Protecting the vulnerable from climate change

Does climate change really have an impact on health? Would we really notice if the earth’s temperature rose by 1°C? These were questions registered nurse Jennifer Wressell asked herself, not realising the links between climate change and the impacts on her practice. Involvement in a climate forum exposed her to statistics about the impact of climate on health outcomes, particularly of the vulnerable. She reports here on how healthcare practitioners can make a difference.

The problem with climate change is that it happens so slowly, it is marching like an insidious snail across the world. We rarely see the effects and we have largely adapted as the climate has started to become more extreme, but climate change is already here — we are living with it. Over the last 100 years the earth surface temperature has increased by .9°C, the water level has risen by 20 cm and the rate of temperature change is increasing rapidly.³ Since the 1950s, snow depths have declined,³ and since the 1970s Northern Australia has become wetter and Southern Australia has become drier. Heavy rainfall now accounts for an increasing proportion of our annual rainfall and extreme fire danger days are increasing.³ The number of very hot days has been increasing in Australia since the 1990s and heatwave events are becoming more common.¹⁰ But humans are good at adapting, learning to cope and developing strategies to mitigate the effects, especially when the adaption required is slow.

Vulnerable communities at risk

Unfortunately in our communities adaptive capacity is not evenly distributed. Certain populations have limited ability to adapt to climate extremes; the elderly, disabled, homeless and individuals with chronic disease are all at risk. This leads to significantly increased health challenges for these populations during heatwaves and cold spells. In one of the most comprehensive studies exploring the impact of heat on illness, Harvard School of Public Health² found that “extreme heat … put the elderly at 18% greater risk of being hospitalised for fluid and electrolyte disorders, 14% greater risk for renal failure, 10% greater risk for urinary tract infections and 6% greater risk for sepsis.” More recently, Lee and Guth⁹ identified significant relationships between temperature extremes and increased occurrence of subarachnoid haemorrhage.

The relationship between extreme temperatures and cardiac presentations is the most well established, with short-term exposure to climatic change increasing the risk of ischemic cardiac events, pulmonary heart disease, cardiac arrhythmia, heart failure, ischemic stroke and myocardial infarct.^1,8 In Australia, research conducted following the 2009 heatwaves in Melbourne demonstrated a 12% overall increase in Emergency Department presentations, of which 37% were 75 years in age or older, and a 46% increase in ambulance emergency cases.⁴

How health professionals can help

As health professionals and health system managers, we need to be aware of the increased risk that vulnerable populations face and be part of developing plans to help mitigate the challenges. As a nurse working in the community health sector, environmental solutions that can be used to achieve safer home environments are an important risk mitigation measure. In Victoria initiatives like ‘Climate Safe Rooms’ create partnerships between primary health providers, individuals with chronic diseases and scientists. The idea of this is to create one room in a house were individuals who are at risk during a heatwave or cold spell can retreat into and maintain a stable temperature, reducing the risk of adverse health outcomes.⁵ These initiatives provide the blueprint for sustainable, low-cost housing modifications that reduce associated risks of extreme weather conditions. As nurses, part of our role is to advocate for our clients — more widespread use of these types of climate adaption measures could significantly reduce the risks faced by individuals with chronic diseases, the elderly or the disabled.

Education should be provided to all health professionals, to allow for adaptive health service provision. Health services need to be able to educate the public, as well as manage appropriate public health programs and work in partnership with community organisations to create local adaption plans.⁷ As health service managers, nurses need to become more adept at recognising the effect of climate change and matching this to local population data; predictive modelling can then be used to anticipate future health needs and develop staffing models to allow for surges in demand.⁶

As nurses, we play a vital role in advocacy for our communities; recognising the impact of heatwave and cold spell weather extremes is an important part of providing proactive health care. Given that the links between climate extremes and healthcare needs is well established, education, planning and risk mitigation should be important parts of our role. The development of a cohesive strategy needs to be incorporated at all levels of healthcare provision to ensure responsive systemic planning.

*Jennifer Wressell has over 20 years of experience in the nursing profession and is passionate about climate change and its effects on our health system, both now and into the future. In 2016 she moved out of the healthcare industry and into science and exploration, managing tradies and scientists over a winter in Antarctica for the Australian Antarctic Division. She currently works as a health program consultant for mindful innovative action.

References

1. Atsumi, A., Ueda, K., Irie, F., Sairenchi, T., Limura, K., Watanabe, H., Iso, O. & Aonuma, K. (2013) Relationship between cold temperature and cardiovascular mortality, with assessment of effect modification by individual characteristics: Ibaraki prefectural health study. Circulation Journal, 77, pg 1854 – 1861.
2. Bobb, J., Obermeyer, Z., Wang, Y. & Dominici, F. (2014) Cause specific risk of hospital admission related to extreme health in older adults. Journal of the American Medical Association, 321, 24, pg 2659 – 2667.
3. Bureau of Meteorology (2016) State of the Climate 2016, Commonwealth of Australia.
4. Department of Human Services (2009) Heatwave in Victoria: An assessment of Health Impacts, Government of Victoria, Melbourne.
5. Geelong Sustainability (2018) Building resilience to extreme weather with Climate Safe Rooms, 26 September 2018, Geelong Sustainability.
6. Haines, A., Kovats, R., Campbell-Lendrum, D. & Corvalan, C. (2006) Climate change and human health: Impacts, vulnerability and public health. Public Health, 120, 7, pg 585 – 596.
7. Hansen, A. & Bi, P. (2017) Climate change adaption: no one size fits all. Lancet, 1, 9 pg 353 – 354.
8. Hori, A., Hashizume, M., Tsuda, Y., Tsukahara, T. & Nomiyama, T. (2012). Effects of weather variability and air pollutants on emergency admissions for cardiovascular and cerebrovascular disease. International Journal of Environment and Health Research, 22, 416 – 430.
9. Lee, S. & Guth, M. (2017) Associations between temperature and hospital admissions for subarachnoid haemorrhage in Korea. International Journal of Environmental Research and Public Health, 14, 449.
10. Steffen, W., Hughes, L. & Perkins, S. (2014). Heatwaves: Hotter, longer, more often, Climate Council of Australia, Ltd.

Image credit: ©stock.adobe.com/au/michaeljung