Marie McInerney writes:
Climate health experts are concerned that the first Health Issues Paper released by the Royal Commission into last summer’s horrific bushfires does not mention climate change or climate health in the questions it poses on health arrangements for the sector.
Cardiologist and Australian National University academic Dr Arnagretta Hunter told Croakey that the omission of a direct reference to ‘climate change’ in the paper on ‘Health arrangements in natural disasters’ “makes no sense … other than politics”.
“The Royal Commission is asking questions about the health impacts of natural disasters on Australians and a tremendously important part of that is the predictions of our climate scientists that these extreme weather events will increase in frequency and intensity,” she said.
The Royal Commission into National Natural Disaster Arrangements was announced in late February by Prime Minister Scott Morrison in response to the devastating 2019-2020 bushfire, which killed 33 people, destroyed thousands of homes, shrouded cities in toxic smoke and inflicted a massive toll on wildlife and country.
It is being led by former Chief of the Australian Defence Force Air Chief Marshal Mark Binskin, former Federal Court Judge Dr Annabelle Bennett, and Professor Andrew Macintosh, an environmental law and policy expert at Australian National University (ANU).
Given the Coalition Federal Government’s continuing resistance to action on climate change, there have been worries the inquiry would take too narrow a scope on the issue.
The Commission’s first (electronic) public hearings opened last week and looked on its first day at the “changing global climate and natural disaster risks”, hearing first from Karl Braganza, Head of Climate Monitoring at the Bureau of Meteorology’s National Climate Centre.
But while the health issues paper includes the Royal Commission’s terms of references which, among others, refer to “Australia’s arrangements for improving resilience and adapting to changing climatic conditions”, it does not mention climate change or climate health in the six questions it asks, nor in the relevant contexts.
- Are the current national health coordination arrangements appropriate to respond to natural disasters in Australia? If not, how should they be improved?
- Should primary care providers and primary health networks be better integrated in natural disaster preparedness, response and recovery? If so, how should this be done?
- What approaches could be adopted to better support primary care providers to provide health services in the response and recovery phases of a natural disaster?
- Should a standard approach to reporting and categorising air quality across Australia be implemented, and if so, how?
- How should public health information about bushfire smoke be improved?
- What should be the priority areas of research concerning the physical and mental health impacts of natural disasters?
The paper says it “does not seek to cover every health issue that the Royal Commission may consider” but notes that responses will inform the Royal Commission’s consideration of Australia’s health and mental health frameworks and whether any improvements should be made to these frameworks to make Australia more resilient to natural disasters.
Hunter said: “Maybe (climate change) is implied [in the questions] but it should be explicitly recognised as an extremely important variable.”
A significant omission
Dr Chris Moy, President of the Australian Medical Association (AMA) in South Australia, who played a key role in the AMA’s declaration last year of climate change as a “health emergency”, also said it seemed a significant omission from the paper.
“It seems at odds with the current successful approach [with the coronavirus] where we have a combination of trusting health and science in responding to a pandemic that could have clearly been a disaster,” he told Croakey.
Fiona Armstrong, Executive Director of The Climate and Health Alliance, said the health impacts of climate change will continue to be overlooked in Australia until government agencies and task forces start to “connect the dots”.
“You have to studiously address those links because it’s insufficient to look at health divorced from climate change and climate change without considering its impact on health,” she said.
“Climate change is the greatest threat to global public health so it requires something more than being subsumed into some arrangements around natural disasters.”
Hunter, who is a member of the ANU-based Commission for the Human Future, said she expected many health organisations and experts still would “strongly focus” on climate change in their responses to the paper.
That’s certainly been the case so far in general submissions to the Royal Commission from the Royal Australian College of General Practitioners (RACGP), the Australian Healthcare and Hospitals Association (AHHA), the National Rural Health Alliance and the George Institute for Global Health.
As well as the need for climate action, they have raised other issues, including the need to plug major gaps in climate health research, particularly on the long-term impacts of bushfire smoke, to establish a national office for planetary health, retain innovations from pandemic responses, and recognise Aboriginal and Torres Strait Islander knowledges in caring for Country.
See some key points from a number of submissions below.
Lack of robust evidence
In its submission to the Royal Commission, the AHHA says the Australian Government must demonstrate leadership through a national response addressing climate change and health that outlines coordinated action across all levels of government, plus adopt a target of net zero carbon emissions by 2050 with a comprehensive plan as to how this objective will be achieved.
It called also for the Federal Government to recognise the influence of the environment on health in the upcoming National Preventive Health Strategy.
“Areas such as pollution reduction, nature conservation, homelessness, food security, affordable transport and education must be in scope when planning for better health and wellbeing if we are to mitigate the negative impacts of natural disasters and climate change,” its submission says.
The AHHA raises concerns around toxic bushfire smoke that hung over Australia for months, citing data presented last week to the Royal Commission by Professor Fay Johnston, a specialist in environmental health at the University of Tasmania.
Johnston’s work has found bushfire smoke responsible for 417 excess deaths, 1,124 cardiovascular hospitalisations, 2,027 respiratory hospitalisations and 1,305 emergency department asthma presentations during the 2019-2020 bushfire season.
The AHHA is calling for immediate funding for coordinated research to inform an evidence base on respiratory illness and the long-term effects of prolonged exposure to bushfire smoke.
It said that in the ten years since the National Health and Medical Research Council (NHMRC) first included climate change and health as a priority, impacts of climate change on health have attracted “extremely limited funding” and last summer’s bushfires highlighted a lack of robust evidence on the long-term health effects of bushfire smoke.
The AHHA is urging the NHMRC to follow the lead of the Canadian Institutes of Health Research (CIHR), which it said immediately responded to 2016 bushfires by providing targeted funding to investigate the impacts of bushfires on people’s health.
It also wants NHMRC funding rules to be modified to allow research organisations, health networks and government agencies, and relevant organisations “beyond the traditional domains of health”, to collaborate for cost-effective, long-term, longitudinal studies on the impacts of climate change on public health.
In other issues, the AHHA says specific responses in a disaster have to come “through a bottom up approach” but that the Federal Government, while slow to respond, was able to support local recovery through grants and access to the national medical stockpile, “once activated”.
It warns that clear and consistent systems and communication on access to medical equipment is vital in times of emergency, saying “disjointed and inconsistent” distribution of personal protective equipment (PPE) in both the bushfire crisis and COVID-19 led to some shortages, and anxiety and uncertainty in health services, affecting patient outcomes.
Indigenous knowledges and participation
In other recommendations, the AHHA urged the Australian Government to learn from its “highly lauded engagement” with peak Aboriginal and Torres Strait Islander groups (the Coalition of Peaks) for the Closing the Gap refresh to bring equity to its disaster processes and responses, and from its COVID-19 responses to quickly remove workforce barriers.
The need to respect and embrace Aboriginal and Torres Strait Islander knowledges and practices for climate health is a big focus of the submission from the George Institute for Global Health, which also recommends setting up a national office that covers planetary health and includes a National Expert Committee on Air Pollution and Health Protection.
It says any examination of the health impacts of bushfires must recognise that bushfire crises can worsen existing social inequities, and value Aboriginal and Torres Strait Islander understanding of health and wellbeing that includes the physical, social, emotional, cultural and spiritual.
“Through this paradigm, it becomes clear that when Country is unwell (i.e., the negative effects of bushfires on flora, fauna and climate), then the population is also unwell, placing an increased burden on our healthcare and social systems,” it says.
The AHHA submission also calls for health services to provide cultural safety for Aboriginal and Torres Strait Islander people, and urges “swift and comprehensive action to combat the impacts of climate change”.
In its submission, the National Rural Health Alliance says rural communities are often hit hardest by climate change, because of higher exposure to extreme weather, its potential to exacerbate pre-existing health inequities, and greater impacts on factors like an increase in the pattern of vector-born disease, air pollution, and water scarcity.
The NRHA also highlights workforce issues for rural and regional areas in disasters, not just the need to make sure health professionals are brought into affected communities, but that they stay long enough to properly respond, particularly in mental health where issues may take months after the event to emerge.
It also calls for a focus on early restoration of essential services, particularly in telecommunications so people can get access to critical information and to telehealth services, and for access to social security payments and other support, given people in rural areas are often more economically disadvantaged to begin with.
Bring GPs in from the cold
The Royal Australian College of GPs (RACGP) submission to the Royal Commission raises long-held concerns that GPs are not part of formal emergency response planning and were sidelined or blocked from offering help in the summer bushfires.
It catalogues a list of problems due to lack of consistent information and particularly inconsistency of communication between jurisidictions, including:
- GPs working in or near bushfire affected areas experienced a lack of coordination and evidence of lack of planning and consultation with general practice.
- The role of primary care is not integrated into emergency responses, and in some instances, ignored, despite the fact that the majority of presentations at evacuation centres during the bushfires were GP related presentations.
- There were no formal arrangements in place to utilise GPs to their full capacity during the response phase.
- GPs were turned away from refuge/evacuation centres who were willing and able to offer help, as they were not part of the area’s response plan.
- PHNs were not adequately supported and coordinated and as such, were communicating inconsistent messages out to general practices operating in their areas, “creating confusion and division”.
Answering early to one of the questions posed in the Royal Commission’s issues paper, it says the role of primary care is not integrated into emergency responses “and was over summer in some instances ignored, despite the fact that the majority of presentations at evacuation centres during the bushfires were GP related presentations”.
On mental health, the RACGP said GPs are overwhelmed by patients experiencing issues following disasters, which often arise in consultations where mental health is not the primary presenting problem.
“They will attend for a script or a mole check-up, for example and then tell their GP of their despair, their hopelessness, and their frustration with their bank,” it said.
“GPs reported that there were no accessible, affordable courses to support rapid mental health upskilling and waiting lists for established counselling services were too long, with some patients still on waiting lists months after referral.”
The RACGP also says more research into long term effects of smoke pollution is needed as are climate mitigation strategies to tackle key underlying cause of increased bushfire risk.
More bushfire smoke equates to significant short and long term health impacts, especially for the most vulnerable members of the community and puts increasing pressure on general practices with more attendances.
“Consecutive summers of intense bushfire smoke under worsening climate change conditions, will negatively impact health outcomes,” it says.