Physical and Mental Health Effects of Bushfire and Smoke in the Australian Capital Territory 2019–20

The 2019–20 bushfire season in south-eastern Australia was one of the most severe in recorded history. Bushfire smoke-related air pollution reached hazardous levels in major metropolitan areas, including the Australian Capital Territory (ACT), for prolonged periods of time. Bushfire smoke directly challenges human health through effects on respiratory and cardiac function, but can also indirectly affect health, wellbeing and quality of life. Few studies have examined the specific health effects of bushfire smoke, separate from direct effects of fire, and looked beyond physical health symptoms to consider effects on mental health and lifestyle in Australian communities. This paper describes an assessment of the health impacts of this prolonged exposure to hazardous levels of bushfire smoke in the ACT and surrounding area during the 2019–20 bushfire season. An online survey captured information on demographics, health (physical and mental health, sleep) and medical advice seeking from 2,084 adult participants (40% male, median age 45 years). Almost all participants (97%) experienced at least one physical health symptom that they attributed to smoke, most commonly eye or throat irritation, and cough. Over half of responders self-reported symptoms of anxiety and/or feeling depressed and approximately half reported poorer sleep. Women reported all symptoms more frequently than men. Participants with existing medical conditions or poorer self-rated health, parents and those directly affected by fire (in either the current or previous fire seasons) also experienced poorer physical, mental health and/or sleep symptoms. Approximately 17% of people sought advice from a medical health practitioner, most commonly a general practitioner, to manage their symptoms. This study demonstrated that prolonged exposure to bushfire smoke can have substantial effects on health. Holistic approaches to understanding, preventing and mitigating the effects of smoke, not just on physical health but on mental health, and the intersection of these, is important. Improved public health messaging is needed to address uncertainty about how individuals can protect their and their families health for future events. This should be informed by identifying subgroups of the population, such as those with existing health conditions, parents, or those directly exposed to fire who may be at a greater risk.

A Case Study on Reliability, Water Demand and Economic Analysis of Rainwater Harvesting in Australian Capital Cities

This paper presents reliability, water demand and economic analysis of rainwater harvesting (RWH) systems for eight Australian capital cities (Adelaide, Brisbane, Canberra, Darwin, Hobart, Melbourne, Perth and Sydney). A Python-based tool is developed based on a daily water balance modelling approach, which uses input data such as daily rainfall, roof area, overflow losses, daily water demand and first flush. Ten different tank volumes are considered (1, 3, 5, 10, 15, 20, 30, 50, 75 and 100 m3). It is found that for a large roof area and tank size, the reliability of RWH systems for toilet and laundry use is high, in the range of 80–100%. However, the reliability for irrigation use is highly variable across all the locations. For combined use, Adelaide shows the smallest reliability (38–49%), while Hobart demonstrates the highest reliability (61–77%). Furthermore, economic analysis demonstrates that in a few cases, benefit–cost ratio values greater than one can be achieved for the RWH systems. The findings of this study will help the Australian Federal Government to enhance RWH policy, programs and subsidy levels considering climate-sensitive inputs in the respective cities.

1478Extreme daily numbers of general practice encounters of asthma and allergic rhinitis in Australia

Background Asthma affects approximately 11% of Australia’s population and allergic rhinitis 19%. Grass pollen is associated with asthma and allergic rhinitis exacerbations. This study tested the hypothesis that days with extreme numbers of general practice (GP) encounters for asthma and allergic rhinitis aligned with grass pollen season. Methods The MedicineInsight GP database contains longitudinal data on persons attending a sample of Australian GPs. We created time series of daily counts of asthma and allergic rhinitis encounters by state and territory to identify extreme encounter days; days with counts above the 99th percentile. Results Of 3,036,678 attendances during the study period, 2.4% were for asthma. There were 83 extreme encounter days during April to December, across Australia. Victoria and South Australia had the highest increase in attendances on extreme days. Allergic rhinitis encounters represented 0.9% of attendances. Of the 69 extreme allergic rhinitis encounter days across Australia, Victoria and Australian Capital Territory had the highest increase in attendances. Allergic rhinitis extreme days were clustered between mid-October and early December (72%), compared to 22% of the asthma extreme days. Conclusions Extreme asthma GP encounters were not as strongly associated with grass pollen season compared to allergic rhinitis encounters. Victoria had a high number of encounters on asthma and allergic rhinitis extreme days, many associated with thunderstorm asthma. Key messages Extreme asthma encounter days can be associated with cooler months, grass pollen season and school holidays. Extremes allergic rhinitis presentation days were aligned with grass pollen season.

A new bottom-up method for the standard analysis and comparison of workforce capacity in mental healthcare planning: Demonstration study in the Australian Capital Territory

The aims of this study are to evaluate and describe mental health workforce and capacity, and to describe the relationship between workforce capacity and patterns of care in local areas. We conducted a comparative demonstration study of the applicability of an internationally validated standardised service classification instrument—the Description and Evaluation of Services and Directories—DESDE-LTC) using the emerging mental health ecosystems research (MHESR) approach. Using DESDE-LTC as the framework, and drawing from international occupation classifications, the workforce was classified according to characteristics including the type of care provided and professional background. Our reference area was the Australian Capital Territory, which we compared with two other urban districts in Australia (Sydney and South East Sydney) and three benchmark international health districts (Helsinki-Uusima (Finland), Verona (Italy) and Gipuzkoa (Spain)). We also compared our data with national level data where available. The Australian and Finnish regions had a larger and more highly skilled workforce than the southern European regions. The pattern of workforce availability and profile varied, even within the same country, at the local level. We found significant differences between regional rates of identified rates of psychiatrists and psychologists, and national averages. Using a standardised classification instrument at the local level, and our occupational groupings, we were able to assess the available workforce and provide information relevant to planners about the actual capacity of the system. Data obtained at local level is critical to providing planners with reliable data to inform their decision making.

Sexual identity or religious freedom: could conversion therapy ever be morally permissible in limited urgent situations?

Conversion therapy refers to a range of unscientific, discredited and harmful heterosexist practices that attempt to re-align an individual’s sexual orientation, usually from non-heterosexual to heterosexual. In Australia, the state of Victoria recently joined Queensland and the Australian Capital Territory in criminalising conversion therapy. Although many other jurisdictions have also introduced legislation banning conversion therapy, it persists in over 60 countries. Children are particularly vulnerable to the harmful effects of conversion therapy, which can include coercion, rejection, isolation and blame. However, if new biotechnologies create safe and effective conversion therapies, the question posed here is whether it would ever be morally permissible to use them. In addressing this question, we need to closely examine the individual’s circumstances and the prevailing social context in which conversion therapy is employed. I argue that, even in a sexually unjust world, conversion therapy may be morally permissible if it were the only safe and effective means of relieving intense anguish and dysphoria for the individual. The person providing the conversion therapy must be qualified, sufficiently independent from any religious organisation and must provide conversion therapy in a way that is positively affirming of the individual and their existing sexuality.