Health equity – Caring for priority populations

According to the 2022 Close the Gap report, climate change has a disproportionate impact on the health and wellbeing of Aboriginal and Torres Strait Islander peoples. As outlined in the 2022 report, climate change 'compound[s] historical injustices and disrupt[s] cultural and spiritual connections to Country, a central determinate of Aboriginal and Torres Strait Islander health and wellbeing’ ⁹. 

When preparing for an emergency, it is important to take into consideration the needs of local Aboriginal and Torres Strait Islander people, their connection to country and potential loss of culturally significant sites. Losing a particular site may mean the loss of an ability to perform cultural practices and may give rise to longer term grief. 

Aboriginal and Torres Strait Islander communities are not homogenous and will need different approaches, collaboration and co-ordination to devise emergency response plans. General practices are encouraged to be in regular contact with Aboriginal and Torres Strait Islander patients and their families to understand what they need, and how they may be able to provide appropriate care.

Evacuation plans need to be a collaborative process with Aboriginal and Torres Strait Islander community groups to facilitate temporary relocation to culturally appropriate land, and they may need long term healing and counselling services to help adjust to the changes brought about by the emergency ¹⁰.

The 'Close the Gap 2022' report and The Australian Indigenous Health InfoNet website provides information on collaborating with Aboriginal and Torres Strait Islander people and local communities to ensure culturally appropriate emergency management plans.

People who experience homelessness have diverse experiences. They may be:

• sleeping outdoors or in improvised shelter
• sleeping in a homeless shelter or boarding house
• living in supported accommodation
• living in crowded conditions
• staying with friends, relatives or acquaintances.

Extreme weather can exacerbate the issues faced by people experiencing homelessness as they may have limited economic, social and community resources needed to prepare for, evacuate, and recover from a natural disaster or emergency.

Emergencies may also have a greater impact on a person who is homeless and their ability to access health care, social security and other governmental supports, particularly in the context of greater physical and mental stressors. Their ability to prepare for emergencies (including buying food, seeking shelter, ensuring warm clothes and bedding etc.) may be impacted by lack of adequate funds to purchase these goods and services ¹¹. 

GPs should also be alert for patients who were previously in secure housing but have become homeless due to an emergency and who may not articulate this during consultations.

It is important for general practices to consider people from culturally and linguistically diverse (CALD) backgrounds in their emergency management response. CALD communities include migrants (including the children of migrants), refugees and asylum seekers. While each situation will vary, those who identify as part of this cohort may be more vulnerable to natural disasters and other emergencies due to reasons such as unfamiliarity with Australia’s climate and natural hazards, limited English proficiency, limited support networks and prior traumatic experiences.

The Australian Red Cross has developed the Emergency Resilience in Culturally and Linguistically Diverse Communities tool which provides recommendations and strategies for stakeholders to build partnerships with local CALD populations and may assist with the development of your emergency response plan.

Older people may be more at risk from the dangers associated with natural disasters and other emergencies due to limited mobility, chronic health conditions, social isolation and financial stresses associated with finite income ¹².

The federal Department of Health and Aged Care update their website regularly with information on protecting older Australians during emergencies.

People who identify as LGBTQIA+ have a unique set of experiences that may make them more vulnerable during natural disasters and other emergencies. 

In addition to physical losses associated with natural disasters and other emergencies, many may feel fear, marginalisation, misunderstanding, exclusion and discrimination when accessing mainstream support services, staying in temporary accommodation, using gender specific bathrooms, or accessing temporary gender affirming clothing. Previously accessible safe spaces and trusted services may become inaccessible during and after a natural disaster or emergency, leading patients who identify as LGBTQIA+ to access services they haven’t built a trusting relationship with yet.

A person who has not publicly disclosed their sexuality may be exposed unnecessarily or need to disclose their sexuality where they wouldn’t have needed to otherwise. Others who have lost their home may fear returning to their family or staying with certain people due to discrimination ¹³. 

It is always important for general practice staff to understand that people may have divulged their identity in the general practice context but may not be ready to do so with certain friends or family. As natural disasters and other emergencies can be intense and unpredictable, it is important that practice staff maintain confidentiality and support patients with different circumstances.

It is common for people to experience feelings of distress during and after an emergency. For most, these feelings will reduce with time. 

People with pre-existing mental health conditions (including those with depression, schizophrenia and those who engage in harmful use of alcohol and/or drugs) are particularly at-risk during emergencies, as they often require uninterrupted access to basic needs and clinical care.  The onset of an emergency can bring about or compound acute conditions such as grief, post-traumatic stress disorder, drug and alcohol use and depression and anxiety ¹⁴.

Natural disasters and other emergencies can impact the health, wellbeing and safety of people who are in contact with the criminal justice system. People who are in contact with this system include those who:

• are currently held within prisons
• have been released from prison
• are on bail
• are currently on a suspended sentence
• are currently on probation
• currently work within prison populations.

Risks to this cohort include:

• dependence on prison staff to ensure health and safety and an inability to make their own decisions regarding evacuation
• building damage and the difficulties in temporarily re-housing people in prison
• health concerns due to excessive heat, particularly if prisons do not have adequate cooling systems ¹⁵
• higher risk of homelessness, unemployment, mental health conditions, chronic physical disease, tobacco smoking and high risk drug and alcohol consumption ¹⁶, which may impact their ability to access services and accommodation.

People who inject drugs or who are participating in a pharmacotherapy program may be at increased risk from the harms of natural disaster and other emergencies due to the following factors:

• services such as psychological and pharmacotherapy may be paused due to the emergency
• drug markets may be disrupted, or treatment interrupted resulting in the person suffering withdrawal symptoms
• the person may participate in risky behaviour to obtain drugs
• the person may be more likely to share needles due to shortages ¹⁷.

People living with a disability are more likely to be disproportionately impacted by natural disasters and other emergencies due to difficulty accessing evacuation services, shelter and food distribution and recovery efforts ¹⁸. 

During emergencies, people with a disability are also at greater risk of neglect and may suffer ‘abuse, domestic violence, isolation and restrictive practices’ due to factors such as governmental responses following inadequate consultation with people with disabilities, social isolation and inaccessible information and communications ¹⁹.

Natural disasters and other emergencies can trigger or exacerbate existing domestic violence, with higher reports of women experiencing physical and psychological violence inflicted by men. Domestic violence during or following natural disasters and other emergencies may be exacerbated due to the tension caused by 'displacement, unemployment, increased drug and alcohol use, trauma and grief and loss’ ²⁰. There can also be a disproportionate effect of domestic violence across socioeconomic groups, with higher rates of domestic violence occurring in lower socio-economic areas ²⁰.

As possible first responders to emergencies, it is important for GPs and practice staff to consider their approach to people experiencing domestic violence. Your practice could:

• ensure training to all staff on identifying risks of violence
• not to excuse the behaviour when responding to cases of possible domestic violence
• provide care that promotes victims’ safety and privacy ²⁰.