Climate change’s impact on health and healthcare in Northern NSW: Urgent action needed

A systematic review published in the International Journal of Environmental Research and Public Health describes the impact of climate change on health and health services in Northern New South Wales, Australia. This region is considered a “hotspot” for floods and bushfires in Australia.

Review: Impacts of Climate Change on Health and Health Services in Northern New South Wales, Australia: A Rapid Review. Image Credit: Cloudcatcher Media / Shutterstock

Background

Human activities such as the combustion of fossil fuels are primarily responsible for the production of greenhouse gases. These gases absorb solar energy and trap the heat near Earth’s surface, leading to global warming and climate change.

In Australia, about 1.4 °C induction in surface temperature and 1 °C induction in ocean water temperature have been observed since 1910, significantly increasing the risk of extreme environmental events across the country, including heat waves, bushfires, dust storms, floods, and droughts.

Northern New South Wales is considered a “hotspot” for climate disaster declarations for floods and bushfires in Australia. In New South Wales, Local Health Districts are responsible for providing healthcare services to defined geographical regions. Thus, at the regional level, Local Health Districts play an essential role in managing health adversities induced by climate change.

In this systematic review, scientists have summarized the available information on the effect of climate change on health and health services in Northern New South Wales. This information will be helpful for Local Health districts to understand and manage climate change-related health hazards at the regional level.

Study design

Scientists systematically reviewed the literature using various scientific databases to collect information on observed and predicted impacts of climate change on health and health services in Northern New South Wales.

The final screening led to the identification of 11 peer-reviewed articles published between 2012 and 2022. The majority of these studies (9 out of 11) were observational.

Of these studies, two were qualitative studies investigating individuals’ experience of climate impacts; one was a descriptive study reporting the change in mosquito abundance and human disease following environmental changes; and six were time-series, longitudinal, or cross-sectional studies investigating the association between climate exposure and health outcomes.

Only one study reported the long-term health impacts of climate change and estimated the future health risk of climate exposure.    

Important observations

The majority of selected studies primarily investigated the mental health impact of floods and droughts. Regarding health services, the primary focus was on healthcare utilization due to respiratory, cardiovascular, and mortality outcomes associated with bushfires or heat waves.

None of the studies investigated the health impact of tidal waves, sea-level rise, and environmental exposures to pollen, dust, or ozone. Similarly, no information was available on the direct health impacts of climate changes, such as heat stress-related health adversities. Indirect health impacts, such as water- or food-borne diseases, as well as climate change-related chronic diseases, were also not found in the literature.

Mental health outcomes

Mental health was the most studied climate change-related health outcome in Northern New South Wales. A large number of studies reported a significant increase in mental health conditions, including post-traumatic stress disorder, anxiety, and depression, among people affected by major flooding in 2017. The impact was more pronounced for people belonging to marginalized communities (Aboriginal and Torres Strait Islander peoples), people living on income support, and those living with disabilities.

Besides home displacement by flood, restricted social and healthcare access was identified as a major trigger for psychological distress in these studies.    

Evidence also indicated that prolonged droughts are often associated with financial deprivation and psychological distress, especially among farmers and communities living in rural and remote areas. In this context, studies reported that farmers and residents of rural and remote areas are mostly concerned about water insecurity, recurrent natural disasters, financial loss, loss of personal belongings, and inaccessibility to social and health supports, which are collectively responsible for their psychological distress.

A quantitative study involving 11 rural and urban regions of New South Wales found a positive association between the duration and intensity of droughts and the risk of suicide in rural regions. However, no such association was observed in urban regions.

Vector-borne disease

One ecological study reported that two years of extreme droughts followed by an intense rainfall event and high tides have led to a significant increase in mosquito count and subsequent human infections with Ross River virus (RRV) and Bamah Forest virus (BFV) in northeast New South Wales.  

Mortality

The impact of heat and cold waves on mortality was assessed by a time-series analysis. The findings revealed that extreme heat waves are associated with increased mortality in urban, rural, and remote regions in New South Wales.

Similarly, intense cold waves were found to be associated with increased mortality rates in rural and remote regions.

Impact on health services

Three studies reported the associations between extreme events (heat and cold waves, bushfires, and floods) and health service utilization. Specifically, extreme heat waves were found to be associated with higher rates of ambulance callouts and emergency department visits.

Similarly, an association was observed between extreme cold waves and higher rates of emergency department visits, especially in rural and remote regions.

Summer bushfire events of 2019-2020 in New South Wales were found to be associated with increased emergency department visits for respiratory and cardiovascular complications. The 2019 and 2022 flood events in Northern New South Wales were found to limit access to health and social services, especially for people living with disabilities.

To summarize, the escalation of uncontrolled climate change exacerbates health hazards, particularly among vulnerable groups, while placing strains on healthcare systems. Local Health Districts must be prepared for the repercussions of climate impacts and respond accordingly.

The review highlighted a dearth of research on climate change and its impact on health, with a specific focus on the mental well-being of individuals affected by floods and droughts, increased healthcare utilization stemming from respiratory and cardiovascular issues associated with bushfires and heatwaves, and outbreaks of arboviruses.

Research gaps identified encompass various critical areas, including climate-related health outcomes like injuries, heat-related illnesses, water- and food-borne diseases, and chronic health conditions. Additionally, gaps exist in understanding the impacts on the health system, population exposure to bushfire smoke, dust, and rising sea levels. Furthermore, the absence of predictive modeling hinders the assessment of future health risks and healthcare utilization within the region.

Local Health Districts must address these gaps by gaining a better understanding of the cumulative effects of extreme events, by collecting pertinent local data, extending support to vulnerable populations, and prioritizing research efforts in line with their capabilities. These actions will provide the necessary insights to steer future policies.

Journal reference:

• Lee GW. 2023. Impacts of Climate Change on Health and Health Services in Northern New South Wales, Australia: A Rapid Review. International Journal of Environmental Research and Public Health. https://www.mdpi.com/1660-4601/20/13/6285