2020 Sidney Sax Medal awarded to the Australian National University’s College of Health and Medicine's Bushfire Impact Working Group

During the 2019-2020 Australian bushfires that sent smoke rolling into Canberra, current President of the Australasian Faculty of Public Health Medicine, Professor Lucas, was on holiday in Aotearoa New Zealand. Typically, Canberra is known for its fresh, crisp air and blue skies, so it was to Professor Lucas’s astonishment when her daughter contacted her asking if she could bring home an air purifier. No air purifiers could be found anywhere in Canberra, as the area was experiencing the worst air quality in the world for many days over the period of the bushfires. Dr Hunter, a cardiologist with a strong focus on preventative medicine and patient-centred care, recalls: “We lived through November and December of 2019 with smoke haze and high levels of air pollution. I was working at the Canberra Hospital, on call, at the end of December 2019. We had several critically bad days of both bushfire risk and hazardous air pollution in December 2019 and in early January 2020.” The BIWG sprang into action in early January 2020, collaborating with community groups, Chief Health Officers, Chief Medical Officers and professionals who knew about air pollution. “Immediately after the new year, with ANU Campus closed because of bushfire smoke, the Dean of our College, Russell Gruen, called an informal meeting of anybody who was in Canberra in health who strongly felt we had to do something,” recalls Professor Lucas. “Our group brought together psychology, climate science and disaster communication people, as well as clinicians and public health experts, all in the room together. These multidisciplinary and interdisciplinary models are an important part of how we can work in the future, especially when addressing issues such as climate change and its effects on health. So, you can say that this disaster, that no one wanted to see happen, gave us an opportunity to rekindle our ANU commitment, academic curiosity and engagement with the health risks of climate change. But this was not just professional, it was personal too with three of our CHM Professors who had been in evacuation centres along the south coast during the worst fire period. There were several people in our group who were personally affected by some element of the bushfire disaster on the south coast, and all of us were affected by bushfire smoke exposure,” reflects Dr Hunter. Professor Lucas recalls, “What could we do as a university and as a College of Health and Medicine to help in this situation to protect people’s health? We had these long meetings, three or four hours every day, day after day after day. We eventually pinpointed the need for simple, evidence-based communication, in multiple languages, as an urgent need. At the same time a huge piece of work was going on, we developed four broad themes of research, to understand the impacts and provide direction for interventions to support physical health, mental health, communities and social functioning, and the health system response.” Before long, the BIWG was distributing guides to people about wearing masks, the appropriate masks to wear, air purifiers, and about limiting one’s physical activity during the bushfire smoke. These guides trended across social media with tens of thousands of hits. “We initiated multiple research projects on physical health and we are still analysing and writing papers from some of that data. A big project on mental health, including from the smoke and from the fires, in terms of loss of the ability to be outside and connect with nature. Quite a lot of work with communities in Canberra affected by the bushfires, particularly people who were socially isolated, and how we maintained social connectedness,” recounts Professor Lucas. “We also did some work with an Aboriginal community in Mogo, New South Wales, which highlighted that one of the groups that were most at need of support were actually the Aboriginal health workers who themselves were suffering from the bushfires, but who were having to give so much to the people that needed them. They were getting pulled and impacted in both directions.” Dr Hunter continues, “We also engaged in the policy space. There was a Senate Committee report into the bushfires and there was the Royal Commission into National Natural Disaster Arrangements (also known as the Bushfire Royal Commission). As a group of health practitioners, we were active participants advocating for the importance of human health through the prism of natural disasters. Our voice was effective and was useful in terms of the policy impact of that work.” Dr Hunter maintains the important work of the BIWG today. As she explains, “There’s flow on work from the BIWG. We are continuing to meet and the publications that are stemming from last year’s work are beginning to accumulate. Our Mother&Child2020 Study, led by Professor Chris Nolan FRACP, has recruited more than 1,000 women who were pregnant during the fires and smoke exposure period. Despite not having any funding for this research, we are very keen to continue this through whatever means we can. We also have other active research questions which we are continuing to work on, and ongoing work in the policy space. With the Institute for Climate, Energy and Disaster Solutions we have been involved in several workshops looking at the Bushfire Royal Commission and the health system and public policy response.” Professor Lucas reflects, “We’ve done a really good job of describing what the effects of climate change on health and wellbeing are likely to be. We’ve done a less good job on being able to actually attribute a burden of disease to climate change or to environmental factors. It makes it hard to then quantify the effect of climate change, but now I think there’s a real move to people saying we know there are going to be effects, what can we do about it. It has now become very action oriented. We know that the sea level is going to rise, we know that there are a whole lot of Torres Strait Islands that are already being inundated, affecting lifestyles and food sources, and with a number of cultural impacts. Our work must now move to what we are going to do about it. “We understand that there are co-benefits from mitigation, and that climate change is happening, we are on track for more than 1.5 degrees of warming, so there will be things that we will have to deal with. A real focus now is on how we prevent ill health and loss of wellbeing. “Physicians have a role in the community, we are trusted. People understand that we read the evidence, we assess it, we do what’s best for patients and populations, we have a pivotal position to be able to say to people look we’ve looked at all the evidence, we've assessed it, we believe this is the truth, and it's really important. We take a role of an advocate. As doctors, we also have tan important role in our own practices, in terms of the amount of greenhouse gases that healthcare generates.” Dr Hunter agrees, “More broadly than the BIWG, there is invigorated enthusiasm we have for thinking about climate change and health, and its influencing some of the teaching that we do at the medical schools. We have a whole generation of medical students who are aware of climate change, and we can provide good quality teaching around environment and climate change as a health impact concern. This Black Summer event gave many of our general practitioners, our physicians, our hospital services direct experience in the inter-relationship between environment and health. These difficult, complex problems that affect, at their core, our human health and wellbeing. We hope we can come up with some great solutions with collaborative approaches. “The climate, the natural environment, the world in which we live affect our health and wellbeing. We know this intuitively and through good quality research and science we will continue to understand the health links. We need to have better appreciation of this in our policy and research agendas. I’d love to see an increased awareness of this spread not just in my own institutions, but as a broader policy perspective for the College. I know there’s a lot of enthusiasm for this from many parts of our medical community and from College members. I’d love to see people engaging in a deeper understanding of the environment in which we live and the effect on human health and wellbeing. What does that mean in practice? The Bushfires Royal Commission highlights the concern that Black Summer is the beginning of decades ahead of our climate changing with increasing risk of national natural disasters. The Royal Commission also offers us a pathway for better adaptation. There’s an opportunity for us to engage not just with our own individual patients, but with the communities in which we live. Particularly when we think of adaptation, through an increasingly hot or unstable climate, as doctors, it is our job to help to defend the health and wellbeing of our communities. It’s an extraordinary opportunity for us to engage in population protection mechanisms and working with communities on air pollution, heat preparation and disaster resilience, because we know this has big impacts on our mental and physical health and wellbeing going forwards.”