Rural Healthcare And Climate Change – Expert Reaction

Vulnerabilities
in rural healthcare services were exposed when Cyclone
Gabrielle tore through the North Island last
month.

In the aftermath of the storm, reports have
come through of a pregnant woman facing a three-hour
drive to a birthing unit due to highway closures,
Rotorua mental health professionals fundraising
to revisit flood victims, and pharmacists calling for a
prescription
fee waiver to be extended to help ease the financial
burden on affected communities.

The SMC asked experts
to comment on how rural health services will fare in a
warming world.

Professor Garry Nixon, Associate Dean
– Rural Health, University of Otago, and rural doctor at
Dunstan Hospital; and Dr Margaret Fielding, Clinical Lead
and GP, Wairoa Hospital, comment:

“Extreme weather
events will happen with increasing frequency as climate
change progresses and we need to make plans for rural health
that are sustainable and resilient in this new environment.
The burden of climate change events isn’t falling evenly.
This will exacerbate the existing health disparities faced
by many of these communities, often with large Māori
populations, resulting from levels of socioeconomic
deprivation and poor access to services.

“In order
to cope, health services need to be as decentralised as
possible. Local rural health services can be all that is
left for a community, often for prolonged periods. These
services can be very responsive and adaptable, and can pivot
rapidly to address immediate community needs; but they need
to be resourced and empowered to do this. This includes not
only maintaining and building existing services (often from
a low base in rural areas) but also taking advantage of
evolving technologies such as point of care laboratory
testing and ultrasound.

“The health challenges are
often more about accessing routine care than about emergency
care. These challenges, for both isolated communities and
health care providers haven’t gone away and will last for
many more months. Local health services are on the ground
and in the best place to take the lead during the disaster
and the recovery phases. Regional services then need to
support them by responding to their priorities and meeting
their requests for additional help.

“The breakdown
in communication systems proved a major problem for local
health services at all levels; communication between
patients and the local health service, between different
parts of the local health service and with base hospital
services. This will have impacted all emergency services and
there will likely be an effort to put in back-up solutions
for the future. Local rural health services will need to be
consulted and included in the solutions as they are rolled
out.

“Major changes on where rural communities can
most easily access secondary health services have been
forced by the weather events. The hospital they
traditionally accessed may no longer be the closest or most
accessible. The traditional catchment boundaries of
hospitals need to be able to change temporarily or even
permanently to accommodate this and everyone, communities
and hospital staff need to be onboard with the changes. Waka
Kohati and Te Whatu Ora need to work together to ensure the
health system is responding to these changes in the roading
network.

“Access to distant specialist
investigations and appointments will be disrupted. This will
further exacerbate the health inequities in many rural
communities and will need an active period of ‘catch
up’.”

No conflicts of interest
declared.

Dr Kyle Eggleton, Associate Dean –
Rural Health, Department of General Practice and Primary
Health Care, University of Auckland,
comments:

“Climate change events will occur more
frequently and be more severe, as we have seen with recent
flooding events in Auckland and Cyclone
Gabrielle.

“Based on the literature we know that
rural communities will be affected more severely, for a
range of reasons. These include climate-threatened primary
industry livelihoods such as farming, fishing, and forestry,
resulting in unemployment, financial stress, and poor mental
health wellbeing; a higher vulnerability of remote coastal
communities to coastal erosion; poorer quality housing in
low-income rural communities, exacerbating housing related
illnesses such as infectious diseases and respiratory
illnesses; reliance on untreated drinking water sources
leading to gastrointestinal illness; and critical
infrastructure issues (such as electricity and transport
links).

“Perhaps more importantly, rural areas have
an overall higher percentage of Maori compared with urban
areas, and this will result in an exacerbation of the
already existing rural-urban health
inequities.

“Evidence suggests that rural general
practices are not well equipped to deal with severe climate
change events. In a recent
study by our team, rural general practices said that the
likelihood of them being able to provide ongoing support to
communities as a climate event continued decreased over
time.

“Strategies that might help rural general
practices cope better with evolving climate change events
include acute disaster capacity response preparedness e.g.,
generators, well equipped emergency rooms, interagency
cooperation, support with long-term disaster recovery phase
planning, partnership with iwi/hapū, community health
promotion activities and awareness programmes, and central
government leadership.”

No conflict of
interest.

Dr Lauren Vinnell, Lecturer of Emergency
Management, Joint Centre for Disaster Research, Massey
University, comments:

“While the state of national
emergency has ended in Tairāwhiti and Hawke’s Bay, it is
important to remember that the recovery from Cyclone
Gabrielle will take a long time. Many people will still
require mental health support while processing this event,
as well as dealing with ongoing challenges such as insurance
claims, rebuilding, relocating, and coping with lost
livelihoods. It’s crucial that services are available as
widely as possible, appropriate for the people engaging with
them, and that they reach people who are usually less likely
to reach out for help, such as men, people who live in less
urban areas, and people who were already socially isolated
before this event.”

No conflict of
interest.

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