20/04/2019

Strengthen Health Systems To Cope With Climate Change Challenges

Medical Journal of Australia - Gerard J FitzGerald | Anthony Capon | Peter Aitken

A system that integrates all aspects of health care is essential for facing future challenges

After another Australian summer of record‐breaking temperatures, bushfires, floods and widespread drought, it is clear that our health systems should be strengthened to cope with the challenges of climate change.
We must also reduce the carbon footprint of health care, and continue to advocate that Australia play its part in dealing with the fundamental causes of climate change.
In May, the 21st biennial congress of the World Association for Disaster and Emergency Medicine (WADEM) will be hosted by Brisbane.
The congress will bring together investigators and practitioners from around the world to discuss disaster health care, future risks, community vulnerabilities, and the strategies required by resilient health systems.
The threats resulting from climate change will differ according to location. The rise in temperatures will not be consistent across the planet, and may increase or reduce local rainfall, depending on other factors.
The effects of climate change will also vary regionally as individuals and societies adapt behaviourally, structurally, and physiologically. Effective adaptation will require economic competence and leadership.
Australia is geophysically stable, protecting us to some extent from catastrophic events such as earthquakes and tsunamis, but we are vulnerable to climate‐related disasters and emergencies, including heatwaves, bushfires, droughts, cyclones and floods, the frequency, intensity and duration of which are being amplified by climate change.
Rising temperatures affect the health and wellbeing of people directly, causing heat stress, hyperpyrexia and heat stroke, as well as indirectly through their impact on individuals with chronic cardiovascular, respiratory and renal diseases or mental health problems, and by changing the distributions of allergens and pathogens and their vectors.
These effects can be moderated by adaptive strategies but exacerbated by other factors, such as pollution and humidity, as well as by dehydration, exercise, and infectious diseases and other health conditions.
Climate change will affect whole communities, and migration and relocation of populations are likely, determined by the habitability of particular localities and the economic viability of certain industries.
The health consequences of disasters require nuanced assessment to ensure that our responses are targeted appropriately. Identifying immediate direct effects (injuries and deaths) is relatively straightforward, but longer term impacts and indirect health consequences are less clear.
For example, while 64 deaths in Puerto Rico could be directly attributed to Hurricane Maria in 2017, the estimated increase in all‐cause mortality over the following 3 months was 4645 deaths. Even in high income countries such as Australia, the long term consequences — particularly the long term mental health effects — of climate‐related events are difficult to predict, and the strategies required to minimise them will depend on the overall effectiveness of our health system.
Indeed, lack of access to ongoing health care is often the greatest threat to health and wellbeing after disasters and emergencies in highly developed countries. At the same time, we need to consider the risks of relying on electronic systems and ensure that structural redundancy and cybersecurity measures are in place.
So how do we prepare our health systems for climate‐related disasters and emergencies? We need to plan to safeguard both their capability and capacity to respond to these situations. Firstly, we need to take a whole‐of‐system approach, integrating all elements of population health and health care throughout the continuum of preparedness, response, and recovery.
As Burns and her colleagues argue in this issue of the MJA, it is particularly important to better incorporate primary care into such planning. While Australia has a relatively resilient health care system, it is subject to the routine pressures of a growing and ageing population.
We have never experienced an emergency event with 22 000 casualties — but every day 22 000 people attend hospital emergency departments. We need systems that can respond with standardised policies and procedures to a wide range of problems, from the routine to the unexpected, and to do so for both small and large scale events.
This also demands an integrated approach that brings together state and federally funded organisations. A system that integrates all areas of health care — community, primary, hospital, and aged care, as well as public and mental health care — is essential for facing future challenges.
Secondly, we need to improve the timeliness of surveillance.
Current disease notification systems are slow, and monitoring of the response capacity of the health system relies on individuals recognising and reporting emerging problems. Enhanced real time surveillance of ambulance, emergency department, and hospital capacities and of patterns of demand should enable more timely recognition of new problems and increase the response capability of the health system.
Thirdly, we need to determine the standards of care relevant to particular situations. In extreme events, this includes sympathetic care for people who cannot be saved.
A comprehensive whole‐of‐system approach will help Australia build a resilient health system that can adapt to the challenges of climate change.
The task will not be easy, and there will inevitably be difficult discussions for all health professionals.
 Whole‐of‐system approaches are feasible if they are built upon routine processes and they respectfully engage all elements of the health system, both institutional and community‐based.
The article by Burns and colleagues in this issue of the Journal can help start the discussion, and the WADEM congress in May will develop it further.

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Company Directors Urge 'Very Clear' Action On Climate, Energy Policies

Fairfax - Natassia Chrysanthos

Leading company directors have expressed widespread concern over energy and climate change policy, and have warned the lack of clear direction is affecting investment and affordability.
Directors across the private, public and non-profit sectors said climate change was the number one long-term and number two short-term issue for the federal government to address when responding to the Australian Institute of Company Directors' (AICD) half-yearly report on director sentiment.
AICD chief executive Angus Armour said there was a "great deal of convergence" surrounding what was a "very serious policy issue".

Australian Institute of Company Directors chief executive Angus Amour. Credit: Dominic Lorrimer
"In the context of the current election, the director community, which I think represents the views of the broader community, would be looking for competing parties to be very clear in what they intend to do," he said.
"We’ve reached a point where a second-best option that was agreed on a bipartisan basis, that would carry forward the next five or 10 years, would still be better than no policy certainty at all."
While taxation reform remains a significant short-term issue for  directors, it dropped on a relative level as concern for government action on climate change rose by 12 percentage points in the past six months.
Directors' immediate priority remains energy policy, with 50 per cent nominating it as the most important area for government action.
Renewable energy was considered the top area of importance for infrastructure investment by 51 per cent of directors, ahead of regional infrastructure, water supply, roads and telco networks such as the NBN.
Mr Amour said there was "widespread" concern across the community about climate and energy policy affecting investment and affordability.
Climate change was identified as the third biggest economic challenge facing Australian business, following global economic uncertainty and China's outlook.
"It’s not just business," Mr Amour said. "It’s non-profits, it’s small business - everyone is calling for certainty around climate change police and energy policy.
"The length of time that’s passed without certainty for energy policy has clearly made it a top of mind issue for our community."
The report also showed directors were the least confident about the outlook for business they have been since the first half of 2015.
The number of directors who predict the Australian economy to be weak over the next year has nearly doubled over the past six months, with 50 per cent having a low assessment of the health of the domestic economy.

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Forget Brexit And Focus On Climate Change, Greta Thunberg Tells EU

The Guardian - 



Greta Thunberg's emotional speech to EU leaders

Who is Greta Thunberg?
'Never too small to make a difference'
Thunberg (16) began a solo climate protest by striking from school in Sweden in August 2018. She has since been joined by tens of thousands of school and university students in Australia, Belgium, Germany, the United States, Japan and more than a dozen other countries.
'Irresponsible children'
Speaking at the United Nations climate conference in December 2018, she berated world leaders for behaving like irresponsible children. And in January 2019 she rounded on the global business elite in Davos: “Some people, some companies, some decision-makers in particular, have known exactly what priceless values they have been sacrificing to continue making unimaginable amounts of money. And I think many of you here today belong to that group of people.”
Inspiration
Veteran climate campaigners are astonished by what has been achieved in such a short time. Thunberg has described the rapid spread of school strikes for climate around the world as amazing. “It proves you are never too small to make a difference,” she said. Her protests were inspired by US students who staged walk-outs to demand better gun controls in the wake of multiple school shootings.
Family
Her mother, Malena Ernman, has given up her international career as an opera singer because of the climate effects of aviation. Her father is actor Svante Thunber. Greta has Asperger’s syndrome, which in the past has affected her health, he says. She sees her condition not as a disability but as a gift which has helped open her eyes to the climate crisis.
The teenage climate activist Greta Thunberg has chided EU leaders for holding three emergency summits on Brexit and none on the threat posed by climate change.
In a clarion call to Europe’s political leaders ahead of European parliament elections in May, the founder of the school strike movement said if politicians were serious about tackling climate change they would not spend all their time “talking about taxes or Brexit”.
In a typically blunt speech, she said politicians were failing to take enough action on climate change and the threats to the natural world.
“Our house is falling apart and our leaders need to start acting accordingly because at the moment they are not,” the 16-year old schoolgirl from Sweden told a standing room-only meeting of MEPs and EU officials in Strasbourg.
“If our house was falling apart our leaders wouldn’t go on like we do today,” she said. “If our house was falling apart, you wouldn’t hold three emergency Brexit summits and no emergency summit regarding the breakdown of the climate and the environment.”
While climate change is sometimes discussed at the EU’s regular summits, the issue has never dominated because Brexit, migration or the eurozone crisis have monopolised the attention of Europe’s top leaders.
Greta’s 10-minute speech was interrupted by frequent applause and ended with a 30-second standing ovation.
Before she began speaking, many in the room rose to their feet to applaud and take photos of her as she sat on the podium surrounded by cameras.
As the young climate activist spoke of a “sixth mass extinction”, her voice faltered. “The extinction rate is up to six times faster than what is considered normal, with up to 200 species becoming extinct every single day,” she said. “Erosion of fertile topsoil, deforestation of the rainforest, toxic air pollution, loss of insects and wildlife, acidification of our oceans – these are all disastrous trends.”
She was applauded after getting to the end of the passage and continued the speech without faltering again.
Greta had previously addressed the UN climate change summit in Poland and the World Economic Forum in Davos since her lone protest outside the Swedish parliament last August triggered a worldwide school strike movement to raise the alarm about climate change.
Neither was it the first time Greta had taken her uncompromising message to the EU institutions. In February, she told an audience including the European commission president, Jean-Claude Juncker, the EU needed to double the ambition of its climate targets.
Greta Thunberg wipes her eyes as she delivers her speech on climate change to MEPs in Strasbourg. Photograph: AFP/Getty Images
At that time, the parliament’s senior leaders, led by the European parliament president, Antonio Tajani, decided against inviting Greta to address MEPs in the parliament’s debating chamber. Centre-right and liberal groups argued against the invitation, which had been proposed by the Greens. Objections ranged from the potential vulnerability of a child exposed to the chamber to a desire to reserve the plenary address for politicians or senior officials.
The meeting took place in the more low-key setting of a special meeting of the European parliament’s environment committee.
Noting the imminent European elections and the fact that her generation could not vote, Greta urged MEPs to listen to scientists and millions of children who had taken part in school strikes. “In this election, you vote for the future living conditions of humankind,” she said.
Referring to Monday’s fire at Notre Dame in Paris in her speech, Greta called for “cathedral thinking” to tackle climate change.
“It is still not too late to act. It will take a far-reaching vision, it will take courage, it will take fierce, fierce determination to act now, to lay the foundations where we may not know all the details about how to shape the ceiling,” she said. “In other words it will take cathedral thinking. I ask you to please wake up and make changes required possible.”

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