Building health system resilience

Health practitioners have the opportunity to contribute their expertise to help reduce the health consequences of climate disasters across the prevention, preparedness, response and recovery phases of disaster management, say the authors of a Perspective published  by the Medical Journal of Australia.

Apart from the acute health consequences of extreme weather events – deaths from drowning, injuries, poisonings and infections – climate disasters interrupt treatment and overall health care, exacerbating conditions or even causing deaths, wrote the authors, led by Professor Sotiris Vardoulakis, Professor of Global Environmental Health at the National Centre for Epidemiology and Population Health, which is part of the Australian National University.

“Underlying vulnerabilities, including obesity, diabetes, cancer, mental illness and other non-communicable diseases (NCDs), complicate disaster recovery efforts in communities affected by extreme events,” they wrote.

“Interruption may be caused by loss of belongings including medication, damaged transport routes, reduced health services, disrupted telecommunications, loss of power, and evacuations, often compounded by disrupted sleep, stress and reduced access to healthy food and safe water.”

Vardoulakis and colleagues pointed out that health professionals have responded heroically to COVID-19, bushfires and floods over the past 2 years “but it is not sustainable in the long run”.

“Extreme events, pandemic fatigue, overstretched clinical services, spiralling demand for mental health services, and staff burnout could drive the health care workforce to collapse,” they wrote.

“Beyond the health system, the COVID-19 pandemic has altered the social capital (ie, community attachment, solidarity and social trust) and exposed health inequities in our communities.

“Disaster preparedness and recovery plans should be developed in partnership with disability organisations and community grassroots, including Aboriginal and Torres Strait Islander communities, to ensure that scientific knowledge is combined with local knowledge gained from experience and built from the ground up.”

Vardoulakis and colleagues called for the development of a coordinated cross-sectoral whole-of-system response, covering health, the environment, land-use planning and social housing, to floods.  This should focus on long term public health prevention and preparedness for more frequent and intense extreme events.

It should also incorporate meaningful community engagement, including Aboriginal and Torres Strait Islander, culturally and linguistically diverse, and socio-economically marginalised communities.  These steps would build social cohesion, reduce inequities and develop culturally appropriate risk communication strategies and person-centred adaptation plans.

They also backed the strengthening of non-communicable disease (NCD) prevention, including mental health and wellbeing services, particularly for rural and remote communities disproportionally affected by environmental change and extreme events.

There should also be stronger environmental public health surveillance for infectious diseases and NCDs, and climate-informed predictive models and early warning systems linked to emergency, public and mental health services.

The authors called for the establishment of a sustainable health unit, similar to the Greener National Health Service in England, that will help improve the health sector’s resilience to climate and health emergencies, and monitor and reduce the carbon footprint of health services.

Finally, they backed an increase in research capacity and capability to identify gaps in local service delivery, communication and coordination and evaluate the effectiveness of interventions aiming to increase health sector and community resilience of at-risk populations to floods and other climate disasters.