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Climate change and pharmacy in Australia: 2. Work days gained, water-related disease and impacts on pharmacy practice.

Con Berbatis
A Pharmacy Researcher Perspective

Issue 76: October 2008
Page: 1 of 1 Author's Profile | Send to a Friend | Printer Version

Editor: The ‘Garnaut Climate Change Review’ (4 July 2008) estimated climate change-related changes in deaths and hospitalisations in Australia under ‘unmitigated’ (no action) and ‘mitigation’ scenarios to the year 2100. The estimated gains in heat-related working days lost but increased rates of food- and mosquito-borne infections are considered together with a review of key international studies.
Con Berbatis relates the important climate change effects on health to pharmacy in Australia.

1.0 Background and aims
The Garnaut Climate Change Review reported a number of climate change-related effects on health in Australia under unmitigated (no action) or partially mitigated climate change scenarios. 1 

Heat-related deaths and hospitalisations were projected to increase with marked differences in health outcomes in the scenarios appearing by 2075. 2 

In October 2008, the final Garnaut report will be issued.

Australia and New Zealand showed signs of climate change during the 20th century with warming in daily minimum temperatures and decreased frequency of sub-freezing days having occurred in both. 3 

The CSIRO has predicted wetter conditions in central and north Australia above a Broome-Hobart diagonal and much drier conditions to the west will become obvious during the 21st century.

The World Health Organisation and leading health professional bodies internationally including the Australian Medical Association have recognised the effects of climate change on human health and have committed to implementing methods to address the adverse effects of climate change.4 

On 5 September 2008 a Garnaut report entitled ‘ Targets and Trajectories’ was released.5 

The report quantified the per capita lowering of global carbon dioxide emissions required to achieve the ideal global gas concentration ideally of 450 ppm CO2-e (e=equivalents) but more realistically of 550 ppm CO2-e in 2020 and 2050 .5 

Present emissions are around 455 ppm CO2-e . Under unmitigated scenarios temperatures increase by ~4.5oC . Under mitigation scenarios of 450 ppm CO2-e , global warming increases by ~1.5 oC and by ~2.0 oC for mitigation scenarios of 550 ppm CO2-e . 1, 2 

In order to estimate the allocation of target emissions required for Australia and other countries a number of parameters were taken into account. 5 

The starting year for convergence begins in 2013 and for countries which ratified the Kyoto protocol the starting point is their ‘Kyoto compliance levels’ (Figure 1). 2050 was used as the year of convergence or the time by which all countries have equal per capita emissions to achieve the desired gas concentration outcomes. Allocations were weighted by regions for their population. Rapidly growing countries were conceded ‘ headroom’ time or years of transition required by them to comply with the convergence line.

Figure 1. Allocations of per capita emissions for Australia and other major countries and regions for the 550ppm scenario outcome to the year of convergence in 2050.5,6 

For example, to achieve a 550 ppm global greenhouse outcome by 2020, Australia is required to contribute an approximate 30 per cent reduction in per capita emissions by 2020 and a 90 percent reduction by 2050 (Figure 1) .5 

By comparison , the European Union’s per capita target would be a 17 per cent reduction by 2020 and a 69 per cent reduction by 2050.

The aims of this report are to :
1. Assess the estimated temperature-related impacts on work days lost , cases of bacterial gastroenteritis (food- borne) and Dengue (mosquito-borne) infections; and
2. Identify the implications for pharmacy practice and bodies in Australia.

2.0 Method
An advanced search of Medline (Ovid) using Basic Search (this search functionality allows users to type in a research question or phrase) and the search terms “effect of climate change on health” and the “include related terms” box (the latter finds synonyms of words used in the search), the results are sorted by relevancy to original search. Reports were selected for their relevance and the main results summarized (Table 1).

The results for heat-related working days lost and increased rates of food- and mosquito-borne infections were obtained from the Garnaut Climate Change Review and submissions. 1, 11-14 

3. Results : population health impacts due to climate change
International and Australian researchers have reported on the potential adverse population effects related to climate changes have been reported . The results were summarised in Table 1 and Figures 2 and 3.
In order to prevent or reduce the effects of environment change , climate mitigation and disease-specific measures have been recognised. The latter avenue is clearly most relevant to pharmacy practice.

3.1 International reviews of climate change- associated health disorders
The following results were summarised from the international reports retrieved from the above search (Table 1) . 3, 4 7-10 

Table 1.
International potential adverse health effects related to environmental changes. 3, 4 7-10 

Health disorder


Most serious adverse impact


Cerebrovascular, respiratory, mental health and infectious diseases


Gas and particulate matter- increased bronchitis and lost work days;

Deforestation – increased malaria, mental health of forest dwellers


Morbidities and mental health disorders and severe climate changes.


Low-lying coastal regions

Mental health – due to displacement

Injuries , morbidity and death – due to heat and flooding



Thermal stress, severe  climate injuries and vector-borne diseases


Not prioritised.

Emphasises education and leadership  roles of health workers and agencies 


Vector-borne diseases, higher hospitalisation and

food poisoning

Australia rural and remote

Aged people suffer poorer health .

Mosquito-borne and Ross-River virus


Respiratory disorders  and particulate matter


Not prioritised

Respiratory disorders (eg asthma, bronchitis)


Children: floods, severe climate disorders, infectious and vector-borne diseases


Not prioritised



3.2 Temperature-related working days lost
Working days lost were extrapolated primarily from the deaths and hospitalisations in those aged less than 65 years with various adjustments. 11 

Neither adaptation to heat changes over time nor the cardiovascular or other adverse effects of the increased prevalence of obesity were included. The results showed an improvement in work days , that is, estimated gains in days lost (Figure 2).

Figure 2. Estimated number of working days lost (millions) for Australia due to years of active life lost (YLL) that considers both mortality and hospitalisations
(Figure revised by authors on request).11 

3.2 Temperature-related bacterial gastroenteritis
Salmonella and many pathogenic microbes proliferate more rapidly at higher temperatures. 15 

Person-to-person transmission of enteric bacteria occurs readily when there is a lack of water. 16 

Notifications of Salmonellosis increase with temperature. 16 

From 2050 the estimates of bacterial gastroenteritis cases in Australia reveal marked differences not just between the unmitigated scenarios but also between the two different temperature scenarios M1,M2 and M4 (Figure 3). 11 

Separate studies with both statistical and biological models of dengue, a mosquito-borne virus infection, predicted large increases in the population at risk in northern Australia as a result of climate change. 11, 15 

Figure 3. Expected annual number of bacterial gastroenteritis cases (including Salmonellosis)
in Australia due to climate change for each of the five temperature scenarios.11

4.0 Discussion
There may be contrasting adverse and beneficial health effects associated with climate change.15 

For example, increasing temperature may lead to reduced winter deaths and disease events in some temperate countries, whereas more, very hot days may result in increased daily deaths and disease events. The strongest evidence of climate change-associated adverse health effects include the following:
- temperature extremes and thermal stress
- floods and associated injuries deaths, infectious diseases and mental health disorders
- food-poisoning due to diarrheal disease especially Salmonellosis
- water-borne infection (eg Cholera) and water-warming of coastal areas and estuaries
- vector-borne infections (eg malaria and dengue fever borne by mosquito)

The results produced by the Garnaut Review research showed relatively small increases in climate-change-associated deaths and hospitalisations up to 2075 and little apparent difference between the mitigated scenarios.1, 2 

The increases in water-borne and vector-borne infectious diseases appeared much earlier and marked differences were evident between the mitigated scenarios by 2050.

The most publicised climate change events have been the immense disruption , injuries and deaths caused by the hurricanes ‘Katrina’ and ‘Ike’ in Louisiana and Texas. During ‘Katrina’, pharmacies were successfully integrated into a linked electronic health records system.17 

Adapting to climate changes has implications for educating individuals in self-care and informing pharmacy practice as well as for cooperation between governments and national and international health bodies in producing population infrastructure and health policies.4, 8 

The above results show relatively modest effects of climate change on the limited health indicators modelled .
The Garnaut Review researchers emphasised that this research is incomplete and it is premature to draw conclusions on the impact of climate change on health overall.

4.0 Conclusions
The following conclusions relating to pharmacy practice were drawn from the above international reports and the Garnaut Review of climate change:
· Relatively modest increases in climate-change-associated deaths and hospitalisations were apparent until late in the 21st century and little difference appeared between the mitigated scenarios.
· The increases in water-borne and vector-borne infectious diseases appeared much earlier. Marked differences were evident between the main mitigated scenarios by 2050
· Pharmacy educators and the Pharmaceutical Society of Australia will note the leadership initiatives taken by the Australian Medical Association and by international bodies; pharmacists need to be educated for the health consequences most strongly associated with climate change
· More broadly the Pharmacy Guild needs to heed the workplace and lifestyle changes resulting from government actions in implementing energy , transport and building design efficiencies.
The Garnaut researchers emphasised that this research is incomplete and it is premature to draw conclusions on the overall impact of climate change on health.

Con Berbatis
School of Pharmacy
Curtin University of Technology (Western Australia)
28 September 2008.
Email: berbatis@git.com.au

Acknowledgement :
Diana Blackwood
Faculty Librarian, Health Sciences
University Library
Curtin University of Technology ,
For conducting the literature search summarised in the Method and Table 1.

1. Garnaut Climate Change Review. Draft Report. June 2008. At: http://www.garnautreview.org.au accessed 28 September 2008.
2. Berbatis C. Climate change and pharmacy in Australia: 1. Increased deaths and hospitalisations . i2P Issue 74: August 2008. Accessed at : http://archive.i2p.com.au/?page=site/article&id=1056
3. Bi P, Parton KA. Effect of climate change on Australian rural and remote regions: What do we know and what do we need to know? Aust J Rural Health 2008; 16 ; 2–4.
4. Jackson R, Shields KN. Preparing the U.S. health community for climate change. Annu Rev Public Health 2008; 29: 57–73.
5. Garnaut Climate Change Review. Targets and trajectories. Supplementary Draft Report. September 2008. At: http://www.garnautreview.org.au accessed 28 September 2008 : 13-21.
6. Breusch J. Cut emissions by 10pc – Garnaut. The Weekend Financial Review September 6-7, 2008: 4.
7. Patz J, Campbell-Lendrum D, Gibbs , Woodruff R. Health impact assessment of global climate change: expanding on comparative risk assessment approaches for policy making. Annu Rev Public Health 2008; 29:27–39.
8. Frumkin H, Hess J, Luber G, Malilay J, McGeehin M. Climate change: the public health response. Am J Public Health 2008;98:435–445.
9. O'Neill MS, Kinney PL, Cohen AJ. Environmental equity in air quality management: local and international implications for human health and climate change. J Toxicol Environmental Health 2008; PartA, 71:9,570 — 577.
10. Shea KM and the Committee on Environmental Health. Global climate change and children’s health . Pediatrics 2007;120;e1359-e1367; originally published online Oct 29, 2007;DOI: 10.1542/peds.2007-2646.
11. Bambrick H, Dear K, Woodruff R, Hanigan I, McMichael A. The impacts of climate change on three health outcomes: temperature-related mortality and hospitalisations, Salmonellosis and other bacterial gastroenteritis, and population at risk from dengue. Garnaut climate change review. 2008. At: http://www.garnautreview.org.au/CA25734E0016A131/WebObj/03-AThreehealthoutcomes/$File/03-A%20Three%20health%20outcomes.pdf
12. Berry H, Kelly BJ, Hanigan IC, Coates JH, McMichael AJ, Walsh JA, Kjellstrom T. Rural mental health impacts of climate change. Garnaut climate change review. June 2008. At: http://www.garnautreview.org.au/CA25734E0016A131/WebObj/03-DMentalhealth/$File/03-D%20Mental%20health.pdf
13. Bambrick H, Woodruff R. Climate change impacts on the burden of Ross River virus disease. Garnaut climate change review. June 2008. At: http://www.garnautreview.org.au/CA25734E0016A131/WebObj/03-BRossRivervirus/$File/03-B%20Ross%20River%20virus.pdf
14. Green D. Climate impacts on the health of remote northern Australian indigenous communities. Garnaut climate change review. February 2008. At: http://www.garnautreview.org.au/CA25734E0016A131/WebObj/03-CIndigenous/$File/03-C%20Indigenous.pdf
15. McMichael AJ, Woodruff RE, Hales S. Climate change and human health : present and future risks. Lancet 2006; 367: 859.
16. Barry M, Hughes JM. Talking dirty- the politics of clean water and sanitation. N Engl J Med 2008; 359:784-787.
17. Berbatis C. Electronic medication records for Pharmacist only (PO)-S3s and S8s in Australia’s pharmacies . i2P Issue 42, October 2005. At : http://i2P.com.au/?page=site/articled&id=318 accessed 28 September 2008.


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