Rural health issues are likely to be in the news thanks to a conference starting in Alice Springs today, hosted by the Rural Doctors Association of Australia (RDAA) and Australian College of Rural and Remote Medicine (ACRRM).
Perhaps any discussions about rural health should also be contemplating the impact of climate change – that’s the suggestion from a number of recent articles.
The Australian Journal of Rural Health has an editorial from the ANU’s Professor Tony McMichael, who writes that rural and remote communities can expect to feel the increasing brunt of human-induced climate change:
“… as global climate change progresses over coming decades, dust, smoke, flames, water and wind will impinge more damagingly on many of Australia’s rural and remote communities. Property, harvests, incomes, jobs and community vitality are at risk. More troubling, there are great risks to physical and, in particular, mental health.”
McMichael overviews four studies in the journal:
• A study of a community-development intervention in rural communities (the Rural Adversity Mental Health Program), which he says provides encouraging evidence that a combination of mental health literacy, enhanced social and service provider networking and activity, and education about coping with drought can engage whole communities in collective response to the threats posed by drought.
• A study evaluating the experiences of 150 older NSW farmers, which found that, although they faced the same drought-related pressures as their younger peers, their difficulties were compounded by the constraints of ageing, by seeming to fight a losing battle to cope with rapid social and agricultural changes (including the perceived high-handed imposition, by government, of new procedural demands on farmers), and by the draining experience of a pervasive sense of loss. As well, many were reluctant to use mental health services.
• A study investigating the experiences and feelings of young people, which found that many were worried about the social and economic impact of drought on their families, communities and futures. The study also revealed a need for a more coordinated support system within rural schools, more information about mental health and where to go for support for themselves and their friends – from people who really understand drought and rural circumstances.
• A study exploring the experiences, needs and wishes of Indigenous Australians in rural NSW, which found that the recent drought had adversely affected Aboriginal social and emotional well-being – by disrupting culture, exacerbating money pressures and causing a sense of loss, particularly in relation to the land.
(The journal and Wiley have kindly made the link to McMichael’s editorial freely available in response to a Croakey request but the other papers mentioned are subscriber only.)
Meanwhile, thanks to Medical Observer for allowing re-publication of this interview with Dr Rob Grenfell who has a first-hand understanding of the impact of natural catastrophes upon the health of individuals and communities.
Mental toll of climate change
Andrew Bracey writes:
Earlier this year, Victorian GP and public health physician Dr Rob Grenfell was asked to contribute his observations and experiences about climate change and its impact on mental health to a landmark Climate Institute report.
Sadly, he felt overqualified.
Dr Grenfell, who now spends much of his time in Melbourne working for the Heart Foundation returns to his beloved community of Natimuk – where he practised as a GP for 13 years – at least once a fortnight and is glowing in his summation of the town’s determination and character in its struggle against what he describes as “biblical” adversity.
Already reeling after years of record-breaking droughts that have devastated the Wimmera region’s farming sector, the community was not spared the tragedy of the Black Saturday bushfires in 2009.
As Natimuk willed itself back to its feet, it was dealt yet another blow earlier this year in the form of widespread flooding that destroyed homes, damaged properties and contaminated water supplies.
The lingering floodwaters made outside medical assistance to the area virtually impossible in the immediate aftermath. The subsequent rise in the mosquito population resulted in the town becoming unenviably, as Dr Grenfell puts it, “the centre of the Ross River outbreak in Victoria”.
“We’re just waiting for the horsemen of the apocalypse to come through the town,” he laughs dryly.
“Now we have the locusts and the mice – don’t worry mate – they’re all there!”
Like many locals, Dr Grenfell has both praised and criticised aspects of the efforts by various levels of government charged with preparing and responding to the litany of disasters that has befallen the region.
But perhaps of most concern to Dr Grenfell has been the response to the mental health toll the town has racked up.
“What is a certainty with climate change is more catastrophic events – that is clear,” he says. “Protracted dries [will lead to] droughts and depression, population shifts and social decline and all these things are going to cause mental illness – we know they are all linked.”
Throw into this mixture the ongoing disputes many locals continue to experience with insurance companies over payment for flood damage – the result of which is driving many into heavy debt – and the picture becomes still more grim.
“There is a woman there who is a welfare worker and she has $250,000 worth of damage. Where is she going to get that from?” he asks.
Given the experiences of his community, understandably Dr Grenfell does not have much patience for those who doubt the science behind climate change and the need to respond to what he believes is its continued fallout.
“We need to stop denying climate change at the highest political levels so that the uncertainty is removed and so we have a common enemy that we are all attacking,” he says.
On a local mental health level, Dr Grenfell was involved in doing just that.
“The suicide rate was getting to a point where we were working with the local division of general practice to work out how we institute finding people [who need help]. We were looking at mental health first-aid programs, so even the novel idea of getting hairdressers to look for warning signs and to know what to do.”
As part of the response, the division was also involved in training medical reception staff on how to recognise warning signs in patients, while increased awareness and training was also offered to GPs and practice nurses.
“We had a crisis where we came together with all the health groups to say, ‘How the hell are we going to deal with this?’ Even the [practice] of looking after your mate and trying to normalise that it is okay to feel bad about this – because it is a really bad situation!
“Farmers will try to hide it right to the point of not telling you – they are of very few words anyway and that is really the horrendous part of it.”
The Climate Change Institute’s report, A Climate of Suffering: The Real Costs of Living with Inaction on Climate Change, to which Dr Grenfell contributed these and other experiences, concludes that “the consequences of climate change are unknown territory, but the human and economic costs will almost certainly rise disastrously with every degree”.
Dr Grenfell hopes that with improved and better informed responses to climate change, including better mental health, social, industry and community planning will ensure communities like Natimuk will not eventually be listed as casualties.