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Rural Health Webinar Series - Climate Change and Rural Health

Alright. Hello, and welcome everyone to the latest instalment of our rural health webinar series. It is on Addressing Climate Change and Rural Health. Thanks everyone for joining us tonight.  I am Dr Catherine Pendrey and I am the facilitator tonight. And I am a GP who has an interest in health equity and sustainability.
So I would like to acknowledge the traditional owners of the land on which we are meeting tonight and pay my respects to Elders past and present and to emerging leaders. I am speaking to you from the land of the Boonwurrung and Wurundjeri Woiwurrung people of the Kulin nation. And I would like to acknowledge their stewardship of land, seas and sky and continuing connection to country, as well as acknowledging any and all Aboriginal and Torres Strait Islander people that are joining us tonight.
So we would like to thank our sponsor for this evening tonight, Ochre Health and Recruitment, who have made this event possible. Very grateful for their support. So they are a group that has been established and run by a couple of procedural GPs and they operate medical centres around Australia, as well as a medical recruitment company that helps staff both hospitals and practices throughout Australia and New Zealand.
So, finally, before we start, just some basic housekeeping. Everyone is on mute tonight, just to prevent background noise, but we do encourage you to use the chat and the Q and A box. And when you are using the chat we do encourage you to select all panellists and attendees, so that everyone can see your questions and comments. And also just to make a note that this webinar is accredited for two CPD points, but to gain these you need to be present for the whole webinar. And we do also ask that you complete the evaluation, yes.
Alright, so we are very lucky to have a very impressive panel here with us tonight. We are going to hear from all of them and we will hopefully have some time for questions at the end. So first we will hear from Associate Professor Lachlan McIver. He is a rural generalist and a public health physician, with over 15 years of experience working in remote indigenous and tropical communities in Australia, Africa and Asia Pacific. He has done a PhD on the health impacts of natural disasters and climate change in Pacific island countries, and he has worked for the World Health Organisation for several years as a consultant on that topic. He is currently working as Tropical Diseases and Planetary Health Advisor for Medecins Sans Frontieres in Geneva, and that is where he is joining us from tonight. And he is also an Adjunct Associate Professor with JCU, particularly in the area of tropical medicine. And he is the co-founder and director of Rocketship Pacific which is an NFP that works on strengthening primary health care in the Pacific.
After that, we will hear from Bob Vickers, a rural generalist and advocate for local public health preventative measures, particularly in the area of air quality in the Hunter Valley. Now he regularly speaks on the health impacts of air pollution from fossil fuels and wood smoke and he has appeared on a range of media including the ABC’s very notable Fight for Planet A series, and also The Project.
Associate Professor Lyn Fragar is a public health physician who has focused a lot throughout her career on improving health service delivery and farm safety in rural Australia. She is a Director of GP Synergy. She is a Chair of the Rural Safety and Health Alliance, and she is the immediate past Chair of Hunter New England Health Service which is leading healthcare sustainability in Australia, having committed to net zero carbon and waste by 2013.
And our final speaker tonight will be Associate Professor Dr Anne Poelina and she is a Nyikina Warrwa woman from the Kimberley and she is a community leader. She is a human and earth rights advocate, a filmmaker, and a highly respected academic. She has three masters and a PhD spanning the fields of health, education and social policy. She holds senior academic appointments at Notre Dame, Charles Darwin University, and ANU’s Crawford School of Public Policy in the Water Justice Hub. And just doing pioneering work on the new green economy.
So without any further ado or more from me, I will now hand over to Lachlan to start his presentation. Thanks very much, Lachlan.
Thanks Catherine and good evening everyone. I think I just need Catherine or
Tori to stop sharing their screen, so I can do so, please. Catherine or Tori? Great thanks. Okay, so all going well I think you should be able to see my version of that first slide. Is that is that right, Catherine? Yes, great thanks. Alright so yes, good evening everyone. It is a privilege to be with you and certainly an honour to be sharing the panel with such distinguished colleagues. Thanks for the kind introduction, Catherine. Let us get into it. So I will be talking about the perspective of MSF on climate change and health and particularly how we are choosing to frame it here at MSF Operations Centre Geneva, which is in terms of planetary health, thinking a bit more broadly beyond just climate change to other aspects of planetary health.
So what I will be reviewing in the next few minutes is how we have determined our medical priorities within the domain of planetary health, which is one of the five strategic pillars of our current triennial plan. A brief review of the key science and evidence upon which we are basing our decisions about which topics to focus on. What that means for us operationally in the 30-something countries where we currently work. And I will give you a few examples of what planetary health looks like in the field for MSF. Okay, and also give you some indication of where we think this field of work is heading over the next few years.
So in considering what are the medical priorities for MSF in relation to planetary health, we are considering a key definition of the term, in that planetary health refers to health problems in human populations arising from the interaction between humans, animals in the environment. So you can see already, that that captures the health impacts of climate change, but also considers other phenomena such as the non-hydro-meteorological disasters, earthquakes, tsunamis, volcanoes as well as forms of environmental degradation that are not explicitly linked to climate change, but there is some overlap. Things like deforestation, desertification, salination of water sources, artisanal mining et cetera.
When we look at the last 10 years of what MSF Operational Centre has reported as the topics that are being addressed in our projects that most closely link to that definition of planetary health and how commonly those topics occur in relation to each other, the word cloud looks like this. So, I am sure most of you have at least a sort of a reasonable level of understanding of what the key health problems are that relate to climate and environmental health so there will be few surprises in here for you, I imagine. Vector borne diseases, particularly malaria, dengue and other viruses, waterborne diseases, particularly diarrhoeal diseases including cholera, malnutrition, natural disasters and neglected and emerging infectious diseases represent the top five priorities for us in terms of what we have been working on in the past. Now there is a whole big mess of problems out there that MSF has really not yet gotten into. Things like air pollution, heat, climate change, latent effects on non-communicable diseases, psychological health. These are areas that we have not yet waded into, but in terms of focusing our objectives, this is what we have recently been working on and will help guide our work over the next few years.
This graph here is just intended to show that these problems, the malaria, the malnutrition, the cholera, and natural disasters across the countries where OCG works, tend to occur repeatedly and in more than one form at the same time. So the purpose of this exercise, and I imagine you probably cannot see the names of the countries very clearly, is just to point out that we needed to find a way to focus our efforts because we cannot be doing everything, everywhere, immediately, and indefinitely. So there are a few countries where planetary health related problems were greater and more extended over time. So it is no surprise that we are currently investing most of our efforts in relation to planetary health in countries like Sudan and South Sudan, Niger, Democratic Republic of Congo and Cameroon.
I will just give a brief, very brief, overview of the weighted evidence linking those priority medical topics with climate change in particular. I am sure most of you are familiar with schematics like this, this one has been published most recently in The Lancet Countdown on Climate Change and Health to which MSF has contributed over the last few years. We think about malaria, it is probably the single most important climate sensitive disease for MSF. The best evidence we have suggests that over the next few decades, climate change will cause an additional 15 million cases of malaria. And when we consider that 90% of the malaria burden worldwide, occurs in sub Saharan Africa and two thirds of the deaths from malaria occur in children, what that means is that in the next few decades, climate change will cause an additional 50 deaths of children every day due to climate change, and we think this is completely unacceptable. In addition, there will be an additional billion, one billion people, exposed to dengue fever. When it comes to diarrhoeal diseases like cholera, you would be aware I am sure that diarrhoeal diseases are already among the top killers of children worldwide. Responsible for 1.5 million deaths in children under five. And it has been estimated, the best evidence we have, is that for every one degree Celsius increase in ambient temperature, the incidence of diarrhoeal disease will increase by 5%. When you think 5% does not sound like much, but when you put that in context of diarrhoeal disease causing 1.5 million deaths, 5% sounds like a lot more.
Malnutrition is a key climate related health problem. There is a lot of debate, for example, in the current climate in Madagascar about whether it is climate change related or not. To me, this is immaterial. We do not need or want to get caught in the so-called attribution trap of whether climate change is responsible for specific events. It is the trends that we are concerned about and the overall impacts on health in populations around the world. The WHO estimates that of climate change related mortality, that we are approaching already at least 250 thousand avoidable deaths per year due to the climate change. This is a very deliberate underestimate, because it only considers four categories of climate related ill health. Malnutrition is one of them, and it represents about 50% of that annual mortality burden. So it is almost inevitable that the number of people each year affected by malnutrition related to climate change is going to increase, as will the burden of natural disasters, particularly those that are hydro-meteorological or related to climate change, droughts, floods and severe storms in particular. These already cause 50 to 60 thousand deaths per year, and the overall burden of natural disasters is that they are going to become more frequent and intense over time.
Of course we are in the midst of a pandemic that is likely related to a zoonotic virus spill over event, as have been most pandemics throughout human history that we are aware of. Most emerging infectious diseases are viruses, most of them come from animals, and surveillance of emerging infectious diseases is extremely complex, as is the development of the diagnostic tools, the therapeutics to manage those epidemics when they occur. These are very closely related to this definition of planetary health, increased interactions between humans, animals and the environment. And for an organisation like MSF, well we are very accustomed to responding to such outbreaks when they occur. One of the challenges for us at the moment is figuring out how we can sort of move our focus a bit upstream and be more involved in the surveillance, to be able to anticipate what such viruses might affect human populations, and then how those spill over events can be avoided.
We are also, as I mentioned at the beginning of the presentation, increasingly concerned about other aspects of planetary health, not just those sort of more or less directly linked to climate change. I do not have time to really get into issues around deforestation, desertification, other forms of environmental degradation, including artisanal mining at the moment, but these are growing concerns for global health, planetary health and for organisations like MSF.
So what does that mean for us? How are we trying to translate the prioritising of these medical topics into concrete activities on the ground? So, for vector borne diseases, we are working hard at the moment to develop meteorological and environmental based early warning systems for severe malaria epidemics in South Sudan and Tanzania, to enable a more informed and precisely plan preventive actions, including vector control, health promotion, community based test and treat activities. We are trying to take a more data driven approach to emergency preparation, such as for natural disasters, and improve our surveillance and anticipation of food and nutrition security crisis, malnutrition, just to name a few examples.
Very briefly, to give you some sense of what we have been doing in this area of work in the last 12 months. We responded to the double hurricane disaster in northern Honduras in late 2019 that occurred in the context of the worst dengue epidemic in a generation. And our efforts mostly focused on water sanitation, hygiene and vector control. Something similar happened in Mozambique several months later, two cyclones battered the northeast coast. The worst in a generation. And the cholera outbreak followed. So what you see in the picture here is distribution of chlorine while we are doing at the same time and oral cholera vaccine program.
And now the work that we are about to launch in Madagascar is going to be in the region which is the most affected by the feminine. But we are also going to be attempting to address the vector borne diseases, diarrhoeal diseases, neglected tropical diseases, and natural disasters that occur across the country. So, to conclude, we are exploring new ways of doing things and new sources of information and new types of tools to enable us to take a more holistic perspective on how these health problems occur in the places and populations, where we work, be humble in our approach, acknowledge that MSF is not an environmental organisation, we have not historically been particularly concerned or expert in the environmental determinants of health. But we are trying to build on our experience and be a bit more sort of open minded, proactive, and lateral thinking in terms of the types of data and partnerships that we can take on board in applying a planetary health lens to our work. So thanks again for the opportunity to share some of these insights with you, I respect the roles, the border roles you are all playing as GPs and rural GPs in Australia. Thank you very much for the opportunity to participate in the webinar this evening.
And so much, Lachlan. I think many of us have been confronted by the climate change and health effects that we see in Australia, but seeing a global perspective, I think, is even perhaps more confronting, so thank you for sharing those insights. Alright, I will now hand over to Dr Bob Vickers. Over to you, Bob.
Thanks. Look, I would first also like to acknowledge that I am here tonight on the land of the Wonnarua people, and that sovereignty was never ceded. So this is a crash course in air pollution health effects and what we can do about it. Fundamentally, I think the right to breathe clean air is a justice issue, as well as a health issue. Everyone should have a right to breathe clean air. So the basic health side of things, just seeing if I can click through. There we go, too far. Look evolution is generally measured in PM10, PM2.5 and gas pollutants such as sulphur dioxide, nitric oxide and mercury. There are other particulates as well that all have different health effects. So each of these particulates has a different short term and long term effect on human health. So, for example, in the short term high levels of the course particulates PM10, people can get hay fever symptoms. Long term exposure there is evidence that shows increasing premature mortality. And with PM2.5 the particles are small enough that they enter the bloodstream. Long term exposure also causes premature mortality amongst other effects. Sulphur dioxide, daily spikes have been shown to increase asthma admissions and hospital presentations in children. Long term nitrogen oxide exposures and the PM2.5 exposures have been shown to impair childhood lung development, increases the rate of asthma diagnoses in total. Air pollution has also been linked to increased rates of preterm birth, low birth weight babies, lung cancer, stroke, heart disease, heart attacks and many other negative health effects. So it is a big problem. How big?
The next slide. It is that big. It is a big one. Air pollution causes a significant number of premature deaths every year in Australia. Around 2,600, a bit above that, based on recent evidence. I have chosen these other examples of annual mortality because they are all great examples of injustice. It is not to diminish how important they are to address. These deaths usually involve someone else as a significant contributor. So we do not make most air pollution changes on an individual level, it usually requires systematic changes for us to address those premature deaths. For example, when the road tall was higher, we have added tools like seat belts, airbags, crumple zones, speed limits, RBTs, heaps of changes. And now cars are much safer on our roads. But the road toll is not the problem with cars anymore, it is the internal combustion engine. So EVs and hybrids are practical. They are already used all around the world. I took my EV for a 600 kilometre family holiday. I can use it to tow a trailer to the dump. I can go and get mulch. There is a myth of EVs not being suited to long distances or rural areas, which is all pretty outdated. We have two Teslas in our family and the current charging infrastructure is perfectly adequate. The frustration is Australian fuel standards. The Australian fuel standards for sulphur dioxide emissions are 10 to 15 times the international standards. This can be easily fixed with legislation. Our vehicles also have the sixth highest fuel consumption averages in the world, they are actually really horribly inefficient. We are now using more fuel. It is really heartbreaking to see large vehicles all idling, waiting for children at school pick up. The roadside pollution at their height is terrible. So that is cars.
We have also got power stations. They are a massive source of air pollution in Australia. There is plenty of evidence that power stations alone lead to hundreds of deaths in Australia every year. In my area, particularly in the Hunter Valley, the pollution from the power stations is generally controlled by a small number of people, executive decision makers at AGL, Delta and Origin, the EPA and Environment Minister. So they can determine how much pollution is acceptable from our power stations. And this is what we get. So Bayswater, for example, is licensed to admit at least 10 times, this is the license, the EU standard for power stations of a similar size around the world, and almost 20 times the Japanese standard. So every time someone says the word “clean coal” when referring to Australian coal, you can call it out as complete nonsense. And this is entirely preventable.
There are two filters that, if they are installed on Bayswater, would reduce the sulphur dioxide and nitrogen dioxide pollution by over 90%. This is decades old technology, unlike carbon capture and storage, it actually works. It is well within the annual budget. AGL could afford to install these filters, but until the EPA makes them do it, they will not install them, and until the Environment Minister changes legislation, the PA cannot make them do it. So AGL has even decided to demerge and move their brand away from the power stations, it is that embarrassing.
We have also got mining machinery and methods in Australia creating pretty unacceptable levels of air pollution, regardless of what is being mined. We all know thermal coal’s days are numbered from a greenhouse gas perspective. That has another side problem. But it is not just thermal coal. We need to reduce other industrial pollution sources as well. So there is decades left in mine rehab another resource extraction industries. And anyone who has seen these mining trucks knows that they are pretty big, it takes a flight of stairs to get to the top of the cabin. Collectively, mining trucks and machinery in New South Wales burn 700 million litres of diesel every year, just in New South Wales. Not only do they not pay a fair share of fuel tax on it, so we do not reap any kind of health savings, on last review by the EPA, it was found that most mining machinery fell into the worst or second worst category for admissions standards on their exhaust. There is a scheme in New South Wales where mining companies should be paying a pollution license fee, based on their total pollution. Despite being responsible for almost 90% of coarse particle pollution, our mines are exempt from this scheme. Other companies pay it. So instead, they get fines when they happen to catch them breaching their license conditions. AGL has had over 100 breaches of their license conditions in the last five years, so clearly that scheme is not working very well. So that is industrial.
Households are a big contributor too, and I think a lot of people forget that. Most houses have evolved from using an old wood stove to cook, but they still burn for heating and recreational wood fires. Reduction in wood smoke is something that the community can get behind, but backyard fire pits are getting more popular in dense living areas. I was abused recently by hundreds of online commenters when I read a story on channel seven about addressing this issue and tried to call out Bunnings for selling so many fire pits in urban areas. So we need to start removing fireplaces and replacing them with clean heating options. Council rebates, new house construction standards, this is all easy stuff to do. Gas is also a source of household air pollution, particularly nitrogen dioxide. So induction cooking and electric cooking is something that has significant health benefits, especially for children in small households.
So there are a lot of non-industrial sources of air pollution. So we need to start addressing those as well. But it is harder. So we cannot stop bush fires. These events are going to keep happening at increased frequency and ferocity until we reduce the atmospheric greenhouse gases and that has not going to happen for a little while. We are going to continue to do hazard reduction burns. What we can do is provide early warning systems when the air quality is harmful to human health. We have got monitors locally, that we have for our coal mines and they were really hopeful during the bush fire smoke events.
So what can we do as doctors, about it? Find a representative on our regional air quality government advisory committee. I meet regularly with the EPA and industry representatives. I have raised my concerns directly with AGL. When they did not listen, I went and actually spoke to their biggest shareholders and educated them on the fact that this is a litigation risk. I talk locally to Council members. I have spoken to media, as I mentioned before, on the issue, appearances not just on The Project and ABC, but our local ABC radio, FM radio, print media. People generally want to know about this, especially journalists, they want to know how to fix it. I think our qualifications and position in the community carry a significant amount of trust. Despite the few politicians and shock jocks who worship fossil fuels and deny science, most community members, mostly journalists and some political representatives are concerned about this, they will follow our recommendations. So, there are things that you can do, talking directly to your patients about their own controllable sources indoor air pollution and backyard pollution, the same way you talk about smoking cessation. When I do an asthma action plan, as well as asking, does anyone in the household smoke, I say what do you use to cook? Do you have gas or electric cooking? Do you have a fireplace for heating? Do you have a recreational fire pit? I ask if they leave the engine running whilst waiting at school pick up. So this is stuff we can do every day. If you decide to take on a more political, media, or advocacy role, remember this kind of work can be pretty overwhelming. You can make a lot of enemies, so do not go it alone. There are a lot of people out there to help. And be absolutely sure to keep a balance with family, friends and quality time. So good luck with whatever you choose to do.
Brilliant, thanks so much Bob, and I think there are some really tangible examples for us all in there, right from talking about air pollution and asthma action plans, to calling up the local Bunnings and even taking it to the next level, and it certainly sounds like you have had to be a bit courageous at times in terms of the pushback but that you are certainly setting a fantastic example as to what rural GPs and doctors can do in that space.
Alright, so next we are going to hand over to Lyn who is going to be speaking to us about her role as the Chair of Hunter New England Health Service, in really taking them to the cutting edge of healthcare sustainability in Australia. Thanks so much.
I think you are just on mute Lyn, sorry.
You are right. I am coming to you this evening, as a guest on Wiradjuri Country in central west New South Wales and acknowledge with respect Elders past, present and emerging. I am a public health physician, I am not a specialist in sustainability, but I just would like to take you very briefly on my journey as a public health physician leading the Hunter New England District Health Service along its journey. Hunter New England Health Service is there in red. It is a large health service, in New South Wales it provides services to nearly a million people. It is the only district in New South Wales with a large metropolitan centre and hospital, the John Hunter Hospital in Newcastle, and then a mix of several large base hospitals, along with many smaller health services right across that area.
The sustainability journey for us began in 2019. Now at that point, the reality of the effects of severe drought, bush fires, that I had not experienced in the 30 years that I had been living on our small farm in northern New South Wales, this was my reality. These couple of pictures of just the forest, as I was driving backwards and forwards in northern New South Wales in my patch. That is not from bushfire, that has from drought. And a lot of those trees actually since it has been raining, have not recovered, so it was really quite severe and significant. My front yard. My bird bath attracted lots of lovely birds in a really pretty natural setting, and then the front yard was reduced to this. And this was the one remaining kangaroo that was coming around the house. Normally we might have had up to 30 or 40 at any time in that area. And this was the last one that I know of remaining in that area. And you can see how skinny the poor thing is. So that was my reality, back then, along with the bushfires, and as Chair of the Hunter New England Board, we had had bushfire threats to even the John Hunter Hospital. It is located in the middle of the bush. But at that point, spot fires were everywhere and it was a real issue.
But in late 2019, I was invited to a small meeting with Dr David Pencheon, who came from the NHS Sustainable Development Unit in the UK, and he spoke about the impact of climate change on the health of communities and we all shared an understanding of that. I was confronted with two things. First of all, the carbon footprint of providing health care was actually significant in the UK, where there have been measures done for quite some time, and The Lancet Countdown along with the MJA and Sydney Uni, had found that in Australia, health services in Australia account for 7% of carbon emissions. So we ourselves, in terms of the care and service that we are providing are part of the problem, as well as having to manage the impact that I think we have been hearing about this evening. And so I was confronted with that. But I was also confronted with the fact that as David spoke, he started to talk about the actions that were being taken in the NHS that were actually saving money. Now as a Chair of a health board, we have never got enough money to provide the services we want to provide that are needed, and we are always struggling to do it. When I was confronted with that, what choice did I have but to say, hang on, in the interests of our health service as well as well as the climate, we must as a board and a health service, take some take some action in that area.  
Now fortunately, it is only a couple of years, but at that stage, it was a sort of an odd thing to put on the agenda of hospital, of a health service agenda, that we will take on our own carbon emission reduction program and sustainability plan. But fortunately, the global green and healthy hospital system, we joined in with that, and they had a framework for us to take. And these are the elements of that framework, leadership, we had to address chemical waste, energy, water, transport, food, pharmaceuticals, buildings. So we were given something to hold on to. And in that action, I took an agenda item to the board, and the board members and senior executives said yes, we should be doing something about it. And the board then decided as well, before we actually got into development of a strategic approach and putting resources to this endeavour for sustainable healthcare, the board itself decided to model in the way the board acted, to model best practice as far as we could determine it in those in those areas. I will not go through all of them, but clearly leadership learned it was important. In terms of waste, we took our own cups, so we were going around the area and being given plastic cups. We took our own cups. In terms of transportation, we car share more than we had. We adjusted the schedule of meetings so that we did not have to travel so much ourselves and that others did not have to travel. So we said, while we are working on this, we will model it.
And Bob spoke about vehicles and electric vehicles. At that point, the board members all decided that in purchasing of their own cars, we cannot determine what cars that board members buy themselves, they would use this Commonwealth Government Green Vehicle Guide, which for every make and model of car in Australia, you can actually compare emissions. And while we are waiting on better standards and all of that sort of stuff, there is still action. So we committed to that.
And so the Chief Executive, Michael DiRienzo appointed Ramsey Awad who is the Director of Planning and Infrastructure to take carriage of this, and Alicia was appointed as the project officer and under the oversight of a Board Committee then we put together and started working immediately on our sustainability program. A green vision, again I do not want to go through all of this quickly, but you can see the provision of healthcare 7% of Australia’s total emissions. Really important that as an organisation, we do no harm, because the health of our patients is at risk. And planetary health now was seen to be part of our business.
And we set goals in areas as you do, and they there and I am imagining Catherine, that the slides can be shared later, so that people can take time to read them. An important element was to adopt Aboriginal stewardship values for our environment and caring for Country and we looked to leadership for that, we have an excellent Aboriginal member, a Biripi woman who has been leading that on the board committee.
The approach that we took is just the basic change management approach, establishing the case setting measures and targets, and whatever, so there is nothing new and clever about that. But we put our mind to it and we ended up focusing on energy waste, water, and water is always a big issue for rural New South Wales, infrastructure procurement, transport, those are the key elements that we had to tackle. We set targets, so our target for energy is zero electricity consumption from non-renewable resources by 2030, and so we set measures for that. The Department of Primary Industry and EPA helped us with actually doing our own emissions inventory. And we had strategies for energy with solar panels, lighting, chillers, you can see the things that were there in terms of strategies for energy. And by 2020, by the end of last year, we had already achieved by doing those things, savings that we could identify of more than two million dollars.  Now, two million dollars does buy little bit more medical care, healthcare. And this is what I was saying really challenged me from David Pencheon’s discussion, when you look at it like that, good efficient governance of a health service now requires that we are basically being really good stewards and being good stewards of the resources that we have is now clearly including much more than we perhaps were thinking about. Now I will not go through all of this because there is a lot of it, and time is quite poor, but we set waste strategies, we set water strategies to reduce water consumption, and capture and reuse water, and you have got the strategies that are there. But one of the major achievements that we had already by 2020, was the recycling of our renal dialysis water at Tamworth Hospital and that has become now a prototype for what we are doing in other hospitals. But even at Morisset Hospital, just getting people, once your antenna are out about it, and we had people looking at leakage, because they were starting to have to examine their water bills, water rates, and so forth. Savings of 140 thousand dollars just to repair leakage. It sounds ridiculous now and I am sorry, as I hear myself say it, I feel like my goodness, why did we not think about that earlier?
Transport is important as well.
Lyn I am sorry, I just need you to bring it to a close pretty soon.
Yes, I will, quite quickly. We will move to electric vehicles, we are on hybrids at the moment. And we have got the water achievements there. And I just want to go right through to, we have got the strategies for all of that. Procurement is hard, but we are getting there. Infrastructure, we are going to have a green new John Hunter hospital. But when building a movement, we have already got 150 people who nominated themselves as sustainability champions around the districts, with a whole range of projects that they are currently working on. And I just want to indicate, as I think this is the last slide, that we set targets in each of those areas of carbon emissions, rainwater capture and reuse, and over here is last one, this is my last one on waste. And the targets for 2030 were set and they were challenging, but already by the end of 2020, those are 17%. We exceeded our target for emissions, rainwater recapturing, water recycled and waste. So it is a fantastic effort. It is not done by me, I am not clever at all at this sort of stuff, but we certainly started a movement.
Thanks so much, Lyn.
Thanks. It certainly sounds like you have achieved an incredible amount and it is quite inspiring to hear how, as you say, coming to it as a clinician, a medical professional, being able to transform a whole health service in an area where sustainability can be quite contentious in the in the Hunter Region, so thank you so much. Alright, I will now hand over to an Adjunct Professor Anne Poelina. Alright, thank you so much, Anne.
Thank you, I can just see a screen there, so I am presuming I have come on screen. Is that right?  Can you hear me, Lyn?
Okay, so I am on, is that right?
Yes, you are.
Okay, look, this is amazing. I want to thank you for your story and the previous storytellers. It is all about story, and your story is a very powerful one in terms of how you are transforming change. So I just wanted to acknowledge you coming after you. Ngajanoo Nilawil Anne Poelina, ngayoo yimardoowarra marnin. Jayida Buru Yawuru and Jukun (Djugun) Country, nyayoo my home. In my language, I said, hello, my name is Anne Poelina I am a woman from the Mardoowarra Fitzroy River. Welcome to Yawuru and Jukun Country. I am in Broome, and Broome is my home. But in my introduction, I said, I am a woman who belongs to the Fitzroy River. The Martuwarra in the Kimberley region of Western Australia. So I wanted to be very clear that as indigenous people, we see ourselves as planetary citizens. We have traded across the seas right through to South America, going back 30,000 years and everything is evidence based. So I want to place this in the context that not only are we planetary citizens, but we are planetary citizens with a duty of care to work with the complexity of what we see across the world, because we need collective wisdom. So indigenous people in this country were the first everything. The first scientists, the first diplomats, astrologist, astronomy, engineers, we go on and on. And I think we are at a point where we need to look and say, what is this wisdom that we have in our lands? What is this wisdom and this gift of knowledge that indigenous people who have lived with the anthropocene, you know going back 10 thousand years. How can we stop being othered, and bring the voices of our wisdom into framing how we deal with complexity? We need collective wisdom. I heard the phrase of avoidable death, because one of my questions is, what is the cost of a life saved? What is the cost of a life saved in our nation, with all the intelligence and all of the resources that we have? So from me, I am sharing, you know, I had a life, many years ago as a nurse. I have Masters in Public Health and Tropical Medicine. I have three Masters, two PhDs, because, for me as an indigenous person, the more I know, the more I do not. And I need to connect and create the coalition of hope. Because what we are talking about is that we need to stop the misogyny to Mother Earth. The greatest challenge that we all have each and every one of us, is the challenge we have around sustainable development. How can we have peace with indigenous people and with nature, so that we can stop having these destructive environmental impacts that are destroying our world and our lives? There is so much out there that we want to share when we talk about planetary health, but this is the greatest challenge. How do we come to a point that we recognise that we are so destructive as a human species and that each of us need to connect and build this coalition of hope, because we are failing at government and governance levels. In Australia, the laws and public policies are no longer fit for purpose. I live in a state where the premier has absolute power. They are introducing a bill right now to destroy our sacred sites. There is a policy being framed to be the next big land grab. And all we can say as indigenous people is that we are coming to you with a gift of peace. This was recognised in the declaration from Sydney in the Sydney Peace Prize. But we cannot have peace when we are confronted by invasive, unjust development, that all we can see is foreseeable harm, not just of us as indigenous people, but of multi species justice. When we are born, we are given a totem, a jadiny, to teach us as a human being, how to be humble, how to have dignity, how to recognise that multi species justice, my totem is the blue tongue lizard. I am bonded to that lizard for the rest of my life. That lizard teaches me how to be fully human.
I want to acknowledge the great work that is being done right across this planet, but particularly in Australia from doctors for the environment. We are dealing with some of the biggest disasters in the world where I live, and what we are saying is that, how do we extend the hand of peace? We are about to create the biggest man made destruction in the world, because we are going to frack the Canning Basin, 500 thousand square kilometres on shore, and 100 thousand off. We have plans by the government to come and take the Fitzroy River for the few greedy frogs who have transported themselves from the Murray Darling basin. And what we are saying is that it is time to stop. Seriously, it is time to have peace with indigenous people in this country. We can work together, we can frame the ways, that we have governance from the beginning of time. We need to look at place based governance, regionalism, to show how people can work together. We need a unity pathway, we need to share information. One of the things that we do not have as indigenous people in this country, particularly faced with invasive, destructive, development, is we have no free prior and informed consent, we have no ability to bring in multiple sources of evidence to say what is the cost-benefit of not allowing that destruction to happen. What is the benefit, not just to our nation, but to our world? So I am working with many, many people across the planet. What I just told you was the story called Green Crime, were state sanctioned violence allows the destruction of the environment and our people who have been the stewards from the beginning of time to say stop, we have the solutions for planetary health, we have the wisdom, we have the knowledge, but we cannot do it without you. So what I am saying is that all of these things that we are talking about are symptoms of a greater dysfunction, which is the predatory elite of the greed. Whether it is in my country, whether it is across the globe, these green crimes are state sanctioned and they are lawful. So what we are saying is that we need a new way to bypass the system so that citizens can mobilise together, so that we can share information, we can have informed consent decision making, and we can look at what does justice and equity look like, not just for indigenous people in this country, but right across the planet. We need a just energy transition, we as indigenous people, we care about people working in the oil and gas, particularly coal. Gas cannot be the next transition energy fuel. It cannot. What we are saying is that those towns that have built communities around coal, let us get behind them, let us work with them, let us make that transition plan, because those families need our help too.
So what we are saying is that we have in Australia, the opportunity to lead the world in renewables, in the green economies that I am talking about. I am saying do not come and build this diamond mine on my home because the diamonds, I can show you in the sky are in perpetual, they are forever. Do not come and destroy us when all we can see is the GST revenue for the state. So I am very, very passionate about this because I work right across a lot of fields, and I think the answers are really with the people. The revolution needs to be opening up, we say, wake up the snake. How do we wake up the consciousness to bring the people with us? Because one of the questions I have is that without indigenous knowledge, without indigenous wisdom, without indigenous economies, we will not be able to right size the planet and sustain humanity. We have the models there from indigenous people, the bio regional framework is a federal government policy till 2030. Every region in Australia is already mapped out. Where is the investment? Where is the political goodwill? So, in closing, what I want to say is, I too believe that our lives are avoidable deaths. We cannot have this intended harm because it will create ecoside and genocide. And so my question back is, what is the cost of our lives saved? What is the cost-benefit of preventing a disaster? So thank you very much. Kaliya maboo. Thank you for sharing.
Thank you, Anne for sharing. Just powerful, compelling words. I think your call to action for us all to speak up in changing our society and how we relate to each other, our country and respecting a first nations perspective, I think, is a critical call that we all need to listen to.
Alright, we are now going to have some time for question and answer. We have had some questions that are posted in the chat. And, first of all there is been a couple of questions that I will ask Lachlan McIver to answer. There is a question about whether MSF embraces a one health perspective, which highlights the interactions between humans and non-human animals, and there is also a question in there about whether or not there are issues with an appetite to address climate change in other countries where MSF operates as we have seen in Australia for a reasonable amount of time now, although I do think that might be changing.  But Lachlan, if you are able to respond to those questions, that would be fantastic. Thanks very much.
Thanks Catherine, and hi Rosalie, hi Aileen, nice to nice to hear from you both. One health. Very briefly, MSF is divided weirdly and historically and bizarrely into five operational centres. Five and a half. I work at the Operational Centre Geneva, which is probably the one taking the lead of the sections in terms of sort of setting and driving forward a planetary health agenda. They have chosen specifically to frame it as planetary health, after having considered the alternative definitions and terminologies, and look, it was a largely sort of political but also partly practical decision. The recognition is that planetary health, the sort of classic definition if you like, is this the health of human civilization and the state's natural systems upon which it depends. That “and” is key, that sort of means to treat it equally. But you can also imagine there is kind of this historical legacy of MSF being an organisation that is focused pretty exclusively on human health. So even adopting a sort of a version of that planetary health definition around health and human populations arising from an interaction between humans and animals and the environment, reflects that broader definition of planetary health, which relates to one health, it relates to eco health, it respects climate and environment health and the other kind of variations on that theme that are out there. So we are not framing it, Rosalie, as one health specifically or exclusively, the consensus is that planetary health is the best fit, or the least controversial fit, but it does respect and attempt to capture those other definitions that are out there. And that is also reflected in what we are doing operationally. I mean my last meeting was about our emergency response to the floods in South Sudan, where we are already seeing increases in malaria, increase in snakebite. We are going to be trying reach affected populations that are crammed on these little islets in the middle of the floodwaters with the livestock and the rodents and everything, so we are going to be seeing lepto, so it is part of the package of work and the approach that we are trying to apply to our operations. But Rosalie, happy to have follow up discussions with that. Feel free to email me. I think we have sort of crossed paths in the past, we have got things to chat about.
And Aileen, the reason I was mentioning about the five sections of MSF, is because there is often a bit of sort of friendly disputes between the sections. But generally speaking, yes, there is an appetite for addressing planetary health issues, both in terms of what those medical topics are, priorities are. And what it means for MSF, to become a more responsible humanitarian actor. So there is a high level debate happening today about whether the other sections are going to follow Operation Centre Geneva's lead in committing to Paris level, Paris Accord level reductions in their carbon emissions. That is, 50% reduction in our carbon emissions by 2030. And I think that it is likely that momentum will carry us in that direction. So, broadly speaking, yes, this is the way MSF is going, but there is a bit of sort of weight of our history and work that we are having to be lumbered with in doing so. I hope that is enough for now.
Brilliant, thanks Lachlan. Well, we have another question in the chat box, which is directed to Lyn. And the question Lyn, is about, with respect to procurement, how do you manage or assess the problem carbon footprint supply chain? So I think that might be getting different scopes of emissions. If you are happy to speak to that Lyn? Thank you.
Yes, well you are getting you are getting into the technicalities that I am not right across myself. However, Hunter New England is responsible to purchase a lot of stuff itself, but most of it comes from our central government purchasing. So our job is actually to also influence the state government and its purchasing processes, and we are beginning to do that as well, but the procurement as far as we have control, must take into account the footprint of the manufacturers, the footprint of what it takes to transport the goods to where finally we get to use them. And so it is a complex issue that we have specialists working in, and I am sorry I cannot be more specific than that.
Brilliant, Lyn. I think it is still very useful insights for everyone as a practical step. And there is information, as I think Lyn highlighted, the Global Green and Healthy Hospitals resource which has been very useful to Hunter New England, and that has something that is available to everyone, as well, and there are a number for those online who are general practitioners, there are a number of Green Hospital guides. I think we are still working on one specifically for Australia, but there is a UK and a New Zealand one as well, but those are more in the GP space.
But we do practical things in terms of, like our suppliers are now up-setting a criteria about the sustainability plans and programs. So the suppliers of our accommodation, we are now wanting, not only for them to have lip service, but when they say they are not going to wash our towels unless we put them on the ground, that they actually do it.
Brilliant. Accountability, a very important lesson I think for us all. And this may be our last question for tonight. It is from Kate Wiley and we will direct it to Anne. So, what can we do to help stop Woodside and protect Martuwarra? Are there any advocacy options or groups that we can work with?
Yes. It is not so much Woodside. Woodside is down in the Pilbara and you will see a huge project which is going to just create greenhouse emissions which kind of blow everything out of the water, but I am talking about the Fitzroy River and, most importantly, what happened yesterday, was we prevent the enactment into law of a bill that will destroy our culture and our heritage forever in Western Australia. So we are really keen for people, I put my Martuwarra Fitzroy River Council website up there, we are keen that Australians, fellow Australians, will stand with us to demand that that needs to be co-designed with us. We cannot let our sacred sites be destroyed. This is ancient culture, this is, from the beginning of time, this is world culture, that what we blew up with Juukan Gorge, which was the first sign of 46 thousand year old human thought. So we have got things precious here and we need our fellow Australians to stand with us, so I would be saying if you have got a chance, write to the Premier and say that bill should be retracted. We have gotten a formal complaints mechanism through the United Nations to say this is just insane, if not criminal. But get on the website. There is much beautiful things happening here despite the pain and suffering, there are amazing people who are working with us. Get to look at the Martuwarra Fitzroy River website. I am the Chair of six different nations and we are standing in solidarity. And in terms of multi species justice, the Martuwarra Fitzroy River has been published across the globe in many, many peer reviewed journals, so we are transforming a whole range of things. It is exciting, because we are building a coalition of hope, who one, share our values and ethics and believe that we can collectively dream and walk in our dream for what the world should be.
Thank you, Anne. I think that is the absolutely perfect note to end on, a coalition of hope. We have heard some confronting things tonight, but I think all of our speakers have given us ideas and options about how we can get involved and take action and that is what we need to do to maintain hope in the front of, sometimes overwhelming prospects of climate change. I am sorry Bob, we have not directed a question to you in Q and A time, but I did see that you have been busy answering them in the chat box, so appreciate it. Thank you so much.
Alright, so for anyone who is interested in addressing climate change, there are absolutely opportunities everywhere, at home, at work, in our communities. You can become a green practice, you can decide to have a conversation every day about how climate change is a health issue. You can change to green power at home, you can divest from fossil fuels, and you can do all the things that our speakers have talked about tonight. I encourage everyone to join the RACGP Rural Faculty Facebook page, which is a great place to connect and to collaborate with colleagues. And there is also the RACGP Climate Change and Environmental Medicine Specific Interest Group. The link for the RACGP Rural Facebook page, we will just pop it in the chat now.
Alright, so we would again like to thank our sponsor for tonight, Ochre Health, without whom tonight would not be possible. A one minute evaluation will pop up at the end of this, and we do encourage everybody to complete that evaluation, and your CPD points will be processed in the coming days. If you from another college, you can email RACGP Rural if you would like CPD points for tonight. Alright, that is about all the housekeeping we need to get through at the end of the night, so very, very sincere thanks to all of our speakers for making themselves available. Associate Professor Lachlan McIver who has just had to pop off to another meeting, Adjunct Professor Anne Poelina, Dr Bob Vickers and Associate Professor Lyn Fragar. We thank you all for your words of wisdom and we thank everyone for joining us tonight. Thank you all, everyone and good night.
Thanks, Catherine.

Thank you so much, Lyn.

Other RACGP online events

Originally recorded:

2 December 2021

Climate change is the greatest global health threat facing the world in the 21st century, but it is also the greatest opportunity to redefine the social and environmental determinants of health’ – Lancet Countdown on Health and Climate Change

Climate change is already having profound effects on the mental and physical health of rural and remote communities in Australia, and general practitioners are on the frontline. So how can we respond to this challenge and help our communities to transition to a cleaner, healthier and more resilient future? Join us to hear from rural doctors who are leading the way in Australia and globally and learn more about what you can do.

Learning outcomes

  1. Describe the health effects of climate change and the impact on rural communities and their residents
  2. Identify ways to incorporate sustainability for a rural based practice
  3. Recognise and identify advocacy opportunities as a rural practitioner regarding the health impacts of climate change
  4. Describe the impacts of climate change on Aboriginal and Torres strait islander communities and how Indigenous ecological knowledges can inform responses to climate change and promote health and wellbeing
This event attracts 2 CPD points

This event attracts 2 CPD points

This event is part of Rural Health Webinar Series. Events in this series are:


Associate Professor Lachlan McIver
Tropical Diseases & Planetary Health Advisor

Lachlan McIver is a rural generalist and public health physician with over fifteen years of experience working in remote, Indigenous and tropical communities in Australia, Africa and the Asia-Pacific. Lachlan did his PhD on the health impacts of natural disasters and climate change in Pacific island countries. He has worked for several years as a consultant for the World Health Organization on this topic, from the Western Pacific Regional Office to WHO Headquarters in Geneva. Lachlan’s current role is Tropical Diseases & Planetary Health Advisor for Médecins Sans Frontières at their Operational Centre in Geneva. Lachlan is also adjunct Associate Professor of Tropical Medicine at James Cook University and is a co-founder and Director of Rocketship Pacific, a small international health not-for-profit organisation focused on primary healthcare systems strengthening in Pacific island countries.

Associate Professor Lyn Fragar AO
Public Health Physician

Associate Professor Lyn Fragar is a Public Health Physician whose professional career has focussed on improving health service delivery and farm safety in rural Australia. Lyn is a Director of GP Synergy, Chair of the Rural Safety and Health Alliance and immediate past Chair of Hunter New England Health Service, which is leading the way in healthcare sustainability as one of only two health services in Australia that has joined the United Nation Race to Zero.

Dr Bob Vickers
Rural Generalist & Clean Air advocate

Dr Bob Vickers is a rural Generalist and advocate for local public health measures, particularly improving air quality in the Hunter Valley. He regularly speaks on the health impacts of air pollution from the fossil fuel industry and wood smoke, including appearing on the ABC’s Fight For Planet A, NBN News and The Project. Bob is also a spokesperson on safe medical working hours and workforce planning for rural and remote Australia.

Dr Anne Poelina
Academic & Managing Director of Madjulla

Dr Anne Poelina is a Nyikina Warrwa (Indigenous Australian) woman in the Kimberley region of Western Australia. Poelina is an active Indigenous community leader, human and earth rights advocate, filmmaker and a respected academic researcher, with a Doctor of Philosophy (Health Science), Doctor of Philosophy, Master of Public Health and Tropical Medicine, Master of Education, Master of Arts (Indigenous Social Policy) a Signatory to the Redstone Statement 2010, she is a 2011 Peter Cullen Fellow for Water Leadership. In 2017, she was awarded a Laureate from the Women’s World Summit Foundation (Geneva), elected Chair of the Martuwarra Fitzroy River Council (2018), Adjunct Professor and Senior Research Fellow with Notre Dame University and a Research Fellow with Northern Australia Institute Charles Darwin University. Poelina is a Visiting Fellow with the Crawford School of Public Policy at the Australian National University, Canberra Australia Water Justice Hub to focus on Indigenous Water Valuation and Resilient Decision-making.



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