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.


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Australian climate change inaction threatens lives
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29 thoughts on “Doctors need to meet challenge of climate change

  1. Anonymous says:

    New Idea used to run a Leyton and Bec cover on an approximately 3-4 week cycle.
    It all became a bit ho-hum: same old, same old.
    Bit like climate change at MJA Insight.

  2. Sadiq says:

    Great comment Anonymous!

    I think I’ve been reading the exact same article for about 10 years now.

  3. John Bolous says:

    Arnagretta,

    Would you propose some practical suggestions on how you intend to control emissions, that would take into account the biggest polluters in the world such as China and India, who do not have the money to throw into renewables, and have booming populations? If what you state is true, then we are all stuffed one way or another, unless we have another world war to wipe out half the world’s population… Unless anyone else has some bright ideas that take in all the world?

  4. Anonymous says:

    Stick to your knitting. I expect professional literature to be that!

  5. Ian Hargreaves says:

    Well-timed article during a savage winter flu season.

    Worth considering that a return to the climate of only 11,000 years ago, before anthropogenic global warming,
    would see all of Scandinavia, Russia and Canada buried beneath an ice sheet. The Northern half of China, India, and the USA would be uninhabitable – the Wisconsin glaciation was so named because that’s how far south the ice sheet extended. Hard to imagine what the UN climate change folks would think when their New York HQ was covered by 1,000m of ice.

    Given that such a reversal to a time before anthropogenic climate change would kill at least half the world’s population (and possibly the other half, if Messrs Putin, Xie and Trump decided to use their nuclear weapons rather than simply let their people freeze to death), perhaps we should join Bob Brown on his diesel-powered bus, and prefer to consume brown-coal-fired electricity via Basslink than build another wind turbine.

    Like so many medical advances, where serendipity trumps reason, global warming has inadvertently been the greatest ever public health measure undertaken by humans.

  6. Joe Kosterich says:

    Always awe inspiring to see doctors virtue signalling their “woke” credentials.

  7. Dr Sarah Mollard says:

    Come on anonymous at 12:49. Feel free to put your name to your misogyny!

    So disappointing that a group of professionals who base their work on science seem as unwilling to face the significant consensus in climate science as the general population. Shame on the science deniers in our ranks.

  8. Beau Frigault says:

    Fantastic article Dr. Hunter!

    It’s a shame people are already starting to become “bored” with the topic, or think that the situation is beyond repair.

    As far as I’m concerned we only have one option – to act on this and to act with all our might!

  9. Marcus Aylward says:

    “Act”.

    Definition please Beau.
    Don’t hold back on the specifics.
    Oh, and as with any proper discussion of treatment, make sure to mention the side effects.

  10. Arnagretta Hunter says:

    Great commentary, thanks! Particularly like the advice about the knitting! Will take that on board.

    Health professionals can make a compelling case for individual action, both for health and climate change. Every day I spend time talking to people about the advantages of increased physical activity, and dietary alterations. My recommendations are evidence based, improve health outcome across a broad spectrum of conditions, and improve wellbeing. These actions can also reduce an individual’s carbon footprint.

    It is easy to be overwhelmed by the science, complexity and scale of climate change. Defeatism and denialism are understandable, quite human reactions. To focus on our patients health offers us is a straightforward message this challenging discussion. Please don’t be fooled that it doesn’t matter. Climate Change is the most significant health challenge of our time and we can play a serious role in addressing it.

    For those interested in the broader challenge: now (winter) is a great time to assess whether your local health service, or local community is adequately prepared for the coming summers. Forecasts suggesting significant increase in maximum temperatures (spikes) warrant our attention for the health of our communities. Is your town at risk of a 45+ (50?) degree summer? How can we prepare? The Victorian government has released its Heat Health Plan. It is worth reading. And all other states / territories need a similar document. Similarly water shortages during the worst drought to hit the Murray Darling basin in 120 years. Can hospitals in towns with severe water shortages operate on a ‘business as usual’ model – or do we need well developed strategies to offer best care to our regional population?

    Thank you all for reading the article and considering the issues. Debate is central to solutions!

  11. Marcus Aylward says:

    A gracious response to the apparent knitting slur, Arnagretta – rather than the leap to misogyny offence from #7 – but in fact the expression has occurred as an idiom in English dating back at least to the 1800’s, more or less meaning that one should concentrate on areas in which one has some expertise.
    “Can hospitals in towns with severe water shortages operate on a ‘business as usual’ model – or do we need well developed strategies to offer best care to our regional population?” Given that doctors have been almost completely marginalised from hospital boards to provide advice on health care delivery, one has to have some uncertainty as to how doctor-as-civil-engineer would be received by such boards.
    Such questions of expertise extend also to climate scientists, who are qualified to tell us what they have documented and what they have modelled for the future but who are neither qualified (nor elected) to formulate government policy, which across the world has to deal with the welfare of the extant 7 billion people.
    And so one is always troubled by the selective concern: we should be concerned about potential future deaths from heat, yet figures from the UK show that deaths from cold in existing populations are rising as a consequence of energy poverty from artificial distortions in energy market pricing. Yet the here-and-now population seems of no apparent concern set against the (potential) welfare of a hypothetical future; a peculiar misanthropy – particularly for doctors – which seems explicable only if the concerns for such future populations are but crocodile tears and the real quest is more to return Gaia to her virgin state, depleted of wicked humanity.

  12. Anonymous says:

    A wonderful reasoned article Arnagretta and by one of the generation below me. But why are is the government bent on denying there is a problem or on a global basis, India and China have much to do with the climate problems. It is frustrating for older folks to do more than just support the younger generations and live using the principles of recycling, reuse, etc.. On the smaller scale, many of the older folks are downsizing and it is very hard not to discard some of our belongings to waste. Nevertheless we can all do our bit and hope the leaders will do the right thing

  13. Anonymous says:

    Climate change is crap.
    It has become a religion for the Woke generation.
    We are currently (luckily) in an interglacial period.
    Science can’t explain the Little Ice Age, or the Medieval Warm Period.
    CO2 is plant food.
    And Australia’s 1% of global emissions are irrelevant to weather and climate.

  14. Frank New says:

    Climate change commenced when climate first developed. It gas always been so.
    Australia’s climate would not be changed at all if Carbon emissions in Australia ceased completely from today. Australia’s contribution is so small, and many other influences on climate continue.
    Australia’s climate is not produced in Australia. It is subject to many other word, even extra-planetary factors.
    In my opinion, far bigger challenges to our future welfare arise from population explosion, and consumer explosion but, most importantly, waste. The current obesity problem is the first time this has been experienced in the history of humanity.
    There is plenty to do, but focussing on Carbon emissions is a sad distraction, especially disappointing when adopted by people who have the education and skills to assess evidence independently, rather than by using politically driven sources, conveniently not attending to major but difficult problems.
    Educating women in the third world has provided dramatic results.
    Better than inappropriately employing modern technology within old ideologies to abort female pregnancies, distorting the gender balance and building future problems, as is occurring in China and India (and others) at an increasing rate.

  15. Naomi W says:

    Thankyou Dr Hunter for a timely article as unprecedented wildfires burn in the Arctic, as reports of deaths in the heatwaves in Europe begin, and as we approach Earth Overshoot Day earlier, yet again, this year. In particular, the unseen effects of heatwaves such as disrupted exercise programmes and worsened glycaemic control gives food for thought, in addition to the more obvious effects of climate change.

    It is concerning to see denial of climate change, when the science is so clear, discussed in response to an article in an evidence-based journal. Climate change is one of the biggest health issues, if not the biggest, that we face today. That is not to diminish other issues that also impact on health, of course, as these are frequently interlinked.

    I welcome Dr Hunter’s suggestions to build and work within climate adaptation strategies. I would also welcome further guidance on implementing workplace practices and patient advocacy, perhaps through a follow-up article?

  16. Anonymous says:

    “Pseudo-moralistic virtue-signalling to impress friends and family” (J Peterson)
    Read anything by Bjorn Lomborg to see how the trillions (yes, trillions) of dollars that are being directed to current ‘action on climate change’ will make no/zero/nada difference to the future global temperature.
    But you will certainly feel smugly superior that you have ‘done your bit’.

  17. Sam Nelapati says:

    Why are Climate “Emergency” skeptics called deniers?

  18. Edward Kain says:

    A good article. Some dullard responses.

    For those who are bored of seeing articles about climate change: I am too, and there would be less need to keep rolling them out if we would accelerate the actions we need to undertake to address the issue. What is becoming exceedingly boring is dullard deniers.

    For those asking for ‘specifics please’ regarding the authors call to ‘act’: don’t be cute, you know what these solutions are, some are difficult and/or expensive, but they remain necessary and the technology and ability to do them is available NOW. This is a short article, there is no need to go into that here.

    For those harping-on about the ‘woke’ generation: get your use of that term off Breitbart did you ? Do you know what it means ? Do you know where its from ? Ultimately even the derogatory meaning still includes people having ‘woke’ up to some facts about an issue. Its about time you woke-up. I, btw, am not a millennial.

    Depressing to see those working in a profession that is meant to be strongly science based role out the usually rubbish. As another commentor correctly noted, shame is what they should feel.
    They probably have old boy private school ‘mates’ with shares in coal or aluminum. Champagne cognitive dissonance turkeys. Keep on fooling yourselves.

  19. Dr. A.R.C. says:

    The problem of global warming and climate change is still diametrically opposed as ever it is.
    The real question is whether so called anthropological causes of CO2 cause climatic change and highly paid boffins in Canberra with their computer projections continue to brain wash the general laity. As scientists, we can research the pros and cons of the issue and form our own unbiased decisions.
    I’ve said it before on this issue, that more people die from cold than they do from heat!

  20. John Graham says:

    Back to basics. Is the worlds temperature climbing beyond what is expected? All the climate expert models have grossly exaggerated the rise and constantly have to downgrade their predictions. There has been a rise since the last little ice age as expected but it is not higher than the previous peaks of this interglacial period . Millions of years of history tell us that after an interglacial period comes a fall in temperature. If the rapidly rising CO2 is causing catastrophic temperature rise then where is it. Earths global temperature peaked in 2016. It might go up again or not but the rise to date has been small and not following the runaway CO2 levels. The USA, China and India would not destroy humanity if they believed the narrative of death by climate change as they too would be destroyed. They are certainly not stupid or that inhumane. Lets just wait and see.

  21. Anonymous says:

    I am so glad to see so many informed and educated and considered comments by doctors like me who do NOT believe this Global Warming/Climate Change/Climate Emergency rubbish.
    I read the science.
    I am a science skeptic – I don’t like being called a “denier” with it’s Holocaust associations…
    I recommend that some of the social justice warriors and virtue signallers read up – Professor Bjorn Lomberg, Professor Richard Lindzen, Professor Judith Curry, Dr Roy Spencer, Professor John Christy etc etc.
    There is NO consensus that human emissions of Carbon Dioxide are contributing to catastrophic weather and climate changes.

  22. Bruni Brewin says:

    That there is climate change is obvious. That we implement solar panels we now know is a future of having to discard them. As a country we seem to like using other countries off-casts. Most of our solar panels are so bad that they will only last 10 years before they are useless, so any money made by the purchaser is negligent. Wind turbines give us approx 6% energy – the land would be better utilised by planting trees that eat up on CO2 and give out life needed oxygen. Political activists are not climate change scientists, and it doesn’t take much internet research to see that the figures are skewed and I have even read that some scientists have threatened court proceedings before they can have their names removed and who are in disagreement but are on the list as though they agree. I am struggling with an old nbn computer system. One that was purchased when it was already old-hat. We send our rubbish overseas when we are told that we could use this ourselves for recycling to build better roads and building materials. And how much was it we now needed to spend to rectify inferior concrete building in Melbourne? There is technology where see-through solar panels could be used in houses and all-day the house would catch the sun energy for electricity. Why aren’t we using these instead of antiquated ideas that do very little? The trouble today is that everything is politically motivated or short-sighted International sell-offs that cost us more in the long run end. What happened to this project https://reneweconomy.com.au/wa-designed-clear-glass-solar-windows-gear-production-52522/ The company in Western Australia says the windows can currently generate a minimum of 30W per square metre, while also providing insulation from heat and cold, and UV control. With further R&D, they expect generation to reach 50W per square metre. Will it yet again be an Australian product going to overseas corporations? India got together and people planted 66 Million trees in 12 hours as part of an action plan for climate change. Whilst Adani has a worldwide record of destruction that affects our water in rivers and underground leeching into our drinking water.

  23. Anonymous says:

    Greenhouse gas emissions by China hit 12.3 billion tonnes in 2014, up 53.5% in just a decade, the country’s environment ministry says.

    China’s carbon emissions data is notoriously opaque, but as a signatory to the United Nations Framework Convention on Climate Change, Beijing is obliged to submit an official inventory to the UN on a regular basis.
    China in just a decade ADDED 12 times Australia’s total emissions.

    China’s emissions (or at least what it admits to): 12.3 billion tonnes

    Australia’s emissions: 558 million tonnes

    And China isn’t finished… It’s CO2 emissions keep increasing because it has no obligations under the Paris Agreement.

    Australia’s CO2 emissions are totally irrelevant. We need more coal fired power stations to keep electricity prices down, and to help Australia’s poor. Surely all caring Australian Doctors understand that.

  24. Anonymous says:

    All the recent Climate Hysteria is about 200 years of weather records. (Since the Little Ice Age).
    CO2 levels have been much higher before and temperatures have been much lower and much higher in the history of Planet Earth.
    The evidence for Anthropogenic (Human Induced) Global Warming is lacking.
    The science is flawed.
    As doctors we have to educate and inform our patients and our communities.

  25. Kathryn Woolfield says:

    Thank-you Arnagretta Hunter for your well-written article. It is astonishing to me how many climate-change deniers have come out of the woodwork. I doubt we would see the same kind of comments on an article recommending improving vaccination rates.
    Climate change is a real issue and sadly one that will be affecting our children and our children’s children more than many who have commented here.
    I agree that Australia does seem small on a world scale. But we are also a comparably wealthy country. Historically, we have gone to war on principle and yet we take minimal action when the effects are already being felt as droughts, floods and bushfires ravage. And we cannot excuse the fact that our exports contribute to emissions elsewhere. And our consumption of products made in China also count. I do think that educating women in developing nations to curb population explosion is an important part of the response required.
    Yes the challenge is great. But we can and should act. I look forward to part 2.

  26. Nicholas Coatsworth says:

    A great article, and one that should stimulate debate, not provoke some of these disturbed comments from anonymous readers. For those who seek to comment under the guise of Anonymous, at least have the courage to put your name to your posts. Casting public opprobrium and being unwilling to be scrutinised and judged for it is the worst sort of behaviour.

  27. Anonymous says:

    Perhaps Nicholas, when the public opprobrium towards those who question an apparently settled science elevates itself above the witch hunt and risk of job loss normally accorded to Holocaust-deniers – the name Peter Ridd comes to mind – then it will be deemed safe to contribute a non-anonymous opinion.
    That such is necessary says a great deal about the climate of the debate.
    Put your head above the parapet so you can be shot?: not that smart. But by lodging even anonymous comments, it becomes clear that the fabled ‘consensus’ is a mirage.
    When is science ever settled??

  28. Anonymous says:

    Remember the “population and food shortish crisis “ of the 70s and the “Y2K” of 1990s.
    Climate change is another one but far more dangerous as it is an attempt to radically change the economic balance of the world and transfer incredible power to undeserving industry giants (think AGL locally)and politicians of the Left.eg The Green New Deal of the US Democrat Party.
    Of all the numerous variables that effect climate over eons,”climateers” pick CO2 which is at last rising to a healthy level for our environment (world deserts are
    “greening”)and has risen after,not before, a warming climate in the past.
    We are coming out of a mini ice age of the 14th C.when people lived on the frozen river Thames in winter.

  29. Anonymous says:

    I think you would find some similar responses regarding vaccination rates, if you said measles in China or India could be cured by vaccinating all Australian children!

    If the science is so solid and undisputed, why do money markets/banks etc not follow this evidence and sell all their soon to be worthless land, which will apparently be underwater or ice soon? Why do rich tycoons/politicians have waterfront homes, they don’t seem to be selling – wont these be underwater soon?

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