Climate Change and Health

Climate Council

World Health Organization:
The global warming that has occurred since the 1970s was causing over 140,000 excess deaths annually by the year 2004.
(Fact sheet N°266, January 2010)

Climate Council:
Australia’s emergency management authority estimates that in the last 100 years heatwaves "caused more deaths than any other natural hazard (except disease) …"
(Climate Change and Health, p 10)

The Important Role of Health Professionals

Why does climate change matter to health professionals?

Climate change is a threat to our health

Communities with a deeper understanding of the health implications of climate change are better equipped to participate in decisions about addressing climate change and preparing themselves for changes that cannot now be avoided.


Health professionals have a special role as trusted communicators

An initial survey found that health professionals are among those trusted to provide truthful information about climate change.

What should health professionals do about climate change?

Communicate

[Public] health professionals and health organisations have many opportunities to help the public and decision makers better understand the implications of climate change, including the [threats] to human health and Australia’s health infrastructure.


Lead by example

Leadership by trusted health professionals … can have a significant ripple effect in the community.
[Health] professionals and services that proactively prepare for future extreme weather events will … help build more resilient communities.
(p 36)

Contents

Preface

Introduction

Climate Change Will Affect Our Bodies

Climate Change Will Affect Our Minds

Some People Are Particularly Vulnerable

Urgent Action Can Protect Our Health

Climate Council

• The Critical Decade: Climate change and health, Climate Commission Secretariat, Department of Climate Change and Energy Efficiency, Commonwealth of Australia, November 2011.
  Lesley Hughes & Tony McMichael.
  
  

  Preface

  
  In this special report [our] aim is to provide up-to-date information on the challenges to human health in a changing climate and how we can manage them. …
  
  Some animal populations are suffering from declining food supplies, and several species are already thought to have become extinct as a result of climatic stress.
  
  The human species is also [facing] significant risks [including] direct physical risks, for example from extreme weather events and heatwaves, and many other less-direct risks, for example from increases in some infectious diseases and reduced access to fresh water.
  
  Evidence about these consequences is growing, although significant gaps in our knowledge of potential health risks remain.
  This information is critical for making the right decisions about climate change action, including the type and scale of actions we take to reduce our greenhouse gas emissions and limit climate change, and how we adapt to changes we cannot avoid.
  (p 3)
  
  
  

  Introduction

  
  

  1.1 Health matters …

  
  Australia is a healthy nation …
  Our life expectancy at birth continues to rise and is among the highest in the world — almost 84 years for women and 79 years for men.
  This good health provides a foundation for our way of life, our society and our economy. …
  
  The collective investment in our health, as a percentage of gross domestic product (GDP), has increased steadily over the last decade. …
  In 2008–09 we spent over $5,000 per Australian, and governments funded almost 70% of Australia’s health expenditure. …
  
  As the climate changes, many of those health burdens and costs are likely to rise.
  
  
  
  

  Figure 1
  Federal Government spending on health compared to other sectors, as a percentage of GDP

  
  (p 5)
  
  
  

  1.2 Our health depends on our climate

  
  The sustained good health of any population depends on reliable access to basic resources, such as food, water, shelter and energy. …
  Droughts and floods can affect the availability and affordability of foods [and without] a healthy diet, humans are susceptible to a range of nutrition-related diseases like obesity, diabetes, heart attack and bowel cancer.
  Changes in temperature, rainfall and humidity can also affect the distribution and impact of food-borne infectious diseases, such as salmonella. …
  
  [Serious] environmental impacts on health [include:]
  • heatwaves leading to exhaustion and heart failure;
  • bushfire smoke inducing asthma attacks; and
  • post-traumatic stress from natural disasters such as droughts, floods and cyclones. …

  Climate change mitigation

  
  Mitigation means a reduction in the release of greenhouse gases into the atmosphere — for example, through

  • reducing our reliance on emissions-intensive sources of fuel and increasing the use of renewable electricity like wind or solar [and]
  • the removal of greenhouse gases from the atmosphere through the use of ‘sinks’ such as forests. …

  
  

  Climate change adaptation

  
  Adaptation is action taken to … reduce our vulnerability to potentially damaging impacts.
  For example, in the face of more frequent and intense bushfires, building regulations may need to change to improve fire resistance and even prevent new buildings in more fire-prone areas.
  Some adaptation occurs spontaneously, as when populations adjust physiologically over time (for example, decades) to living at higher temperatures.

  (p 6)
  
  
  

  1.3 Climate change affects our health in many ways

  
  Direct risks include:
  • more frequent and intense heat waves [—] resulting in more heart attacks, strokes, accidents, heat exhaustion and death;
  • more frequent or intense extreme weather events — particularly storms, floods and cyclones — resulting in more injuries, deaths and post-traumatic stress; and
  • more fires [—] increasing the number of cases of smoke-induced asthma attacks, burns and death.
  
  Risks of flow-on effects, although more complex and harder to predict in timing and extent, include:
  • more exposure to some air pollutants and air-borne allergens, such as pollens and moulds,
    exacerbating respiratory illnesses, such as asthma, hay fever and longer-term heart and lung diseases;
  • changed rainfall patterns — increases in rainfall in some regions and decreases in others — and hotter temperatures
    increasing the spread and activity of disease-transmitting mosquitoes and increasing the chances of food-borne infections;
  • warming and drying in some regions
    leading to a higher prevalence of mental health problems and lower morale in rural communities;
  • changed rainfall patterns and hotter temperatures
    leading to reduced supply and increased prices of some foods, resulting in reduced nutrition;
  • changes, such as rising sea levels, hotter conditions and changed rainfall patterns,
    causing displacement of people from within and outside of Australia and community-wide negative effects on social and economic wellbeing; and
  • increased pressure on health systems and emergency responses delaying effective delivery of health care.
  (p 7)
  
  
  

  Table 1: Summary of risks and most vulnerable Australians.
  Event	Examples of health effects	People most affected
  Higher temperatures	Higher incidence of allergies caused by pollen mosquito-borne diseases food- and water-borne diseases	Those with existing illnesses Those in hotter climates Children
  Heatwaves	Higher incidence of heat-related illnesses, such as exhaustion, heatstroke and acute renal failure Exacerbation of existing health conditions, such as predisposition to heart attack and kidney disease Higher incidence of mental and behavioural disorders More premature deaths	Those with existing illnesses City dwellers Low-income households Outdoor workers Older Australians Indigenous communities Tourists Obese and overweight people Children
  Bushfires	More injuries, burns and accidental death Higher incidence of respiratory illness, such as asthma attacks mental health problems, including trauma and longer-term disruptions to social systems	Rural, urban-fringe and other fire-prone communities Indigenous communities Children Older Australians
  Long-term drought Decreased rainfall	Reduced access to fresh healthy food from reduced food yield Higher incidence of illness from contamination of water supplies and reduced hygiene due to water shortage mental health problems, including suicidal behaviour, from loss of income and morale and disruptions to social systems	Rural communities and regional cities Indigenous communities Low-income households Children
  Flood Increased rainfall	More injuries, drowning and other accidental deaths Higher incidence of infectious disease, such as from contamination of food and water supplies Increased risk of respiratory illness from mould	Rural communities Children
  Extreme weather events	More injuries and death Higher incidence of mental health problems Exacerbation of existing illnesses from reduced access to health care Reduced access to fresh healthy food and clean water	Emergency workers Children Rural communities Older Australians Tourists Low-income households Coastal communities

  
  (p 8)
  
  
  
  

  Figure 2
  Climate change affects our health and wellbeing in many ways, through both direct physical impacts and flow-on social and economic changes.

  
  (p 9)
  
  
  

  Climate Change Will Affect Our Bodies

  
  If core body temperature exceeds 38°C for several hours, the body can suffer heat exhaustion and reduced mental and physical capacity.
  (p 10)
  
  
  

  2.1 Injuries, disease and death from heat extremes

  
  [Above] 39°C, more serious heat stroke and unconsciousness may occur.
  Serious heat stroke and even death occurs after a relatively short time if core body temperature goes above 42°C. …
  
  In the last five decades the number of record hot days in Australia has more than doubled. …
  
  Recent heatwaves around Australia have caused increased hospital admissions for kidney disease, acute renal failure and heart-attacks …
  … Melbourne sweltered through three consecutive days at or above 43°C in late January [2009.]
  There were 980 deaths during this period — 374 more than the estimated 606 that would have occurred on average for that time of year, or an estimated increase of 62% [mostly] among people aged 75 or older.
  
  
  
  

  Figure 3
  Temperature effects on the human body.

  
  (p 11)
  
  

  Figure 4
  The urban heat island effect.
  The average annual air temperature in cities (more than one million people) may be 1 to 3°C hotter than surrounding areas.

  
  During the Brisbane heatwave of 7–26 February 2004 … the maximum temperature ranged from 26° to 42°C.
  Overall deaths increased by 23% … compared with the same period in 2001–2003, when the temperature ranged from 22°C to 34°C. …
  
  A recent study estimated an approximate 80% probability that the unprecedented and extreme July 2010 heatwave in Moscow — which resulted in thousands of premature deaths — would not have occurred without climate warming.
  
  [In] Adelaide, studies of the 2008 and 2009 heatwaves found that patients with kidney disease were particularly susceptible to extreme heat events …
  (p 12)
  
  In Melbourne, a study across 1999 to 2004 found that hospital admissions for heart attacks increased by about 10% on days when temperatures exceeded 30°C, and by almost 40% during heatwaves in which the three-day average temperature exceeded 27°C.
  
  Children and people who are elderly, work in heat-exposed jobs or have low incomes are all at greater risk from heat extremes …
  
  The average annual air temperature of a city with a million people may be 1 to 3°C hotter than the surrounding areas [due to the urban heat island effect.]
  In the evening, the difference can be as high as 12°C.
  [Threats] to infrastructure, including curtailed rail services (for example, buckled railway lines), over-extended emergency services, and failures of gridded electricity supply [can pose indirect risks to health].
  (p 13)
  
  

  Occupational health and heat extremes

  
  Working outdoors exposed to the sun, or indoors without adequate ventilation, is particularly dangerous and can lead to serious heatstroke and even death. …
  There can also be psychological impacts, such as confusion, aggression and other behavioural changes.
  
  Workers at risk of extreme heat exposure include those who work outdoors, such as construction workers and builders, maintenance workers, those on outside mine sites, farmers and emergency and essential service providers.
  The protective clothing often required in these industries can inhibit the cooling effect of sweating and may increase the risk of heat exposure. …
  
  [Days] when sweat will be insufficient to regulate a person’s temperature and when body temperature will increase by 2.5ºC in less than 2 hours [are called “dangerous days” and] heat stroke is a real risk after only a few hours.
  [In Perth the estimated] number of dangerous days for acclimatised people doing physical labour … will increase from 1 day per year to 21 days per year by 2070.
  For unacclimatised people … the number of days will increase from 17 days per year to 67.

  (p 14)
  
  
  Projections
  
  [Unmitigated climate change could increase deaths] markedly in Queensland and the Northern Territory (with 10 times as many deaths by the end of the century …) and in Western Australia (twice as many deaths).
  
  [Nationally,] reductions in cold-related deaths are likely to be significantly outweighed by heat-related deaths by mid-century.
  
  
  
  

  Figure 6
  Projected temperature-related deaths in Australia with and without action on climate change.

  
  (p 15)
  
  
  

  2.2 Injuries, disease and death from other extreme weather events

  
  There is evidence that climate change has already led to a change in the frequency, duration and intensity of extreme weather events, such as temperature extremes, storms and floods. …
  
  The December 2010 and January 2011 flooding in Queensland and tropical cyclones Anthony and Yasi demonstrate the catastrophic effects that extreme weather events can have on life, health and infrastructure.
  More than 78% of Queensland was declared a disaster zone … 35 people were killed [and] about 2.5 million people were affected [in total]. …
  [March 2012 - up to 75% of NSW affecting by flooding]
  • … 1,396 booked elective surgeries [were canceled] as a result of both increased demand on hospitals and staff unavailability;
  • More than 200 patients in areas affected by cyclones were transferred to Brisbane hospitals, leading to a 73% increase in ‘long waits’ for elective surgery;
  • 501 clinical staff [were] deployed [to assist] 10,000 people affected …
  • Over 17,000 tetanus/diphtheria vaccines were distributed to reduce the risk of disease …
  
  The Queensland and Federal governments are providing $18.1 million … to repair damage caused to health facilities [and $37.8 million to] provide long-term mental health support …
  
  Even as flood waters recede …
  • [contact] with contaminated floodwater and soil can cause diarrhoeal and other bacterial infections;
  • stagnant waters provide a breeding ground for disease-carrying mosquitoes; and
  • mould triggers allergies, asthma and respiratory infections.
  (p 16)
  
  It is difficult to directly attribute individual extreme events … to climate change …
  However, recent changes … such as the warming of the surface of the ocean are creating conditions that are more favourable for generating … floods and intense cyclones. …
  Older people, children, low-income earners, rural communities, coastal communities and remote Indigenous communities are particularly at risk [from such extreme weather events].
  
  
  Projections
  
  [Conditions] that favour large and intense bushfires — extreme temperatures, high winds and low humidity — are likely to become more common in … south-eastern Australia. Intense rainfall events are also likely to increase … in northern Australia [making] flooding more likely. A combination of higher sea levels and storm surges is also likely to cause greater inland flooding and erosion in … parts of the Victorian and Queensland [coastline]. …
  
  In the autumn of 2000, floods in the UK damaged nearly 10,000 properties, severely disrupted services and caused insured losses of around £1.3 billion (approximately $3.6 billion) …
  Researchers found that climate change contributed to an intensification of heavy rainfall events over large [sections] of the northern hemisphere and substantially increased the risk of flood occurrence in England and Wales.
  
  
  

  2.3 Respiratory illness from air pollutants and air-borne allergens

  
  Climate change is likely to lead to increases in certain types of air pollutants, as well as air-borne allergens …
  These have serious impacts on people who suffer from respiratory illnesses [and] heart disease.
  Respiratory illnesses are … common … with around six million chronic sufferers.
  
  [Even] small increases in these exposures can result in significant impacts on health and healthcare costs.
  Long-term exposure to urban air pollution accounts for 1.5% of all deaths in Australia and short-term exposure accounts for a further 0.8%.
  (p 17)
  
  Young children are likely to be disproportionately affected by increases in air pollutants and air-borne allergens …
  The elderly may have a higher risk of early death and of disease associated with heart and breathing problems …
  People living on low incomes and Indigenous people have a higher risk of dying from asthma.
  
  
  Projections
  
  
  • Ozone
    
    Hotter temperatures will enhance ozone production in the lower (especially urban) atmosphere [where it becomes a toxic component of ground-level smog].
    Exposure to ozone can reduce lung function and increase respiratory problems, including [asthma, and may] be associated with premature death … especially in people with heart and lung disease.
  
  
  • Particulates
    
    [Greater] exposure to airborne particulates [increases morbidity and mortality] from respiratory and heart disease. …
    More frequent and intense bushfires are projected as a result of climate change and [the] corresponding increase in particulates … is likely to exacerbate the severity of asthma.
    Drought and severe dust storms have also been linked to increases in asthma severity and decreased lung function in major cities …
  
  
  • Air-borne allergens
    
    Triggers include outdoor aeroallergens such as pollens and fungal spores, and indoor aeroallergens, such as those from moulds, cockroaches, house dust mites and rodents.
    
    There is good evidence that climate change is affecting the timing of allergenic pollen production. …
    An earlier start to the pollen season will bring forward the start to the season for allergic respiratory diseases, like hay fever.
    The amount of pollen released into the atmosphere may also increase with hotter temperatures, contributing to an increase in the severity and occurrence of asthma and allergies.
  (p 19)
  
  

  Health effects on children

  
  Asthma is already the most common chronic disease in Australian children …
  A recent US report predicted that climate change could cause an average 7.3% increase … in ozone-related asthma visits to emergency departments by children in the New York City region by the 2020s.
  
  The behaviour of children may also increase their vulnerability [eg when] playing unsupervised outside, children may [fail to] recognise the signs of heat stress in themselves or their playmates.
  
  Exposure to stress and trauma … is of particular concern because the brains and emotional regulation systems of children are still developing.
  Following Cyclone Larry in March 2006, a study of school children in Northern Queensland found one in ten suffered from [symptoms of] post-traumatic stress disorder … including flashbacks, nightmares and a general state of distress.
  Studies conducted after bushfires have shown that childhood stress and trauma has longer-term adverse effects on learning ability and mental health …
  
  Children are also affected [indirectly] when parents and caregivers [experience] increased stress or illness, such as [that] seen in rural communities during and after drought.

  (p 18)
  
  
  

  2.4 Infectious disease from mosquitoes, food and water

  
  [Alterations] in temperature, rainfall and humidity, is beginning to affect the occurrence of various infectious diseases around the world — some mosquito-borne, some water-borne and some food-borne.
  
  In Australia, mosquito-borne infectious diseases such as dengue fever and Ross River virus are likely to extend their range and activity.
  Climate change may also increase the likelihood of newly-introduced infectious diseases.
  (p 19)
  
  In other [places], hotter and drier conditions may reduce the numbers and survival rates of mosquitoes, [reducing] the risks of mosquito-borne diseases, like malaria. …
  
  [Reported] changes include the extension of transmission zones for tick-borne Lyme disease in south-eastern Canada and Scotland, and for ticks that transmit viral encephalitis in Sweden.
  [Recent warming may be causing a] rising incidence of malaria at higher [altitudes] in Kenya. …
  
  [Sanitation,] hygiene and the safety of drinking water can be compromised by both lower rainfall (through concentration of bacteria) and floods (through contamination and mixing with sewage and runoff).
  
  
  

  Dengue fever

  
  Dengue fever is [a mosquito-borne] infectious tropical disease that causes fever, headache, joint pain, skin rash and, in a few cases, haemorrhage and dangerously-low blood pressure.
  There is currently no vaccine …
  
  
  
  

  Figure 7
  Projected spread of dengue fever by 2100.

  
  In 2008-09, over 1,000 cases occurred in and around Cairns.
  [Wetter] conditions favour mosquito breeding and warmer temperatures speed up the maturation of viruses within the mosquitoes.
  [Outbreaks] may become more difficult to control … more geographically widespread, and have broader public health consequences such as reducing the pool of available blood donors.
  (p 20)
  
  There is evidence that the geographic range of the disease within Queensland may have expanded in recent years.
  
  
  Projections
  
  [Unmitigated climate change may increase] the population at risk of exposure from 430,000 to between five and eight million Australians by the end of the century. …
  [By contrast, scenarios] that involve substantial reductions in greenhouse gas emissions indicate that far fewer people would be at risk—fewer than 1 million people by 2100.
  
  [Apart from hotter temperatures] the installation of large water tanks could potentially have an even greater effect on [the spread of the mosquito.]
  
  
  

  Food- and water-borne disease

  
  Increasing climate variability and temperature may [increase the risk of food and water contamination by boosting] the prevalence of bacteria, parasites and viruses.
  
  
  • Food
    
    [There are] about 5.4 million cases of gastroenteritis [annually] resulting in an estimated … 2.1 million days of lost work.
    [Of the resulting] 15,000 hospital admissions … almost one-fifth … are for follow-on illnesses (such as reactive arthritis and irritable bowel syndrome).
    About 120 people die …
    Young children and adult carers report the highest rates …
  (p 21)
  
  
  • Water
    
    [Flooding] can cause sewage or farm run-off to enter drinking-water supplies, leading to outbreaks of cryptosporidiosis and giardiasis. …
    
    Droughts may also increase concentrations of some pathogens in water that have the potential to overwhelm disinfection and purification processes in water treatment plants.
    [Blooms] of toxic blue-green algae, or cyanobacteria, in dams and waterways during droughts … can cause liver damage, stomach upsets and disorders of the nervous system in humans [in addition to being] hazardous to livestock.
  
  
  Projections
  
  A 2008 study estimated that between 205,000 and 335,000 new cases of bacterial gastroenteritis could occur each year by 2050 [resulting in between:
  $56.6 and 92.3 million in increased health and surveillance costs; and
  570,000 and 1.5 million in lost work days. …]
  
  Flooding events may become more intense and/or more frequent …
  [Water] availability is likely to decline in south-west Western Australia and in south-east Australia, although there is considerable uncertainty about the magnitude and seasonality of the change.
  (p 23)
  
  

  Food yields, affordability, nutrition and health

  
  Our sources of plant and animal foods, whether farmed or wild, are attuned to average local climatic conditions — temperature, rainfall, soil moisture, and biodiversity (including pollinating species).
  [The] severe heatwave in Western Europe in 2003 reduced grain yields in much of France by 25%, and the extreme and prolonged heatwave in south-west Russia in 2010 reduced the wheat harvest by around one-third.
  Floods in Southeast Asia and in Pakistan have destroyed large areas of rice crops over the past two years …
  
  [In] subsistence farming [communities] the growth, development … and survival of children … are threatened by food shortages [and] chronic under-nutrition increases susceptibility to some infectious diseases.
  In the Pacific region, rising sea level is already impairing the productivity of some low-lying coastal crops, including coconut palms. …
  
  While scientists foresee the possibility of some gains in Australian farm yields in the early phase of climate change … as climate change evolves … it is likely to lead to downturns in local food yields, reduced food quality and increased food prices.
  [This will] impinge most on lower-income families and on remote communities where food choices are often limited, resulting in dietary insufficiencies, nutritional imbalances and health impairments (especially in young children).

  
  

  Climate Change Will Affect Our Minds

  
  

  3.1 Stress and mental illness from drought, extreme weather events and heat extremes

  
  [One] study in New South Wales [estimated] that a decrease in annual rainfall by about 300mm would lead to increase in the suicide rate by about 8% of the long-term average suicide rate. …
  
  In metropolitan South Australia, admissions for mental, behavioural and cognitive disorders have been found to increase by around 7% during heatwaves. …
  
  Extremes of heat, through dehydration and disorientation, affect mood, judgment and behaviour — and can predispose people to accidents and injuries. …
  [Apprehension about] climate change [may be a source] of stress for some, including young people concerned about the future.
  [For others, it may signal the need for] major changes in how we produce, consume and live [and offer] positive opportunities to think anew about our priorities as a community.
  (p 25)
  
  

  Climate change effects on rural health

  
  More frequent and extreme bushfires, droughts and floods will increasingly affect physical wellbeing, mental health and incomes. …
  Climate change may increase the demand for social support and mental health services, and, at the same time, make these services harder to sustain. …
  
  The experience of drought and associated loss of income, changes to social roles and changes to the environment are associated with anxiety, stress and, tragically, suicidal thoughts and acts.
  
  Community resilience … can be built through … education about mental health and weather, building social networks and increased activity by health service providers.

  (p 26)
  
  
  

  3.2 Societal stress and longer-term change

  
  Climate affects almost every aspect of food production:
  • the plants and animals used,
  • average production and production variability,
  • product quality,
  • which areas are farmed,
  • what soil types are preferred,
  • the management systems and technologies used,
  • input costs,
  • product prices and
  • natural resource management.
  
  Irrigated agricultural production in the Murray-Darling Basin could decline by up to 92% by 2100 …
  Many crops may be less nutritious, because protein content of plant tissues may decline as they respond to higher amounts of carbon dioxide in the air. …
  
  In 2009, 17 million people around the world were displaced by natural hazards, and 42 million in 2010.
  Those located in coastal areas, including residents of the Torres Strait Islands, are particularly at risk from rising sea levels.
  (p 27)
  
  
  

  Some People are Particularly Vulnerable

  
  

  4.1 Australians most likely at risk

  
  
  

  Table 2: Australian populations likely to be especially vulnerable to the health impacts of climate change
  Populations vulnerable to the health impacts of climate change	Factors that may increase their vulnerability
  Remote Indigenous communities	Isolation and remoteness Poor access to healthcare services and poor existing health Poor living conditions (especially sanitation and hygiene), as well as inadequate shelter from climate extremes due to homelessness and poor quality housing Disruption of traditional connections to land and country through loss of cultural practices and history
  People with low incomes	Poor access to healthcare services and poor existing health Limited social support networks Limited financial resources to respond to food price rises Less access to public health information and warnings Limited ability to take action in response to public health advice and warnings
  Elderly	Physical and social isolation, limited support networks Diminished physical and mental abilities (especially ability to regulate body temperature, and existing acute and chronic disease) Less able to care for themselves during adverse weather Prescription medication use can mask early symptoms of heat stress and exacerbate effects Less able to take appropriate action in response to public health warnings
  Children	Immature physical responses, and reduced capacity to cope with adverse weather and air pollutants Behaviours that can lead to increased exposure to adverse weather, for example, spending a lot of time outdoors playing, not recognising signs of thirst and exhaustion Increased rest requirements (compared to adults) – lack of sleep during hot nights may be particularly harmful Experiencing extreme events can lead to increased mental health and post-traumatic stress issues in later life
  Physical workers (especially outdoor workers)	Physically demanding activities during hot weather become dangerous to health – in particular, outdoors or in poorly ventilated indoor environments Reduced productivity under increasingly difficult and dangerous conditions Lack of rest periods, and lack of cool resting places, during working hours, and/or working longer hours to make up for lost productivity during hot periods Multiple extreme weather events, especially those in close succession, may contribute to mental health issues among emergency responders, medical staff
  Those with existing medical conditions	Poor existing health Decreased physiological function and response to stressors Responses may be further complicated by prescription medication use, for example, diminished thirst signals can heighten risk of dehydration
  Rural communities	Poorer access to healthcare services, and poorer infrastructure for health-promoting activity (shade, sporting clubs) Close dependence on environment for livelihood and lifestyle Higher proportion of occupations with a direct relationship with climate and higher proportion of businesses in regional cities and towns directly or indirectly dependent on a supportive climate
  Tourists (including domestic tourists)	Lack of familiarity with Australian climate and how to cope (for example, sun protection, higher fluid intake) Lack of familiarity with public health warnings Language barrier preventing understanding of how to respond appropriately to warnings (for example, daily reports of UV index, pollen count) Lack of familiarity with local resources and procedures at times of need (for example, emergency evacuation routes, bushfire safety)

  
  (pp 30-31)
  
  
  

  Urgent Action Can Protect Our Health

  
  The importance of good health for our way of life, society and economy means we need to [prevent those health impacts we still have time to prevent, and prepare for those that are now unavoidable.]
  
  [The choices we make over the next decade] will determine the severity of climate change health risks that our children and grandchildren will experience.
  The longer we wait, the more serious the consequences.
  
  
  
  

  Figure 8
  Possible timeline of some future adverse health impacts in Australia from climate change.

  
  

  5.1 Strengthening the foundations of Australia’s good health

  
  Planning for change
  
  We can minimise the [health impacts] from climate change … by strengthening the foundations of our good health. …
  • [securing] water quality, food safety and housing [and]
  • [improving] disease surveillance, early warning systems … health promotion; and … access to medical services.
  (p 33)
  
  [Effective] planning should ensure that the public hospital system can cope with higher demand during heatwaves and that emergency services are sufficiently prepared and equipped to respond to more frequent and severe natural disasters. …
  
  Improved housing and suburb designs should also protect residents from extreme events like flooding and bushfire.
  
  
  Taking action
  
  [Some] workers at container terminals in the Port of Melbourne have a union-negotiated ‘heat agreement’, entitling them to a 15-minute break every hour if the temperature exceeds 35°C.
  Above 38°C, outdoor workers can stop working altogether until the temperature cools. …
  
  [In] the first 72 hours after the 7 February 2009 Black Saturday bushfires, 390 people presented to hospital emergency departments and 24 to the specialised referral centres for burns at The Alfred Hospital and the Royal Children’s Hospital
  (p 34)
  
  [More frequent bushfires] may lead to more people needing treatment for severe burns.
  Such patients need considerable surgical resources devoted to them, particularly in the first 72 hours.
  
  

  Australia’s Greenest Hospital

  
  The new Royal Children’s Hospital in Melbourne … expects to reduce

  • greenhouse gas emissions by 45% [through] greater energy efficiency, an on-site gas tri-generation power plant, solar panels and a biomass fuel boiler [and]
  • water use [by 20%] through water treatment, water efficiency measures and rainwater collection.

  (p 35)
  
  
  

  5.2 Reducing the threat to our health

  
  Most scientists agree that the potentially catastrophic impacts of climate change can be avoided if we keep the global temperature rise to no more than 2°C above pre-industrial levels.
  
  [We can emit no] more than 1 trillion tonnes of carbon dioxide equivalent between 2000 and 2050 if we are to have a 75% chance of limiting temperature rise to 2°C or less.
  In the first nine years of this period, humanity emitted 305 gigatonnes, or over 30% of the budget in less than 20% of the time period. …
  
  [In addition to mitigating climate change, reducing] greenhouse gas emissions … can have immediate health benefits …
  • Cleaner energy sources and [greater energy efficiency] will lead to healthier air.
  • Improving the design of our cities and towns so that it is easier and safer to get around on foot, by bike and by public transport will reduce transport emissions and help people become more physically active.
  • [Consuming] less meat could substantially reduce [rates of] heart disease and Type 2 diabetes [as well as] emissions of methane and nitrous oxide.
  (p 38)
  
  

  [The case for] active travel

  
  [Making] it easier to get around on foot and bike has the potential for substantial benefits to our health, economy and greenhouse gas emissions. Physical inactivity causes over 13,000 deaths each year in Australia, and increases the risk of heart disease, Type 2 diabetes, breast and bowel cancer, depression and anxiety. …
  [Increasing] by only 5% the number of Australians who do 30 minutes of moderate activity each day, could save 600 lives a year.
  A Scandinavian study found that the death rate in workers who cycled to work was 28% lower than for others. …
  
  One study found that Australians who walked for recreation as little as about 10 minutes a day were 72% more likely to report better physical health and 33% more likely to report better mental health, than those who walked less. …
  
  Current cycling levels are estimated to save the Australian health system $22.72 million annually. …
  A New Zealand study found that a 5% increase in short bicycle trips (less than 7 km) could have annual net health savings of NZ $200 million. … Transport generates 13% of Australia’s emissions [of which passenger] cars make up about half …
  [A reduced] reliance on private car-use and [could] significantly reduce emissions.

  (p 39)