As the fires continue to burn across eastern Australia, the full scale of the health impacts and the capacity of health services to adequately respond is emerging.
Many thousands of people have been affected by fire, and many displaced from their homes. Millions of Australians have been and are still affected by hazardous bushfire smoke.
Mental health effects from bushfires are common, ranging from short-term anxiety and panic, to longer-term depression and PTSD.
A sizeable part of the Australian population has been through trauma, which will almost certainly have ongoing effects. And, of course, the fires are still burning.
Doctors on the frontline who are working in evacuation centres report they are dealing with up to 1000 evacuees, with very little equipment or support. As reported by Australian Doctor, others express their frustration at the lack of integration of GPs into emergency and evacuation plans.
There has obviously been concerns about the levels of air pollution experienced across eastern Australia, which is unprecedented in terms of coverage, severity and duration. And, we have seen this week, the Federal Government announced it is releasing 1.8 million masks from the National Medical Stockpile.
The majority of air pollution-related health impacts are mediated through ‘fine particulate matter’; particles and droplets that are less than 2.5 microns in diameter (PM2.5).
Their size enables them to deposit toxic components deep in the lungs, analogous to the drug-carrying particles produced by asthma inhalers.
PM2.5 are known to cause heart attacks, strokes, asthma/COPD exacerbations, lung cancer, diabetes and preterm births, with more recent studies having linked acute exposure to septicaemia, fluid and electrolyte disorders, urinary infections and acute renal failure.1
These dose-dependent health effects occur even at the low ambient levels, normally seen in Australian cities, and well below WHO air quality guidelines for 24-hour average exposure of 25mcg per cubic metre, but bushfires have pushed levels many, many times higher, with Canberra nearing 5000mcg per cubic metre this week.
Some groups are especially vulnerable: pregnant women, children, elderly people and those with existing cardiorespiratory diseases.
Particulate composition, produced by bushfires, has not been well studied in Australia, but high levels of toxic air associated with these fires demonstrated overseas may mean bushfire smoke is more harmful than air pollution from other sources such as motor vehicles.
Health impacts from medium-term exposure is less clear, but data from the 2014 Hazelwood coal mine fires in Victoria, which burned for six weeks, would suggest there will be longer-term impacts.2
Scientists have long predicted the compound nature of climate change impacts: in addition to the direct effect of the fire-related injuries and damage, there would be superimposed effects from air pollution, heat, disruption to transport routes and medical supplies, interruption of electricity services, and contamination of clean water.
From a health perspective, an AMA submission on the nation’s readiness for extreme weather events remains salutary, even though it was written seven years ago.3
The report highlighted fundamental gaps in Australia’s capacity to minimise and respond to the health impacts of extreme weather events, including the fact that government policy is fragmented, without a nationally co-ordinated approach to managing the health impacts associated with extreme weather events and climate change.
It said there was a lack of understanding of the scope and scale of health implications of extreme weather events, including in the health sector itself. There was a failure to sufficiently engage with the health sector in planning.
And, there was also a lack of sustained investment and long-term planning especially on preventative measures
Unfortunately, little of the recommendations were taken up and implemented. The country continues to be hopelessly underprepared, despite consistent warnings by the health sector, the financial sector and government departments themselves over many years, if not decades.
Last year, many groups, including former fire chiefs, fire scientists and meteorological chiefs, tried to communicate the deep urgency for action needed by the government in the lead-up to a summer predicted to be our most challenging ever.
As the summer evolves, we must now implement a climate and health strategy inclusive of preparation and mitigation, as has been proposed by many health groups, including Climate and Health Alliance, Doctors for the Environment Australia and the Royal Australasian College of Physicians.
The overarching concern that the fires have highlighted is climate change. These events have occurred with just 1 degree Celsius of global warming.
The latest Intergovernmental Panel on Climate Change report gives us a timeline of around 10 years to steeply reduce carbon emissions if we are to avoid catastrophic climate change impacts.4
Complying with the Paris Agreement means our emissions would need to peak by around 2020, and then drop by 7.6% per annum, yet global emissions and Australia’s emissions are still rising.
Already, further warming based on current emissions are locked in, and business as usual will take us to a 4C warmer world, one beyond the experience of human civilisation, by the end of this century.
Understandably, people are pessimistic as to the likelihood of achieving such a rate of change in the context of the inertia within geopolitical and global economic systems. This is certainly not a technical problem, as existing technology can achieve significant emissions reductions; it is about political will.
As doctors, we are charged with the duty of care to protect the health and wellbeing of our communities.
It is time we accept the science and the challenge before us, and choose to act so that our children might have a healthy future.
- This article was co-authored by Dr George Crisp, a Perth GP and member of Doctors for the Environment Australia.