The Climate Commission recently outlined the trend of major extreme weather events in different regions of Australia, including heatwaves, floods, droughts, bushfires, cyclones and storms.1 These events already impose an enormous health and financial burden onto society and are projected to occur more frequently and intensely. Unless we act now, further financial losses and increasing health burdens seem inevitable. We seek to highlight the major areas for interdisciplinary investigation, identify barriers and formulate response strategies.
Extreme weather events affect people's health and the health system directly and immediately. These effects vary with time, space and population group. The extent of vulnerability to each event depends on environmental factors (e.g. climate type, proximity to the sea, air pollution) and social-psychological factors (e.g. socio-demographic characteristics, health status, life style, attitudes and perceptions, preparedness and resilience). Early warnings about when and where the events are likely to occur and where at-risk communities are located, are needed to manage the health impacts effectively.
The extent of health impacts also depends on community preparedness. Responses range from national and international long-term mitigation strategies to adaptation measures such as green space, building insulations, flood barriers and cooling shelters at local and regional levels. However, little is known about the preparedness of the most vulnerable groups, as well as the effectiveness of adaptation measures.2 Research in this area should also focus on socio-demographic and psychological factors such as knowledge and perceptions of risk and protection, threat and susceptibility, and affordability and accessibility of the programs. These will provide policy makers with the evidence needed to develop response strategies to manage and minimise health risks. This should also engage public health professionals and practitioners who are at the forefront of health service provision.
One area in need of attention is community engagement. While health professionals and medical practitioners play a primary part, a study in Victoria found gaps in their knowledge of heat protection mechanisms that could leave the vulnerable elderly at risk.3 This is despite frequent heatwaves across Australia. Much less is known about professionals’ and non-professionals’ knowledge and attitudes concerning less frequent events, particularly in regard to vulnerable individuals and groups such as children, the elderly, the homeless, remote and rural communities, people with pre-existing conditions, Indigenous people, and people from non-English speaking backgrounds (NESB).
Another critical consideration is the capability and resilience of the health care industry, especially in the face of concurrent severe events. Hurricane Katrina affected many health care staff as they struggled with the need to protect their own family and property, as well as fulfilling work obligations. Furthermore, we know little about the surge capacity and preparedness of the Australian health facilities in general and emergency health services specifically.
Despite a considerable volume of research, fragmented information prevents a clear picture of the health effects of extreme weather events particularly in vulnerable groups and locations. For instance, we know a lot about heat-related mortality and morbidity in Australian capital cities, but very little about other areas and events, and their impact on vulnerable groups and remote communities. Much of our current assumptions about at-risk groups are based on overseas studies, where climates, societies and experiences can vastly differ. This may, at least partly, be due to a number of reasons:
- Difficulties in using administrative data (e.g. mortality and morbidity): These records do not contain all the required information, nor do they cover specific groups or locations. Furthermore, organisational restrictions can hinder access to these data;
- Community-based research: Conducting research and data collections, particularly in affected populations, could be costly, time-consuming, have ethical dilemmas, and be difficult to implement due to the rapidly evolving nature of an event;
- Interdisciplinary collaboration: Specialisation in one area can hinder effective engagement in interdisciplinary collaborations among researchers, practitioners and policy makers;
- Funding priorities: Larger cities may be seen as more important, however smaller communities, particularly those at high risk, should also receive higher attention. Even in a large city, some areas and groups are at higher risk. A more targeted, rather than a one-size-fits-all, approach is needed.
As efforts are concerted mainly at the local level,4 we propose a community profile to be produced at a local government level, which should contain the following vital information:
- level and type of risk (historically, projected)
- population characteristics and at-risk groups
- community preparedness, vulnerability and resilience
- areas of strength and weakness
- areas of priority research and improvement (immediate, short-, mid-, long-term)
To achieve this, a systematic approach, and interdisciplinary collaboration and co-ordination is required among researchers, policy makers, health professionals and practitioners, and the communities involved. Some areas of immediate improvement should include:
- Setting research priorities at local government levels.
- Identifying data and information sources.
- Creating community profiles based on existing information.
- Designing, implementing and evaluating response/adaptation measures.
- Facilitating quantitative and qualitative research on communities’ preparedness, resilience and vulnerability.
- Developing, communicating and promoting effective adaptation strategies, particularly targeting vulnerable groups.
- Prioritising funding policies to encourage collaborations in identified areas.
Some shifts are necessary in our approach to adapt to climate change. More cohesive and interdisciplinary collaboration and better communication among researchers, policy makers, health practitioners and the wider community are urgently needed to minimise and prevent the health impacts of climate change.