Climate Change and Environmental Health Crises

The WHO has declared climate change to be "the single biggest health threat facing humanity."[79] Climate change poses a significant threat to the health and wellbeing of Australians. Its detrimental impact on human health is already being experienced in Australia through heat stress, changing rainfall patterns and climate-related air pollution.

Climate change has the potential to directly and indirectly influence cancer outcomes in Australia. For example, climate change may contribute to increased incidence of cancer, impact consistent and continuous delivery of cancer care, and affect equity of cancer outcomes for people affected by cancer, by particularly impacting priority population groups.

Increased incidence of cancer and treatment requirements lead to an ever-growing damage to the environment. This climate toxicity is observed in many areas of healthcare, including clinical research, diagnosis, treatment and patient travel.

Impact on cancer incidence and prevention

Climate change is expected to have a direct impact on cancer incidence due to factors such as:

• Worsening air pollution
• Higher exposure to ultraviolet (UV) radiation
• Insecurity of food supply associated with low quality nutrition
• A climate that is less suited to outdoor activity and active travel (e.g. walking, cycling), and potentially disincentivising physical activity.

These factors are all expected to contribute to a growing number of cancer cases, in particular lung, upper respiratory tract, skin, gastrointestinal and liver cancers[80]. Extreme environmental changes also have the potential to undermine the impact of preventive health initiatives related to cancer control, such as promotion of the benefits of sun protection, healthy eating, and exercise.

Impact on cancer care delivery

Climate change may also have an indirect impact on the consistent delivery of cancer care across the care continuum, including screening, diagnosis, treatment, and end-of-life care.

Extreme weather events, such as intense heatwaves, bushfires, and floods, have the potential to disrupt healthcare by interrupting and/or diverting the supply of power, water, medical equipment, healthcare personnel, pharmaceuticals, and access to healthcare facilities for patients, carers and the health workforce. Delayed diagnosis and diagnosis at more advanced stages of cancer, together with interruptions to ongoing treatment regimens, may lead to adverse outcomes for cancer patients and reductions in survival.[1]

Impact on priority population groups

Defined groups of the Australian population are likely to be disproportionately impacted by climate change due to inequity and vulnerabilities. Disparities associated with cultural and social determinants of health such as location, financial status, or other characteristics historically linked to discrimination or exclusion are further exacerbated by the effects of climate change.[81][82][83]

People likely to experience the greatest impact of climate change on their health are those who live in, or have connection to, areas prone to flooding, bushfire and extreme heat.[18][84][85] These groups include Aboriginal and Torres Strait Islander people, people living in rural and remote communities, culturally and linguistically diverse (CALD) populations, children, older people, and people in lower socioeconomic groups.[79] There is significant intersectionality between these groups, amplifying the impact of climate change on a community’s health.  For example:

• Aboriginal and Torres Strait Islander people have cultural connections to Country which are central to health, identity, knowledge systems, and culture. The effects of extreme weather events on traditional lands and waters will be detrimental to community connection to Country and responsibilities in caring for Country that will impact overall social and cultural wellbeing[86]
• People living in rural and remote communities are among those most likely to be impacted by hotter temperatures in inland areas, rising sea levels in coastal and island communities, cyclones, rainfall events, and bushfires.[86] These factors may exacerbate inequities experienced by Aboriginal and Torres Strait Islander people who are proportionally more likely than non-Indigenous Australians to live in remote and very remote areas[19][77]
• People in lower socioeconomic groups spend a disproportionate amount of their household income on energy, food and water.[85] The cost of these essential items is expected to rise as a result of climate change (due to scarcity and supply challenges) which will put additional pressure on already-disadvantaged families, impacting their physical and mental health and reducing the amount of money available to them to spend on healthcare
• Children and older people are more likely to feel the effects of climate-related health conditions such as those caused by heat stress and poor air quality.[79][87]

Australian Cancer Plan activities to address the impact of climate change on cancer

• Cancer prevention and early detection activities identified for cancers exacerbated by climate change, such as skin cancer and lung cancer[80], along with screening approaches based on individual risk due to environmental factors
• Tailored models of navigation that improve equitable experiences and outcomes, and reduce variations in access and service delivery, can support consumers most likely to be impacted by the effects of climate change to navigate the healthcare system[88]
• An Australian Comprehensive Cancer Network can increase equity of access across services for all patients. This would reduce the need to travel for cancer care and minimise disruption of ongoing treatment, including at times when travel is impeded by extreme weather events, by providing networked access to expertise regardless of location and through a shift to primary- and community-based care where appropriate
• Advanced technology and telemedicine can enable the delivery of comprehensive cancer care irrespective of location
• Increased research funding into the impacts of climate change on cancer incidence and outcomes can inform evidence-based cancer control policies and efforts 
• Workforce initiatives can improve the flexibility, resilience and responsiveness of the cancer care workforce. This includes identifying emerging workforce gaps in delivery of care to rural and remote communities and other priority population groups; and building the capability of the multidisciplinary workforce to be working at its full scope of practice and able to deliver high-quality cancer care.

Key frameworks, strategies and plans relevant to cancer care and climate change