Author: Dr Rhonda Kerr - Committee Member

This article reviews the recent Australian Climate Service report on risks associated with climate change and considers the implications for planning health services and health infrastructure.

Background

On 15 September, Australia’s first National Climate Risk Assessment was released, reporting on expected changes in climate and their impacts on people, services, and infrastructure.

Read the full report HERE

From an economy and society wide perspective, health risks are at the forefront of government concern. Key risks include:

• Risks to human health, medical, and emergency services from damage and disruption to critical health facilities and supporting infrastructure (energy, water, transport), particularly in regional and remote communities.
• Risks to health and wellbeing of individuals and communities in exposed and vulnerable situations that increase inequity as a result of impacts on the wider determinants of health and reduce access to health and social support services.
• Risks to health and wellbeing from slow onset and extreme climate impacts including increasing temperatures, heat extremes, storms, floods, and bushfires.
• Risks to mental health and wellbeing including post-disaster trauma, climate anxiety, and a lost sense of belonging and connection to Country.
• Risks to delivery of health and social support services and the health workforce that are caused by increased demand, cost and disruptions.
• Risks to health and wellbeing from aeroallergens and worsening indoor and outdoor air quality.
• Risks to health and wellbeing from the emergence and increased transmission of communicable diseases.
• Risks to health and wellbeing from compromised ecosystem services that support food and water security.
• Specific risks to Aboriginal and Torres Strait Islander peoples, including food, water, energy and housing insecurity, and impacts on connection to Country.
• Risks to physical health and care infrastructure that affect the accessibility of healthcare and social support resources
• Risks to buildings and building liveability that reduce building life expectancy and increase maintenance and running costs.
• Risks to energy production and distribution infrastructure that increase outages and reduce energy supply reliability.

The report also highlights that extreme heat will significantly strain hospital access (page 21) and increase admissions (page 42). It stresses the need for health systems infrastructure including hospitals, clinics, and other facilities to be equipped with resilient technology and resources.

Managing Risks in Service Delivery

To deliver required healthcare during times of climate change and a cascading series of climate events the Report advises that the health “system’s infrastructure includes hospitals, clinics and other healthcare facilities equipped with the necessary technology and resources.’’ (page 128).  How do we manage these risks into planning for effective service delivery?

Hazardous conditions with high risks of injury and death are increasing across Australia. With high certainty, the report projects:

• Heatwaves will cause more deaths and hospital admissions nationwide, especially in northern Australia.
• Tropical cyclones in the north will increase in frequency and severity, leading to more injuries and fatalities.
• Droughts will become more frequent and prolonged in many regions.
• Bushfires in southern regions will become more common, compounding air quality issues and respiratory illness.
• Flooding (riverine and flash) will increase in prevalence.
• Mental health burdens will rise across affected populations.

Table 11 (page 132) quantifies these effects in terms of increased mortality, while page 137 identifies heightened risks of communicable diseases, including waterborne and vector-borne pathogens such as cryptosporidium and cyanobacteria.

Integrity of Planning

Health service and facility planning must incorporate the increased demand for acute care associated with climate change. Unexpected risks from outside Australia may also arise (e.g. COVID). Risks from climate change are described as ‘’cascading and compounding’’ rather than one-off events.  They represent a new and evolving normal.

Prudent planning requires:

• Provision for additional beds, ED bays, ambulances, pathology (including mortuary), procedural areas, and equipment to meet surges in demand.
• Testing hub-and-spoke acute care models for access during heatwaves, fires, and floods.
• Mental health service provision should be calibrated against projected demand under climate stress to ensure services and facilities are evidence-based and robust.
• Ensuring workforce reliability, including clinician travel arrangements.
• Expanding stores and supplies in case of disrupted supply lines.
• Strengthening ICT systems and ensuring medical record access during climate events.
• Assessing the integrity of facilities (fabric, energy, air and water supply) to ensure continuity of care.

Conclusion

The Australian National Climate Risk Assessment makes it clear that demand for hospital services will rise as climate-related events increase.  Provision must be made when planning hospitals to respond to the risks outlined, to ensure that health infrastructure is robust, adaptable, and fit for purpose.

It is widely held that improved prevention of illness, personal responsibility for health and affordable primary care can reduce the demand for hospital care. While this may one day be proven, the current demand for acute healthcare, coupled with the certainty of increasing climate-related demand, requires professional health planners to prepare expanded services that can meet the risks outlined in the National Climate Risk Assessment.  Hospitals and health facilities must be designed and resourced to withstand climate impacts and deliver care reliably under stress.