This year, natural disasters exacerbated by climate change and a global pandemic, revealed the growing systemic inequalities in Australia and around the world. With climate change and infectious diseases on the rise, doctors, climate and health experts as well as frontline community leaders are pushing for solutions that both mitigate climate change and reduce inequality.

This is the second article in a two-part series on tackling climate change and inequality. Read the first article here.

joining the dots: Climate Change and health

In 2019, the Australian Medical Association (AMA) joined other health organisations around the world – including the American Medical Association, the British Medical Association, and Doctors for the Environment Australia – in recognising climate change as a health emergency, however, this declaration has not elicited a major response from the government.  

In May of this year, Dr Arnagretta Hunter, a physician and cardiologist, co-authored a study in The Lancet Planetary Health that emphasised the need to address the link between climate change and health, by calling for climate change to be added as a factor on death certificates— especially in regards to heat and smoke. The researchers found that over the past 11 years, the number of deaths attributed to excessive natural heat is at least 50 times greater than is recorded on death certificates in Australia.  

"If you have an asthma attack and die during heavy smoke exposure from bushfires, the death certificate should include that information,” Dr Hunter told ANU. 

The Royal Commision into the 2019-20  bushfires heard that the smoke from these fires caused an estimated 445 deaths and put more than 4,000 people in hospital. By recognising the impact of large-scale environmental events, and recording that, Dr Hunter believes that we might be able to mitigate it. 

"Climate change is the single greatest health threat that we face globally even after we recover from coronavirus…We are successfully tracking deaths from coronavirus, but we also need healthcare workers and systems to acknowledge the relationship between our health and our environment."

While the pandemic has largely played out in Australia in the cooler months, new reports from the U.S. show the nexus between climate, health and inequality with the pandemic compromising low income communities access to relief from dangerous levels of heat, especially among the elderly and those with pre-existing heart conditions. 

Dr. Katherine Barraclough, a nephrologist and the chair of the Victorian Committee Doctors for the Environment Australia, told MedicGuild that the government needs to respond with the same level of vigilance and coordination with the medical and scientific communities to the climate crisis, as it has done with the coronavirus pandemic. 

“The government has based its response to the Covid-19 pandemic on the advice of scientific and health experts. It needs to do the same in responding to the climate crisis,” Barraclough said. 

“Already climate change is having major impacts on the health and wellbeing of our communities - we saw this all too clearly over the summer with the horrific bushfires and smoke pollution that affected so many Australians. We know that the health impacts of climate change will only escalate over time.” 

According to Dr. Tony Bartone, the president of the AMA, “doctors in training and medical students rate climate change as one of the greatest challenges facing them as future doctors,” yet there doesn’t appear to be a coordinated approach to teaching climate change and health. 

In 2017, The Medical Deans of Australia and New Zealand established a Climate Change and Health Working Group to support medical educators from several Australasian medical schools to explore the development of potential learning objectives and learning resources for teaching climate change and health. 

Although, "these suggestions have been circulated to all medical schools as a potential curriculum resource, it's up to individual schools if they incorporate it," Helen Craig, CEO of The Medical Deans of Australia and New Zealand told MedicGuild. 

Forbes McGain, an anaesthetist and intensive care physician working at Western Health in Melbourne, has long advocated for more sustainable healthcare so that the sector can reduce its current production of 7% of Australia’s carbon emissions. But for all the changes he and others have made with individual hospitals, “Australia’s current ad hoc, piecemeal approach by engaged clinicians to improve hospital sustainability and translate this to all hospitals is not working,” he wrote in the Conversation. 

Instead, he maintains, that for substantial headway to be made in terms of sustainability, the federal government, which funds around half of all healthcare, needs to create mandatory environmental standards for hospitals. 

centering communities and building the political will for systemic change

Sharon Friel, health equity professor at ANU, also agrees that the environmental and systemic social changes needed to address climate change and health inequality require the political will from governments to work.

Taking lessons from the government’s initial response to the pandemic, Friel hopes that it paves the way to improve health and social well-being post-covid. “We’ve seen this ability to hold economic, social and health goals together, it’s not just about the economy,” she said in a recent Vichealth event. 

“We saw the introduction of policies that were thought unimaginable before covid, happen overnight…so the message we take away from that is, if politicians want it to happen, it can absolutely happen.” 

But Friel says for policies to be successful, the voice of communities most impacted by systemic inequalities and climate change have to be front and center. “Having a voice in decision making processes to make sure they are fit for purpose and meeting needs of the community is essential to build health equity going forward,” she said.  

In Victoria, the state hardest hit by the second wave of the coronavirus pandemic, migrant and refugee communities have been disproportionately impacted by the virus as well as by police enforcement of covid control measures. In addition to this imbalance, an estimated 1.1 million people who are in Australia on temporary visas are excluded from jobkeeper and jobseeker support, 97,000 of those being asylum seekers on bridging visas who now face homelessnes.  

The hard lockdown of Melbourne public housing towers was the toughest and most controversial of these covid control measures. As Anisa, a Somali-Australian resident of a North Melbourne tower, told the Conversation, “the enforced lockdown is a direct reflection of the systematic inequalities [people face] in public housing.” 

Commentators have also noted that the resurgence of the pandemic via breaches of infection control with subcontracted hotel quarantine security guards, highlights that systemic inequalities within the workforce, including the causation of workers, poor working conditions and the precarity of low-wage jobs, “extends throughout the society to which those workers belong”.

Epidemiologists have also mapped the connection between occupation types, indicating the ability to work from home, and the locations of COVID-19 cases across Melbourne in the recent second wave. Their findings highlight the health inequities that arise from low-wage, casual and insecure employment.

Premier Daniel Andrews has continually referred to the pandemic as a "public health bushfire" adding that, “we are all in this together. This is no less serious than a bushfire.” 

But in a recent article for MJA’s Insight, Dr. Ngaree Blow, a public health registrar and director of First Nations health at Melbourne University, questioned the sentiment that, “we’re all in this together,” during the pandemic and the bushfire crises, citing the ongoing impact of racism on the health of First Nations communities, Black communities and communities of colour in Australia. Dr. Blow encouraged doctors to address these injustices by making the connection between systemic inequalities and their work as clinicians. 

 “We are at a critical turning point and we now more than ever need “activist doctors,” Dr. Blow wrote. 

“Doctors who can not only provide evidence-based, high quality care at the bedside, but who strive for health justice, advocate for more equitable health policies and are willing to challenge harmful systemic issues like institutional racism...It is imperative that we work in a way that recognises the ongoing impact of wider systemic issues in our justice, education, health, employment and housing systems on health outcomes.” 

Public health experts, activists and commentators have all noted that the global Black Lives Matter uprisings did not appear in a vacuum of the multiples crises of 2020, as Sudanese-Australian writer Yassmin Abdel-Magied, wrote in her article for TIME magazine, “[this] phenomenon has demonstrated with crystal clarity, the failure of states to fully protect their citizens, especially those from Black communities. After months of economically and socially devastating lockdown, there is not only undeniable evidence of systemic inequality. There is also the time and space for people to grapple with the reality of structural racism.” 

In a recent interview on MedicGuild’s podcast, Dr. Blow, in addition to highlighting systemic inequalities, pointed to the success of Aboriginal Community Controlled Health Organisations in stemming the threat of COVID-19 to First Nations Communities. Dr. Blow talked about the swift, informed action of these community controlled organisations and added that this demonstrates what is imperative for policy decisions. “If there are things involving communities we need to be involved at the forefront,” Dr. Blow said. “We know our communities and we know how to tackle our own issues, of course there needs to be support from allies, but there needs to be voices from communities.”

ANU PhD candidate and Euahlayi man Bhiamie Williamson, who has been researching the impact of the bushfires on Aboriginal communities agrees that when it comes to solutions to address these crises, First Nations voices need to be centralized. As Williamson told Croakey news, what inquiries into both bushfires or the pandemic need to recognise and would benefit from, is “the experience of First Nations peoples, their knowledge of the land, how it’s changed over time, and what’s required to live in a world that’s been impacted by disasters and (to which) societies have to change and adapt”

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