Impacts of Climate Change on Health and Health Services in Northern New South Wales, Australia: A Rapid Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Research Questions
2.2. Search Strategy
2.3. Eligibility Criteria
2.4. Screening
2.5. Data Categorisation and Extraction
2.6. Quality Assessment
3. Results
3.1. Articles Selected
3.2. Study Characteristics
3.3. Research Gaps
3.4. Summary of Findings
3.4.1. Mental Health
3.4.2. Vector Borne Disease
3.4.3. Mortality
3.4.4. Health Services Utilisation
3.5. Quality Assessment
4. Discussion
4.1. Main Findings
4.2. Research Gaps
4.3. Research Directions
4.4. Limitations
5. Conclusions
Author Contributions
Funding
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations and Acronyms
Appendix A
First Author | Year | Title | Location | Population/ Participants | Study Type/Period | Exposure/ Outcome | Key Findings | Limitations |
---|---|---|---|---|---|---|---|---|
Austin et al. [38] | 2018 | Drought-related stress among farmers: findings from the Australian Rural Mental Health Study. | NSW non-metropolitan regions (inner regional, outer regional, remote, very remote regions). | Adults living and/or working on a farm (n = 664) aged >18 from the Australian Rural Mental Health Study (ARMHS) Predominately live on farms in inner and outer regional areas. | Longitudinal cohort ARMHS 2007–2013 Generalised Estimating equations model. | Exposure: drought (rainfall deficiency) Outcome: mental health (generalised psychological distress K10 scale, Personal Drought-related Distress (PDS) and Community Drought-related Distress (CDS) Likert scale). | Significant: Compared to those who live on a farm only, those who live and work on a farm were likely to experience PDS (IRR = 1.50; 95% CI: 1.32–1.72). Significant: Compared to female farmers, male farmers were likely to experience elevated general psychological distress. Significant: Compared to older farmers >35, farmers aged 18–35 were likely to experience elevated PDS and CDS. Significant: Compared with farmers from inner regional areas, farmers from outer regional and remote and very remote areas were likely to experience elevated PDS (outer regional IRR = 1.88, 95% CI: 1.59–2.23; remote IRR = 2.02, 95% CI: 1.65–2.48); very remote IRR = 2.55, 95% CI: 2.55, 95% CI = 1.97–3.30) and CDS (outer regional IRR = 2.05, 95% CI: 1.76–2.38; remote IRR = 2.17, 95% CI: 1.83–2.58; very remote IRR = 2.80, 95% CI: 2.26–3.47). Significant: Compared to farmers with comfortable financial status, farmers with lower financial security were likely to experience elevated general psychological distress (IRR = 2.99, 95% CI = 1.52–5.89) and PDS (IRR = 1.72, 95% CI = 1.38–2.14). | Application of the meteorological definition of drought may miss out on mental health effects captured by other measures of drought type. Self-reporting of health outcomes can introduce bias and misclassification. |
Austin et al. [32] | 2020 | Concerns about climate change among rural residents in Australia. | NSW non-metropolitan regions (inner regional, outer regional, remote, and very remote regions). | Adults from non-metropolitan NSW (n = 823) Age > 18 ARMHS Participants. | Open-ended questionnaire. Word frequency test, thematic analysis 2007–2013. | Exposure: drought, climate change Outcome: perspectives and concerns. | Qualitative: Many respondents believed climate change was natural and not caused by human actions. Key concerns were the financial, environmental (particularly water insecurity), and health and social impacts. Both governments’ inaction to mitigate climate change and the cost of such actions were of concern. | Analysis of free text based on an open-ended questionnaire may not capture in-depth opinions. |
Bailie et al. [35] | 2022 | Exposure to risk and experiences of river flooding for people with disability and carers in rural Australia: a cross-sectional survey. | Northern NSW (6 Local Government Areas: Ballina Shire, Tweed Shire, Richmond Valley, Kyogle, Byron Shire, and Lismore City). | Adults (n = 2252) Age > 16 Predominately female, aged >45; People with disability (n = 165); Carers (n = 91). | Snowball, cross-sectional survey, 6 months post-flood event in 2017. | Exposure: flood event Outcome: mental health. | Significant: Compared to other respondents, the odds of having homes flooded were elevated for people with disability (OR = 2.41, 95% CI: 1.71–3.39) or carers (OR = 1.76, 95% CI: 1.10–2.84). The odds of having to evacuate and be displaced for more than 6 months were elevated for people with disability (OR = 3.78, 95% CI: 2.18–6.55). The odds of not getting timely help or access to health and social services were elevated for people with disability (OR = 3.98%, 95% CI = 2.82–5.60). Significant: Compared to other respondents, the odds of experiencing probable PTSD elevated for carers or people with disability (OR = 3.32, 95% CI: 2.22–4.96). | Limited generalisability. Difficult to establish causation. Self-reporting of mental health conditions can introduce bias and misclassification. |
Hanigan et al. [39] | 2012 | Suicide and drought in New South Wales, Australia, 1970–2007. | NSW (11 rural or urban regions, including Northern NSW. | Age > 10 by males and females. | Time series 1970–2007 Poisson generalised additive model. | Exposure: drought (Hutchinson Drought Severity Index HDSI) Outcome: suicides. | Significant: Increase in relative risk of suicide by 15% (95% CI: 8–22%) in rural males aged 30–49 years per the first to third quartile increase in the HDSI. The predicted annual suicides in this subgroup was 4 (95% CI: 2.14–6.05) or 9% of the total number in the age group). Significant: Decrease in relative risk of suicide for rural females aged 30–49 (RR = −0.72, 95% CI: −0.31 to −0.01). No association between drought and suicide in urban populations. | Likely underestimation of historical suicide risk in farmers. |
Hanigan et al. [42] | 2022 | Climate Change, Drought, and Rural Suicide in New South Wales, Australia: Future Impact Scenario Projections to 2099. | NSW (11 rural or urban regions, including Northern NSW. | Age > 10 by males and females. | Modelling Baseline: 1970–1999; Projection: 2000–2099. | Exposure: drought (HDSI) Outcome: suicides. | Significant: Compared to the attributable number (AN) of excess suicides per annum in drought for rural males aged 30–49 in the historical period, an 84% increase (95% CI: 2–159) was projected under the driest scenario RCP 4.5 (AN = 1.5, 95% CI: 0.84–2.13). Significant: Decrease in AN of excess suicides per annum in drought for rural females aged 30–49 between historical (AN = −0.29, 95% CI: −0.61 to −0.03) and projected (AN = −0.53, 95% CI: −1.14 to −0.05) period. Significant: Elevated gender differences in AN of excess suicides per annum in drought between rural males and females aged 30–49 in the projected period (AN = 2.04, 95% CI: 1.98–2.18). No gender difference in drought-related suicide rates in urban populations. | Limited assessment of regional patterns in the modelled climate data may introduce exposure misclassification bias. Did not consider the effect of temperature on suicide. |
Hime et al. [34] | 2022 | Weather extremes associated with increased Ross River virus and Barmah Forest virus notifications in NSW: learnings for public health response. | NSW east coast/northeast NSW (4 major population centres on central, mid-north, and north coast of NSW). | NSW residents of northeast NSW. | Ecological Descriptive analysis February 2020. | Exposure: High rainfall, high tides, high mosquito counts Outcome: RRV/BFV detections and Human RRV/BFV notifications. | Descriptive: Following two extremely dry years and after a significant rainfall event and high tides in February 2020, there was a substantial increase in mosquito abundance occurred after 2 weeks, followed by RRV and BFV notifications in northeast NSW after 8 and 9 weeks, respectively. Mosquito bite avoidance messaging should be instigated within 2 weeks of high summer rainfall, especially after an extended dry period. | Environmental, entomological, and epidemiological events may not necessarily be linked. Underestimation of human infections by surveillance system due to asymptomatic infections. |
Jagasothy et al. [40] | 2017 | Extreme climatic conditions and health service utilisation across rural and metropolitan New South Wales. | NSW (3 regions: major cities, inner regional and outer regional /remote/very remote areas). | NSW residents. | Time-series 2005–2015 Poisson regression model. | Exposure: Cold wave, heat wave Outcome: mortality, ambulance callouts, and emergency department (ED) presentations. | Significant: A positive dose–response relationship was observed between the severity of heat waves and ambulance callouts in each study region. Significant: Compared with a non-heat wave days, incidence rate ratio (IRR) of ambulance call-outs were elevated in NSW after low-intensity (IRR = 1.018, 95% CI: 1.015–1.022), intense (IRR = 1.047, 95% CI: 1.039–1.056) and very intense (IRR = 1.109, 95% CI: 1.077–1.142) heat waves. This was also the case for each study region. Significant: ED presentations were also elevated in NSW after low-intensity (IRR = 1.009, 95% CI: 1.004–1.014) and intense (IRR = 1.036, 95% CI: 1.024–1.048) heat waves. Significant: Mortality was elevated after intense (IRR = 1.024; 95% CI: 1.008–1.041) and very intense (IRR = 1.108; 95% CI: 1.045–1.174) heat waves for NSW. This is also the case for major cities. This maybe due to the urban heat island effect. Significant: ED presentations were elevated after low (IRR = 1.047; 95% CI: 1.042–1.052); intense (IRR = 1.093; 95% CI: 1.080–1.106) and very intense (IRR = 1.082; 95% CI: 1.050–1.116) cold waves in outer regional/remote/very remote areas. | |
King et al. [36] | 2020 | Disruptions and mental health outcomes following Cyclone Debbie. | Northern NSW (6 Local Government Areas: Ballina Shire, Tweed Shire, Richmond Valley, Kyogle, Byron Shire, and Lismore City). | Adults (n= 2180) Age > 16 Predominately female, aged >45; Direct disruption (n = 1228); Indirect disruption (n = 605). | Snowball, cross-sectional survey, 6 months post-flood event in 2017. | Exposure: flood event Outcome: Mental health, loss of access to social/health care, food, and utilities. | Significant: Compared to non-disrupted respondents, odds of experiencing distress (OR = 3.31; 95% CI: 1.79–6.12), probable PTSD (OR = 13.48; 95% CI: 5.45–33.35), depression (OR = 4.26; 95% CI: 2.35–7.73), anxiety (OR = 3.64; 95% CI: 1.74–7.62), and suicidal ideation (OR = 2.86; 95% CI: 1.36–5.99) were elevated for directly disrupted respondents. Mental health outcomes of indirectly disrupted respondents were less severe, but the odds of experiencing probable PTSD (OR = 3.52, 95% CI: 1.36–9.15) were still elevated. Significant: Compared to non-disrupted respondents, odds of experiencing distress (OR = 1.86, 95% CI: 1.38–2.49), probable PTSD (OR = 1.93, 95% CI: 1.38–2.7), anxiety (OR = 2.67, 95% CI: 1.64–4.35) and suicidal ideation (OR = 1.74, 95% CI: 1.14–2.66) were elevated for those who lost access to social services/healthcare. | Limited generalisability. Difficult to establish causation. Self-reporting of mental health conditions can introduce bias and misclassification. |
Matthews et al. [37] | 2019 | Differential mental health impact six months after extensive river flooding in rural Australia: A cross-sectional analysis through an equity lens. | Northern NSW (6 Local Government Areas: Ballina Shire, Tweed Shire, Richmond Valley, Kyogle, Byron Shire, and Lismore City). | Adults (n= 2180) Age > 16 Predominately female, aged 35–74. | Snowball, cross-sectional survey, 6 months post-flood event in 2017. | Exposure: flood event Outcome: mental health. | Significant: Compared to unexposed respondents, odds of experiencing distress (OR = 25.70, 99% CI: 9.20–71.81), probable PTSD(OR = 24.43, 99% CI: 7.05–84.69), anxiety (OR = 14.50, 99% CI: 5.15–40.85), and depression (OR = 8.38, 99% CI: 3.04–23.10) were elevated for respondents who were displaced after 6 months. This was also the case for those whose homes/businesses/farms were evacuated/flooded. Significant: Odds of experiencing probable anxiety (OR = 2.16, 99% CI: 1.08–4.33) and depression (OR = 2.09, 99% CI: 1.04–4.23) were elevated for Aboriginal and Torres Strait Islanders. This was also the case for income support recipients’ respondents (anxiety OR = 1.89, 99% CI: 1.26–2.85; depression OR = 1.84, 99% CI: 1.22–2.79). | Limited generalisability. Difficult to establish causation. Self-reporting of mental health conditions can introduce bias and misclassification. |
Ng et al. [33] | 2015 | Climate adversity and resilience: the voice of rural Australia. | NSW (2 regional centres, 2 rural villages). | Adults who experienced drought and flood within 5 years Age > 18 (n = 46). | In-depth focus groups and interviews Purposive and convenience sampling. | Exposure: drought and flood Outcome: experience, health, and wellbeing. | Qualitative: Flood and drought contributed to emotional stress and anxiety due to fear about the reoccurrence of the disasters, financial loss; loss of possession; loss of status, family heritage, generational history, and rural community structure; loss of material procession; loss of physical infrastructure. Social connectedness can promote resilience in disaster-struck rural communities. | Limited generalisability of research findings to the broader rural population due to differences in climate, farming practices, community, and rural culture. |
Wen et al. [41] | 2022 | Excess emergency department visits for cardiovascular and respiratory diseases during the 2019–2020 bushfire period in Australia: A two-stage interrupted time-series analysis. | NSW (28 Statistical Area 4 regions in NSW). | NSW residents. | Time-series Two-stage interrupted analysis 2019–2020 bushfire period. | Exposure: Bushfire event Outcome: respiratory and cardiovascular-related ED visits. | Significant: Compared to the same periods of 2017–2018 and 2018–2019, the relative risk (RR) of excess ED visits for respiratory (RR = 1.05, 95% CI: 1.02–1.09) and cardiovascular diseases (RR = 1.10, 95% CI: 1.07–1.13) were elevated during the 2019–2020 bushfires. Significant: The RR of excess respiratory -related ED visits were elevated in low SES regions compared to high SES regions (RR = 1.12, 95% CI: 1.06–1.18); and in regions of high fire intensity compared to low fire intensity. For cardiovascular-related ED visits, no significant difference was found when stratified by SES and fire intensity. | Outcome classification maybe introduced in diagnostic outcome data as they were not coded by clinicians. |
Author, Year, Title | Level of Evidence | Consistency of Evidence | Clinical Impact | Risk of Bias | Generalisability and Applicability |
---|---|---|---|---|---|
Austin et al., 2018 [38] Drought-related stress among farmers: findings from the Australian Rural Mental Health Study. | Level III-2 * | Mostly consistent with other studies and inconsistency may be explained. | Very large | Moderate | Population/s studied in body of evidence are the same as the target population in question. Directly applicable to Australian healthcare context. |
Bailie et al., 2022 [35] Exposure to risk and experiences of river flooding for people with disability and carers in rural Australia: a cross-sectional survey. | Level III-2 * | Mostly consistent with other studies and inconsistency may be explained. | Very large | High | Population/s studied in body of evidence are the same as the target population in question. Directly applicable to Australian healthcare context. |
Hanigan et al., 2012 [39] Suicide and drought in New South Wales, Australia, 1970–2007. | Level III-2 * | Consistent with other studies. | Moderate | Moderate | Population/s studied in body of evidence are the same as the target population in question. Directly applicable to Australian healthcare context. |
Hanigan et al., 2022 [42] Climate Change, drought and rural suicide in New South Wales, Australia: Future impact scenario projections to 2099. | Level III-2 * | Consistent with other studies The authors discussed in detail the similarity with other study findings and with the findings from their previous studies. | Moderate | Moderate | Population/s studied in body of evidence are the same as the target population in question. Directly applicable to Australian healthcare context. |
Hime et al., 2022 [34] Weather extremes associated with increased Ross River virus and Barmah Forest virus notifications in NSW: learnings for public health response. | Level III-2 * | Consistent with other studies. | Very large | Moderate | Population/s studied in body of evidence are the same as the target population in question. Directly applicable to Australian healthcare context. |
Jagasothy et al., 2017 [40] Extreme climatic conditions and health service utilisation across rural and metropolitan New South Wales. | Level III-2 ** | Mostly consistent with other studies and inconsistency may be explained. | Very large | Low | Directly applicable to Australian healthcare context. |
King et al., 2020 [36] Disruptions and mental-health outcomes following Cyclone Debbie. | Level III-3 ** | Mostly consistent with other studies and inconsistency may be explained. | Very large | High | Population/s studied in body of evidence are the same as the target population in question. Directly applicable to Australian healthcare context. |
Matthews et al., 2019 [37] Differential Mental Health Impact Six Months After Extensive River Flooding in Rural Australia: A Cross-Sectional Analysis Through an Equity Lens. | Level III-2 * | Mostly consistent with other studies and inconsistency may be explained. | Very large | Moderate | Population/s studied in body of evidence are the same as the target population in question. Directly applicable to Australian healthcare context. |
Wen et al., 2022 [41] Excess emergency department visits for cardiovascular and respiratory diseases during the 2019–2020 bushfire period in Australia: A two-stage interrupted time-series analysis. | Level III-2 * | Mostly consistent with other studies and inconsistency may be explained. | Moderate | Low | Populations studied in body of evidence are the same as the target population in question. Directly applicable to Australian healthcare context. |
Author, Year, Title | Level of Evidence | Risk of Bias | Evidence for Practice |
---|---|---|---|
Austin et al., 2020 [32] Concerns about climate change among rural residents in Australia. | Level 3 Descriptive studies | Do not report full range of responses. | Demonstrate that a phenomenon exists in a defined group. Identify practice issues for further consideration. |
Ng et al., 2015 [33] Climate adversity and resilience: the voice of rural Australia. | Level 3 Descriptive studies | Do not report full range of responses. | Demonstrate that a phenomenon exists in a defined group. Identify practice issues for further consideration. |
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Key Concept | Keywords |
---|---|
Climate change | (exp climate change/OR (climate change * or global warm * or sea level ris *).mp.) AND (cyclonic storms/OR (cyclon * or storm *).mp. OR droughts/OR drought *.mp. OR floods/OR flood *.mp. OR lightning/OR lightning.mp. OR rain/OR (rain * or extreme rain *).mp. OR tidal waves/OR tid * wave *.mp. OR exp natural disasters/OR (natural disaster * or landslide * or wildfire * or bushfire * or landscape fire or fire storm * or tornado *).mp. OR air pollutants/OR (air pollutant * or particulate matter or dust or pollen or ozone).mp. OR air pollution/OR air pollution.mp. OR exp temperature/OR (hot temperature or heat wave or extreme heat).mp. OR extreme weather/OR extreme weather.mp. OR humidity/OR humid *.mp.) AND |
Human health and | exp health/OR health.mp. OR health equity/OR health equity.mp. OR disease/OR (disease * or cardiovascular or respiratory).mp. OR exp mortality/OR (mortal * or death or premature death or fatal *).mp. OR mental health/OR (mental health or well?being).mp. OR anxiety/OR anxiety.mp. OR depression/OR depress *.mp. OR exp heat stress disorders/OR (heat stress or heat stroke * or heat?related illness * or heat exhaustion).mp. OR exp vector borne diseases/OR (vector?borne disease * or mosquito?borne disease * or arbovirus infection *).mp. OR |
Health services | exp “health care facilities, manpower, and services”/OR (health service * or community health * or (emergency adj2 service *) or mental health service * or rural health or regional health or urban health or aboriginal health or general practice or public health).mp. OR (workforce * or health infrastructure or supply chain * or transport or health plan *).mp. OR “health services needs and demand”/OR (health * adj3 demand *).mp. OR health servic *.mp. OR Ambulatory care/OR (ambulatory care or ambulance *).mp. OR disasters/or disaster planning/or emergencies/or emergency shelter/OR (disaster * or disaster plan * or emergenc * or emergency shelter *).mp. AND |
Australia and Northern NSW | exp Australia/OR (Australia * or New South Wales or Northern Territory or Western Australia or South Australia or Victoria or Tasmania or Queensland or Australian Capital Territory or Torres Strait Island *).mp. OR New South Wales/OR (New South Wales or NSW or local government or “Northern New South Wales Local Health District” or “Northern New South Wales” or Northern New South Wales or east coast or north coast or Northern Rivers or Lismore).mp. |
Characteristics | Number (n = 11) | References | |
---|---|---|---|
Type of study | Qualitative | 2 | [32,33] |
Descriptive | 1 | [34] | |
Cross-sectional | 3 | [35,36,37] | |
Longitudinal cohort | 1 | [38] | |
Time-series | 3 | [39,40,41] | |
Detection and attribution model | 1 | [42] | |
Location | State level with a focus on regional areas | 8 | [32,33,34,38,39,40,41,42] |
Northern NSW | 3 | [35,36,37] | |
Climate exposure | Meteorological | 1 | [34] |
Extreme heat and heat wave | 1 | [40] | |
Flood | 3 | [35,36,37] | |
Drought | 5 | [32,33,38,39,42] | |
Bushfire and air quality | 1 | [41] | |
Health outcome | All-cause mortality | 1 | [40] |
Infectious diseases (vector-, food-, water-borne) | 1 | [34] | |
Respiratory, cardiovascular | 1 | [41] | |
Mental health | 8 | [32,33,35,36,37,38,39,42] | |
Health system | Health services | 3 | [35,40,41] |
Health Outcome | n | Climate Exposure | Location | Summary of Findings |
---|---|---|---|---|
Mental health | 8 | Flood and storm | Northern NSW | Cross-sectional analyses found that the 2017 flood event in Northern NSW was associated with probable post traumatic stress disorder (PTSD), anxiety, and depression, particularly for people whose homes, businesses, and farms were inundated, displaced [37], and particularly for marginalised communities (e.g., people with a disability) [35,36]. The disruption of access to healthcare and social services due to floods was also associated with probable PTSD [36]. |
Drought | NSW with a regional focus | A time series analysis found an association between drought and increased risk of suicide in the period of 1970–2007, particularly for male farmers from rural regions of NSW [39]. Modelling of future climate scenarios found that an increase in the duration and intensity of droughts will increase suicide rates among males in rural NSW between 2000–2099 [42]. A longitudinal study found that younger farmers that experienced the Millennium Drought of 1997–2010 in regional NSW were more likely to report drought-related stress [38]. Qualitative studies found that concerns for the environmental, financial, health and social impacts of climate change may impact the mental health and well-being of rural communities [32,33] | ||
Health service utilisation | 3 | Flood | Northern NSW | A cross-sectional analysis found that access to healthcare and social services were disrupted during and after the 2017 flood event for affected communities in the Northern Rivers, particularly for people with disabilities and for carers [35]. |
Heat waves | NSW with a regional focus | A time series study found that heat waves were associated with greater ambulance callouts and emergency department (ED) presentations in the period of 2005–2015 across urban, regional and remote areas of NSW [40]. | ||
Bushfire | NSW with a regional focus | A time-series study found that the 2019–2020 bushfire elevated the use of ED visits due to cardiovascular and respiratory conditions. Respiratory related-ED visits were elevated in regions of lower socioeconomic status and higher fire densities [41]. | ||
Vector-borne disease | 1 | Rainfall | Northern NSW | A descriptive study found that Ross River virus (RRV) and Bamah Forest virus (BFV) human disease notifications increased in northeast NSW following a significant rainfall event, high tides, and substantial increase in mosquito abundance in the summer of February 2020 [34]. |
Mortality | 1 | Heat waves | NSW with a regional focus | A time series analysis found an association between heat waves and mortality across urban, regional, and remote areas of NSW in the period between 2005–2015 [40]. |
Cardiovascular and respiratory | 1 | Bushfire | NSW with a regional focus | A time-series study found that the 2019–2020 bushfire found increased cardiovascular and respiratory-related ED visits [41]. |
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Lee, G.W.; Vine, K.; Atkinson, A.-R.; Tong, M.; Longman, J.; Barratt, A.; Bailie, R.; Vardoulakis, S.; Matthews, V.; Rahman, K.M. Impacts of Climate Change on Health and Health Services in Northern New South Wales, Australia: A Rapid Review. Int. J. Environ. Res. Public Health 2023, 20, 6285. https://doi.org/10.3390/ijerph20136285
Lee GW, Vine K, Atkinson A-R, Tong M, Longman J, Barratt A, Bailie R, Vardoulakis S, Matthews V, Rahman KM. Impacts of Climate Change on Health and Health Services in Northern New South Wales, Australia: A Rapid Review. International Journal of Environmental Research and Public Health. 2023; 20(13):6285. https://doi.org/10.3390/ijerph20136285
Chicago/Turabian StyleLee, Grace W., Kristina Vine, Amba-Rose Atkinson, Michael Tong, Jo Longman, Alexandra Barratt, Ross Bailie, Sotiris Vardoulakis, Veronica Matthews, and Kazi Mizanur Rahman. 2023. "Impacts of Climate Change on Health and Health Services in Northern New South Wales, Australia: A Rapid Review" International Journal of Environmental Research and Public Health 20, no. 13: 6285. https://doi.org/10.3390/ijerph20136285
APA StyleLee, G. W., Vine, K., Atkinson, A.-R., Tong, M., Longman, J., Barratt, A., Bailie, R., Vardoulakis, S., Matthews, V., & Rahman, K. M. (2023). Impacts of Climate Change on Health and Health Services in Northern New South Wales, Australia: A Rapid Review. International Journal of Environmental Research and Public Health, 20(13), 6285. https://doi.org/10.3390/ijerph20136285