** Note this post was updated on 15 January to respond to the Government’s announcement of funding for research into the health impacts of the bushfires.**
While the current bushfires crisis in Australia may be ‘unprecedented’, it is (unfortunately) unlikely to be unique.
Below Associate Professor Lesley Russell outlines the reasons why we need comprehensive, long-term research to assess the mental and physical health impacts of the current bushfires and to help inform our response to similar threats in the future and minimise their harms to the community.
Lesley Russell writes:
For several weeks now, along with other public health experts (see, for example, Professor Rebecca Ivers writing for Croakey), I have been calling for the establishment of long-term, longitudinal research studies to track, understand and address the health effects (both physical and mental) from the bushfires.
Who has responsibility in Australia for collecting, assessing health data (long term) from this bushfire crisis? @aihw @jfredlevesque @JBraithwaite1 @cbr_heartdoc @gemcarey @rebeccaivers @SimonChapman6 @ACSQHC @acemonline @AusHealthcare @CroakeyNews https://t.co/AQhHFO2LpD
— Lesley Russell Wolpe (@LRussellWolpe) January 4, 2020
Why I’m pushing for research and longitudinal tracking of people (esp RFS) to be funded immediately! https://t.co/QdRKht5tvV
— Lesley Russell Wolpe (@LRussellWolpe) January 6, 2020
More research needed on health impacts of bushfires. Time for Australia to step up, but researchers need access to funds @nhmrc
@gemcarey @cbr_heartdoc @DrRuthAtLarge @ellyhowse https://t.co/EuKuL35fjz
— Lesley Russell Wolpe (@LRussellWolpe) January 6, 2020
Here’s why I think this is so important – and why this is a call to action. Researchers and experts in this area must make the case to the Morrison Government that this is a national priority, as important as addressing the future of our iconic wildlife.
Long term effects
The bushfires that have loomed over the Australian landscape and Australians’ lives have brought death and destruction to communities and to the environment, flora and fauna. Rebuilding – in every sense of the word – will take time and effort and significant financing. There will be long-term economic, environmental, social and health costs and impacts.
The level of exposure of individuals (especially firefighters) and communities to bushfire smoke is unprecedented and unmatched in terms of severity, duration and extent. Additionally, for those caught up in and displaced by the fires, there will likely also be mental health issues and post-traumatic stress disorder (PTSD) may be triggered.
Even for those well removed from the fires, there have been effects and worries; Sydney’s air quality this summer is already three times worse than at any time in the past five years. Is this what the Prime Minister has called “the new normal” or will there finally be meaningful political action to address the health and environmental impacts of climate change?
No comprehensive public health plan
While it is recognised that there are now, and will continue to be, health consequences from the bushfire crisis – now several months old – as yet we have no comprehensive public health plan to address these.
Moreover, there are significant research gaps in understanding the links between exposure to bushfire smoke and human health and most of what is known relates to exposure for days rather than weeks or months.
The health effects of bushfire smoke are mainly mediated by suspended fine particulate matter (PM2.5) which affects the respiratory, cardiovascular and immune systems when inhaled. There are indications that this affects physical development in utero and in young children. People with existing medical conditions or vulnerable populations, such as children, women who are pregnant and older people, are most at risk.
We know little about the medium- to long-term effects of breathing in the high amounts of fine particles from bushfire smoke, but there are indications that this affects physical development. Current evidence is that there is no safe lower threshold of exposure to this form of particulate matter.
A number of approaches
In order to recognise, understand and address long-term health issues in a timely fashion, a number of approaches is necessary.
- Longitudinal study of all recognised firefighting personnel
The population cohort should be easy to identify and register (with their permission and with privacy safeguards). Baseline information will be required about their current health status and their levels of exposure (even if this is measured simply in terms of time).
Where possible it would make sense for these people to be registered with a GP of choice who could then take responsibility for the supply of information relating to their health (mental and physical) to the data collection centre.
- Longitudinal study or studies of communities most exposed to bushfires
Doing this on a community basis would help with co-operation and follow-up. Obviously determining who should be involved and who or what will serve as “controls” will need to be resolved.
The Primary Health Networks (which already have some baseline data) might well serve as a focal point for this work. There are also a series of current longitudinal studies underway in Australia (eg 45 and Up Study; Growing Up in Australia: Longitudinal Study of Australian Children; Longitudinal Study on Women’s Health) that might be utilised.
- Awareness and guidance for clinicians across the nation
Because the bushfire smoke has been so widespread, and because some of the people trapped in fires were visitors or will move away from their former homes, there is a national aspect to this project. In particular, it will be important to monitor and provide information to pregnant women and small children.
Research from the Hazelwood coal fire that burned for 45 days in 2014 has highlighted health problems years later for babies in the womb and infants. Being pregnant in a climate emergency is a source of anxiety for many mothers.
General practitioners, practice nurses, Aboriginal Health Workers and other members of the primary care team must be provided with educational materials and training about recognising and address the health consequences of bushfires.
- Research projects and data analyses
There is an important research agenda ahead that will provide information not just to Australia but to the world. Research funds and time are precious, so agreement on the priorities is important. Some guidance can be found from work overseas.
It was heartening to get a response from the Canadian Institutes of Health Research to my tweets.
The following research projects were ultimately funded through this competition: https://t.co/nPaxQLrVyM
Please feel free to contact us if you need more information.
— CIHR (@CIHR_IRSC) January 6, 2020
The CIHR has funded a series of research projects following the 2016 fires in Alberta. These are the sorts of projects that the NHMRC, the MRFF or the Australian Research Council must support.
The figure below which outlines key research needs is taken from a recent publication, Building a Practice-Based Research Agenda for Wildfire Smoke and Health: A Report of the 2018 Washington Wildfire Smoke Risk Communication Stakeholder Synthesis Symposium. It is quite general in outline but could serve as a useful starting point for discussions about Australian research.
Some tough questions
There are some tough and essential questions to be answered before anything can happen:
Who will do this work? Should it be a (new) government agency or a consortium of academic researchers or (definitely not favoured but should be considered) a private contractor?
Who will fund this work, which will need reliable funding and resources into the future (for at least 10 years)? The major government-supported sources of health funding (the National Health and Medical Research Council and the Medical Research Future Fund) currently do not fund this sort of research – and indeed, with a 11 percent success rate in the last round of NHMRC, it could be argued that the chances of getting funding for a project looking at bushfire health effects are minimal under the current system. Could some of the generous private and community donations be steered to this purpose? For example, the Paul Ramsay Foundation has committed $30 million to “support communities affected by the bushfires” – money that would presumably not be subject to government whims and redirection down the road. Just one-tenth of that ($3 million) would make a big impact on the research agenda. The Morrison Government boasts about the MRFF and how it will “improve health care now” and the Prime Minister has said “we will meet every cost”: it’s time for them to put up. The Labor Opposition has announced that it would fund research into the long-term health consequences associated with more severe bushfire seasons.
Time is of the essence. Tomorrow is not too early to start this work. The ability to inform and link in the firefighters and people who need medical monitoring will diminish over time as they return home or move away. Doing this research work will require a communications effort to ensure understanding, trust and buy-in from the people involved, both those to be monitored and those doing the research. Who should do this? Under the present circumstances, arguably not the Prime Minister or his senior ministers!
Long term consequences must be addressed
To date, the Federal Government’s efforts have been directed primarily at providing face masks and deployment of Australian Medical Assistance Team (AUSMAT) personnel. The announcement of $76 million for mental health and community support services is welcome, but the timeframe for these additional services is not clear.
There is a necessary focus on the immediate issues. But it is critical that the long-term consequences are also addressed concomitantly; they cannot be left aside for later.
There will be substantial costs involved in undertaking this work. A report from the Australian Business Roundtable for Disaster Resilience and Safer Communities shows that although the tangible costs (damage to property and infrastructure and business and network disruptions) of natural disaster like bushfires are high, the intangible costs (death and injury, impacts on health and wellbeing and community connectedness) are almost always higher.
For example, for the 2009 Victorian Black Saturday fires, the tangible costs were $3.1 billion but the intangible costs were $3.9 billion. Of these latter costs, the largest was mental health care, estimated at $1 billion.
Costs and opportunities
But there are even greater costs involved in failing to undertake this work – along with lost opportunities to improve the ability of the public health and healthcare systems to respond to future crisis situations. For example, research undertaken into the effects of the Hazelwood fires has been limited by small sample sizes.
The conservative Morrison Government may resist efforts to study the long-term health effects of bushfires, fearful that there will eventually be compensation claims. That may well be the case, but such claims will come anyway (the firefighters could be the Australian equivalent of the 9/11 Ground Zero warriors). It can be argued that being alert to possible health effects will enable them to be addressed earlier, and even mitigated for future bushfires.
Finally, it is crucial to acknowledge that those people who are already experiencing entrenched disadvantage have been and will continue to be hardest hit by the bushfires and their consequences. Natural disasters and subsequent recovery efforts consistently exacerbate economic inequality. So it is imperative that whatever efforts are made in the research space acknowledge this and work to minimise the harms.
The Acting Chief Medical Officer of Australia has issued a statement about reducing the risk of prolonged exposure to bushfire smoke.
The Chief Medical Officer and State and Territory Chief Health Officers’ have issued guidance on the health effects of short-term exposure to bushfire smoke and how to avoid this.
Bushfire smoke: what are the health impacts and what can we do to minimise exposure? A factsheet from the Centre for Air pollution, energy and health Research (CAR) December 2019
Black C et al. Wildfire Smoke Exposure and Human Health: Significant Gaps in Research for a Growing Public Health Issue Environmental toxicology and pharmacology vol. 55 (2017): 186-195. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5628149/
Building a Practice-Based Research Agenda for Wildfire Smoke and Health: A Report of the 2018 Washington Wildfire Smoke Risk Communication Stakeholder Synthesis Symposium. file:///C:/Users/Lesley/Downloads/ijerph-16-02398%20(5).pdf
British Columbia Centre for Disease Control. Evidence review: Wildfire Smoke and Public Health Risk from British Columbia, 2014. http://www.bccdc.ca/resource-gallery/Documents/Guidelines%20and%20Forms/Guidelines%20and%20Manuals/Health-Environment/WFSG_EvidenceReview_WildfireSmoke_FINAL_v3_edstrs.pdf
Resources on Wildfire Smoke and Health from the Canadian National Collaborating Centre for Environmental Health.
There’s an interesting series of articles published on the Northern California Public Media website that explores the impact of the 2017 fires in the communities of Santa Rosa and Paradise in Northern California on youth health.
The New Zealand Science Learning Hub has begun a curation of resources and articles on air quality.
US Environmental Protection Agency. Wildland Fire Research to Protect Health and the Environment. Research areas and resources.
In the 24 hours since this piece was published, Health Minister Greg Hunt has announced $5 million in funding from the Medical Research Future Fund for the sort of research I have outlined below: $3 million for research into the physiological impacts of prolonged bushfire smoke exposure and $2 million for research into the mental health impacts of bushfires on affected communities. The funding will be distributed under what is described as “an open and competitive grant round”.
This is welcome news. As outlined in the Minister’s media release, the funding will enable the collection of information on the biological, psychological and behavioural impacts of prolonged exposure to bushfire smoke and the effectiveness of exposure reduction methods. The mental health research funding “will support long term tracking of individuals, communities, and in particular emergency service personal who have been in the fire effected areas”.
It is imperative that this precious research funding is spent as wisely as possible on research areas that are agreed priorities. A consultative and transparent review process should be established to ensure this is the case. It is important that the affected people and communities are part of the consultation process and that research findings are communicated back to them as they come to hand.
The rebuilding of lives, homes, businesses and communities will place huge drains on the Government’s financial resources, so it is somewhat churlish to point out that $5 million is insufficient to do the research that is needed over the timeframe that is necessary for meaningful results. My guesstimate is that this research will require an annual commitment of $5 million for the next 10 years.
It would be a great investment in the future of all Australians if some of the funds so generously donated to help bushfire victims could be used to supplement the Government’s commitment and drive this important research effort.
A note: I am not an epidemiologist and the health impacts of bushfires is not my areas of expertise. I write this to engender discussion and debate and to drive the most appropriate responses to this health crisis. I have previously written about the role of government and long-term monitoring for the health effects of environmental hazards in work that was done in the US in the wake of the Gulf oil spill (Preparing for the Next Public Health Crisis). This is not directly applicable to the Australian situation, but some of the broad principles apply.
Click here to see Croakey’s coverage of the 2019-2020 climate bushfire crisis.