3. Rural and remote populations experience a
confluence of health risk factors
Worsening
workforce
shortages?
Medical
workforce
shortages
Increased
climate risk
exposure
Health
inequities
Population health outcomes
5. 0
100
200
300
400
500
Major cities Inner regional Outer regional Remote Very remote
2013 2016
Doctors per 100,000 Population. Australian Government Department of Health, NWHDS Medical Practitioner 2016.
8th OECD 35th OECD
↑BOD
Viability
↑Travel time
↑Practice scope
↑Turn over
Workforce shortages increase with remoteness
6. Low recruitment of
rural trainees
Urban-focussed
training
High demands & lack
of support
Personal &
professional isolation
Family (partner’s job,
children’s education…)
Lack of professional
development
Low recruitment
& workforce
shortages
Low retention
& high levels
of burnout
7. ABC News; RACGP
'It's mostly about the job’
- Allen et al. 2020
>1/3 rural and remote doctors report
high levels of emotional exhaustion
- BeyondBlue 2013
62% new rural doctors left rural
practice within 5 years
- Bailey et al. 2016
8. Climate change and rural communities
Worsening
rural
workforce
shortages?
Medical
workforce
maldistribution
Increased
climate impacts
in rural areas
Rural, remote &
Indigenous
health gaps
Population health outcomes
9. Australia’s rural and remote areas are highly
sensitive to climate risks
Gena Dray, ABC 2020
BOM 2019; Nick Moir 2020; SBS 2013
9
10.
11. Rural, remote & Indigenous health inequities
Worsening
rural
workforce
shortages?
Medical
workforce
shortages
Increased
climate risk
exposure
Health
inequities
Population health outcomes
12. Poorer health in rural and remote areas, especially for
Aboriginal & Torres Strait Islander individuals
50
55
60
65
70
75
80
85
90
Non-Indigenous Females Non-Indigenous Males Indigenous Females Indigenous Males
Major Cities
Inner & Outer Regional
Remote & Very Remote
NT
Life expectancy
ABS, 2018
14. • Surveyed Northern Territory (NT) doctors Nov 2020
• NT - 1.35 million km2 , population 233,000
• Alaska - 1.7 million km2, population 733,000
• Adapted from pre-existing surveys
• Rural Allied Health Workforce survey, Climate of the Nation survey
• Distributed via local professional networks
NT Medical Workforce Retention Survey
15. • Surveyed Northern Territory (NT) doctors Nov 2020
• Response rate 25·5% (359 / 1407)
• Similar age, gender, professional distribution to workforce
NT Medical Workforce Retention Survey
16. Do you intend to leave the NT?
41%
30%
29%
0% 10% 20% 30% 40% 50%
Overall
Don't know
No
Yes
17. Do you intend to leave the NT?
55%
34%
32%
21%
39%
32%
24%
27%
35%
0% 10% 20% 30% 40% 50% 60%
DIT
GP / RG
non-GP specialist Don't know
No
Yes
Family Physicians
Other Specialists
Junior doctors
20. Climate change is causing…
31%
53%
15%
44%
32%
19%
Parts of NT to become
uninhabitable
Negative effects on patients
health
Me to consider leaving the NT
Already Likely Unlikely Will not Don't know
21. Climate change is causing…
61%
78%
66%
76%
71%
23%
14%
25%
14%
19%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Water shortages
More extreme heat
Threaten coastal communities
More bushfires
More floods and cyclones
Already Likely Unlikely Will not Don't know
25. “Central Australian Aboriginal people are very resilient. They have
evolved to cope with the harsh and variable desert climate, but there
are limits. Without action to stop climate change, people will be forced
to leave their country and leave behind much of what makes them
Aboriginal. Climate change is a clear and present threat to the survival
of our people and their culture.”
- Dr Josie Douglas, Wardaman Woman and Executive Manager
Policy and Governance at Central Land Council, Northern Territory
27. Rerferences
• Pendrey CG, Quilty S, Gruen RL, Weeramanthri T, Lucas RM. Is climate change exacerbating health-care workforce shortages
for underserved populations? Lancet Planet Health. 2021 Apr;5(4):e183-e184. doi: 10.1016/S2542-5196(21)00028-0
• Pendrey C, Quilty S, Lucas R. Surveying the changing climate of Northern Territory medical workforce retention. Aust J Rural
Health. 2022 Jun;30(3):402-409. doi: 10.1111/ajr.12858. Epub 2022 Mar 1.
• Department of Human Services. January 2009 Heatwave in Victoria: an Assessment of Health Impacts [Internet]. Melbourne;
2009. Available from: https://www2.health.vic.gov.au/getfile//?sc_itemid=%7B78C32CE8-A619-47A6-8ED1-1C1D34566326%7D
• Climate Change and Australia's Healthcare System: A Review of Literature, Policy and Practice. RACP, Monash Sustainable
Development Institute, Climate and Health Alliance & University of Melbourne. October 2021
• Quilty S, Frank Jupurrurla N, Bailie RS, Gruen RL. Climate, housing, energy and Indigenous health: a call to action. Med J Aust.
2022 Jul 4;217(1):9-12. doi: 10.5694/mja2.51610.
• Healthy, Regenerative and Just: Framework for a national strategy on climate, health and well-being for Australia. Climate and
Health Alliance. October 2021. Led by the Climate and Health Alliance, health stakeholders and interdisciplinary experts have
produced Healthy, Regenerative and Just – a framework for a national strategy on climate, health and well-being for Australia.
28. ‘Other’ motivations – 96 reported
• Training requirements & career development (n=32)
• Negative workplace experiences (n=25)
• Social isolation & distance from friends / family (n=20)
• Lifestyle & community preferences (n=13)
• Climate (n=8)
• Conclusion of fixed period of employment (n=7)
• Remuneration & employment conditions (n=6)
• COVID-19 impacts / restrictions (n=4)
• Access to health & support services (n=3)
• Partner preference (n=3)
29. NT Medical Workforce Retention Survey
• NT doctors - 359 / 1407, 25·5%
• Similar age / gender distribution
DIT, 35%
GPs / RG,
26%
non-GP
Specialist,
39%
CMO, 0.3%
Career category (n = 352)
NT, 7%
Australia,
elsewhere,
71%
Overseas,
22%
Training Location (n = 359)
30. Do you intend to leave the NT?
41%
30%
29%
0% 10% 20% 30% 40% 50%
Overall
Don't know
No
Yes
Health Workforce Modelling, NT. Rosalyn Malyon Yuejen Zhao Steven Guthridge. 2010
31. February 22, 2022
Shirley Chen, MPH
Canadian Field Epidemiology Program, Public Health Agency of Canada
and BC Centre for Disease Control
Schizophrenia and mortality during the 2021
extreme heat event in British Columbia, Canada
32. Overview
• 2021 extreme heat event in British Columbia, Canada
• Schizophrenia and extreme heat
• Population-based case control study
• Data!
• Conclusions and takeaways
32
Overview
33. Extreme heat event in
British Columbia (BC),
Canada
• Extreme heat event
(EHE) in June 2021
• Record-breaking
temperatures 10-20°C
(18-36°F) above normal
• Impossible without
underlying effects of
climate change
• 95% increase in mortality
and 740 excess deaths
33
Background
NASA Earth Observatory
35. Intersecting risk factors and pathways for heat
mortality among people with schizophrenia
35
Background
Physiological
- Medication
- Heat susceptibility
Social
- Isolation
- Poverty
- Housing
Disease
- Severity
- Time since
diagnosis
Behavioural
- Lack of insight
- Adaptative behaviours
Environmental
- Housing
- AC
Person-
specific
- Age
- Sex
Co-morbidities
- Mental illness
- Hypertension
- Diabetes
- Substance use
36. Population-based Case Control Study
Antipsychotic dispensation
Age
Sex
Local health unit of residence
Comorbidities
Measures of schizophrenia
severity
36
Methods
People with
schizophrenia in BC
CASES
Deceased
CONTROLS
Alive
1) 𝐸𝐻𝐸 𝑀𝑜𝑟𝑡𝑎𝑙𝑖𝑡𝑦 = 𝐴𝑛𝑡𝑖𝑝𝑠𝑦𝑐ℎ𝑜𝑡𝑖𝑐 𝑑𝑖𝑠𝑝𝑒𝑛𝑠𝑎𝑡𝑖𝑜𝑛 + 𝐴𝑔𝑒 + 𝑆𝑒𝑥 + 𝐶𝑜𝑣𝑎𝑟𝑖𝑎𝑡𝑒1 + … + 𝐶𝑜𝑣𝑎𝑟𝑖𝑎𝑡𝑒𝑛
2) 𝐸𝐻𝐸 𝑀𝑜𝑟𝑡𝑎𝑙𝑖𝑡𝑦 = 𝐴𝑛𝑡𝑖𝑝𝑠𝑦𝑐ℎ𝑜𝑡𝑖𝑐 𝑑𝑟𝑢𝑔𝑛 + 𝐴𝑔𝑒 + 𝑆𝑒𝑥 + 𝐶𝑜𝑣𝑎𝑟𝑖𝑎𝑡𝑒1 + … + 𝐶𝑜𝑣𝑎𝑟𝑖𝑎𝑡𝑒𝑛
Multivariable logistic regression models:
37. Data for climate and health-related analyses in BC
Available
Accessible
Linkable
37
Methods
Vital Statistics
Chronic Disease
Registries
Physician billings
Hospital
discharges
Drug
dispensations
Client roster
40. Conclusions
• People with schizophrenia at disproportionate risk of death during
extreme heat event
• Antipsychotic medication is an important risk factor among many
other risk factors and pathways
• People with schizophrenia who are in contact with health system are
still at risk
• Having the right data and being able to use it is the key
• Need to target interventions towards populations most vulnerable to
heat mortality and impacts of extreme heat events
40
Conclusions
41. Acknowledgements
BC Centre for Disease Control
Sarah Henderson
David McVea
Michael Lee
Kathleen McLean
Public Health Agency of Canada
Kathleen Laberge
41
