Health, education, social services, recreation and tourism
This chapter considers the implications of climate change for buildings
and infrastructure relied on in a wide range of areas, including health care,
aged care, education, tourism and public recreation.
Health care, aged care and emergency services
The evidence received during this inquiry about the implications of
climate change for health-related services can be grouped in the following
- direct risks to buildings used for these services, such as
inundation from sea‑level rise;
infrastructure required for these services becoming less
reliable, such as electricity outages and damage to transportation
- services being overwhelmed due to health risks associated with
These three categories are related. The Australian Medical Association (AMA)
Human health is ultimately dependent on the health of the
planet and its ecosystem. Consequently, climate change poses a myriad of direct
and indirect risks to human health. These health impacts manifest inequitably,
both within and between countries, with some groups being particularly
vulnerable. The impact of climate change on the health system is twofold as
extreme weather events increase the demand on health services whilst impeding
the capacity of health systems to provide even the most basic care.
It was also highlighted that during extreme weather events, health
systems can come under substantial pressure relatively quickly. The AMA noted:
As the intensity and frequency of extreme weather events
increase, the consequences cascade and manifest in unpredictable ways. It is
clear that there are vulnerabilities in the Australian system. Hurricane
Katrina and the 2003 San Diego wildfires are tangible examples of the complex
and volatile challenges that extreme weather events present, and a sobering
reminder that even the most developed healthcare systems can struggle under
sustained environmental pressure.
Direct threats to buildings and
Health and emergency services buildings and infrastructure in high-risk
coastal areas face the same climate challenges as other buildings located in
these areas. Sustainable Business Australia submitted that, by 2100, a 1.1
metre sea-level rise would 'place $266 billion of coastal infrastructure at
risk, including 258 police, fire and ambulance stations as well as 75 hospitals
and health services'.
Extreme events such as flooding and bushfires also disrupt normal health
services, including to the point of shutdown. In addition, to disrupting
facilities, these events can also damage or contaminate equipment and supplies.
Health and emergency services rely on other infrastructure, such as
transportation and energy networks, and disruption to these networks can have
significant consequences. Energy implications are particularly significant. The
AMA noted that hospitals and community health centres 'are dependent on a
secure and stable energy supply'. For hospitals, the AMA highlighted that 'the
consequences of even momentary disruptions to electrical circuits are
catastrophic'. The AMA provided the following observations about recent energy reliability
issues to demonstrate the potential for future risk:
Hospitals can utilise backup power generators to accommodate
for temporary lapses in power supply, however in recent years there have been a
number of instances in which extreme weather events have also disrupted the
functionality of backup power systems, leading to failure of critical medical
equipment and emergency patient evacuations.
In late 2016, a number of hospitals in South Australia lost
power, after generators failed during a state-wide blackout which was caused by
an extreme weather event. At Flinders Medical Centre, as a result of the power
outage, patients requiring ventilation had to be evacuated to a neighbouring
medical facility, and a number of embryos awaiting transfer were tragically
destroyed. The human toll of this power outage was likely minimised due to the
availability of the nearby medical facility with capacity to accept these
patients. However, if future power outages were to occur in the midst of a mass
casualty event or in a more remote part of Australia, the feasibility of such
evacuations is drastically reduced.
Disruption to transportation infrastructure can affect the ability of
staff to report for work, as well as the ability to transport patients and to
undertake community or home-based visits.
During a previous inquiry, the committee also was advised that there is
a direct relationship between higher temperatures and hospital staffing and
budgets. Mr Andrew King from Stormwater South Australia gave the following
evidence on this issue:
Hospitals have a key temperature in the high thirties where
they put on extra staff, and the cost to the health service every year of that
cut-off point is hundreds of millions of dollars. They budget that they are
going to get five or six of those days a year. That is budgeted in. If we raise
our city temperatures by 10 degrees and those five or six days become 12,
even doubling it, you have hundreds of millions.
Increases and changes in demand for
Evidence regarding health and aged care services being required to cope
with increased demand focused on how climate change is expected to result in heatwave
events occurring more frequently. However, other factors are also evident, such
- that any increase in the frequency of natural disasters would
place pressure on emergency support; and
- with ageing populations, there is 'likely to be increased
pressure on social services to support people to age in place and to utilise
social support infrastructure'.
Nevertheless, heat stress is considered to be 'the primary climate change
driver of increased demand for social and health services'. As noted by the AMA, 'heatwaves kill more Australians than any other type of
natural disaster'. The AMA argued that climate change 'is no longer a
projection of what is to come, but rather the present reality for which
Australia's healthcare system remains ill prepared'.
The AMA commented on the 2009 heatwave event as well as other heatwaves
to demonstrate the pressure these events are already placing on the health
system. On the 2009 event, the AMA submitted:
The January 2009 heatwave was an indicator of what Australia
confronts should global warming patterns continue on current trajectories. Some
parts of Australia experienced unseasonable periods of temperatures above
43 degrees for three consecutive days, whilst overnight lows failed to
yield their usual reprieve. Ambulance services were quickly overwhelmed as they
became inundated with calls for help from patients experiencing cardiac
arrests, heatstroke, exacerbation of pre-existing conditions and other heat‑related
conditions. Emergency departments struggled to make room for the influx of
The AMA explained that the excess mortality of 374 deaths (that is,
374 excess deaths over what would otherwise be expected) attributed to the heatwave overwhelmed the conventional storage capacity of the
mortuary 'and temporary refrigeration systems had to be brought in to
accommodate the unprecedented amount of fatalities'.
The AMA also commented on a severe heatwave that affected southeast
Australia in 2014. In Victoria, that heatwave 'resulted in a 24 per cent
increase in mortality and a 97 per cent increase in cardiac emergencies'.
In considering heatwave events, it was noted that the elderly are
particularly vulnerable. Hobsons Bay City Council advised that in the 2014
heatwave, the number of aged care clients admitted to hospital increased by 250
In addition, it was suggested that consideration needs to be given to
the implications of heatwave events for maternal and child health. Hobsons Bay
City Council advised that maternal and child health nurses are 'already
rescheduling checkups and immunisation appointments for parents who do not wish
to take their infants out and expose them to extreme weather'. The Council highlighted
that 'low income families are particularly impacted as they are less
likely to have an air conditioned car to safely transport their child to
and from appointments during heatwaves'.
When considering the impacts of climate change under different emissions
scenarios, the health system's impact on climate change was highlighted.
The Australian Health Economics Society noted that 'health systems in
developed countries typically generate between 4 and 8% of national greenhouse
gas emissions'. The Society argued that the 'continued imperative to reduce
emissions through effective design and planning of health infrastructure
therefore remains critical to climate change mitigation efforts'.
CSIRO suggested that the health system would be supported by measures to
address some of the heat-related health risks people face due to urban and
building design (this evidence was discussed in Chapters 4 and 6). For example,
CSIRO identified that, due to the reduction in urban heat that would result,
doubling Melbourne's vegetation coverage 'would reduce heat-related mortality
by 5 to 28 per cent'.
This report has already examined research indicating that inefficient
building design has serious implications for human health during heatwave
events. As noted in Chapter 6, a study of the 2009 Melbourne heatwave concluded
that upgrading building energy ratings would have a significant impact on
related mortality. Assuming that the occupants of 0.9 energy star houses were
the victims of the 2009 heatwave event, if all Melbourne homes had at least a
1.8 star energy rating, the number of excess deaths from a 2009 type heatwave
is projected to reduce to around 240. This would reduce further to 37 if all
houses can be upgraded to a minimum of 5.4 stars.
It is also projected that increases in the energy efficiency of
dwellings would result in declining rates of ambulance calls, emergency
department presentations and after hours doctor consultations. Therefore,
addressing heat stress in housing could lead to potential savings from reduced
demand for these services.
The Australian Health Economics Society also noted that other variables
in the future demand for health services need to be taken into account, such as
population ageing, changing disease burdens, risk factors (such as obesity) and
changing medical technologies. Nevertheless, it was recognised that there are 'a range of more direct
impacts of climate change on health care infrastructure that can be identified
To help manage risks to facilities, Regional Development Australia –
South West argued that emergency services infrastructure and hospitals 'should
not be located within the vicinity of "at risk" areas or where
disaster events could be reasonably believed to impact on transport,
communications or energy infrastructure'. Similarly, the Australian Health Economics Society suggested that the
resilience of health care infrastructure could be maximised by robust site
selection; that is 'avoiding the siting of facilities in high-risk locations
altogether, and minimising site-specific risks where they cannot be completely
The Climate and Health Alliance added that the design of new health
facilities and the maintenance of new and existing facilities should be subject
to mandatory standards that prioritise resilience to direct and indirect
In addition, the Australian Health Economics Society outlined several
other suggestions for improving the resilience of health services
infrastructure in the face of climate change. These include:
- designing 'for maximum passive cooling capability during hot
conditions'—it was suggested that more traditional building designs are
superior to lightweight modular buildings in terms of managing the risk of
- designing and maintaining 'for maximum resilience of IT and
- ensuring 'back-up and/or redundant supplies of key utilities
(e.g. electricity, water)';
- developing and maintaining effective business continuity plans
and undertaking exercises for extreme weather events; and
- ensuring 'access to "surge" capacity to deal with peak
demand during extreme weather events—this could include 'opening normally
closed wards, or going as far as some US states who, in response to lessons
from Hurricane Katrina, maintain "shuttered" hospitals as reserve
capacity to be staffed by personnel whose home facility has had to be
Outreach strategies and further research relating to vulnerable
populations was suggested. For example:
- On maternal and child health, Hobsons Bay City Council referred
to research into how maternal and child health services 'could be effectively
delivered despite climate change pressures'. The Council argued that 'further
research and sharing of this research is needed'.
- It was argued that pressures on the health system could be
reduced if new migrants receive support to learn to adapt to Australian
The AMA argued that a national strategy for climate change and human
health is required. The AMA envisaged that the strategy would seek to enhance
healthcare preparedness to 'safeguard the provision of healthcare services in
the context of an increasingly volatile climate'. The AMA also argued that
consideration should be given to ensuring that the health sector 'is adequately
resourced to meet the significant demands of extreme heat events'.
Other submitters pointed to international initiatives and strategies
that could support the Australian health care system to adapt. For example:
Doctors for the Environment Australia suggested that the
Australian Government should adopt the World Health Organization's 'Health in
all Policies' framework, in recognition 'that policy decisions in non-health
arenas such as infrastructure can have profound effects on population health'.
It was argued that doing so would help identify 'potential synergies for health
and environmental protection'.
- The Climate and Health Alliance argued that the Australian
Government should work with the state and territory governments to expand and
promote the Global Green and Healthy Hospitals initiative.
On heat stress risks, representatives from the City of Melbourne and the
South East Councils Climate Change Alliance drew the committee's attention to
the Victorian Government's Healthy Homes Program. Under that program, up to 1000 vulnerable and low income Victorians who
live with complex healthcare needs can seek energy efficiency upgrades for
their house. However, the program is limited to two geographic regions (Melbourne's
western suburbs and the Goulburn Valley) and is focused on improving indoor
temperatures in winter.
Finally, it was noted that further research could assist with better understanding
the costs and benefits associated with minimising climate-related health risks.
For example, the researchers who studied the 2009 Melbourne heatwave advised
that they are considering undertaking a more detailed cost–benefit analysis to
quantify the extent that measures to improve the energy efficiency of housing
could reduce costs in the health system.
The main point made in submissions regarding the implications of climate
change for school infrastructure is that, as with other buildings, schools
could be at risk from climate change-related flooding, inundation and extreme
weather events. Higher temperatures will also place pressure on operating
budgets due to increased expenses associated with cooling.
It was also emphasised that children 'are particularly vulnerable to
extreme heat'. In addition, it was noted that many school buildings are not well
suited to extreme weather conditions. Hobsons Bay City Council explained:
There are no design standards to ensure that schools,
childcare centres and other related facilities protect them from extreme heat.
Many school buildings were designed and built with no or minimum insulation,
poor airtightness and inefficient heating and cooling systems. School
playgrounds are not typically designed to protect children from a range of
elements including extreme heat.
Hobsons Bay City Council argued that indoor and outdoor facilities used
for children 'need to be designed with climate impacts, specifically extreme
heat, in mind'.
On school design, Williamstown High School was highlighted as an example
of efficient and sustainable design which could be followed elsewhere. Green
Building Council Australia submitted that in 2005, an $11 million project to
redevelop the school resulted in 5 Star Green Star certification. In addition
to efficiency and sustainability benefits, Green Building Council Australia
argued that green schools can support student performance; it submitted
that research indicates green schools can improve 'progression by 20 per cent
in mathematics and 26 per cent in reading, while improving student health by
41.5 per cent'.
School finish times also attracted comment. Hobsons Bay City Council
noted that schools 'often finish at around 3 pm, which, in summer, is often the
hottest part of the day'. The Council provided the following overview of the
possible implications of this:
Many students use active transport, such as walking and
cycling, to get home. An increase in temperatures may increase the risk of heat
stress. In addition to this, transport congestion during term time may
increase due to extreme weather events. Similarly, students who catch the train
home can also find their mode of transport impacted by extreme weather.
To address this risk, the Council argued that schools and families 'need
the capacity to plan for and manage the risk posed to students by a range of
extreme weather events during this commute'.
Tourism and public recreation
Australia's national parks, tourism assets, public recreation areas and
sporting facilities face a diverse range of challenges due to climate change.
- as with other coastal assets, assets in coastal regions can be at
risk of inundation and damage from storm surges and, in some areas, cyclones;
- Australia's snowfields are expected to be significantly affected
by climate change, with modelling undertaken by a CSIRO researcher indicating
that, by 2050, snow cover in the Victorian Alps could decrease by up to 80
per cent from current levels; and
areas such as the Blue Mountains could face increased bushfire
Overview of climate change risks
In a 2018 report on the implications of climate change for tourism, the
Climate Council of Australia concluded that the top five attractions for
international visitors—beaches, wildlife, the Great Barrier Reef, wilderness
areas and national parks—are all 'at risk from climate change'.
Although a common theme in submissions around the country is that coastal
areas are relied on for tourism, the potential consequences for Queensland were
particularly highlighted. The Queensland Tourism Industry Council (QTIC) submitted
that the coast is 'fundamental to the attractiveness and competitiveness of a
large number of destinations across Queensland'.
On extreme weather events, the QTIC submitted:
Extreme weather can render resorts, hotels or facilities
unusable, creating stranded assets and causing financial losses to investors
thereby making Queensland a less attractive investment state. Further
consequences of extreme weather events on tourism infrastructure are additional
costs associated with protecting assets. A large proportion of Queensland is
now deemed at flood and/or cyclone risk resulting in high insurance premiums
and creating a more challenging business environment for operators.
Tropical cyclones, which are projected to increase in intensity due to
climate change, have caused extensive damage to tourism infrastructure and
assets in the past. For example, Cyclone Debbie caused in excess of $10 million
in damage to natural park infrastructure across the Whitsunday Islands. Reduction
in visitor numbers following the cyclone also affected local businesses reliant
The implications for tourism from coral bleaching of the Great Barrier
Reef are also widely recognised. The committee examined this in the detail in
2017 as part of its inquiry into the impacts of climate change on marine
fisheries and biodiversity.
Coastal councils provided examples of issues facing their region for
public recreation and tourism. For example, Hobsons Bay City Council explained
- aerial photos show there has been significant loss of low lying
coastal parklands in its jurisdiction, particularly around Altona Coastal Park
and the Ramsar-listed Cheetham Wetlands; and
- the cost associated with protecting, upgrading and repairing
assets such as coastal tracks, which already have to be replaced or relocated
due to storm surge damage, 'is expected to increase with climate change and sea
Lake Macquarie City Council noted that an increase in relative sea level
of 0.9 metres in its jurisdiction could result in permanent inundation of
over 93 hectares of residential land, which includes public foreshore land.
This would reduce public access to the foreshore and result in the 'damage or
loss of sensitive foreshore ecosystems'.
Climate change will also have implications for public recreation and
sporting facilities, with higher temperatures and heatwave events of particular
concern. The implications of climate change for public recreation has been
recognised for some time, an example being the Western Australian Government's
2007 publication intended to assist organisations to understand how climate
change could affect sport and recreation activities.
How heat affects stadiums is a clear example of climate risk, with a
striking case being the Ashes test cricket series in 2017–18 where, during the
Sydney test match, the temperature reached 43.4°C. The Australian Open tennis tournament has also experienced heatwaves in
When considering the impacts of climate change on tourism and public
recreation infrastructure, it is important to note that, as with other areas
discussed in this chapter such as the health system, tourism is dependent on
other infrastructure which could be disrupted due to climate change. The
Northern Territory Government submitted:
Many tourism and recreational experiences across the
Territory are dependent on road, rail, marine and air transport. Climate change
disruption to transport networks may therefore also impact on recreation and
tourism infrastructure and facilities.
There are also particular challenges associated with areas of particular
natural beauty or ecological or cultural significance, such as world heritage
sites. The QTIC observed that there is a likelihood of such areas being closed
more frequently due to increases in various risks such as temperature, fire
risk and extreme weather events. Adaptive actions in response can be more
challenging than in other areas; this is because 'each natural park site is
unique, adaptive actions are expensive, contentious, and often one-off
experiments that come with the risk of losing the very asset that is trying to
In response to the threats presented by climate change, it was suggested
that for coastal parklands, 'foresight, planning and regulation' would be required.
In particular, it was argued that 'the most effective method of protection
is to leave room for coastal retreat particularly along waterways'. More generally, the need for government
support 'to assist coastal communities to manage the loss or relocation of
these assets and to prepare their local economies' was also highlighted.
Local governments that are dependent on tourism are also constructing
infrastructure in response to climate risks. The committee was informed that
the Gold Coast City Council is currently undertaking a project to build a
16-kilometre seawall to protect the City's beaches.
The design of stadiums could also be reassessed. In an article published in The Conversation,
Dr Paul Govind, a lecturer at Macquarie University, argued that greater
consideration needs to be given to sustainable and climate-adaptable stadium
design due to Australian summers becoming more prone to extreme heat
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