In recent weeks, emergency medicine specialist Dr Simon Judkins has been asking colleagues about their key climate change and health concerns for his new column, Out of the Box.
Simon Judkins writes:
Professor Hubertus Jersmann is a respiratory physician who practises largely in Adelaide, but I caught up with him (sadly, online rather than in person) on one of his regular trips to Alice Springs, where he also works.
He has a particular interest in the impacts of heat, the increasing pollution in urban environments and the impacts this has on the population. He cites recent research which estimates 10.2 million global excess deaths in 2012 due to particulate matter from fossil fuels combustion.
The rising heat in urban environments impacts childhood development, respiratory function and neurological development and, notably, is also increasing inequity, as these issues are more prevalent in poorer communities.
But Jersmann is concerned there is not enough attention to these problems in Australian cities. “If you don’t measure, you don’t see..,” he says, stating that the resources just aren’t there to provide accurate data in Australian environments.
In our major cities, the combination of heat and road pollution will be impacting health, asthma and lung development in children, as well as those with chronic diseases.
In Melbourne, where I live, childcare centres are popping up along Hoddle St and this is a concern. Jersmann says it will take years to see the impacts, but we know from international studies that we are creating long-term health issues for those living in these areas.
Studies undertaken in the US are relevant in the urban areas of Australia and show the impacts of heat on physical development, but also capacity to learn. Pollution, heat and the capacity to mitigate the impacts further increases health and wealth gaps.
But these health effects are also reversible with improvements in air quality.
Advocacy matters
Dr Kimberley Humphrey, also based in Adelaide, is an emergency physician and the deputy chair of the national board for Doctors for the Environment Australia (DEA) and, most importantly, a parent of two children.
We spoke about the importance of advocacy and the fact that climate change is “our lane” as health professionals. We also spoke about what state governments are doing and the momentum they are providing – despite the Federal Government inaction.
“It’s a big election issue and the DEA will be pushing the Federal Government on having a better climate policy,” she said. To which I responded, “That isn’t a very high bar.”
Humphrey also notes the issue of “global warming versus climate change”, and points to the freeze in the US Midwest as an example of an increasingly unpredictable, chaotic environment.
In the Australian context, the impacts of heat, bushfires, drought and displaced populations are immediate concerns, as are changes in disease vectors.
“Dengue is moving down the east coast ,” she says, and Ross River is becoming more common.
Over the last year, there has been a significant increase in mosquito-borne illnesses in South Australia, and we will explore the links to climate change in later articles.
Policy lagging
Speaking from Brisbane, Professor Gerry FitzGerald, recently retired Professor of Public Health from QUT, says that there is a disconnect between climate change and the impacts on health because, for many Australians, these impacts are not visible or affecting them. Most manage through the heatwaves, most turn on a tap and get fresh water, most are able to source food they need.
So, in order to change their lifestyle, there almost needs to be a sense of altruism, doing something which is perceived as inconvenient now for future generations and populations in other far-flung places.
But, our cities are heating, pollution is rising and our health systems are increasingly stretched.
FitzGerald says: “Climate change will impact health and health systems through both direct and indirect actions. The direct effects include heat waves and the exacerbations of chronic illness, as well as heat-related mental health issues. Indirect effects include weather-related disasters, impacts on food and water supplies and changes in disease vectors.”
He sees that these issues are playing out in the Australian environment now, but the linkages are being ignored. “Science must inform and lead”, but government policy is lagging behind. Government policy must assist individuals in making change, not hinder them.
He says:
Good examples are the use of solar and investment in EVs [electric vehicles]. Good policy will support these individuals in implementing the changes they want to make in their lives.
Probably the thing that interests me most about this debate is that the community is out ahead of the leadership. Community attitudes have changed for the majority.
Encouraging greener industries (including the health sector) as a pathway to better health. I think the debate is largely over for most. It is not a question of if but when we transition.”
Mental health concerns
After interviewing clinical psychologist Reem Ramadan, working with Orygen in youth mental health, and Professor Ian Hickie from Sydney University, it is clear that the range of mental health impacts is broad and very current.
We see our younger people are experiencing eco-anxiety, depression and anger. Loss of trust in leaders, and a loss of hope and confidence is clearly impacting our youth.
“I can understand why young people here are feeling even more despair,” says Ramadan.
“Scott Morrison was very clear in saying that all this discussion about climate change is causing anxiety amongst young people”, but his response was to shut down the conversation and patronisingly tell the youth that they needn’t worry, just go back to school.
However, Ramadan says that not having these conversations will lead to more anxiety. But “if you show that you are dealing with things, this will lead to less anxiety”.
Ian Hickie spoke of how climate-related events (worsening floods, droughts, bushfires) and the displacement and destruction of communities will have acute impacts, but also long-lasting mental health issues.
The undermining of community supports, social cohesion and livelihoods leads to suffering for communities and individuals within those communities.
“We are already seeing it,” Hickie told me. “It’s a really live issue in mental health. It’s happening now, and we need to take preventative action to secure the future.”
He said “leadership from health professionals is key” – even though he has received some negative feedback when speaking out.
Trusted voice
Professor Nicholas Talley, Editor-in-Chief of The Medical Journal of Australia, lives and works in the heart of coal mining territory, the Hunter Valley region of News South Wales, an area that has also experienced bushfires and droughts.
“A lot of my neighbours are coal miners,” he says. But Talley is firm on his belief that a transition has to occur.
“We need to make sure people are retrained and new jobs, major new jobs, are made available in new technologies and industries,” he says. “You can’t take someone’s livelihood away without providing an alternative.”
A strong advocate of climate and health issues, Talley has seen an evolution in the MJA actively supporting climate issues. He is also a Past-President of the Royal Australasian College of Physicians and believes that “the colleges have a really important voice here”.
He would like to see more clinicians engaging in evidence-based discussions on climate and health.
He is most concerned about the Federal Government’s attitude and the lack of planning “despite the writing being on the wall”. He is concerned that the science supporting climate action has been politicised, and calls this a “self-centred and selfish” form of politics.
“The medical fraternity is a trusted voice and, even though many argue that we are not climate scientists, we have a significant role in leading by example,” says Talley.
“We can do more working on our health systems becoming net-zero and health professionals can drive it.”
Champion change agent
Dr Forbes McGain is an anaesthetist and intensive care physician working at Western Health, Melbourne, and a champion of change when it comes to waste reduction and greening our hospitals.
The healthcare industry contributes enormously to carbon emissions, waste and landfill and needs to do a lot more to become “green”, he says.
And, yes, it is sadly ironic that our health systems contribute so much to poor environmental health.
But McGain also has a strong passion regarding biodiversity destruction. He says: “Biodiversity loss, or mass extinction is a travesty…to think of what mankind is doing to this planet and the sheer wonder of what has been lost.”
Biodiversity loss is not attracting the attention it needs to although the impacts on health are well known. Sadly, Australia is a world leader in environment destruction, which will act synergistically with the changing environment to impact human health.
Organisational change
Tony Walker, the CEO of Ambulance Victoria (AV), says his organisation is changing to meet the challenge. Not only are they aware of the significant increased demand for their services when the heat dial is turned up, but they are also concerned about the risks for staff.
A work environment which exposes his staff to the risks of extreme heat, pollution, thunderstorm asthma events and bushfires mean he needs to be acutely aware of the health impacts.
“We have to work with our staff regarding hydration, sun-protection etc. I can’t control the external environment.”
Walker told me AV are moving to reduce their carbon footprint, with a commitment to 100 percent renewable energy by 2025. They have already signed a power purchase agreement for high use sites that provides a seven percent reduction in their overall emissions and are moving to hybrid vehicles for their administrative fleet and exploring future options for an electrified ambulance fleet.
They have appointed a Sustainability Officer and their workforce is very positive about the changes and moving to a much more environmentally sustainable position.
Maybe the progressive approach of AV will have a significant impact in communities and drive further change. The electrification of ambulances will mean a visible change with charging points at ambulance station in communities across the state and the probable need for similar infrastructure in our hospitals.
Walker sees that AV can “create infrastructure which could benefit the communities they work in and used more broadly”…a very positive approach.
Do more
Speaking with such a variety of colleagues, I am struck that one of the common themes is that doctors and other health professionals need to do more to raise awareness.
We know that the coal industries, the polluters and their financial backers have tried and trusted methods to change the narrative, to take the science and the facts and manipulate the messages to raise doubt, to discredit the messenger.
History tells us – from tobacco and alcohol industry campaigns to the power of the gun lobbies in the US, and the opioid crisis – that industry advocacy campaigns will delay action on reducing population harm, despite the best evidence.
Vested interests have manipulated the public debate about climate change for decades, and our health and that of our communities is paying the price. Our children’s health is also suffering as a result.
“Clinicians and health professionals need to do more. There is no time to waste,” Reem Ramadan told me. I agreed.
The longer we leave it, the less chance we have of preventing harm, and the escalation of the climate change feedback loops will leave us with a “disease” for which there will not be a cure.
Clinicians need to engage, promote awareness of the health consequences of inaction and provide a voice to counterbalance the deflection and diversion of those who support the status quo. If we don’t act now, all of our treatments and interventions will mean little in the years ahead.
As Dr Kimberley Humphrey told me, this is our lane…
• Croakey acknowledges and thanks Dr Simon Judkins for providing this column as a probono service to Croakey readers. Follow him on Twitter: @JudkinsSimon
This article is published as part of Croakey’s contribution to the Covering Climate Now initiative, an unprecedented global media collaboration launched last year to put the spotlight on the climate crisis, of which Croakey Health Media is a member.
It is co-founded by The Nation and the Columbia Journalism Review (CJR), in partnership with The Guardian.
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