Is climate change exacerbating health-care workforce shortages for underserved populations?
Authors: Catherine G Pendrey, Simon Quilty, Russell L Gruen, Tarun Weeramanthri, Robyn M Lucas
Journal: The Lancet Planetary Health (2021)

Like many countries, Australia is faced with substantial maldistribution of the health-care workforce and inequity in access to health-care services. This inequity is especially acute in rural and remote areas, where health-care professionals are continuously in short supply, and where recruitment and retention are major policy challenges.1Wakerman J Humphreys J Russell D et al.Remote health workforce turnover and retention: what are the policy and practice priorities?.Hum Resour Health. 2019; 17: 99Crossref PubMed Scopus (48) Google Scholar, 2WHOGlobal strategy on human resources for health: workforce 2030. World Health Organisation, GenevaJuly 7, 2020https://www.who.int/publications/i/item/9789241511131Date accessed: December 20, 2020Google Scholar It is well established that, in these areas of Australia, increasing ambient temperatures caused by global climate change are heightening the risk of heat-related illnesses.3Hall NL Crosby L Climate change impacts on health in remote Indigenous communities in Australia.Int J Environ Health Res. 2020; (published online June 16.)https://doi.org/10.1080/09603123.2020.1777948Crossref PubMed Scopus (6) Google Scholar, 4Talley NJ Stanley FJ Lucas T Horton RC Health and climate change MJA–Lancet Countdown report: Australia gets another failing grade in 2020 but shows signs of progress.Lancet. 2020; (published online Dec 18.)https://doi.org/10.1016/s0140-6736(20)32632-5Summary Full Text Full Text PDF Scopus (3) Google Scholar Heat might also be affecting health and access to health-care by making work in these locations less appealing to medical practitioners, but little is known about the specific effects of heat on the health-care workforce. We aimed to assess these effects in the Northern Territory of Australia, a geographically remote and sparsely populated region spanning 1·42 million km2. First Nations people make up 30·9% of the Northern Territory population, compared with 3·3% of the population of the entire country. They have much poorer health outcomes and a life expectancy of 66·6 years for men and 69·9 years for women, compared with the average of 78·1 years for men and 82·7 years for women in the non-Indigenous population of the Northern Territory.5Australian Bureau of StatisticsAboriginal and Torres Strait Islander Peoples. Australian Bureau of Statistics, Canberra2018https://www.abs.gov.au/statistics/people/aboriginal-and-torres-strait-islander-peoplesDate accessed: December 31, 2020Google Scholar The Northern Territory is being increasingly exposed to extreme heat, water insecurity, and violent storms.3Hall NL Crosby L Climate change impacts on health in remote Indigenous communities in Australia.Int J Environ Health Res. 2020; (published online June 16.)https://doi.org/10.1080/09603123.2020.1777948Crossref PubMed Scopus (6) Google Scholar, 6Bureau of MeteorologyAnnual Climate Summary for Northern Territory—Northern Territory in 2019: a very warm and dry year. Bureau of Meteorology, Australian Government, Canberra2020http://www.bom.gov.au/climate/current/annual/nt/archive/2019.summary.shtmlDate accessed: December 20, 2020Google Scholar In December, 2019, and January, 2020, the temperature in the Northern Territory was almost 4·0°C higher than the long-term average, and in 2019, Katherine, the third largest town in the Northern Territory, recorded 54 days of temperatures above 40°C;6Bureau of MeteorologyAnnual Climate Summary for Northern Territory—Northern Territory in 2019: a very warm and dry year. Bureau of Meteorology, Australian Government, Canberra2020http://www.bom.gov.au/climate/current/annual/nt/archive/2019.summary.shtmlDate accessed: December 20, 2020Google Scholar extreme heat that is associated with considerably increased morbidity and mortality.3Hall NL Crosby L Climate change impacts on health in remote Indigenous communities in Australia.Int J Environ Health Res. 2020; (published online June 16.)https://doi.org/10.1080/09603123.2020.1777948Crossref PubMed Scopus (6) Google Scholar, 4Talley NJ Stanley FJ Lucas T Horton RC Health and climate change MJA–Lancet Countdown report: Australia gets another failing grade in 2020 but shows signs of progress.Lancet. 2020; (published online Dec 18.)https://doi.org/10.1016/s0140-6736(20)32632-5Summary Full Text Full Text PDF Scopus (3) Google Scholar Poorly maintained and overcrowded housing, energy insecurity, lack of air conditioning, and substantial socioeconomic disadvantages aggravate the health risks of the population in these areas, particularly among Indigenous communities with high rates of chronic disease.3Hall NL Crosby L Climate change impacts on health in remote Indigenous communities in Australia.Int J Environ Health Res. 2020; (published online June 16.)https://doi.org/10.1080/09603123.2020.1777948Crossref PubMed Scopus (6) Google Scholar We surveyed registered practicing medical professionals working in the Northern Territory during November, 2020, to assess their perceptions of climate-related health effects and investigate whether climate change is affecting their intentions to stay in the Northern Territory. Our survey was adapted from pre-existing surveys for the evaluation of medical workforce retention and community attitudes to climate change.7Campbell N Smedts A Lowe S Keane S Smith T The Northern Territory Allied Health Workforce study final report. Flinders University, Darwin2010https://www.academia.edu/7824137/The_Northern_Territory_Allied_Health_Workforce_Study_The_Northern_Territory_Clinical_School_and_the_University_Departments_of_Rural_Health_at?pls=RHCr9pbNOZDate accessed: December 10, 2020Google Scholar, 8Merzian R Quicke A Bennett E Campbell R Swann T Climate of the Nation 2019: tracking Australia's attitudes towards climate change and energy. The Australia Institute, CanberraSeptember 2019https://australiainstitute.org.au/report/climate-of-the-nation-2019Date accessed: December 30, 2020Google Scholar The online survey was distributed electronically through local professional networks. Ethics approval was granted by the Human Research Ethics Committees of the Australian National University, Canberra, Australia and of the Northern Territory Department of Health and Menzies School of Health Research, Darwin, Australia. Overall, 362 doctors (25·7% of 1407 registered)10Australian Health Practitioner Regulation AgencyRegistrant Data: reporting period 01 July 2020 to 30 September 2020. Medical Board of Australia, MelbourneNovember 2020https://www.medicalboard.gov.au/News/Statistics.aspxDate accessed: November 30, 2020Google Scholar took the survey. Of the 359 respondents who completed demographic questions, 198 (55·2%) were women (compared with 50·8% of all Northern Territory medical professionals), and 215 (59·9%) were aged 30–49 years. In 352 respondents indicating their professional category, 122 (34·7%) were doctors in training, 92 (26·1%) were general practitioners or rural generalists, 137 (38·9%) were other specialists, and one (0·3%) was a non-specialist medical officer. Of 359 eligible responses, only 24 (6·7%) reported having completed their medical training in the Northern Territory, whereas 256 (71·3%) completed it elsewhere in Australia and 79 (22·0%) were overseas graduates. Over a third (34%) of the respondents indicated that climate change is already causing, or likely to cause, them to consider leaving the Northern Territory (table). 85% of respondents reported that climate change is already causing, or likely to cause, negative effects on the health of their patients, and nearly three-quarters (74%) responded that climate change is already causing, or likely to cause, parts of the Northern Territory to become uninhabitable. Responses to the survey also indicate that climate change is already causing, or is likely to cause, an intensification of environmental health stressors through more extreme heat events (92% of respondents), more extreme weather events such as floods and cyclones (90%), rising sea levels threatening coastal communities (90%), more severe bushfires (90%), and water shortages (84%).TableMedical professionals' perception of climate-related health effects in the Northern Territory, AustraliaClimate change is already causingClimate change is likely to causeClimate change is unlikely to causeClimate change will not causeDo not knowMe to consider leaving the Northern Territory (n=342)50 (15%)65 (19%)114 (33%)89 (26%)24 (7%)Negative effects on the health of my patients (n=339)180 (53%)108 (32%)12 (4%)12 (4%)27 (8%)Parts of the Northern Territory to become uninhabitable (n=340)104 (31%)148 (44%)22 (7%)12 (4%)54 (16%)Water shortages in our communities (n=340)208 (61%)79 (23%)17 (5%)11 (3%)25 (7%)More heatwaves and extremely hot days (n=342)266 (78%)47 (14%)6 (2%)6 (2%)17 (5%)Rising sea levels threatening our coastal communities (n=340)223 (66%)84 (25%)7 (2%)8 (2%)18 (5%)More bushfires (n=341)258 (76%)49 (14%)9 (3%)8 (2%)17 (5%)More extreme weather events, such as floods and cyclones (n=341)243 (71%)64 (19%)6 (2%)8 (2%)20 (6%)Total survey respondents: 362. Open table in a new tab Total survey respondents: 362. Our findings indicate that the vast majority of doctors in the Northern Territory perceive that the effects of climate change are already having serious adverse effects on local health, and causing a large proportion of them to consider moving elsewhere to work. Out-migration to cooler climates is a response to worsening heat stress that is available to doctors, who generally have the financial means and ability to relocate.9Black R Bennett SR Thomas SM Beddington JR Migration as adaptation.Nature. 2011; 478: 447-449Crossref PubMed Scopus (445) Google Scholar However, if even modest numbers of medical practitioners in the Northern Territory did so, health-care workforce shortages, staff turnover, and reliance on short-term staff would be greatly exacerbated, leading to less effective care, higher hospitalisation rates, and higher costs of health care.1Wakerman J Humphreys J Russell D et al.Remote health workforce turnover and retention: what are the policy and practice priorities?.Hum Resour Health. 2019; 17: 99Crossref PubMed Scopus (48) Google Scholar, 2WHOGlobal strategy on human resources for health: workforce 2030. World Health Organisation, GenevaJuly 7, 2020https://www.who.int/publications/i/item/9789241511131Date accessed: December 20, 2020Google Scholar Climate change has multiple effects on the health of populations, and is a driver of migration within and between countries.9Black R Bennett SR Thomas SM Beddington JR Migration as adaptation.Nature. 2011; 478: 447-449Crossref PubMed Scopus (445) Google Scholar Our survey suggests that the disproportionate mobility of the professional medical workforce compared with the local populations in increasingly hot zones will eventually lead to severe health-care workforce shortages, especially for disadvantaged populations.2WHOGlobal strategy on human resources for health: workforce 2030. World Health Organisation, GenevaJuly 7, 2020https://www.who.int/publications/i/item/9789241511131Date accessed: December 20, 2020Google Scholar, 9Black R Bennett SR Thomas SM Beddington JR Migration as adaptation.Nature. 2011; 478: 447-449Crossref PubMed Scopus (445) Google Scholar Health-care workforce supply should be considered in climate-related health risk assessments and adaptation strategies, and climate-related concerns should feature in the national health workforce strategy. A comprehensive National Plan for Health and Climate Change would address the challenges faced by remote and Indigenous communities, who are at particular risk, and by the workforce that supports their health needs.2WHOGlobal strategy on human resources for health: workforce 2030. World Health Organisation, GenevaJuly 7, 2020https://www.who.int/publications/i/item/9789241511131Date accessed: December 20, 2020Google Scholar, 4Talley NJ Stanley FJ Lucas T Horton RC Health and climate change MJA–Lancet Countdown report: Australia gets another failing grade in 2020 but shows signs of progress.Lancet. 2020; (published online Dec 18.)https://doi.org/10.1016/s0140-6736(20)32632-5Summary Full Text Full Text PDF Scopus (3) Google Scholar We declare no competing interests.