We asked The George Institute for Global Health’s respiratory expert Professor Christine Jenkins about the health effects of exposure to bushfire smoke and how you can take steps to manage them.

What is smoke exposure doing to us?

Short term exposure to smoke is definitely not good for you. Various factors influence how you will be affected by this - some being how close you are to the smoke, how intense it is and how prolonged the exposure is. Your personal vulnerability is also important – if you have asthma or other types of lung disease you are more prone to breathing difficulty and coughing when you have smoke exposure.

What advice would you have to look after yourself?

Minimise your exposure to the smoke, stay indoors if possible and wear a P2 mask if you’re outside. If you have heart or lung disease it is especially advisable to stay inside.  If you have asthma or other types of lung disease, be conscientious about taking your preventer medications. Don’t just rely on your reliever medication.

What is a P2 mask? 

This mask has a filter that can remove most of the PM2.5 particles – the tiny particles that can damage your airways and be absorbed into your bloodstream. It must be fitted snugly over your nose and around your face and chin to be effective. Paper (typical blue “surgical”) masks are not effective in eliminating fine particles (or PM2.5s).

Is there a safe time limit?

Levels below 50 are generally considered safe, although ideally, they should be below 25. On a normal, clear spring day in Sydney, PM2.5’s average about 20 micrograms per cubic metre.

How big an issue is this smoke for people with respiratory problems?

For people with airways disease, lung disease or heart disease there is a significant risk of increased symptoms. It is especially irritating for people with asthma and chronic obstructive pulmonary disease (or COPD), as these diseases cause the airways to be inflamed and the smoke can aggravate them quite substantially. Long term smoke exposure over months and years is not good for your heart or lungs whether you already have lung disease or are a healthy person.

What if you are otherwise in good health? Would it be alright to exercise?

It is definitely unwise and not recommended to exercise outdoors in these conditions. When you exercise you dramatically increase your ventilation, and the amount of air that goes in and out of your lungs increases 5 to 10 fold. It is very significant and you’re just increasing your exposure to the polluted air and potential irritants. Choosing a form of exercise you can do indoors is by far the better decision.

What organs and parts of the body would it affect aside from its respiratory system?

Fine particle pollution can be absorbed and so has the capacity to reach all organs. Cardiovascular disease is significantly increased by sustained air pollution exposure, thought to be due to in inflammatory coronary vasculitis and possibly heart muscle damage induced by these tiny particles. 

On the 4th of December 2019, The George Institute for Global Health was honoured to host Distinguished Fellow Professor Göran Tomson at our Sydney office for a special seminar on the limitations of global governance for health.

To improve health outcomes globally, countries need to work collectively on a global scale as well as within their own borders. It almost goes without saying that challenges will arise if the governance of collective actions are not in alignment.

Global Governance for Health (GG4H) involves determining what governance arrangements are needed to progress agreed global health goals.

During this talk Professor Tomson explained the limitations of the current international collective actions in the context of achieving the Sustainable Development Goals. Drawing upon case studies and The Lancet-University of Oslo Commission on GG4H, he addressed five global governance dysfunctions: inadequate policy space; institutional stickiness; democratic deficit; weak institutions and weak accountability.

The George Institute for Global Health's Honorary Fellow Dr Seye Abimbola provided a response, highlighting four main points; global health governance is too global, and needs to focus more on local realities within countries; to enact change we need to become more bold in arguing for what we know to be just and fair; change happens over a long period – any change needs to recognise there will be further changes along the way; researchers need to be more political, engaging policy makers and community representatives early on. The talk concluded with a discussion together regarding how global health needs to become more local and the need to challenge power structures.

‘Every action matters, every bit of warming matters, every year matters, every choice matters’ Prof Kristie Ebi, University of Washington

On 5 and 6 December 2019, I joined Professor Ebi and others as a participant at the Symposium of Climate Change and Health, hosted by the Swiss Tropical and Public Health Institute in Basel, calling for global thinking and local action.

At the time of writing, there are only 25 sleeps to go before we enter a new decade. Looking back over 2019, we have witnessed a surge in public awareness of, and campaigns to protect, the health of our planet, as reflected by Collins Dictionary naming ‘climate strike’ their Word of the Year.

The term ‘climate change’ is often used interchangeably with ‘global warming’ to signal the effects of excessive emissions of greenhouse gases such as carbon dioxide, to which the main contributor is the combustion of fossil fuels, e.g. coal and oil. If we continue with ‘business-as-usual’ without firm actions to stall such change, we will see more extreme climate-related events at a greater frequency and intensity, the world over in the next 10 years. The threat this poses to the health of every species, including humans, of this planet, cannot be understated.

Climate-related health risk

Climate change poses major risks to health globally. Some vector-borne diseases (e.g. malaria, dengue) are highly sensitive to increased temperature or rainfall, which ultimately affects vector distributions and the ecosystem as a whole. These diseases are disproportionately affecting populations in tropical countries.   

Non-communicable diseases (NCDs) relating to climate change are also being increasingly studied, as in my work with PEAK Urban as a researcher with The George Institute for Global Health at the University of Oxford. Alarming evidence is emerging that climate change not only reduces overall crop yields, but also depletes nutritional quality in terms of reduced iron, zinc and many other micronutrients. This carries significant impacts on long-term population health through possible malnutrition. The complexity, prevalence and reach of chronic mental health conditions are also posing significant burdens on the global community. For example, flooding has been associated with anxiety in affected communities while increased temperature seems to be linked to an increased suicide rate in this multi-city study.

Climate change can also impact health through social factors, for example, climate-related migration. This complex and context-specific issue is a focus of by the Informal Cities project team which looks at the socioeconomic and geopolitical drivers of migration, urbanisation and health. Symposium discussions also underscored the major injustice faced by individuals and communities in the Global South. Such populations are likely contributing the least to this climate crisis, but are currently paying the greatest price for it with immense challenges to combat climate change while urbanisation shifts the environmental and social face of nations burdened with infectious and non-communicable disease, and in the absence of strong investment in sustainable, climate-sensitive infrastructure. Recent floods in east Africa claimed lives and affected hundreds of thousands more. It is crucial that wealthier countries in the Global North re-examine and firmly implement their climate-related policies such as ceasing the sale of the poorest possible quality diesel to Africa (containing up to 630 times more sulphur than diesel sold in Europe). So too, it is crucial to work collaboratively to close data gaps; one of which I am working on with PEAK Urban colleagues as we investigate the role of broader environmental factors on children’s respiratory health across all sub-Saharan African countries.

Resolving to put health at the heart of climate action

Where there is risk, there is opportunity. The health-related benefits that would result from mitigating the progression of climate change are substantial. For instance, policies targeting short-lived climate pollutants (e.g. black carbon, ozone) in local areas can strongly contribute to cleaner air and better health, a justified motivator of near-term actions for all stakeholders.

In the wake-up call of this climate crisis, healthcare systems should take the opportunity to move towards smart and climate-resilient healthcare, which is particularly important for the most vulnerable regions.     

Symposium participants were asked ‘what is the most important mitigation measure that individuals can take to reduce [their] carbon footprint?’. Responses included: minimising air travel; eating less meat; consuming less; reducing reliance on car travel – why not resolve to adopt one or more as 2020 dawns the future awaits. Now is the time to act.