On 3 September 2019, the Australian Medical Association (AMA) added their voice to the growing list of international health organisations declaring climate change a health emergency and calling for urgent government action on climate change on health grounds.

The AMA’s position comes one year after the World Health Organization’s (WHO) COP24 Special Report on Health and Climate Change, outlining how climate change has become the greatest challenge to human health globally with illness and disease caused by pollution, severe weather and extreme heat events, threats to safe drinking water and food security, mosquito-borne diseases and the increasing impact on mental health.

Both the WHO and AMA recognise that climate change highlights and exacerbates health inequities globally, right down to the local community level.

Those with the means (the money, resources and information) are best placed to adapt and mitigate the health impacts of climate change. Those already disadvantaged and marginalised, without the means to more readily adapt, are more exposed to and suffer more from these health impacts.

Understanding how climate change is an amplifier of health inequities is demonstrated by the way people within and across communities fare in heatwaves.

In its climate emergency statement, the AMA highlighted how the increase in frequency and intensity of heatwaves caused by climate change is a significant contributor to ill-health and death in Australia.

Heatwaves kill more people in Australia than all other natural hazards combined.

Critical step

The development of the Monash Heat Vulnerability Index by Monash University’s Water Sensitive Cities CRC was a critical step in being able to identify which communities in Australia’s capital cities are at greater risk during heatwaves.

This risk is, in part, determined by the existence of the Urban Heat Island Effect caused by low-levels of cooling green (trees and vegetation) and blue (water) infrastructure to offset heat absorbing surfaces (concrete and asphalt), along with socio-economic disadvantage and other demographic and health indicators.

Based on this Index, it is reasonable to infer that the parts of our cities that are hotter, requiring greater adaptation during heatwaves, are also poorer. This means a higher proportion of these communities are less able to adequately protect themselves and their families from ill-health caused by heatwaves.

University of Adelaide public health researcher, Dr Scott Hansen-Easey, describes heatwaves as being inherently unfair due to the strong interplay between existing social vulnerabilities (for example, poverty, mental illness, homelessness, people experiencing family violence).  Hansen-Easey describes climate change as creating a “new frontier of heatwave risk”.

Health professionals and organisations are in the front-line of witnessing the health impacts of climate change and the consequent exacerbation of health inequities and are therefore critical actors in driving climate change mitigation and adaptation.

Since 2016, Lord Mayor’s Charitable Foundation has prioritised funding towards increasing the capacity of health organisations to understand and respond to the health impacts of climate change.

The Foundation consulted with Emergency Management Victoria, Victorian Council of Social Services and the Department of Health and Human Services when considering this work.

A gap was identified in resourcing the frontline health and grassroots social service organisations to be active partners in planning for and responding to extreme weather, with heatwaves being the most predictable and prevalent of these events and having disproportional health outcomes for people on low-incomes.


Hot Spots launch

In October 2018, the Lord Mayor’s Charitable Foundation launched its Hot Spots initiative to test the resourcing of local level, cross-sector collaborations focused on addressing the health impacts of heatwaves on vulnerable community members.

The aim was for this collaborative work to be led by the local health and social service organisations, which have existing relationships with community members most at risk during heatwaves.

The Monash Heat Vulnerability Index was used to identify the parts of Melbourne that most urgently needed this work. These areas are largely in the West, North and South-East of Melbourne.

Expressions of interest were sought from community health organisations in these identified areas to lead this work.

Three Hot Spots projects are currently underway, led by IPC Health in Brimbank, enliven in Dandenong and cohealth working at three high-rise public housing estates in inner-Melbourne.


Reaching out

The Hot Spots projects are collaborations between community health and social services providers, local government and emergency services.

These projects focus on reaching out to hundreds of community members who are most at-risk during extreme heat events, communicating heat-health messages, increasing their capacity to respond to this information and co-designing local adaptive solutions to prevent the health impacts of heatwaves.

The projects have successfully galvanised support from cross-sector organisations, including hospitals and other health organisations, early years and family services, seniors’ groups, culturally and linguistically diverse (CALD) agencies, settlement services, youth organisations, women’s organisations, neighbourhood and community houses, Victoria Police, Ambulance Victoria and a wide-range of local government departments including the environment and sustainability teams.

The Hot Spots projects have highlighted the limited means many community members have to adapt and keep cool.

Many key community organisations don’t currently receive the government heat health alerts and don’t implement heat planning for their organisations or the community members they support.


Learning from communities

At the same time, lessons have been learnt from communities who are getting on with taking care of one another during heatwaves. For example, a seniors’ group in Dandenong use WhatsApp to gather members at the homes of those with air-conditioning to socialise and keep cool together.

The 2019-20 summer season will see these projects progress as health, social service, emergency service and local government organisations work more closely with each other and the broader community to understand the impacts of heatwaves and test local adaptive solutions.

Hot Spots is being formally evaluated by RMIT to test the effectiveness of supporting the community sector to lead cross-sector collaborations reducing heatwave vulnerability in at-risk urban areas.

Increasing awareness and understanding and then addressing the inequitable health impacts of climate change requires significant effort from all levels of government, every part of our health and community services sector and the broader community.

While climate change mitigation is the most critical intervention to preventing these health impacts, investment in adaptation work that creates informed and resilient health systems and communities that are able to adapt to the health impacts of climate change is vital.

This article appeared on Croakey Health Media as part of the Covering Climate Now initiative.