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As 2020 draws to an end, what have we learnt?

The interconnections between planetary health and human health were under the spotlight at the Australasian College for Emergency Medicine’s online conference today – check the Twitter stream at #ACEM20 where Dr Amy Coopes has been live-tweeting for the Croakey Conference News Service.

Dr Arnagretta Hunter, a consultant physician and cardiologist, and academic at the Australian National University, reflected upon the connections between COVID, the climate crisis and caring for the planet in her presentation, which follows below.


Arnagretta Hunter writes:

Medicine has changed in 2020. Always an occupation that engages and excites, where problem solving is rewarding, it is a career that inspires commitment and passion, often with a degree of altruism. The coronavirus pandemic has subtly shifted this for many of us, and more overtly in our Emergency Departments.

Many health workers have been thinking about their own mortality within the context of their work. From changed living environments at home and altered interactions with friends, through to checking income protection and life insurance. We may have that checked our ‘Last Will and Testament’ is up to date. This is a small, but profound shift from a rewarding rich profession to an occupation that can affect our life-expectancy.

This is an important framework to begin discussion on the learnings from COVID and how they are applied to the challenge of climate change. I wanted to start by acknowledging the challenges and shifts that have happened in my profession this year due to COVID, but also want to restate the words of the World Health Organization, that ‘climate change is the greatest global health challenge of this century’.

The warming world also offers subtle, but increasingly obvious threats to our way of life, to our work and to our survival.

How?

Last year, pre-pandemic, most of us in New South Wales, Queensland, the Northern Territory and parts of Victoria and South Australia, were given a textbook case of how climate change impacts the environment around us and consequently on our health.

Smashing records

Beginning in January 2019 with a longer and more intense heat wave that lasted weeks rather than the usual period of days, we entered a year that smashed climate records – devastating drought, almost no rain, hotter temperatures, no moisture in the soil, creeks and rivers that dried up so water was trucked into towns, native animals and plants died due to drought and heat.

And this was before the most devastating fire season Australia has ever experienced.

Months of fire extending from Queensland to Victoria, 24 million hectares burnt, billions of animals died, and more than 12 million people exposed to bushfire smoke. These are the events made much more likely, more intense and more dangerous by climate change.

It is tragic but remarkable that only 33 people died as a direct effect of bushfire, particularly in contrast to the single day event in 2009 Black Saturday in which 173 people died; however, we know the health impacts are much larger.

Colleagues from University of Tasmania have shown that about 400 people died due to bushfire smoke exposure, and many thousands of people presented to emergency departments with respiratory and cardiac complaints at least partly attributable to bushfire smoke exposure.

In the ACT region, prescriptions for asthma inhalers during the period of intense smoke were 200 percent times greater than usual for the summer period.

And the health impacts linger on. The mental health impacts are certainly still resonating through our communities. From Black Saturday research from the University of Melbourne we know those health impacts last for many years.

The cough many of us had for a month or two at the beginning of the year resolved, but it will be interested to see if there are longer term effects on lung function. And our group at ANU is hoping to understand whether bushfire smoke exposure affects pregnancy and the developing child.

A teaching framework

I wanted to start with the framework I use when teaching at medical school or the hospital: biology, society and environment. ‘Biology’ is key to medicine:  what happens on the cellular level, understanding physiology and pathology, pharmaceuticals and repair, this is core knowledge for doctors.

Over the past few decades, we have become more aware of another important layer, the ‘social determinants of health’ – economics, employment, geography, education and relationships.

As a cardiologist I am particularly aware how strong these factors are in affecting an individual’s risk of cardiovascular disease. Have these factors been important in COVID? Yes, absolutely!

Cultural determinants of health are an important part of understanding health and wellbeing. I am so grateful for the patience and kindness of our Indigenous friends and colleagues in consistently telling us of the importance of culture, history and country in health.

Finally, we are listening and learning about how important Indigenous knowledge and cultural connections are to health and wellbeing. And we see the success of this framework through the NACCHO response to chronic diseases and their extraordinary response to the COVID pandemic.

There is one last layer that has not yet received the attention it deserves: ‘Environment/Ecology’.

First Nations people have been telling us how important caring for country is in caring for human health and wellbeing. Environmental factors and their influence on health offers great opportunities for research and projects for students and doctors alike.

Variables like temperature, air and water quality, extreme weather events, access to green spaces and human interaction with natural environment, how we live in cities. These are all environmental variable that impact on our health.

Environmental matters

What do we know about environmental influence?

We know that air pollution is a much bigger source of morbidity and mortality than is generally acknowledged in our biological framework.

We know hot temperatures might account for at least two percent of Australia’s mortality and this is likely to grow as the continent warms. We know hotter summers increase mortality for our older populations and heat for outdoor workers is a serious health threat.

Loss of overnight cooling increases violence within our communities, and hot weather affects academic performance and work productivity across our population.

We know when we look for a relationship between climate variables and human health, we often find them.

The coronavirus pandemic has shown us how we might respond to serious threats to human survival. From a diversity of responses from around the world – good, bad and very ugly – we see that how we rise to a challenge has a deep influence on our individual and population health and wellbeing. It also gives us a lot of insight into how to approach the challenge of climate change.

Starting with biology and science. Using science is key to health threats. Doctors, epidemiologists, and many other scientists, understand viral infections, particularly infectious respiratory viruses such as coronaviruses. We know about viral reproduction and curves of infection and we know what interventions work to ‘flatten the curve’.

Climate change has a curve too. The relationship between average temperature and CO2 and other greenhouse gases in our atmosphere follows a curve and is explained using atmospheric and climate science that relies on the laws of chemistry, maths and physics.

Like COVID, we can see that massively decreasing greenhouse gas production is the route to mitigate climate change, or to ‘flatten the temperature curve’, a temperature curve that will affect and likely shorten many lives across the globe.

Social responses

We have also seen that society is the key to an appropriate response to the pandemic. Rolling out excellent public health advice to wash hands, stay home, socially distance and wear masks is very important.

But unless our communities are resourced, respected and supported, cracks quickly emerge in our response.

We have seen these cracks emerge and grow particularly in places where the challenges of the social determinants of health are dominant – insecurity, inequality and stress, economic precarity, educational disadvantage. Social policy, particularly financial interventions such as JobKeeper, JobSeeker and business support have been key to the COVID response.

Similarly, climate change cannot be solved with energy transition alone.

The footprint of carbon consumption is almost ubiquitous across so much human economic activity. Social support and intervention, working with communities on creative ways of reimagining work and economics will be a key part of a durable climate response. This is an exciting opportunity to improve both human health and wellbeing, as well as decreasing carbon consumption.

And health is one of the best prisms through which to view the benefits of climate action. Transitions toward active transport and nutritional changes can make genuine difference for non-communicable diseases like heart disease, diabetes and osteoarthritis.

Reducing air pollution in our cities reduces hospital admissions with heart attacks and strokes, respiratory infections and many other conditions.  Changing conditions for work and social support carry a myriad of benefits for health and wellbeing, and the social policy changes needed to really combat climate change carry deep advantages for our society.

Finally, both climate change and COVID remind us acutely of the central relationship between human and planetary health.

Novel infections such as SARS-CoV-2 have emerged from human interactions with a natural environment that should be better respected. Without human behaviour change, we remain at significant risk for subsequent infectious pandemics.

Climate change, with increasing natural disasters the likes of which were seen in 2019, reminds us all that this planet is our home, and that caring for our local environment, our continent and our world must be a central part of our human future.

Dr Arnagretta Hunter is a consultant physician and cardiologist, and member of Doctors for the Environment Australia.
Follow on Twitter at @cbr_heartdoc

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MyHospitals website
National Commission of Audit 2014
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Pregnancy and childbirth
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Croakey Conference News Service 2013 – 2019
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Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
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AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
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Population Health Congress 2015
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