Carol Nader, reproduced with permission from The Age.
Little consideration has been given to the effects on our health of more extreme weather, but experts agree that we should be prepared for a marked increase in infectious diseases, respiratory illnesses and food poisoning.
IN THE big city, it’s called the heat-island effect. As the city sweats and swelters, heat is trapped and retained because of a mass of concrete and tar and scant green space. The temperature dips in the evening in the outer suburbs and the country, but there is no such reprieve in the city.
Endure this heatwave over a long period of time and it begins to pose problems. Problems for which Australian governments seem ill prepared.
For the frail and elderly, very hot days can kill, or at least trigger serious health problems such as heart attack and stroke. The number of people aged over 65 who will die because of more frequent and severe heatwaves could at least double by the middle of the century, predicts Professor Tony McMichael, director of the National Centre for Epidemiology and Population Health at the Australian National University. And that’s just in Australia’s capital cities.
Across the nation, the changing climate is expected to result in increases in respiratory problems and infectious diseases, as well as problems due to water shortages and poorer water quality, at least in some areas. Then there is the psychological impact of living in a less-predictable, less-secure world.
And while the greatest and most immediate impacts of a warmer, drier world are likely to be in the developing world, experts warn that developed nations such as Australia are far from immune. Witness the extraordinary European heatwave in 2003, in which 35,000 people died, many of them in France.
Professor David Shearman, secretary of Doctors for the Environment Australia, sums up the current state of affairs: “If nothing’s done about curbing climate change, you could say the quality of life and Australia as we know it will be unrecognisable.”
In Australia, much of the focus on climate change has been on the scientific evidence of a drying and warming environment. Only recently has attention turned to its effects. And even then, there has been very little consideration given to the impact climate change will have on human health – or the extent to which the health system will be able to cope with the many challenges it will bring.
That is likely to change in the lead-up to this year’s federal election. Opposition Leader Kevin Rudd has defined climate change as “the great moral challenge of our generation”. Prime Minister John Howard responded this week by dismissing Rudd’s assertion as “misguided at best; misleading at worst”. But the Greens, led by Senator Bob Brown, intend to campaign hard on the impact of climate change on human health in the weeks before the election. Dr Richard Di Natale, a public health specialist and the Greens Senate candidate for Victoria, says climate change is a looming health crisis for which, largely due to the Prime Minister’s “scepticism”, we are unprepared.
There is a lot to do. Tony McMichael is one of the top experts on the health impacts of climate change and the review editor of the health chapter of the Intergovernmental Panel on Climate Change report, which was put together by the world’s top climate scientists. He has compiled a comprehensive list of ways that climate change will affect human health.
Governments already spend billions of dollars on the health system. In decades to come, they will have to spend much more.
As more extreme weather patterns bring disasters such as floods, cyclones and bushfires, hospitals will have to cope with more injuries and death.
One impact of climate change will be a greater risk of food poisoning from salmonella and other intestinal infections. Salmonella proliferates more rapidly at higher temperatures. Shearman says the combination of heat and lack of water for hygiene will conspire to cause more food poisoning. Aboriginal communities, which are already severely disadvantaged, will feel the effects of this more severely.
Di Natale says outbreaks of gastroenteritis, such as the recent case in Victoria in which five nursing home residents died, will be a more common occurrence. But the health system isn’t ready for it. “The Victorian public health unit is already struggling in part because it’s inadequately resourced, and as the frequency of these food-borne illnesses increase, public health units are going to be unable to cope,” he says.
The spread of infectious diseases is also tipped to become a bigger problem. Malaria hasn’t existed in Australia for decades, apart from in returned travellers who picked it up in other countries. But if the climate changes as anticipated, it will create conditions that are more favourable for the mosquito that spreads malaria.
A more serious problem is dengue fever. It exists in parts of northern Australia, but is likely to travel further south, as far as Rockhampton in Queensland and Carnarvon in Western Australia.
Shearman says if governments do nothing, it’s possible it could spread even further south. “If we start to cut back carbon dioxide emissions, then they’ll go down to Rockhampton and Carnarvon anyway. Its severity will increase if greenhouse emissions are not curbed.”
Environmental conditions are also linked to respiratory problems such as asthma. Respiratory illnesses are one of the most common reasons people see GPs and are admitted to hospital. If the weather becomes more erratic or extreme, there is likely to be more people needing treatment for respiratory diseases.
Associate Professor Lou Irving, director of respiratory and sleep medicine at the Royal Melbourne Hospital, says a rise in atmospheric pollution is likely to increase respiratory ill health. “Sudden change in atmospheric conditions can cause a surge of respiratory diseases that can put marked demands on the health-care system,” he says. “If climate change worsened pollution or made it more favourable for respiratory viruses to circulate, it’s highly likely we would see an increase in respiratory disease.”
This also presents a problem in rural areas, where exposure to heat, dust and smoke from bushfires can also set off respiratory problems.
The nation’s health ministers have been slow to act, although a federal Health Department spokeswoman says it is likely that it will be on the agenda of a health ministers’ meeting “in due course”. The Health Department, she says, already takes issues such as the increased risk of skin cancer very seriously and has an ongoing campaign to alert people of this danger. In the meantime, she says, the department will act swiftly as new evidence emerges.
Victoria’s Department of Human Services is hosting a conference on climate change and human health in October, in recognition that planning needs to start now to help the health system cope in the future. Conference themes will include planning for heatwaves, mental health, aged care, infant and child wellbeing and communicable diseases.
But it seems the warning signs are already here. Almost two years ago, the Australian Medical Association and the Australian Conservation Foundation produced a report on the public health impacts of climate change. It said: “The World Health Organisation estimates that internationally tens of thousands of people are dying every year due to the modest climate change we have witnessed over the last two decades.”
Last month, a key recommendation that emerged from a national rural health conference in Albury was that the Federal Government should immediately invest substantial funds for research to establish the impact of the drought and water shortages on rural communities and child and family wellbeing. Such research would form the basis of new interventions to support community resilience. It would help prepare rural Australia for the consequences of global warming and climate change.
The attention in rural areas has been on the mental rather than the physical health impacts of climate change. As farmers devastated by the drought ponder how they will provide for their families, the problem is compounded by a scarcity of mental health services in the bush.
There’s a sense of despair, says Mark Wootton, who has a beef and sheep farm just north of Hamilton and is the chairman of the Climate Institute. The drought is already making life tough for farmers. “Everyone I know is going to lose money this year and the question is how much,” he says. “My saying is I’m going to lose my shirt. I just hope I don’t lose my jumper as well.”
The psychological impact won’t only be felt by farmers. There are also significant effects on the emotional development of young children who grow up in families that are stressed and anxious about reduced household income and poor food production. As conditions get more stressful, people might be more likely to turn to smoking and alcohol and self-medicate – which are all risky to their health.
Shortages of fresh water can also potentially compromise the health of people living in the most remote areas, affecting hygiene and increasing the risk of dehydration.
Recent international reports on climate change have suggested that it is “very likely” that human activity led by burning fossil fuels account for most of the global warming in the past 50 years. And Shearman says that in the next few decades, many of these things are going to happen because of the amount of carbon dioxide in the atmosphere. But he says if the world takes stringent action, further damage might be prevented.
There are things governments can do. McMichael reels off a list. They need to urgently support more research into the impact of climate change on human health. And they need to start planning now to ensure the health system is prepared for the anticipated impacts.
The health workforce, for instance, needs to be better prepared. There needs to be early warnings about heatwaves. Hospitals, ambulances and other emergency services all need to focus attention on the issue. And there is a need for urban design that can better handle extreme heat. One way is by having more green space in the inner city, which has a cooling effect.
“We need greener and better ventilated urban space and we need better insulated buildings and houses,” McMichael says. “Unfortunately, Australian houses tend to have lost their external shade facilities. We don’t have verandas and shades the way we used to, we just rely on internal air-conditioning, which is basically a very unsustainable way of building houses. It commits us to enormous energy dependency for keeping our houses cool.”
Di Natale wants a climate-change health taskforce at the federal level. “The most damning indictment on state and federal governments’ response to this is the fact that we have been for a number of years preparing for looming health crises such as the influenza pandemic and bioterrorism responses. And we’ve done very little when it comes to responding to climate change and its impact on human health.”
As for life on the farm, Mark Wootton says it has now got to the point where farmers are discouraging – or at least not actively encouraging – their children to persist with farming. “If you can’t produce off your farm what you could do in the past in terms of an economic outcome, then how are you going to encourage your children to stay there?” he says.
Wootton says farmers will find themselves working longer and harder. Their work-life balance will suffer as a result. There will be less time for family and friends, the people who make us feel good about ourselves. “Tractors aren’t particularly good psychotherapists, are they?”
Carol Nader is Age health editor.
The pain of change
• More illness and deaths from more frequent and severe heatwaves.
• More injury and death from floods, cyclones and bushfires.
• Increased risk of infectious food poisoning.
• Changes in spread of mosquito-borne infections.
• Fresh-water shortages in remote areas.
• More respiratory problems.
• Effect on mental health.
SOURCE: PROFESSOR TONY McMICHAEL, DIRECTOR, NATIONAL CENTRE FOR EPIDEMIOLOGY AND POPULATION HEALTH, AUSTRALIAN NATIONAL UNIVERSITY.
This article appeared in the Age, April 2007