Doctors need to meet challenge of climate change

IT IS easy to imagine that climate change isn’t a problem in health care. Individual doctors hold personal opinions on the proposed Adani mine in Queensland or on the importance of health care sustainability practice, but whether climate change affects health and the practice of medicine can seem murkier.

It is easy for busy doctors to be distracted by the sea of patients waiting to be seen in emergency departments, in clinic waiting rooms, the referrals for consultations, procedures and follow-up all mounting up in the office. Good medicine involves attention to the patient and their concerns. So, is there time for climate change in this?

Climate change creeps into the consulting room in all sorts of ways. There are the obvious issues – caring for farmers during drought is always a humbling lesson in the power of nature, and how we have no control over the weather. Much is written about drought and farmers’ health: deterioration in hypertension control with stress, the neglect of self-care and the issues with overwork, fatigue and injuries. Suicide is more common among male farmers during drought. Community resources and coping capacity are often sorely tested by protracted drought with obvious effects on local health and wellbeing.

Heat is just a part of the ongoing changes to our climate. The increase in frequency and severity of extreme weather events creates direct damage to health, affects livelihoods and relationships and has longer term consequences related to trauma. The water insecurity faced by significant areas of regional Australia affects many aspects of rural health.

Extreme weather has an impact on our exercise routines, our food quality, and sometimes even on access to food; it affects our nutrition and food choices. Our mental health and wellbeing can also be affected. It can challenge the physical environments in which we live, either through direct damage (flood, fire) or through demonstrating inadequacy of thermal protection against heat, cold or rapid temperature change. Heat affects school and academic performance, collective violence, and our children’s long term wellbeing. Heat stress affects productivity and work performance, exerting another burden on our economy. All of this, in my opinion, affects our health.

Health data are skewed by what is known of causal relationships. For example, heart disease is routinely analysed through prisms of smoking, diabetes and hypertension, through geography and, increasingly, through the social determinants of health. However, our health data do not yet robustly reflect the inter-relationship between climate and wellbeing. The Australian Institute of Health and Welfare (AIHW) offers Australian morbidity and mortality data with comparisons on years gone by, but rarely interrogates data through the prism of climate events. A search of “climate change health” on the AIHW website site offers six items over the past 20 years. “Weather health” offers two items, and “weather events health”, two.

International data show that after extreme weather events such as hurricanes, there is a rise in cardiovascular events and mortality, and this effect can last for months. Extremes of temperature have been associated with a rise in cardiovascular events and infections (also here and here). But the link to climate events is not yet recorded in Australian health data; not even on the death certificates for those dying from heat events. Do we know the magnitude of the health effect from climate change so far in Australia?

The past summer was very warm in Canberra and the surrounding Riverina – it was the warmest January on record. We were advised to stay cool, indoors and keep well hydrated. Despite this advice, there were admissions to hospital with dehydration and heat stress. But what was seen in the clinic was often more subtle. All patients, young, old, infirm and robust, had their exercise routines disrupted for at least a month over that very hot period at the end of summer. Many patients with diabetes reported slight deterioration in glycaemic control, likely a physiological consequence of heat stress. Many of my patients with heart failure struggled significantly, particularly as peripheral oedema was common as a manifestation of heat.

The consequence of these subtle changes can resonate for months. With less exercise and activity there are adverse changes to blood pressure and glycaemic control, muscle strength and flexibility. Some may never regain the physical strength present before an enforced rest period. In practice, this may translate to a higher risk of falls, infections and possibly an increase in mortality.

The health data from the past summer haven’t been published in any Australian state or territory. These recent associations remain a subjective observation, but warrant research and consideration. With a wealth of data on the benefits of exercise, all medical practitioners should consider the long term health consequences of being faced with a month or more each year of seriously restricted physical activity due to heat.

When the “fall-back” desalination plants in Melbourne and Sydney are required, we may see a subtle rise in cardiovascular events, such as that seen in Israel. Electrolyte change is proposed as a mechanism but it remains unclear. Recognising and measuring the health effects of climate change is a public health imperative.

While much of the climate change discussion has focused on energy (coal) and mitigation strategies through carbon pollution reduction, it is time to address climate adaptation strategies, particularly in health. June 2019 was globally the hottest month ever recorded, and the forecast for the Australian summer to come demands attention today, particularly planning for extreme heat. Are there adequate systems and policies in place to deal with the health effects of protracted hot weather? Schools, work environments and hospital systems are all likely to be stressed by protracted extreme heat. Our cities, towns and regions all need to include climate adaptation as a central part of health planning.

Just recently, the Victorian government released a Heat Health Plan. All other state and federal governments need to follow suit. We need heat and water shortage plans to be as well developed and understood as the fire planning that emerged after the tragedy of the Black Saturday fires in Victoria. Medical practitioners can offer an effective voice in developing and implementing these much-needed plans for their communities.

Climate change is everywhere through human health. It resonates and affects every medical specialty and, while its effects can sometimes seem vague, it demands our attention now. Action to reduce greenhouse gas emissions can improve human health, reducing air pollution, for example. Decreasing air pollution decreases urban mortality (here and here). Increasing active modes of transportation such as walking and cycling improves wellbeing over so many indices of health. Changes toward sustainable nutrition can translate to profound benefits for many chronic diseases, at the same time as reducing greenhouse gas emissions. Considering our housing and energy structures may improve social relationships and make us more able to cope with the challenges to come. Our health community needs to recognise the fundamental health challenge of climate change and work now on adaptation planning for Australian health and wellbeing.

The balance between physician scientist and physician advocate is complex. As doctors, we must collect evidence and analyse the science. However, to acknowledge climate science is to recognise that time is of the essence. To achieve the United Nations Climate Change (UNFCCC) 1.5-degree target, action must be taken today. The recent Intergovernmental Panel on Climate Change report shows that a delay of months or years has a measurable effect. Delaying mitigation action increases costs and risks.

In an environment of fake news and distrust of science, our role as advocates for human health is crucial. If we wait until the health effects of climate change are overwhelming, it will be too late. It is time for health practitioners to work with our patients and together act on climate change adaptation and mitigation. We can play a significant role in our local communities and our governments in calling for and achieving action.

It is the biggest health challenge we have ever faced, and it deserves our attention and resources today.

Dr Arnagretta Hunter, BA (Hons) MBBS MPH FRACP, is a Canberra-based cardiologist and a member of Doctors for the Environment Australia.

 

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.