NACCHO Aboriginal Environmental Health : With #ClimateChange contributions from @RACGP Dr @timseniorand @climatecouncil @CroakeyNews and @HealthInfoNet What are the environmental factors that impact on the health of our Aboriginal and Torres Strait Islander communities?

“We’ve had more people coming in the last few weeks, with the smoke coming down from the bushfires in New South Wales, presenting with coughs, difficulty breathing – more than you’d usually expect,” he says.

I’ve been aware increasingly of people coming in with symptoms that could be put down to climate change. The other doctors are seeing the same things; we’re all seeing that ” 

Dr Tim Senior, who works at the Tharawal Aboriginal Corporation in south-west Sydney, is always busy, but the practice has been getting even more traffic lately. Like other GPs across the country, Dr Senior has a front-row seat to the growing impact of the climate crisis on the health of Australians : Read full RACGP article Part 3 Below 

 ” A NEW CLIMATE COUNCIL report has found this summer is shaping up as a terrible trifecta of heatwaves, droughts and bushfires, made worse by climate change. “Dangerous Summer: Escalating Bushfire, Heat and Drought Risk” finds the catastrophic events unfolding across Australia are not normal.“
Climate change is supercharging the extreme weather events we are witnessing. We have seen temperature records smashed, bushfires in winter and a prolonged drought.
Climate change is influencing all of these things,” said Climate Councillor and report author, Professor Will Steffen.“It is only the beginning of summer, which means the biggest danger period may yet be to come,” he said.
Report Key Findings

  • If greenhouse gas emissions continue to rise, the unusually hot weather currently experienced will become commonplace, occurring every summer across the country. Sydney and Melbourne could experience unprecedented 50°C summer days by the end of the century.
  • The current prolonged drought across eastern Australia is threatening crops for a third year in a row, and national summer crop production is forecast to fall by 20 percent to 2.1 million tonnes.
  • The period from January 2017 to October 2019 have been the driest on record for the Murray-Darling Basin as a whole.
  • Wildlife has been badly affected by the ongoing bushfires, with reports of at least 1,000 koala deaths in important habitats in New South Wales, Queensland and South Australia.
  • Australia must contribute to the global effort to deeply and rapidly reduce greenhouse gas emissions and we must prepare our emergency and fire services and communities for worsening extreme weather events.

” Aboriginal and Torres Strait Islander people in Australia are especially vulnerable to the impacts of climate change 

 For those Aboriginal and Torres Strait Islanders in remote parts of Australia, increases in temperature will reduce the amount of bush tucker and other native foods available. For people in coastal areas, rises in sea levels may force people off their land .

This is especially concerning considering the connection that Aboriginal and Torres Strait Islander people have to their Country, and may result in poor mental health and other social issues .

Extreme weather events such as cyclones and floods will affect the infrastructure in remote Aboriginal and Torres Strait Islander communities, and these communities may be cut-off from services for long periods of time .

To address some of the issues associated with climate change, a process called ‘adaptation’ is being used. Adaptation refers to the practical changes that individuals and communities can make to help them manage the issues that climate change will bring, and to protect their communities 

A key part of the Australian strategy on climate change is adaptation .

From Healthinfonet  : For some of the ways communities are adapting to climate change : See Part 2 Below 

” In mainstream settings, there is no battle for recognition or resources for environmental health from finance departments. There is nothing more to prove and a fully resourced framework is in place.  But Aboriginal environmental health is something else again.

Aboriginal environmental health combines deep cultural knowledge of how things work in Aboriginal communities with these hard scientific facts about disease. Aboriginal environmental health must forge high-trust partnerships with community. Aboriginal environmental health is a community asset. And Aboriginal environmental health is needed now more than ever.   Why is this so?

Public housing and public utilities have largely been taken out of Aboriginal control. In some locations, funding for the Aboriginal Environmental Health workforce has evaporated.

Sometimes, the power to make the simplest decision on the ground has been ripped away from local communities.

Instead, this power is with someone far away who doesn’t even know us. This is nowhere more manifest than in Aboriginal housing.  

Effective Aboriginal environmental health programs must be in Aboriginal hands.

 Community controlled organisations must drive the necessary knowledge exchange between those who hold technical expertise and those who have been denied it.

The very nature of this work means that Aboriginal communities must retain the reins – and retain the knowledge ” 

Selected extracts NACCHO CEO Pat Turner addressing the National Aboriginal and Torres Strait Islander Environmental Health Conference

Read full Speech HERE

Croakey : Reaching out to community members who are most at-risk during extreme heat events

Part 1 What are the environmental factors that impact on the health of Aboriginal and Torres Strait Islander communities?

The environments in which Aboriginal and Torres Strait Islander people live have a significant impact on their health. It is important to recognise healthy practices and identify and fix the risks present in Aboriginal and Torres Strait Islander communities.

The key factors in the physical environment which impact on the health and wellbeing of Aboriginal and Torres Strait Islander communities include:

  • water treatment and supply
  • access to affordable and healthy food and food safety
  • adequate housing and maintenance and minimisation of overcrowding
  • rubbish collection and disposal
  • sewage disposal
  • animal control (including insects)
  • dust control
  • pollution control
  • personal hygiene.

Examples of the types of health problems associated with the environment include; respiratory, cardiovascular and renal diseases, cancers and skin infections. Diseases can be spread as a result of overcrowding, pollution, poor animal management and gastrointestinal illnesses can be due to poor water quality, contaminated food or poor hygiene.

Preventing health problems by ensuring healthy environment standards reduces suffering and treatment costs.

What strategies are in place for the environmental health of Aboriginal and Torres Strait Islander communities?

The enHealth Council was responsible for the implementation of The National Environmental Health Strategy: 1999 .

The enHealth Council provides national leadership on environmental health issues, for example, by setting environmental health priorities and coordinating national policies and programs.

The council is made up of representatives from government and public health agencies, the environmental health profession and the community, including the Aboriginal and Torres Strait Islander community. Aboriginal and Torres Strait Islander environmental health is seen as a priority for the council and the National Environmental Health Strategy acknowledges the need to improve the health status of Aboriginal and Torres Strait Islander communities in rural, remote and urban areas, ‘through the development of appropriate environmental health standards commensurate (matching) with the wider Australian population’.

Who is responsible for healthy environments?

The responsibility for environmental health lies primarily with individuals and communities. However, communities often need to work with a range of government and non-government organisations to put into operation plans for improving environmental health standards in a community, evaluation of strategies and risk management.

Individuals and organisations who work in environmental health may differ between states and territories and between Aboriginal and Torres Strait Islander communities and include the following:

  • Environmental Health Officers and Workers
  • the Community Government Council, and its employees, for example, Essential Services Officers
  • electricity and water authorities
  • government housing departments
  • Aboriginal and Torres Strait Islander housing authorities
  • government departments responsible for land, planning and the environment
  • private consultants and contractors, for example, electricians, plumbers, builders
  • other non-government service providers, for example, land care agencies.

Many Aboriginal and Torres Strait Islander communities have an Environmental Health Worker based in their community who plays a vital role in reducing the day to day environmental risks which can affect the health and wellbeing of the communities’ residents. The Environmental Health Workers job is varied and often challenging as they are required to undertake a number of tasks including:

  • attending to day to day repairs and maintenance of infrastructure (e.g., housing and rubbish tips)
  • attending to urgent environmental health problems (e.g., sewage overflow)
  • planning and implementing programs
  • gaining the support of the community members and managers for community based programs

Part 2

Select from all the above Healthinfonet environmental factors 

Climate change

Climate change refers to a change in weather patterns because of a rise in the earth’s temperature [1][2]. Some of this change is natural, but some changes in climate have also been caused by human actions, such as the burning of fossil fuels (oil, gas and coal) [1]. Climate change has a negative impact on:

  • the Australian coastline (rising sea levels and potential flooding)
  • cities and other built environments
  • farming (an increase in temperature and droughts)
  • water (rainfall levels are decreasing)
  • natural ecosystems (increases in non-native species and decreases in native species)
  • health and wellbeing (increased risk of injury, disease and death due to rising temperatures)
  • extreme weather events such as floods and fires [3].

Aboriginal and Torres Strait Islander people in Australia are especially vulnerable to the impacts of climate change [4]. For those Aboriginal and Torres Strait Islanders in remote parts of Australia, increases in temperature will reduce the amount of bush tucker and other native foods available. For people in coastal areas, rises in sea levels may force people off their land [1].

This is especially concerning considering the connection that Aboriginal and Torres Strait Islander people have to their Country, and may result in poor mental health and other social issues [4]. Extreme weather events such as cyclones and floods will affect the infrastructure in remote Aboriginal and Torres Strait Islander communities, and these communities may be cut-off from services for long periods of time [1].

To address some of the issues associated with climate change, a process called ‘adaptation’ is being used. Adaptation refers to the practical changes that individuals and communities can make to help them manage the issues that climate change will bring, and to protect their communities [5]. A key part of the Australian strategy on climate change is adaptation [6]. Some of the ways communities are adapting to climate change are:

  • setting up good evacuation and early warning processes
  • upgrading and strengthening buildings
  • managing energy use
  • teaching people about the importance of staying healthy [1].

There are also ways that Aboriginal and Torres Strait Islander people and communities can lessen some of the risks associated with climate change [1]. These include:

  • planting trees
  • managing feral animals
  • reducing the number of bushfires by undertaking planned burning initiatives, such as the

Tiwi Carbon Study: Managing Fire for Greenhouse Gas Abatement

  • switching to renewable energy sources, like solar power [1].

Part 3 RACGP

Read the RACGP Climate Change policy HERE 

The health impacts of climate crisis-related events have never been more apparent in Australia, with recent catastrophic fire conditions visibly contributing to respiratory and cardiovascular problems. But medical professionals warn that the climate emergency is likely to have a far wider reach.

The Royal Australian College of General Practitioners (RACGP) put out a climate change and human health position statement this year, recognising the climate crisis as a key public health issue.

The position statement cites a long list of health effects that could result from higher temperatures and increased heatwaves, bushfires, droughts and storms. These include risk of stroke and heat stress, worsening chronic respiratory, cardiac and kidney conditions, and psychiatric illness.

Dr Tim Senior, who works at the Tharawal Aboriginal Corporation in south-west Sydney, is always busy, but the practice has been getting even more traffic lately. Like other GPs across the country, Dr Senior has a front-row seat to the growing impact of the climate crisis on the health of Australians.

“We’ve had more people coming in the last few weeks, with the smoke coming down from the bushfires in New South Wales, presenting with coughs, difficulty breathing – more than you’d usually expect,” he says.

“I’ve been aware increasingly of people coming in with symptoms that could be put down to climate change. The other doctors are seeing the same things; we’re all seeing that.”

Brace for impact: it’s going to get worse

The RACGP’s concerns are wide ranging, and cover the short and long term. Dr Senior says changing environmental impacts, such as air pollution, water access, and nutrition, will have flow-on effects for people’s health.

There are also concerns specific to different regions.

“Some GPs in southern Queensland will see more dengue fever coming through,” Dr Senior says. “Where I live it might be more Ross River or Barmah Forest virus.”

Then there are the indirect impacts, such as the effect of drought on food production, resulting in a poorer quality diet. Vulnerable patients, who already struggle to afford adequate housing, heating or cooling, will be the first affected and least able to deal with weather extremes.

The mental load

Drought, bushfires and floods have been shown to have severe and long-term effects on mental health. They can also make existing problems worse.

“If you’re already struggling for money or work, having other difficulties piled on top – such as drought, going through a flood, or seeing your children get unwell because of the effect of a heatwave – that adds stress,” Dr Senior says.

Instead of drinking water, “yellow sludge” came out of the taps on the day that Dr Senior visited Walgett, a town in northern NSW. Residents had to boil it or wait for bottled supplies.

“You can imagine the [mental] impact of having to do that for something that we take for granted – it is terrifying.”

Born into a heating world

Older Australians, children, and those with pre-existing conditions are likely to feel the health effects of the climate crisis earlier than the general population, but children have the most to lose, according to a report by Doctors for the Environment Australia. Research has found that globally, 88% of disease due to climate change is borne by children under the age of five, the report says.

“It’s hard to get your head around that,” Dr Senior says. “They will live through climate change in a way that no other generation has had to. They won’t know anything but chaotic climate.

“And we know from a lot of the research into health inequality that the first five years of life, as well as pregnancy, are crucial in terms of future health. They have a massive impact.”

Managing your health in a changing environment

Dr Senior says GPs understand what communities are going through, because it’s affecting them, too. GPs are best placed to help patients understand how changing temperatures and environment can affect their current conditions, or potentially spark new health concerns.

“We’ve always been advising behavioural change, and it’s based on having a therapeutic relationship with people,” he says.

“The behaviours that keep us well – walking more, driving less, eating less meat and less processed food, for example – also protect the environment.

“Our patients come first, which means our interventions are based on good science and evidence, along with a good understanding of the people we’re working with.”

That can entail advising individual patients at risk from heat or smoke to stay indoors at particular times, or advocating for those with respiratory illnesses to get better housing (as Dr Senior does).

It can also mean discussing interventions – such as diet, transport, energy usage, and community initiatives – to limit the effects of the climate crisis.

“We treat people and then we send them back to the circumstances that made them unwell,” Dr Senior says, “but it’s much better for all of us if we’re able to be kept well.”

GPs see 84% of the Australian population each year.

“That’s a massive reach. It’s a real opportunity to talk about the ways of mitigating climate change, the effects on their health.”

The Royal Australian College of General Practitioners (RACGP) is Australia’s largest professional general practice organisation – our mission is to improve the health and wellbeing of all people in Australia by supporting GPs, general practice registrars and medical students.

NACCHO Aboriginal Health #SocialDeterminants and #ClimateChange : How the @Walgett_AMS community members and market garden are at risk from high sodium in water in drought-stricken NSW town

Unfortunately in our community and particularly Aboriginal people, they have a high incidence of chronic disease,

I believe we are going to have an increase in chronic disease here, particularly from the water consumption,

In my life here in Walgett for 40 odd years, it’s the first time I’ve never drank straight from the tap.

I just worry for people who have to drink straight from the tap.”

Chief Executive of the Walgett Aboriginal Medical Service, Christine Corby, said high blood pressure, heart disease, kidney disease and diabetes were common health issues:

The Australian guidelines do state that medical practitioners who are concerned about people with hypertension should advise that people drink water with no more than 20 milligrams of sodium per litre. The Walgett drinking water is about 15 times that amount … so we need to be thinking about action to address that

Salt of the earth see Part 2 below

” It’s part of good health, it’s part of healthy living, it’s part of prevention and treatment of chronic disease.

For now, the garden has an exemption from the town’s level-5 water restrictions, I’m not sure how long that would last. And even with the exemption, the bore water on offer may not be suitable for gardens.

The research that we’ve received from the University of New South Wales has indicated the long-term effects, the quality of the plants, they will deteriorate, the nutrients will be reduced so it doesn’t work,

“In the long term we can’t sustain the garden.”

The Walgett Aboriginal Medical Service runs a community garden which provides fresh produce for its chronic-disease clients.

Christine Corby said the garden was crucial to these people

The Garden was featured recently in our #refreshtheCTGrefresh campaign

Part 1 : Walgett has always been a river town, perched near the junction of the Barwon and the Namoi rivers.

But with the drought biting hard, the water from those rivers isn’t making it to this northern New South Wales town.

See original ABC post here

With nothing to pump from the local weir, Walgett is the latest town forced to go underground for water.

It is now on an emergency supply of bore water, and many locals are worried it is damaging their health.

PHOTO: The Barwon River at Walgett is just a series of stagnant pools at the moment. (ABC: Danielle Bonica)

Dharriwaa Elder, Thomas Morgan, said the water was no good for drinking.

“Too much salt in it,” he said. “The kids, my grandkids, they’re starting to spit it out, they don’t like it.”

Elder Rick Townsend lives near the water treatment plant.

“I get the smell of it every morning and it’s the foulest smell,” he said.

“I don’t drink it, not at all. I drink the water at the hospital, tank water. Or I’ll buy the water in the supermarkets.”

Dharriwaa Elders Clem Dodd, Thomas Morgan, Rick Townsend and Richard Lake are concerned that the town’s emergency bore water isn’t healthy for people to drink.

Another local, Chantelle Kennedy, said most people were avoiding the tap water. “Most of us go to IGA and buy packs of 24 bottles for $20. It’s dear,” she said.

“A lot of people have been buying fizzy drinks because of the water. Some of them come out and buy hot drinks, which is cheaper than buying water.”

Part 2 : Salt of the earth

The bore water is from the Great Artesian Basin, and tests have shown the sodium levels in the water exceeded Australian Drinking Water Guidelines.

Associate Professor Jacqui Webster, from the George Institute for Global Health, said the sodium levels were concerning.

“The sodium levels in the Walgett water supply are at 300 milligrams per litre and the Australian drinking water guidelines are 180 milligrams per litre, so that’s substantially higher,” she said.

Dr Webster said the guidelines for sodium in drinking water were based on taste rather than health.

But she said high sodium levels did pose serious health risks, particularly for people with underlying health problems.

“The Australian guidelines do state that medical practitioners who are concerned about people with hypertension should advise that people drink water with no more than 20 milligrams of sodium per litre,” she said.

“The Walgett drinking water is about 15 times that amount … so we need to be thinking about action to address that.”

Dr Webster said those who avoided salty drinking water by drinking alternatives such as soft drinks were solving one problem and creating another.

“If they are drinking the water it’s potentially a problem but if they are substituting it with other things that is also a cause for concern,” she said.

“Indigenous communities are suffering from greater incidences of diabetes, obesity and hypertension,” she said.

“In general people get a disproportionate amount of salt from processed foods in communities where there is limited access to fresh foods, so compounding that with sodium from the water supply is a problem, and it’s something we need to be looking into.”

PHOTO: Chief Executive of the Walgett Aboriginal Medical Service, Christine Corby, says the community garden may be forced to close if the town’s water situation doesn’t improve.(ABC Western Plains: Jessie Davies)

Part 3 Community veggie garden under threat

The Walgett Aboriginal Medical Service runs a community garden which provides fresh produce for its chronic-disease clients.

Christine Corby said the garden was crucial to these people.

“It’s part of good health, it’s part of healthy living, it’s part of prevention and treatment of chronic disease,” she said.

For now, the garden has an exemption from the town’s level-5 water restrictions, but Ms Corby said she was not sure how long that would last. And even with the exemption, the bore water on offer may not be suitable for gardens.

“The research that we’ve received from the University of New South Wales has indicated the long-term effects, the quality of the plants, they will deteriorate, the nutrients will be reduced so it doesn’t work,” she said.

“In the long term we can’t sustain the garden.”

 

‘It’s going to keep everyone alive’

Walgett’s mayor, Manuel Martinez, said the shire commissioned the town bore to provide water security in the event of shortages just like this one.

“Two years ago, we had the foresight to sink a bore. We’re drought-proofing our whole shire,” Cr Martinez said.

“This is Australia. We’re in a drought and until the drought breaks, that’s the only water supply we’ve got.”

“It’s going to keep everyone alive, and that’s what we’re here to do,” he said.

“The sodium level is a bit high, higher than normal, higher than preferred, but it’s within the guidelines and it’s the same level it is with other bores.

“I’ve lived in Lightning Ridge for the last 32 years with only bore water. Most of outback Queensland is on the Artesian Basin.”

Cr Martinez said that as soon as there was water in the rivers again, Walgett would be back on river water — or at least on a mixture of river and bore water.

He said the bore water was a short-term emergency supply.

“I’m not doubting what they say, long-term effects of anything can be harmful, especially sodium or salt in the water system,” he said.

Part 4 The upstream imbalance

PHOTO: Elders in Walgett say locals are sad and sorry that pastimes like fishing and swimming in the river are no longer possible. They’re concerned the river is dry not just because of drought but because of mismanagement and water use upstream. (ABC: Danielle Bonica)

Many residents in Walgett believe it is not just the drought that is to blame for the dry rivers.

They say the waterways have not being managed properly and that too much water is being taken out upstream.

Chairman of the Walgett Aboriginal Medical Service, Bill Kennedy, said it was hard when people saw so much water in the rivers not far up the road.

“We’ve lived through droughts before but there was always some water, and some running water,” he said.

“I guess progress has changed all that with irrigators, farming, and especially cotton further up the river.

“I was driving to Tamworth, Newcastle last week and there’s water in the rivers further up at Gunnedah, Narrabri, Wee Waa.

PHOTO: Chairperson of Walgett Aboriginal Medical Service Bill Kennedy. (ABC Western Plains: Jessie Davies )

The mayor agreed, and said it was frustrating to see so much water upstream in both rivers.

“Even in this present time now you’ll see irrigators spraying all their crops,” Cr Martinez said.

“You’ve got a town with no water supply and you go 30kms up the road and irrigators are pumping”

Cr Martinez said the last two water releases from Lake Keepit were supposed to flow down as far as Walgett but they never made it.

“It’s beyond council’s control … we can only apply to push, to get another release, and try and get water to make it down to us.”

He said there was another water release from Lake Keepit on its way and hopefully this one will make it all the way to Walgett.

Spirits at low ebb

Many people in this community were deeply saddened by the state of the two rivers here.

Elder Rick Townsend says it was the worst dry spell anyone could remember.

“It’s a pretty bad state of affairs,” he said.

“It’s the worst I’ve ever seen it in all my life that I’ve lived here.”

For countless generations, the rivers have been a place to meet, fish and swim. But locals said at the moment that was simply not possible.

“There’s no fish or anything in the river any more,” says another Elder, Thomas Morgan.

“People used to come down here and fish every day, catch heaps of fish and crayfish. [They would] come with their kids and spend a good day here with them and be happy, and now they can’t do that.”

PHOTO: Dharriwaa Elders Group chairperson Clem Dodd. (ABC Western Plains: Jessie Davies )

For Clem Dodd, a spokesman for the Dharriwaa Elders Group, the implications for the community were dire.

“This place will be a ghost town before long,” he said.

“If there’s no water, everything’s going to die. There’ll be nothing here for people — they’ll all be moving out.”