This article was originally published by The Fifth State 

Have you ever experienced that feeling of utter exhaustion and sleep-deprivation during a summer heatwave? If so, you’re among the growing number of Australians at risk of illness or death from climate impacts. It’s a public health emergency that’s received scant attention, something researchers are looking to address.

Whether it’s increased emergency department presentations due to heat-related cardiovascular events or higher numbers of suicides due to the mental health toll of heat events, the Australian climate is becoming more lethal. However, according to researchers, we don’t know exactly how many people are dying due to heat in Australia.

This lack of data has been a complicating factor in achieving the appropriate level of action across policy areas including housing, planning, health, business, emergency services, energy and human rights.

A new project by Natural Hazards Research Australia, Heatwave resilience and impacts, aims to help address the gaps in knowledge, data and practice around how we manage to keep people alive and well in the warming climate.

The project will assess the effectiveness and reach of current heatwave warning services; develop a methodology for real-time, accurate reporting of heat-related mortality; explore the full impact and costs of heat-related events; and explore the electricity sector’s role in community vulnerabilities to extreme heat and opportunities for adaptation.

The research team includes experts from the Bureau of Meteorology, Energy Networks Australia, Monash University, The University of Sydney, Australian National University, Charles Sturt University, Virginia Tech, Swinburne University of Technology, WA Health, NT Health, Australian Institute of Health and Welfare, Australian Institute of Health and Safety, Country Fire Service (SA), Australian Bureau of Statistics, Resilient South, and the University of New South Wales.

Linking heat, health and housing

Director of the Heat and Health Research Centre at the University of Sydney, Dr Ollie Jay, is contributing to the project. He is also chair of the Hazards and Impacts Working Group for the Global Lancet Countdown on Health and Climate Change team.

Speaking at a recent webinar on heat and mental health organised by the Royal Australian and New Zealand College of Psychiatrists, Jay said the impact of heat on mortality rates is “accelerating under all plausible (climate change) scenarios”.

Heat impacts and managing them need to be embedded in public health policy, he said.

It also needs to be embedded in how we address housing, as the results of the Sweltering Cities 2024 Summer Survey showed.

Dr Emma Bacon, co-founder and director of Sweltering Cities, told webinar attendees the survey also found that one in three people leave their homes to go somewhere cooler. The discomfort of their home becomes a “push factor” that sends people to retail centres, libraries or pools.

Not everyone is able, however, to leave their home and escape the heat. Lack of transport, lack of finances, disability, illness or isolation can all result in someone having to sweat it out and experience health effects ranging from lack of sleep, cardiovascular issues and mental health crisis through to fertility issues or a diabetes crisis.

“This is an issue of housing rather than heat in some ways,” Bacon said. “Too many people don’t feel safe in their hot home.”

Renting is a heat health hazard

The most vulnerable people, and those reporting the highest frequency of health effects from heat in the survey, are low-income persons, social housing tenants and private market renters.

“There are insufficient protections for renters. Heat is putting a bigger burden of disease on them than people who own their home,” Bacon said.

Energy costs also mean that renters who have a home with air conditioning (although many do not) may be hesitant to run it. Bacon says both private market renters and public housing tenants need to be provided with cheap, renewable energy.

“They can’t be left behind.”

Rising patient loads for GPS

Executive director of Doctors for the Environment Australia, Dr Kate Wylie, said that for medical practitioners, the climate crisis “is our lane as health professionals.”

“This is not a future problem, it is a current problem,” Wylie said.

It is also increasingly part of a GP’s daily work.

“We need to expect that on hot days we’ll see more heart attacks, more mental health illness, more domestic violence – and we need to plan for it.”

Slow burn in planning policy

While there has been some recent movement in relation to the planning system and climate change resilience, including a recent NSW Government Planning and Environment Portfolio Committee Inquiry into the planning system and the impacts of climate change on the environment and communities, the approach remains piecemeal.

Western Sydney Regional Organisation of Councils (WSROC) commented on the state government’s response to the inquiry, welcoming the acknowledgement of recommendations on heat resilience.

However, the government fell short of sufficient acknowledgement of the role of place-based planning, according to WSROC president, Councillor Brad Bunting.

“A well-designed home is about more than just comfort; it can reduce cost-of-living, deliver better health outcomes and support life safety in extreme events,” he said in a media statement.

Planning is a “team sport”, and delivering cooler suburbs will require state and local government working together.

“Research shows that failing to implement proactive planning rules now will lead to reactive retrofits which are estimated to cost 3-4 times more, without properly solving the heat problem.”

Dude, where’s the data?

Senior research fellow at the Urban Transformations Research Centre at Western Sydney University, Dr Thomas Longden, published a research paper in 2019 that used mortality data from the decade between 2006-2017 to scope the magnitude of heat-related mortality. His research found over 36,000 heat-related deaths. It is likely deaths have been under-reported up to 50-fold.

He tells The Fifth Estate that it’s positive more people are talking about heat, as it is “making the invisible, visible.”

Who gets caught out

Most people have experienced a “worst day” and have a story about feeling “close to the edge” or themselves or someone they care about ending up in hospital – or worse.

The introduction of community safety tools such as the BoM heatwave alerts in the BoM weather app also mean more people are cognisant.

However, what is “sorely missing” is targeted conversations with people who have vulnerabilities including age, existing medical conditions, language barriers, cultural barriers, disability, low household incomes or low levels of control over their residential and/or work environments.

“We want to prevent people getting caught out,” Longden says.

Some people find themselves at risk because they try to get to a heat-safe place, but the mode of transport available exposes them to heat extremes. People who work outside, including courier drivers, or even regular commuters standing at unshaded train stations or bus stops, are also at risk.

Much of the research has also focused on capital cities, which means we are not gaining a picture of how heat is affecting regional, rural and remote populations. That’s nearly 10 million people whose heat experience needs to be considered.

Fundamentals need to shift

Longden says that the current building and planning codes, which are based on climate zones, may need adjusting because the climate is changing.

“People will need to change their behaviours to adapt,” he says. “We will probably need to adopt the concept of a ‘heat season’ when a lot of people won’t be able to do what they have been used to doing during other seasons.”

Things such as working hours, school hours and social practices may need to change.

There is also a need for research into temperature-related energy security, and this needs to be done according to our climate zones.

Insurance needs to catch up

While the property insurance industry has already started down the path of understanding climate impacts, Longden says the health insurance sector remains focused on behavioural choice matters such as diet and exercise, things individuals can control.

“Heat is a health risk multiplier, but health insurance has not gone down the road of helping people avoid heat harms,” Longden says.

The data gap also needs to be addressed. While there are diagnosis codes for heat-related illnesses, it is rare for a GP to report excessive heat on a death certificate, Longden says. This needs to change.

Other important adaptation measures to protect health could include retrofit programmes for insulation to improve passive cooling performance during heat extremes, adopting something similar to the UK Priority Services Register to identify persons with health issues that make them more vulnerable during power outages, and supporting medical practitioners to engage with prevention strategies.

“There could be a Medicare item enacted for heatwaves, and the GP calls their three most vulnerable patients and talks to them to advise them of how to prepare for extreme heat,” Longden explains.

Above all, he stresses the need for an integrated policy approach across health, climate adaptation and energy.

“We need much more cross-sectional thinking about heat that incorporates an understanding of health, energy and healthy homes.”

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