Introduction by Croakey: The smoke blanketing Sydney and wider NSW is creating a public health emergency that demands a national response, according to a senior emergency physician.
Dr Simon Judkins, immediate past president of the Australasian College for Emergency Medicine, suggested today that medical teams from interstate may be needed to relieve the burden on emergency departments grappling with a surge in presentations, especially among people with chronic conditions.
“Maybe we need to get medical teams from other parts of the country to help NSW and alleviate the pressure,” he said during a #CroakeyGO at Sunshine in western Melbourne on #HeatwaveHealth. (Watch the full interview with Judkins here.)
Judkins also called for national leadership to respond to the “public health disaster” in Sydney, but said the Government’s silence was “deafening”.
His comments came as a new international report awarded Australia the lowest Climate Policy rating, stating that “the newly elected government has continued to worsen performance at both national and international levels”.
Meanwhile, emergency medicine doctors set a powerful example to the wider health sector in putting a strong focus on climate health leadership at their recent conference in nipaluna/Hobart.
Speakers profiled the growing health threats of the climate emergency, as well as issuing rousing calls for action, directed at individual clinicians, disciplines, professional organisations and the health sector more broadly, reports Amy Coopes for the Croakey Conference News Service.
Amy Coopes writes:
Doctors have been urged to get out of their comfort zones, and to use their power in engaging in advocacy for climate action, including through influencing power-holders such as the media, and in contributing to “unlikely alliances”.
The recent Australasian College for Emergency Medicine (ACEM) annual scientific meeting also heard calls for doctors to provide support to young people who are “begging for help in a climate of fear”.
Other key messages for effective action shared at the meeting included the power of acting in small groups on practical initiatives, place-based projects to engage and strengthen local communities and social cohesion, and the importance of human connection, empathy, courage and hope.
Emergency doctors had an obligation and responsibility to advocate, educate and use their positions of influence to stress the urgency of climate action, and to start in their own backyards by addressing sustainability and waste within their departments and hospitals, the conference heard.
In a timely suggestion, given the bushfire emergency now enveloping eastern Australia, emergency medicine also was urged to consider taking its work out of the hospital and into different settings, to ensure already overtaxed frontline services remained available for those who most needed them, through measures such as field hospitals in surge period.
The meeting, which was themed The Changing Climate of Emergency Medicine, concluded with a protest march through central Hobart and the College declaring a climate emergency.
A number of climate-specific plenaries, keynotes and workshops focused on the science, strategies for engagement and priorities for emergency medicine both pragmatically and politically. We’ve summarised some of the major themes and messages below.
Science and strategies
Marine ecologist Professor Gretta Pecl and pyrogeographist Professor David Bowman shared some of the data on accelerating warming of the oceans, dramatic redistributions of species and the unprecedented fire crisis currently engulfing much of Australia’s east coast.
Bowman’s talk, Bushfires in the Anthropocene, was subtitled A meditation on courage, and he urged emergency doctors – people who “have to stare almost certain death in the face” every day at work – to step that bravery out of the ED and into the streets at the local, regional and global level.
“We are now in very confronting times,” said Bowman of the fire emergency which has so far destroyed more than 700 homes, razed hundreds of thousands of hectares of national park and claimed six lives, enveloping Sydney in hazardous plumes of smoke.
“We need to be the thought leaders, we need to show the courage, because if we don’t, no one else will.”
Bowman, who is an expert in fire behaviour, said Australia had never seen a fire season like the one currently underway in northern NSW, with conditions combining to stoke infernos of such ferocity they could destroy previously defendable homes and raze rainforests and banana plantations – “literal bags of water” which had never before burned.
These events were clustering in regions prone to accelerating climate change, Bowman said.
The smoke from the east coast mega-fires was fumigating a third of the Australian population and was so intense it had reached New Zealand, Bowman said, contributing to a an estimated $400 million in smoke-related health costs for 2019.
Describing climate change as now “embedded” in Australia, Bowman said the political debate needed to extend beyond the “sterile” territory of emissions taxes, and required pragmatic and frank discussion about adaptation and organising hospitals and frontline services to respond.
Increasing urbanisation had driven a disconnect from the natural environment that had allowed a certain complacency to take root about the urgency of the climate challenge, Bowman said.
He asked what it might take to shake this, giving examples such as extinction of koalas in the wild, and threats to water and air quality in Australia’s major cities.
Pecl said an epic redistribution of Earth’s species – the largest since the last glacial maximum – was already underway, with 30,500 climate-driven shifts already recorded, a “mind-blowing” number she described as merely the tip of the iceberg.
In Tasmania, where the meeting was taking place, Pecl said the east coast was warming at about four times the global average, with 50 percent of local intertidal species moving further south.
Such shifts, which would also include pathogens and disease, had huge implications for ecosystem structure and function, livelihoods, food and global security, human health, feedback on the climate system and culture. Pecl said Indigenous peoples had described it as the “second wave of colonisation”.
She said climate change was essentially a marine issue, with small changes to the oceans translating into major planetary impacts. Half of Earth’s oxygen was produced by its oceans, and they supported some 2.2 million species, as well as 15 percent of humanity’s protein consumption. The oceans also absorbed 50 percent of Earth’s additional carbon and 90 percent of its excess heat.
“Our oceans are very much central to the future of humanity and human health,” Pecl said.
By 2044, Pecl said the Great Barrier Reef would experience annual bleaching events. Two-thirds of top corals had died off in such an event during 2016-17, and it would take a decade to recover. Sea levels had risen worldwide by 27-28cm since 1880, damaging infrastructure and leading to flooding and inundation.
Despite the very clear scale of the issue, Pecl said discussing climate change and getting people to feel a sense of connectedness to it was difficult.
She described a cognitive dissonance around climate change where it was perceived as too far in the future and too big to be believed, with impacts both too diverse and too distant to come to grips with, prompting a psychological distancing from the idea.
There was no “silver bullet” to overcome this, Pecl said, but research had shown that place-based actions and positive emotions could be effective, with initiatives working best when they engaged people on an intellectual, emotional and behavioural level.
She shared the success of a citizen science initiative called Redmap allowing people to submit unusual marine species sightings in their area.
A study of the project had shown that 80 percent of people involved believed that species were shifting and this was due to climate change, 78 percent had discussed this knowledge with another person, and 97 percent trusted the information provided by the platform.
Pecl said the initiative tapped into place-based attachment, making climate change locally relevant, salient and tangible.
In a panel discussion following their talks, Pecl and Bowman both pointed to the importance of providing actions, “that 5, 10-point plan for making the world a better place” – which, even if futile, was so important psychosocially.
“We need a sense of hope, and at the moment we have to be those strong enough to provide that hope,” Bowman said. “Everyone who is going to be persuaded now has been, we need to provide actions.”
Read a 33-page Twitter Summary of the discussions.
Helen Berry, a professor of climate change and mental health from the University of Sydney and one of the authors of Australia’s Lancet Countdown, delivered three keynotes at the ACEM event, examining the impacts of the climate emergency, its antecedents, and a path forward in the face of policy stalemate and political intransigence.
With Australia breaking 206 climate-related records in 90 days last year and disasters coming “thick and fast”, Berry said we were well on our way to surpassing the most conservative projections that, by 2030-2050 climate change would cause 250,000 excess deaths per year and greatly increase morbidity including in mental health.
Different kinds of events were associated with different psychological profiles, with acute weather emergencies linked to the development of anxiety while droughts and heatwaves were associated with mood disorders (depression and mania).
Focusing on heatwaves, Berry said they were the silent killer, claiming more lives than all other extreme weather events combined, with exponential increases in suicide, particularly for men, and a surge of violent events due to increased stress, cortisol release and loss of emotional control.
Psychiatric medications like lithium also lost their effectiveness at high temperatures, she said.
This was important given Australia received about double the global average increases in warming due to its geographic peculiarities.
“You can see why our kids are scared,” Berry said.
How an individual would be impacted by climate change was to a great degree influenced by where they lived, Berry said.
Shared root causes
Dr Marianne Cannon, an ED physician from the fire-hit NSW north coast, who has been instrumental in developing ACEM’s Sustainability Action Plan, echoed this in a later session when she shared a recent conversation with a local farmer about her interest in climate change. “Oh, you mean you’re interested in suicide,” was his reply.
Berry said climate change aggravated the root causes of mental health problems such as poverty, violence, war, migration and disasters, and in fact shared a common causal chain with all of these: “The exploitation of the world and its resources and its people without consideration of what that means; to build wealth and power for the few at the expense of the many”.
“Mental health and climate change you could say have the same root cause, and they also interact with each other to make the situation worse,” Berry told Croakey in an interview.
Attacking some of those underlying philosophical or even moral or ethical kinds of issues is one thing that I think we need to do.
We, as humanity, need to make the case, the way that children and young people are currently making the case around climate change, that plundering the planet without regard for the consequences is not ok.
There are all sorts of things that it produces that are not ok, but that act itself is not ok: it’s immoral, it’s wrong, and it shouldn’t happen.
That’s part of the message that I think we need to send out as professional bodies, that this is just wrong.
It creates bad things as well, and it is not sustainable and all of that, but it’s also just plain wrong, and doing things that are just plain wrong in and of themselves can cause mental health problems.”
The election of conservative governments had been shown to elevate the suicide rate, Berry said, something she put down to harsh policies and rhetoric espoused by such parties.
This underscored the importance of medical professionals and others speaking out loudly and publicly to say “we know and we care and this isn’t OK in our book either, and we are doing everything we can to make this different”, she said.
“The vast majority of doctors are held in the highest possible esteem by Australians, and so they should be,” Berry said. “This is a position of power and influence that can and should be leveraged, in my view.”
While climate change and mental health were both the product of causal chains and systems so complex they could seem unmanageable, Berry said engaging with this complexity through systems thinking was essential to unlocking the potential solutions therein.
She shared a number of maps showing how climate change and events like drought impacted mental health and, conversely, how this thinking could be applied to conceptualise effective action in this space.
“We have become very selfish, and in our confidence in our wealth and all it buys us we have forgotten how much we need each other,” said Berry. “Climate change can be an opportunity for us to reconnect with each other, and turn the crisis into something good… an opportunity for social capital through community-conceived and driven solutions.”
Mental health magic of collective action
In her final talk, titled The Magic of Acting Together on Climate Change, Berry said the most effective and most sustainable actions were not necessarily large-scale or official, but involved small groups of people carrying out small projects for the public good.
When competently led and managed, and fun for those involved, such initiatives were the “gold dust” of good mental health, begetting creativity, energy, vision and social cohesion.
“There’s very little that any one of us, even the most powerful among us, can do on our own,” said Berry. “But together we are infinitely powerful, as we can see from the inroads that children and young people are making on the public consciousness about climate change and what it’s doing to their future.”
Neuroscientist Dr Fiona Kerr hit on many of the same themes in a talk on complex decision-making that generated tremendous discussion and engagement.
She shared research from her PhD studies showing that people who were good at connecting with those around them were also often good at solving complex problems, because empathising – at an electrochemical level – unlocked the ability to engage long-lens, consequential thinking.
This was really important when thinking about complex issues like climate change, she said, because if people could become more empathic about it, they would also be able to think about it more strategically, and with a longer-term mindset.
Kerr showed how powerful it was for humans to work in groups, with the “resonance” of coming together unleashing a cascade of endorphins, chemicals and hormones that actually allowed their brains to become more nimble, absorb more information, and contribute more creatively.
As social animals, Kerr said humans were able to not only shape and reshape their own brains, but the brains of those around them.
See this 10-page Twitter Summary of Berry and Kerr’s opening keynotes.
See this 17-page Twitter Summary of Berry’s keynote on climate advocacy.
Watch our interview with Berry
Choosing Wisely on the path ahead
Many of the ASM discussions were focused on what attendees could or should do at a practical level to make a difference, and there was plenty of food for thought, with suggested actions both within and beyond the workplace.
Health service organisations had plenty of work to do, according to new ACEM president John Bonning, who described the system as “on fire” in a session on sustainability and Choosing Wisely.
Responsible for global emissions which would, in nation terms, make health the fifth-largest emitter on the planet, Bonning said there were huge gains to be made in areas including inhaled medications, anaesthetic gases and surgical waste.
Overdiagnosis and overtreatment were also issues that needed greater scrutiny, Bonning said, with the widely-cited figure that 30 percent of health spending was wasteful.
Outgoing president Dr Simon Judkins presented some compelling data from the Choosing Wisely rollout in Victoria, where the targeting of 28 low-value care practices translated to a monthly cost saving of $85,000, or some $1million annually.
Judkins also showed the emissions equivalent for the collection, processing and analysis of some of the most common tests ordered in the ED including an arterial blood gas (driving a car 400 metres), urea and electrolytes or a coagulation panel (both 500m) or a full blood count (600 metres).
Rather than defaulting to a diagnostic test, both Bonning and Judkins urged colleagues to consider whether it was appropriate or warranted, and both emphasised the importance of shared decision-making with patients focused on what mattered to them, rather than what was the matter with them.
Cannon, who has represented ACEM in climate discussions in Canberra and has also spoken about the issue in the mainstream media, said doctors had a role as leaders and educators of their patients, communities, political leaders and colleagues.
Part of that role was not just to inform but to stress the urgency of the climate issue, something that was often overlooked, or ridiculed.
“We have the credibility to knock on doors, start conversations and make a difference,” Cannon said.
As respected, educated and connected members of society, Cannon said doctors had an obligation to draw on their personal networks to access and attempt to influence those in power, including the media, which she described as probably the most difficult aspect of climate advocacy in Australia, particularly in the Murdoch stronghold of Queensland.
On this front, both Cannon and Berry suggested applying financial leverage by buying shares in and subscribing to rivals, particularly outlets committed to the #CoveringClimateNow campaign.
They both also pointed to the importance of holding industry to account, with Berry sharing the example of a mass citizen buyup of Adani shares to get a motion on climate change on the agenda of the company’s AGM (subsequently voted down but forever in the ASX record).
Messaging needed to be strategic, persuasive, and focused on the idea that climate change is a personal issue for everyone (her own son is a firefighter on the NSW north coast). Though it was important to win hearts and minds, Cannon said there were also times where it was necessary to be impolite.
As the generation who would write the history of this defining moment of our times, Cannon urged her colleagues to listen to and support young people, both within and outside the College. “They are begging for our help in a climate of fear,” she said. “How do we wish to be remembered in their story?”
She said alliances, particularly unlikely ones, were important, as were breaking down silos to help climate academics and researchers get their messages out.
Her final message was a simple one: Use your power, do what you can, start now.
At a College level, Dr Lai Heng Foong – chair of the Public Health and Disaster Committee – said ACEM had divested from fossil fuels and developed a heat health resource.
“We need to leave the comfort zone of our clinical work and take on the challenge of being advocates for our patients. The greatest threat to our planet is the belief that someone else will solve (these problems); the time to act is now.”
Some suggested actions were small (buy your juniors a Keep Cup, get rid of plastic cups and cutlery in your department), others required more commitment (employ a sustainability officer to audit and embed sustainability in all your procurement contracts).
There was some discussion about the NHS experience, where a carbon reduction strategy published a decade ago has resulted in an 18.5 percent emissions reduction, at the same time as clinical activity has increased by 27 percent.
This was achieved via a range of measures including switching of anaesthetic gases, improving the energy efficiency of buildings, using electric ambulances, boosting public transport to and from NHS sites, recycling of non-clinical (and some clinical) waste and powering sites using 100 percent renewable energy.
Berry said the health system needed to work smarter rather than simply doing more of the same (more taxes, more disaster response funding, more doctors, more antidepressants).
In the new climate era she said emergency medicine needed to think about taking its work out of the hospital and into different settings to ensure already overtaxed frontline services remained available for those who most needed them.
This could involve setting up field hospitals in surge periods, walk-in clinics for subacute cases, and partnering with primary care. Not only was this better for healing, she said, it also had a much lower carbon footprint than the hospital setting.
See the Choosing Wisely and sustainability discussion at this thread: https://twitter.com/coopesdetat/status/1196209872003457025
See the Public Health and Disaster Committee session at this thread: https://twitter.com/coopesdetat/status/1196277869275574272
Click here to see Croakey’s coverage of the 2019-2020 climate bushfire crisis.
The 2019 ACEM ASM was held in Hobart from November 17-21. Amy Coopes is covering it for the Croakey Conference News Service. Bookmark this link to track our coverage, and read our previous ACEM ASM coverage here and here.