Torres Strait Climate Change and Health – First Pass Risk ... · 7.4 Potential Climate Change...

Torres Strait Climate Change and Health – First Pass Risk Assessment

Document prepared by BMT Global for the Torres Strait Regional Authority.BMT Eastern Australia Pty LtdLevel 8, 200 Creek StreetBrisbane Qld 4000Australia

PO Box 203, Spring Hill 4004Tel: +61 7 3831 6744

ABN 54 010 830 421www.bmt.org BMT Project Manager: David RissikTSRA Project Manager: John Rainbird Photographic creditsFront cover and inside sleeve: John RainbirdAll others see individual photo credits

This document should be citied as:Torres Strait Climate Change and Health – First Pass Risk Assessment (2018). Report prepared by BMT Global for the Environmental Management Program, Torres Strait Regional Authority. October 2018. 46pp.

Creative commons licence

TSRA (2018) Torres Strait Climate Change and Health – First Pass Risk Assessment (2018). Report prepared by BMT Global for the Environmental Management Program, Torres Strait Regional Authority, October 2018, 46pp.

This publication is available for download from the TSRA website:www.tsra.gov.au

First Pass Risk Assessment for the Health System of the Torres Strait iContents

Contents

1 Introduction 11.1 Background 1

1.2 Locale 1

1.3 Approach 2

2 Climate Change Adaptation in the Torres Strait 43 Climate Change in the Torres Strait Region 5

3.1 Current Climate 5

3.2 Future Climate 53.2.1 Temperature 5

3.2.2 Rainfall 6

3.2.3 Evaporation 7

3.2.4 Wind Speed 7

3.2.5 Cyclones 7

3.2.6 Sea-level Rise 7

3.3 Emerging Science 9

4 Hospital and Health Service Facilities in the Torres Strait 105 Introduction to Health and Climate Change 16

5.1 Torres Strait Health Context 16

5.2 Existing Climate Related Health Challenges in the Torres Strait 19

5.3 Impacts to Health from Future Climate Change 20

5.4 Heat Related Health and Wellbeing Risks for the Torres Strait 21

6 Climate Change Risk Screening 237 Discussion 32

7.1 Summary of Climate Change Risk Screening 32

7.2 The Torres Strait Regional Adaptation and Resilience Plan 2016-2021 33

7.3 Torres Strait Communities Considered Most at Risk From Climate Change Impacts on Health 33

7.4 Potential Climate Change Impacts on Key Sectors 33

7.5 Information about Climate Change and Human Health 34

7.6 Health Sector Linkages 35

7.7 Emission Reduction and Sustainability 36

8 Recommendations 378.1 Collaboration and Engagement to Ensure Effective Action 37

First Pass Risk Assessment for the Health System of the Torres Strait iiContents

8.2 Reducing Demand on The Health System and Responding to Changes in Demand Due to Climate Change 37

8.3 Understanding and Addressing Climate Risk on Health Facilities and Operational Capacity 39

9 References 40Appendix A Interview Participants A-1

List of FiguresFigure 1-1 Study Locality 3

Figure 3-1 Heat related climate change projections for the Torres Strait. The green dot shows the observed average, red dots show high emission scenario (RCP8.5) and the blue dots a low emission scenario (RCP4.5). The error bars show the variability between different climate models used for the analysis (data from www.coastadapt.com.au) 6

Figure 3-2 Changes to rainfall and dry periods in the Torres Strait. The green dot shows the observed average, red dots show high emission scenario (RCP8.5) and the blue dots a low emission scenario (RCP4.5). The error bars show the variability between different climate models used for the analysis (data from www.coastadapt.com.au) 7

Figure 3-3 Sea level rise projections for the Torres Strait. Red shows high emission scenario (RCP8.5) and blue a low emission scenario (RCP4.5). The green line shows actual sea-level data collected over the past 20 years (data from www.coastadapt.com.au). 8

Figure 4-1 Map showing locations of health care facilities operated by the Torres and Cape Hospital and Health Service in the Torres Strait. Map from https://www.health.qld.gov.au/services/torres-cape 10

Figure 5-1 Torres Strait 2014 Chronic Disease Burden (McIver and Liu 2015) 17

Figure 5-2 Direct and indirect effects of climate change on health and wellbeing (Watts et al. 2015) 21

List of TablesTable 4-1 Description of each of the Torres and Cape Hospital and Health Service’s

facilities in the Torres Strait. These provide an insight into the diversity of facilities operated by the TCHHS across the region (information from https://www.health.qld.gov.au/services/torres-cape). 11

Table 5-1 Challenges faced by clinicians when managing chronic disease in Torres Strait (adapted from McIver and Liu 2015) 18

Table 6-1 Climate Change Risk Screening 24

Table A-1 Names and positions of people interviewed for the risk assessment A-1

First Pass Risk Assessment for the Health System of the Torres Strait iiContents

8.2 Reducing Demand on The Health System and Responding to Changes in Demand Due to Climate Change 37

8.3 Understanding and Addressing Climate Risk on Health Facilities and Operational Capacity 39

9 References 40Appendix A Interview Participants A-1

List of FiguresFigure 1-1 Study Locality 3

Figure 3-1 Heat related climate change projections for the Torres Strait. The green dot shows the observed average, red dots show high emission scenario (RCP8.5) and the blue dots a low emission scenario (RCP4.5). The error bars show the variability between different climate models used for the analysis (data from www.coastadapt.com.au) 6

Figure 3-2 Changes to rainfall and dry periods in the Torres Strait. The green dot shows the observed average, red dots show high emission scenario (RCP8.5) and the blue dots a low emission scenario (RCP4.5). The error bars show the variability between different climate models used for the analysis (data from www.coastadapt.com.au) 7

Figure 3-3 Sea level rise projections for the Torres Strait. Red shows high emission scenario (RCP8.5) and blue a low emission scenario (RCP4.5). The green line shows actual sea-level data collected over the past 20 years (data from www.coastadapt.com.au). 8

Figure 4-1 Map showing locations of health care facilities operated by the Torres and Cape Hospital and Health Service in the Torres Strait. Map from https://www.health.qld.gov.au/services/torres-cape 10

Figure 5-1 Torres Strait 2014 Chronic Disease Burden (McIver and Liu 2015) 17

Figure 5-2 Direct and indirect effects of climate change on health and wellbeing (Watts et al. 2015) 21

List of TablesTable 4-1 Description of each of the Torres and Cape Hospital and Health Service’s

facilities in the Torres Strait. These provide an insight into the diversity of facilities operated by the TCHHS across the region (information from https://www.health.qld.gov.au/services/torres-cape). 11

Table 5-1 Challenges faced by clinicians when managing chronic disease in Torres Strait (adapted from McIver and Liu 2015) 18

Table 6-1 Climate Change Risk Screening 24

Table A-1 Names and positions of people interviewed for the risk assessment A-1

First Pass Risk Assessment for the Health System of the Torres Strait 1Introduction

1 Introduction

1.1 BackgroundThis project was undertaken for the Torres Strait Regional Authority (TSRA) as a first step in addressing concerns that communities in the Torres Strait might experience comparatively greater climate related health impacts in the face of climate change, as compared to most mainland communities. It has been hypothesised that this increased vulnerability to health risks associated with climate change could arise from a range of factors, such as:

• The region’s close proximity to the impoverished villages of Papua New Guinea’s WesternProvince, which have poor health care and high disease burdens.

• Existing high community health burdens including diabetes, obesity and cardiovascular disease.

• Remoteness of communities and consequences for available levels of health care.

• Relatively high temperature and humidity levels.

• Mental health implications related to concerns about sea level impacts on low lying communities,as well as other climate change impacts (e.g. impacts on key resources such as seafood).

• Variable levels of water security and quality.

• Limited access to air-conditioning and levels of over-crowding.

• Existing risks from vector borne diseases such as dengue fever.

This report aims to develop a broad understanding of the risks associated with a changing climate that face the health sector in the Torres Strait. It is meant as a first step in documenting common concerns (primarily from health professionals), prioritising key risks, and providing recommendations with respect to future actions for addressing risks and filling existing gaps.

1.2 LocaleThe Torres Strait Islands are a group of several hundred islands spread over more than 48,000 square kilometres (see http://www.tsra.gov.au) of shallow sea located between the southern coastline of Papua New Guinea (PNG) and the tip of Cape York on mainland Australia (Figure 1-1).

The region includes 18 communities on 17 inhabited island communities and the communities of Bamaga and Seisia at the tip of Cape York fall within the interests of the Torres Strait Regional Authority. Islands within the Torres Strait are allocated to one of five major Island groups: central islands, eastern islands, inner islands, near western islands, and top western islands.

Torres Strait is physically, culturally, and administratively complex. The Torres Strait Treaty was signed in 1978 and ratified in 1985. While administratively part of the Commonwealth of Australia, the treaty allows traditional visitation between Torres Strait Islands and the inhabitants of specific villages on the PNG coast, as well as traditional hunting and fishing by both groups. The proximity of Torres Strait to PNG and Asia confers a strategic importance on Torres Strait as a frontline against health, quarantine, defence, and law and order risks. Quarantine risks are managed by a series of nested zones within the region.


1.3 ApproachWe undertook semi-structured telephone interviews with a range of key relevant stakeholder representatives involved in the health sector in the Torres Strait, or with detailed knowledge of the impacts of climate change on Torres Strait communities. Interview participants are listed in Appendix A. In undertaking the interviews, we considered the changes to the climate that will occur in 2030 and 2050. Our interviews were augmented with a desktop review of available information and reports.

We developed a series of questions which underpinned the interviews with stakeholders. The questionnaire included questions relevant to the key areas of interest in the context of this assessment, namely:

• Identification of potential direct and indirect health impacts assuming current controls with 2030and 2050 projections of climate variables.

• Assessing current levels of awareness of climate change health implications within the TS healthsector.

• Assessing current levels of controls for primary climate change health risks.

• Identification of vulnerable groups, sectors or areas.

• Identification of gaps.

• Identification of key linkages with other sectors.

In producing this report we considered health risks to the population of the Torres Strait that may be directly or indirectly related to climate change, and which may increase demands on the health system in the region. We also considered some of the implications of climate change to the infrastructure and operations of the health system in the region. The recommendations in the report are not directed at a single entity and are broad ranging. Responsible organisations for addressing recommendations have not been identified, and many cases may potentially be cross-jurisdictional.


1.3 ApproachWe undertook semi-structured telephone interviews with a range of key relevant stakeholder representatives involved in the health sector in the Torres Strait, or with detailed knowledge of the impacts of climate change on Torres Strait communities. Interview participants are listed in Appendix A. In undertaking the interviews, we considered the changes to the climate that will occur in 2030 and 2050. Our interviews were augmented with a desktop review of available information and reports.

We developed a series of questions which underpinned the interviews with stakeholders. The questionnaire included questions relevant to the key areas of interest in the context of this assessment, namely:

• Identification of potential direct and indirect health impacts assuming current controls with 2030and 2050 projections of climate variables.

• Assessing current levels of awareness of climate change health implications within the TS healthsector.

• Assessing current levels of controls for primary climate change health risks.

• Identification of vulnerable groups, sectors or areas.

• Identification of gaps.

• Identification of key linkages with other sectors.

In producing this report we considered health risks to the population of the Torres Strait that may be directly or indirectly related to climate change, and which may increase demands on the health system in the region. We also considered some of the implications of climate change to the infrastructure and operations of the health system in the region. The recommendations in the report are not directed at a single entity and are broad ranging. Responsible organisations for addressing recommendations have not been identified, and many cases may potentially be cross-jurisdictional.

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First Pass Risk Assessment for the Health System of the Torres Strait 4Climate Change Adaptation in the Torres Strait

2 Climate Change Adaptation in the Torres StraitWhile this report focuses on climate change risks to the health sector, it must be remembered that climate change impacts to communities in the Torres Strait are broader than this and, in many cases, multifaceted. As such, climate change adaptation in a health context should not be considered in isolation. Rather, much work has, and is being done by others in terms of developing other climate change adaptation and resilience building strategies more broadly. The outcomes and recommendations of this report should be viewed in conjunction with, and complementary to, these other strategies.

In this respect, the potential effects of climate change in the Torres Strait are well known (as summarised in Section 3). A series of key planning documents have been developed to underpin climate change adaptation for the region. These include The Torres Strait Climate Change Strategy: Building community adaptive capacity and resilience (TSRA 2014), and the more recent Torres Strait Regional Adaptation and Resilience Plan 2016-2021 developed by the TSRA in collaboration with the Torres Shire Council, the Torres Strait Island Regional Council, Queensland government partners and local communities to set a course of action for the future (TSRA 2016).

The later plan outlines a five capitals approach to addressing climate change impacts in the region. Most notably, it focusses on improving resilience of Torres Strait communities to the effects of a changing climate and includes a pathway of actions that can be taken over time. There is significant consistency and alignment between actions in the plan and many of those recommended in this report. This includes addressing challenges that affect demand on the health system and direct and indirect impacts on the infrastructure and operations of the hospital and health system.

Other climate change related plans are under development in the region. For example, a Coastal Hazard Adaptation Strategy is under development for Torres Strait Council and Torres Strait Island Regional Council.

First Pass Risk Assessment for the Health System of the Torres Strait 4Climate Change Adaptation in the Torres Strait

2 Climate Change Adaptation in the Torres StraitWhile this report focuses on climate change risks to the health sector, it must be remembered that climate change impacts to communities in the Torres Strait are broader than this and, in many cases, multifaceted. As such, climate change adaptation in a health context should not be considered in isolation. Rather, much work has, and is being done by others in terms of developing other climate change adaptation and resilience building strategies more broadly. The outcomes and recommendations of this report should be viewed in conjunction with, and complementary to, these other strategies.

In this respect, the potential effects of climate change in the Torres Strait are well known (as summarised in Section 3). A series of key planning documents have been developed to underpin climate change adaptation for the region. These include The Torres Strait Climate Change Strategy: Building community adaptive capacity and resilience (TSRA 2014), and the more recent Torres Strait Regional Adaptation and Resilience Plan 2016-2021 developed by the TSRA in collaboration with the Torres Shire Council, the Torres Strait Island Regional Council, Queensland government partners and local communities to set a course of action for the future (TSRA 2016).

The later plan outlines a five capitals approach to addressing climate change impacts in the region. Most notably, it focusses on improving resilience of Torres Strait communities to the effects of a changing climate and includes a pathway of actions that can be taken over time. There is significant consistency and alignment between actions in the plan and many of those recommended in this report. This includes addressing challenges that affect demand on the health system and direct and indirect impacts on the infrastructure and operations of the hospital and health system.

Other climate change related plans are under development in the region. For example, a Coastal Hazard Adaptation Strategy is under development for Torres Strait Council and Torres Strait Island Regional Council.

First Pass Risk Assessment for the Health System of the Torres Strait 5Climate Change in the Torres Strait Region

3 Climate Change in the Torres Strait Region

3.1 Current ClimateProjected changes to the future climate in the Torres Strait need to be considered in the context of the existing current climate. The Torres Strait Islands are a hot and humid tropical environment located at a latitude of approximately 10º south. The following information of the current climate of the region is drawn from a report by Suppiah et al. (2010).

• The annual average air temperature for the Torres Strait is 26.8ºC. Average monthly airtemperatures are fairly consistent with the highest temperatures occurring in December (28.1ºC)and the coolest in August (25.3 ºC).

• Annual sea temperatures in the region are around 28 ºC with little annual variability.

• An important measure for the Torres Strait is apparent temperature which is based ontemperature, humidity, solar radiation and wind speed. The annual apparent temperature is 38.4ºC. In the wet season apparent temperature is 43.8 ºC and in the dry season 33.6 ºC.

• Rainfall varies seasonally with a wet season averaging 1750mm and a dry season averaging only90mm.

• The northerly position of the Torres Strait means that direct impact from cyclones is small.However, the region is affected by storm surges associated with cyclones in the Gulf ofCarpentaria and those heading towards the north-east coast of Australia.

A brief description of the likely climate future for the Torres Strait is provided the following sections. Data and descriptions have been obtained from resources available from the Queensland State Government, CSIRO and NCCARF. The ultimate source for all the data and figures that are presented is the climatechangeinaustralia.gov.au website maintained by CSIRO and the Bureau of Meteorology.

3.2 Future Climate

3.2.1 TemperatureBy 2030, if the global emission trajectory remains the same as present (RCP8.5) annual average temperatures are expected to be between 0.5 and 1.1ºC above the average climate of 1986-2005(23.4ºC). By 2070, average temperatures are expected to be 1.1 and 3.3 ºC higher than the average climate of 1986-2005 (23.4ºC). Projections indicate that by 2090 the region will experience on average 337 days above 30ºC. The increased temperatures will be experienced together with increased duration of warm spells (Figure 3-1).


Figure 3-1 Heat related climate change projections for the Torres Strait. The green dot shows the observed average, red dots show high emission scenario (RCP8.5) and the blue

dots a low emission scenario (RCP4.5). The error bars show the variability between different climate models used for the analysis (data from www.coastadapt.com.au)

3.2.2 Rainfall Rainfall projections for a high emission scenario show that rainfall in the region will be highly variable. With the number of very wet days increasing slightly and the dry periods increasing as well. This indicates that the intensity of rainfall events will increase. There will also be an increase in the average length of the dry season.


Figure 3-1 Heat related climate change projections for the Torres Strait. The green dot shows the observed average, red dots show high emission scenario (RCP8.5) and the blue

dots a low emission scenario (RCP4.5). The error bars show the variability between different climate models used for the analysis (data from www.coastadapt.com.au)

3.2.2 Rainfall Rainfall projections for a high emission scenario show that rainfall in the region will be highly variable. With the number of very wet days increasing slightly and the dry periods increasing as well. This indicates that the intensity of rainfall events will increase. There will also be an increase in the average length of the dry season.


Figure 3-2 Changes to rainfall and dry periods in the Torres Strait. The green dot shows the observed average, red dots show high emission scenario (RCP8.5) and the blue dots a

low emission scenario (RCP4.5). The error bars show the variability between different climate models used for the analysis (data from www.coastadapt.com.au)

3.2.3 EvaporationEvaporation will increase in the region with between a 7-9% increase by 2070. Evaporation will not vary markedly between seasons.

3.2.4 Wind SpeedWind speeds are projected to increase in the regions by approximately 3.4% annually. The increase will vary between seasons with increases of 5% in winter and spring. Summer wind speeds are projected to increase by 1% in 2090 under a high emission scenario.

3.2.5 CyclonesTropical cyclones are a major cause of severe weather in the wet tropics causing strong winds, heavy rainfall, storm surges and large wave conditions. Projections suggest that there will be a decline in the rate at which cyclones form, but an increase in the intensity of cyclones that do occur.

3.2.6 Sea-level RiseAt a high emission scenario, projections indicate that sea-levels will rise by 0.8 m above present day levels (Figure 3-3). This is an average level and does not indicate the annual or tidal variability.

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8First Pass Risk Assessment for the Health System of the Torres Strait

Climate Change in the Torres Strait Region

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8First Pass Risk Assessment for the Health System of the Torres Strait

Climate Change in the Torres Strait Region First Pass Risk Assessment for the Health System of the Torres Strait 9Climate Change in the Torres Strait Region

3.3 Emerging ScienceClimate change models and associated projections are continually being resolved as new information and data become available, particularly as the scale and composition of greenhouse gas emissions become clearer. Despite the signing of international agreements to reduce emissions, there is little reduction to date and emissions continue to track at a high rate (consistent with RCP8.5). In many areas of Australia, particularly the southern regions, the present climate is already equivalent to the projected climate for 2030 (Karoly pers. comm.). Sea-level rise is reportedly occurring at higher rates and with greater magnitude than projected in IPCC 5.

These increased levels have not been incorporated into policy as yet, but it is important that they are considered when assessing risk and determining adaptation responses. The recently released IPCC report: Global Warming of 1.5 °C (IPCC 2018) suggests that adaptation is expected to be more challenging for ecosystems, food and health systems at 2°C of global warming than for 1.5°C (medium confidence). Some vulnerable regions, including small islands and Least Developed Countries, are projected to experience high multiple interrelated climate risks even at global warming of 1.5°C (high confidence).The USA’s National Oceans and Atmosphere Administration has recently reported that sea-level rises of up to 2.5 metres may occur by 2100 as a result of rapidly melting ice in Greenland and at the poles (Sweet et al. 2017).

It is important to recognise that a lot of the climate change data are made available as averages and while averages present part of the picture, the upper extremes are more likely to present problems and should be the basis of adaptation.

First Pass Risk Assessment for the Health System of the Torres Strait 10Hospital and Health Service Facilities in the Torres Strait

4 Hospital and Health Service Facilities in the Torres StraitThe Torres and Cape Hospital and Health Service (HHS) is responsible for the health services of approximately 25,000 people widely spread across Cape York, the Northern Peninsula Area and the Torres Strait Islands. Sixty-six per cent of the population in the Torres and Cape HHS identify as Aboriginal and/or Torres Strait Islander. The HHS has facilities on 13 of the Torres Strait islands(Figure 4-1).

The Torres Strait is a complex and variable area servicing communities that are highly distributed. This requires an active network of facilities and regular movement of health professionals andpatients across the region. There is a strong reliance therefore on infrastructure such as jetties,airports and roads. In addition, there is a need for good telecommunication infrastructure to enable liaison and interaction. A list of the facilities in the Torres Strait is provided below, together with information on the number of people on each island and the other islands that are serviced by staff at each facility.

Figure 4-1 Map showing locations of health care facilities operated by the Torres and Cape Hospital and Health Service in the Torres Strait. Map from

https://www.health.qld.gov.au/services/torres-cape


4 Hospital and Health Service Facilities in the Torres StraitThe Torres and Cape Hospital and Health Service (HHS) is responsible for the health services of approximately 25,000 people widely spread across Cape York, the Northern Peninsula Area and the Torres Strait Islands. Sixty-six per cent of the population in the Torres and Cape HHS identify as Aboriginal and/or Torres Strait Islander. The HHS has facilities on 13 of the Torres Strait islands(Figure 4-1).

The Torres Strait is a complex and variable area servicing communities that are highly distributed. This requires an active network of facilities and regular movement of health professionals andpatients across the region. There is a strong reliance therefore on infrastructure such as jetties,airports and roads. In addition, there is a need for good telecommunication infrastructure to enable liaison and interaction. A list of the facilities in the Torres Strait is provided below, together with information on the number of people on each island and the other islands that are serviced by staff at each facility.

Figure 4-1 Map showing locations of health care facilities operated by the Torres and Cape Hospital and Health Service in the Torres Strait. Map from

https://www.health.qld.gov.au/services/torres-cape


Table 4-1 Description of each of the Torres and Cape Hospital and Health Service’s facilities in the Torres Strait. These provide an insight into the diversity of facilities operated

by the TCHHS across the region (information from https://www.health.qld.gov.au/services/torres-cape).

Name and location of health centre

Badu Island Primary Health Care CentreAlso services St Paul’s, Kubin and Mabuiag Islands. The centre services 810 people and also services St Pauls’s, Kubin and Mabuiag Island.

Boigu Island Primary Health Care CentreBoigu Island is the most northern point of Australia located 4km south of Papua New Guinea. The facility services 270 people.

Dauan Island Primary Health Care CentreThe facility services 191 people.

Erub (Darnley Island) Primary Health Care CentreErub (Darnley Island) is part of the Eastern Cluster of the Torres Strait Islands. The population is approximately 328 people and also provides services on Ugar and Mer islands.



Iama (Yam Island) Primary Health Care CentreIama (Yam Island) is situated in the Central Cluster of the Torres Strait Islands, approximately 100 km north-west of Thursday Island.Iama has a population of approximately 315 people

Kubin Community Primary Health Care CentreKubin is one of two communities located on Moa Island (Banks Island). The other community is St Paul's, located 22 km away by sealed road. Both communities have separate health care centres and operate independently of each other but areable to support each other if required.Moa Island is the second largest island in the Torres Strait and lies in the Near Western Cluster, about 40 km north of Thursday Island.The population of Kubin is approximately 163 people

Mabuyag (Jervis Island) Island Primary Health Care Centre. Mabuiag Island is located in the Near Western Cluster of Torres Strait Islands.Other islands in the cluster are Badu and Moa Island. Mabuiag Island has a population of approximately 260 people

Masig (Yorke Island) Primary Health Care CentreMasig (Yorke Island) forms part of the Central Cluster of islands. The population of Yorke Islandis approximately 270 people.



Iama (Yam Island) Primary Health Care CentreIama (Yam Island) is situated in the Central Cluster of the Torres Strait Islands, approximately 100 km north-west of Thursday Island.Iama has a population of approximately 315 people

Kubin Community Primary Health Care CentreKubin is one of two communities located on Moa Island (Banks Island). The other community is St Paul's, located 22 km away by sealed road. Both communities have separate health care centres and operate independently of each other but areable to support each other if required.Moa Island is the second largest island in the Torres Strait and lies in the Near Western Cluster, about 40 km north of Thursday Island.The population of Kubin is approximately 163 people

Mabuyag (Jervis Island) Island Primary Health Care Centre. Mabuiag Island is located in the Near Western Cluster of Torres Strait Islands.Other islands in the cluster are Badu and Moa Island. Mabuiag Island has a population of approximately 260 people

Masig (Yorke Island) Primary Health Care CentreMasig (Yorke Island) forms part of the Central Cluster of islands. The population of Yorke Islandis approximately 270 people.



Mer (Murray Island) Primary Health Care CentreMer (Murray Island) is part of the Eastern Cluster of the Torres Strait Islands. Mer has a total population of approximately 365 people.

Ngurapai (Horn Island) Primary Health Care CentreNgurapai (Horn Island) is located in the Inner Cluster of the Torres Strait Islands. It lies approximately 2 km south east of Thursday Island, 900 km north of Cairns and 40 km northwest of the tip of Cape York. Horn Island is often referred to as the ‘gateway’ to other islands in the region as it has the only airport in the Torres Strait with a domestic terminal.The population of Horn Island is approximately 531 people.

Poruma (Coconut Island) Primary Health Care CentrePoruma (Coconut Island) is situated in the Central Island Cluster of the Torres Strait Islands. It is a narrow coral island approximately 1.4 kilometres long and 400 metres wide, bounded by shallow, fringing coral reefs. The population of Coconut Island is 167 people,

Saibai Island Primary Health Care CentreSaibai Island forms part of the Top Western cluster of islands situated in the northern region of the Torres Strait. Saibai has a population of approximately 465 people. Boigu and Dauan Islands are close neighbours and the border villages of Papua New Guinea are only a few kilometres away.



St Pauls Community Primary Health Care CentreSt Paul's community is one of two communities on Moa (Banks Island). It is located on the northern end of the island, accessible by boat and helipad, and a 20 minute drive from the island’s airstrip.The other community is Kubin, located 22 km away by sealed road.Moa Island is the second largest island in the Torres Strait and lies in the Near Western Cluster, about 40 km north of Thursday Island.St Paul's has a population of approximately 258 people,

Thursday Island Community Wellness Centre

Thursday Island HospitalThe island has an area of about 3.5km2. At the 2016 census, Thursday Island had a population of 2900.Thursday Island Hospital is the referral hospital for seventeen Primary Health Care Centres in the Torres Strait Islands.

Thursday Island Primary Health Care CentreThursday Island is located 35km north-west of Cape York and 800km north of Cairns and is the major administrative centre for the Torres Strait region and Northern Peninsula Area of Queensland. Thursday Island has a population of approximately 2,900. Staff provide services for the region including inner islands, outer islands and the Northern Peninsula area (about 12,000 people).



Ugar (Stephen Island) Primary Health Care CentreUgar (Stephen Island) is situated in the Eastern Cluster of the Torres Strait Islands. The other islands in the cluster are Erub and Mer. It is home to the region’s smallest community of about 50 people. Staff from Mer attend one day a week.

Warraber (Sue Island) Primary Health Care CentreWarraber (Sue Island) is located in the Central Cluster of the Torres Strait Islands. Other islands in the cluster with health care facilities are Iama (Yam Island), Masig (Yorke Island) and Poruma (Coconut Island). Warraber has a population of approximately 250 people

First Pass Risk Assessment for the Health System of the Torres Strait 16Introduction to Health and Climate Change

5 Introduction to Health and Climate Change

5.1 Torres Strait Health ContextBefore examining climate and climate change interactions with health, it is worthwhile providing an introduction to the existing state of health of Torres Strait Islanders more broadly. According to the 2016 Australian census figures, the population of the Torres Strait Region was 9,555, of which 80%identified as Torres Strait Islanders (7,615) (ABS 2017). Aboriginal and Torres Strait Islander people are generally recognised as having an increased burden of chronic disease in comparison to non-indigenous Australians, and this situation is worse in remote areas (McIver and Liu 2015).

At the National level, the ‘Close the Gap’ campaign initiated by the Council of Australian Government in 2008 is relevant in that it sets out the overarching National targets for health (and also education and employment) indicators, with the aim of addressing the entrenched and multigenerational disadvantage for Indigenous Australians. Within this campaign, the specific health targets include(DPMC 2018):

(1) Close the gap in life expectancy within a generation (by 2031); and

(2) Halve the gap in mortality rates for Indigenous children under five by 2018.

In terms of present progress against these targets (nation-wide), the following is reported in the 2018 Closing the Gap Report (DPMC 2018):

• The target to close the gap in life expectancy by 2031 is not on track. Between the periods 2005-2007 and 2010-2012 there was a small reduction in the gap of 0.8 years for males and 0.1 yearsfor females. Over the longer term, Indigenous mortality rates have declined by 14 per cent since1998.

• The target to halve the gap in child mortality by 2018 is on track. Over the long term (1998 to2016) the Indigenous child mortality rate has declined by 35 per cent, and there has been anarrowing of the gap (by 32 per cent). Improvements in key drivers of child and maternal healthover the past few years suggest there are further gains to be made.

In the Queensland context the health gap is the difference between the Aboriginal and Torres Strait Islander burden of disease estimates and those for the general population. In Queensland the life expectancy gap is currently estimated at 10.8 years for males and 8.6 years for females (Queensland Health 2018). In Queensland there are six leading drivers of the health gap, which together explain 74% of the health gap. These include:

• Cardiovascular disease – an estimated 20% of the health gap;

• Diabetes – an estimated 16% of the health gap;

• Mental disorders – an estimated 16% of the health gap;

• Chronic respiratory disease – an estimated 9% of the health gap;

• Intentional injuries – an estimated 7% of the health gap; and

• Cancers – an estimated 6% of the health gap.


Cardiovascular disease, diabetes and mental disorders are the leading contributors to the health gap, including in remote areas such as the Torres Strait, together accounting for 52% of the health gap in Queensland (Queensland Health 2018).

In terms of disease burden, the key risk factors include:

• Smoking, alcohol and other drugs;

• Obesity, low rates of physical activity and poor nutrition;

• High blood pressure and high cholesterol;

• Unsafe sex; and

• Child sexual abuse and intimate partner violence.

Of these, obesity and smoking were the largest individual causes of health loss, contributing 13% and 11% respectively to the total burden of disease (Queensland Health 2018).

McIver and Liu (2015) provide a review specific to chronic disease in the Torres Strait, recording hypertension, type II diabetes mellitus and dyslipidaemia (e.g. hypercholesterolemia) as the most common chronic diseases (Figure 5-1).

RF = rheumatic fever, RHD = rheumatic heart disease COAD = chronic obstructive airways disease, HTN = hypertension, CLD = chronic liver disease (mainly hepatitis B), CHD = chronic heart disease, DM II = INS = diabetes mellitus, type II on insulin

Figure 5-1 Torres Strait 2014 Chronic Disease Burden (McIver and Liu 2015)

Torres Strait health professionals interviewed during the course of this project reflected that the above health trends are broadly applicable to the Torres Strait. Specific existing (non-climate) health concerns mentioned in the context of Torres Strait included:

• The Torres Strait community tend to be affected by chronic diseases at earlier stages in life andhave earlier progression of disease, when compared to elsewhere.


• Health issues associated with overcrowded housing (i.e. living arrangements).

• Lower socio-economic backgrounds limiting preventative and follow-up care.

• International border risks (i.e. the close proximity to Papua New Guinea means that tuberculosis,leprosy, mumps and yaws are more visible).

• The geographical spread and isolation of the islands presents unique (and perhapscomplicated/expensive) logistical and operational challenges for the health system.

Given the high prevalence of chronic diseases in the Torres Strait, chronic disease management is a critical health priority (McIver and Liu 2015). McIver and Liu (2015) go on to summarise key challenges to managing chronic disease in the Torres Strait (). It is expected that climate change will add an additional pressure that compounds health issues for the local communities and health system.

Table 5-1 Challenges faced by clinicians when managing chronic disease in Torres Strait (adapted from McIver and Liu 2015)

Challenge Category Challenge

Environmental Limited options at supermarket

Lack of facilities and human resources

Remoteness, distance

Desalination of water

Hot climate deters patients to exercise

Patient Getting patients motivated

Poor patient compliance

Cultural values, affecting eating habits

Lifestyle, poor eating habits

Lack of knowledge to the importance of health, poor understanding

Lack of health education and access to technology for more health knowledge

Clinician Lack of continuity of care

Lack of coordination, teamwork, consistency

Lack of time, human resources

Multiple systems for recording data

Lack of recall system

Lack of effort in non-medical side, e.g. health promotion

Lack of standardisation of management


• Health issues associated with overcrowded housing (i.e. living arrangements).

• Lower socio-economic backgrounds limiting preventative and follow-up care.

• International border risks (i.e. the close proximity to Papua New Guinea means that tuberculosis,leprosy, mumps and yaws are more visible).

• The geographical spread and isolation of the islands presents unique (and perhapscomplicated/expensive) logistical and operational challenges for the health system.

Given the high prevalence of chronic diseases in the Torres Strait, chronic disease management is a critical health priority (McIver and Liu 2015). McIver and Liu (2015) go on to summarise key challenges to managing chronic disease in the Torres Strait (). It is expected that climate change will add an additional pressure that compounds health issues for the local communities and health system.

Table 5-1 Challenges faced by clinicians when managing chronic disease in Torres Strait (adapted from McIver and Liu 2015)

Challenge Category Challenge

Environmental Limited options at supermarket

Lack of facilities and human resources

Remoteness, distance

Desalination of water

Hot climate deters patients to exercise

Patient Getting patients motivated

Poor patient compliance

Cultural values, affecting eating habits

Lifestyle, poor eating habits

Lack of knowledge to the importance of health, poor understanding

Lack of health education and access to technology for more health knowledge

Clinician Lack of continuity of care

Lack of coordination, teamwork, consistency

Lack of time, human resources

Multiple systems for recording data

Lack of recall system

Lack of effort in non-medical side, e.g. health promotion

Lack of standardisation of management


5.2 Existing Climate Related Health Challenges in the Torres Strait As outlined above, Torres Strait communities and the local health system face a variety of existing and inter-related health challenges. Current weather patterns and climatic extremes (i.e. existing climate in the absence of future climate projections) also contribute to the challenges. Most notably:

• The low-lying islands of Saibai, Boigu, Masig, Warraber, Iama and Poruma are regularly affectedby saltwater inundation and subject to coastal erosion). Low lying villages on Mer, Erub andMabuiag are also at risk of flooding and erosion close to their homes and key infrastructure. Thiscauses extreme distress and worry in the community.

• Excessive heat (air temperatures) and humidity result in lower rates of physical activity in thecommunities (i.e. exercise), which has flow on effects to health.

• Higher temperatures contribute directly to poor health of vulnerable people in the community andcause incidence of heat rash, heat exhaustion and heat stroke, and may also contribute to heartattacks and deaths (Green et al. 2010).

• High temperatures and high rainfall at certain times of year can increase the transmission ratesof infectious diseases.

• Some islands have little space for housing (i.e. little land space for additional dwellings to be built)and existing houses are often overcrowded by National standards. Housing conditions alone, butalso in combination with climatic factors such as heat and storm surge events, can facilitate thespread of disease through communities and add to mental health burdens.

• Outbreaks of Dengue fever and other mosquito borne viruses can be associated with wet weatherevents.

• There are often shortages of safe drinking water in many places and a reliance on desalinationto help fulfil the needs of communities. There is frequently a need to boil even municipal watersupplies.

• Climate can affect the productivity of horticulture (both locally and elsewhere), and therefore theavailability, affordability and quality of fresh produce for human sustenance and nutrition.

• Periods of warmer than usual sea temperatures have caused widespread coral bleaching, andare also (anecdotally) blamed for productivity declines in the local seafood catch, including bothartisanal and commercial seafood catches. Seafood is a key protein source throughout the TorresStrait and is an important source of income and livelihoods, particularly for the eastern group ofislands. Reduced seafood supply can affect health both directly (i.e. diet, mental health) andindirectly (i.e. affordability and access to health good and services).


5.3 Impacts to Health from Future Climate ChangeIt is anticipated that climate change will have a range of direct and indirect impacts on human health and on the services provided in the human health services area. Direct impacts are those caused by exposure to climate change related events such the increasing frequency and intensity of weather events such as drought, flood, storms, hot days and heat waves. Indirect impacts are those whereother drivers of human health are changed due to climate effects. Additionally, climate change is likely to act as a risk multiplier, exacerbating many of the pressures and risks which occur at present.The following have all been identified as direct or indirect impacts of health and wellbeing due to climate change:

• Increased risk of heat related health impacts (heat stress, dehydration, cardiovascular failure,increased conflict);

• Death or injury from extreme weather events;

• Spread of vector-borne diseases such as dengue, chikungunya and malaria;

• Increased allergens impact respiratory allergies and asthma;

• Declines in the quality and availability of food;

• Declines in the availability, safety and quality of drinking water;

• Increased impacts on mental health;

• Increased risk of antibiotics resistance; and

• Displacement of people from their homes, forced migration.

Some people are more sensitive to the impacts of climate change. These include the elderly, young children, people with medical conditions, people with a mental illness, people with a disability,pregnant women, culturally and linguistically diverse groups, and low-income households. Impacts on these communities will place more pressure on the public health system, noting that climate change could also directly affect health system assets and services (Watts et al. 2015). Figure 5-2conceptually summarises some of the key direct and indirect interactions between climate change and human health.


5.3 Impacts to Health from Future Climate ChangeIt is anticipated that climate change will have a range of direct and indirect impacts on human health and on the services provided in the human health services area. Direct impacts are those caused by exposure to climate change related events such the increasing frequency and intensity of weather events such as drought, flood, storms, hot days and heat waves. Indirect impacts are those whereother drivers of human health are changed due to climate effects. Additionally, climate change is likely to act as a risk multiplier, exacerbating many of the pressures and risks which occur at present.The following have all been identified as direct or indirect impacts of health and wellbeing due to climate change:

• Increased risk of heat related health impacts (heat stress, dehydration, cardiovascular failure,increased conflict);

• Death or injury from extreme weather events;

• Spread of vector-borne diseases such as dengue, chikungunya and malaria;

• Increased allergens impact respiratory allergies and asthma;

• Declines in the quality and availability of food;

• Declines in the availability, safety and quality of drinking water;

• Increased impacts on mental health;

• Increased risk of antibiotics resistance; and

• Displacement of people from their homes, forced migration.

Some people are more sensitive to the impacts of climate change. These include the elderly, young children, people with medical conditions, people with a mental illness, people with a disability,pregnant women, culturally and linguistically diverse groups, and low-income households. Impacts on these communities will place more pressure on the public health system, noting that climate change could also directly affect health system assets and services (Watts et al. 2015). Figure 5-2conceptually summarises some of the key direct and indirect interactions between climate change and human health.


Figure 5-2 Direct and indirect effects of climate change on health and wellbeing (Watts et al. 2015)

5.4 Heat Related Health and Wellbeing Risks for the Torres StraitMost heat stress research has focused on higher latitude communities where seasonal temperature variation is greater than in the tropics, and where heat waves tend to be more extreme and have led to significant impacts on health and wellbeing.

Whilst tropical regions tend not to be subject to such temperature extremes, they experience prolonged seasons of high temperatures accompanied by significantly higher humidity levels. The effects of exposure to heat combined with high humidity results in extreme heat stress risks lasting many months. Whereas acclimatisation offers some protection, human thermoregulatory capacity has upper physiological limits. Further exacerbation of heat and humidity extremes elevates risks for all who live in tropical regions as global warming progresses.

People living in hot regions of the world are already at or close to the upper limit of their potential to acclimatise to any further increases in temperature. Factors that increase vulnerability to heat stress include obesity, age (very young and very old), lack of physical fitness, illnesses that reduce the body’s thermoregulatory capacity (illness that affect the cardiac, nervous and renal systems in particular).

It is possible that despite being acclimatised to warm weather, that many Torres Strait Islanders are already close to the limits of their capacity to cope with heat stress, a situation that will be exacerbated due to increasing temperatures due to climate change. Periods of very hot weather can also exacerbate other social issues as people’s social tolerance levels decrease from heat irritation. A study reviewing heat impacts on human conflict found a very strong relationship between increase


in warmer temperatures and increased rates of interpersonal violence (Quantifying the Influence of Climate on Human Conflict, Hsiang et al 2013).

The capacity to significantly upscale acclimatization diminishes among those in hot regions, where acclimatization is already approaching thermal maxima for human tolerance. Survival will require capacity to lessen extreme heat exposures through expansion of existing technical and behavioural adaptations, where possible. These nations are at extreme heat risk. Hanna and Tait, 2015: Limits to thermoregulation and Acclimatisation Challenge Adaptation to Global Warming

Annual average apparent temperatures in the Torres Strait are currently around 38.4°C (summer average apparent temperatures are 42.3°C). Annual average temperatures are projected to increase an annual apparent temperature of 42.2°C by 2070 under current high emissions trajectories. The U.S. National Oceanic and Atmospheric Administration (NOAA) provides a Heat Index table as a ready reckoner to test when climatic conditions fall into the danger zones for human health (Fig. 1). An examination of this Heat Index table shows current temperature and humidity conditions in the Torres Strait already fall into the danger zone of extreme human health risk at intervals during summer (Fig 2.).

Cultural adaptations among Torres Strait Islanders recognise the impacts of heat and avoid participating in vigorous outdoor activities during hot weather when able. However, the imposition of a western 9-5 workday regime means that many people now undertake outdoor activities throughout the year, at direct risk of increased exposure to heat related health impacts. Whilst access to cool area is a key adaptation option, the excessive use of air-conditioning may also be contributing to a lowering of the acclimatisation levels of some members of the community. Many homes in the Torres Strait do not have air-conditioning and often lack good passive design to reduce heat uptake.

The convergence of multiple risk factors heralds significant heat risks among Torres Strait Island communities. Multiple strategies are required to alleviate the associated health risks which are escalating under a warming climate. A baseline study is needed to characterise and quantify heat exposures, current practices, and community perceptions of their risks. Strategies will need to be worked out in collaboration with the community to ensure community buy-in and appropriateness.


in warmer temperatures and increased rates of interpersonal violence (Quantifying the Influence of Climate on Human Conflict, Hsiang et al 2013).

The capacity to significantly upscale acclimatization diminishes among those in hot regions, where acclimatization is already approaching thermal maxima for human tolerance. Survival will require capacity to lessen extreme heat exposures through expansion of existing technical and behavioural adaptations, where possible. These nations are at extreme heat risk. Hanna and Tait, 2015: Limits to thermoregulation and Acclimatisation Challenge Adaptation to Global Warming

Annual average apparent temperatures in the Torres Strait are currently around 38.4°C (summer average apparent temperatures are 42.3°C). Annual average temperatures are projected to increase an annual apparent temperature of 42.2°C by 2070 under current high emissions trajectories. The U.S. National Oceanic and Atmospheric Administration (NOAA) provides a Heat Index table as a ready reckoner to test when climatic conditions fall into the danger zones for human health (Fig. 1). An examination of this Heat Index table shows current temperature and humidity conditions in the Torres Strait already fall into the danger zone of extreme human health risk at intervals during summer (Fig 2.).

Cultural adaptations among Torres Strait Islanders recognise the impacts of heat and avoid participating in vigorous outdoor activities during hot weather when able. However, the imposition of a western 9-5 workday regime means that many people now undertake outdoor activities throughout the year, at direct risk of increased exposure to heat related health impacts. Whilst access to cool area is a key adaptation option, the excessive use of air-conditioning may also be contributing to a lowering of the acclimatisation levels of some members of the community. Many homes in the Torres Strait do not have air-conditioning and often lack good passive design to reduce heat uptake.

The convergence of multiple risk factors heralds significant heat risks among Torres Strait Island communities. Multiple strategies are required to alleviate the associated health risks which are escalating under a warming climate. A baseline study is needed to characterise and quantify heat exposures, current practices, and community perceptions of their risks. Strategies will need to be worked out in collaboration with the community to ensure community buy-in and appropriateness.

First Pass Risk Assessment for the Health System of the Torres Strait 23Climate Change Risk Screening

6 Climate Change Risk ScreeningThe climate change risk assessment component of this report is presented as a tabulated climate change risk screening.

This risk screening lists various climate change hazards (i.e. sea level rise, air/sea temperature, cyclones, drought etc.), noting that Section 3 indicates the projected hazard change. Multiple potential health related effects/impacts are listed for each hazard, as applicable. For each of these effects, subsequent table columns provide detail with respect to the following:

• Have these occurred in the past in the Torres Strait and what was the effect?

• Is there an existing risk management strategy in place to tackle this hazard?

• Is there any residual (remaining) risk from this hazard?

• Does this hazard have the potential to become problematic in future? If so how and under whatlevel of climate change?

• Recommended actions.

• Broad (high/medium) prioritisation of recommended actions.

For clarity, the potential climate change effects to health services have been allocated to one of the following categories:

(1) Risk to Hospital and Health related infrastructure;

(2) Risks to hospital operational activities including risks to staff and patients; and

(3) Risk to demand on the health system.

The climate change risk screening is presented on the following pages as Table 6-1.

For the prioritisation of recommended actions, we have provided an indication of the relative high level priorities. To do this we assigned two categories: high and medium. Further information (e.g. defining urgency, funding allocations and other key decision making criteria) would be required to prioritise further. High priorities reflect actions which address issues where there is already a residual risk from the climate stressor, and where immediate benefits will be derived from those recommendations. Medium priority reflects those recommendations which address areas of risk which are not apparent at present, or where current management actions are working effectively.Note that some recommendations will be listed as high priority for one stressor and low priority for others.

Tabl

e 6-

1C

limat

e C

hang

e R

isk

Scre

enin

g

Pote

ntia

l haz

ards

Hav

e th

ese

occu

rred

in th

e pa

st in

the

Torr

es S

trai

t an

d w

hat w

as th

e ef

fect

?

Is th

ere

an e

xist

ing

risk

man

agem

ent s

trat

egy

in

plac

e to

tack

le th

is

haza

rd?

Is th

ere

any

resi

dual

(r

emai

ning

) ris

k fr

om th

is

haza

rd?

Doe

s th

is h

azar

d ha

ve th

e po

tent

ial t

o be

com

e pr

oble

mat

ic in

futu

re?

If so

how

and

und

er w

hat

leve

l of c

limat

e ch

ange

?

Rec

omm

ende

d ac

tions

(act

ions

list

ed in

ital

ics

are

iden

tifie

d in

the

Torr

es S

trai

t Reg

iona

l A

dapt

atio

n an

d R

esili

ence

Pla

n)

Prio

rity

Ris

k to

hos

pita

l and

hea

lth re

late

d in

fras

truc

ture

Stor

ms

Thes

e ha

ve o

ccur

red

but

have

not

dire

ctly

impa

cted

ho

spita

l and

hea

lth re

late

d in

frast

ruct

ure,

alth

ough

they

ha

ve c

ause

d flo

odin

g an

d er

osio

n.

Not

spe

cific

ally

for h

ealth

se

rvic

e in

frast

ruct

ure,

but

se

a w

alls

hav

e be

en b

uilt

whi

ch p

reve

nt e

xten

sive

eros

ion.

Floo

ding

occ

urs

on lo

w

lyin

g m

ud is

land

s (c

onfir

mat

ion

requ

ired

as to

w

heth

er h

ealth

in

frast

ruct

ure

has

flood

ed in

th

e pa

st).

Yes,

dam

age

does

occ

ur

durin

gst

orm

sat

som

e lo

catio

ns

An in

crea

se in

sto

rm m

agni

tude

may

impa

ct h

ealth

in

frast

ruct

ure

on s

ome

isla

nds

by c

ausi

ng fl

oodi

ng

or d

irect

sto

rm re

late

d da

mag

e. T

his

is li

kely

to

occu

r by

2030

and

bey

ond.

Incr

ease

d st

orm

act

ivity

will

als

o lik

ely

lead

to m

ore

regu

lar d

isru

ptio

n to

ele

ctric

itysu

pplie

s,w

ith

asso

ciat

ed im

pact

on

the

abilit

y of

the

hosp

ital

syst

em to

ope

rate

effe

ctiv

ely.

In m

any

case

s ai

r co

nditi

oner

s ar

e un

able

to o

pera

te w

hile

bac

kup

gene

rato

rs a

re b

eing

use

d, w

hich

cou

ld b

e pr

oble

mat

ic d

urin

g pe

riods

of h

ot w

eath

er.

Loss

of e

lect

ricity

may

pre

vent

heal

thca

re fa

cilit

ies

from

usi

ngm

oder

n eq

uipm

ent a

nd to

ols.

Onc

e re

new

able

ene

rgy

infra

stru

ctur

e su

ch a

s so

lar

and

win

d in

frast

ruct

ure

is d

evel

oped

ther

e m

ay b

e a

risk

that

thes

e w

ill be

dam

aged

dur

ing

stor

ms.

Thi

s is

like

ly to

occ

ur in

207

0.

Ade

taile

d cl

imat

e ch

ange

risk

ass

essm

ent o

f ho

spita

l and

hea

lth in

frast

ruct

ure

shou

ld b

e un

derta

ken

and

a pr

ogra

m in

itiat

ed to

upg

rade

fa

cilit

ies

to in

crea

se th

eir r

esilie

nce

to c

limat

e ch

ange

im

pact

s.Th

is s

houl

d be

sup

porte

d w

ith a

n ec

onom

ic

anal

ysis

to d

eter

min

e w

hen

the

mos

t app

ropr

iate

tim

es a

re fo

r im

plem

entin

g ac

tions

suc

h as

repa

iring

fa

cilit

ies

afte

r im

pact

, enh

anci

ng re

silie

nce

of fa

cilit

ies

to re

duce

impa

ct o

r rel

ocat

ing

faci

litie

s.

Ren

ewab

le e

nerg

y an

d ba

ttery

sou

rces

sho

uld

be

used

to p

ower

faci

litie

s. I

n th

e lo

nger

term

, bat

tery

te

chno

logy

sho

uld

be c

onsi

dere

d as

an

alte

rnat

ive

to

back

up g

ener

ator

s.

Hig

h

Cyc

lone

sEx

trem

e w

inds

and

as

soci

ated

sto

rm s

urge

as

soci

ated

with

cyc

lone

s ca

n ca

use

dire

ct d

amag

e to

he

alth

faci

litie

s (e

.g. r

oof a

nd

win

dow

s).

Stor

m s

urge

rela

ted

dam

age

on lo

w ly

ing

isla

nds.

Sea-

wal

ls to

redu

ce e

rosi

on

Hea

lth fa

cilit

ies

cons

truct

ed

in a

ccor

danc

e w

ith d

esig

n st

anda

rds

for c

yclo

ne

area

s.

Emer

genc

y m

anag

emen

t pl

an to

be

enac

ted

whe

n cy

clon

es o

ccur

Sea

wal

ls h

ave

been

dam

aged

by

stro

ng s

urge

s on

som

e is

land

s.

Stor

m s

urge

inun

datio

n is

not

re

duce

d by

sea

-wal

ls.

Stro

nger

and

long

er la

stin

gcy

clon

es a

nd h

ighe

r se

a-le

vels

will

resu

lt in

gre

ater

impa

ct fr

om w

inds

an

d st

orm

sur

ge th

an th

ose

face

d at

pre

sent

and

th

ese

may

impa

ct h

ospi

tal i

nfra

stru

ctur

e, a

cces

s ro

ads

and

emer

genc

y se

rvic

es fa

cilit

ies.

Fac

ilitie

s,ro

ads

and

infra

stru

ctur

e on

low

-lyin

g is

land

s ar

e pa

rticu

larly

vul

nera

ble.

This

is li

kely

to b

ecom

e m

ore

appa

rent

afte

r 205

0.

A de

taile

d cl

imat

e ch

ange

risk

ass

essm

ent o

f ho

spita

l and

hea

lth in

frast

ruct

ure

shou

ld b

e un

derta

ken

and

a pr

ogra

m in

itiat

ed to

upg

rade

fa

cilit

ies

to in

crea

se th

eir r

esilie

nce

to c

limat

e ch

ange

im

pact

s.Th

is s

houl

d in

clud

e a

revi

ew o

f all

heal

th

faci

litie

s bu

ildin

g co

des.

Thi

s sh

ould

be

supp

orte

d w

ith a

n ec

onom

ic a

naly

sis

to d

eter

min

e w

hen

the

mos

t app

ropr

iate

tim

es a

re fo

r im

plem

entin

g ac

tions

su

ch a

s re

pairi

ng fa

cilit

ies

afte

r im

pact

, enh

anci

ng

resi

lienc

e of

faci

litie

s to

redu

ce im

pact

or r

eloc

atin

g fa

cilit

ies.

Hig

h

Sea-

leve

l ris

eIm

pact

on

grou

nd w

ater

sa

linity

on

low

lyin

g is

land

s.

Supp

lies

can

be

cont

amin

ated

.

Hos

pita

ls u

se d

esal

inat

ion

and

bottl

ed w

ater

Not

at p

rese

nt a

lthou

gh p

last

ic

bottl

es re

sult

in a

was

te

man

agem

ent i

ssue

.

Impa

cts

on g

roun

d w

ater

reso

urce

s an

d ot

her w

ater

supp

lies

likel

y to

incr

ease

with

a re

sulta

nt in

crea

se

in re

lianc

e on

des

alin

ated

wat

er o

r on

bottl

ed w

ater

.

This

will

incr

ease

exp

ense

s an

d th

e w

aste

m

anag

emen

t cha

lleng

e w

ill b

e ex

acer

bate

d.

Ren

ewab

le e

nerg

y an

d ba

ttery

sou

rces

sho

uld

be

used

to p

ower

faci

litie

s. I

n th

e lo

nger

term

, bat

tery

te

chno

logy

sho

uld

be c

onsi

dere

d as

an

alte

rnat

ive

to

back

up g

ener

ator

s.

Ther

e is

a n

eed

to w

ork

with

com

mun

ities

, loc

al a

nd

stat

e go

vern

men

ts to

add

ress

clim

ate

risks

to w

ater

se

curit

y an

d su

pply

.

Med

ium

Sea-

leve

l ris

eSe

a-le

vel r

ise

has

exac

erba

ted

beac

h er

osio

n ra

tes

on s

ome

low

-lyin

g is

land

s.

Sea-

wal

ls c

onst

ruct

ed to

re

duce

ero

sion

(TI a

nd

Saib

ai).

Som

e in

divi

dual

s an

d co

mm

uniti

es h

ave

Ther

e is

resi

dual

risk

as

eros

ion

cont

inue

s to

occ

ur in

so

me

area

s.

Sea-

leve

l ris

e m

ay le

ad to

hea

lth in

frast

ruct

ure

on

low

lyin

g is

land

s be

ing

inun

date

d, p

oten

tially

af

fect

ing

infra

stru

ctur

e an

d se

rvic

es.

The

exte

nt

(hei

ght a

nd ti

min

g) o

f inu

ndat

ion

will

vary

as

will

the

impa

ct o

n th

e fa

cilit

y. R

ates

of s

ea-le

vel r

ise

will

incr

ease

afte

r 205

0.

A de

taile

d cl

imat

e ch

ange

risk

ass

essm

ent o

f ho

spita

l and

hea

lth in

frast

ruct

ure

shou

ld b

e un

derta

ken

and

a pr

ogra

m in

itiat

ed to

upg

rade

fa

cilit

ies

to in

crea

se th

eir r

esilie

nce

to c

limat

e ch

ange

im

pact

s.Th

ese

may

incl

ude

rais

ing

elec

trici

ty-b

ased

an

d ot

her i

nfra

stru

ctur

e w

ell a

bove

inun

datio

n he

ight

, It

may

be

nece

ssar

y to

relo

cate

faci

litie

s on

or

betw

een

isla

nds.

Hig

h

24First Pass Risk Assessment for the Health System of the Torres Strait 23Climate Change Risk Screening















Pote

ntia

l haz

ards

Hav

e th

ese

occu

rred

in th

e pa

st in

the

Torr

es S

trai

t an

d w

hat w

as th

e ef

fect

?

Is th

ere

an e

xist

ing

risk

man

agem

ent s

trat

egy

in

plac

e to

tack

le th

is

haza

rd?

Is th

ere

any

resi

dual

(r

emai

ning

) ris

k fr

om th

is

haza

rd?

Doe

s th

is h

azar

d ha

ve th

e po

tent

ial t

o be

com

e pr

oble

mat

ic in

futu

re?

If so

how

and

und

er w

hat

leve

l of c

limat

e ch

ange

?

Rec

omm

ende

d ac

tions

(act

ions

list

ed in

ital

ics

are

iden

tifie

d in

the

Torr

es S

trai

t Reg

iona

l A

dapt

atio

n an

d R

esili

ence

Pla

n)

Prio

rity

unde

rtake

n th

eir o

wn

wor

ks

to a

ddre

ss e

rosi

onSe

a-le

vel r

ise

will

incr

ease

the

impa

ct o

f sto

rm

surg

e fro

m c

yclo

nes

and

stor

ms.

Thi

s m

ay in

crea

se

the

likel

ihoo

d an

d co

nseq

uenc

e of

dam

age

to

heal

th s

ervi

ce b

uild

ings

, and

ess

entia

l inf

rast

ruct

ure

(e.g

. roa

ds, j

ettie

s, e

lect

ricity

).

Hea

t and

hea

twav

esH

eat a

nd h

eatw

aves

cre

ate

a re

lianc

e on

ele

ctric

ity to

driv

e ai

r-co

nditi

onin

g, e

nsur

e su

ffici

ent w

ater

sup

plie

s ar

e av

aila

ble

etc.

Hea

t can

als

o im

pact

ele

ctric

ity

infra

stru

ctur

e di

rect

ly.

Ther

e is

a h

igh

dem

and

on

dies

el to

driv

e ge

nera

tors

an

d pr

ovid

eel

ectri

city

.

Elec

trici

ty fa

ilure

can

co

mpr

omis

e ab

ility

of

impo

rtant

infra

stru

ctur

e to

op

erat

e. E

.g. w

ater

tre

atm

ent.

No

Incr

ease

d he

at a

nd lo

nger

hea

twav

es w

ill in

crea

se

dem

and

on e

lect

ricity

sup

plie

s an

d m

ay c

ause

di

srup

tion

to e

lect

ricity

sup

plie

s.A

lthou

gh fa

cilit

ies

have

gen

erat

ors,

som

e of

thes

e m

ay n

ot b

e ab

le to

ru

n ai

r con

ditio

ners

in a

dditi

on to

ena

blin

g ot

her

heal

th s

ervi

ces

to b

e su

stai

ned

at e

ach

loca

tion.

Elec

trici

ty fa

ilure

can

dis

rupt

oth

er e

ssen

tial

serv

ices

suc

h as

sew

age

treat

men

t and

wat

er

desa

linis

atio

n pl

ants

, whi

ch c

an im

pact

the

heal

th

serv

ice

and

thei

r sta

ff.

Ther

e is

a n

eed

to a

sses

s th

e cr

oss

depe

nden

cies

be

twee

n di

ffere

nt s

ervi

ces

(roa

ds, e

lect

ricity

, wat

er,

com

mun

icat

ions

) to

help

to u

nder

stan

d th

e m

ost

susc

eptib

le a

spec

ts o

f the

sys

tem

.

Ren

ewab

le e

nerg

y an

d ba

ttery

sou

rces

sho

uld

be

used

to p

ower

faci

litie

s. I

n th

e lo

nger

term

, bat

tery

te

chno

logy

sho

uld

be c

onsi

dere

d as

an

alte

rnat

ive

to

back

up g

ener

ator

s.

Loca

l gov

ernm

ent a

nd th

e he

alth

sec

tor s

houl

d co

llabo

rate

to id

entif

y w

here

ther

e ar

e ris

ks to

hea

lth

from

wat

erqu

ality

and

wat

erse

curit

y in

the

Torr

es

Stra

it. M

anag

emen

t pla

ns s

houl

d be

dev

elop

edin

hi

gh a

nd m

ediu

m ri

sk a

reas

.

Med

ium

All h

azar

dsIm

pact

s on

hea

lth

infra

stru

ctur

eH

ealth

ser

vice

s ar

e up

grad

ed in

resp

onse

to

pres

ent e

vent

s an

d ne

eds

No

Hea

lth in

frast

ruct

ure

plan

ning

is n

ot ta

king

clim

ate

chan

ge in

to a

ccou

nt a

nd re

sour

ces

may

be

bein

g in

vest

ed in

to s

hort-

term

out

com

es a

nd n

ot

cons

ider

ing

the

futu

re.

For e

xam

ple,

sho

uld

new

in

frast

ruct

ure

be b

uilt

on th

e no

rther

n C

ape

rath

er

than

the

isla

nds?

A de

taile

d ris

k as

sess

men

t sho

uld

be u

nder

take

n fo

r al

l hea

lth c

are

faci

litie

s. T

his

shou

ld b

e us

ed to

de

velo

p a

long

-term

pla

n fo

r mai

nten

ance

, upg

radi

ng

or re

loca

ting

faci

litie

s an

d se

rvic

es.T

his

shou

ld b

e su

ppor

ted

with

an

econ

omic

ana

lysi

s to

det

erm

ine

whe

n th

e m

ost a

ppro

pria

te ti

mes

are

for

impl

emen

ting

actio

ns s

uch

as re

pairi

ng fa

cilit

ies

afte

r im

pact

, enh

anci

ng re

silie

nce

of fa

cilit

ies

to re

duce

impa

ct o

r rel

ocat

ing

faci

litie

s.

Med

ium

Dro

ught

sLo

ng d

ry p

erio

ds re

duce

w

ater

ava

ilabi

lity

and

wat

er

supp

ly in

frast

ruct

ure

is m

ore

susc

eptib

le to

con

tam

inat

ion.

Des

alin

atio

n pl

ants

, Pu

rcha

sing

bot

tled

wat

er.

No,

but

doe

s co

ntrib

ute

to

was

te m

anag

emen

tiss

ue fo

r he

alth

ser

vice

s

Des

alin

atio

n is

ver

y po

wer

hun

gry

and

is e

xpen

sive

. Bo

ttled

wat

er is

als

o ex

pens

ive

and

cont

ribut

es

exte

nsiv

ely

to w

aste

r iss

ues.

Was

te m

anag

emen

t fa

cilit

ies

are

an im

porta

nt a

spec

t of h

ealth

ser

vice

in

frast

ruct

ure.

On

som

e is

land

s ex

tend

ed d

roug

ht w

ill in

crea

se fi

re

and

bush

fire

risk,

whi

ch m

ay p

ose

risks

to h

ealth

se

rvic

es a

nd in

frast

ruct

ure

Ren

ewab

le e

nerg

y an

d ba

ttery

sou

rces

sho

uld

be

used

to p

ower

faci

litie

s. I

n th

e lo

nger

term

, bat

tery

te

chno

logy

sho

uld

be c

onsi

dere

d as

an a

ltern

ativ

e to

ba

ckup

gen

erat

ors.

Loca

l gov

ernm

ent,

and

the

heal

th s

ecto

r sho

uld

colla

bora

te to

iden

tify

whe

re th

ere

are

risks

to w

ater

se

curit

y in

the

Torr

es S

trait.

Man

agem

ent p

lans

sh

ould

be

deve

lope

d in

hig

h an

d m

ediu

m ri

sk a

reas

.

Isla

nds

shou

ldha

ve th

e ca

paci

ty to

man

age

and

cont

rol f

ires

in o

r nea

r the

ir co

mm

unity

are

as

Med

ium
















Pote

ntia

l haz

ards

Hav

e th

ese

occu

rred

in th

e pa

st in

the

Torr

es S

trai

t an

d w

hat w

as th

e ef

fect

?

Is th

ere

an e

xist

ing

risk

man

agem

ent s

trat

egy

in

plac

e to

tack

le th

is

haza

rd?

Is th

ere

any

resi

dual

(r

emai

ning

) ris

k fr

om th

is

haza

rd?

Doe

s th

is h

azar

d ha

ve th

e po

tent

ial t

o be

com

e pr

oble

mat

ic in

futu

re?

If so

how

and

und

er w

hat

leve

l of c

limat

e ch

ange

?

Rec

omm

ende

d ac

tions

(act

ions

list

ed in

ital

ics

are

iden

tifie

d in

the

Torr

es S

trai

t Reg

iona

l A

dapt

atio

n an

d R

esili

ence

Pla

n)

Prio

rity

Ris

ks to

hos

pita

l ope

ratio

nal a

ctiv

ities

incl

udin

g ris

ks to

sta

ff an

d pa

tient

s

Stor

ms

Hea

vy ra

ins

and

stro

ng

win

ds d

urin

g st

orm

s ha

ve

been

not

ed to

impa

ct

Infra

stru

ctur

e on

som

e lo

w-

lyin

g is

land

s. T

he im

pact

ha

s ei

ther

bee

n a

resu

lt of

flo

odin

g (o

n m

ud is

land

s) o

r er

osio

n (o

n sa

ndy

isla

nds)

. Th

e ab

ility

to tr

ansp

ort

peop

le b

y ro

ad o

r air

is

com

prom

ised

. P

atie

nts

beco

me

isol

ated

and

mus

t w

ait l

onge

r for

car

e.

Hea

lth s

ervi

ces

have

an

emer

genc

y m

anag

emen

t pl

an w

hich

is im

plem

ente

d as

requ

ired,

and

whi

ch is

w

orki

ng e

ffect

ivel

y un

der

curr

ent c

ondi

tions

.

No

An in

crea

se in

sto

rm m

agni

tude

is li

kely

to im

pact

he

alth

infra

stru

ctur

e an

d ac

cess

rout

es to

hea

lth

faci

litie

s.

Incr

ease

d st

orm

act

ivity

will

als

o lik

ely

lead

to m

ore

regu

lar d

isru

ptio

n to

ele

ctric

ity s

uppl

ies,

with

as

soci

ated

impa

ct o

n th

e ab

ility

of th

e ho

spita

l sy

stem

to o

pera

te e

ffect

ivel

y. In

man

y ca

ses

air

cond

ition

ers

are

unab

le to

ope

rate

whi

le b

acku

p ge

nera

tors

are

bei

ng u

sed.

St

orm

s al

so d

amag

e in

frast

ruct

ure

(incl

udin

g el

ectri

city

). T

his

can

affe

ct e

quip

men

t and

sof

twar

e an

d im

pact

s th

e ab

ility

forh

ealth

care

faci

litie

s to

use

mod

ern

equi

pmen

t and

tool

s.

Wea

ther

war

ning

s sh

ould

be

used

to u

nder

pin

cont

inge

ncy

plan

ning

and

the

pote

ntia

l for

pat

ient

is

olat

ion

shou

ld b

e a

key

cons

ider

atio

n w

hen

dete

rmin

ing

and

prio

ritis

ing

man

agem

ent a

ctio

ns.

The

acce

ss ro

utes

to a

nd fr

om h

ealth

faci

litie

s sh

ould

be

ass

esse

d to

det

erm

ine

thei

r sus

cept

ibilit

y re

silie

nce

to c

limat

e ch

ange

effe

cts.

Thi

s sh

ould

als

o in

clud

e as

sess

men

ts o

f boa

t ram

ps, j

ettie

s an

d ai

rstri

ps. A

long

-term

pla

n sh

ould

be

deve

lope

d to

up

grad

e pr

iorit

y in

frast

ruct

ure.

Med

ium

Stor

ms

Floo

ds c

an c

onta

min

ate

wat

er s

uppl

ies.

C

rypt

ospo

ridiu

m a

lread

y an

is

sue

Des

alin

atio

n pl

ants

, Pu

rcha

sing

bot

tled

wat

er.

Goo

d gu

idan

ce a

vaila

ble

and

staf

f aw

aren

ess

is

high

.

Boili

ng w

ater

No,

good

gui

danc

e is

av

aila

ble,

and

the

com

mun

ity

has

a go

od a

war

enes

s of

the

issu

e.

Was

te m

anag

emen

t is

anis

sue.

Des

alin

atio

n is

ver

y po

wer

hun

gry

and

is e

xpen

sive

. Bo

ttled

wat

er is

als

o ex

pens

ive

and

cont

ribut

es

exte

nsiv

ely

to w

aste

r iss

ues.

Was

te m

anag

emen

t fa

cilit

ies

are

an im

porta

nt a

spec

t ofh

ealth

ser

vice

in

frast

ruct

ure.

Ren

ewab

le e

nerg

y so

urce

s sh

ould

be

used

to p

ower

fa

cilit

ies.

In

the

long

er te

rm, b

atte

ry te

chno

logy

sh

ould

be

cons

ider

ed a

s an

alte

rnat

ive

to b

acku

p ge

nera

tors

.

Hos

pita

l and

hea

lth s

ervi

ces

shou

ld d

evel

op a

was

te

man

agem

ent p

lan

to s

uppo

rt fa

cilit

ies

to m

anag

e th

eir w

aste

app

ropr

iate

ly.

Wat

er q

ualit

y m

onito

ring

shou

ld b

e co

ntin

ued

and

used

to in

form

hos

pita

l man

ager

s to

ens

ure

that

sta

ff an

d pa

tient

s ar

e no

t affe

cted

by

poor

wat

er q

ualit

y.

Med

ium

Cyc

lone

sD

urin

g cy

clon

es a

nd

asso

ciat

ed b

ad w

eath

er,

patie

nt tr

ansp

ort i

s di

srup

ted.

Th

ere

is a

relia

nce

on

helic

opte

rs,p

lane

san

d bo

ats.

Whe

n th

ese

are

com

prom

ised

, pat

ient

s be

com

e is

olat

ed a

nd c

anno

t ge

t to

heal

th c

linic

s or

the

larg

ehe

alth

car

e fa

cilit

ies

on

Thur

sday

Isla

nd o

r in

Cai

rns.

Cyc

lone

s af

fect

acc

ess

to

and

from

hos

pita

ls a

nd

heal

th s

ervi

ces.

Thi

s m

akes

it di

fficu

lt to

mov

e si

ck

peop

le, e

rode

s ro

ads,

da

mag

es d

estro

yin

frast

ruct

ure.

Hea

lth s

ervi

ces

have

an

emer

genc

y m

anag

emen

t pl

an w

hich

is im

plem

ente

d as

requ

ired,

and

whi

ch is

w

orki

ng e

ffect

ivel

y un

der

curr

entc

ondi

tions

.

Yes,

alth

ough

wor

ks w

ell m

ost

times

it c

an b

e st

rain

ed d

urin

gex

trem

e ev

ents

An in

crea

se in

the

mag

nitu

de a

nd s

treng

th o

f cy

clon

es a

s a

resu

lt of

clim

ate

chan

ge, c

ombi

ned

with

hig

her s

ea le

vels

will

incr

ease

the

curr

ent

chal

leng

es o

n th

ese

com

mun

ities

. Th

is c

ould

in

clud

e th

e ne

ed fo

r mas

s ev

acua

tions

from

low

ly

ing

isla

nds

to re

duce

pot

entia

l for

loss

of l

ife.

Maj

or c

yclo

nes

in th

e C

airn

s re

gion

can

als

o im

pact

th

e To

rres

Stra

it th

roug

h im

pact

s on

sup

ply

lines

to

the

regi

on a

nd th

e gr

eate

r nee

d fo

r hea

lth a

nd

emer

genc

y se

rvic

es re

sour

ces

to b

e de

ploy

ed o

n th

e m

ainl

and

The

HH

S sh

ould

dev

elop

a B

usin

ess

Con

tinui

ty P

lan

for e

ach

faci

lity

outli

ning

how

to fu

nctio

n ef

fect

ivel

y du

ring

and

follo

win

g ex

trem

e ev

ents

.Th

is s

houl

d in

clud

e cl

ose

liais

on w

ith th

e Em

erge

ncy

Serv

ices

se

ctor

.

Wea

ther

war

ning

s sh

ould

be

used

to u

nder

pin

cont

inge

ncy

plan

ning

and

the

pote

ntia

l for

pat

ient

isol

atio

n sh

ould

be

a ke

y co

nsid

erat

ion

whe

n de

term

inin

g an

d pr

iorit

isin

g m

anag

emen

t act

ions

.

The

acce

ss ro

utes

to a

nd fr

om h

ealth

faci

litie

s sh

ould

be

ass

esse

d to

det

erm

ine

thei

r sus

cept

ibili

ty

resi

lienc

e to

clim

ate

chan

ge e

ffect

s. T

his

shou

ld a

lso

incl

ude

asse

ssm

ents

of b

oat r

amps

, jet

ties

and

airs

trips

. A lo

ng-te

rm p

lan

shou

ld b

e de

velo

ped

to

upgr

ade

prio

rity

infra

stru

ctur

e.

Hig

h
















Pote

ntia

l haz

ards

Hav

e th

ese

occu

rred

in th

e pa

st in

the

Torr

es S

trai

t an

d w

hat w

as th

e ef

fect

?

Is th

ere

an e

xist

ing

risk

man

agem

ent s

trat

egy

in

plac

e to

tack

le th

is

haza

rd?

Is th

ere

any

resi

dual

(r

emai

ning

) ris

k fr

om th

is

haza

rd?

Doe

s th

is h

azar

d ha

ve th

e po

tent

ial t

o be

com

e pr

oble

mat

ic in

futu

re?

If so

how

and

und

er w

hat

leve

l of c

limat

e ch

ange

?

Rec

omm

ende

d ac

tions

(act

ions

list

ed in

ital

ics

are

iden

tifie

d in

the

Torr

es S

trai

t Reg

iona

l A

dapt

atio

n an

d R

esili

ence

Pla

n)

Prio

rity

Cyc

lone

sC

yclo

nes

can

incr

ease

de

man

d fo

r ser

vice

s an

d ca

use

stre

ss fo

r sta

ff

The

heal

th w

ork

forc

e is

not

su

ffici

ent (

in n

umbe

rs a

nd

skills

) and

not

wel

l or

gani

sed.

Cha

lleng

ed w

ith

addr

essi

ng c

urre

nt n

eeds

.

No,

ther

e is

stro

ng s

uppo

rt fro

m Q

ueen

slan

d H

ealth

and

th

e em

erge

ncy

serv

ices

sec

tor

Incr

ease

d m

agni

tude

of c

yclo

nes

will

exac

erba

te

the

chal

leng

e. S

taff

and

patie

nts

need

to b

e co

nfid

ent t

hat t

he s

yste

m is

abl

e to

cop

e du

ring

thes

e ev

ents

.

In la

rge

even

ts s

uppo

rt fro

m Q

ueen

slan

d he

alth

an

d th

e Em

erge

ncy

Ser

vice

sm

ay ta

ke lo

nger

than

ex

pect

ed.

The

HH

S sh

ould

dev

elop

a B

usin

ess

Con

tinui

ty P

lan

for e

ach

faci

lity

outli

ning

how

to fu

nctio

n ef

fect

ivel

y du

ring

and

follo

win

g ex

trem

e ev

ents

.Th

is s

houl

d in

clud

e cl

ose

liais

on w

ith th

e Em

erge

ncy

Serv

ices

se

ctor

.

Staf

f sho

uld

be tr

aine

d in

how

bes

t to

mai

ntai

n pa

tient

ser

vice

s du

ring

extre

me

even

ts.

Med

ium

Cyc

lone

sIm

pact

s on

des

alin

isat

ion

plan

ts a

nd w

ells

, can

affe

ct

wat

er s

ecur

ityon

affe

cted

is

land

s.

Floo

ds c

an c

onta

min

ate

wat

er s

uppl

ies.

C

rypt

ospo

ridiu

mal

read

y an

is

sue.

Bottl

ed w

ater

is u

sed

and

wat

er is

boi

led.

Gui

delin

es

are

avai

labl

e fro

m th

e D

epar

tmen

t of h

ealth

.

No

Impa

cts

on w

ater

sup

ply

and

wat

er tr

eatm

ent

serv

ices

follo

win

g cy

clon

es, m

ay le

ad to

a s

prea

d of

illn

ess

or b

acte

ria.

Bottl

ed w

ater

is a

lso

expe

nsiv

e an

d co

ntrib

utes

ex

tens

ivel

y to

was

ter i

ssue

s. W

aste

man

agem

ent

faci

litie

s ar

e an

impo

rtant

asp

ect o

f hea

lth s

ervi

ce

infra

stru

ctur

e.

Hos

pita

l and

hea

lth s

ervi

ces

shou

ld d

evel

op a

was

te

man

agem

ent p

lan

to s

uppo

rt fa

cilit

ies

to m

anag

e th

eir w

aste

app

ropr

iate

ly.

Wat

er q

ualit

y m

onito

ring

shou

ld b

e co

ntin

ued

and

used

to in

form

hos

pita

l man

ager

s to

ens

ure

that

sta

ff an

d pa

tient

s ar

e no

t affe

cted

by

poor

wat

er q

ualit

y.

Med

ium

Cyc

lone

sC

yclo

nes

dest

roy

hous

es

crea

ting

prob

lem

s fo

r sta

ff an

d pa

tient

s.

Hou

ses

are

built

to d

esig

n st

anda

rds

Yes,

in s

ome

area

s ho

uses

are

lo

w ly

ing

and

at ri

sk fr

om w

ind

and

asso

ciat

ed s

torm

tide

da

mag

e.

Staf

f hou

sing

may

be

impa

cted

, pre

vent

ing

staf

ffro

m a

ttend

ing

wor

k.St

aff h

ousi

ng s

houl

d be

ass

esse

d an

d up

grad

ed to

in

crea

se re

silie

nce

to w

inds

and

sto

rm s

urge

.Thi

s ca

n be

don

e in

col

labo

ratio

n w

ith a

ctio

ns p

lann

ed b

y th

e TS

RA

.

Hig

h

Sea-

leve

l ris

eSa

lt w

ater

ingr

ess

into

gr

ound

wat

er o

n so

me

isla

nds

affe

ctin

g gr

ound

wat

er

Saltw

ater

ingr

ess

into

se

wer

age

infra

stru

ctur

e ca

n im

pact

the

abilit

y of

the

sew

age

treat

men

t pla

nt to

fu

nctio

n.

Drin

king

bot

tled

wat

erYe

sIm

pact

s on

wat

er s

uppl

y an

d w

ater

trea

tmen

t se

rvic

es fo

llow

ing

cycl

ones

, may

lead

to a

spr

ead

of

illnes

s or

bac

teria

.

Bottl

ed w

ater

is a

lso

expe

nsiv

e an

d co

ntrib

utes

ex

tens

ivel

y to

was

ter i

ssue

s. W

aste

man

agem

ent

faci

litie

s ar

e an

impo

rtant

asp

ect o

f hea

lth s

ervi

ce

infra

stru

ctur

e.

Non

-func

tioni

ng s

ewag

e tre

atm

ent f

acilit

ies

can

impa

ct h

ealth

ser

vice

sta

ff an

d op

erat

ions

Hos

pita

l and

hea

lth s

ervi

ces

shou

ld d

evel

op a

was

te

man

agem

ent p

lan

to s

uppo

rt fa

cilit

ies

to m

anag

e th

eir w

aste

app

ropr

iate

ly.

Wat

er q

ualit

y m

onito

ring

shou

ld b

e co

ntin

ued

and

used

to in

form

hos

pita

l man

ager

s to

ens

ure

that

sta

ff an

d pa

tient

s ar

e no

t affe

cted

by

poor

wat

er q

ualit

y.

Eng

age

with

TS

RA

to u

nder

stan

d th

e im

plic

atio

ns o

f se

a-le

vel r

ise

to g

roun

d w

ater

and

acc

ordi

ngly

to th

e op

erat

iona

l act

iviti

es o

f the

hea

lth s

ervi

ce.

Hig

h

Sea-

leve

l ris

eSe

a-le

vel r

ise

to d

ate

has

exac

erba

ted

beac

h er

osio

n in

som

e ar

eas.

Sea-

wal

ls c

onst

ruct

ed b

y go

vern

men

t or b

y pr

ivat

e in

divi

dual

s

No,

ero

sion

stil

l occ

urs

in

som

e ar

eas

and

sea-

wal

ls

have

faile

d at

tim

es.

This

has

no

t affe

cted

the

heal

th s

ervi

ce.

Sea-

leve

l ris

e w

ill co

ntin

ue to

incr

ease

ero

sion

rate

s at

unp

rote

cted

are

as.

This

may

caus

e is

sues

for

acce

ss ro

utes

to h

ealth

ser

vice

s.

The

acce

ss ro

utes

to a

nd fr

om h

ealth

faci

litie

s sh

ould

be

ass

esse

d to

det

erm

ine

thei

r sus

cept

ibili

ty

resi

lienc

e to

clim

ate

chan

ge e

ffect

s. T

his

shou

ld a

lso

incl

ude

asse

ssm

ents

of b

oat r

amps

, jet

ties

and

airs

trips

. A lo

ng-te

rm p

lan

shou

ld b

e de

velo

ped

to

upgr

ade

prio

rity

infra

stru

ctur

e.

Med

ium

Sea-

leve

l ris

eIn

frequ

ent i

nund

atio

n of

ac

cess

road

s to

hos

pita

lN

o m

anag

emen

t pla

n in

pl

ace.

Ye

s, b

ut v

ery

low

resi

dual

risk

Reg

ular

inun

datio

n of

acc

ess

road

s to

hos

pita

l po

tent

ially

impa

ctin

g su

pply

cha

ins,

acc

ess

by

patie

nts

and

staf

f. T

he e

xten

t of i

mpa

ct w

ill va

ry

betw

een

isla

nds.

The

acce

ss ro

utes

to a

nd fr

om h

ealth

faci

litie

s sh

ould

be

ass

esse

d to

det

erm

ine

thei

r sus

cept

ibili

ty

resi

lienc

e to

clim

ate

chan

ge e

ffect

s. T

his

shou

ld a

lso

incl

ude

asse

ssm

ents

of b

oat r

amps

, jet

ties

and

airs

trips

. A lo

ng-te

rm p

lan

shou

ld b

e de

velo

ped

to

upgr

ade

prio

rity

infra

stru

ctur

e.

Med

ium
















Pote

ntia

l haz

ards

Hav

e th

ese

occu

rred

in th

e pa

st in

the

Torr

es S

trai

t an

d w

hat w

as th

e ef

fect

?

Is th

ere

an e

xist

ing

risk

man

agem

ent s

trat

egy

in

plac

e to

tack

le th

is

haza

rd?

Is th

ere

any

resi

dual

(r

emai

ning

) ris

k fr

om th

is

haza

rd?

Doe

s th

is h

azar

d ha

ve th

e po

tent

ial t

o be

com

e pr

oble

mat

ic in

futu

re?

If so

how

and

und

er w

hat

leve

l of c

limat

e ch

ange

?

Rec

omm

ende

d ac

tions

(act

ions

list

ed in

ital

ics

are

iden

tifie

d in

the

Torr

es S

trai

t Reg

iona

l A

dapt

atio

n an

d R

esili

ence

Pla

n)

Prio

rity

Hea

t and

Hea

twav

esSt

aff n

ot a

ffect

ed to

dat

eH

eat m

anag

emen

t gu

idan

ce a

vaila

ble

from

Q

ueen

slan

d he

alth

.

Bottl

ed w

ater

ava

ilabl

e fo

r st

aff a

nd p

atie

nts.

Air c

ondi

tione

rs p

rese

nt in

he

alth

ser

vice

bui

ldin

gs.

No

Incr

ease

d de

man

d fo

r ele

ctric

ity d

urin

g ex

cess

ivel

y ho

t day

s or

hea

twav

es c

an le

ad to

ele

ctric

ity fa

ilure

. Th

is h

as im

plic

atio

ns fo

r the

abi

lity

of h

ospi

tals

to

prov

ide

serv

ice.

Bac

kup

gene

rato

rs m

ay n

ot b

e ab

le to

sup

port

air c

ondi

tione

rs.

Dis

rupt

ion

of e

lect

ricity

as

a re

sult

of c

yclo

nes

and

extre

me

stor

ms,

can

pre

vent

hos

pita

ls fr

om

prov

idin

g se

rvic

e.

Ren

ewab

le e

nerg

y an

d ba

ttery

sou

rces

sho

uld

be

used

to p

ower

faci

litie

s. I

n th

e lo

nger

term

, bat

tery

te

chno

logy

sho

uld

be c

onsi

dere

d as

an

alte

rnat

ive

to

back

up g

ener

ator

s.

Med

ium

All h

azar

dsD

iffic

ult t

o at

tract

sta

ff to

w

ork

in is

olat

ed a

reas

No

Con

ditio

ns a

ssoc

iate

d w

ith a

cha

ngin

g cl

imat

e w

ill re

duce

the

attra

ctio

n fo

r pot

entia

l sta

ff in

the

isla

nds

whi

ch c

an im

pact

the

abilit

y fo

r the

hea

lth s

ervi

ces

to o

pera

te e

ffect

ivel

y.

Hou

sing

and

acc

omm

odat

ion

for h

ealth

and

hos

pita

l st

affm

ust b

e m

ade

clim

ate

frien

dly

and

com

forta

ble,

an

d re

silie

nt to

clim

ate

rela

ted

impa

cts.

Thi

s w

ill he

lp

to e

nsur

e th

at s

taff

can

be a

ttrac

ted

to w

ork

in th

ese

loca

tions

.

Effo

rt sh

ould

be

mad

e to

bui

ld c

apac

ity a

nd tr

ain

loca

l Tor

res

Stra

it Is

land

ers

in h

ealth

sec

tor s

kills

. Th

is w

ill in

crea

se th

e lik

elih

ood

of m

aint

aini

ng s

taff

num

bers

into

the

futu

re.

The

conn

ectio

n w

ith th

e To

rres

Stra

it in

term

s of

cul

ture

and

spi

ritua

lity

has

addi

tiona

l pot

entia

l ben

efits

.

Med

ium

Ris

k to

dem

and

on th

e he

alth

sys

tem

Hea

t, he

atw

aves

and

as

soci

ated

hum

idity

Dur

ing

perio

ds o

f ver

y ho

t w

eath

er, e

lder

ly p

eopl

e ha

ve

been

mor

e pr

one

than

usu

al

to h

eart

atta

cks

and

othe

r ca

rdio

vasc

ular

and

re

spira

tory

issu

es.

Oth

er v

ulne

rabl

e gr

oups

su

ch a

s yo

ung

child

ren

and

thos

e su

fferin

g fro

m o

ther

illn

esse

s ar

e al

so a

ffect

ed.

Incr

ease

d ho

spita

l ad

mis

sion

s ar

e m

anag

ed

thro

ugh

regu

lar

appr

oach

es.

Ther

e is

a g

ood

exis

ting

know

ledg

e in

the

com

mun

ity a

bout

the

need

to

drin

k lo

ts o

f flu

ids

and

avoi

d ph

ysic

al e

xerti

on.

(Do

all h

ospi

tals

and

hea

lth

faci

litie

s ha

ve a

ir co

nditi

onin

g?)

(Wha

t are

impl

icat

ions

for

staf

f hou

sing

?)

Yes,

the

heal

th w

ork

forc

e is

no

t suf

ficie

nt (i

n nu

mbe

rs a

nd

skills

) and

not

wel

l org

anis

ed.

Cha

lleng

ed w

ith a

ddre

ssin

g cu

rren

t nee

ds.

With

exp

ecta

tions

of i

ncre

ased

hea

t and

long

er

heat

wav

es, i

mpa

cts

of h

eat a

nd h

eatw

aves

are

lik

ely

to in

crea

se, r

esul

ting

in in

crea

sed

hosp

ital

adm

issi

ons

and

pote

ntia

lly in

crea

sed

mor

talit

y.

Dis

cour

agin

g ph

ysic

al e

xerti

on c

an re

duce

phy

sica

l ac

tivity

and

lead

to o

ther

hea

lth ri

sks.

The

effe

ct o

f hea

t and

hea

twav

es is

like

ly to

impa

ct

the

pote

ntia

l of r

ecru

iting

qua

lity

heal

th s

taff

to th

e ar

ea.

This

will

also

be

com

poun

ded

by o

ther

cl

imat

e ch

ange

rela

ted

pres

sure

s.

Mon

itor i

mpa

cts

on h

ealth

dur

ing

heat

eve

nts.

Hou

sing

des

ign

shou

ld b

e im

prov

ed to

hel

p al

levi

ate

heat

and

hum

idity

stre

ssor

s. B

ette

r des

ign

can

help

to

mak

e th

e m

ost o

f sea

bre

ezes

for e

xam

ple.

Mor

e sh

adin

g sh

ould

be

prov

ided

on

all i

nhab

ited

area

s. P

otab

le w

ater

sho

uld

also

be

easi

ly

acce

ssib

le.

The

heal

th s

ervi

ces

shou

ld d

evel

op a

nd c

ircul

ate

guid

ance

for i

ndoo

r and

out

door

wor

kers

to s

uppo

rt th

em to

wor

k sa

fely

dur

ing

heat

and

hea

twav

es.

This

m

ay in

clud

e fre

quen

t drin

k br

eaks

, opp

ortu

nitie

s to

se

ek re

spite

from

hea

t in

air-

cond

ition

ed a

reas

, and

ac

cess

to b

ette

r qua

lity

and

mor

e su

itabl

e cl

othi

ng.

This

can

be

done

in c

olla

bora

tion

with

pro

ject

wor

k pl

anne

d by

the

TSR

A.

The

impl

icat

ions

of r

educ

ed p

hysi

cal a

ctiv

ity s

houl

d be

mad

e cl

ear t

o co

mm

unity

lead

ers

and

appr

oach

es

to in

crea

se a

ctiv

ity s

afel

y sh

ould

be

cons

ider

ed a

nd

impl

emen

ted.

E.g

. sha

ded

exer

cise

equ

ipm

ent a

nd

easy

acc

ess

to d

rinki

ng w

ater

.

Hig

h
















Pote

ntia

l haz

ards

Hav

e th

ese

occu

rred

in th

e pa

st in

the

Torr

es S

trai

t an

d w

hat w

as th

e ef

fect

?

Is th

ere

an e

xist

ing

risk

man

agem

ent s

trat

egy

in

plac

e to

tack

le th

is

haza

rd?

Is th

ere

any

resi

dual

(r

emai

ning

) ris

k fr

om th

is

haza

rd?

Doe

s th

is h

azar

d ha

ve th

e po

tent

ial t

o be

com

e pr

oble

mat

ic in

futu

re?

If so

how

and

und

er w

hat

leve

l of c

limat

e ch

ange

?

Rec

omm

ende

d ac

tions

(act

ions

list

ed in

ital

ics

are

iden

tifie

d in

the

Torr

es S

trai

t Reg

iona

l A

dapt

atio

n an

d R

esili

ence

Pla

n)

Prio

rity

It is

impo

rtant

that

ada

ptat

ion

optio

ns d

o no

t co

ntrib

ute

to g

reen

-hou

se g

as e

mis

sion

. Fo

r ex

ampl

e, c

oolin

g op

tions

sho

uld

use

rene

wab

le

ener

gy. A

n ex

ampl

e of

a k

ey a

ctio

n is

to re

duce

the

relia

nce

on d

iese

l in

the

Torr

es S

trait.

Hea

t and

hea

twav

esH

ighe

r tem

pera

ture

s an

d ot

her e

xtre

me

cond

ition

s di

scou

rage

peo

ple

from

ex

erci

sing

Prog

ram

s in

pla

ce to

en

cour

age

exer

cise

Yes,

mos

t peo

ple

still

pr

efer

ring

to ta

ke ta

xis

(eve

n fo

r sho

rt di

stan

ces)

Hot

ter w

eath

er a

nd lo

nger

hea

twav

es w

ill co

ntin

ue

to d

isco

urag

e pe

ople

from

exe

rcis

ing.

This

can

ha

ve a

n im

pact

on

the

gene

ral h

ealth

of t

he T

orre

s St

rait

com

mun

ity a

nd in

crea

se a

dmis

sion

s.

The

bene

fits

of e

xerc

isin

g ea

rly in

the

mor

ning

or a

t ni

ght i

n co

oler

con

ditio

ns s

houl

d be

pro

mot

ed.

Infra

stru

ctur

e sh

ould

be

deve

lope

d to

sup

port

safe

ex

erci

se.

Hig

h

Hea

t and

hea

twav

esH

igh

elec

trici

ty d

eman

dN

o, d

eman

d is

und

er c

ontro

l at

pres

ent

Pote

ntia

l dis

rupt

ion

to e

lect

rical

sup

plie

s du

e to

di

srup

tion

of e

lect

ricity

dur

ing

heat

wav

es w

ill pr

even

t peo

ple

from

bei

ng a

ble

to b

oil w

ater

or

freez

e fo

ods.

Thi

s co

uld

impa

ct h

ealth

and

incr

ease

de

man

don

the

heal

th s

ervi

ces.

Ren

ewab

le e

nerg

y an

d ba

ttery

sou

rces

sho

uld

be

used

to p

ower

faci

litie

s. I

n th

e lo

nger

term

, bat

tery

te

chno

logy

sho

uld

be c

onsi

dere

d as

an

alte

rnat

ive

to

back

up g

ener

ator

s.

Med

ium

Sea-

leve

l ris

eH

igh

tides

alre

ady

impa

ct

som

e ar

eas

of th

e To

rres

St

rait.

The

se in

clud

e la

nd

loss

inso

me

area

s an

d th

e ab

ility

to d

evel

op n

ew h

omes

on

low

lyin

g la

nds.

Thi

s is

le

adin

g to

ove

rcro

wdi

ng.

Ove

rcro

wdi

ng (m

ore

than

2

peop

le p

er b

edro

om) l

inks

di

rect

ly to

poo

r hea

lth –

gene

rally

thro

ugh

infe

ctio

ns

and

chro

nic

dise

ases

.

Peop

le li

ving

on

very

low

re

lief i

slan

ds a

lread

y ha

ve n

o op

tion

but t

o de

velo

p in

er

osio

n pr

one

area

s.

Ther

e ar

e at

tem

pts

to b

uild

m

ore

hous

es, m

ost i

s go

vern

men

t hou

sing

but

th

ere

is li

mite

d la

nd

avai

labl

e.

Yes,

ove

rcro

wdi

ng c

ontin

ues

Clim

ate

effe

cts

on h

ousi

ng a

nd h

ousi

ng a

vaila

bilit

y is

the

bigg

est i

ssue

ove

r the

tim

efra

mes

of t

his

proj

ect.

Hig

her s

eas

will

cont

inue

to re

duce

the

amou

nt o

f lan

d av

aila

ble

(eith

er th

roug

h in

unda

tion

or fr

om lo

ss o

f lan

d to

ero

sion

). Th

is w

ill ad

d fu

rther

st

ress

to th

e ho

usin

g sy

stem

and

exa

cerb

ate

all

heal

th im

plic

atio

ns.

Ove

rcro

wdi

ng s

houl

d be

add

ress

ed th

roug

h th

e pr

ovis

ion

of s

afe

and

resi

lient

hou

ses.

Whe

re la

nd is

lim

ited

stak

ehol

der e

ngag

emen

t mus

t be

unde

rtake

n to

und

erpi

n th

e de

velo

pmen

t of a

sus

tain

able

long

-te

rm p

lan,

incl

udin

g th

e po

tent

ial f

or re

loca

ting

som

e of

the

com

mun

ity.

Hig

h

Sea-

leve

l ris

eN

orth

ern

sand

and

mud

is

land

s (n

ot ro

cky

isla

nds)

ar

e ex

perie

ncin

g a

grea

ter

frequ

ency

of i

nund

atio

n. L

ow

lyin

g ar

eas

in S

aiba

i, Bo

igu

and

Yam

isla

nds

alre

ady

resu

lt in

hou

ses

and

infra

stru

ctur

e be

ing

flood

ed.

Impa

cts

incl

ude:

Incr

ease

d ris

k of

vec

tor

born

e di

seas

esD

amp

and

mou

ld in

hou

ses

–in

crea

sed

skin

infe

ctio

ns a

nd

resp

irato

ry il

lnes

sIn

crea

sed

anxi

ety,

stre

ss a

nd

asso

ciat

ed m

enta

l hea

lth

issu

es b

ecau

se o

f dam

age

to

$25

milli

on h

as b

een

spen

t co

nstru

ctin

g a

seaw

all,

but

this

was

not

aim

ed a

t re

duci

ng fl

oodi

ng b

ut a

t re

duci

ng e

nerg

y an

d fo

resh

ore

eros

ion.

Yes

Sea-

leve

l ris

e w

ill co

ntin

ue to

affe

ct lo

w ly

ing

isla

nds.

As

the

impa

ct b

ecom

es c

lear

er, t

helik

elih

ood

of s

tress

and

ass

ocia

ted

men

tal i

llnes

s w

ill in

crea

se.

An e

duca

tion

and

awar

enes

s pr

ogra

m s

houl

d be

un

derta

ken

in a

ffect

ed o

r at-r

isk

com

mun

ities

. Th

e Ad

apta

tion

and

Res

ilienc

e Pl

an fo

r the

Tor

res

Stra

it sh

ould

be

impl

emen

ted

and

mon

itore

d an

d ad

just

ed

acco

rdin

gly.

Nee

d be

tter e

ngag

emen

t with

loca

l pol

itica

l lea

ders

to

get

them

to h

elp

driv

e ch

ange

. Com

mun

ity le

ader

s ne

ed to

eng

age

mor

e ef

fect

ivel

y an

d m

ore

regu

larly

w

ith th

e br

oade

r Tor

res

Stra

it Is

land

er c

omm

unity

.

Hea

lth p

ract

ition

ers

mus

t be

wel

l tra

ined

in

asse

ssin

g, d

iagn

osin

g an

d ad

dres

sing

men

tal h

ealth

is

sues

. As

the

inci

denc

e of

thes

e is

sues

incr

ease

s,

the

heal

th s

yste

m s

houl

d be

pre

pare

d to

pro

vide

ef

fect

ive

supp

ort.

Thi

s in

clud

es a

ppro

pria

te

reso

urci

ng.

Hig

h
















Pote

ntia

l haz

ards

Hav

e th

ese

occu

rred

in th

e pa

st in

the

Torr

es S

trai

t an

d w

hat w

as th

e ef

fect

?

Is th

ere

an e

xist

ing

risk

man

agem

ent s

trat

egy

in

plac

e to

tack

le th

is

haza

rd?

Is th

ere

any

resi

dual

(r

emai

ning

) ris

k fr

om th

is

haza

rd?

Doe

s th

is h

azar

d ha

ve th

e po

tent

ial t

o be

com

e pr

oble

mat

ic in

futu

re?

If so

how

and

und

er w

hat

leve

l of c

limat

e ch

ange

?

Rec

omm

ende

d ac

tions

(act

ions

list

ed in

ital

ics

are

iden

tifie

d in

the

Torr

es S

trai

t Reg

iona

l A

dapt

atio

n an

d R

esili

ence

Pla

n)

Prio

rity

hom

e an

d pr

oper

ty a

nd n

ot

havi

ng a

ny a

ltern

ativ

es.

Als

o pe

ople

wor

ryin

g ab

out f

amily

m

embe

rs.

Impa

cts

on p

eopl

e’s

men

tal

heal

th a

s th

ey s

ee th

eir

asse

ts b

eing

affe

cted

. Los

ing

hom

es a

nd li

fest

yle.

The

no

tion

of le

avin

g th

eir

hom

elan

d.

Est

ablis

h m

onito

ring

prog

ram

s th

at c

an a

sses

s im

pact

s of

clim

ate

rela

ted

impa

cts

on h

ealth

Ens

ure

long

-term

pos

t eve

nt m

onito

ring

prog

ram

s ar

e de

velo

ped

to m

onito

r com

mun

ity re

cove

ry

(men

tal a

nd p

hysi

cal h

ealth

and

wel

l-bei

ng).

Sea-

leve

l ris

eIm

pact

on

grou

nd w

ater

sa

linity

and

qua

lity.

Sup

plie

s ca

n be

con

tam

inat

ed

Gui

danc

e on

boi

ling

wat

er

befo

re d

rinki

ng.

Des

alin

isat

ion

plan

ts.

Purc

hasi

ng b

ottle

d w

ater

.

yes

Sea-

leve

l ris

e ca

n af

fect

qua

lity

of g

roun

d w

ater

and

im

pact

wel

lsan

d ca

n al

so d

irect

ly a

ffect

de

salin

isat

ion

plan

ts.

This

can

affe

ct d

rinki

ng w

ater

su

pplie

s.

Incr

easi

ng p

opul

atio

n si

ze (n

ot g

reat

, but

eno

ugh

to

be m

ater

ial)

will

incr

ease

dem

and

whi

ch c

an

pres

ent c

halle

nges

inm

aint

aini

ng s

usta

inab

le w

ater

su

pplie

s.

Purc

hasi

ng b

ottle

d w

ater

redu

ces

avai

labl

e in

com

e of

the

com

mun

ity a

nd c

an re

duce

thei

r abi

lity

toaf

ford

oth

er e

ssen

tial i

tem

s.

Drin

king

wat

er s

houl

d be

mon

itore

d an

d ap

prop

riate

m

anag

emen

t act

ions

sho

uld

be ta

ken

and

reso

urce

d.

Ther

e sh

ould

be

a fo

cus

on e

nsur

ing

acce

ss to

he

alth

y w

ater

for a

ll co

mm

uniti

es.

In m

aint

aini

ng w

ater

sup

plie

s, th

ere

is a

nee

d to

en

sure

that

com

mun

ity g

arde

ns a

nd s

hade

tree

s ar

e ab

le to

get

ade

quat

e w

ater

to e

nsur

e th

at th

e cl

imat

e ch

ange

ada

ptat

ion

bene

fits

they

pro

vide

are

m

aint

aine

d.

Hig

h

Sea-

leve

l ris

eSa

line

grou

nd w

ater

and

tida

l in

unda

tion

can

prev

ent

grow

th o

f fre

sh fr

uit a

nd

vege

tabl

es.

Old

er g

ener

atio

n gr

ow

food

, fis

h an

d hu

nt.

Youn

ger g

ener

atio

n re

lies

on s

hops

Is a

n is

sue

–ol

der g

ener

atio

n st

ill ab

le/h

appy

to g

row

frui

t an

d ve

g an

d so

urce

food

from

th

e la

nd a

nd s

ea, b

ut y

oung

er

gene

ratio

n m

ore

focu

ssed

on

purc

hasi

ng fo

od.

Dis

rupt

ions

thro

ugh

clim

ate

prev

ent s

uppl

ies

and

incr

ease

co

sts.

Abili

ty to

gro

w fr

esh

fruits

and

veg

etab

les

in s

ome

area

s m

ay b

e co

mpr

omis

ed.

This

can

hav

e di

rect

im

plic

atio

ns fo

r hea

lth a

nd w

ell-b

eing

of a

ffect

ed

com

mun

ities

.C

limat

e ch

ange

like

ly to

incr

ease

risk

as

may

affe

ct

trans

port

and

supp

ly o

f foo

d (a

lso

affe

ctin

g fo

od

qual

ity a

nd p

rices

in th

e pr

oces

s),

Influ

ence

the

abilit

y to

gro

w fr

esh

prod

uce

loca

lly

The

abilit

y of

com

mun

ities

to g

row

fres

h fru

it an

d ve

geta

bles

is im

porta

nt.

Com

mun

ity g

arde

ns o

n hi

gh

grou

nd o

r ion

con

stru

cted

gar

den

beds

abo

ve

inun

datio

n le

vels

can

hel

p. T

his

will

incr

ease

acc

ess

to n

utrie

nts

for t

he c

omm

unity

and

hav

e a

posi

tive

influ

ence

on h

ealth

.

Dev

elop

and

impl

emen

t edu

catio

n pr

ogra

m o

n gr

owin

g fre

sh fr

uit a

nd v

eget

able

s ta

rget

ing

youn

ger

com

mun

ity m

embe

rs.

Hig

h

Hea

t (oc

ean)

War

min

g se

as a

nd

asso

ciat

ed c

oral

ble

achi

ng

have

rece

ntly

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sed

a co

llaps

e of

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ry, a

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A

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s th

e lo

cal e

cono

my

and

livel

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ds (a

nd th

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ore

spen

d on

hea

lth).

Yes,

ther

e ar

e no

repl

acem

ent

fishe

ry o

ppor

tuni

ties

Yes,

oce

an te

mpe

ratu

res

cont

inue

to in

crea

se.

With

out g

loba

l clim

ate

miti

gatio

n, c

oral

reef

will

cont

inue

to b

e st

ress

ed a

nd b

leac

hing

will

cont

inue

to

occ

ur.

Whe

n th

is o

ccur

s on

a re

gula

r bas

is,

reco

very

pot

entia

l is

redu

ced.

The

cra

yfis

h fis

hery

w

ill co

ntin

ue to

be

affe

cted

with

flow

thro

ughs

to

com

mun

ity re

silie

nce

and

impa

ct o

n ec

onom

y an

d liv

elih

oods

.

Lack

of a

via

ble

inco

me

can

lead

to m

enta

l hea

lth

issu

es o

f affe

cted

com

mun

ities

.

Fina

ncia

l har

dshi

p re

sulti

ng fr

om c

limat

e ch

ange

re

late

d im

pact

s is

like

ly to

redu

ce th

e ab

ility

of

peop

le to

pre

sent

at c

linic

s an

d ho

spita

ls w

hen

they

ar

e si

ck.

This

can

impa

ct re

cove

ry ra

tes

and

gene

ral p

opul

atio

n he

alth

.

Und

erta

ke in

vest

igat

ions

into

alte

rnat

ive

fishe

ries

for

loca

l bus

ines

ses.

Fai

ling

this

, alte

rnat

ive

busi

ness

/inco

me

sour

ces

shou

ld b

e id

entif

ied.

Hea

lth p

ract

ition

ers

mus

t be

wel

l tra

ined

inas

sess

ing,

dia

gnos

ing

and

addr

essi

ng m

enta

l hea

lth

issu

es.

As th

e in

cide

nce

of th

ese

issu

es in

crea

ses,

th

e he

alth

sys

tem

sho

uld

be p

repa

red

to p

rovi

de

effe

ctiv

e su

ppor

t. T

his

incl

udes

app

ropr

iate

re

sour

cing

.

Hig

h
















Pote

ntia

l haz

ards

Hav

e th

ese

occu

rred

in th

e pa

st in

the

Torr

es S

trai

t an

d w

hat w

as th

e ef

fect

?

Is th

ere

an e

xist

ing

risk

man

agem

ent s

trat

egy

in

plac

e to

tack

le th

is

haza

rd?

Is th

ere

any

resi

dual

(r

emai

ning

) ris

k fr

om th

is

haza

rd?

Doe

s th

is h

azar

d ha

ve th

e po

tent

ial t

o be

com

e pr

oble

mat

ic in

futu

re?

If so

how

and

und

er w

hat

leve

l of c

limat

e ch

ange

?

Rec

omm

ende

d ac

tions

(act

ions

list

ed in

ital

ics

are

iden

tifie

d in

the

Torr

es S

trai

t Reg

iona

l A

dapt

atio

n an

d R

esili

ence

Pla

n)

Prio

rity

Dro

ught

Dro

ught

s ha

ve o

ccur

red

in

the

regi

on a

nd h

ave

put

pres

sure

on

drin

king

wat

er

supp

lies

in s

ome

area

s.

Yes,

ban

s on

drin

king

tap

wat

er a

re o

ften

impl

emen

ted.

Res

iden

ts m

ust b

oil w

ater

be

fore

drin

king

orpu

rcha

se

mor

e ex

pens

ive

bottl

ed

wat

er.

This

redu

ces

avai

labl

e in

com

e an

d re

duce

s ca

paci

ty to

spe

nd

on h

ealth

Wat

er is

bro

ught

to H

orne

Is

land

from

Thu

rsda

y is

land

.

Pres

ently

abl

e to

cop

e w

ith th

e m

anag

emen

t pla

ns th

at a

re in

pl

ace

and

com

mun

ity a

dher

e to

ban

s an

d bo

iling

wat

er

requ

irem

ents

.

Bottl

ed w

ater

use

affe

cts

was

te m

anag

emen

t in

the

Torr

es S

trait

and

incr

ease

s lit

ter.

Dro

ught

s af

fect

gro

wth

of f

resh

frui

ts a

nd a

lso

com

prom

ise

wat

er s

ecur

ity in

som

e ar

eas.

Thi

s in

crea

ses

dem

and

for d

esal

inis

atio

n, w

ater

del

iver

y an

d us

e of

bot

tled

wat

er.

Purc

hasi

ng b

ottle

d w

ater

redu

ces

avai

labl

e in

com

e of

the

com

mun

ity a

nd c

an re

duce

thei

r abi

lity

to

affo

rd o

ther

ess

entia

l ite

ms.

Dro

ught

s in

PN

G m

ay le

ad to

an

incr

ease

in P

NG

na

tiona

ls m

ovin

g to

the

Torr

es S

trait

for r

esou

rces

. Th

is m

ay in

crea

se li

kelih

ood

of d

isea

ses

such

as

mal

aria

and

tube

rcul

osis

bei

ng b

roug

ht in

to th

e ar

ea

Drin

king

wat

er s

houl

d be

mon

itore

d an

d ap

prop

riate

m

anag

emen

t act

ions

that

focu

s on

ens

urin

g ac

cess

to

hea

lthy

wat

er fo

r all

com

mun

ities

sho

uld

be ta

ken

and

reso

urce

d.

In m

aint

aini

ng w

ater

sup

plie

s, th

ere

is a

nee

d to

en

sure

that

com

mun

ity g

arde

ns a

nd s

hade

tree

s ar

e al

so a

ble

to g

et a

dequ

ate

wat

er to

ens

ure

that

the

clim

ate

chan

ge a

dapt

atio

n be

nefit

s th

ey p

rovi

de a

re

mai

ntai

ned.

A To

rres

Stra

it w

aste

man

agem

ent p

lan

shou

ld b

e de

velo

ped

to h

elp

redu

ce th

e im

pact

of p

last

ic

bottl

es.

Med

ium

Floo

dsFl

oods

resu

lt in

poo

ls o

f w

ater

thro

ugho

ut th

e is

land

s en

ablin

g m

osqu

ito b

reed

ing

and

incr

easi

ng th

e ris

k of

ve

ctor

bor

ne il

lnes

ses.

Yes,

the

heal

th s

ervi

ce

mon

itors

for i

ncid

ence

of

vect

or b

orne

dis

ease

s an

d ta

kes

actio

n ac

cord

ingl

y

Yes,

ther

e ar

e oc

casi

onal

ou

tbre

aks

Clim

ate

chan

ge m

ay a

ffect

the

rang

e an

d ex

tens

ion

of m

osqu

ito s

peci

es.

This

may

resu

lt in

diff

eren

t m

osqu

ito b

orne

dis

ease

s be

com

ing

esta

blis

hed

on

Torr

es S

trait

Isla

nds

Mon

itorin

g pr

ogra

ms

shou

ld b

e in

crea

sed

to e

nabl

e ea

rly id

entif

icat

ion

of v

ecto

r bor

ne il

lnes

ses.

Hig

h
















First Pass Risk Assessment for the Health System of the Torres Strait 32Discussion

7 DiscussionHere we build on the climate change risk screening results, by also considering the:

(1) The Torres Strait Regional Adaptation and Resilience Plan 2016-2021;

(2) Areas of the Torres Strait that are considered most at risk from climate change impacts to thehealth system;

(3) Torres Strait communities considered most at risk from climate change impacts;

(4) Torres Strait Sectors considered to be most at risk from climate change impacts;

(5) Information gaps with respect to climate change and human health;

(6) Key health sector linkages; and

(7) Emissions reduction and sustainability.

7.1 Summary of Climate Change Risk ScreeningThe climate variables that were of primary concern were:

• Sea-level rise;

• Heat and heatwaves (on land and in the ocean);

• Storms;

• Cyclones;

• Drought; and

• Floods.

Our assessment showed that previous assessments of climate change risks to the region had identified many of the issues that are likely to influence the health system, although many of these have focussed on risks to the Torres Strait community and the regional infrastructure (e.g. roads, jetties, airstrips), rather than the hospital infrastructure specifically. Climate change is a risk multiplier and many of the existing issues faced by Torres Strait Islanders are likely to be amplified into the future which will increase demand on the health system. The strong relationship between all aspects of Torres Strait Islander livelihoods, lifestyles and the health system were made very clear through the assessment.

Several areas where the health system in the Torres Strait is most at risk from the effects from climate change where identified and are discussed in further detailed below. Further, more detailed risk assessments of the health infrastructure and operational activities of the TCHHS are required. These will help to detect where adaptation action is required (e.g. specific locations) and when variousoptions should be implemented. Some may benefit from small incremental changes, while others might need significant structural or institutional changes, and some facilities may need to be relocated.


7 DiscussionHere we build on the climate change risk screening results, by also considering the:

(1) The Torres Strait Regional Adaptation and Resilience Plan 2016-2021;

(2) Areas of the Torres Strait that are considered most at risk from climate change impacts to thehealth system;

(3) Torres Strait communities considered most at risk from climate change impacts;

(4) Torres Strait Sectors considered to be most at risk from climate change impacts;

(5) Information gaps with respect to climate change and human health;

(6) Key health sector linkages; and

(7) Emissions reduction and sustainability.

7.1 Summary of Climate Change Risk ScreeningThe climate variables that were of primary concern were:

• Sea-level rise;

• Heat and heatwaves (on land and in the ocean);

• Storms;

• Cyclones;

• Drought; and

• Floods.

Our assessment showed that previous assessments of climate change risks to the region had identified many of the issues that are likely to influence the health system, although many of these have focussed on risks to the Torres Strait community and the regional infrastructure (e.g. roads, jetties, airstrips), rather than the hospital infrastructure specifically. Climate change is a risk multiplier and many of the existing issues faced by Torres Strait Islanders are likely to be amplified into the future which will increase demand on the health system. The strong relationship between all aspects of Torres Strait Islander livelihoods, lifestyles and the health system were made very clear through the assessment.

Several areas where the health system in the Torres Strait is most at risk from the effects from climate change where identified and are discussed in further detailed below. Further, more detailed risk assessments of the health infrastructure and operational activities of the TCHHS are required. These will help to detect where adaptation action is required (e.g. specific locations) and when variousoptions should be implemented. Some may benefit from small incremental changes, while others might need significant structural or institutional changes, and some facilities may need to be relocated.


7.2 The Torres Strait Regional Adaptation and Resilience Plan 2016-2021The Torres Strait Regional Adaptation and Resilience Plan 2016-2021 (TSRARP) outlines anintegrated strategic approach to addressing a variety of priority climate change impacts in the Torres Strait. Health related actions in the Plan are focused primarily on health impacts on communities rather than impacts on health services and infrastructure. Several actions are identified which are consistent with or aligned to recommendations in this report. At this stage it is not clear which actions in the TSRARP have been fully implemented and thus all relevant actions to the health sector are restated in this report.

7.3 Torres Strait Communities Considered Most at Risk From Climate Change Impacts on HealthThe following groups within the Torres Strait population will likely be more susceptible to health-related climate change risks:

• Community members with chronic diseases. The Torres Strait community tends to be affected bychronic diseases at earlier stages in life than people from other parts of Australia. They also haveearlier progression of disease when compared to elsewhere. This means that a greater proportionof the community is at risk to heat and heatwaves but are also more dependent on the healthsystem generally.

• Those that are sick and frail – have high care needs and are highly dependent on a health systemthat is fully functional at all times. This is challenged during extreme events such as cyclones andwill in-all-likelihood be more challenged as the climate changes. As mentioned above, sick andfrail people can also be at greater risk from the effects of heat and heatwaves.

• Those from low socio-economic backgrounds who do not have the resources to alleviate/reducethe effects of climate change to their health. (,e.g. lack of access to air-conditioning, or pay forfresh produce or other healthcare related needs).

• Communities living on different islands have different levels of risk. Those on low lying sand andmud islands or in low-lying villages are likely to be substantially affected by sea-level rise andassociated impacts.

• Outdoor workers will be more exposed to high temperatures and high humidity which can causeheat stress.

7.4 Potential Climate Change Impacts on Key SectorsBoth the health system and Torres Strait community are fundamentally reliant of other sectors operating in the Torres Strait. The following key climate change risks for each sector must be considered concurrently. Without a fully functioning electricity sector, the health system and water security are compromised.

• Health Sector: As described above in this report, the health sector in the Torres Strait ischallenged by a variety of direct and indirect climate pressures. These risks are compounded by


impacts to other sectors which influences demand on the health system, and also impacts the ability of the system to function effectively.

• Electricity sector: Increased risk of blackouts with a flow on impact to health infrastructure andservices. Generators are known to fail on a regular basis when in use with implications for foodquality and availability of vaccines (loss of vaccines is a common occurrence). Loss of lighting inhealth facilities impacts night work and results in a loss of communication, particularly individuals(i.e. no ability to charge phones and contact health system when in need). It is essential that theelectricity sector transitions to using renewable sources. This will ultimately make it more reliableand safer.

• Water sector: Water is a limited resource on most communities. Aging water infrastructure andchallenges with infrastructure maintenance often results in the need to boil water prior to use anddaily water restrictions on outer islands is common. Water contamination results in increasedcases of gastroenteritis, despite a boiled water alert. This will likely increase in scale andfrequency in the future. Note that the risk varies from island to island, e.g. Coconut Island has avery limited water supply while Thursday Island has lots of water. Many islanders and healthcentres use bottled water which creates a challenge for waste disposal. There is work being doneat the moment to increase the sustainability and reliability of the water supply systems.

• Fisheries sector: The fisheries sector faces risks from the influence of hotter sea-temperaturesand coral bleaching. This has potential direct and indirect effects on the local economy, includingreducing access to fresh fish, and reducing available funds to spend on personal health care.

• Transport sector: The transport sector is at risk from a variety of different climate pressures.Extreme weather can disrupt transport, preventing movement of patients, nurses and doctorsbetween locations. Storm surge, heavy flooding and a range of other climate related pressurescan have a direct effect on roads, rail and air strips, impacting supply chains of medicine andfood.

7.5 Information about Climate Change and Human HealthThere was consensus amongst participants that the information available about climate change andhuman health is insufficient both within the sector and for the Torres Strait community. The lack of information includes the effects of climate change and the ways to address the challenge that it presents to human health.

Examples of information needs include:

• More locally relevant and reliable data on changes in weather patterns and climate change andbetter projections of future sea level rise in the area. There was a concern for example, that thelack of detailed information creates a risk that new health infrastructure will be constructed in thewrong places. This creates a risk that the assets could be lost without realising any medium orlong-term benefits for the community.

• More information about the effects of climate change on local communities. Improve engagementwith communities about the issue and responses. This can help to develop a better understanding


impacts to other sectors which influences demand on the health system, and also impacts the ability of the system to function effectively.

• Electricity sector: Increased risk of blackouts with a flow on impact to health infrastructure andservices. Generators are known to fail on a regular basis when in use with implications for foodquality and availability of vaccines (loss of vaccines is a common occurrence). Loss of lighting inhealth facilities impacts night work and results in a loss of communication, particularly individuals(i.e. no ability to charge phones and contact health system when in need). It is essential that theelectricity sector transitions to using renewable sources. This will ultimately make it more reliableand safer.

• Water sector: Water is a limited resource on most communities. Aging water infrastructure andchallenges with infrastructure maintenance often results in the need to boil water prior to use anddaily water restrictions on outer islands is common. Water contamination results in increasedcases of gastroenteritis, despite a boiled water alert. This will likely increase in scale andfrequency in the future. Note that the risk varies from island to island, e.g. Coconut Island has avery limited water supply while Thursday Island has lots of water. Many islanders and healthcentres use bottled water which creates a challenge for waste disposal. There is work being doneat the moment to increase the sustainability and reliability of the water supply systems.

• Fisheries sector: The fisheries sector faces risks from the influence of hotter sea-temperaturesand coral bleaching. This has potential direct and indirect effects on the local economy, includingreducing access to fresh fish, and reducing available funds to spend on personal health care.

• Transport sector: The transport sector is at risk from a variety of different climate pressures.Extreme weather can disrupt transport, preventing movement of patients, nurses and doctorsbetween locations. Storm surge, heavy flooding and a range of other climate related pressurescan have a direct effect on roads, rail and air strips, impacting supply chains of medicine andfood.

7.5 Information about Climate Change and Human HealthThere was consensus amongst participants that the information available about climate change andhuman health is insufficient both within the sector and for the Torres Strait community. The lack of information includes the effects of climate change and the ways to address the challenge that it presents to human health.

Examples of information needs include:

• More locally relevant and reliable data on changes in weather patterns and climate change andbetter projections of future sea level rise in the area. There was a concern for example, that thelack of detailed information creates a risk that new health infrastructure will be constructed in thewrong places. This creates a risk that the assets could be lost without realising any medium orlong-term benefits for the community.

• More information about the effects of climate change on local communities. Improve engagementwith communities about the issue and responses. This can help to develop a better understanding


of the community’s needs for dealing with (and minimising) health risks associated with extreme events and climate change.

• Better leveraging of traditional knowledge on identifying and responding to changes in weather,seasons etc. This can assist with making climate change discussions and awareness raising morerelatable. Changes can include local evidence such as bird migrations occurring earlier thanhistorically normal etc. People understand that the whole ecosystem is integrated.

• More information on the human health carrying capacity of each island (over time, and in differentclimate change scenarios). This will help the health service to plan for changes in demand andensure they are able to support communities.

• There is a need for a more strategic focus on the long-term when planning and building allinfrastructure, including health related infrastructure. Ensuring that infrastructure is adapted, willhelp to reduce demand, will help the health service to provide comfortable and safe environmentsfor patients and staff, and to function effectively in a changing climate.

• Better information on distribution and control of the mosquitos Aedes albopictus and Aedesaegypti which can carry and transmit a variety of viruses.

• Information on climate effects on fauna and flora that are important for the well-being and cultureof Torres Strait communities e.g. turtles, fisheries. People are dependent on these for food andincome. This should also include gaining a better knowledge of the impacts of other pressuressuch as overfishing, physical damage to ecosystems etc to underpin an integrated managementapproach.

• There is a need for more information in the health service and the community about reducinggreenhouse gas emissions and about waste reduction in general, including from hospital andhealth service activities and from the use of plastic water bottles used to augment supplies.

7.6 Health Sector LinkagesParticipants identified a number of important linkages that they believe should be established or strengthened to help the sector to adapt to climate change effectively. These include:

• Administrative and managerial staff in the health sector should liaise/engage better with TSRAand council to improve collaboration, communication and improve use of time and resources.Collaboration includes better sharing of data and information to support decision making.

• Need to link to organisations that can help to provide climate change projections andinterpretations and integrate these with health and population projections to underpin healthplanning. This is essential when planning for addressing long-term sustainability of areas such asrehabilitation, aged care, renal dialysis and dementia services.

• The health sector should engage with the housing sector and local government. Overcrowdingand health and wellbeing impacts of less than optimal house design are important contributors tohealth vulnerabilities.

• Links with the Public Health Unit in Cairns can ensure better access to support and information.

• Infrastructure and transport agencies to ensure that the health system can function effectively.


• Health managers or climate change workers should be made aware of the Traditional EcologicalKnowledge Project and should consider how they can make use of the information that isbecoming available.

7.7 Emission Reduction and SustainabilityA recent study published in The Lancet Planetary Health indicated that the health sector contributes 7% of Australia’s greenhouse gas emissions and makes a substantial contribution to climate change (Malik, Lenzen, McAlister and McGain 2018). While the focus of this risk assessment and associated recommendations is on climate change adaptation, The Torres and Cape Hospital and Health Service (TCHHS) should make an effort to reduce its emissions, helping to ensure that climate change remains below dangerous levels. In addition, adaptation actions should not contribute to additional emissions. For example, air conditioning to reduce heat stress of workers and patients should be powered by renewable energy as much as possible.

Examples of actions that TCHHS can take include:

• Implementing energy efficiency measures within all facilities;

• Installing renewable energy sources to reduce demand on the electricity network;

• Ensuring that suppliers are implementing energy efficient measures; and

• Minimising waste generation.

In addressing climate change impacts, it is essential that the TCHHS assesses its contribution to green-house gas emissions and implements actions to reduce emissions. These include:

(1) Reduce potential for maladaptation (i.e. whereby adaptation action increase greenhouse gasemissions). An example is increased use of non-renewable electricity to drive air conditioners.

(2) Consider joining the Global Green and Healthy Hospitals Network (www.greenhsopitals.net)to enable sharing of leading practices and solutions with other organisations.

As identified through the risk assessment, in addition to the need for energy efficiency and the use of renewable energy, several other sustainability initiatives should be implemented on the islands by the TCHHS, local government and other management agencies. These include:

• Assessing water management approach (supply, quality and efficiency) through understandingrisk to the water supply and sewerage system on each island, and for each health facility andestablishing a detailed plan to upgrade and adapt the existing system. The reliance of the watersupply and treatment system on the energy system, makes it essential that these are consideredin tandem.

• The health and hospital systems create substantial waste through their activities. This iscompounded by the waste resulting from the use of bottled water in many facilities. The TCHHSshould develop a waste strategy focussing on waste reduction and management.


• Health managers or climate change workers should be made aware of the Traditional EcologicalKnowledge Project and should consider how they can make use of the information that isbecoming available.

7.7 Emission Reduction and SustainabilityA recent study published in The Lancet Planetary Health indicated that the health sector contributes 7% of Australia’s greenhouse gas emissions and makes a substantial contribution to climate change (Malik, Lenzen, McAlister and McGain 2018). While the focus of this risk assessment and associated recommendations is on climate change adaptation, The Torres and Cape Hospital and Health Service (TCHHS) should make an effort to reduce its emissions, helping to ensure that climate change remains below dangerous levels. In addition, adaptation actions should not contribute to additional emissions. For example, air conditioning to reduce heat stress of workers and patients should be powered by renewable energy as much as possible.

Examples of actions that TCHHS can take include:

• Implementing energy efficiency measures within all facilities;

• Installing renewable energy sources to reduce demand on the electricity network;

• Ensuring that suppliers are implementing energy efficient measures; and

• Minimising waste generation.

In addressing climate change impacts, it is essential that the TCHHS assesses its contribution to green-house gas emissions and implements actions to reduce emissions. These include:

(1) Reduce potential for maladaptation (i.e. whereby adaptation action increase greenhouse gasemissions). An example is increased use of non-renewable electricity to drive air conditioners.

(2) Consider joining the Global Green and Healthy Hospitals Network (www.greenhsopitals.net)to enable sharing of leading practices and solutions with other organisations.

As identified through the risk assessment, in addition to the need for energy efficiency and the use of renewable energy, several other sustainability initiatives should be implemented on the islands by the TCHHS, local government and other management agencies. These include:

• Assessing water management approach (supply, quality and efficiency) through understandingrisk to the water supply and sewerage system on each island, and for each health facility andestablishing a detailed plan to upgrade and adapt the existing system. The reliance of the watersupply and treatment system on the energy system, makes it essential that these are consideredin tandem.

• The health and hospital systems create substantial waste through their activities. This iscompounded by the waste resulting from the use of bottled water in many facilities. The TCHHSshould develop a waste strategy focussing on waste reduction and management.

First Pass Risk Assessment for the Health System of the Torres Strait 37Recommendations

8 RecommendationsSeveral recommendations are made from this assessment. These reflect findings from the risk assessment screening, together with feedback from interview participants.

8.1 Collaboration and Engagement to Ensure Effective Action

• The Torres Strait Adaptation and Resilience Plan 2016-2021 identifies several actions that arespecific to the health system. It is essential that strong links are developed between the TSRAand the Torres Cape Hospital and Health Service to ensure close collaboration in deliveringprojects and in monitoring the outcomes of projects that are implemented.

• Break down barriers and stop operating in silos. This is needed within and outside oforganisations. Without an effective and integrated system, the health sector will not be positionedto cope with the increased demands associated with a changing climate.

8.2 Reducing Demand on The Health System and Responding toChanges in Demand Due to Climate Change

• There is a good general awareness of the ways in which climate change affects human healthand associated demands on the health system. This should be augmented with a detailedassessment specific to the effects of climate change on human health in the Torres Strait.

• Gather more data and information about links between health and climate in the Torres Strait,and ensure it is available to the TCHHS together with guidance on how to utilise the information.

• Significant effort should be made in preventative measures to reduce the demand on the healthsystem. This requires increasing the awareness and knowledge of health service professionalsto ensure that the right programs are in place and that engagement with communities is conductedappropriately and sensitively. Discussions should be solutions oriented.

• The effects of climate change on the health system in the Torres Strait is a socio-ecological issue.There are many externalities which affect the ability of the health system to function now andunder a changing climate. These include access to fresh food, ability of the community to generatean income, and cultural links to the land and sea. Housing and associated overcrowding is alsoan important consideration. The implications climate change on all of these variables must beunderstood and managed.

• Improving food security and sustainability of the region by supporting locally grown foods. Easierand cheaper access to fresh produce directly supports the health of the population and increasesthe amount of available funds that are available to help invest in other health care relatedproducts.

• The general sustainability of each island should be assessed to better understand its populationcarrying capacity. This includes understanding needs for water, electricity and other resources,and a realistic assessment of the likely availability of these into the future. This understanding


should project forward under a climate affected future. These resources are critical for the health system to be able to function effectively.

• Improve education and awareness of climate change for health professionals and the community.This will help them to understand what the future looks like, how and why certain plans are beingmade, and support decisions about future infrastructure and workforce needs.

• Long term planning for communities must be undertaken together with the community. Thisshould be done with a focus on the health system. What infrastructure needs to be developedand where? Does any infrastructure need to be relocated? What can be learned from previousrelocation events? For example, there was relocation of community from Saibai to Cape York inthe 1960’s but there is no discussion about lessons learned from this at present.

• There is a need to develop a better understanding of disease movements in the Torres Strait,including through mosquito borne movement.

• Increased understanding of climate change impacts on marine and terrestrial ecosystems.

• Climate change must be considered as being central to everything in the Torres Strait goingforward.

• Need to consider the various ways in which Traditional Communities may be affected culturallyby climate change and these might in turn affect the demand on the health system. For example,the loss of the ability to undertake customary activities such as hunting may have stress andidentity issues leading to mental health challenges.

• Understand climate risk to housing on the islands and build a strategy for adapting existing housesto be resilient to future pressures. Ensure that there is a very good understanding of areas offuture risk and prevent the development of new houses in high risk areas. This can help to reducestress and mental health issues that are likely to be a demand on the health sector in the future.

• Need a better understanding of PNG health issues and the potential flow of any health-relatedissues into the Torres Strait. This also requires a broad understanding of the implications ofclimate change for PNG locations near the Torres Strait.

• The Public Health Unit in Cairns needs to prepare for a bigger role in understanding vector bornedisease movement and information sharing. The system is working now but this may become abigger issue and it should be prepared.


should project forward under a climate affected future. These resources are critical for the health system to be able to function effectively.

• Improve education and awareness of climate change for health professionals and the community.This will help them to understand what the future looks like, how and why certain plans are beingmade, and support decisions about future infrastructure and workforce needs.

• Long term planning for communities must be undertaken together with the community. Thisshould be done with a focus on the health system. What infrastructure needs to be developedand where? Does any infrastructure need to be relocated? What can be learned from previousrelocation events? For example, there was relocation of community from Saibai to Cape York inthe 1960’s but there is no discussion about lessons learned from this at present.

• There is a need to develop a better understanding of disease movements in the Torres Strait,including through mosquito borne movement.

• Increased understanding of climate change impacts on marine and terrestrial ecosystems.

• Climate change must be considered as being central to everything in the Torres Strait goingforward.

• Need to consider the various ways in which Traditional Communities may be affected culturallyby climate change and these might in turn affect the demand on the health system. For example,the loss of the ability to undertake customary activities such as hunting may have stress andidentity issues leading to mental health challenges.

• Understand climate risk to housing on the islands and build a strategy for adapting existing housesto be resilient to future pressures. Ensure that there is a very good understanding of areas offuture risk and prevent the development of new houses in high risk areas. This can help to reducestress and mental health issues that are likely to be a demand on the health sector in the future.

• Need a better understanding of PNG health issues and the potential flow of any health-relatedissues into the Torres Strait. This also requires a broad understanding of the implications ofclimate change for PNG locations near the Torres Strait.

• The Public Health Unit in Cairns needs to prepare for a bigger role in understanding vector bornedisease movement and information sharing. The system is working now but this may become abigger issue and it should be prepared.


8.3 Understanding and Addressing Climate Risk on Health Facilities and Operational Capacity

• A second-pass risk assessment should be conducted on hospital and health facilities in the TorresStrait. The assessment should also include critical infrastructure relating to access for EmergencyServices, patients and staff. This should be supported with an economic analysis to determinewhen the most appropriate times are for implementing actions such as repairing facilities afterimpact, enhancing resilience of facilities to reduce impact or relocating facilities.

• The ability to attract health service staff to the Torres Strait is an important consideration and along-term plan should be made to ensure that the staffing needs of a continually expandingsystem can be accommodated.

• Climate change strategies of health services should be aligned with sustainability plans. Thesewill ensure consideration of energy, water and associated critical infrastructure. Wastemanagement is also an important element for consideration.

First Pass Risk Assessment for the Health System of the Torres Strait 40References

9 ReferencesABS (2017) Torres Strait Islands: 2016 Census. Changing characteristics of the Torres Strait region and its people, 2011 to 2016. Australian Bureau of Statistics.

DPMC (2018) Closing the Gap Prime Minister’s Report 2018. Commonwealth of Australia, Department of the Prime Minister and Cabinet, Canberra.

Green, D., Alexander, L., Mclnnes, K., Church, J., Nicholls, N., & White, N. (2010). An assessment of climate change impacts and adaptation for the Torres Strait Islands, Australia. Climatic Change (2010) 102:405–433.

IPCC (2018). Global Warming of 1.5 °C. IPCC, Geneva, Switzerland.

Malik, A., Lenzen, M., McAlister, S., & McGain, F. (2018). The carbon footprint of Australian health care. The Lancet Planetary Health, 2(1), e27-e35.

McIver, L. and Liu, A. (2015) Streamlining chronic disease management in the Torres Strait: review of current practice and recommendations for improvement. Paper in Proceedings of 13th National Rural Health Conference, 24-27 May 2015 (Darwin).

Queensland Heath (2018) Closing the gap performance report 2017. State of Queensland (Queensland Health), April 2018.

Suppiah, R., Bathols, J., Mark Collier,M.,,Kent, D. and O’Grady, J. (2010) Observed and future climates of the Torres Strait region. CSIRO, Marine and Atmospheric Research. Report to the Torres Strait Regional Authority, 66p.

Sweet WV et al. 2017. Global and regional sea-level rise scenarios for the United States. NOAA technical Report NOS CO-OPS 083.https://tidesandcurrents.noaa.gov/publications/techrpt83_Global_and_Regional_SLR_Scenarios_for_the_US_final.pdf ).

Torres Strait Regional Authority (2014) Torres Strait Climate Change Strategy 2014-2018. Report prepared by the Land and Sea Management Unit. Torres Strait Regional Authority. 36p.

Torres Strait Regional Authority (2016) Torres Strait Adaptation and Resilience Plan 2016-2021. Report prepared by the Environmental Management Program. Torres Strait Regional Authority. 108p.

Watts N, Adger W, Agnolucci P, Blackstock J, Bypass P, Cai W, et al. (2015) Health and climate change: policy responses to protect public health. Lancet.386(10006):1861–1914.

First Pass Risk Assessment for the Health System of the Torres Strait 40References

9 ReferencesABS (2017) Torres Strait Islands: 2016 Census. Changing characteristics of the Torres Strait region and its people, 2011 to 2016. Australian Bureau of Statistics.

DPMC (2018) Closing the Gap Prime Minister’s Report 2018. Commonwealth of Australia,Department of the Prime Minister and Cabinet, Canberra.

Green, D., Alexander, L., Mclnnes, K., Church, J., Nicholls, N., & White, N. (2010). An assessmentof climate change impacts and adaptation for the Torres Strait Islands, Australia. Climatic Change(2010) 102:405–433.

IPCC (2018). Global Warming of 1.5 °C. IPCC, Geneva, Switzerland.

Malik, A., Lenzen, M., McAlister, S., & McGain, F. (2018). The carbon footprint of Australian health care. The Lancet Planetary Health, 2(1), e27-e35.

McIver, L. and Liu, A. (2015) Streamlining chronic disease management in the Torres Strait: reviewof current practice and recommendations for improvement. Paper in Proceedings of 13th NationalRural Health Conference, 24-27 May 2015 (Darwin).

Queensland Heath (2018) Closing the gap performance report 2017. State of Queensland(Queensland Health), April 2018.

Suppiah, R., Bathols, J., Mark Collier,M.,,Kent, D. and O’Grady, J. (2010) Observed and future climates of the Torres Strait region. CSIRO, Marine and Atmospheric Research. Report to the TorresStrait Regional Authority, 66p.

Sweet WV et al. 2017. Global and regional sea-level rise scenarios for the United States. NOAAtechnical Report NOS CO-OPS 083.https://tidesandcurrents.noaa.gov/publications/techrpt83_Global_and_Regional_SLR_Scenarios_for_the_US_final.pdf ).

Torres Strait Regional Authority (2014) Torres Strait Climate Change Strategy 2014-2018. Report prepared by the Land and Sea Management Unit. Torres Strait Regional Authority. 36p.

Torres Strait Regional Authority (2016) Torres Strait Adaptation and Resilience Plan 2016-2021. Report prepared by the Environmental Management Program. Torres Strait Regional Authority. 108p.

Watts N, Adger W, Agnolucci P, Blackstock J, Bypass P, Cai W, et al. (2015) Health and climatechange: policy responses to protect public health. Lancet.386(10006):1861–1914.

First Pass Risk Assessment for the Health System of the Torres Strait A-1Interview Participants

Appendix A Interview ParticipantsTable A-1 Names and positions of people interviewed for the risk assessment

Name Position

Dr Anthony Brown Executive Director, Torres and Cape Hospital and Health Service

Dr Allison Hempenstall Medical Doctor, Torres and Cape Hospital and Health Service

Mr David Murray Clinical Nurse Consultant, Torres and Cape Hospital and Health Service

Dr Ineke Wever GP, Senior Health Officer, Torres and Cape Hospital and Health Service

Dr Marlon Coates A/Northern Director of Medical Services, Torres and Cape Hospital and Health Service

Mr Vic McGrath Senior Community Liaison Officer, Torres Strait Regional Authority

Mr John Rainbird Torres Strait Regional Authority

Dr Sophie Dwyer Executive Director, Queensland Health

Dr Peter Schneider Senior Policy Officer, Queensland Health

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