Doctors warn Australian health system not prepared for climate change
Today, doctors and public health experts published an article in the Medical Journal of Australia, the official journal of the Australian Medical Association (AMA), calling for a more resilient health system, recommending three fundamental changes.
- A whole-of-system approach, integrating all elements of population health and health care throughout the continuum of preparedness, response, and recovery.
- Improve the timeliness of surveillance as current disease notification systems are slow.
- Determine the standards of care relevant to particular situations.
Dr Gerard J. Fitzgerald, from QUT’s School of Public Health and Social Work, Professor Anthony Capon from the University of Sydney and psychiatrist Dr Peter Aitken of Queensland Health says that natural disasters of the 2018-19 summer made it clear that the health system has to be strengthened.
Dr Fitzgerald believes that the medical profession understands climate change and the impacts it may pose to the health system.
“The vast majority understand climate change and its impacts on the health profession. Doctors are scientifically trained. Anyone scientifically trained gets it. But there’s need for awareness about its impacts on the health system.”
The article was published in advance of the 21st biennial congress of the World Association for Disaster and Emergency Medicine (WADEM), which will be held in Brisbane in May.
How will climate change affect the health of Australians?
According to the researchers, the health threats presented by climate change will vary according to geographic location.
“The rise in temperatures will not be consistent across the planet, and may increase or reduce local rainfall, depending on other factors,” they write.
“The effects of climate change will also vary regionally as individuals and societies adapt behaviourally, structurally, and physiologically.”
The primary threats, specifically caused by rising temperatures include heat stress, hyperpyrexia and heat stroke, and indirectly through their impact on individuals with
chronic cardiovascular, respiratory and renal diseases or mental health problems.
Rising temperatures also has been shown to change the distributions of allergens and pathogens and their vectors.
“These effects can be moderated by adaptive strategies but exacerbated by other factors, such as pollution and humidity, as well as by dehydration, exercise, and infectious diseases and other health conditions,” they say.
Mental health impacts
According to Dr Fitzgerald, the medical profession has to increase its awareness of not just the direct impacts of natural disasters, but also the indirect impacts.
“If you think of a disaster, such as a cyclone or flood, there are people directly affected. The directly affected are those who might drown in a flood or are injured by a falling building during a cyclone.
“The indirect effects are less obvious. There are mental health consequences if someone loses their home or a loved one. What’s even more stressful is fighting with insurance companies three years after the event. They’re battling with questions such as where to live or what they’re going to do with the kids.”
Those most adversely affected by the indirect and direct impacts of climate change, Dr Fitzgerald says, are people of poorer communities.
“It’s too late to reverse climate change so now we have to adapt. The people who have the economic power to adapt will cope better. People who can’t afford that are the people at greater risk from heat waves and other natural disasters.
“People living in low lying easily flooded areas such as those in Queensland, where property is cheap, hits poorer populations. Natural disasters are well known to affect poorer populations.”
One of the three recommendations put forward in article is “a whole-of-system and comprehensive approach” to help the Australian health system prepare for climate-related disasters and emergencies, according to Dr Fitzgerald.
“Identifying immediate direct effects (injuries and deaths) is relatively straightforward but longer term impacts and indirect health consequences are less clear,” he says.
“For example Hurricane Maria killed 64 people in Puerto Rico in 2017 but the estimated all-cause increased mortality for the following three months was 4645.”
The example of Hurricane Maria prompted the researchers to advocate for a whole-of-system approach that starts with preparedness through to recovery.
The second recommendation requires an improvement in disease notification systems, which currently rely on individuals recognising and reporting emerging problems, according to the researchers.
“Enhanced real time surveillance of ambulance, emergency department and hospital capacities and of patterns of demand should enable more timely recognition of new problems and increase the response capability of the health system,” they write.
Lastly, they say the standards of care relevant to particular situations need to be determined. “In extreme events, this includes sympathetic care for people who cannot be saved,” the paper reads.
“Every day 22,000 people attend hospital emergency departments in Australia – we have never had an event with 22,000 casualties,” says Dr Fitzgerald. “We need to have scalable arrangements which can deal with the full range of challenges from the routine to the totally unexpected using standardised policies and procedures.”
Doctors, lawyers and firefighters raising their voices
The doctors behind this most recent paper join a slew of outcries concerning Australia’s lack of preparedness for the impacts of climate change from some of the country’s most respected professions.
Last week, 20 former fire and emergency chiefs warned Australia is unprepared for the impacts of climate change, asking for more “national firefighting assets.”
The second-longest serving fire and rescue commissioner in New South Wales Greg Mullins, who is now a councillor with the Climate Council, said he could no longer predict the seasons.
“I started firefighting in 1971 and the bushfire seasons were extremely predictable.
“You knew when there was a bad season coming because there was an El Nino and drought. In the 90s, I stopped being able to predict it.”
Dr Fitzgerald will speak at the 21st World Association for Disaster and Emergency Medicine congress on disaster preparedness.