Excess winter mortality (EWM) has been used as a measure of how well populations and policy moderate the health effects of cold weather. We aimed to investigate long-term changes in the EWM of Aotearoa New Zealand (NZ), and potential drivers of change, and to test for structural breaks in trends. We calculated NZ EWM indices from 1876 (4,698 deaths) to 2020 (33,310 deaths), total and by age-group and sex, comparing deaths from June to September (the coldest months) to deaths from February to May and October to January. The mean age and sex-standardised EWM Index (EWMI) for the full study period, excluding 1918, was 1.22. However, mean EWMI increased from 1.20 for 1886 to 1917, to 1.34 for the 1920s, then reduced over time to 1.14 in the 2010s, with excess winter deaths averaging 4.5% of annual deaths (1,450 deaths per year) in the 2010s, compared to 7.9% in the 1920s. Children under 5 years transitioned from a summer to winter excess between 1886 and 1911. Otherwise, the EWMI age-distribution was J-shaped in all time periods. Structural break testing showed the 1918 influenza pandemic strain had a significant impact on trends in winter and non-winter mortality and winter excess for subsequent decades. It was not possible to attribute the post-1918 reduction in EWM to any single factor among improved living standards, reduced severe respiratory infections, or climate change.
Four decades of research on the health effects of ‘connection to nature’ identifies many wellbeing advantages for young people. Yet this literature has developed largely without reference to biophysical evidence about mass biodiversity loss, the degradation of marine environments and climate change. As these interlocking planetary crises progress, children will be more likely to witness the marine environments they learn about degrade or disappear as they grow up. Improving ocean literacy is important to protect marine environments into the future. However little is known about how learning about ocean degradation affects young people’s emotional wellbeing. We undertook qualitative research to investigate how ocean literacy educators in Aotearoa New Zealand view the content they deliver in relation to the emotional wellbeing of young people. Semi-structured interviews were conducted with 21 key informants from non-government organisations (NGOs), Ministry of Education funded programmes, university-community partnerships, youth-led initiatives and local and national museums and aquariums. Transcripts were analysed using the six steps of Braun and Clarke’s (2022) reflexive thematic analysis. Ocean literacy education was described as positively affecting young people’s emotional wellbeing through interactive experiences in coastal environments. These provided opportunities for experiencing wonder, curiosity and a shared sense of connection and belonging. Educators reported witnessing distress and overwhelm in young people when some information was delivered. This resulted in educators ‘not focusing on the negative’ and moving straight to solutions young people could take part in. Our findings provide opportunities for re-imagining ocean literacy education as a space for promoting mental wellbeing, especially when young people have the opportunity to be part of collective experiences that promote joy and wonder. Intergenerational solutions where young people can be supported to take action with adults who work in solidarity with them are also recommended. Further research into how educators can be resourced to acknowledge and facilitate support around young people’s negative emotional responses (such as grief, overwhelm and anxiety) is required.
Recent extreme weather events attributable to climate change have major implications for policy. Here we summarize and evaluate the current state of climate change adaptation policy, from a health perspective, for Aotearoa New Zealand, based on government sources. Legislation relating to both environmental management and health are currently subject to major reforms. At present, adaptation policy emphasises protection of health care facilities from climate extremes; there is insufficient attention paid to broader determinants of health. We argue for greater health input into adaptation planning. Without intersectoral collaboration, contributions from diverse communities, and better support of indigenous solutions, climate change policy is unlikely to achieve effective health outcomes and there is a risk that climate change will exacerbate inequities. We recommend that the Climate Change Commission engage formally and directly with health bodies to strengthen the Commission’s advice on the implications of climate change, and of national climate change policies, on health and equity. Climate resilient development does not occur without better public health. For this reason, the health sector has a critical role in the development and implementation of adaptation policy.
Background: Prior studies have shown that meteorological factors may be associated with increases in legion-ellosis (Legionnaire’s disease, (LD)), caused by Legionella, a globally ubiquitous bacterium found naturally in aquatic habitats, soils, and compost. The aim of this retrospective time series analysis was to examine the as-sociation between meteorological factors and air pollution parameters and the incidence of sporadic, community -acquired, laboratory confirmed LD.Methods: Daily cases of community-acquired legionellosis, meteorological and air pollution data from two urban areas, Auckland (North Island) and Christchurch (South Island) were collected from January 1, 1997 until December 31, 2020. Using Quasi-Poisson regression, associations between symptom onset and meteorological and air pollution variables were investigated using an interrupted time series analysis.Results: The two cities had different meteorological conditions and LD epidemiology and seasonal patterns of Legionella spp. LD incidence rates (per 100,000 population) were higher in Christchurch than Auckland for L. pneumophila (25.8 vs 10.8) and L.longbeachae (78.2 vs 4.9). Seasonal patterns were detected in Christchurch with a higher risk of LD during spring and summer (RR: 1.87, 95% CI: 1.42, 2.49) compared to autumn and winter months. In Auckland, the level of particulate matter 9-10 days prior to the onset date was positively associated with LD occurrence (RR: 1.02, 95% CI: 1.00, 1.04) compared to Christchurch, where Tmax recorded one day prior the onset (RR: 1.03, 95% CI: 1.00, 1.07) and sulphur dioxide 6 days prior to the onset date (RR: 1.27, 95% CI: 1.10, 1.45) were positively associated with LD occurrence. Atmospheric pressure 12 days prior (RR: 0.95, 95% CI: 0.90, 1.00) and wind speed 13 days prior (RR: 0.94, 95% CI: 0.89, 0.99) to the onset date were negatively associated with LD risk. In both cities, no association was detected between the level of precipitation and LD risk.Conclusions: Meteorological factors and air pollutants were associated with the risk of LD. However, different seasonal patterns and prevalent LD species seem to have distinct patterns of association between the two cate-gories of exposures. These findings suggest the importance of considering meteorological and air quality con-ditions in conjunction with the source of exposure and the LD species involved. They also imply potential climate change impacts on LD and benefits from reducing air pollution, though findings need to be replicated in other geographical regions.
BACKGROUND: Climate change is already affecting Aotearoa New Zealand (Aotearoa-NZ). The public health effects are varied and complex, and rural primary care staff will be at the front line of effects and responses. However, little is known about their understanding and experience. OBJECTIVES: To determine understanding, experiences and preparedness of rural general practice staff in Aotearoa-NZ about climate change and health equity. METHODS: A mixed-methods national cross-sectional survey of rural general practice staff was undertaken that included Likert-style and free-text responses. Quantitative data were analysed with simple descriptive analysis and qualitative data were thematically analysed using a deductive framework based on Te Whare Tapa Whā. RESULTS: A proportion of survey respondents remained unsure about climate science and health links, although many others already reported a range of negative climate change health impacts on their communities, and expected these to worsen. Twenty to thirty percent of respondents lacked confidence in their health service’s capability to provide support following extreme weather. Themes included acknowledgement that the health effects of climate change are highly varied and complex, that the health risks for rural communities combine climate change and wider environmental degradation and that climate change will exacerbate existing health inequities. CONCLUSIONS: The study adds to sparse information on climate change effects on health in rural primary care. We suggest that tailored professional education on climate change science and rural health equity is still needed, while urgent resourcing and training for interagency disaster response within rural and remote communities is needed.
The importance of a safe climate for human health is recognised by healthcare professionals, who need to be equipped to deliver environmentally sustainable healthcare and promote the health of natural systems on which we depend. The inclusion of climate-health in Australian and New Zealand accredited master-level public health training and medical programs is unclear. Educators identified by their coordination, convenorship, or delivery into programs of public health and medicine at universities in Australia and New Zealand were invited to participate in a cross-sectional, exploratory mixed methods study to examine the design and delivery of climate change content in the curricula, and the barriers and opportunities for better integration. Quantitative surveys were analysed using descriptive statistics and qualitative interview content was analysed via a modified grounded theory approach. The quantitative survey had 43.7% (21/48) response rate, with 10 survey respondents completing qualitative interviews. Qualitative interviews highlighted the minimal role of Indigenous-led content in this field, the barriers of time and resources to develop a coherent curriculum and the role of high-level champions to drive the inclusion of climate change and planetary health. Building pedagogical leadership in in the area of climate change and health teaching at universities through stronger partnerships with policymakers, community stakeholders and advocacy organisations will be important for future health workforce training amid increasing climate risks. Supplemental data for this article is available online at https://doi.org/10.1080/13504622.2022.2036325 .
It is recognized that as humans age, their ability to withstand high or low temperatures reduces. Temperature extremes can also worsen chronic conditions, including cardiovascular, respiratory and other health issues. This study analyses 40 apartments in a single building in Auckland, New Zealand to determine whether the newly designed and constructed apartment, specifically for retirees, is delivering a suitable thermal interior environment during the warmest months of the year. Despite holding this green certification and meeting specific requirements to achieve cooling points that are meant to reduce the likelihood of overheating, the building exhibits significant signs of overheating in the two warmest months of the year (January and February) with two-thirds of apartments failing the CIBSE TM59 overheating criteria. The summertime performance of this green-rated building crucial insights for design professionals policymakers and developers of green building rating tools.
Extreme heat events are a leading natural hazard risk to human health. Under all future climate change models, extreme heat events will continue to increase in frequency, duration, and intensity. Evidence from previous extreme heat events across the globe demonstrates that adverse cardiovascular events are the leading cause of morbidity and mortality, particularly amongst the elderly and those with pre-existing cardiovascular disease. However, less is understood about the adverse effects of extreme heat amongst specific cardiovascular diseases (i.e., heart failure, dysrhythmias) and demographics (sex, ethnicity, age) within Australia and New Zealand. Furthermore, although Australia has implemented regional and state heat warning systems, most personal heat-health protective advice available in public health policy documents is either insufficient, not grounded in scientific evidence, and/or does not consider clinical factors such as age or co-morbidities. Dissemination of evidence-based recommendations and enhancing community resilience to extreme heat disasters within Australia and New Zealand should be an area of critical focus to reduce the burden and negative health effects associated with extreme heat. This narrative review will focus on five key areas in relation to extreme heat events within Australia and New Zealand: 1) the potential physiological mechanisms that cause adverse cardiovascular outcomes during extreme heat events; 2) how big is the problem within Australia and New Zealand?; 3) what the heat-health response plans are; 4) research knowledge and translation; and, 5) knowledge gaps and areas for future research.
OBJECTIVES: To investigate associations between long-term exposure to PM(2.5), NO(2), mortality and morbidity in New Zealand, a country with low levels of exposure. DESIGN: Retrospective cohort study. SETTING: The New Zealand resident population. METHOD: The main analyses included all adults aged 30 years and over with complete data on covariates: N = 2,223,507. People who died, or were admitted to hospital, (2013-2016) were linked anonymously to the 2013 census, and to estimates of ambient PM(2.5), and NO(2) concentration. We fitted Poisson regression models of mortality and morbidity in adults (≥30) for all natural causes of death, and by sub- group of major cause. Person-time of exposure, censored at the time of death, was included as an offset. We adjusted for confounding by age, sex, ethnicity, income, education, smoking status and ambient temperature. Further analyses stratified by ethnic group, and investigated respiratory hospital admissions in children. RESULTS: There were statistically significant positive associations between pollutants and natural causes of death: RR (per 10 μg/m(3)) for PM(2.5) 1.11 (1.07 to 1.15) and for NO(2) 1.10 (1.07 to 1.12). For morbidity, the strongest associations were for PM(2.5) and ischaemic heart disease in adults, RR: 1.29 (1.23 to 1.35) and for NO(2) and asthma in children, RR: 1.18 (1.09 to 1.28). In models restricted to specific ethnic groups, we found no consistent differences in any of the associations. CONCLUSIONS: The results for NO(2) are higher than those published previously. Other studies have reported that the dose-response for PM(2.5) may be higher at low concentrations, but less is known about NO(2). It is possible NO(2) is acting as a proxy for other traffic-related pollutants that are causally related to health impacts. This study underlines the importance of controlling pollution caused by motor vehicles.
Over the last century, nutrition research and public health in New Zealand have been inspired by Dr Muriel Bell, the first and only state nutritionist. Some of her nutritional concerns remain pertinent today. However, the nutritional landscape is transforming with extraordinary changes in the production and consumption of food, increasing demand for sustainable and healthy food to meet the requirements of the growing global population and unprecedented increases in the prevalence of both malnutrition and noncommunicable diseases. New Zealand’s economy is heavily dependent on agrifoods, but there is a need to integrate interactions between nutrition and food-related disciplines to promote national food and nutrition security and to enhance health and well-being. The lack of integration between food product development and health is evident in the lack of investigation into possible pathological effects of food additives. A national coherent food strategy would ensure all components of the food system are optimised and that strategies to address the global syndemic of malnutrition and climate change are prioritised. A state nutritionist or independent national nutrition advocacy organisation would provide the channel to communicate nutrition science and compete with social media, lead education priorities and policy development, engage with the food industry, facilitate collaboration between the extraordinary range of disciplines associated with food production and optimal health and lead development of a national food strategy.
Social vulnerability indicators are a valuable tool for understanding which population groups are more vulnerable to experiencing negative impacts from disasters, and where these groups live, to inform disaster risk management activities. While many approaches have been used to measure social vulnerability to natural hazards, there is no single method or universally agreed approach. This paper proposes a novel approach to developing social vulnerability indicators, using the example of flooding in Aotearoa New Zealand. A conceptual framework was developed to guide selection of the social vulnerability indicators, based on previous frameworks (including the MOVE framework), consideration of climate change, and a holistic view of health and wellbeing. Using this framework, ten dimensions relating to social vulnerability were identified: exposure; children; older adults; health and disability status; money to cope with crises/losses; social connectedness; knowledge, skills and awareness of natural hazards; safe, secure and healthy housing; food and water to cope with shortage; and decision making and participation. For each dimension, key indicators were identified and implemented, mostly using national Census population data. After development, the indicators were assessed by end users using a case study of Porirua City, New Zealand, then implemented for the whole of New Zealand. These indicators will provide useful data about social vulnerability to floods in New Zealand, and these methods could potentially be adapted for other jurisdictions and other natural hazards, including those relating to climate change.
