vulnerability accentuates pre-existing inequalities for these populations. 
For example, some outdoor workers may have trouble changing jobs or adapting due to their socio-economic constraints. The unhoused population is disproportionately affected due to lack of adequate housing, pre-existing health conditions, and the prevalence of substance use problems. 

Households experiencing insecurity

Some low-income households are particularly vulnerable to extreme cold due to high heating costs and the insulation of their homes often being insufficient. This precarious situation leaves them more exposed to the cold, which impacts their physical and mental well-being. 
These economic difficulties favour the appearance of health problems linked to the cold. For example, in Quebec, emergency room visits for heart problems caused or aggravated by the cold are more frequent in regions with a lower socio-economic level.

Indigenous communities

In Quebec’s far north, Indigenous communities, particularly those in Nunavik, are highly exposed to the cold. This vulnerability can also be explained by socio-economic factors, such as material deprivation and economic and psychological distress.

The figures speak for themselves: between 2015 and 2021, of the 142 deaths from hypothermia recorded in Quebec, 21 occurred in these communities. This alarming observation highlights the inequality in the face of climate hazards and the need to protect these populations.

Essential support for action 

In Quebec, the management of extreme cold episodes is based on a multi-level alert system. The SUPREME system provides information to public health workers, while the Canadian government issues public alerts when the temperature or wind chill reaches well-established critical thresholds. 

To anticipate and better manage these hazards, the VRAC-PARC program, launched in 2019 by the INSPQ, allows regions to assess their vulnerability to climate change, including cold weather. It aims to develop regional adaptation plans to reduce the climate’s impact on health and social inequality. These plans provide excellent support for initiating an adaptation process in regions that have identified cold temperatures as a priority.