ANMJ Featured Story

Agents of change: Nurses and midwives tackle climate change head on

Friday 23rd March, 2018

The impact of climate change on the health of Australians and people around the globe are fast becoming evident. Lives are being lost at an increasing rate while adding significant economic burden to already financially crippled healthcare systems. Yet despite politicians stagnating to address the issue, healthcare professionals, including nurses and midwives, are tackling climate change head on, writes Jessica Gadd.

Solomon Islands, 2016. A delegation of international guests attending the South Pacific Nurses Forum are shown firsthand the effects of climate change on the small island nation.

A table, traditionally used by the elders for important ceremonial activities, is slowly submerging under the rising ocean. “It had been there for generations, holding a particularly important cultural significance, and that is just being lost,” says ANMF A/Federal Secretary Annie Butler, who was one of the delegates at the forum.

“We learnt that, in addition to the physical effects of climate change in the Pacific – that is, villages disappearing under water, there are the mental and psychological effects on culture to take into consideration as well. The ANMF is trying to work with nurses specifically in these areas to try and address this problem with them.”

The South Pacific Nurses Forum, the International Council of Nurses, and Global Nurses United are just some of the organisations that the ANMF works with in an attempt to address climate change and its health effects on people around the globe. In Australia, the ANMF works with the ACTU, participating in programs such as ‘A Just Transition’, which supports a move away from coal fired power towards renewable energy sources, while still maintaining livelihoods.

The ANMF also works with the Climate and Health Alliance (CAHA), which advocates for action on climate change on behalf of the Australian health sector. CAHA recently worked with health stakeholders to produce a Framework for a National Health Strategy on Climate Health and Well-being (2017) in an attempt to build understanding among policymakers and guide action on the issue of climate change and human health.

“Along with CAHA we have written to Australia’s Environment Minister and Health Minister, trying to get their support for the CAHA Framework for a National Health Strategy on Climate Health and Well-being,” Ms Butler says. “They have written back saying, basically, thanks but no thanks, at this stage.”

However, Ms Butler says inaction is not an option. The World Health Organization predicts that between 2030 and 2050, climate change is expected to cause approximately 250,000 additional deaths per year, from malnutrition, malaria, diarrhoea and heat stress.

“Hundreds of thousands of people around the world are already dying directly from the effects of climate change,” Ms Butler says. “And unfortunately, many of those copping the worst of the effects of climate change, such as the Pacific Islands, frankly, have not caused it.”

Climate change is happening now

A glance at global weather events for the first few months of 2018 is telling. In Africa, residents of South Africa’s capital city, Cape Town, are grappling with extreme water rations as they face the prospect of becoming the first major international city to run out of water due to drought. In the Pacific Cyclones Gita and Hola in February and March caused severe damage in parts of Tonga, Vanuatu and New Caledonia.

In March the Polar Vortex, a zone of persistent low pressure that typically keeps high latitude cold air constrained to the North Pole, weakened to the point that a blast of icy air brought parts of Europe to a standstill and claimed the lives of nearly 50 people. At around the same time as the ‘Beast from the East’, as it was dubbed by the UK media, ravaged Europe and the UK, the world’s northern-most weather station, at Cape Morris Jesup in Greenland, recorded a temperature of around 6o degrees, which is about 35 degrees above normal for this time of year.

In Australia, a heatwave in January saw South Australian officials shorten the international bike race - Tour Down Under, experts warned players could die of heat exhaustion at Melbourne’s Australian Open, and residents of Sydney suburb Penrith swelter through one of the hottest Australian days on record at 47.3°C.

“A lot of people don’t realise this, but heatwaves are one of the most deadly effects of climate change, causing the highest numbers of deaths,” Ms Butler says.

Australia’s Southeastern heatwave in 2009, for example, claimed the lives of an estimated 374 people in just a few short weeks – a 45% increase in the death rate.

It preceded, and contributed to conditions that encouraged, the Black Saturday bushfires, which took the lives of another 173 people.

According to the Climate Council, Australia’s worst heatwave, during the ‘Angry Summer’ of 2013, featured more than 200 record-breaking extreme weather events driven by climate change, and it resulted in The Bureau of Meteorology adding a new range of 52-54°C to its forecasting chart.

“Heatwaves are happening earlier than they used to, they’re lasting longer, and they’re more intense,” says Queensland University of Technology Faculty of Health Professor Hilary Bambrick, an environmental epidemiologist and bioanthropologist whose research focuses on the health impacts of climate variability and change.

“We don’t necessarily pick up on these things ourselves, particularly because Australians are stoic – we’re used to drought, bushfire, and all the things that come along with living in a land of extremes. But when you actually start looking at the data and see how much has already changed just in our lifetime, you can really see that climate change isn’t something that’s way off in the future – it’s actually something we can see is happening now.”

In January 2018, the Climate Council released a report confirming that the world experienced its hottest five years on record during 2013 to 2017. The report stated that is was ‘part of a sharp, long-term upswing in global temperatures, with 17 out of the 18 hottest years on record all occurring in this century’.

Experts predict that unless there are sudden and drastic attempts to curb emissions the current heatwave conditions will be ‘the new normal’ in 10-15 years’ time.

Healthcare impacts of extreme weather

Increased numbers of heat-affected people presents a problem for health services that are not equipped to cope with the increase in hospitalisations, or the increase in mortalities, that come with heatwaves.

“During the 2009 Melbourne heatwave, for example, there wasn’t enough room in the morgues and in some cases the bodies had to be kept in refrigerated trucks,” Professor Bambrick says.

“We often think of older people as being the ones at increased risk during heat events and that’s certainly true, but also there are the emergency and health workers who have to keep working through in those temperatures and are often themselves highly exposed to the extreme weather.”

Other climate change related, extreme weather events that will increasingly have acute impacts for healthcare here in Australia, says Professor Bambrick, are bushfires, severe storms, cyclones, and flooding – including from rising sea levels and storm surges.

Cyclone Debbie in 2017 resulted in 14 lives lost. Australia’s deadliest cyclone since Cyclone Tracy devastated the Queensland coast and caused widespread flooding across the border and into NSW.

A less obvious impact of cyclones is the resulting reduction and affordability of fresh food.

“We saw this last year with Cyclone Debbie, which took out a large proportion of important food crops for Australians,” Professor Bambrick says. “But food production will also be affected by more chronic things such as drought, and even the changing climate in the sense that you can no longer grow things in particular places. For example, there’s concern that our stone fruit areas soon won’t be able to produce stone fruit because it’s no longer cold enough.

“And if you’re thinking about extreme heat, livestock such as dairy cattle are not too comfortable in extreme heat, and their milk production declines quite considerably.”

While cows might not enjoy the heat, mosquitos certainly do, and along with increased mosquito numbers comes increased chances for the spread of vector-borne disease such as Dengue Fever.

“In hot and humid weather mosquitos mature much more quickly, which means they are biting earlier than they would otherwise, and they have increased survival, which means more mosquitos are surviving to bite,” Professor Bambrick explains.

“In the right weather conditions their metabolic rate is increased, they get hungry more quickly and therefore bite more frequently, so they’re more likely to transmit a pathogen that they’ve picked up. Not only that, the pathogen itself replicates more quickly inside the mosquitos, so there’s a shorter timeframe for transmitting that disease.”

Professor Bambrick points out that warmer weather also means increased outbreaks of salmonella, a particular concern for people living in aged care facilities, institutional facilities, and childcare facilities.

Climate change is a human health emergency

While many politicians might be slow to make the connection between health and climate change, the health industry certainly is not. In 2015 the world’s leading medical journal, The Lancet, released a report on climate change and human health that labeled climate change as ‘a public health emergency’.

“The scale of the impact that climate change is having on human health in the short, medium and longer term is so immense, and it requires such a comprehensive and urgent response, that it does lead to the assertion that it’s an emergency,” says Climate and Health Alliance (CAHA) Founder and Convenor Fiona Armstrong.

“The fundamentals that are being impacted are the things that human health and wellbeing are entirely dependent on, such as our access to clean air, soil and water, a safe climate in the sense of a set of conditions that are optimum for human functioning and those are being eroded incredibly quickly.”

In 2012, CAHA released a report, Our Uncashed Dividend, which explored the largely untapped opportunity to take action on climate change and improve human health at the same time.

This ‘co-benefit’ approach delivers both human health benefits and economic savings from avoided ill health, and the associated productivity gains.

The improvement in overall respiratory health from reducing emissions from burning fossil fuels and the associated air pollution is a classic example of this, Ms Armstrong says.

“For people living in proximity to either coal combustion or other forms of coal production or coal transport, exposure to coal pollution has very serious health impacts, as it does for all of us who are impacted by the resulting poor air quality. So, obviously moving away from coal-powered energy, which is one of the biggest contributors to climate change globally as an energy source, is a win for the environment and a win for our health.”

Ms Armstrong says a 2014 study by the MIT Joint Program on the Science and Policy of Global Change, which provided impact assessments for several different climate change scenarios, has helped to put a dollar value on the health benefits from action on climate change.

“This study looked at different climate policies and what they would deliver in terms of co-benefits for health and economic savings. One of the scenarios they looked at was a nationwide carbon price or emissions trading scheme, and what they found was a national emission reduction scheme of this nature actually delivers health benefits that are ten times the value of the cost of implementing the policy.

“This completely blows out of the water the argument that we can’t afford to act on climate change, and it makes the case very strongly that we can’t afford not to do something about it.”

Nurses take action on climate change

The ANMF (Victorian Branch) has a dedicated environmental health officer, Ros Morgan, who helps run CPD course, Nursing for the environment: a practical introduction to environmentally sustainable practices.

Ms Morgan is involved in organising ANMF (Victorian Branch’s) annual Environment and Sustainability Conference, headlined this year by Craig Reucassel, presenter of the ABC series War on Waste.

ANMF (Victorian Branch) also runs the highly active and effective Green Nurses and Midwives Facebook Group, a space where members can share knowledge and experiences in trying to establish green initiatives.

Ms Morgan says that activity on the page, and her own prior experience as a clinician trying to establish waste reduction schemes in her workplace, made it clear there was a need for a position that could educate about the resources available, and facilitate the uptake of best practice waste management systems in hospitals and healthcare facilities.

“We were aware of a lot people giving up time and energy, and in a lot of cases reinventing the wheel – often pulling teeth trying to find out answers to questions,” Ms Morgan explains. “So the ANMF lobbied the Victorian government on behalf of its members, and in the last Victorian state Budget, secured funding for a new Waste Education Officer. This role will provide a resource base and support members implementing environmentally sustainable practices.”

Ms Morgan says while the appointment is being made, a project working group consisting of representatives from the ANMF (Victorian Branch), Sustainability Victoria, Victorian Human Health Services (VHHS, formerly DHHS), and other senior healthcare professionals is working to furnish the Waste Education Officer with accurate, EPA-endorsed materials.

“We know, for example, that there is often inconsistency with healthcare policy documents because quite often the authors are not sure on how to interpret the guidelines from the EPA,” Ms Morgan explains.

“As a direct result of ANMF intervention, we now have an EPA member on that project working group, so that they can endorse the materials that are released by the new Waste Education Officer, with the intention of bringing clarity to some of these areas of confusion. As a result, healthcare organisations can feel confident in developing or amending some of their protocols.”

The Waste Education Officer role will help to create a consistent approach across healthcare facilities and departments, says ANMF (Victoria Branch) Assistant Secretary Pip Carew.

Ms Carew believes that these improved efficiencies, and increased connections with stakeholders, should help to drive behavioural change for best practice in waste management.

“We’ve had success with government support for this role because improved waste management makes sense from an economic point of view. We can demonstrate a clear value proposition – less waste means less disposal costs.”

The ANMF (Victorian Branch) has recently moved into a purpose-built, 5 Star Green Star, award-winning building. The building features solar panels, natural light responsive LED lighting, storm water-fed toilets, smart lifts, onsite high-speed composting, low VOC materials, improved stream sorting for recycling, carefully positioned staircases to encourage people to use the stairs, end-of-trip facilities to encourage walking or riding to work, and an increased number of smaller car spaces.

Ms Carew says it was designed to support the ANMF’s member-driven mandate to reduce emissions and to aid members implementing environmentally sustainable practice.

“As representatives for our members we want to make sure their building has the hallmark of sustainability and is not contributing to harming people,” Ms Carew says. “One of the reasons we won our CitySwitch Signatory of the Year (Victoria) award was that in addition to the environmental credentials of the building we’ve also been able to develop our Nursing for the Environment course to run in the building.

“Nurses wanted structure around advocating in the workplace, so that they could genuinely make a difference in their workplaces. We see it as the project for building our future.”

Code of ethics addresses environmental issues

In March 2018 the Nursing and Midwifery Board of Australia (NMBA) adopted the International Council of Nurses Code of Ethics. Ms Morgan says some elements of the code supports nurses addressing environmental issues that might not traditionally have been part of the clinical sphere. For example, under section 3, Nurses and the profession, the code states:

•     The nurse practices to sustain and protect the natural environment and is aware of its consequences on health.

•     The nurse contributes to an ethical organisational environment and challenges unethical practices and settings.

“The point of view that nurses should not step outside the clinical sphere is sometimes a stumbling block for nurses who want to introduce environmentally sustainable practice,” Ms Morgan says. “But waste management is unquestionably a part of the nurse’s brief. Is it really acting ethically to mindlessly practice when there are changes that we can make that will have significant impacts?

“Most people are concerned about climate change, but many of them haven’t quite recognised the link that the same pollution that causes climate change is the same pollution that causes ill health. So we’re showing the healthcare sector how to join the dots - that this great big issue is directly related to how we’re practising at work. Addressing this issue is a part of our calling as health professionals, it’s a very clear part of our rationale.”

Climate and Health Alliance: Our Climate, Our Health

As part of its ‘Our Climate, Our Health’, campaign, CAHA has an online petition through which health professionals can email their local Members of Parliament, and an advocacy toolkit for health professionals to use in lobbying their local MPs for action on climate change.

“The toolkit is designed to help nurses let politicians know that – as health professionals – they are concerned about climate change and want to see a response from political leaders,” says Ms Armstrong. “CAHA also has an emerging network of ‘climate health champions’ who can provide in person support for people who want to meet with their local MPs.”

Ms Armstrong says the other thing that nurses and midwives can do is to encourage their hospitals or health service to join the Global Green and Healthy Hospitals Network, if they have not already. Australian and New Zealand member hospitals in the rapidly growing network are demonstrating world-leading initiatives in terms of their impact on reducing emissions.

“There’s an online virtual community with tools, resources, and support available 24/7, 365 days a year, so nurses can log in to that network, ask questions and read case studies,” Ms Armstrong says.

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