Balancing Professional and Advocacy Roles: Birth of an ENGO

The Canadian Association of Physicians for the Environment is an important advocacy organization. Its website ( has a capsule history of the organization that, oddly, fails to mention the three founding leaders came together to bring CAPE into being: Trevor Hancock, Warren Bell, and myself, Tee Guidotti. I have not been active in the organization since 1998 but many years ago they dubbed me “President Emeritus”, so I feel a responsibility to preserve the early history of the organization (even if I do refer to myself in the third person in the text that follows, adapted from a memoire in the organization’s newsletter).
CAPE was founded for the purpose of responsible advocacy separate from one’s professional role. Scientists, engineers, and physicians, together with many other professionals are usually reluctant to take controversial positions through their professional societies. Most professional societies also have some diversity of opinion among the members, so achieving consensus is difficult. Member are concerned with suggesting that their work is objective and avoid taking positions that could introduce or give the impression of bias on issues that are unsettled. Leaders are reluctant to damage the credibility and acceptance of their most important professional networks by seeming to go outside their area of expertise. Although these organizations often do take positions on public issues, they generally do so by consensus, with great care, where the evidence is to their satisfaction, and only after careful deliberation, on issues that are clearly within their scope and interest. Professionals who want to take a more activist role need a vehicle outside their professional society. One solution is to establish a different organization with different objectives, one that is intended for advocacy and functions independently from the scientific or professional society.

In the 1980’s, this was the situation among a group of physicians in Canada who wanted to speak out about environmental issues and sustainability (although the term was less often used then) and to do so with an emphasis on health. So physicians and some non-physician health professionals established a new organization specifically for the purpose of advocating positions on a wide range of environmental (and sustainability) issues. They started what the international diplomacy community calls an “ENGO”, a “non-governmental organization” dedicated to environmental issues.

Dr. Hancock was already a distinguished consultant on health issues in the early 1980’s and was part of a team that had brought community health services in Toronto to great heights and international recognition. Dr. Hancock was also the first leader of the Green Party in Canada, from 1984 to 1986. His private consulting work led him to blend issues of the environment, health, and community empowerment, especially in the Healthy Cities movement. His “mandala of health” model was well-known in health circles. In his writings and speeches he frequently called upon Canadian physicians to form a group that he called “Physicians for the Environment” as a way of uniting health and environmental concerns and giving physicians a voice in ecosystem-related issues. Dr. Hancock and I worked together on a Task Force on Human and Ecosystem Health, emphasizing climate change, for the Canadian Public Health Association in 1992.

Dr. Bell, who became the first elected President of CAPE in 1995, is a family physician in practice in Salmon Arm, British Columbia. He was then and remains a strong advocate for linking environmental issues to the realities of social justice and economic equity. He also has a strong interest in complementary and alternative medicine. In 1989, Dr. Bell conceived of an organization of Canadian physicians concerned with the environment, with strong community links, to which he gave the name Global Healing. Together with two like-minded Canadian physicians, they announced the formation of Global Healing in a letter to the Canadian Medical Association Journal in 1990, receiving over 40 responses. However, this was not enough to support a viable national organization, so he put his efforts behind Physicians for Global Survival, the Canadian affiliate of the International Physicians for the Prevention of Nuclear War (IPPNW). IPPNW famously won the Nobel Prize in 1985 for its activist work and was broadening its interests from a narrow focus on reducing the threat of nuclear war to include large-scale environmental issues. Dr. Bell eventually served as President from 1995 to 1997.

Dr. Bell and I met at the International Conference on Ecosystem Health in Ottawa in 1993 and together they resolved to establish CAPE, along the lines that Dr. Hancock had proposed and Dr. Bell had attempted.

I had also attempted to organize an organization of physicians concerned about the environment in 1989, in connection with the planned World Congress on Health in Beijing. This Congress was abruptly cancelled due to the violence in Tienanmen Square. At about that time, with no venue or opportunity to complete the international organizing effort on the scale he had planned, he learned that ISDE had started and of its organization as an international federation of national societies of physicians concerned with the environment. He arranged for a small group of associates to put their names on an application for incorporation in 1993 and applied to the International Society of Doctors for the Environment (ISDE) for recognition of a Canadian affiliate in 1993, before CAPE was fully organized. On 18 September 1994, following I’s presentation at the ISDE annual meeting held that year in Koblenz (Germany), ISDE recognized CAPE as its Canadian affiliate. (In its second year, on 16 August1996, CAPE hosted the international meeting of ISDE, in association with the International Society for Environmental Epidemiology, which was held in Edmonton.)

In the early years of CAPE, its activities were linked with and partially supported by the Tricouncil EcoResearch Chair in Environmental Risk Management at the University of Alberta, held by Dr. Steve Hrudey (an engineer). By tying the development of the organization to the Chair’s programs in risk communication and professional education, the new organization benefited from office support from the University as an academic activity and could also serve as a proving ground for new ideas and approaches in professional development. Later, the EcoResearch Chair supported production of a book, The Canadian Guide to Health and the Environment (University of Alberta Press, 1999, 322 pages) which became a best-seller for the publisher and which CAPE used to raise funds in its early years.

The first organizational meeting for CAPE was held on 9 November 1993 in my living room in Edmonton. A lawyer friend, Ms. Bettyanne Brownlee, volunteered to do the legal work on a pro bono basis and filed applications for letters patent, provisional bylaws, and a charitable number so that the new organization could function as a not-for-profit registered charity. Approval came from Ottawa on 24 December 1994. The existence of the new organization was first announced in a letter to the editor in the Canadian Medical Association Journal on 15 January 1995, which was followed by a feature article on CAPE in the same year.

The date 22 April 1995 was chosen to be the official anniversary date of CAPE’s founding as an organization, in recognition of the twenty-fifth anniversary of the first Earth Day. The first annual meeting was held on 25 November 1995 at the University of Alberta Faculty Club in Edmonton, with ten members participating. At that meeting, a charter was unveiled declaring CAPE the official Canadian affiliate of the International Society of Doctors for the Environment. We also adopted a spiffy logo, still used by the organization, that was drawn by Sam Motyka, my preferred artist in the graphics department of the University of Alberta.

CAPE remains the Canadian affiliate of ISDE, which was founded on 25 November 1990 in Cortona, Italy. ISDE consolidated and expanded an earlier loose federation of national organizations in Switzerland, Germany, Austria and Italy. The Swiss organization, in particular, had undergone phenomenal growth in numbers and influence in the late 1980’s, becoming a significant national movement. By the early 1990’s, when CAPE was beginning to pull together, ISDE was struggling but had about 30 recognized affiliates around the world, was recognized as a consultative NGO by the World Health Organization, and produced a small journal edited by Dr. Lorenzo Tomatis (1929 – 2007), an eminent cancer epidemiologist who had retired from the World Health Organization. I served for many years as the CAPE delegate to ISDE. ISDE was an oddly ineffectual organization in those days, its efficiency not helped by the fact that the common working language of the leadership was Italian, which none of the rest of us on the board spoke. However, under the leadership of Peter von Hazel (of the Netherlands) it was revitalized and gave rise to the International Network for Child Health, Environment, and Safety (INCHES, which I always thought should have been reworded to fit the acronym CENTIMETRES).

CAPE had newsletter (hard copy in those days) that we produced at the University of Alberta. Back issues from that era are not posted on the current CAPE website, which may be just as well. I remember writing a critique of Farley Mowat, the famous Canadian writer who had a habit of bending the truth to the breaking point. In my opinion, he had inexcusably defamed dedicated Canadian federal wildlife scientists. (He had written that they had been obstructionist to his work, but years later in an interview he admitted that he had exaggerated to make a better story.) I think my colleagues were a little embarrassed by it as they never spoke of it.

In the earliest years, CAPE adopted a strategy of bringing together issue experts and highly-motivated activists who primarily saw themselves as advocates, represented at the time by the energetic and articulate Peter Carter. Its membership was never limited to physicians and is broad enough to include a wide range of advocates as well as experts on different issues. The concept was that the experts would ensure that the positions the organization took were valid, and the activists would advocate those positions most effectively. It worked because the membership of the organization had both types of members, enthusiastic about making a constructive contribution to both health and environmental protection. Since then CAPE has moved toward a more traditional model of advocacy.

Once the leaders had done their work, however, it was time to let go and so the organization has been led by its membership for many years. Since then, CAPE has become a strong and influential organization. The organization became particularly active on pesticide-related issues and climate change. CAPE has won several prestigious national awards for advocacy and has entered into partnerships on issues such as child health and the environment and “green” healthcare.

CAPE’s later success owes everything to other dedicated leaders who came later, and particularly the tireless efforts of Dr. John Howard (University of Western Ontario). Twenty years later, I find myself working at the University of Ottawa with Scott Findley, who was an early leader in CAPE.

Not every member of CAPE necessarily agreed with every position or the priorities of the organization, but CAPE articulates a health-centered point of view and serves as an important counterweight on big issues with a dimension of health. Canadian environmental advocacy would be poorer without it.

I remain a member of CAPE but have not been active for years. This has not been a matter of indifference on my part. It simply reflects the move away. I cannot tell you what CAPE is like now or how it developed after 1998 or anything about its current policies. I can, however, tell you lots about how it got started.