October’s repeat serious flooding in Ōtepoti Dunedin was made more likely and more severe by climate change, making the HNAP important. Major floods nationally have been responsible for a largely invisible burden of illness and distress that general practices, hospitals and public health services are ill-prepared for. This takes the form of substantial ongoing mental distress, increases in heart and lung disease, gastroenteritis, and injuries.
Much of this burden of disease is through pathways that lie outside the health sector’s direct control, especially through damp, mouldy and cold housing, already responsible for a substantial burden of health effects, such as asthma, chest infections and heart disease. These conditions worsen with flooding, especially if houses are not properly dried and repaired afterwards or are made permanently damp by rising groundwater.
These effects worsen the preventable health injustices that already exist. The lowest income households are more likely to live in poor quality housing, and much of the lowest-cost housing is also in areas more likely to flood. Tenants in private rental houses have little control over their housing conditions, including over drying and repairs following a flood, because recent legislation changes leave people vulnerable to eviction, and healthy homes standards are not yet enforced. People with disabilities are particularly hard hit as accessible housing on flat land is in such short supply and more likely to be low-lying.
The HNAP makes strong positive commitments to health sector preparedness to support communities affected by floods, sea-level rise and other climate change effects on health. It commits the Ministry of Health and Te Whatu Ora Health NZ to partnering with iwi, hapū and local government, collaborating with communities, and working across sectors to ensure resilient, equitable and healthy housing, urban planning and food systems.
Yet the current rounds of cuts and restructures to the public health system leave it too stretched to meet these commitments. A properly funded and well-designed hospital that is able to stay up and running during increasingly frequent severe weather events, and with the capacity to tackle an increasing burden of climate change-related disease, is one important foundation of climate adaptation. Cuts to capital funding not only undermine capacity but also the elements of design that would ensure resilience. General practices, which act as the first port of call for flooding health effects, are also in a fragile state, with three quarters of GPs suffering from burnout and a third planning to retire within five years. GP clinics are often affected by severe weather events themselves. Mental health services are unable to provide the basic services currently needed, and there are no signals of the further funding that will be needed to respond to an increased mental health burden related to climate change.
The National Public Health Service (Te Whatu Ora’s population health promotion and protection function) is responsible for implementing the local partnership and prevention actions in the HNAP. Yet the service has experienced multiple recent restructures and funding cuts, leaving its capacity threadbare and threatening its ability to respond to the most pressing public health issues happening now.
The gaping chasm between what is promised in the HNAP and the reality on the ground is deeply concerning. We are already experiencing an unmet need for climate change-related health services, and the increasing frequency of severe weather events further stresses the ability of communities and the health system to recover.
Reducing global and local climate pollution remains our best protection from worsening health consequences of climate change. When the costs of responding to the health effects of climate change are counted, a healthy, just transition to zero carbon makes strong economic sense, and well-designed emissions reductions bring tangible savings to the health system through disease prevention, including through healthier housing, city planning and food systems.
We also know that when communities are meaningfully engaged in long-term decision-making, they are able to put collective health and fairness at the heart of adaptation and feel more control over the choices that need to be made, with flow-on wellbeing benefits and health savings.
A safety net for everyone as climate impacts hit requires a societal and cross-political party re-commitment to high-quality publicly funded physical and mental health services, acknowledging the rising costs of the climate change health burden. If the HNAP is to be more than words, substantial strengthening and increasing capacity for public health functions will also be needed, with capacity to work on planning in close partnership with communities and local government. Fairness suggests a real tax on emissions is needed for major climate polluters to pay for their health damages.
Alex Macmillan is a professor of public health (environmental health) at Ōtākou Whakaihu Waka University of Otago, where she is a member of He Kaupapa Hononga climate change research network, and co-director of Climate Health Aotearoa national research centre.
