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The Current Transcript for September 25, 2024

Host: Matt Galloway

STORIES FROM THIS EPISODE

Prologue

[Music: Theme]

SOUNDCLIP

DR. HARVEY MAX CHOCHINOV: We must ask patients what they would want known about them as persons to provide them the best care possible.

MATT GALLOWAY: For more than 40 years, Dr. Harvey Max Chochinov has been pushing medicine to treat the entire person, not just the sick body part. As an innovator of palliative care, the first things the Winnipeg physician asks his patients are personal questions about themselves, and he uses the answers to help guide the treatment. He wants all of health care to follow his lead. And in 30 minutes, we'll talk about whether it's possible to provide passionate care and compassionate care in a medical system that's already stretched past its limit and how the human touch could actually make death more dignified. Also this morning, hug a tree if you can find one.

SOUNDCLIP

VOICE ONE: Certainly, when you have more trees in a neighbourhood, it makes it more attractive.

VOICE TWO: It cools the air around us. The surface temperature of a tree lined street and a not tree lined street, the difference is huge.

MG: Trees offer shade, comfort, a barrier to noise and wind and a sense of beauty, but those things aren't available to everyone. In an hour, why some urban neighbourhoods have more tree cover than others, and why advocates of so-called tree equity say we need to rethink the value of trees beyond dollars and cents and ensure access to their benefits is seen as a right, not a privilege. We begin, though, with those caught in the escalating conflict between Israel and Hezbollah. Good morning. I'm Matt Galloway and this is The Current.

[Music: Theme]

Fears of escalating violence in Lebanon and Israel

Guests: Hadi Murad

SOUNDCLIP

JUSTIN TRUDEAU: The violence needs to stop. The women, the children killed in Lebanon is is extraordinarily concerning. The people of Lebanon, Lebanese Canadians are watching this and incredibly worried. We need to make sure there is de-escalation both by Israel and Hezbollah. We need to protect civilian lives. We need to make sure we are moving towards peace and stability in the entire region.

MG: That's Prime Minister Justin Trudeau speaking at the United Nations General Assembly yesterday as attacks between Israel and Hezbollah intensify. Thousands of people on both sides of the Lebanese Israeli border have been displaced as a result of the fighting. More than 500 people have been killed in Lebanon that country's health ministry says, including two Canadians. And for civilians watching this unfold, fears of a full scale war are growing. Hadi Murad is one of those people concerned about a wider conflict. He's a doctor in Beirut. Hadi Murad, hello.

HADI MURAD: Hello, there. And thank you for hosting us.

MG: How are you doing?

HADI MURAD: The situation is really hectic in the middle of Beirut and [unclear] and with our families, the refugees and the children are everywhere. Actually, they are trying to search for a tent. They are just to search for food, for the medications. This is really disastrous. And now, we have to raise our voices to say loudly that the UN and all the countries in the world are responsible to a degree to go for this escalation of the war, because Lebanon is really, really, really a very, very beautiful country that should not be in this situation right now. In the death that we are living. Imagine less than 48 hours, we have more than 700 [unclear] in Lebanon who would actually have passed away. The enemy, the Israeli enemy is doing massacre in the middle of Lebanon. And we have all to say it loudly because we have in Lebanon many Lebanese citizens and many, many expats from other countries. We have from Canada, we have from States, we have from Australia, from Europe. Those countries should raise their voices, should stand with us, should stand with the Lebanese government. And the Lebanese government is the only responsible to de-escalate this war.

MG: What are you hearing from-- you're in Beirut-- what are you hearing from people further in the south?

HADI MURAD: Actually, all the people in Lebanon are really in panic. They are in fear because they do not want to lose their homes. They don't want to lose their homeland. They are coming to Beirut and to those maybe between quotations, "safer places" because they want to live and they want to fight against this enemy. However, nobody is standing with them. And the Lebanese people really need this assist and this aid from everyone. We need the medical aids, actually, as a doctor, who will speak right now about it. But they are all in a feild fear manner, in a panic manner. And we need a real intervention from the international community.

MG: What do you want from the international community?

HADI MURAD: Yesterday there was a very big assembly and President Biden was talking about the importance of having the peace in the Middle East and in all the countries. We don't want just speeches and just words. You know, Lebanon is a great country in the middle of this crisis. Why should we actually make Lebanon a country of death? We have suffered a lot in 4 August explosion. And we were talking to you actually four years ago when we had this major incident in Lebanon. So right now, we are repeating the same thing. We need an intervention. We need any intervention. We do not want the escalation. We are saying one word: we do not this war, because this war can lead to the death of thousands and thousands of people in Lebanon. We have to raise the voice and tell them this issue. It's so important to talk about it, especially from your platform.

MG: Hadi Murad, stay safe and thank you for talking to us.

HADI MURAD: Thank you so much.

MG: Hadi Murad is a doctor in Beirut. People in northern parts of Israel have also been caught in the crossfire of strikes launched by Hezbollah. In Snir, close to the border, most of about 600 residents have left, only a handful of who stayed to protect the area's agricultural land. Lior Shelef is one of those people. He's a reservist in the army. Lior, hello to you.

LIOR SHELEF: Hello. How are you?

MG: I'm well. How are you doing? Snir is right on the border with Lebanon. So, what is life like there in your community?

LIOR SHELEF: Well, I can tell you exactly what happened yesterday, and that will tell you the exactly way of life we're suffering here in the last year. Yesterday, there was a rocket attack once again. A few rockets fell around the Kibbutz. And since it's an agricultural land, there's a lot of hay around us for the cattle ranch. Everything is burning up. Flames of five, six metres. And after four or five hours of fighting the fire, we stopped the fire legally on the houses of the Kibbutz of the community and managed to protect everyone. And that doesn't stop because we went to, after one hour, we had to go back and once again fight the fire. Once again it started. And that's pretty much the routine here since the Hezbollah started the attack on us about almost a year ago.

MG: So many people have fled the community. Why have you stayed?

LIOR SHELEF: I've stayed here for a very simple reason. My roots here in the ground are as big as the olive tree. My family has built this Kibbutz, and we were here for many generations. And we're here to stay. We will not move from here. This is our land.

MG: Is it safe for you to stay there?

LIOR SHELEF: Nope. It's not safe. But we love our land the same way we love our family. And it's important for us to make sure that my kids can grow up here without need to suffer from constant rocket launching by Hezbollah.

MG: Where is your family right now?

LIOR SHELEF: Everyone from our Kibbutz were evacuated in the beginning of the war. So, for almost a year, they live in a hotel, in a very, very small room away from their home, away from their dogs, away from their father, away from their friends.

MG: How are they holding up? You mentioned your kids. How are they holding up?

LIOR SHELEF: Well, it's a very, very, very hard year for everyone. The kids are very, very post-traumatic. They're suffering from the noise of the rocket launching around them and the constant of going to the safe room to protect themselves. They're very afraid for the moment, for a few days now, they don't have school. So, you know, it affects their self-confidence also. And we're going through a very, very rough year here. We're very strong and very determined to hold the line and protect it. And the only thing we want is to protect ourselves in a way that we can live here peacefully.

MG: How worried are you in the face of all of this that-- I mean, we just heard the concerns from a Lebanese civilian-- that a greater war, a larger war could unfold and it will be civilians that will be caught in the middle of this?

LIOR SHELEF: First of all, I'm very, very concerned. I don't want a war with anyone. In the last 20 years, since the second Lebanon war has ended, Hezbollah has armed themselves with over 100,000 rockets. And what they're doing now is launching rockets on all of Israel, specifically on the northern border. That's affect our lives significantly. I'm very, very worried about it. I'm sure that our army is very strong to protect us. I must say that what the attacks that Israel are doing now in Lebanon was only after a year we waited for the Hezbollah to stop launching rockets. And it's not a massacre because we're aiming the rockets specifically to places where the Hezbollah rockets are standing. I have nothing with the Lebanese. I'm fighting the Hezbollah, which is a terror organization.

MG: Lior Shelef, thank you for speaking with us. And as I said to our previous guests, please stay safe.

LIOR SHELEF: No worries. Thank you very much.

MG: Lior Shelef is a tour guide in Snir, Israel. Aaron David Miller is a senior fellow at the Carnegie Endowment for International Peace and a former U.S. State Department Middle East analyst and negotiator. He is in Washington. Good morning to you.

AARON DAVID MILLER: Good morning. Thanks for having me.

MG: Thank you for being here. In the days following the pager attacks, we have seen a significant escalation from both sides in this conflict. What do you think-- we'll begin with the Israeli prime minister, Benjamin Netanyahu-- what do you think his aim is here?

AARON DAVID MILLER: Well, the overriding principle, organizing principle of Benjamin Netanyahu's world is to maintain himself in power. On trial for bribery, fraud and breach of trust in a Jerusalem district court. Four years running, he's due to testify in December. We'll see if that happens. He must maintain his coalition. And that means, given the events of the last 11 months since October 7th and the extraordinary intelligence failure on the part of the IDF and its operational failures, single bloodiest day for Jews since liberation of the Nazi death camps. Mr. Netanyahu understands that the minute the shooting stops, the issue of responsibility and accountability is going to surface. There's no threat to his immediate prime ministership right now. I suspect he'll be prime minister well into 2025. But maintaining a, I would argue, a controlled level of escalation both in Gaza and in the north, suits his purposes. So, one other point-- the Israelis have a legitimate argument on one hand. I mean, October 8th, Hezbollah decided unprovoked to join the axis of resistance in a sort of performative move to support Hamas's October 7th terror suit. As a consequence in doing that, they tripped off a escalatory cycle which has been managed over the last 11 months. I think the Israeli Defence Forces have made a judgement that the real threat to Israel does not come from Hamas in the south, it comes from Hezbollah in the north, and there's clearly been a fundamental change in strategy. The Israelis are not reacting. They're pre-empting. They believe Hamas cannot threaten, cannot use the situation in the north to escalate. It's much diminished as a military force. They don't have much faith or trust in American diplomacy. No disrespect to the Biden administration. It's very tough to get Israel and Hezbollah into any sort of negotiation. And as a consequence, I don't think they want a regional war. But clearly their moves over the last week suggest that baked into their assumption cake is the real possibility that Hezbollah might just respond by launching precision guided missiles into Israeli population centres like Tel Aviv. If that happens then the Israelis will respond massively and we will, we could easily morph into something the Middle East has never seen before, which is a multi-front regional war.

MG: What do you think the strategy of Hezbollah is? You have said that Hezbollah has placed-- these are your words-- "The entire population of Lebanon in the dock."

AARON DAVID MILLER: I think that Hezbollah is trapped and caught in a dilemma. The Israelis maintain escalation dominance. The pager and walkie talkie attack and who knows what the Israelis have planned next. It's basically undermined Hezbollah's faith in its own communications system. A military cannot operate given the loss of command and control. The Israelis are eliminating senior Hezbollah commanders. Hezbollah understands because geography is destiny, that, in fact, if they launch-- and they did today launch-- what I think was probably a short range Scud missile, which is the first time that Hezbollah has done this, toward Israel. Now, they launched a single missile, which is relatively easy for Israel's layered air defence system to intercept. But should they launch redundant saturation attacks, they can launch 3000 missiles a day. If we come to that, then we're talking massive Israeli casualties, extraordinary damage to Israeli population centres, electricity grids, water desal plants. Israel will experience, the Israeli civilian population will have experienced something that it's never experienced before. So, Hezbollah needs to be credible. They need to not back down. The real question in coming days is whether they choose to escalate. I suspect they won't. But this is the Middle East, after all.

MG: You had a fascinating conversation last night with the Lebanese foreign minister who said Lebanese have had enough war. It's dangerous for Lebanese civilians to speak out against Hezbollah. But what is your sense as to how the Lebanese public views Hezbollah in light of what's happening right now?

AARON DAVID MILLER: I mean, I think you're not going to get an accurate reading of public opinion. And remember, Lebanon is a confessionally divided society. Still, its roughly 30 plus per cent of Lebanese who are Shia. The underprivileged, under-served constituency in Lebanese politics. Lebanese politics was dominated for most of the decades by the Sunnis and primarily by the Christians. So, Hezbollah responds to their needs: health, education, subsidies. But on balance, I think Hezbollah is very much aware that the vast majority of Lebanese do not, repeat, do not want a major escalation that will allow the Israelis to visit upon them the kind of violence and death and destruction that the Israelis are capable of producing in prosecuting a war against Hezbollah. So, Hezbollah has to maintain that sensitivity to the Lebanese domestic constraint. But it is an organization, after all. It needs to maintain its credit credibility and its cohesion. Very hard for me to imagine it's going to back down. And I frankly, right now, I don't think there'll be enormous pressure in the part of the Lebanese public or the political class to force it to back down.

MG: The foreign minister was also very critical of the United States and Joe Biden's comments at the United Nations. And you've been critical of Biden as well. You said on PBS that Biden has been reluctant and or refused to impose a single, these are your words, "A single consequence that normal humans would regard as sustained or serious pressure on Israel."

AARON DAVID MILLER: Right.

MG: What is it that Joe Biden can or can't do?

AARON DAVID MILLER: Well, that's a factual statement. And look, I worked for half a dozen secretaries of state administrations, Republicans and Democrats. And it should be evident by now, no American president, regardless of party, wants to or feels the need to get involved in a major fight with an Israeli prime minister, let alone a sustained public breach.

MG: Let alone two months away from an election.

AARON DAVID MILLER: That I think puts a very fine point, I think, on the reality here. And Joe Biden is a guy who says, you know, he says he's a Christian Zionist who said if there was no Israel, we'd have to create one. His bond with security of Israel, the idea of Israel, the people of Israel, not with the Netanyahu government, is deeply, deeply imprinted, I think, on his emotional and political DNA, largely based on his experience with Israelis in previous decades and his long career in the Senate. Look, the Israelis had three, excuse me, the Americans could have done three things. Number one, they could have seriously, conditionally restricted U.S. Military assistance to Israel. They haven't done that. They could have introduced their own UN Security Council resolution or voted for someone else who is highly critical of Israel. They could have done that. They could have joined 140 plus other countries, including most recently, the Spanish, the Norwegians and the Irish and unilaterally recognized Palestinian statehood. They haven't done that. And I think the reasons are number one, is Biden's persona. And every American president brings its own, his own personal sensibility and experiences and makeup to the office. I think because of that and because of the reality and again, I've asked people, it's a rhetorical question to some extent. When was-- I'll ask you-- when was the last time the United States you've sustained your serious pressure on any of its allies, its friends and its partners? That's not the way we deal with the Brits, the French, the Canadians, the Austrians, the Japanese, the Germans. Yes, there are differences and at times there is pressure. I just, you know, I spent almost 30 years in the Department of State. I cannot recall, and American presidents in the past on select occasions for specific reasons have, in fact, upped the pressure on the Israelis. But nothing along the lines of what people have been calling for, including, I might add, mainstream Democratic Senators. Chris Van Hollen, Chris Coons, Chris Murphy, all of whom have called for conditioning at one point or another, military assistance. So, I think it's a thought experiment, particularly as you point out, given we're 50 days or so from one of the most consequential elections in modern American history.

MG: We're out of time, but I'll just ask you very briefly, and we haven't even mentioned Iran, but how concerned are you, in a word or two, how concerned are you that this spills into a larger regional conflict on multiple fronts?

AARON DAVID MILLER: Very concerned, but the Iranians clearly don't want it. They don't want a conflict with the Israelis, and particularly they do not, given the symmetry of military power, they do not want a sustained military conflict with the United States.

MG: Doesn't seem like anybody wants it, and yet everybody is sleepwalking towards it.

AARON DAVID MILLER: You've just broken the code, I think, of how so many confrontations in Middle East occur. But I will leave with one point. If the future of this region in this particular pocket are in the hands of Yahya Sinwar, the leader of Hamas, Hassan Nasrallah, the leader of Hezbollah, the Supreme Leader Ali Khamenei of Iran, and Benjamin Netanyahu-- we got problems.

MG: Aaron David Miller, great to talk to you as ever. Thank you very much.

AARON DAVID MILLER: Thanks for having me.

MG: Aaron David Miller is a senior fellow at the Carnegie Endowment for International Peace, a former U.S. State Department Middle East analyst and negotiator. The CBC News with the latest on this story is coming up next. And then:

SOUNDCLIP

DR. HARVEY MAX CHOCHINOV: How can we claim to be providing person-centred care in the absence of knowing something that is just so central to who that person is?

[Music: Theme]

MG: Winnipeg's Dr. Harvey Max Chochinov is receiving a lifetime achievement award for his work on the importance of personalized end-of-life care. Coming up, we will talk about why it matters deeply for a doctor to know the person behind the patient to treat a patient as a person. That's coming up in six minutes. I'm Matt Galloway. You're listening to The Current on CBC Radio and the CBC Listen app. Stay with us.

[Music: Fades up]

Asking doctors to see the person behind the patient

Guests: Dr. Harvey Max Chochinov

MG: Hello, I'm Matt Galloway and you're listening to The Current.

SOUNDCLIP

DR. HARVEY MAX CHOCHINOV: Patients are looking for a reflection in the eye of the health care provider that will affirm their sense of themselves. If all they see in this metaphorical reflection is a problem checklist, they end up feeling that the essence of who they are as a person has fallen off our radar.

MG: Those are words of advice at the White Coat Ceremony for this year's incoming medical class at the University of Manitoba. Dr. Harvey Max Chochinov is on a mission to improve the doctor patient experience for all of us.

SOUNDCLIP

DR. HARVEY MAX CHOCHINOV: This idea of personhood being under assault or threatened or starting to disintegrate has long been considered central to the experience of human suffering. So, we must ask patients what they would want known about them as persons to provide them the best care possible. Take it from me, the responses you will get to that question will permanently change the way you see your patients.

MG: Dr. Chochinov' groundbreaking work on patient centred palliative care has been adopted around the world. His list of accomplishments is long, but to name a few, the Queen's Golden Jubilee Medal, Officer of the Order of Canada, Inductee to the Canadian Medical Hall of Fame. And tomorrow in the Netherlands, he will receive the Arthur M Sutherland Award for lifetime achievement in the field of Psycho-Oncology. Dr. Harvey Max Chochinov is a distinguished professor of psychiatry at the University of Manitoba and a senior scientist at Cancer Care Manitoba Research institute in Winnipeg, and he is in our Winnipeg studio. Dr. Chochinov, good morning.

DR. HARVEY MAX CHOCHINOV: Good morning, Matt.

MG: I want to begin just with that question that you pose in those remarks there. What would I like you to know about me for me to get the best care possible? Why, from your perspective as the doctor, why is that question so important?

DR. HARVEY MAX CHOCHINOV: When people enter into health care oftentimes the things that becomes kind of paramount, in fact, even overshadowing everything, is being ill, and being understood on the basis of their illness. Recently, I was speaking somewhere in the introduction, the woman who was introducing me talked about illness casting a long and dark shadow. And I was thinking, Yeah. And it's hard to be seen when you're standing in that shadow. One of the ways to make sure that the individual is seen within that shadow was to ask, so what would you want known about you as a person in order for us to take the best care of you that we can? Bringing back the patients, you know, to the centre of the conversation matters.

MG: You said in those remarks to doctors to-be that the answer to that question can be really profound and will change the way that they see their patients. What have your patients told you? When that question has come up, what do you want me to know about you, what have you heard back?

DR. HARVEY MAX CHOCHINOV: You'll hear things that you can't unhear. You'll see things that you can't unsee. For example, I remember one Indigenous woman who was in her mid-fifties dying of a metastatic condition When she was asked the question, she said, Well, what you need to know about me is I'm a residential school survivor. My family moved 82 times so no one would get to know us too well. And then she said, And you know what? People in white coats, I don't really trust them. I don't think they're going to give me the information that I need in order for me to make decisions. Another woman that comes to mind is somebody who was in her mid to late 80s. She was dying in our palliative care ward, and I walked in and she said, Well, what you need to know is that my coming death is not really such a tragedy. I have lived a long and good life, but if you want to know what keeps me awake at night, it's the fact that my young son in his mid-fifties is dying in the hospital on the other side of the river. And what will happen to my daughter in-law and what will happen to our grandchildren? And again, when I hear those examples, I think, you know, how can we claim to be providing person-centred care in the absence of knowing something that is just so central to who that person is? I would say that, you know, without knowing that, you can provide perhaps efficient care or a kind care, seemingly attentive care, but without knowing who that person is, you really can't provide person-centred care.

MG: How did those stories change how you approached those patients?

DR. HARVEY MAX CHOCHINOV: Well, it goes beyond just, you know, how it changed me. I mean, we have studied this approach, you know, with hundreds of patients. And now at this point, I mean, the patient dignity question, and that's how we refer to it, has been studied in thousands of patients. And so, what the data shows is, first of all, all patients, and to my knowledge without exceptions, say this is information that needs to be placed on my clinical chart. In other words, they're saying, this is how I want to be seen. And what we know from the health care provider perspective is that at least in 90 per cent of instances, they learn something that they didn't previously know, that they have reported that in the vast majority, this increases sense of connectedness, empathy and respect. And also, interestingly, that it enhances their job satisfaction, that if you are engaged with people in a way that is not simply technical and transactional, but also relational, that increases job satisfaction.

MG: Is that something-- I mean, I've spoken with doctors in emergency departments, for example, and they will talk about how they can often feel like the relationship with the patients that they're treating is those words-- transactional. Does that happen more broadly in medicine?

DR. HARVEY MAX CHOCHINOV: Absolutely. I mean, as you're giving that example, I'm thinking of a nephrology nurse who is working in dialysis. And she said, you know, after all these years, the truth is that patients begin to look like kidneys on legs. And she knew that that wasn't good for her. She knew that wasn't good for patients or families because nobody likes to be seen as being defined by their illness. And, you know, and the great irony is, of course, we we spend all of our professional lives learning how to look after patients. But patients really don't like, nobody likes to be treated just like a patient because being a patient is a generic designation. You know, it's based on a specific kind of biology or pathophysiology, but it's not based on who you are as an individual. And patients begin to suffer if they feel that personhood, the essence of who they are, is under assault of disintegration.

MG: How does that happen? That personhood, that that nature of the person, the individual is disintegrating?

DR. HARVEY MAX CHOCHINOV: You know, when I spoke to the medical students a couple of weeks ago, I kind of forewarned them that this was a potential danger because in order to wrap your mind around the complexities of medicine, what we do, just even in teaching in medicine is we have to silo people into various different systems. So, I talked about they're going to be learning neurology and nephrology and pathology and many ologies. But what can happen is all of that siloing can sidetrack the fact or displace the fact that they're really dealing with with whole person. So, when people are somewhat ill, they usually brush it off because we put back on our clothes and we put back on our kind of healthy persona and we carry on. But when you're ill, you don't have those kinds of reserves. And so, those assaults can be profound. We know in our research, for example, that when to think I mean, shoulder to shoulder with feeling, you know, I can't do things I used to do and I'm worried about, and I have symptom distress, shoulder to shoulder with that is, I don't feel like me anymore.

MG: So, that speaks to that idea of dignity. You talked about this being a patient dignity question. Why do you use that word intentionally?

DR. HARVEY MAX CHOCHINOV: Well, I have conducted a large program of research on dignity. And the entry point was actually having looked at what was happening in the Benelux countries around practices of euthanasia and assisted suicide. This goes back to the early 90s and we were interested in knowing what is it that happens to people that undermines their wish to go on living. And so, there was some really important work that was done in Holland, a paper that came out in The Lancet that reported why patients had sought out this way of having their lives ended. And indeed, what these investigators did is they approached the doctors who were listed on the death record of those who had died as a result of euthanasia and assisted suicide and said, So why did your patient walk that path? And over and above anything else that these Dutch physicians reported was lost sense of dignity. And so, we decided that, you know, if dignity is worth dying for, then dignity is worth studying. And for, you know, a number of decades, dignity has been an important thread in our research because we went into it with the idea that it appears that loss of dignity seems to, you know, render a state where life becomes untenable, unsustainable.

MG: You've done research on this, but if you don't mind me asking, I mean, there is a personal dimension to this as well, and that you've spoken publicly about your sister Ellen, who died from complications from cerebral palsy.

DR. HARVEY MAX CHOCHINOV: Correct.

MG: How did that personal experience shape some of what you're saying and some of how you think about this?

DR. HARVEY MAX CHOCHINOV: You know, there was one article that I wrote that specifically told one facet of Ellen's story. I mean, Ellen died at the age of 55. And several years before her death, she had been admitted to an intensive care unit. She had lousy respiratory capacity based on anatomical distortions because of kyphosis and scoliosis and the like. So, she was now in intensive care. On the brink of the intensive is trying to determine whether or not she would need to be intubated, whether a breathing tube would be needed. And, you know, of course, the family is there. We're all kind of beside ourselves with worry. And the intensivist is kind of, you know, pacing about this unit, trying to kind of make some decisions. And he came up to me and he asked me the only question that he asked about, quote unquote, "personhood." And the question was, does she read magazines? Which struck me as just kind of completely bizarre and random rant like, what do you mean does she read mag? And then it occurred to me that what he was saying is, you know, I can see her kyphosis. I can see your scoliosis, I can see her dropping blood gases. But what he couldn't see was Ellen. And the question he was asking was, you know, is this the sort of person we ought to be intubating? And I mean, I remember I almost felt kind of faint thinking, Oh my God, you know, like, her life hangs in the balance. So I took a moment and a deep breath and I said, Well, yes, she reads magazines, but only when she's in between novels.

MG: What did that tell you about a better way forward?

DR. HARVEY MAX CHOCHINOV: Well, that particular article used her story to illustrate a concept that I've referred to as the platinum rule. Is the perception of the health care provider something that shapes patient experience? Then we better understand something about that health care provider lens. And what if that lens is shaped or distorted in a way that can't necessarily see somebody else's lived experience? And, you know, so could that lead to a certain sense of kind of therapeutic nihilism? You know, would I want to be that disabled? Would I want to be that fragile? Would I want to be that vulnerable? Perhaps even in leading to advice to help that person avert a future that the health care provider, him or herself, wouldn't be able to tolerate. So, what the insight I hoped that I revealed in that particular article on the platinum rule is, you know, doing unto patients as they would want done unto themselves. In other words, always to check our own biases and appreciate that we are seeing things in a seemingly accurate way, but we have to admit to ourselves that, I mean, the lens that we're looking through has been shaped in ways that we may not even be aware of.

MG: Is your sense that how we as a society, but particularly within your field of work, when we look at dying patients, patients at the end of their life, has that changed since you were a medical student?

DR. HARVEY MAX CHOCHINOV: So, I remember when I was a medical student, you know, we would do rounds with the senior physician on staff and be taken around to, you know, all of the patients, except if somebody had a condition that was considered, you know, beyond the realm of, beyond the reach of cure. They would be made quote unquote, "non teaching." In other words, the focus, the separation was, you know, if you can't fix it, then it's really not within the lane of medical practice.

MG: There's nothing we could learn from that patient.

DR. HARVEY MAX CHOCHINOV: Well, not only is there nothing that we can learn, but we, I mean, I would say, you know, we were out of touch with just how powerful our arrival in that room and being present, you know, could be. But that just wasn't part of the dialogue at that time.

MG: Is that different now? For a long time we didn't talk about death. I mean, and that's broadly, but it feels like within medicine as well. That discussion, and part of that is about advances in palliative care, part of that is also just understanding that it's coming for us. It doesn't matter whether you want to talk about it or not. And so, we need to figure out ways to be comfortable with that, ways to think about what a so-called good death can be. Is your sense that that is materially changing?

DR. HARVEY MAX CHOCHINOV: I hope so. I think so. I'm certainly doing everything within my ability to try and raise the bar on that. Just last year, I published an article in the Journal of Clinical Oncology introducing an approach that I coined "intensive caring." You know, borrowing from, you know, the notion of intensive care. When you're in terrible physical distress, you know, dire straits, physically, we offer intensive care. But what happens when people are in a state of, you know, dire psychological or existential or spiritual distress? Could we then invoke something that I refer to as intensive caring? And in some ways it was kind of inspired by the work of Dame Cicely Saunders, who was the founder of the modern hospice movement. And Dame Cecily famously said, "You matter because you were you and you matter to the end of your life" Well, what happens when people reach a state where they don't feel like they matter, where they feel helpless and hopeless and worthless? So, intensive caring describes an approach that hopefully helps us shift the paradigm. And the traditional medical paradigm is we examine, we diagnose, we fix. If we accept that there are facets of human suffering that are beyond the realm of being fixed, then we need a different paradigm. And that paradigm looks like, who is this person? Understanding the nature of their suffering and finding ways of being with. And even though that may sound kind of, you know, in medicine, they refer to it as "touchy feely." I mean, one of the first tenants of intensive caring, for example, is non abandonment. You know, showing up. You may say, well, that sounds kind of lame. You know, when you're thinking about human suffering, you're saying showing up matters, is going to make a big difference. We know there are studies that have been done that show that people who weren't offered follow up, who are living with advanced malignancies, that is, follow up with their health care system, showed a higher prevalence of suicidality. And there was another, more recent study in the United States that looked at correlations or associations between suicidality and the strength of the relationship between the patients and their health care provider. And it was the most ardent predictor of suicidality, even over and above psychotropic medication. So, does showing up matter? Well, it matters to the extent of, you know, life versus death.

MG: Sometimes patients can benefit from a bit of touchy feely.

DR. HARVEY MAX CHOCHINOV: Well, in really profound ways. Yeah.

MG: Can I ask you, as somebody who works in palliative care, are you comfortable with increasing access to medical assistance in dying?

DR. HARVEY MAX CHOCHINOV: It's a complex question. Medical assistance in dying is why I initially got into the study of dignity. And it's provided incredible insights into kind of conditions of human suffering. Medical aid in dying is always going to be something that a tiny facet of individuals are going to want in terms of the timing and the circumstances of their dying. But for me, the approach is far too narrow in that I mean, I'm interested in human suffering and the breadth of human suffering. And over the years, of course, have looked at finding ways to understand that more broadly and even have introduced ways of being able to be more effective in response to human suffering.

MG: And so, if people feel as though the way to alleviate that suffering is to choose their own time and method of departure, is there anything wrong with that?

DR. HARVEY MAX CHOCHINOV: Well, you know, again, I come at this not with a political agenda or an ideological agenda. My lane, my work, my papers and books have all been in the area of, how do we attend to suffering? You know, there are some people who are very ardent in their position to say, this is about autonomy. This is about my body, my decision, and therefore it's a dignity issue. And in fact, before we had done any studies on dignity, you found dignity cited frequently in the literature. And on that side of the political fence, that was the dignity card that was played. But on the opposite side of the political fence, were people saying, you know, this undermines the patient-doctor relationship. This is a violation of the Hippocratic Oath. This is the taking of human life. That that is a dignity issue, fundamentally. We said, you know what, we're not the moral police. We are clinicians. We are scientists. We're interested in understanding human suffering. The wish to die is an expression of human anguish. And anybody engaged in health care needs to understand that, needs to be able to explore that, and find out, what's that about?

MG: Let me ask you just two final things before I let you go. One is, we hear a lot about problems in health care. There aren't enough family doctors. There is a lack of access to primary care, just broadly. People can't get into emergency departments. People can't get the care they need. It takes forever for people to be recommended to a specialist, and the system is stretched in a bunch of different directions. Do we have the capacity in our health care system now to provide dignity?

DR. HARVEY MAX CHOCHINOV: Well, I mean, I would say can we afford not to? Because what happens when we don't take into account personhood? You know, when we don't recognize that we're dealing with people who are, I mean, they may be in a health care crisis and I mean, there may be something bodily that's going on with them, but the fact is that, you know, this is, there's a human drama unfolding here. And if we're not in touch with that and recognize the pathos of that, what happens is that people become less trusting. They don't necessarily tell us to the extent we need to know what's going on. There's a heightened likelihood of kind of discordance in goals of care.

MG: But you understand the strains on that, as well? That the doctor or whoever's treating you has you to treat and then fifty other people down the line. And I can't spend any more time with you because I have to get to this person and then I get to have to get to that person. And that that can seem like an assault on dignity to the person who is being treated.

DR. HARVEY MAX CHOCHINOV: Right. Well, I mean, time is always invoked as a problem and a limitation. And that's not to say that it isn't. But, you know, if you have two minutes, you've got the same two minutes to make a good impression or a bad impression, to act like somebody who is distracted or to be somebody who sets aside the pager and is fully present for that person. There have been studies that have looked at something as basic as whether the physician sits or stands. And if the physician sits, the perception of the patient is that they were there five times longer than they actually were. And 90 per cent of them say they were satisfied with the transaction versus about only 40 per cent when the physician was standing. Not changing anything else in terms of the transaction that took place between them.

MG: Just finally, how has your life's work and this work on human suffering shaped your own outlook on life? Do you think differently about life because of the work that you have done?

DR. HARVEY MAX CHOCHINOV: You know, my father at one point in his career was an insurance salesman. And so, the conversations about, you know, I mean, the probability of death and, you know, based on, you know, age and illness, I mean, these conversations, you know, were frequent around our kitchen table. So, it's interesting that in my life, as I move forward, I mean, you know, I am dealing with conversations about death and dying every day. I mean, I know life is a time limited event. And in fact, even, you know, today's interview and doing lots of speaking, I see myself in the third act of my career. And if there's any agenda that I have, it's that, you know, during this remaining time, you know, before my health and creativity and energy deteriorates, that I will be able to do what I can to spread the word as widely in order to raise the bar on person centred care.

MG: You're not wasting time.

DR. HARVEY MAX CHOCHINOV: Thank you.

MG: It's a real pleasure to talk to you about the work that you're doing. Congratulations on all of the recognition that that's getting, but also on the difference that you're making for all of us, not just as patients, but as people. Thank you very much.

DR. HARVEY MAX CHOCHINOV: You're quite welcome. Thank you.

MG: Dr. Harvey Max Chochinov is a distinguished professor of psychiatry at the University of Manitoba. He's being recognized for his lifetime achievement by the International Psycho Oncology Society tomorrow. That idea of being a person, not just a patient, is fascinating. Are there times or is there a time when you have been treated or maybe a loved one has been treated like a person, not a patient? And what difference has that made in your life or in theirs? Let us know. It's a really simple thing, but a really powerful thing. And you can email us with a story about that at thecurrent@cbc.ca.

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MG: Well, coming up after your regional update, we're going to talk about trees, the beauty of them and why they are distributed in our neighbourhoods in an unequal way. We'll get an answer to that coming up on The Current.

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Why all parts of a city deserve ‘tree equity'

Guests: Hashem Akbari, Janet McKay

MG: Hello again, I'm Matt Galloway and you're listening to The Current. You ever turn down a street and immediately noticed that the weather has changed? Maybe the air seems cooler and fresher. The noise of the traffic has calmed. It's even been replaced with the chatter of birds. Maybe the hot sun seems less intense. The wind seems less blustery. If you look around when that's happening, one thing will stick out. It's trees. Terri Chu lives in Toronto's annexe neighbourhood, where the benefits of lots of trees are noticeable.

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TERRI CHU: Well, we're walking down a really nicely shaded street right now. You see this? It's providing us a lot of shade, a lot of coverage. It cools the air around us. The surface temperature of a treelined street and a not tree lined street, the difference is huge. So, there's lots of those benefits. There are studies that show that tree lined streets, there are health benefits to it. People have fewer incidents of heart attacks because they are likely out more exercising. Or they walk more, it's a more pleasant walk.

MG: Julia Keech lives on the other side of that city in Wexford in Toronto's Northeast, and her walk feels quite different.

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JULIA KEECH: We're walking east on Lawrence from Warden and there's about six lanes of traffic. There are very few trees. And yeah, in this last stretch, I don't think we've hit any kind of shaded area. There are a few trees off, You know, the main drag. But it's hot. It's loud.

MG: In cities across Canada and the United States, work is being done to address the difference in tree access that we just heard about. And we'll hear about this concept, it's known as 'tree equity,' in just a moment. But first, the scientific benefits of an urban tree canopy. Hashem Akbari is an environmental engineer at Concordia University and one of the founders of the Heat Island Group at the University of California, Berkeley. He joins us from New York City. Hashem, hello.

HASHEM AKBARI: Hello.

MG: What do we know about the impact that trees have on the temperature below them? We just heard two examples in the same city of very different experiences. What do we know about what's going on there?

HASHEM AKBARI: Trees, through the process of evapotranspiration, which is part of the photosynthesis process, take some water from the ground and evaporate that into the earth. And as a result of that, it can make the environment a few degrees cooler. In addition to that, by intercepting the solar energy through the shading to create a cooler temperature underneath the canopy of the trees. And since the cooler temperature, air temperature is slightly heavier than warmer air temperature, they stay on the ground. So, that is the way that they typically help to cool air.

MG: I mean, we have seen in cities across North America, heat related deaths becoming much more of an issue in recent years. Given what you just described, how can the urban tree canopy impact our health?

HASHEM AKBARI: The heat waves that come in the trees and can help a little bit, but still the damages by the heat wave are substantial. However, what they do is just definitely more shading the streets that would help the pedestrians not to be overstressed by walking under the sun. As a result of that, it has the potential of saving a life.

MG: I mean, one of the things is shade and actually allowing people, you know, somewhere to go and hide from the heat. But there's also the issue of air quality. How can trees in a specific area impact the air quality there?

HASHEM AKBARI: The large dust particles that are in the air when they are insolated under tree leaves, they tend to get stuck and to the leaf and when the rain comes down, they wash the leaves. The other way is that they also absorb some of the ozones that are in the street [unclear.] And that would also help to improve the air quality a little bit.

MG: Do these benefits, do they come from specific types of trees or is any tree going to provide some benefit in an urban setting?

HASHEM AKBARI: Almost all trees would have the same type of benefit. But if you would like to have the benefit of the shade during the summer and the benefit of the sun penetrating to the branches, you are better off with deciduous trees. However, if you are looking for the green barrier and sound barrier, you are much better off with evergreen trees, that are dense enough to divert or absorb most of the incoming sun.

MG: We heard earlier from Teri Chu, who lives in the west end of downtown Toronto. It's an area that has a lot of trees. Here she is again.

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TERRI CHU: I am in the midst of clearing tree roots from my old clay pipe right now, actually. It's a 100-year-old house that's going to get in and it's part of owning a house. And it's just an expense that you have to deal with at some point if you want the pleasure of living in a nice community with trees, and that's comfortable.

MG: So, she says that, I mean, sounds pretty positive in terms of, you know, having the trees around. But she's clearing, you know, tree roots out of a pipe. You have trees that might fall down and branches end up on your car or your house. They hit power lines. The trees die. They need to be removed. For people who say that the headache of urban trees isn't kind of worth the benefits that you're describing, what would you say to them?

HASHEM AKBARI: From the bean counting approach, which would be basically trying to monetize the positive or negative without considering some of the aesthetic and some other detailed social economic impact of the way of living, definitely, it is very hard to recommend trees on that point of view. As an example, if you are planting a tree to shade your house, to save energy during the summer and also protect you with the wind from the cold winter during the winter, there is some benefits, but that benefits is in the order of, you know, a couple of hundred dollars a year. Now, if you have a branch of a tree falling on your house, you tell me what is the cost of it? If you have the root of over grown trees under your drainage, that's a major expense. So, the point to be made in here is that trees are part of the integral life of us. And once we are trying to emphasize the positive aspect of it, we should definitely try to intervene in those areas that people are more interested to having trees, to help them to put the right kind of tree at the right places so it would minimize all the potential costs. I definitely would like to live in a tree neighbourhood that has more trees and more amenities like that, so I can walk, I can enjoy neighbourhood, rather than to be living in-- not desert like, but barren like and warm and that there is no trees. And basically I have to jump into the car in order to go to do something.

MG: You used the phrase bean counter. I mean, there is a monetary value that has been assigned to trees. The city of Toronto, for example, in its forestry plan, said that the trees in the city, the value of the tree canopy was something like seven billion dollars. You have said that trees in Canadian cities might provide energy savings of around 20 per cent through the shade that they create in the summer and the windbreak that they offer in the winter. Do you think that we, I mean, from a monetary perspective, and I get that there are other benefits to it, but from a monetary perspective, do we value the trees in our cities enough?

HASHEM AKBARI: There are things that I know how to count. Energy impact, air quality impact, and there are things that I do not know how to count. Improving the property value. When you are improving the property value, most established neighbourhoods already have a lot of trees. So, when you buy property there, you are already paying for that tree that it is planted. If you look only from the energy and air quality benefits of trees, only on these things, the cost benefits are not very good. But in general, people like of trees, cities that are green are more often visited by many, many visitors and cities that are green or preferred areas to live, neighbourhoods that are green are preferred because they're green. Then the question is that how to make that as an integral part of the whole society and a whole community that the parts that appear to be costly are minimized?

MG: We're going to speak about this issue of tree equity in just a moment. But before I let you go, given what you said, what would you like to see from cities in terms of how they think about their environmental design and how trees fit into the landscape of a city? A city is a lot of different things. What would you want to see the place of trees be in that?

HASHEM AKBARI: Sure, absolutely. I think that the thing that I would recommend is basically trying to have programs for the private property trees that would help residences and the residential neighbourhoods and also try to have programs for the streets and commercial areas or public areas. Also trying to create some courses in the highest school level to help, you know, some students they would be adopting and planting a few trees they would be having the pleasure of growing with those trees in terms of both responsibilities. So, thinking about an integrated program. And there are examples of these such as City of Sacramento, who planted 700,000 trees back 20 years ago, city of Los Angeles, who's actively doing it, and of course, the city of Toronto that I work with them some almost 30 years ago in order to have their initial tree program developed.

MG: Hashem, thank you very much.

HASHEM AKBARI: My pleasure.

MG: Hashem Akbari is an environmental engineer at Concordia University and one of the founders of the Heat Island Group at the University of California, Berkeley. Aside from the climate benefits of trees in urban areas that Hashem is talking about, there's also a push to recognize their social benefit. The City of Toronto recently released a map. It shows a community's tree equity score. The hope is that this map will give a clearer picture of which areas have trees and which areas don't. Julia Keech, who we heard from earlier, thinks a lot about the impact of trees or lack thereof and the impact that that can have on her family.

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JULIA KEECH: I do think that certainly when you have more trees in a neighbourhood, it makes it more attractive. I would go as far as to say that it increases property value. You know, I grew up in rural Nova Scotia on a farm and we spent days outside playing. And so, being a mom and having two young kids, it's... I sometimes feel a bit sad that, you know, my kids won't necessarily have the freedom to just get out inside and run around in nature. There are very few parks, whereas in other neighbourhoods in Toronto, you know, you step outside and there might be a small parkette or there are trees everywhere. So, you do have a sense that you're, you know, close to nature and you have that green space to play and to just de-stress.

MG: The environmental non-profit LEAF helped build Toronto's tree equity score map. Janet McKay is the founder and executive director and joins us now. Janet, good morning to you.

JANET MCKAY: Good morning, Matt.

MG: What's tree equity?

JANET MCKAY: Tree equity refers to the fair distribution of trees in neighbourhoods in a urban setting, regardless of race or income, so that everyone has access to the many benefits that you were just discussing. The benefits that come with a healthy, vibrant urban forest.

MG: What does that mean, the fair distribution of trees? People might look at a city and they might think, Well, the trees are here, there are trees there, but there are trees in this neighbourhood. What does that mean? The fair distribution of trees?

JANET MCKAY: So, proximity to trees makes it makes a huge difference. So, if we look at the canopy cover across the city as a whole, that's one thing. But when we start to dig down and see, okay, what does that actually mean neighbourhood by neighbourhood, you see pretty significant differences. And most cities are like this. So, actually the proximity to the trees themselves really does have an impact on how each person experiences some of the benefits that are offered by those trees. So, for example: shade, air quality. These things all require you to be close to the trees that are providing that. Privacy, sound barriers, buffering that trees offer us in a bustling, busy city. You need to have trees close to you to experience those benefits. And the mental health benefits of trees. You know, we, there's more and more research demonstrating significant mental health benefits of being close to trees. So, it's not just having trees over all across the city, but it's like where are those trees located and who is actually receiving those benefits?

MG: How do you measure a neighbourhood's tree equity score?

JANET MCKAY: The Toronto tree equity score analyzer that was developed with American Forests, it basically, it takes open-source data from a whole bunch of sources and then combines it to create a map that scores neighbourhoods from 0 to 100. So, we start with the existing tree canopy. So, that is a layer of the map, and then it also looks at what the canopy goal is for the city. So city of Toronto, for example, has set a goal of 40 per cent canopy cover by 2050. And then it looks at neighbourhoods in order of priority. And the data there that would be included would be things like income, employment, health indicators, like surface temperature, for example, building density, income unemployment, race, language and age. So, these are all combined into sort of a priority index that then tells us, okay, so for a neighbourhood we've got this existing tree canopy, this is the goal and this is the degree of priority that this neighbourhood has. So, the map then tells you, okay, where in the city should we be focusing our efforts in terms of getting closer to that tree equity goal?

MG: When you looked at the data and crunched the numbers in terms of the amount of trees and the amount of tree cover, what were the trends that you were able to pull out when it comes to who lives in places with good versus a bad tree equity score? Where there are more trees versus fewer trees?

JANET MCKAY: These are trends. Of course, there are exceptions to this, but in general, when we look at it, we see areas of higher income have higher canopy cover. We see the inverse. Areas of low income have lower canopy cover, and we also see trends around neighbourhoods with high Black Indigenous and people of colour populations having lower canopy cover. And again, inversely, neighbourhoods with high white populations have higher canopy cover. And so again, these are trends. There are exceptions to this, but that's some of what becomes clear when you start looking at the tool.

MG: In the conversations around what is important in a city, when people are, for example, struggling with cost of living, trying to figure out how they can afford to live anywhere, trying to afford how they can get around and what might, you know, keep them in the city in the first place, why does something like tree equity matter, do you think?

JANET MCKAY: It really affects our day-to-day quality of life so much. And I think some of the guests that you had that were walking around their own neighbourhoods really attested to that. How it can make a difference when you're walking to work or to dropping your kids off at daycare or wherever you have to go. It can make such a huge difference. It's really something that we feel. And the previous guest talked about the measurable benefits, things like air quality improvements and temperature reduction and things like stormwater attenuation, right? Trees slow the rain down and they absorb it so we don't have to move and treat as much stormwater, which is a huge expense for municipalities. But the immeasurable benefits, the ones that we can't really measure in numbers, but we feel them and we know that they are there. They're just such great value. And they make it, they make cities liveable, basically.

MG: So, if there are areas of cities that don't have-- and we've been talking about Toronto, but this could be applied, I'm sure, across the country-- if there are areas of the city that don't have that equitable distribution, a fair distribution of trees, what do we do about that? How do you go about improving a city's tree equity score? Is it as simple as planting trees?

JANET MCKAY: It's not.

MG: Definitely not, in part because you're talking about cities that are already built up, right? I mean, unless you break up the concrete and reorganize the cities, it's hard to plant a lot of trees in perhaps neighbourhoods that don't have those trees.

JANET MCKAY: Yeah. There's so many reasons why it's complex. And that's certainly one. Just the physical structure of the neighbourhood and like how much paving is there? And that's one of the sort of root causes of some of the inequity is just the urban planning and development practices that have prioritized that grey infrastructure over green infrastructure. You know, in the past, trees were sort of treated as an afterthought, sort of a luxury, right? As opposed to a right or a need.

MG: And you think that they're a right?

JANET MCKAY: I do. Yeah. I mean, when we talk about the benefits, we're talking about the air we breathe. We're talking about our physical and our mental health. And I think they should be considered as a right. Yeah, I do. We need all of these things. We simply can't live without them. I mean, they give us oxygen. They provide so many benefits. If we treat them as a luxury, then only those who can afford luxuries get the benefit.

MG: So, if we can't just plant more trees, what do we do?

JANET MCKAY: First, we have to understand why there are historical discriminatory practices around how neighbourhoods were built. And it was very, very well researched and documented in the U.S. But it also happened in Canada, where folks who lived in certain neighbourhoods were denied mortgages and-- from lending institutions because they were considered high risk. And so, there's that to contend with. People were prevented from building intergenerational wealth. And so, that has an impact now in terms of who owns what property, who lives where. Simply property size itself has a huge impact. So, larger properties obviously have more soil volume. That means you can plant more trees. And then I think finally barriers to community engagement. So, as a non-profit organization, we need to be asking ourselves like, who are we engaging? How are we reaching out to folks? We need to be listening and learning and understanding what people who are living in those little lower canopy areas, what they need, what they want, what their concerns are, and co-designing those programs to help support them and to actually move the needle on that tree equity issue.

MG: The federal government has promised to plant something like two billion trees. There's been great discussion as to whether that actually will be possible or not. But there are, I mean, Montreal committed to planting something like 275,000 trees in parking lots and in schoolyards and near hospitals and in areas that are designated heat islands. There are other cities as well, Ottawa and others that are trying to improve their tree canopy. Are you confident that those are meaningful steps to address this issue of tree equity?

JANET MCKAY: I'm hopeful. I'm not confident. It is extremely encouraging to see that many municipalities are recognizing this issue. They're trying to build strategies to address it, and we're working in partnership with City of Toronto City, the City of Voughn, Region of York, Region of Durham, other municipalities, to understand and begin to take steps to address it. It's not going to be easy or simple. And I think that's what they, that's what is being grappled with. It is not as simple as planting trees. It is going to take time and effort and a lot of community engagement and a lot of listening and learning. And it's going to take different stakeholders being involved. I think there's a role for many different stakeholders in this to really be able to tackle the issue successfully.

MG: And if we don't-- just finally-- if we don't, we know that huge part of this population live in cities and those cities are getting hotter and the weather's becoming more extreme. What's at stake?

JANET MCKAY: Well, simply our physical and mental health and the fair distribution of benefits that can really support the physical and mental health of people living in urban areas.

MG: Janet, thank you very much for this.

JANET MCKAY: Thank you.

MG: Janet MaKay is executive director and founder of the organization LEAK. That is The Current for this Wednesday, the 25th of September. Q is up next on CBC Radio One. And just talking about trees in the city and their beauty and their benefits, there is, of course, a Canadian song about this most Canadian of subjects. It's by our friend Dan Mangan. It's Leaves, Trees, Forest. I'm Matt Galloway. Thanks for listening to The Current. We'll see you tomorrow.

[Music: 'Leaves, Trees, Forest' by Dan Mangan]

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