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Flash flooding across the east, destructively hot bushfires in the west and rising sea levels all around our giant continent. Every year, there’s more evidence to suggest that climate change is directly affecting the lives of the 7 million Australians who live rurally.
Rural Australians are more likely to have present poorer health outcomes than Australians living in metropolitan areas (AIHW, 2019). This has previously largely been attributed to poorer access to health services. However, the rising climate crisis will add majorly to this health outcome disparity (National Rural Health Alliance, 2021), and in all likelihood identify even more areas of health with disparate outcomes for rural and metropolitan Australians.
But why do these differences between rural and metropolitan health outcomes exist? And how will the climate crisis exacerbate or minimise these differences?
Note: ‘rural Australians' refers to Australians living in inner and outer regional areas, remote areas and very remote areas. ‘Metropolitan Australians’ refers to Australians living in major cities. These definitions are influenced by the Australian Institute of Health and Welfare’s web report on rural and remote Australians: find the report here.
What are the current key health differences between metropolitan and rural Australians?
Some people swear by the refreshing country air, while some say the bustling nature of the city is as good as a coffee to keep you energised. When it comes to more favourable health outcomes, however, official data says that Australians living in the ‘Major Cities’ category – as defined by the Australian Institute of Health and Welfare – see generally better health outcomes than those living outside that category (AIHW, 2019).
A few examples of poorer rural health outcomes include:
Life expectancy: life expectancy for both males and females decreases as remoteness increases (AIHW, 2019).
Disease presentations: according to a 2015 study, the total disease burden rate in remote and very remote areas was 40% higher than in major cities (AIHW, 2019).
Hospitalisations: potentially preventable hospitalisations in very remote areas were 150% higher than in major cities (AIHW, 2019).
Major factors that come into play when considering these discrepancies between metropolitan Australians and rural and remote Australians are:
Accessibility to health services: rural Australians have to travel further than metropolitan Australians to receive general healthcare, and rural GPs are often required to shoulder a larger burden of care due to a lack of specialist facilities nearby (AIHW, 2019). Additionally, rural facilities have access to a smaller pool of healthcare workers from whom to receive emergency or last-minute support.
Economic welfare: while levels of unemployment tend to fluctuate in both rural and metropolitan areas, rural Australians are increasingly voting for smaller parties and independent candidates which suggests a lack of financial stability and opportunity in non-metro areas (Daley et al, 2017).
Cultural background: over 77% of Indigenous Australians live outside capital cities (National Rural Health Alliance, 2014). Indigenous Australians, regardless of where they live, tend to be socio-economically underprivileged in settler-colonial Australia. When this is compounded by living rurally, the health outcomes for Indigenous Australians generally become less favourable than non-Indigenous Australians living rurally (Bragge et al, 2021).
Given these discrepancies already exist, how will the climate crisis affect rural Australians? And is there anything we can do to mitigate worsening health outcomes?
How could the climate crisis affect rural Australians?
According to the National Rural Health Alliance, there are three main points of change that will affect rural Australians more than their metropolitan counterparts:
Extreme weather events: the Bureau of Meteorology and CSIRO are predicting a steady decrease in southern rainfall in Australia, meaning fire seasons will be longer and more intense, droughts will increase in frequency and duration, and intense heavy rainfall – which leads to flash flooding – will also occur more often (National Rural Health Alliance, 2021).
Food security: the IPCC has reported that climate change has ‘adversely impacted food security’ across the globe by rapidly warming the land surface air temperature (IPCC, 2019).
Vector-borne diseases: as vector-borne diseases are limited to certain geographical pathways, climate change-related alterations to the traditional seasonal weather patterns could cause these pathways to change. If these pathways change, more people will be exposed to these diseases (National Rural Health Alliance, 2021).
This incredibly in-depth report is essential reading for anyone working in rural healthcare, or who wants to understand the impending changes in rural practice and presentations.
Is the rural healthcare system able to support the healthcare fallout from these climate threats?
The short answer to this is: we don’t know. There’s currently a lack of funding available for research into rural health capacities and vulnerabilities, and subsequent forecasting into when, how and why those capacities will be challenged by climate-related health issues. Given we don’t know much about what the current vulnerabilities are, it’s almost impossible to accurately predict the rural healthcare fallout that may happen due to the climate crisis.
As a response to this gap in knowledge, the Royal Australian College of Physicians to the Australian Federal Government has highlighted seven recommendations. One of these recommendations is to ‘invest in climate health vulnerability and capacity assessments with a focus on locally-led planning' (Bragge et al, 2021). One of the RACP’s other recommendations perfectly complements this: ‘invest in prevention and early intervention as a key element of climate health action' (Bragge et al, 2021).
What the RACP is saying is that Australia currently doesn’t know what it doesn’t know when it comes to rural healthcare and its inherent vulnerability to climate change. This could prove incredibly dangerous for rural Australians, not to mention the integrity of some of Australia’s biggest industries such as agriculture and mining which rely on the health of the rural population in order to function at full capacity.
If the government take these recommendations seriously, Australia’s rural healthcare services and practitioners will be able to start building a post-climate crisis strategy that could be implemented incrementally. Given the rural healthcare system is already seeing a lack of food security, an increase in frequency of extreme weather events, and a growth in vector-borne disease presentations, it’s clear that rural Australia needs a climate crisis strategy as soon as is physically possible.
Is there any way to address this issue in your practice?
This article by no means addresses every aspect of this growing healthcare emergency: to learn more about the nuances of climate change and rural health, there are some great discussions and position papers available online. To start, read these:
If you choose to log these in your CPD portfolio, use the reflection as an opportunity to both contextualise this knowledge within your practice as well as create a plan for action. Are you able to help by signing up as a travel or agency nurse for a nearby remote area? Or maybe you could share these reports with your colleagues so you all stay up to date on the struggles of your rural counterparts?
Whether you choose to critically engage with this issue on a practice, policy or personal level, all of these avenues start the same way: reading up on the issue itself.
IPCC, 2019. ‘Climate Change and Land: an IPCC special report on climate change, desertification, land degradation, sustainable land management, food security, and greenhouse gas fluxes in terrestrial ecosystems: Summary for Policymakers.’ International Panel on Climate Change. Accessed 21 April 2022 via https://www.ipcc.ch/srccl/chapter/summary-for-policymakers/