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Building healthy and sustainable communities:

How do we know if they really work?

Dr Helen L Berry

Professor of Psychiatric Epidemiology & Associate Dean Research Faculty of Health

University of Canberra, Australia

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1. Major challenges to contemporary communities

2. Why we should attend to mental health

3. The pivotal role of (multiple) communities

4. Built form in an urban world

5. Designing research for healthy & sustainable communities

Overview

Thanks to those contributing slides, esp. L O’Brien

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1. Globalisation

2. Urbanisation

3. Individualisation

4. Virtualisation

5. Commercialisation

6. Demographic change

7. Climate change

1. Major challenges: Ilona’s list, plus one A ‘radically’ changing world

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1850-2011 global surface temperature anomalies

Australian Bureau of Meteorology, 2012

World population, tech advance, emissions

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Earth has been warming for 100+ years Tracking temperature & temp. anomalies

Trend 1997-2013: GISS: +0.75°C/century UAH: +0.94°C/century

Nicholls, 2014

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How much will the climate change? Global emissions & future scenarios

globalcarbonproject.org

Global agreed target is 2oC above which

change is considered “dangerous”

RCP: Representative Concentration Pathways

Gt = giga tonne = 109 t = thousand, million tonnes

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From the IPCC 4th Assessment Report, adapted by the Climate Council in Australia for its report: The Angry Summer (funding crowd sourced)

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Copenhagen Climate Congress, March 2009 (five years ago): Summary Message #1

• Recent observations confirm that, given high rates of observed emissions, the worst-case IPCC scenario trajectories (or even worse) are being realised.

• For many key parameters, the climate system is already moving beyond the patterns of natural variability within which our society and economy have developed and thrived.

• There is a significant risk that many of the trends will accelerate, leading to an increasing risk of abrupt or irreversible climatic shifts.

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The Lancet Commission on Managing the Effects of Climate Change ‘Climate change is the biggest global health threat of the 21st century’, May 2009

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Why we should attend to mental health

‘Social & emotional wellbeing’ Caring for (ancestral) land

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“We live in a society, not an economy”

Favourite quotes (i): Eva Cox Professorial Fellow Jumbunna University of Technology Sydney

The 1995 Boyer Lectures A TRULY CIVIL SOCIETY

By Eva Cox Lecture 1: BROADENING THE VIEWS

(Broadcast: Tuesday, 7th November 1995, 8.30am on Radio National.)

Why should we care about MH? …

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Mental health problems The focus of most MH research

By far the leading cause of disease burden (1-in-5+) Profoundly disabling, extreme suffering Affects self, others, every realm of life and society Exceptionally expensive Stigmatised, not ‘real’, malingering, exclusion Cinderella issue -- under-funded, under-researched Hard to understand, address: End of long, complex

causal chains Very sensitive: cause, outcome, indicator

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Good mental health ‘Social and emotional wellbeing’

By far the best investment for global disease burden Profoundly enabling, empoweing, transformative Self, communities, every realm of life and society

Exceptionally good value for money Very important for effective inclusion Cinderella – wins the prince End of long, complex causal chains (levers in system) Very sensitive: cause, outcome, indicator Know soon if you’re doing well

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A working definition of mental health ‘Social and emotional wellbeing’

World Health Organization definition of MH: … a state of well-being in which the individual

realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community.

(Helen Herrman and WHO, 2001; 2005)

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Some key implications of this definition:

Mental health is a process Ongoing through time (lifelong, intergenerational) Applies across context (work, community) About skills, competence (coping) About the everyday (with normal stresses of life) Rights and responsibilities , not ‘all about me’ (contributing)

This is resilience in dynamic social & physical place A radically changing world means a new normal – We need a new (level of?) resilience

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“Most mental health problems are socially caused and must be

socially solved”

Favourite quotes (ii): David Fryer Psychologist

B.A. Hons., M.A., Ph.D., C.Psychol. F.B.Ps.S., F.S.C.R.A.

Professor Extraordinarius, University of South Africa Institute for Social and Health Sciences

and Medical Research Council-University of South Africa Safety and Peace Promotion

Research Unit | University of Queensland | Honorary Senior Research Fellow, University of

Stirling, Scotland …

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Mental health as societal –

The pivotal role of communities

1. Natural meeting place of social and physical space (workplaces, homes, suburbs; incl. online, psychological)

2. Intuitively coherent: meaningful, comprehensible, manageable

3. Not too big, not too small

4. Amenable to intervention

5. Researchable – natural living labs

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Pivotal (mediating) role of communities (messy) Example: Climate change & health in Australia

Community structure, assets, function

Regional drying, warming

Child (nutritional) health/development

Lower family incomes

Extreme bushfires …and heat extremes

Adult health

Property damage

Impaired food and nutritionsecurity

Reduced food availability, quality

Smoke exposure …and heat

Drought amplification

More extremeweather events

Mental health problems

Physical health problems (resp/CVD)

Injury, death

Climate change

Bereavement; Post-traumatic Stress Disorder

Health Impacts

Coping capacity -- social capital

Mediators of health risks

Reduced farm yields(food; + fibre, forests)

a

b

c

Community structure, assets, function

Regional drying, warming

Child (nutritional) health/development

Lower family incomes

Extreme bushfires …and heat extremes

Adult health

Property damage

Impaired food and nutritionsecurity

Reduced food availability, quality

Smoke exposure …and heat

Drought amplification

More extremeweather events

Mental health problems

Physical health problems (resp/CVD)

Injury, death

Climate change

Bereavement; Post-traumatic Stress Disorder

Health Impacts

Coping capacity -- social capital

Mediators of health risks

Reduced farm yields(food; + fibre, forests)

a

b

c

NHMRC 2009, McMichael, Berry, et al.

Meeting of psychological and physical place

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Social capital: A useful general model of community functioning

1. Captures key components essential to mental health

Relevant through time & across context; competence; everyday life; about ‘us’ as much as ‘me’; dynamic

2. Applicable to different kinds of communities, incl. virtual

3. Intuitive, acceptable (research, policy)

4. Existing evidence base (strong-weak)

5. Theoretical capability (explain, predict)

6. Methodological innovation possible

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Wonderful example: Cantus a capella choir

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A simple epidemiological definition of Social Capital Community functioning, underlying processes Sociological, psychological, economic interpretations

Community Participation

Social Cohesion

Health

Social Capital

Baum et al., 2000 Berry & Welsh, 2010

Berry & Shipley, 2009

(behaviours) (thoughts & feelings)

Investment

Return on investment

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‘People and Place’ research program Trying to help address some macro challenges for MH

World Health Organization definition of health: … A state of complete physical, mental and social wellbeing

People and Place Program: … Investigate how to promote everyone’s wellbeing, no matter

who you are or where you live

Two key questions: 1. What makes a great life? 2. How can we promote great lives in cities and in rural

and remote areas?

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One research approach:

Longitudinal, panel and case studies of social capital and mental health

Findings replicate cross-sectional findings

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Dynamics of participation and mental health over time

Longitudinal analysis, HILDA waves 2005-07

Panel analysis, waves 2005-07 and 2009-11 (same results)

Controlling for age, sex, employment, financial situation, hardship, relationship status, household composition, education, SEIFA, ARIA etc

1. Informal social connectedness

2. Civic engagement 3. Political

participation

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MH predicts participation Participation predicts MH (a little – but it matters!)

Potential for small scale / individual interventions

Potential for large-scale interventions. Systemic: builds cohesion, with multiple desirable outcomes, not just MH

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Cohesion: Trust and Mental wellbeing Similar study architecture as for participation (Zhang et al., in prep.)

Current mental wellbeing

0.003** 0.191*

0.100***

Prior mental wellbeing

Generalised Trust

Mental wellbeing

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Social Capital & MH – evidence to date Cross-sectional associations – strong, many Longitudinal & causal associations – few, but consistent with theory and cross-sectional findings

Community Participation

Social Cohesion

Mental health

Social Capital Next analysis

(Ding, Berry, O’Brien, under rev.) (Zhang, Ding, Berry, in prep.)

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Built form in an urban world

Longitudinal, panel and case studies of social capital and mental health

‘The Crace Study’

(O’Brien & Berry)

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• Crace joint venture – CIC Pty. Ltd. (Development company, project manager) – Land Development Agency (local government) – Defence Housing Australia – CHC Affordable Housing

• Crace design – Designed as a ‘mini-city’: high-density urban precinct around a

shopping centre surrounded by suburban areas. – ‘Walkable’ grid design with 25% of total land for common use,

including walking / bike paths, houses in walking distance of parks, shops and amenities.

Crace: A new suburb in Canberra, Australia

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Crace master plan

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Timing • Annual survey

spring each year – Same season,

‘neutral’ season

‘The Crace Study’ study architecture (i) Timing and phasing

Phasing • Everyone gets a ‘dose’

of ‘sustainability’ • Graduated/single dose

– ‘first fleeters’ (slow drip) vs others

Progressive addition of amenities

Single dose

Multiple annual cross-sections (monitor & compare trends) with embedded cohort design

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• To buy in Crace – register with CIC, agree to contact – Access to CIC’s register

• Three comparison groups i. Buyers (& renters) who have moved in ii. Buyers not moved in iii. Did not buy

• Two more comparison groups iv. Living in ‘feeder’ region v. Living in other regions of Canberra

‘The Crace Study’ study architecture (ii) Control groups structure – 5 comparison groups

• Only (i) can be ‘first fleeters’

• All can eventually be new entrants

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Progress • Residences: 550 homes,

approx. (projected total 1,500 and 4,000 people)

• Roads, minor parks built

Participants • 277 people completed all

health measures • 180 Crace residents, 97

residents in other suburbs

Wave 1: Crace in spring 2012

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Wave 2: Crace in spring 2013

Progress • Residences: 950 homes approx. • All parks open, including new

Recreation Park, Hilltops Reserve and community garden

Participants • 516 people participated • 375 Crace residents, 141

residents in other suburbs • 86 people who did the survey in

2012 returned

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Who did the survey? Measure Category

Crace 2012

Crace 2013

Canberra census data

Sample characteristics

Male 43.3% 49.2%

Female 56.7% 50.8%

0 – 17 — — 23.0%

18 – 29 27.2% 24.7% 16.7%

30 – 39 45.6% 44.9% 13.6%

40 – 49 15.0% 16.9% 15.1%

50 – 64 12.2% 10.1% 19.6%

65+ — 3.4% 12.1%

Singles 16.7% 6.0%

Couples 36.7% 42.8%

Couples with kids 37.2% 42.9%

Single parents 8.3% 7.3%

Other 1.1% 1.0%

Full-time 73.9% 65.2%

Part-time 11.7% 25.2%

Other 14.4% 9.5%

0 – 77,999 17.2% 34.5%

78,000 – 129,999 32.2% 21.9%

130,000 – 179,999 28.3% 20.6%

180,000 or more 22.2% 13.8%

GenderMore women in our

sample

Age

Most of our sample are young adults

(Note: Only adults over 18 were

surveyed)

Household structure

More singles in our sample

Work statusMost of our sample in

full-time work

Total household income ($)

Higher income households more

prevalent in our sample

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I am glad I live here in CraceAgree--Strongly agree 76.7 88.1Slightly agree--Strongly Disagree 23.3 11.9

I chat with my neighbour(s) when I bump into them

Yes 78.9 76.1No 21.1 23.9

There are many places to go within walking distance from my home

Agree 48.9 65.3Disagree 51.1 34.7

There are many interesting things to look at while walking

Agree 77.7 85.8Disagree 22.3 14.2

Crace residents in 2012 vs. 2013

2012 2013

Rate of change, n=67

Increase with new parks

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2012 2013How often do you do active stuff (like walking, running and/or lifting) that would add up to at least 30mins total exercise that day?

Everyday 40.0 203 or more times a week 28.3 461 to 2 times a week 20.0 21.2None/less than once a week 11.6 12.8

In general, would you say your health is…

Excellent-Very good 60.5 51.2Good-Fair 39.5 48.8

Crace residents in 2012 vs. 2013

Decrease with arrival of older people

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2012 2013How much of the time have you accomplished less than you would like ... as a result of your physical health?

None of the time-Little of the time 76.7 81.7Some of the time-All of the time 23.3 18.3

How much of the time during the past 4 weeks have you felt calm and peaceful?

Some of the time-All of the time 88.8 95.2None of the time-Little of the time 11.2 4.8

In the last four weeks, about how often did you feel...-...depressed?

None of the time-Little of the time 85 89.9Some of the time-All of the time 15 10.1

Crace residents in 2012 vs. 2013

Happier than a year ago

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Use of parks: Out and about more than a year ago

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Use of parks: increased use

Major recreation parks (newly opened in 2013): Very high % of residents use these parks

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Using mapping to find hotspots and strongspots (in Crace)

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Designing research for healthy and sustainable communities

-- incorporating grand challenges

An example of one approach we are taking

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The ‘People and Place’ research program’s

National Urban Wellbeing

Survey

University of Canberra Program Director: Prof Helen Berry

Project leader: Dr Léan OBrien

People and Place Program

… Investigate how to promote everyone’s wellbeing,

no matter who you are or where you live.

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Wellbeing in Australia’s 100,000+ cities

National Urban Wellbeing Survey

Cities with 100,000 people or more: Sydney, Melbourne, Brisbane, Perth, Adelaide, Hobart, Canberra–Queanbeyan, Albury-Wodonga, Wollongong, Newcastle–Maitland, Geelong, Toowoomba, Gold Coast–Tweed Heads, Sunshine Coast, Townsville, Cairns, Darwin, Launceston

How can we promote great lives in our cities? • Build great places to live (houses, work spaces,

parks, meeting halls etc.) • Make it easy to move across different spheres of

life (good public transport systems) • Have high quality services and governance

processes

What makes a great life? • Being connected and effective, across family,

community and work. • Being physically active and eating good food • Having the resources for this way of living

(human, social, financial, institutional, environmental).

Can all become part of a virtuous cycle (but also potentially a downward spiral).

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National Urban Wellbeing Survey Find ‘hotspots’ and ‘strongspots’

PLACE • Use location and mapping to assess and compare

different suburbs, regions and cities. • Identify where people have…

– great spaces to live, work, and come together as a community,

– good public transport systems, and – high quality services and governance processes.

PEOPLE • Simultaneously identify different sorts of people living

different sorts of lives. • Measure social and physical drivers of health…

– social participation and connectedness in household, work and community contexts, and

– physical activity, including active travel. • Measure mental and physical health

Survey goals 1. We will examine when and how good places support people to live better lives (including for different populations like the elderly and people with complex disadvantage).

2. We can then feed this information back to government and industry to inform best practice in urban design and service delivery.

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Marketing to potential external partners: What is different about this survey?

Unmet data needs “I need to understand the multiple factors affecting life in my city – and where my development sits within that”

“I need to be able to track change over time”

“I need to know what things are driving people’s actions and perceptions about housing/ travel/ sustainability”

Existing social data 1. Surveys • Data typically collected at single

point in time, for single region, looking at single issue

• Not able to compare regions, or report at different scales

2. Census data • Comprehensive description of

social characteristics • Doesn’t explain behaviour,

actions, perceptions, comfortable spaces

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What is different about this survey?

The Urban Wellbeing Survey provides data not available elsewhere, through:

• Large sample, many topics • Tracking change over time (trends, cohort) • Local to national (international) scalability

• Focus on urban ways of living

• Built-in links to existing data, geocoding • Understanding what people are doing,

perceiving and enjoying

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• Online survey, 20-30 minutes

• Flyers, prize draw, social media, email forwards: encourage participation

• Top-line results available publically, online; tailored reports for a fee

• Builds on, links with multiple pilot studies; also with Regional Wellbeing Survey (launched 2013)

• (Mostly) online -- tailored modules can be targeted for different kinds of participants – e.g., older Australians, people living in outer suburbs, working in particular

industries (including developers)

How does it work?

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The place I live meets my needs

I attend community events

National Urban Wellbeing Survey ─ What can it tell us? Profiling an Australian city: Illustrative data only

A B C D

A B C D

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I felt calm and peaceful

Active for 30 minutes or more

A B C D

A B C D

National Urban Wellbeing Survey ─ What can it tell us? Profiling an Australian city: Illustrative data only, sample size insufficient

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I felt calm and

peaceful

Active for 30 minutes or more

The place I live meets my

needs

I attend community

events

A: Positive about built environment, socially and physically active, BUT a little bit stressed B: Positive about built environment, calm and peaceful, BUT a bit low on social and physical activity C: Generally low – AT RISK for poor wellbeing D: Socially active, calm and peaceful, BUT not happy with built environment and low physical activity

A B C D

A B C D

Analyses like these can be conducted at the suburb, district and city level for the 18 cities in Australia with a population of 100,000+

National Urban Wellbeing Survey ─ What can it tell us? Profiling an Australian city (how do multiple factors add up?): Illustrative data only

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National Urban Wellbeing Survey Topics – build in ‘healthy & sustainable’

Survey goals 1. We will examine when and how good places support people to live better lives (including for different populations like the elderly and people with complex disadvantage).

2. We can then feed this information back to government and industry to inform best practice in urban design and service delivery.

Building comfort in work and home

Travel & public transport

Subpopulations Socio-demographics

Complex disadvantage

Services access & quality

Walkable urban design

Public space quality & access

Who people are…

Where they go…

How they get there…

Connectedness & efficacy Satisfaction

Physical activity Neighbourhood

governance & cohesion

Sustainable behaviours

Social behaviour Do good?

Feel good?

Physical health Mental health Be healthy Carbon footprint

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FUNDING …. Partner with the National Urban Wellbeing Survey

NB. Survey partners can also commission customised analyses to answer specific questions (depending on level of partner support, commissioned analyses may attract a discount and/or be included in the partner agreement ).

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Some concluding thoughts ‘tout acte est politique’

1. Health promotion complex & dynamic, esp. mental health needs systemic, long-term, pragmatic ‘real world’ approach types of people, types of places (concrete & virtual settings) blend individual and (mainly) collective approach

2. Vulnerabilities & risks AND strengths & opportunities ‘hotspots’ AND ‘strongspots’, use mapping to find them urban focus but remember rural & remote

3. International responsibility, especially the developing world

4. Shape research to meet grand challenges (e.g., CC) new approaches, new theories, new methods, new lines collaboration – disciplines, sectors & organisations, places advocacy difficult but essential (science communication, media)

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1. First papers from Australia-Norway comparison of sustainable urban form and mental health (one next week!)

2. Collaboration – Govt Shanghai: promoting healthy and sustainable behaviours in the face of grand challenges

3. Oxford, RCPsych Sustainability Summit: Environment, Society and Psychiatry London 1 October (https://www.eventbrite.co.uk/e/rcpsych-sustainability-summit-environment-society-and-psychiatry-tickets-11645505019?aff=es2&rank=2)

4. RCPsych conference Birmingham July 2015 – sustainability (http://www.rcpsych.ac.uk/traininpsychiatry/eventsandcourses/internationalcongress2013.aspx)

5. Australian Academy of Science Think Tank 2014 Brisbane: CC challenges to health; report Dec 2014 (http://www.science.org.au/events/2014-theo-murphy-high-flyers-think-tank-climate-change-challenges-health)

6. Wellcome Trust, new funding stream: sustaining health (http://www.wellcome.ac.uk/funding/Innovations/awards/sustaining-health/)

On the horizon ….

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Is it possible to define quantitatively who gets isolated on the margins of society, and to

describe what happens to them?

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Defining types and sub-types of Australians Funding: FaHCSIA Social Policy Research Program

1. Identify major categories of Australians – For policy purposes for FaHCSIA: ‘clients’ – Family structure, relationship roles, belonging – Mental & physical health – Psychosocial & socio-economic factors

2. Key characteristics of categories – Distinctive strengths & vulnerabilities

Berry, 2008a, b, c

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Defining ‘like types’ using cluster analysis Range of factors included in the analysis

Primary (define & describe) • Sex • Age group • Relationship status • Family type • No. children under 15 • Non-resident children • Employment • Equivalised disposable income • Income support • Education • Physical functioning • Mental health

Secondary (describe) • Age • Financial hardship (incl c/card) • Financial satisfaction • Housing tenure • Marriage / defacto • Life, partner satisfaction • Social support • Parents separated / divorced • Age left home & school • Time pressure / spare time • Substance use (tobacco, alcohol) • General health

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Five Australian Archetypes (slides courtesy of Tegan Cruwys, 2012)

1. Well-connected Retirees

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2. Time-Pressured Couples with Kids

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3. Financially Secure Couples

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4. Dissatisfied Working Age Singles

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5. Marginalised Australians

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Five Archetypes, Twelve types of Australians (We’re interested in all of them)

CONTEMPORARY AUSTRALIAN ARCHETYPES

Connected Retirees

Single Elders

Retired Couples

Financially Secure Working Age

Couples

Baby Boomer Couples

GenXY Couples

Time-Pressured Couples with

Children

Partnered Dads

Partnered Mums

Dissatisfied Working Age

Singles

Separated Mid-Age Singles

Highly Educated Working Singles

Very Young, Still at Homes

Marginalised Australians

Disadvantaged Mature Age

Singles

Disadvantaged Couples with

Kids

Disadvantaged Single Parents

Berry, 2008

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Early life and intergenerational disadvantage: Left home U18, school U16

5

15

25

35

45

55

65

75

ConnectedRetirees

Fin securecouples

Couples w ithKids

Dissatisf iedsingles

DisadvMatureSingles

DisadvCouples &

Kids

Disadv SingleParents

Prop

ortio

n (%

)

Left home U18: solid Left school U16: checked

Marginalised Australians

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Physical & mental health (SF-36)

50

60

70

80

90

100

Still at

Hom

es

GenXY C

ouples

High Ed W

ork Sing

les

Partne

red D

ads

Partne

red M

ums

Sep M

id Age

Singles

Baby B

Coup

les

Disadv

Single P

arents

Disadv

Cou

ples &

Kids

Disadv

Matu

re Sing

les

Retired

Cou

ples

Single Elders

Phys

ical fu

nctio

ning

50

60

70

80

90

100

Men

tal h

ealth

Marginalised Physical health

Mental health

Retirees

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(Lack of) participation & support

25

30

35

40

45

50

GenXY C

ouples

Baby B

Coup

les

Partne

red M

ums

Still at

Hom

es

Retired

Cou

ples

High Ed W

ork Sing

les

Partne

red D

ads

Single Elders

Sep M

id Age

Singles

Disadv

Cou

ples &

Kids

Disadv

Single P

arents

Disadv

Matu

re Sing

les

Com

mun

ity g

roup

s (%

yes

)

4.4

4.6

4.8

5

5.2

5.4

5.6

5.8

Mea

n so

cial

sup

port

Community participation bars; social support line

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Where are they now? Marginalised Australians a decade later

1. Tracking Wave 1 HILDA Survey marginalised to Wave 10 2. Binary logistic regression equation probablistic model of

being marginalised (yes/no) at Waves 1 and 10 Identify marginalised people with 99% accuracy

3. Identify who exited, persisted 4. Predictors of exit In 5 domains (financial, health, social, stigma, early life) Controlling for degree of marginalisation at Wave 1

Funding: ACT Government Community Development Grants Program

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Who Exits Marginalisation?

To start out with, they were:

• Less marginalised • Older • Male • Receiving income support

Then they ….

• Got an education • Got a job • Got a relationship • Didn’t get pregnant (again)

~ 60% exited marginalisation

Not modifiable Modifiable

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0

10

20

30

40

50

60

70

Persistentlymarginalised

Exitsmarginalisation

Nevermarginalised

%

Not modifiable: More disadvantaged initially (e.g., left home under 18)

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Modifiable (1): Obtained full-time employment

2001 2001

2001

2010

2010

2010

0

10

20

30

40

50

60

Persistentlymarginalised

Exitsmarginalisation

Never marginalised

Per

cent

age

Full-

time

Em

ploy

ed

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2001

2001

2001

2010

2010

2010

0

5

10

15

20

25

30

Persistentlymarginalised

Exitsmarginalisation

Never marginalised

Modifiable (3): Tertiary degree

%

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0

10

20

30

40

50

60

70

Significantdecline

No change Significantrecovery

Per

cent

age

chan

ce o

f re

mai

ning

mar

gina

lised

Modifiable (2): Better mental health

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Some concluding thoughts

‘Marginalisation’: entrenched, complex disadvantage Not just about money; stigma, exclusion, little chance in life Affects every part of life Background vulnerability when disaster strikes

Hard to get out, but possible Isolation, mental illness: pernicious centrepiece

Intervene: isolation (participation); tho’ need MH services Address isolation: possible; systemic, multiple benefits Complex, long-term, tailored intervention

ACT ‘ThinkPlace’: http://thinkplace.com.au/

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LINKS BETWEEN CC, SOCIAL CAPITAL AND MENTAL HEALTH:

CC AS A MULTIPLIER OF RISK AND DISADVANTAGE

CLIMATE CHANGE

PHYSICAL ENVIRONMENT

(NATURAL, BUILT)

SOCIAL ENVIRONMENT

(SOCIAL CAPITAL)

HEALTH

BEHAVIOURS

MENTAL HEALTH

INTERACTING DISADVANTAGES

CC RISK CYCLE

e.g. loss of

income

e.g. less social support

e.g. more substance

use

POORER COPING

e.g. more droughts

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LINKS BETWEEN CC, SOCIAL CAPITAL AND MENTAL HEALTH:

CC AS A MULTIPLIER OF RISK AND DISADVANTAGE

CLIMATE CHANGE

PHYSICAL ENVIRONMENT

(NATURAL, BUILT)

SOCIAL ENVIRONMENT

(SOCIAL CAPITAL)

HEALTH

BEHAVIOURS

MENTAL HEALTH

INTERACTING DISADVANTAGES

CC RISK CYCLE

e.g. loss of

income

e.g. less social support

e.g. more substance

use

POORER COPING

e.g. more droughts

Berry, 2011

Can we quantify and project effects of some of these?

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IPCC5 WGII report (Impacts, Adaptation and Vulnerability):

Chapter: health impacts (includes a very brief section on mental health

impacts of CC)

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CLIMATE CHANGE 2014: IMPACTS, ADAPTATION, AND VULNERABILITY

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SOCIOECONOMIC PROCESSES

Socioeconomic Pathways

Adaptation and Mitigation Actions

Governance

CLIMATE

Natural Variability

Anthropogenic Climate Change

RISK Hazards

Exposure

Vulnerability

IMPACTS

EMISSIONS and Land-use Change

Climate change: general pathways of impact

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Social participation in Australia

85

Data • Household, Income and Labour Dynamics in Australia Survey (HILDA) • Large, national survey, representative of Australian population • Wave 6, 2006, N = 11,709

Cluster analysis (two-step) & logistic regression • Identify people’s shared characteristics, then classify people into groups based on

multiple shared characteristics, eg: age, sex, education, early adversity, marital status, ever divorced/separated, work status, household structure, household net worth, financial hardship, etc.

• Cluster analysed multiple times to identify nine meaningful subpopulations sub-groups in Australia.

• The most important distinguishing variables were: household structure, age, marital status, ever divorced/separated, the ability to raise $2000 in an emergency.

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Social participation in Australia

86

• Five populations: (Looking at working adults in these populations) 1. Singles 2. Couples 3. Single parents 4. Nuclear family parents; 5. Blended family parents

• In each population, test whether the influence of ISC on mental

health (SF-36 subscale, 0-100) depends on: – Age (and sex) – Ability to raise $2,000 in an emergency – *Job satisfaction (6-item scale) – Divorced/separated status (if single) – *Relationship stress (if co-habitating; 6 item scale) – *Parenting stress (if resident child under 18 years; 4 item scale)

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Social participation in Australia

87

• ISC was almost always important, but its protective properties had some limits…

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Singles with below average job satisfaction

50

55

60

65

70

75

80

85

Lifelong Divorced

Lo ISC Hi ISC

SF-

36 M

H

88

Singles w. job satisfaction

Demographics. n=1,027; Age: M= 36.72, SE=.41; Female: 37.52%; Divorced: 26.76%; Wrk hrs: M=40.12, SE=.45, Permanent contract: 60.65%.

Singles who had below average job satisfaction also had worse wellbeing. This was only buffered by ISC for divorced/separated people.

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Nuclear parents’ ISC and job satisfaction

Nuclear parents with high ISC or high job satisfaction do well. They do even better if they have both, and rather worse if they have neither.

89

Demographics. n=2,253; Age: M=40.41, SE=.42; Female: 43.18%; Work hours: M=38.57, SE=.30, Perm. contract: 58.81% Yngst child 0-4: 39.24%; No children: M=2.06, SE=.03.

50

55

60

65

70

75

80

85

LowerJob sat

HigherJob sat

Lo ISC Hi ISC

SF-

36 M

H

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Blended family parents who can EASILY raise $2000 in an emergency

50

55

60

65

70

75

80

85

LowerPt stress

HigherPt stress

Lo ISC Hi ISC Parents in blended families who have with easy access to $$ need either high ISC or low parenting stress to maintain wellbeing. This kind of buffering effect does not occur for blended parents who cannot easily raise $2,000, although there are main effects for higher ISC and low parenting stress.

Cannot easily raise $2000

SF-

36 M

H

90

Demographics. n=224; Age: M=39.87, SE=.74.; Female: 39.06%; Wrk hrs: M=40.90, SE=, Perm. contract: 64.38% Yngst child 5-9: 32.24%; No children: M=1.62, SE=.09.

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Single parents who can EASILY raise $2000 in an emergency

50

55

60

65

70

75

80

85

LowerPt stress

HigherPt stress

Lo ISC Hi ISC

SF-

36 M

H

91

Demographics. n=277; Age: M=40.45, SE=.56; Female: 87.92%; Wrk hrs: M=32.00, SE=.95, Permanent contract: 63.98%; Youngest child 10-14: 32.24%; No children: M=1.74, SE=.06.

Single parents with easy access to $$ need either high ISC or low parenting stress to maintain wellbeing. This kind of buffering effect does not occur for single parents who cannot easily raise $2,000.

Cannot easily raise $2000

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Science communication: study participants

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Some key implications of this definition:

Mental health is a process Ongoing through time (thus lifelong and intergenerational) Applies across context (work, community) About adult competence (coping) About the everyday (with normal stresses of life) Rights and responsibilities (self-realisation, contributing, not ‘all

about me’)

This is resilience in social & physical place Climate change means a new normal

WE NEED A NEW RESILIENCE, PERHAPS A NEW SOCIETY

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Complext pathways of impact of CC on MH

CC is a multiplier of risk and disadvantage – and an opportunity

Climate change-related disaster (Specific acute, sub-acute and chronic events)

Community Economic &

social impacts

Mental Health

Physical Health

Damage to landscape & agriculture

Disease risks Altered food/water supply

Injury (smoke, burns)

Loss of livelihoods, out- migration, separation of families, poverty, isolation,

grief & bereavement

Stress, trauma,

solastalgia

Local cultural, economic, social, developmental and environmental context

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10

11

12

13

14

15

16

17

18

19

20

Urban

Z-Mod

Dry

Long

Constant

Constant& Long

Drought impact in urban vs rural/remote Australia (The ‘Big Dry’: HILDA Survey Waves 1-7)

10

11

12

13

14

15

16

17

18

19

20

Rural

Mean K10 scores (moderate distress)

O’Brien, Berry et al. (2014). Funding: NHMRC

K10

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10

11

12

13

14

15

16

17

18

19

20

Urban

Z-Mod

Dry

Long

Constant

Constant& Long

Mean K10 scores (moderate distress)

10

11

12

13

14

15

16

17

18

19

20

Rural

Drought and distress (Kessler 10) (HILDA Survey Waves 1-7)

O’Brien, Berry et al. (2014)

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Competent, confident, connected and calm

Embedded in time and place Lifelong development, cohort effects

Everyday places we live and spend time

Connection to place (and migration)

Aboriginal Australians: ‘Social and emotional wellbeing’

Connectedness to land core component

Defining mental health: where to?

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Happiness Distress

-.167** .200**

.039 .087-.003 .035-.062 .006-.033 .121*

-.068 .069-.165** .137*

.006 .106-.062 .029

Outside of my suburbAnywhere

I do things with my friend(s) who don’t live with me

I socialise with workmate(s) outside work

I do things with family member(s) who don’t live

with me

Outside of my suburbAnywhereInside my suburbOutside of my suburbAnywhereInside my suburb

Inside my suburb

Location- free Happiness DistressI keep in contact with my friend(s) when Iʼm not with them (e.g., -.163** .245**

I keep in contact with family who donʼt live with me (e.g., chatting -.073 .152*

I use social media to keep in touch with people (e.g., facebook & twitter) -.196** .036

Social participation and place

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Droughts

Floods and cyclones Extreme heat

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Drought The ‘Millenium Drought’ or the ‘Big Dry’

2001-08 (main years)

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1. How do you conceptualise and measure drought for epidemiological studies?

2. How do you measure human exposure to drought? 3. Is there a direct relationship between exposure to

drought and mental health?

Using HILDA Survey, Waves 1-7 (2001-07) Millennium drought everywhere Wave 7 had K10 and SF-36 Those who did not move, N~6,500

The ‘Big Dry’ 2001-08 Berry et al.

Funding: National Health and Medical Research Council

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• Exposure variables calculated for our study regions by CCD using a PostgreSQL database [http://www.postgresql.org] with the PostGIS spatial extension [http://postgis.refractions.net] managed by NCEPH, ANU

• Bureau of Meteorology’s gridded monthly climate data, resolution 0.25 degree of latitude-longitude, to calculate drought index based on 6-monthly percentiles for each location’s rainfall record 1890-2008

• Created two indices of dryness (a NSW data-based measure and a Victoria data-based measure) using Smith, Hutchinson & McArthur (1992) method (similar to but advance on Palmer)

• Aligned acceptably with these states’ drought declarations

Measuring drought Hanigan et al., PNAS, 2013; O’Brien, Berry et al. under review

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How to conceptualise and measure drought?

People & places adapt: A relative concept?

-45

-40

-35

-30

-25

-20

-15

-10

-5

0year 2000 2001 2002 2003 2004 2005 2006

-17.5

Drought

occurs when threshold of

Smith, D., Hutchinson, M., & McArthur, R. (1992). Climatic and agricultural drought: Payments and policy. Canberra, ACT: Centre for Resource and Environmental Studies, ANU.

Method 2: count # months >5 ….

…. we combined the two

Some but not absolute correspondence between the two approaches

Method 1

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Calculate indices of dryness, patterns of exposure

19 secondary indices, ways of summing, categorising

For example:

Total months in drought, how often in and out, mean extent of dryness, how long was longest period, last month experienced, quintiles / deciles of length/depth

Use indices in two-step cluster analysis by CCD

Categorise patterns of exposure over all years

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Whether or not dryness has a negative impact on mental health depends on:

• Pattern of dryness over time

• Social context of a person’s community

Drought impact in urban vs rural/remote Australia O’Brien, Berry, Coleman & Hanigan (2014)

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Science communication: Policy debate

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5 Dryness Categories

59.49% Zero-to-Moderate: Most people have experienced some relative dryness but between 2001-2007 has not been extreme

11.44% Very Dry: During dry periods, relative dryness is in the top 15% for the population

17.79% Recent Long period: 11-16 months in unbroken drought between 2005-2007 (M=12.38)

5.37% Constant: 20-32 months in drought between 2001-2007 (M=21.93).

5.90% Constant + Recent Long period: Experienced both of these types of extreme relative dryness

(O’Brien, Berry, Coleman and Hanigan, 2014)

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Rural vs urban drought & mental health (K10) What we expected, with a surprise

Impact of some types of (very bad relative) drought in rural areas What is this?

K10

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Floods and cyclones Queensland’s ‘Summer of Sorrow’

2010-11

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Queensland: Proportion of State affected (Queensland is 13x size of England)

No NDRRA assistance

Category A

Category A & B

Category A, B & C

Category A, B, C & D

Source: Operation Queenslander: The State, community, economic and environmental recovery and reconstruction plan 2011-2013. Queensland Reconstruction Authority 2011

72 of 73 Local Governments Area in QLD received Natural Disaster Relief and Recovery Arrangments 78% Qld ‘disaster

zone’, $7b for infrastructure alone

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Flood damage

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The ‘Mud Army’ (40% participated; injuries 5.6%)

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Queensland’s ‘Summer of Sorrow’ (Berry, McDermott, QHealth, et al.)

Contacted by QHealth early 2011

2011 joint science-policy grant to investigate impact of ‘Summer of Sorrow’ using new ‘brief trauma exposure & impact screen’ (Berry et al.)

Adapted screen for these disasters

Context: Trauma is quite common in Australia • Lifetime prevalence PTSD ~1-8% (Ursano et al. 2004)

• NSMHWB: 12-month PTSD prevalence approx doubled 1997-2007 (3.3% – 6.4%)

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Study design

QHealth annual Self-Reported Health Status survey

• 11 March to 6 June 2011, CATI, random-digit dialling • 2-stage sampling design (region, households) • Sample: N=12,564 adults, R/R 44%, ~no missing • Split-survey, random allocation; Trauma N~6,100 • Weighted (age, sex, Health Service District, selection prob)

1,693,033 adults ’personally affected’ (63%) 236,468 adults ‘still currently distressed’ (7%)

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Trauma exposure & impact (Berry et al., 2010)

What was damaged?

1. Suburb 2. Family, friend or

carer’s home 3. Business 4. Own home

Index (range 0-4): • None • One • Any 2, 3 or 4

How did you feel? (K10; & adapted screen)

1. You thought you might be badly injured or even die (3.9%)

2. You felt terrified, helpless or hopeless (14.3%)

3. You are still currently distressed (7.1%) 4. You are worried about how you will

manage (8.6%)

1=yes, 0=no Index (range 0-4)

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General psychological distress (K10) for cumulative exposure index (Willson et al., in prep.)

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Cumulative exposure index by trauma index (Willson et al., in prep.)

***

***

***

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What about vulnerable groups?

• People living in disadvantaged areas

• People living in rural and remote areas

• Diferent age groups, young people

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Impact of cumulative exposure (trauma) by damage by area disadvantage (SEIFA) (Willson et al. in prep.)

As expected, exposure more traumatic in disadvantaged areas (blue bars)

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Impact of cumulative exposure (trauma) by remoteness (ARIA) by damage (Willson et al. in prep.)

And in rural and remote areas (blue bars)

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Post-disaster trauma by age

25+

18-24

25+

Young people don’t seem more traumatised than older adults

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Impact of cumulative exposure by age by damage (trauma) (Willson et al. in prep.)

Exposure more traumatic to older age groups (green bars)?

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Extreme heat Australia 2009-10

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Causal effect of extreme heat on MH in Australia 2009-10

• Quantify causal effects of extreme heat on individual MH • Wave 9 and 10 of the Household, Income and Labour Dynamics in

Australia (HILDA) Survey – Annual panel N~13,000, social, economic, demographic, health, other

– Interviewed in place (climate zone varies), time of year varies

• Gridded Daily Temperature Data, merged by CCD – Australian Government Bureau of Meteorology

• Fixed effects models: correct for potential individual-level bias in unobserved ability to cope with heat stress – Wide array of statistical controls; in standard deviations, normalised scores

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Data sources

Human health data • Household, Income and Labour Dynamics in Australia (HILDA)

Survey, Waves 9 and 10 (2009, 2010) (good website) – Household-based cohort study – SF-36: Mental health, Vitality, Social functioning, Role-emotional, Overall – Diversity in the month of the year when measuring mental health

• From 2009, date mental health recorded • >10% participants MH measured in warm months • Diverse geographic distribution of participants, detailed geo info (CCD)

– 9,460 individuals in 2-wave balanced panel data • Weather data

– Gridded daily max temperature (Bureau of Meteorology) – 0.05×0.05°(5km×5km) – 5,223,425 CCD-day observations (no missing data)

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An Illustration of Matching

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Day & month heat effects on vitality and role emotional by sex

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Effect of Heat on MH in Australia: # days ≥30ºC 2009 and 2010, FE, Men (N=6,060)

Role emotional

Mental health

Vitality Social functioning

Same day -0.030 -0.082** -0.115*** -0.048

7-day 0.004 -0.003 -0.016* -0.010

30-day 0.001 -0.005 -0.007** -0.007*

90-day 0.000 -0.002 -0.004** -0.004*

365-day -0.001 0.000 -0.002** 0.000

Controlling for: age, sex, aboriginality, immigration, education, relationship, income, income2, employment, physical functioning, role-physical, month of the year, state, section of state,

interaction state x section of state

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Effect of Heat on MH in Australia: # days ≥30ºC 2009 and 2010, FE, Women (N=6,831)

Role emotional

Mental health

Vitality Social functioning

Same day -0.108** -0.065 -0.057 -0.082*

7-day -0.029** -0.008 -0.004 -0.015

30-day -0.016*** -0.009** -0.006 -0.006

90-day -0.009*** -0.005** -0.002 -0.005**

365-day -0.001 0.001 0.000 0.000

Controlling for: age, sex, aboriginality, immigration, education, relationship, income, income2, employment, physical functioning, role-physical, month of the year, state, section of state,

interaction state x section of state

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Yes, this has long been a contentious point. CC overtook GW about 20 years ago for three reasons: 1. 'Warming' sounds nice to many people. 2. Warming is only part of the overall change - albeit the best understood as a 'greenhouse' consequence. 3. IPCC has the phrase 'CC' incorporated in its name, and reflects the perspective of climate scientists. Now that extreme events (including contributions of heat, rainfall, lack-of-rainfall, winds and rising seas) are assuming prominence in the public's mind, CC is obviously the more appropriate term. (But the Climate Commission has mostly explained it, to lay readers, as a consequence of the retention of heat in the troposphere rendering the climate system more energetic, 'on steroids'). No perfect solution. Nor are they mutually exclusive in public discussion -- and the warming bit is the fundamental change.

Tony McMichael, ANU, Professor Emeritus: Email 16 Aug 2014

Climate system ‘on steroids’

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Is it “natural”? Example: Australia Nicholls, 2014

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Global warming means global

Data from http://www.berkeleyearth.org

All inhabited continents have been warming

Nicholls, 2014

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Decision-making under deep uncertainty (Nicholls, 2014)

Adaptation?

Technological uncertainty

Economic uncertainty

Social uncertainty

Future emissions Natural climate

variability

“Climate sensitivity”

Climate change

Health impacts

Health science Politics etc.

Mitigation? Or both?

Other impacts

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Greening psychiatric thinking & services

• Sustainable Healthcare (http://sustainablehealthcare.org.uk/mental-health-susnet)

• Fellowship in Sustainability (http://www.rcpsych.ac.uk/discoverpsychiatry/blogzone/drdanielmaughan.aspx)

• Editorial for International Psychiatry (Maughan, Berry & Davidson, 2014) – Set of articles commissioned on CC & MH (UK, Nepal, Australia)

• Social Psychiatry Group, Oxford Univ Dept of Psychiatry • Australia: national policy, a bit quiet • ANZCP, nothing (but do publish occasional journal papers

https://www.ranzcp.org/Publications/RANZCP-journals-public.aspx) • Department of Health and Ageing cf Government of Victoria

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Australian Government Department of Health Current Corporate Plan Context Statement

The Department of Health operates in an environment where the expectation is that every dollar is well spent ... “The Department’s Corporate Plan has been developed in the context of: • Increased community and stakeholder expectations for information

and involvement in decision making about the services they need • An ageing population with increasing health demands • Challenges of a sedentary lifestyle and increased prevalence of

lifestyle diseases • Demand for better connectivity, communication and convenience in

accessing information and services • The need to operate more efficiently within constrained resources”

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http://www.health.vic.gov.au/sustainability/

‘Mainstreaming’ sustainability and climate

adaptation

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What is the role of public health?

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THE LIKELIHOOD OF

INCREASING MAGNITUDES OF WARMING INCREASE

SEVERE AND PERVASIVE IMPACTS

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Likelihood of realised (mental) health impact

D Schroter and ATeam Consortium, 2004

Vulnerability to actual impact

Can’t always do much about these

Can with these: social, physical

environments

HUGE potential for public health promotion (finding the pearl in the oyster)

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1. Advocacy: In the face of ‘climate denial’ and decision-

making uncertainty Human health is the ‘bottom line’

Important in every continent

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Climate change? Global warming?

‘….. George W Bush swapped the term climate change for global warming in 2002, on the advice of the Republican political consultant, Frank Luntz. In a secret memo before the mid-term elections, Luntz warned Republicans – and Bush in particular – were singularly weak on the environment. He advised a strategy of disputing climate science, and of avoiding the term "global warming' because of its highly negative connotations. “It's time for us to start talking about 'climate change' instead of global warming ... 'climate change' is less frightening than 'global warming',” said the memo obtained by the Environmental Working Group ….’

Suzanne Goldenberg, US Envt Correspondent theguardian.com Wednesday 28 May 2014

Leiserowitz, A., Maibach, E., & Roser-Renouf, C. (2010) Climate change in the American Mind: Americans’ global warming beliefs and attitudes in January 2010. Yale University and George Mason University. New Haven, CT: Yale Project on Climate Change.

The politics of CC – a major issue in Australia

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1998-99 2004-05

Satellite-based measures of average global temperature (near-surface lower atmosphere), by year (Sept-Feb period), 1979-2010

Reference temperature, (1979-1998 average)

2009-10 0.5

0.4

0.3

0.2

0.1

0

- 0.1

- 0.2

- 0.3

- 0.4

Temperature variation (oC), relative to reference temperature

1980 1985 1990 1995 2000 2005 2010

10 years of alleged ‘cooling’ since 1998

Long-term uptrend continues

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2. Emphasise that we must focus on the ‘big picture’ and a long-term approach, e.g., to respond to climate change

Most of the things we would do are also good for health, e.g., 1. eat less red meat 2. use active transport 3. focus less on having ‘stuff’

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Reducing the Health Impacts of Climate Change … with ‘bonus’ Health Co-Benefits (McMichael, 2014)

Baseline (local) disease burden

Now 2050 2100

Dis

ease

bur

den

Health Co-Benefits of mitigation

Mitigation begins

Reduced health risks in distant populations

Net health impact

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EFFECTIVE CLIMATE CHANGE ADAPTATION A MORE VIBRANT WORLD

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3. Framing public (mental) health strategy for climate change

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Mitigation & adaptation are collective activities

Localised impact – great. Generalised – even better. e.g., recycling, cycling – co-benefits for people and planet (Capon)

• Mitigation & adaptation are appropriate (ideal even) for a

public health approach, but must not pressure individuals

• We can think about PH interventions for mitigation &

adaptation in terms of when and where interventions are

targetted

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Framing public health interventions: Interventions matrix

Individual

Household

Community

Region

universal

targeted

early intervention treatment

From Berry et al. 2008

Targeting of intervention

Timing

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Given the requirement for mitigation & adaptation, what should public health interventions emphasise?

Individual

Household

Community

Region

universal

targeted

early intervention treatment

Targeting of intervention

Timing

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MH services for drought in Queensland Where are they?

Individual

Household

Community

Region

universal

targeted

early intervention treatment

From Berry et al. 2008; Saal et al, 2009, CRRMHQ Qld service mapping

Targeting of intervention

Timing

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4. Reminding politicians, the media, our peers and other citizens that nations have a responsibility globally (especially wealthy countries)

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Cumulative Emissions of Greenhouse Gases

Countries scaled according to cumulative emissions (billions of tonnes CO2-equivalent) up to 2002.

(Patz, Gibbs, et al, 2007

Cartogram #1

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Cartogram #2: Mortality Impacts of Climate Change 2000

14 WHO regions scaled according to estimated annual death rates (in year 2000) attributable to the climate change that had occurred 1970-2000. (Patz, Gibbs et al, 2007: based on McMichael et al, 2004)

Annual attributable deaths from malnutrition (~80K), diarrhoea (~50K), malaria (~20K), flooding (~3K) … and (in OECD countries) heatwaves

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http://www.theage.com.au/national/-102r1w.html

A climate of despair, August 13, 2014 Konrad Marshall Senior Reporter for The Age

Nicole Thornton remembers the exact moment her curious case of depression became too real to ignore. It was five years ago and the environmental scientist – a trained biologist and ecologist – was writing a rather dry PhD on responsible household water use. After a two-decade career in green awareness and eco-tourism, Thornton was happy to finally be researching her pet project at the University of Technology in Sydney – but she was also on edge. Thornton had always been easily upset by apathy towards, and denial of, environmental issues. But now she began to notice an oddly powerful personal reaction to “the small stuff” – like people littering, or neighbours chopping down an old tree.

Talk to reputable journalists

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Dear Prime Minister, We urge you to include human-induced climate change and its serious health consequences on the agenda for this year's G20 meeting. The world community looks to high-income countries for a strong lead. Current climate trends, driven by global warming, threaten the basis of future economic prosperity, regional political stability and human health. As concern rises in many countries, including increasing awareness of the risks to human health and safety, many G20 members are strengthening their commitment to substantive mitigation action. … Meanwhile, if Australia passes up opportunities for new energy technologies and efficiencies, we will forfeit gains in long-term economic security and fail to contribute fairly to reducing worldwide risks to human health ……

Open letter to the Hon Tony Abbott MP (McMichael et al., Med Journal of Australia, Aug 2014)

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Your name is appropriate, you should be in a fruit cake with the rest of the global warning dopes. I have just been watching you on Sky News and what a lot of absolute tripe you have presented .… I notice you have red hair so you look Irish. As you know there are thousands of jokes about the stupid Irish so I guess you can be included in many of them … Why in the hell must us taxpayers continue paying your wages when you contribute absolutely nothing but lies to the people of Australia … For God’s sake resign and go and live up in Nimbin with the rest of the airheads who are drug induced and talk rot like you do ... I do not expect a reply from you as I believe your type are a lot of gutless wimps who have had such a bad upbringing they just want to cause havoc to the many decent Australians who do not listen to your garbage.

Fan mail: Climate change and health: IPCC reports emerging risks, emerging consensus http://theconversation.com/climate-change-and-health-ipcc-reports-emerging-risks-emerging-consensus-24213

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1. Australian Academy of Science Think Tank 2014 Brisbane: CC challenges to health; report Dec 2014 (http://www.science.org.au/events/2014-theo-murphy-high-flyers-think-tank-climate-change-challenges-health)

2. Knowledge & beliefs about CC: is concern about CC linked to mental health? Regional Wellbeing Survey 2013 (http://www.canberra.edu.au/murray-darling-crn/regional-wellbeing)

3. First papers from Australia-Norway comparison of sustainable urban form and mental health

4. Collaboration – Govt Shanghai: healthy (smoking) and sustainable behaviours (incl. CC) and mental health

5. RCPsych Sustainability Summit: Environment, Society and Psychiatry London 1 October (https://www.eventbrite.co.uk/e/rcpsych-sustainability-summit-environment-society-and-psychiatry-tickets-11645505019?aff=es2&rank=2)

6. RCPsych conference Birmingham July 2015 (http://www.rcpsych.ac.uk/traininpsychiatry/eventsandcourses/internationalcongress2013.aspx)

A few forthcoming publications and activities

CRICOS #00212K

Some concluding thoughts Mitigate and adapt: Prepare, respond, recover, rebuild

There are things we can do to mitigate and adapt ahead of CC

• Impacts can be specific in nature (e.g., floods & trauma vs generalised distress), place (e.g., droughts & rural), whom affected (heat & women vs men; droughts & poverty), longevity (heat)

• Existing vulnerability is a risk factor, but nuanced: • Youth & age not necessarily risk factors – working age people • Poverty, existing MH & PH and living in remote locations are

• Innovative approaches to public health and research • Advocacy – difficult but essential

• International responsibility, especially the developing world

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World Health Organization definition of health: … A state of complete physical, mental and social

wellbeing

People and Place Program: … Investigate how to promote everyone’s wellbeing, no

matter who you are or where you live.

Wellbeing

CRICOS #00212K

Sister study: The Regional Wellbeing Survey

www.regionalwellbeing.org.au