Environment & energy, Health | Australia, Asia, The World

9 December 2021

Despite the ways our health is tied to the health of the planet, environmental factors aren’t routinely assessed by the health system – this should change, Arnagretta Hunter writes.

Climate change is breaking hearts – it is literally a challenge to cardiac health. It is increasingly evident that the health of our planet plays an essential role in our health and wellbeing.

For cardiology, the environment is central to the health of our hearts, our blood vessels and circulation. It influences our risk of heart attack, palpitations, stroke and cardiac arrest, our health and wellbeing, and that of our friends and family. And yet environmental factors are not routinely assessed in clinical practice, in health research, or hospitals. This should change.

Health systems are adept at assessing cardiovascular disease. Doctors can find the plaque in coronary arteries, the electrical disturbance that causes palpitations and arrhythmias, and work with the structure and function of this remarkable organ, the heart. They treat the plaque, hypertension, diabetes and advise against smoking. There are a remarkable range of drugs, devices and procedures that often improve lives.

While this biological approach to cardiovascular disease, centred on cellular function and structural changes, makes a tremendous difference to those with heart disease, it is only part of the picture.

The society in which a person lives also affects the diagnosis and natural history of heart disease. Factors such as education, socioeconomic status, occupation, relationships, cultural wellbeing, and geographic location – the social determinants of health – are all associated with cardiac disease. Yet, this is only part of the picture.

More on this: From smog to smoke to sustainable wellbeing

The final, and equally important, part of the picture is the environment. The air we breathe, the food we eat and the water we need to survive are the core environmental ingredients. Where people live, and how they live can increase their vulnerability or protect them against the adverse health impacts from changes to these core elements, particularly as the climate and weather becomes more extreme.

These five elements: air, food, water, where, and how people live constitute a framework for the how the environment determines cardiovascular disease. This framework has been developed in a collaborative project through the Australian Cardiovascular Alliance, a national body of cardiologists and cardiovascular researchers who work to reduce the morbidity and mortality associated with cardiovascular disease around Australia and the region.

Why does this matter? And should the focus of the health system go beyond the biological model of cardiovascular disease?

It matters because air pollution is a major driver for cardiovascular disease in Australia, with seven per cent of cardiovascular mortality attributed to poor air quality.

It matters because heatwaves cause cardiovascular death, and this mortality is expected to rise with the increasing intensity of climate change. It matters because environmental factors such as noise, water contamination and other environmental toxins affect our cardiovascular health and wellbeing.

More on this: Delhi’s air quality emergency

And it matters because where and how we live makes a significant difference to our vulnerability to impact from environmental challenges like air pollution, noise, heat, and other extreme weather events.

Worryingly, current Australian clinical guidelines, research agendas and funding, health data, and resources offer only passing reference to the environment. If Australia is to be committed to achieving the best health and wellbeing for its community, it needs to see the whole picture – from biology to society and finally the environment.

Understanding this relationship is important now and will only become more so as the health challenges of climate change test science and human imagination in the years ahead.

To protect our health, we must protect our environment. And the opportunities to improve our cardiovascular health through climate change mitigation strategies are measurable – increased physical activity, less air pollution, and dietary adjustments all help.

Building a health focus into Australia’s climate mitigation strategies will improve population health and wellbeing and help protect the natural environment for generations to come.

As Australia’s health sector increasingly understands the challenge of climate change, there will be opportunities to transform its understanding of health and wellbeing to improve lives, inequities, and vulnerabilities across the country.

There are remarkable opportunities around the rest of the world too. The health sector has an opportunity to consider its use of resources and to use medicine wisely, caring for both people and the planet.

Starting with an energy transition toward renewable sources, all elements of the health system should consider their environmental impact and carbon footprint.

As seen during Australia’s ‘Black Summer’, communities will need to adapt to survive challenges of a world that is two degrees Celsius warmer. A focus on air, food, water, where, and how we live will reduce the cardiovascular mortality from increasing environmental and associated threats such as heatwaves, air pollution, and supply chain disruption.

This is why cardiologists, physicians, and health professionals are now paying attention to the health impacts of the environment, and why we are calling for increased attention and resources for research and collaboration across sectors such as health, housing, and transportation. Australia needs to create a health system and a community response that addresses the full spectrum of factors that cause heart disease.

Health and wellbeing must encompass human biology, acknowledge social behaviour and its effects, and recognise that where and how people live is both central to their health and changing with the climate. It is time for a paradigm shift to protect our hearts and to ensure the best possible human future.

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