Nurses at the frontline: preparing healthcare for climate change

In the face of climate change-induced health challenges, nurses could emerge as vital healthcare providers by drawing from their unique perspective and experiences.

Global warming is one of the greatest challenges of our time, with projections indicating it could lead to over 250,000 additional deaths per year between 2030 and 2050. 

Director of the Planetary Health Equity Hothouse Professor Sharon Friel said climate change could undermine decades of progress in global health.

"Climate change is the greatest threat to human health," professor Friel said.

"We're going to see more people needing healthcare services in the future, and nurses will be on the frontline.

"Already nurses and other healthcare professionals will be seeing the health impacts of climate change."

Heatwaves are becoming more frequent and intense as global temperatures rise, leading to heat-related illnesses, such as heat exhaustion and heatstroke, and an increased strain on emergency departments and critical care units.

Between 2000 and 2018, at least 473 heat-related deaths were reported in Australia, with another study estimating over 36,000 deaths associated with heat between 2006 and 2017. 

Heat stress can worsen pre-existing health conditions such as diabetes, kidney disease, and heart disease, with older people being especially susceptible to its adverse effects.

One study found that as temperatures rose, the number of people going to the emergency department increased, and they were sicker when they arrived. 

During a heatwave in 2009 in Victoria, there was a 12 per cent increase in emergency department visits and 374 more deaths than usual for that time of year.

Professor Friel said the nursing profession had a unique opportunity to integrate climate change into their practice and education.

"Nurses can be powerful advocates for climate action, using their knowledge and expertise to raise awareness and push for change," she said.

"Nurses have firsthand knowledge of the vulnerabilities of different patient populations, and their insights are valuable in developing targeted climate change mitigation and adaptation strategies.

"Climate change requires a multidisciplinary approach, and nurses can collaborate with other healthcare professionals to find innovative solutions."

The world is expected to warm by more than 1.5 degrees above pre-industrial levels by 2027, according to a recent Intergovernmental Panel on Climate Change (IPCC) report.

Warmer temperatures can increase the spread of infectious diseases through disease-carrying organisms like mosquitoes and ticks.

As these organisms move into new areas due to warmer temperatures, Australians are at a higher risk of diseases such as dengue fever, the Ross River virus, and Lyme disease.

For example, the Ross River virus infection affects roughly 265 Australians yearly, and those living around inland waterways and coastal regions are at increased risk.

Typically, epidemics occur after periods of heavy rainfall or high tides that cause salt marshes or coastal wetlands to be flooded.

As global warming is leading to more frequent floodings, thunderstorms and heavy rainfalls, Australia could expect a rise in Ross River virus infections.

Victoria reported nearly 2,000 cases in 2017 following increased rainfall and floods.

In 2022, areas like Lansvale and Camden faced their most severe flooding in forty years, while the floodwaters in Windsor reached their highest level since 1978. 

As natural disasters occur, they profoundly affect a lot of the health infrastructure, professor Friel said.

Global warming and extreme weather events can also lead to more cases of foodborne and waterborne illnesses by affecting the reproduction rates of bacteria and viruses.

Additionally, climate change contributes to air pollution through more frequent and severe bushfires, exacerbating respiratory conditions and cardiovascular problems, thereby burdening healthcare systems.

According to a recent study, the duration of Australia's bushfire season has extended by nearly one month over the past forty years, now spanning 130 days per year.

By releasing large amounts of smoke and particulate matter into the air, pollution can exacerbate respiratory conditions such as asthma, bronchitis, and allergies.

One study found that 97 per cent of people living in the vicinity of the bushfires faced health complications due to smoke, and nearly 20 per cent had accessed healthcare services.

Air pollution also contributes to cardiovascular problems and other chronic diseases, increasing the healthcare system burden.

Professor Friel said Australia needed to prepare the healthcare system for the health problems associated with climate change.

"We need the healthcare system to be resilient," Professor Friel said.

"By increasing capacity, expanding education and adaptation, we can ensure our healthcare system can respond appropriately to the health challenges brought about by a changing climate."

Paradoxically, the healthcare sector is responsible for around 7 per cent of the nation's CO2 emissions, equivalent to the emissions output of entire South Australia. 

The global average is estimated at 4.4 per cent, with figures of 6 per cent in the UK and 10 per cent in the US. 

On the other hand, the health system also serves as the primary defence for people facing health risks associated with climate change.

Research Fellow at the Planetary Health Equity Hothouse Megan Arthur emphasised that collective action and coalitions were crucial in addressing climate change.

"We need a political and policy framework to strengthen the healthcare system and reduce emissions," Ms Arthur said.

"We need to be champions for action across all sectors, calling for mitigation and fair adaptation." 

Vulnerable populations, including older people, young children, and low-income communities, are disproportionately affected by the health effects of global warming. 

They're impacted by climate change through limited access to healthcare, pre-existing health conditions, and social determinants of health. 

Ms Arthur said equitable access to healthcare services and targeted interventions were essential.

"These impacts are inequitably distributed, driven by social, political, and economic systems," Ms Arthur said.

"The health impacts of climate change will grow for future generations."

Reducing greenhouse gas emissions, transitioning to renewable energy sources, and promoting sustainable practices are crucial steps in halting and reversing climate change.

Ms Arthur highlighted that community awareness and education programs could empower the public to adopt climate-friendly behaviours and contribute to collective efforts in combating global warming.

By prioritising the health impacts of climate change, Australia can pave the way for a more sustainable and resilient future, she said.

"It's important to recognise that solving climate change is not solely an individual responsibility.

"But healthcare workers can start by advocating for action within their own circles, communities, and workplaces.

"Collective action and coalitions are crucial in addressing climate change." 

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