Climate, housing, energy and Indigenous health: a call to action

Abstract

Most Australians take safe housing and uninterrupted electricity for granted. Yet in remote Indigenous communities, low quality poorly insulated housing and energy instability are common.1 Most houses require prepaid power cards, resources are meagre, financial literacy is low, and people often have to choose between power and food. New evidence reveals extreme rates of prepaid electricity meters’ disconnection in these communities,2 making people with chronic diseases who depend on cool storage and electrical equipment particularly vulnerable. The convergence of excessive heat, poor housing, energy insecurity and chronic disease has reached critical levels in many parts of northern Australia, and a multisectoral response is needed to avert catastrophe. Medical professionals have a key role to play. Over recent summers it’s been too hot. Particularly them hot days when the power do go off, we all get out of the house, we always sit outside. I normally just sit under the sprinkler or under the hose, over my head. Everything’s been dying out here around Tennant Creek. All the water in the rock holes went dry. The heat killed animals. Even the spinifex went black, it looked like it’d been burnt or poisoned. A lot of them trees around town, not them native trees but cedar trees and African mahogany, all them mango trees around Tennant Creek, all died, nothing left. That heat would just come too low, the heat wave killed the whole lot. (Norman Frank Jupurrurla, Warramungu Elder and dialysis patient from Tennant Creek) Source: Bureau of Meteorology; reproduced with authorisation from Pandora Hope. Some people on the outskirts of Tennant Creek still live in old tin houses and there’s no running water, there’s no power, there’s not even a toilet, not even an old drop toilet. Kids go to school from there and people go to work … “You’ll end up getting cooked in that tin house today,” that’s what we say … There’s a renal patient out there, living in a camp, he got renal at the same time as me and the renal bus go out there, pick him up in the camp, near his tin shed, take him to dialysis with me. Doctors should start asking the question, if you’ve got a fridge or not. I reckon that’s what these doctors think, every Wumpurrarni [Indigenous person] lives the same as a whitefella and they’ve got everything the same. But not all of us got a fridge. When doctors put people on insulin and educate them, when dieticians talk to them and tell them, “You need to be on insulin”, they don’t ask that question “Do you have a fridge? Where do you stay? What kind of condition you live in?” When the power disconnects because we run out of money [on a prepaid meter], you have to hurry up. If you catch it in a few hours, you’ll be lucky, but if I’m out somewhere on the weekend and it goes off, everything goes off in the fridge. When I come in late or at night and find that the power’s been off, everything’s off in the fridge, so I’ve had to throw everything out. I’m in a brick house. I’m in an old brick house still and it’s really hot in that house … It’s really hot in summertime. When you’ve got winter, that brick is really cold. In winter it’s the other way around, that house of mine. Health care practitioners need to be cognisant of the direct impacts of heat on their patients’ health and recognise comorbid conditions and risk factors that increase vulnerability to heat.7 It is equally important for clinicians to understand people’s access to thermal safety, capacity to appropriately store medications, and resources to power essential health infrastructure such as oxygen concentrators. Explicit inquiry about housing conditions, the availability of refrigeration and air conditioning, and how regularly the power turns off may be particularly revealing. Beyond individual patient care, the medical profession can engage with pharmaceutical and health care device industries to ensure that details of thermal stability of products are available to clinicians. For example, although almost all pharmaceuticals’ labelling mandate storage below 30°C, it is likely that many products can withstand higher temperatures. On the other hand, some antibiotics, antidiabetic medications, antiepileptics and warfarin, which are all medications regularly prescribed in Indigenous communities, are known to degrade in the heat.14 In the NT, clinicians need to understand the thermal stability of everything they prescribe. There are also many unknowns and misconceptions about how to protect human health from extreme heat, for instance, air conditioning and cooling technology may not be a panacea.15 Therefore, a high priority is to develop an evidence-based agenda of heat adaptation and health, including public health responses to extreme heat events, that provides a robust basis for advocacy and action as we all try to adapt to a rapidly heating world. In the context of heat, housing, energy, and chronic disease, there is much that health professionals can advocate for to reduce structural inequities that perpetuate Indigenous peoples’ health risks and relative disadvantage.16 This begins with health professions bearing witness to current housing disparities and their impact on health and safety of remote community residents. The profession can highlight the association of housing quality, heat stress and energy security in relation to demand on health services so it is given appropriate priority in government decision making. In relationship to housing and health, our profession needs to advocate for strengthening of building codes and housing standards for remote Indigenous dwellings (Box 3). Identifying and rectifying deteriorating infrastructure, reviewing maintenance standards to ensure dwellings are fit for purpose into the future, and ensuring appropriate design and quality construction of new buildings is all of urgent priority in a warming climate. This includes enhanced responsiveness of public utilities in the interest of the health and safety of remote community residents. You’ve got to stand strong. If you’re going to give up on them and stop holding them accountable, they’ll give up on you too and won’t do what they are supposed to, that’s how they are. If you stop making noise, they’ll just sit there quietly and do nothing, they wouldn’t worry and would leave things broken as they are. They don’t give a damn about you. The way I see it I’ve been in my house for nearly 5 years, and I’ve been trying to get help with housing and providers coming round, trying to ask them for help or support or fix plumbing. I’ve had to report it over and over and over before they do anything about it. If I give up, they’ll give up. But I am not ever going to give up. The community needs to be in charge of what they want done in their housing and how they want their lifestyle, and be allowed to make the solutions. Then they can bring that to the table, to the housing and to the providers. Then it’s not coming from some government from Canberra, it’s not coming from some politician. It’s coming from us, it’s coming straight from the horse’s mouth and straight from the ground, from the grassroots, that’s where you’ve got to listen, from their home. Acknowledgements: We thank Pandora Hope (Bureau of Meteorology) for her work on the climate maps. Open access: Open access publishing facilitated by Australian National University, as part of the Wiley - Australian National University agreement via the Council of Australian University Librarians. Competing interests: No relevant disclosures. Provenance: Not commissioned; externally peer reviewed.

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