News briefs

Loneliness can be a killer

A new study from the United States’ National Institutes of Health shows that loneliness can increase the risk of premature death in older adults by as much as 14%, Forbes reports. “The research team found that perceived social isolation—the ‘feeling of loneliness’—was strongly linked to two critical physiological responses in a group of 141 older adults: compromised immune systems and increased cellular inflammation. Both outcomes are thought to hinge on how loneliness affects the expression of genes through a phenomenon the researchers call conserved transcriptional response to adversity, or CTRA. The longer someone experiences loneliness, the greater the influence of CTRA on the expression of genes related to white blood cells (aka, leukocytes, the cells involved in protecting us against infections) and inflammation. A lessened ability to fight infections along with a slow erosion of cellular health leaves the body open to a host of external and internal problems, some of which worsen over time with few distinct symptoms.” The researchers said the results were specific to “perceived social isolation” and were unrelated to stress and depression.

Fifth retraction for former Baker IDI heart researcher

Retraction Watch reports that JAMA has issued a second retraction for former Baker IDI Heart and Diabetes Institute researcher Anna Ahimastos. In September, JAMA announced that Ahimastos had “fabricated [records] for trial participants that did not exist” in a trial for a blood pressure drug. That trial was retracted, along with a subanalysis. The second paper — Effect of perindopril on large artery stiffness and aortic root diameter in patients with Marfan syndrome: a randomized controlled trial — has been retracted at the request of Ahimastos’ coauthors because it included data from the first discredited paper. The retraction is the fifth for Ahimastos, who has admitted to fabricating data for studies published in the Journal of Hypertension and Annals of Internal Medicine. Three more are expected.

WHO partly to blame for Ebola deaths

An independent group of public health researchers, published in The Lancet, has called for big changes to the World Health Organization in the wake of the 11 000 deaths from Ebola, Wired reports. Suerie Moon from Harvard, a co-author of the report, said: “Ebola was really a wake-up call. If we don’t get together to make reforms after something as devastating as Ebola, you really have to wonder when we will.” According to Wired “in the early days of the Ebola outbreak, WHO’s response was so lackadaisical it [messed] up even the chlorine — the disinfectant doctors got was expired”. The researchers called for a new WHO centre “dedicated to emergency outbreak response, and an independent commission that will hold the agency accountable for its actions”. WHO has since convened another group of independent experts to assess its response to the Ebola outbreak.

Naegleria warning in WA

In the wake of an episode of the ABC’s Australian Story program, the Western Australian Health Department has issued an official warning about the lethal amoeba, Naegleria fowleri, and the subsequent risk of Amoebic meningitis, Outbreak News Today reports. Australian Story told of the Keough family whose son Lincoln who died of the illness after playing in infested water from a garden hose. N. fowleri can be found in any fresh water body or poorly treated water. It thrives in warm water temperatures, between 28oC and 40oC. Amoebic meningitis only occurs if water containing active amoeba goes up the nose and then to the brain. The warning recommended swimming only in saltwater or chlorinated pools.

New president for RCPA

Dr Michael Harrison has been confirmed as the new president of the Royal College of Pathologists of Australia. Dr Harrison, who has been vice-president for the past 4 years, replaces Associate Professor Peter Stewart in the role. He has been a consultant pathologist with Sullivan Nicolaides Pathology for 30 years, first in their clinical chemistry and microbiology division and then as CEO and Managing Partner for the past 12 years.

Red Dust, dingoes, trauma and Sepsis

Dr Chris Edwards of EMJourney recounts his time as a remote retrieval registrar based in Alice Springs. Follow him on twitter @EMtraveller

I’ve had the privilege to work as a Retrieval Registrar for the Alice Springs Hospital Retrieval Service in Central Australia for the last 6 months. How to describe it – words that spring to mind include:

Challenging (unlike many other retrieval jobs, you often are intimately involved in the logistics planning)
Satisfying (providing ICU level care to the most remote parts of Australia)
Scary (providing ICU level care to the most remote parts of Australia!)
Clinical character forming (Brown underpants occasionally needed)
Interesting (When a potassium > 7 and severe rheumatic heart disease no longer turns your head)
Scenic (people pay money to see Uluru from the air, I get paid)

The Central Australian Retrieval service retrieves patients mainly by fixed wing aircraft over a catchment area of 1.6 million square km. We also perform inter-hospital transfers to Adelaide and Darwin (that’s 3.5 hours, one way, either way!) Let me try to put the sheer size of our catchment area and distance from our tertiary referral centres into perspective…

Here is Australia, our tertiary referral centres and our catchment area roughly outlined…

I think you get the idea – this is a huge catchment area! With one other small hospital in Tennant Creek, the rest of our primary retrievals are to remote health clinics, staffed by RANs (Remote Area Nurses).

In our primary retrieval we don’t have sub-specialty retrieval teams so we do it all, although we do occasionally take a paediatrician with us. Common conditions, mostly from our indigenous population but occasionally a grey nomad or overly adventurous backpacker, include:

Trauma (usually penetrating or MVA)
Sepsis (and sometimes overwhelming septic shock)
Snake bites/stick bites
Renal disease – Missed dialysis with APO and/or hyperkalaemia
Threatened/established/imminent/delivered labours at term/pre-term (I mentioned the brown underpants right?)
Paediatrics – URTIs, LRTIs, infected scabies, post-streptococcal glomerulonephritis

Mostly our patient population is young, less than 50 years old – I haven’t retrieved a single NOF fracture since I got here!

Then there’s the inter-hospital retrievals; Mostly to Adelaide, we take intubated patients on inotropes, trauma patients with chest drains and vacmat with spinal precautions, recently lysed STEMIs, including failed thrombolysis with ongoing arrhythmia for rescue PCI (52 shocks is my current record); I’ve even taken two patients so far with intra-cranial bleeds and extra-ventricular drains (first time I had even seen one).

Equipment and Staff

The plane we use is the Pilatus PC-12, a single-engine turboprop made by the Swiss. It has a cruising speed of approximately 500km/hr and a maximum service ceiling of 30,000ft with cabin pressurization of <8000ft. We operate with a single pilot and flight nurse. The passenger cabin is modified to carry two stretchers and 3 seats. The plane also comes with a hydraulic stretcher loader in the rear exit – maximum load of 182kg. The PC-12 is ideal for our environment – it can land on shorter strips and can be flown with only one pilot – keeping our take-off and landing weights down.

Interior of the PC-12

On the plane, we carry the doctor’s bag, which contains central lines, arterial lines, fast trach intubating LMAs, rapid infusion catheters, EZ-IO, scalpels, bougies and other useful gear. We also have onboard a standalone intubation kit, cannulation kit, equipment for infusions, syringe drivers, pump sets, a full cold and warm drug box, an Oxylog 3000, a Zoll X-series monitor/defibrillator/pacer and of course the most important – coffee/tea bag. Additional equipment we can carry includes a maternity pack, trauma pack, neonatal pack, a vacmat, a humidicrib, paediatric ventilator, surfactant, a Sonosite M-Turbo and 2-4 units of packed RBCs.

Our Flight Nurses are the backbone of the clinical service. Trained in both critical care and midwifery they have a broad skill set and a lot of experience. They have invaluable clinical and logistical knowledge and when it comes to obstetric cases, my general approach is to ‘Remain Above The Navel’ and do what I’m told!

The Retrieval Doctors have a varied background – some are Rural and Remote Medicine trained, some are budding intensivists, but the majority are Emergency trainees. What we all need to have in common is the ability to be flexible and manage a difficult airway or an unstable patient on your own, supported by the FACEM in ED and Retrieval specialists.

Typical Day

No such thing as a typical day in this job. You might be heading to Adelaide with an ICU patient – if you do, that’s your whole day, because it’s a 3 hour one way trip. If you aren’t tasked to an inter-hospital transfer, at some point you will likely get an SMS from RFDS operations with a job. You check the email system and read the clinical information – then you call the clinic and speak to the RAN – get the latest details, suggest management or procedures and try to get a feel of how sick the patient is and what equipment you might need to bring. Then it’s a trip into the hospital if you aren’t already there, grabbing your gear and driving or taking a taxi out to the RFDS hanger.

Once there you load up the plane and head off. Most of our retrieval locations are within 1 hour’s flight from Alice Springs, with a few outliers like Elliot and Kiwirrkurra taking 2 hours. Flight time will usually include discussing the plan with your flight nurse and finding out any logistical challenges from your pilot (eg. Day strip only, weights permissible, pilot hours remaining).

Occasionally you may instead be tasked to go to a cattle station, roadhouse or the side of the road but in most cases you will be going to a clinic in a remote community. When you arrive, someone will meet you in a car to take you and your gear to the clinic. The clinics vary in size and equipment but most will have at least a small ‘Emergency’ room.

Typical remote emergency room

It’s hard to really describe accurately the first time you arrive at a remote community clinic. I remember being surprised by all the dogs (and the occasional donkey and camel) and the hurried advice from the flight nurse not to try and pet them. I remember the flies being everywhere (we carry mortein in the plane) and I remember the crowd that greeted us, largely children ages 5-12, mostly with crusty noses and curious smiles and scattered amongst them would be one or two proud elders. I even remember one time where I heard a commotion outside the clinic and popped my head outside to see several children beating a snake with a water bottle, right near where we would be loading the stretcher…

So, at the clinic, you assess your patient(s), perform therapy as necessary and package for transfer. It’s important in this job to not spend unnecessary time on the ground – because you, the plane and the crew are an important resource for a large area of Australia. Once you are ready, you load your patient into the ‘Troopy’.

The Toyota Land Cruiser 70 Troop Carrier, affectionally known as a ‘Troopy’ is the ubiquitous remote area 4wd transport all over the globe. In Central Australia they have been modified to carry one or two stretchers. Having ridden in the back of many of them now, I can definitely say that they are a bumpy ride, but they’re very reliable and spare parts are easy to get.

After arriving at the plane, you load the patient, with or without an escort and head back to Alice Springs – unless another job comes through whilst you are in the air and nearby!

Airstrip intubation due to deterioration – note the fuel barrel table

What is it like to live in Alice Springs

Alice Springs is great. Many of the junior hospital staff are on temporary placements as well – young trainees keen to explore the area. From social nights at the local pubs (Monte’s being the most popular), to bike rides, local hikes and camping trips. The mountain biking and trail running is truly world class with several professional class races held here and the rock climbing hides some real gems and capacity for endless new development.

Within 4 hours driving there are a host of great hiking and camping spots, many with large permanent water holes (some locals have canoes!)– Ormiston Gorge, Palm Valley, Kings Canyon and of course you can’t miss out on a trip to Uluru and you can take a plane there or drive.

Uluru in a rare rainstorm

Local events are varied and the peak season for events and tourists is in Winter. There’s the Finke Desert Race (which I was involved with as a medical officer at Finke), the Beanie Festival, Wide Open Spaces, the typically Territorian Henley on Todd, the Alice Springs Show, Territory Day (the one day of the year you get to buy and use fireworks) and the Camel Races.

Finke Desert Race

Sounds exciting? Well I had a blast. It was a challenging job and I think it begins shaping you as a future consultant. The friends I made and the adventures I had were all great experiences. I urge anyone who might be interested to consider a 6 month rotation up here as a Retrieval Registrar – you’ll get a lot out of it!

This blog was previously published on Life in the Fast Lane and has been republished with permission. If you work in healthcare and have a blog topic you would like to write for doctorportal, please get in touch.

Other doctorportal blogs

Hospital cuts cloud reform outlook

The states are seeking to exert increasing pressure on the Federal Government over its $57 billion cut to public hospital funding amid speculation of a radical overhaul of Commonwealth-State health arrangements.

Queensland Health Minister Cameron Dick told a meeting of the nation’s health ministers last month that the Coalition Government’s decision to rip up the National Partnership Agreement on health services and reduce the indexation of Commonwealth hospital payments to population plus inflation would cut $11.8 billion from the State’s hospital system – the equivalent of 4500 doctors, nurses and allied health professionals.

This follows claims from the Victorian Government that the Commonwealth’s decision will rip $17.7 billion from its health system over the next decade, while New South Wales has figured a $16.5 billion loss, South Australia $4.6 billion, Western Australia $4.8 billion and Tasmania $1.1 billion.

Victorian health officials told a Senate inquiry the impact of the Federal Government’s cuts would be equivalent to shutting down two major hospitals and axing 23,000 elective surgery procedures every two years.

“[It] would equate to the level of service delivery of two health services the size of Melbourne Health [which operates the Royal Melbourne Hospital],” acting Victorian Health Department Secretary Kym Peake told the inquiry.

The big cuts form a challenging backdrop for discussions of reform to Federal-State relations that include proposals for Commonwealth public hospital funding to be replaced by a “hospital benefit payment” that would follow individuals, similar to Medicare.

Government discussions of changes to the private health insurance industry have included reference to option two in the Reform of the Federation Discussion Paper, which proposes a Medicare-style payment for hospital services, regardless of whether they are provided in the public or private system.

Under the arrangement, the price of hospital procedures would be set by an independent body and the Commonwealth would pay a proportion. For patients in the public system, the states would be expected to make up the difference, while in private hospitals the gap would be covered either by insurers or the patients themselves.

States would retain responsibility and operational control of public hospitals and would be able to commission services from the private sector, while the Commonwealth would discontinue the private health insurance rebate.

But the Federal Government is likely to encounter significant resistance to such a change from the states unless it comes up with more money.

The revenue raised from the GST, which is funnelled directly to the states, has been growing far more slowly than expenditure, tightening the squeeze on state budgets and their health funding.

When it was introduced in 2000, GST applied to 55 per cent of spending, but since then its share has shrunk to 47 per cent this year, and consultancy Deloitte Access Economics estimates it will apply to just 42 per cent by 2024-25.

The squeeze on funding has shown up in disappointing public hospital performance.

The latest report from the Australian Institute of Health and Welfare shows that hospitals are struggling to make headway in the face of increasing demand for emergency care.

The proportion of urgent patients receiving treatment within the recommended time fell back in 2014-15 to just 68 per cent – well short of the target of 80 per cent.

The goal for all emergency department visits to be completed within four hours, which was meant to be achieved this year, has also been missed.

The results bear out warnings made by the AMA earlier this year that the Commonwealth’s funding cuts for hospitals would undermine the delivery of care.

Launching the AMA’s annual Public Hospital Report Card, President Professor Brian Owler said the Federal Government’s cuts had created “a huge black hole in public hospital funding”.

“It’s the perfect storm for our public hospital system,” he said. “There’s no way that states and territories can even maintain their current frontline clinical services under that sort of funding regime, let alone build any capacity we actually need to address the shortfalls now.”

Health Minister Sussan Ley rejected the warnings at the time, but the latest evidence of declining performance are likely to make it increasingly difficult for the Government to win State backing for an overhaul of funding arrangements without more money on the table.

Adrian Rollins

[Perspectives] The experiences of a black doctor in the USA: a searing journey

During my first year as an internal medicine house officer working the overnight shift in the medical emergency room (ER) of the busiest public general hospital in Houston, TX, USA, I was assigned to care for a woman with a severe asthma exacerbation. After she had been stabilised and treated, I admitted her to the observation area of the ER. For the next 3–4 h, while scurrying around the ER caring for other patients, I would periodically pass by and wake her so as not to let her respiratory drive decline, which would lead to STAT intubation.

[Comment] Offline: 13/11—The flames of war

It’s likely there will be many accusations of failure in the wake of the appalling terrorist attacks in Paris last week. Failures of intelligence. Failures to take the threat of attack seriously, especially following the murders at Charlie Hebdo and a Jewish supermarket in January. But one aspect of the events that took place on the evening of 13/11 was certainly not a failure—namely, the response of France’s emergency, and specifically medical emergency, services. French health workers deserve international tributes for their professionalism in the face of such harrowing circumstances.

Early drinks call as alcohol toll hits 500,000

Emergency doctors are calling for the nationwide adoption of early closing and pub lock-out laws amid estimates that 500,000 people a year end up in hospital because of the effects of alcohol.

Echoing AMA calls for a national strategy to tackle alcohol-related harm, the Australasian College for Emergency Medicine has urged other states and territories to follow the lead of the New South Wales government in cracking down on the availability of alcohol in late-night entertainment districts.

The College made its call after conducting a study which showed a high proportion of emergency department patients are affected by alcohol.

The study, which involved screening 9600 patients presenting at eight emergency departments in Australia and New Zealand during a one-week period in December last year, found that 8.3 per cent of all visits were related to alcohol, and the proportion jumped to one in eight presentations during peak periods.

Chair of the College’s Public Health Committee, Associate Professor Diana Egerton-Warburton, said the scale of the problem was surprising and disturbing.

“That equates to more than half a million alcohol-related patients attending EDs every year across Australia and New Zealand,” A/Professor Egerton-Warburton said. “It confirms that alcohol is having a huge impact on our emergency departments.”

Last year, a National Alcohol Summit organised by the AMA heard that the damage caused by alcohol – ranging from street violence, traffic accidents and domestic assaults through to poor health, absenteeism and premature death – cost the community up to $36 billion a year.

AMA President Professor Brian Owler told the Summit that alcohol misuse was one of the major health issues confronting the country: “Alcohol-related harm pervades society. It is a problem that deserves a nationally consistent response and strategy.”

While the Queensland Government has joined NSW in pushing for earlier closing times and lock-outs, Professor Owler said the Commonwealth needed to take the lead in developing a coherent and comprehensive strategy to tackle alcohol-related harm that went well beyond calls for individuals take more personal responsibility to address the nation’s drinking culture and increase investment prevention.

Previous studies by the College of Emergency Medicine have shown the high prevalence of alcohol among patients seeking treatment at inner-city hospital emergency departments on Friday and Saturday nights.

But A/Professor Egerton-Warburton said the most recent study was aimed at gaining a broader understanding of the role played by alcohol in ED presentations by extending the time-frame to a week, and including outer metropolitan, rural and regional hospitals in the sample.

She said the results underlined just how pervasive alcohol-related harms were, and how the effects of this ripple through the health system.

“One drunk person can disrupt an entire ED,” A/Professor Egerton-Warburton said. “They are often violent and aggressive, make staff feel unsafe and impact negatively on the care of other patients.”

She said the sheer volume of alcohol-affected patients going through emergency departments meant that they were much more disruptive than patients on the drug ice.

A/Professor Egerton-Warburton said evidence showed that early closing and lock-out laws worked, resulting in a 38 per cent reduction in serious injuries related to alcohol.

“This is a rare opportunity to take policy action that we know works.

“Other jurisdictions should follow NSW, and now Queensland, in introducing early closing times and reducing the availability of alcohol.

“Policy makers have the power to reduce the tide of human tragedy from alcohol harm.”

The AMA National Alcohol Summit Communique can be viewed at: media/ama-national-alcohol-summit-communique

Adrian Rollins

Emergency department care 2014–15: Australian hospital statistics

In 2014–15: there were almost 7.4 million presentations to public hospital emergency departments; 74% of patients received treatment within an appropriate time for their urgency (triage) category; 73% of patients spent 4 hours or less in the emergency department; 2.2 million patients were admitted to hospital from emergency department, and 47% of these were admitted within 4 hours.

Empowering clinicians to address the global challenge of trauma: an example from Myanmar

Investment in clinicians and in hospitals can trigger wholesale change in thinking about health systems

Runner-up — Medical practitioner category

No one had thought to resuscitate him; shocked, hypoxic and drowsy as he was. This Myanmar Delta fisherman had been left alone with his obstructed airway and bleeding, bilateral compound femoral fractures. Hours earlier, he’d fallen from his boat and under the blades of the outboard motor. Dragged out of the water by his comrades, he didn’t receive any first aid and the local clinic care was woefully inadequate. Even at the national trauma hospital in Yangon, the fisherman lay unattended and neglected in the emergency receiving area.

He didn’t receive essential trauma care until we arrived: a team of doctors training to be Myanmar’s first emergency specialists and me, as their tutor. He needed simple airway support, oxygen, intravenous fluids for shock, pressure and immobilisation for his fractures, antibiotics and some pain relief. Not complicated, not expensive, but perhaps too late.

Fast forward 2 years, for that was in 2013, and I’m impressed by the rapid response to another trauma patient. She’s been hit by a car and has severe facial injuries and a tense, swollen abdomen. This time I’m an observer at the Myanmar hospital, visiting my former students who are now leading the care. The team have assembled around the patient in the dedicated resuscitation space of the newly renovated emergency department. She receives simple but effective interventions that stabilise her until the surgeons, called urgently to assist, can take her to theatre.

These are stories of trauma and clinical care. In Myanmar, injuries, primarily from road traffic accidents, remain the leading cause of morbidity and the second highest cause of death. Like other low-income countries, the burden of trauma falls heavily on the young and productive. In Myanmar, and elsewhere, death and disability from trauma have long been unacknowledged by local and global health authorities whose focus is on Millennium Development Goals priorities.

Clinical care of injured patients in low-income countries is substandard or absent. Health systems are weak and underfunded. Crowded, dirty hospitals are perceived as places of death and infection; people don’t trust them to provide emergency care. For donors and funders, hospitals are unsustainable drains on limited resources. An Australian Government aid official told me recently that hospitals are “expensive luxuries” that are not on any global health agenda.

Yet, my experience in Myanmar suggests that investment in clinicians and in hospitals, as critical places of care, can trigger wholesale change in thinking about health systems and health advocacy. Further, given future Sustainable Development Goals targets that aim to reduce death from road traffic accidents, much more attention to clinical care, hospitals and clinicians will be required.

What has been behind the transformation taking place in Myanmar? The examples given above are of life-saving improvements in emergency care, but it’s more than that. In Myanmar, the program that is reducing death and disability from trauma — and any other acute and urgent condition — has expanded from training staff to hospital renovation, introducing acute care systems (such as pre-hospital care and triage), changing legislation and educating the public. Where and how were the seeds sown for this type of change?

One starting point, and perhaps a symbol of the importance of empowering clinicians, is the Primary Trauma Care (PTC) course. Introduced in Yangon in 2009 in the aftermath of Cyclone Nargis, PTC is a 2-day course that aims to train front-line staff with the skills, knowledge and attitude for preventing death and disability in the seriously injured patient. Designed specifically for underdeveloped and low-resource areas, PTC exists under the auspices of a non-for-profit Foundation based in Oxford, United Kingdom (http://www.primarytraumacare.org). It’s free, adaptable to any context and empowers local clinicians to teach the PTC principles in their own environments. First launched in Fiji in 1997, the course is now being taught in over 70 countries and is thriving in parts of Africa, the Middle East and Central America. In the Pacific region (where I’ve also taught), PTC is known as a “gospel message”; it is bringing new vision, new language and new actions to previously limited clinical environments.

After our inaugural PTC course in Myanmar, a young orthopaedic doctor went back to his rural district hospital and mobilised his colleagues and hospital administrators. He sourced funding to renovate and equip a room in the old hospital “receiving area” to provide a safe and effective environment to care for emergency trauma victims. He taught his staff the PTC principles and practised teamwork through simulated trauma scenarios. Six years later, this doctor is now a leader of emergency medicine in the country. He’s meeting government authorities to discuss the national roll-out of acute and trauma care standards, participating in workshops to introduce a coordinated pre-hospital system, making plans for road safety and injury prevention campaigns, and providing good quality clinical care in his well designed, functional emergency department. This doctor was part of our team who tried to save the life of the Myanmar Delta fisherman.

The work to establish these clinical and health system improvements in Myanmar has been substantial, and not just about a short trauma skills course. Supported mostly through a network of volunteers from Australia and Hong Kong, Myanmar doctors and nurses have been trained and empowered to provide better clinical care in superior clinical environments and become national leaders in acute health care.

These Myanmar clinicians already had the vision and drive for change. The PTC course has been a catalyst to realise their desire for improvement. It is a tool that starts with the clinical, then inspires broader thinking about environments and systems of care, and then even the health status of the population. This “clinical to public health” cascade has brought about substantial health improvements in other national contexts. For trauma, the front-line clinicians dealing with injuries agitated for seatbelts, speed limits and helmets.

Investment in clinicians and their hospitals is a priority in order to achieve the right balance between clinical medicine and public health for an effective response to the global challenge of trauma.

Clinicians have often been the “outsiders” in the global health discourse. In low-income countries, they are exhausted and overwhelmed by the service provision needs of their communities. Working their guts out day after day, they often view public health authorities with suspicion. Likewise, the authorities perceive clinicians as somehow less worthy, excluding them from funding sources and health improvement programs. This is a false and harmful division. Public health needs clinical service in order to provide an effective health system and prevent unnecessary death and disability. People need hospitals that they can trust to deliver safe and effective clinical care in order to inculcate confidence in their health system for times of increased need. As the Myanmar example shows, given support, a network and a few simple tools (like the PTC), clinicians can address the global challenge of trauma and become the strongest advocates for public health and health systems improvements.

Climate change is harmful to our health: taking action will have many benefits

“Tackling climate change could be the greatest health opportunity of the 21st century” (The Lancet, 2015)

Humanity is at a critical juncture, where decisions made today will have a dramatic impact on our future. In late November 2015, world leaders will gather in Paris for the 21st Conference of the Parties of the United Nations Framework Convention on Climate Change (COP21). The aim of the meeting is to deliver a global agreement that will reduce carbon emissions, with the aim of limiting global warming to an increase of 2°C. A failure to do so will have far-reaching consequences for human health, in Australia and globally.

While the evidence for human-induced climate change is strong, and the current and projected effects of climate change are well described,1 calls to action often do not mention its health aspects. The Lancet Commission on Climate Change and Health has attempted to redress this omission with their second report, released in June 2015.2 This report summarises the health impacts of climate change and outlines the potential health benefits that would flow from reducing carbon emissions, such as those achieved by reducing particulate air pollution by decreasing fossil fuel combustion.2 The report concludes that “tackling climate change could be the greatest health opportunity of the 21st century”.2 This opportunity comes from maximising the direct health benefits of reducing carbon emissions, as well as from lessening the risk of human harm caused by catastrophic climate change.2 The report also makes a number of specific recommendations, including conducting further research into the impacts on human health of climate change.2

Changes in our climate have the potential to affect human health in many different ways, and some effects are amplified by other projected demographic and social changes, such as ageing populations and population growth increasing the demand on agricultural production.1,2 The consequences for human health include the effects of extreme heat and other climate-related events, such as floods, bushfires and more intense cyclones. The influence of heatwaves on morbidity and mortality is well documented.1,3 For example, the prolonged heatwave in south-eastern Australia during February 2009 was directly associated with an estimated 374 excess deaths in Victoria, more than double the 173 deaths linked with the “Black Saturday” bushfires that occurred during the heatwave.1,3,4 The immediate results of other extreme weather events are self-evident, but less apparent are the public health and mental health effects that can continue for some time after the event.5

The health consequences associated with the impact of climate change on natural, societal and economic systems will become progressively more important as global temperatures rise.2 A stable climate is important for agriculture, and threats to food security will be increasingly evident as a result of increasing temperatures.1,3 Food security does not just mean producing sufficient energy and protein for survival; the consumption of sufficient amounts of fruit, vegetables and whole grains is necessary for good health. Droughts and other climate events can affect the availability and cost of such foods, putting them out of reach for many people.6 The increasing cost of food relative to income also reduces the resources that are available for shelter, education and health services.

Water security is something that Australians know not to take for granted, and increasing drying trends, particularly as the result of more severe El Niño events, will further threaten water security in many parts of Australia. Both water availability and water quality are at risk.1,3 With sufficient resources, wealthy countries can respond to such problems with desalination plants, but these are unlikely to be available across Australia, so that people in rural and remote areas will be the most affected.1,3

The increasing frequency and intensity of extreme weather events, combined with climate change-related impacts on agriculture and the need to expend public money on infrastructure in response to rises in sea levels, will have major consequences for our economy.1,3 In particular, they will reduce the resources available for health and welfare services and education. The poor are most vulnerable to these repercussions, and are also most vulnerable to the effects of rising heat and other extreme weather events.

The impact of climate change on the emergence and spread of infectious diseases is likely to be complex, with some becoming more widespread, and others less so. Some infectious diseases are more prevalent after climate-related events such as cyclones and floods; eg, the outbreak of leptospirosis in Queensland after the 2011 floods.7 The prevalence of bacterial food- and water-borne diseases is likely to increase, and the epidemiology of some vector-borne diseases will probably shift as temperatures rise and ecosystems are transformed.1,3

While Australians are not yet sufficiently motivated to make the changes to our energy generation systems and consumption that are necessary for reducing the risk of dangerous climate change, it would be foolish to think that we will not experience its effects. We are already doing so, and will increasingly do so as temperatures rise.

The writing is on the wall, and Australia must respond. We must reduce our emissions substantially, reduce our economic reliance on the export of fossil fuels, and actively promote drastic emissions reductions in international forums such as COP21. The carbon content of the atmosphere means that we can expect to see an average global temperature rise of 1.5°C by 2030–2040, regardless of any mitigation efforts we might undertake.1 This will have consequences for health, most of which can be avoided if we invest significantly in adaptation measures, including building community resilience (the capacity to adapt and respond to changing conditions), adjusting our agricultural and water systems, and ensuring that our health and social systems are sufficiently flexible and well resourced to respond to the increasing and changing needs of our communities. We must also assist low-income countries to adapt to climate change, both for ethical reasons and to limit the risks of increased migration and conflict.1

As the Lancet Commission emphasises,2 with threat comes opportunity, and we can build a healthier nation by mitigating and adapting to climate change. Reducing air pollution caused by burning fossil fuels, increasing the use of active (walking, cycling) and public transport, and reducing our consumption of meat and animal products will all contribute both to mitigating climate change and to improving health.2 In addition, crucial adaptation measures, such as strengthening our public health systems,5 transforming our economy, improving housing and community resilience, and reducing social inequalities, will make our society a healthier and better place to live for all.1

Radiotherapy in Australia: report on a pilot data collection 2013–14

In this report on the first pilot year collection of national radiotherapy data, data were received from 53 (out of 72) service locations across Australia. These services contributed information about 47,700 courses of radiotherapy delivered in 2013–14.For non-emergency treatment, 50% of patients started treatment within 13 days and 90% started within 33 days. For those who needed emergency treatment, 90% began treatment within the emergency timeframe.