COVID-19: Dress Rehearsal for Climate Change

Macquarie University/The Lighthouse
As climate change pushes the weather into more frequent extremes worldwide, we can expect some health conditions to become more common and their symptoms more severe. But is our healthcare system set up to cope? Professor Jeffrey Braithwaite says the short answer is no.

When it comes to global warming, healthcare is in an unusual position compared to other sectors: it is a significant producer of carbon emissions, but unlike other major producers, it is also on the frontline of dealing with the fallout of climate change.

Pressure cooker: As the effects of climate change worsen, hospitals will be put under even more strain

On a worldwide scale, if healthcare was a country, it would be the fifth-largest emitter of carbon, sitting between Russia and Japan. In Australia, the sector contributes more than seven per cent of our total carbon emissions.

This includes not only aspects such as the electricity needed to power hospitals, and the resources needed to produce and supply medical products, but also areas that might be less obvious, such as powering the vast amount of data storage needed to manage patient records.

The COVID-19 pandemic can be considered a dress rehearsal for the effects of global heating on our health system, except instead of two years, we can expect to experience the worst effects of climate change for at least 20 years – and that's if we decarbonise. If we don't, it will last longer.

The past 30 years have seen an increase in the frequency and severity of extreme weather events worldwide, with extreme heat and cold, bushfires, and rain- and storm-related disasters such as flooding and cyclones all on the rise.

This is already being reflected in increased hospitalisations and deaths, and without significant action, we can only expect these to rise further.

Some conditions will worsen

There are many health conditions that we can expect to become more common, more severe and have a greater impact on the community as the gaps between crises decrease.

Hospitals, particularly emergency departments, and primary providers such as GP clinics are already struggling to meet demand under current conditions. Climate change will put them under even more pressure due to an increase in total caseload, a rise in the number of extreme cases requiring high levels of care, and surges bringing many of these cases at once. Cyclones and flooding, for example, bring with them risk, and can be life-threatening.

For Australia's health system to adequately respond to the effects of climate change, we need to make urgent changes.

Heat-related conditions: Heat exhaustion, heat stroke and dehydration are common health problems during very hot weather, and they can be deadly. While anyone can be affected, vulnerable people, including young children, older people and people with complex, chronic conditions such as diabetes, heart disease and kidney problems, are the most at risk of severe illness. As the effects of climate change accelerate, temperatures will rise and heat waves are likely to become longer and more frequent, resulting in surges of heat-affected patients needing care.

Respiratory illnesses: Large-scale bushfires, such as the Black Summer fires of 2019-20, are also expected to become more intense and more frequent, and with this will come not just smoke but dangerous particulate matter. About one third of Australians already have chronic respiratory conditions such as asthma, chronic obstructive pulmonary disease (COPD) or chronic sinusitis. These people are most at risk from air pollution, but even fit and healthy people can be affected, particularly when air quality is particularly bad, or bad for extended periods.

Another risk is thunderstorm asthma events, which occur when a storm cell draws a large amount of pollen up from the ground and then drops it into the air, even affecting people who have never had asthma before. These events are currently rare but may become more common with climate change, resulting in sudden spikes in demand for emergency treatment.

Vector-borne infectious diseases: Insects, birds and mammals can all carry diseases that they can pass on to humans. Some mosquito-borne diseases, such as Ross River virus, Murray Valley encephalitis and dengue fever, are associated with rainfall and warmer conditions, and outbreaks are commonly linked to high rainfall and flooding.

Other diseases may be associated with the movement of animal populations into new areas as the climate changes, either making their old habitat uninhabitable or opening new opportunities for expansion. Contact with diseases may also be triggered by humans moving into new areas as some places become uninhabitable.

Whatever the cause, outbreaks of new and existing diseases will put pressure on health systems that are not set up to deal with the huge influx. In severe cases, they could mutate and spawn new pandemics.

Mental health conditions: The psychological effects of individual climate-related events such as bushfires and drought can be profound, resulting in depression, anxiety and post-traumatic stress disorder (PTSD).

With raised levels of depression and anxiety remaining from the pandemic, and growing fear and worry related to wars and increasing international political instability, climate change is contributing to what could be described as a continual feeling of existential dread.

Data on current rates of untreated depression and anxiety are already frightening, but as the effects of the climate crisis worsen, so will the mental health crisis.

A looming crisis: Large-scale bushfires are expected to become more frequent and intense, endangering lives and putting significant pressure on our healthcare system

What do we need to do?

For Australia's health system to adequately respond to the effects of climate change, we need to make urgent changes. These changes take two broad forms for every sector: mitigation to reduce the effects of climate change, and adaptation to deal with what we cannot reduce.

Unfortunately, there are no simple fixes, because all the simple fixes have already been made.

Healthcare is making an effort to decarbonise, and services are becoming greener. For example, new anaesthetic gases contain fewer greenhouse gases, and there is a shift towards reusable products. Renewable energy is also taking off, with hospitals using their huge roof spaces for solar panels.

When it comes to adaptation, there are two key areas to address: infrastructure and workforce.

Natural disasters are likely to affect infrastructure, with floods or fires damaging hospital and clinic buildings. Due to its size, Australia already has a higher number of hospitals per capita than many nations, with 1050 hospitals for a population of 27 million.

Futureproofing so many buildings would be prohibitively expensive, but Australia's size works in its favour, making it less likely that all sites would be affected by climate events simultaneously. Rather than thinking of increasing bed numbers or creating field hospitals to cope with surges, we should be focusing on the power of our networked health regions to share the load in times of crisis.

As we saw during the pandemic, we also need extremely robust supply chains to ensure we have the medical supplies we need. This might look like geographically dispersed stockpiles, or the ability to quickly scale up production, or both.

Other important considerations are the possible loss of access to patient records due to power cuts or damage to communications. To overcome these problems, we need to have backups and redundancies in place, such as emergency generators, and access to paper records to ensure safe healthcare can continue to be provided.

The health workforce is already under pressure, still feeling the strains brought by the pandemic. To meet the coming challenges, we will need to not only support the existing workforce better and increase numbers to deal with increased caseloads, but also provide new types of training. We need to prepare our people to treat new or at least locally new conditions, and to make the best use of the new technology being developed in a seemingly constant stream.

We learned a lot from COVID-19, but we need to retain those learnings to prepare for future pandemics before the memory fades and we find ourselves dealing with the double disaster of a pandemic and the effects of climate change.

The current and future state of sustainable healthcare systems is explored in the new book, The Routledge Handbook of Climate Change and Health System Sustainability, edited by Professor Jeffrey Braithwaite, Professor Yvonne Zurynski and Dr Carolynn K-Lynn Smith.

Professor Jeffrey Braithwaite (pictured above) is the Founding Director of the Australian Institute of Health Innovation at Macquarie University.

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