Climate change, health and wellbeing: challenges and opportunities in NSW, Australia

The NSW (New South Wales) Climate Change Policy Framework, launched by the NSW Government in 2016, recognises that climate change presents risks to health and wellbeing. Risks to health and wellbeing come from direct impacts of extreme weather events, and from indirect impacts through effects on air, water, food and ecosystems. Responding to these challenges offers an opportunity to protect and promote health by enhancing environmental amenities, and building adaptive capacity and resilience in populations and systems. To develop policy that effectively protects and promotes health in the face of climate change in NSW it is necessary to define the expected impacts of climate change on health and wellbeing in NSW

Knowledge translation lessons from an audit of Aboriginal Australians with acute coronary syndrome presenting to a regional hospital

Objective: Translation of evidence into practice by health systems can be slow and incomplete and may disproportionately impact disadvantaged populations. Coronary heart disease is the leading cause of death among Aboriginal Australians. Timely access to effective medical care for acute coronary syndrome substantially improves survival. A quality-of-care audit conducted at a regional Western Australian hospital in 2011–2012 compared the Emergency Department management of Aboriginal and non-Aboriginal acute coronary syndrome patients. This audit is used as a case study of translating knowledge processes in order to identify the factors that support equity-oriented knowledge translation. Methods: In-depth interviews were conducted with a purposive sample of the audit team and further key stakeholders with interest/experience in knowledge translation in the context of Aboriginal health. Interviews were analysed for alignment of the knowledge translation process with the thematic steps outlined in Tugwell’s cascade for equity-oriented knowledge translation framework. Results: In preparing the audit, groundwork helped shape management support to ensure receptivity to targeting Aboriginal cardiovascular outcomes. Reporting of audit findings and resulting advocacy were undertaken by the audit team with awareness of the institutional hierarchy, appropriate timing, personal relationships and recognising the importance of tailoring messages to specific audiences. These strategies were also acknowledged as important in the key stakeholder interviews. A follow-up audit documented a general improvement in treatment guideline adherence and a reduction in treatment inequalities for Aboriginal presentations. Conclusion: As well as identifying outcomes such as practice changes, a useful evaluation increases understanding of why and how an intervention worked. Case studies such as this enrich our understanding of the complex human factors, including individual attributes, experiences and relationships and systemic factors that shape equity-oriented knowledge translation. Given the potential that improving knowledge translation has to close the gap in Aboriginal health disparities, we must choose strategies that adequately take into account the unique contingencies of context across institutions and cultures

A conceptual framework for climate change, health and wellbeing in NSW, Australia

Changes in natural hazards related to climate change are evident in New South Wales (NSW), Australia, and are projected to become more frequent and intense. The impacts of climate change may adversely affect health and wellbeing, directly via extreme weather events such as heatwaves, storms and floods, and indirectly via impacts on food security, air and water quality, and other environmental amenities. The NSW Government’s Climate Change Policy Framework recognises the need to reduce the effects of climate change on health and wellbeing. A conceptual framework can support the aims and objectives of the policy framework by depicting the effects of climate change on health, and individual and social wellbeing, and areas for policy actions and responses. A proposed conceptual framework has been developed, modelled on the Driving force, Pressure, State, Exposure, Effect and Action (DPSEEA) framework of the World Health Organization – a framework which shows the link between exposures and health effects as well as entry points for interventions. The proposed framework presented in this paper was developed in consultation with researchers and policy makers. The framework is guiding current research examining vulnerabilities to climate change and the effects of a range of exposures on health and wellbeing

Flight-associated transmission of severe acute respiratory syndrome coronavirus 2 corroborated by whole-genome sequencing

To investigate potential transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during a domestic flight within Australia, we performed epidemiologic analyses with whole-genome sequencing. Eleven passengers with PCR-confirmed SARS-CoV-2 infection and symptom onset within 48 hours of the flight were considered infectious during travel; 9 had recently disembarked from a cruise ship with a retrospectively identified SARS-CoV-2 outbreak. The virus strain of those on the cruise and the flight was linked (A2-RP) and had not been previously identified in Australia. For 11 passengers, none of whom had traveled on the cruise ship, PCR-confirmed SARS-CoV-2 illness developed between 48 hours and 14 days after the flight. Eight cases were considered flight associated with the distinct SARS-CoV-2 A2-RP strain; the remaining 3 cases (1 with A2-RP) were possibly flight associated. All 11 passengers had been in the same cabin with symptomatic persons who had culture-positive A2-RP virus strain. This investigation provides evidence of flight-associated SARS-CoV-2 transmission

Hospitalization Costs of Respiratory Diseases Attributable to Temperature in Australia and Projections for Future Costs in the 2030s and 2050s under Climate Change

This study aimed to estimate respiratory disease hospitalization costs attributable to ambient temperatures and to estimate the future hospitalization costs in Australia. The associations between daily hospitalization costs for respiratory diseases and temperatures in Sydney and Perth over the study period of 2010–2016 were analyzed using distributed non-linear lag models. Future hospitalization costs were estimated based on three predicted climate change scenarios-RCP2.6, RCP4.5 and RCP8.5. The estimated respiratory disease hospitalization costs attributable to ambient temperatures increased from 493.2 million Australian dollars (AUD) in the 2010s to more than AUD 700 million in 2050s in Sydney and from AUD 98.0 million to about AUD 150 million in Perth. The current cold attributable fraction in Sydney (23.7%) and Perth (11.2%) is estimated to decline by the middle of this century to (18.1–20.1%) and (5.1–6.6%), respectively, while the heat-attributable fraction for respiratory disease is expected to gradually increase from 2.6% up to 5.5% in Perth. Limitations of this study should be noted, such as lacking information on individual-level exposures, local air pollution levels, and other behavioral risks, which is common in such ecological studies. Nonetheless, this study found both cold and hot temperatures increased the overall hospitalization costs for respiratory diseases, although the attributable fractions varied. The largest contributor was cold temperatures. While respiratory disease hospitalization costs will increase in the future, climate change may result in a decrease in the cold attributable fraction and an increase in the heat attributable fraction, depending on the location