THE IMPPACTS O
OF EXTREEME WEEATHER ON THEE HEALTH
H AND W
WELL‐BEING OF PPEOPLE WHO ARE HOM
MELESS: VIEW
WS FROM
M VICTO
ORIAN SSERVICE PROVID
DERS CATHER
C
RINE PE
ENDREY
Y
MAR
RION CA
AREY
JANE
ET STAN
NLEY
ISBN: 978-0-9875677-5-8
Report: 14/2
Acknowledgement: The authors would like to thank all those individuals who participated in the study who gave of their time and expertise. Citation: Pendrey, C., Carey, M. and Stanley, J. 2014 The impacts of extreme weather on the health and well‐being of people who are homeless: views from Victorian service providers. Monash Sustainability Institute, Monash University, MSI Report 14/2, June.
2 TABLE OF CONTENTS SUMMARY............................................................................................................................................4
INTRODUCTION.................................................................................................................................5
Extremeweathereventsandclimatechange.........................................................................5
Extremeweatherandthehomelesspopulation...................................................................5
STUDYAIMS........................................................................................................................................7
STUDYDESIGN...................................................................................................................................7
INTERVIEWANALYSIS....................................................................................................................8
STUDYRESULTS................................................................................................................................9
Reportedimpactsofextremeweatheronhomelessclients’health..............................9
Extremeheatevents......................................................................................................................10
Bushfires............................................................................................................................................10
Floods..................................................................................................................................................10
Mentalhealthandsubstanceabuse.........................................................................................10
Determinantsofhealth................................................................................................................11
Vulnerabilitytoextremeweatherimpacts...........................................................................12
Impactsofextremeweatheroncapacityforserviceprovision....................................13
Climatechangeandthehomelessnesssector......................................................................14
Emergencyresponse,recoveryandcommunication........................................................14
DISCUSSION.......................................................................................................................................14
CONCLUSIONS..................................................................................................................................16
REFERENCES.....................................................................................................................................18
3 SUMMARY Extremeweatherevents,suchasbushfires,floods,andheatwaves,havemajorimpacts
onhealthandwellbeingandareexpectedtoincreaseinfrequencyandintensitydueto
climate change. Homeless people are more vulnerable to these events due to greater
environmentalexposure,reducedadaptivecapacityandhighprevalenceofmentaland
physicalhealthproblems.
This semi‐qualitative study investigated the impacts of extreme weather events on
homelesspersonsinthestateofVictoria,Australia,asreportedbyserviceprovidersto
thispopulation.Semi‐structuredinterviewswereconductedwithseventeenhealthand
welfareserviceproviderstothehomeless,frombothurbanandruralVictoria.
Serviceprovidersreportedarangeofadverseimpactsonhomelessclientsfromextreme
weather, including exacerbation of physical and mental health problems. Despite
recognitionthatextremeweatheraffectedthecapacityoftheorganisationstocarefor
clients,someparticipantsindicatedthatclimatechangewasyettobeincorporatedinto
long‐termorganisationalplanning.
This study provides evidence that extreme weather is already adversely affecting the
healthand well‐being of homelesspeopleinVictoria, andislikelytofurtherchallenge
provisionofservicestothispopulationintothefuture.
4 INTRODUCTION EXTREME WEATHER EVENTS AND CLIMATE CHANGE Climate change, in addition to natural climate variability, is predicted to accentuate
changes in the frequency and intensity of extreme weather in Australia and globally
[1,2,3].
Extremeweathereventssuchasfloods,bushfires,drought,severestormsandextreme
heat are expected to have an increasing impact on the health and wellbeing of
populations [3,4]. The severity of these impacts depends on the level of people’s
exposure and vulnerability to these extremes. Vulnerability is a function of sensitivity,
suchasageandstateofhealth,andadaptivecapacity,i.e.havingtheresourcesorability
torespond[2].
Those who have been identified as having increased vulnerability to climate change
includetheveryyoung,theelderly,thosewithchronicillness,thoseonlowincomesand
thoseinisolatedsituations[3,4].InAustraliaandotherdevelopednations,peoplewho
are homeless are amongst the most disadvantaged citizens, and struggle to maintain
goodhealth.Withgreaterexposure,higherratesofillnessandpoorerabilitytoprotect
themselves,theyarelikelytobeamongstthemostvulnerabletoclimatechange[5,6,7].
Greaterexposurecanarisefromalackofaccesstobasicshelter,aswellasatendency
forimpoverishedandmarginalisedgroupstobehousedinmoreclimaticallyhazardous
locations,whichmayalsohavepooreraccesstoservices[8].
Thereisclearlyaneedtobetterinvestigatethehealthoutcomesanddeterminantsfor
vulnerable groups in relation to climate change [7,9]. Yet the intersection of climate
change, health and homelessness is an emerging area of research with little to date in
theliterature.
EXTREME WEATHER AND THE HOMELESS POPULATION Research in Waterloo Canada, undertaken directly with homeless individuals, found
exposuretoweatheroftenexacerbatedexistingphysicalandmentalillnessesincluding
depression, respiratory disease and cardiovascular disease [10]. In Phoenix Arizona, a
relatively high proportion of reported deaths occurring during 2000 to 2005 from
extremeheatwereassociatedwithbeinghomeless[11].
In Australia, there has been anecdotal evidence of homeless individuals suffering in
extremeheat,beingmovedonfromair‐conditionedshelter,andservicesstrugglingwith
increased demand during periods of extreme heat. However formal documentation of
these issues has been minimal [12,13]. A study confined to inner city Adelaide
interviewedhomelesspeopleandrelatedserviceproviderstoidentifyextremeweather
related health needs of this group. It found that extremes of both heat and cold had
relevancetothehealthofthehomelessandposedchallengesforserviceproviders[14].
ThestateofVictoriahasrecordedarangeofextremeweathereventsinrecentyears.In
early 2009, south‐eastern Australia experienced exceptional extreme heat events
5 culminating in the Black Saturday Bushfires. During this heat wave, an estimated 374
excess deaths, a 25% increase in metropolitan ambulance emergency cases and 12%
increase in emergency department presentations were reported [15]. The bushfires
resultedin173deathsanddestructionofover2000homes,leavingthousandsdisplaced
[16].
2013inAustraliabeganwitharecord‐breakingheatwavewithnewrecordhighmean
temperatures [17]. A relatively small change in the average temperature can
significantly increase the frequency of extreme heat events, and the probability of
extreme heat has now increased [2,17] almost five‐fold compared with 50 years ago
[18].Fromlate2010toearly2011,aroundone‐thirdofVictoriawasaffectedbyflooding
orstormdamage,withseveralcommunitiesexperiencingfloodingmultipletimes.Over
3000 residential properties were damaged and isolated, and there were major
disruptionstoinfrastructure,transportandessentialservices[19].
InAustraliaover100,000peoplearehomelessonanygivennight,withover20,000of
theseinVictoria.Tobehomelessisdefinedasstayinginaccommodationthatiswithout
security of tenure or below the minimum accepted standard and can be further
categorised:
 Primary:livingwithoutconventionalaccommodation(e.g.onthestreets,in
desertedbuildings,improviseddwellings,etc.).
 Secondary:movingbetweenvarioustemporarysheltersincludinghomesof
friendsandrelatives,emergencyaccommodation,youthrefuges,hostelsand
boardinghouses.
 Tertiary:livinginsingleroomsinprivateboardinghouseswithoutone’sown
bathroomorkitchenandsecurityoftenure.
 Marginal residents of caravan parks: people renting a caravan, at their usual
address,withno‐oneinthedwellinghavingfull‐timework[20].
Services to the homeless population face a number of challenges including competing
priorities and inadequate resourcing to meet demand. Subpopulations such as the
homelessareoftenpoorlyrepresentedindisasterplanningandpublichealthmessaging
[7,13,21].
Heatwaveplanningisoneexample.ArecentevaluationoftheVictorianHeatWavePlan
identified a need for improved strategies to support non‐government and community
serviceorganisations[22,23].ThekeypublichealthmessagesinVictoriainanticipation
of a heat wave are “Look after yourself and keep in touch with others, drink plenty of
water, keep cool and stay out of the sun” [22]. Health promotion and prevention
assumestheresourcestotakeadaptivemeasures,suchasaccesstowater,shelter,social
support and transport [7]. Likewise planning for bushfires and floods may neglect the
particularimpactsonhomelesspersonsandfailtoexamineifadditionalstrategiesare
required.
6 STUDY AIMS The study aimed to investigate the impacts of extreme weather on the health and
wellbeing of homeless persons in Victoria, as reported by health and welfare service
providers,andthepotentialimplicationsforthispopulationinachangingclimate.The
conceptualframeworkbeingtestedisshowninFigure1.
Figure 1. Conceptual framework STUDY DESIGN We conducted a semi‐qualitative study during 2011 using semi‐structured interviews
withstaffinorganisationsthatprovidehealthandwelfareservicestohomelesspersons
in Victoria. Homelessness was defined broadly using all categories as previously
described. Sites were selected on the basis of high rates of homelessness and recent
experienceofextremeweather,andincludedMelbourneCBDandthreeruralsites.
Ethics approval for the study was obtained from the Monash University Human
ResearchEthicsCommittee.
A stratified sampling frame was constructed that included government and non‐
government workers; organisational and direct care roles; and welfare and health
sectors.Samplingcontinueduntilatleastoneparticipantwasrecruitedineachcategory
of the sampling frame. A database of potential interview participants was generated
through snowballing recruitment. Individuals were predominantly contacted through
primarycareandregionalhomelessnessnetworksandtheAustraliaHousingandUrban
ResearchInstitutehomelessnessresearchnetwork.
Twenty‐seven service providers to people who are homeless were recruited. All
individuals involved in the study were de‐identified, as were their organisations for
privacyandethicalreasons.
7 Twenty interview participants were then selected from the database to maximise
representation across different categories of the sampling frame and study sites. A
greater number of participants were selected from Melbourne to reflect the larger
populationofhomelesspersonsandserviceproviderscomparedtoruralareas.Selected
informants were sent explanatory statements and written consent forms. Signed
consent forms were collected at the interviews. Three selected participants initially
agreed to participate but subsequently did not. One was unable to attend a scheduled
interview, whilst the other two did not respond to attempts to organise an interview
time.Theremainingseventeenparticipatedinaninterview.
Participantswereinterviewedinpersonusingastandardisedquestionnaire.Questions
addressedparticipants’viewsofthefollowingthemes:thedirectandindirectimpactsof
extreme weather events on the health and wellbeing of people who are homeless;
factors contributing to the homeless population’s vulnerability to extreme weather
events, responses of people who are homeless to extreme weather events, effects of
extremeweatheronservicessupportinghomelesspersons,theadequacyofemergency
systems servicing homeless persons, and views and planning in relation to climate
change.
Datawerecollectedthroughaudio‐recordinginterviewsandsupplementarynotestaken
atthetimeoftheinterview.Interviewsweretranscribedwithparticipantsprovidedthe
opportunitytochecktranscriptionsforaccuracy.Thesameprojectofficerundertookall
interviews,transcriptionsanddataanalysis.
A content analysis was performed on transcriptions. Data from each informant was
indexed according to the interview themes. Charts for each theme were created, then
interpretedbysearchingforpatterns,deviationsandassociationstoaddressstudyaims
[24].
The limitations of this study were the small size and the fact this was not a
representative sample of service providers. Organisations were not formally surveyed
through their management structures so that participant views may not reflect the
widerviewsorstrategieswithineachorganisation.
However,oursampleincludedadiverserangeofrolesandexperiencefromwithinthe
homelessnessandrelatedsectors.Thefactthattherespondentsandorganisationswere
notidentifiableallowedparticipantstobefrankintheirviews.Interviewingproviders
with access to large numbers of homeless clients also provided a perspective which
wouldnothavebeenpossiblefrominterviewingindividualclientsdirectly.Nevertheless
furtherresearchinthisareashouldincludepeopleexperiencinghomelessness.
INTERVIEW ANALYSIS Seventeen service providers (from fifteen different organisations) across Victoria
participated, with nine from metropolitan Melbourne, and eight from rural Victoria.
Genderofparticipantswasevenlyspreadwitheightmalesandninefemales.Therewere
nineparticipantsaged20‐39years,sevenaged40‐59yearsandoneinthe60‐69year
8 age group. The professional roles of staff interviewed varied widely across the health
andwelfaresector,forexample,homelessnesssupportworker,primaryhealthservice
manager,hospitalmedicalofficer,outreachandyouthworkers,familyservicesdirector,
housingintakeassessmentworker,andcommunityhealthworker.
STUDY RESULTS REPORTED IMPACTS OF EXTREME WEATHER ON HOMELESS CLIENTS’ HEALTH All interviewees reported that at least one extreme weather event had affected their
clients’ health. Sixteen reported that clients’ health had been affected by floods,
fourteen by extreme heat, thirteen by bushfires and eleven reported impacts from
storms (Table 1). Extreme heat and flooding were the most commonly reported
stressorsonhealthinurbanareas,withbushfireandfloodingbeingthemostmentioned
inruralareas.
Table 1. Number of respondents reporting extreme weather events that affected homeless clients’ health, by type of extreme weather and location Participants Extreme Bushfires Flood Storm Total heat Melbourne 8 5 8 7 9 Rural 6 8 8 4 8 Total 14 13 16 11 17 Nine participants answered they believed extreme weather events had caused the
hospitalisation or death of homeless clients, eleven reported extreme weather events
had led to increased consumption of drugs and alcohol amongst clients and sixteen
reportedthatextremeweathereventshadaffectedclients’mentalhealth.Specifichealth
impactsreportedtohavebeencausedbyvariousextremeweathereventsarelistedin
Table2.
Table2.
Specifichealtheffectsofextremeweatherreportedbyparticipants
Extremeweather
Healthimpacts
event
Extremeheat
Dehydration,heatexhaustion,sunburn,illnessrequiring
hospitalisation,fatalities
Bushfire
Burns,death,respiratoryproblemsfromsmokeinhalation,
healthissuesassociatedwithbeingcutofffrommedicalcare
Floodsandheavy
Becoming wet and cold and being unable to dry oneself,
precipitationevents
increased incidence of respiratory infection, insect bites, skin
infections, respiratory problems from mould in flooded
9 buildings
EXTREME HEAT EVENTS Impacts associated with extreme heat were predominantly reported by urban
participantswhoindicatedthatitactedasanadditionalriskfactorforillnessinclients
experiencing homelessness, with cases of potentially severe dehydration, and
exacerbations of pre‐existing health problems. Rooming house residents and people
sleepingroughwerereportedtobeparticularlyvulnerable.Clientssleepingroughwere
reportedto experienceheat exhaustionandsyncope,aswell as“extremesunburn”and
insectbites.
“Summer is always a hard one because we have clients using, drinking alcohol, not
eatingcorrectly,notdrinkingwater,whichwasamainone.Sowehadalotofpeople
with heat exhaustion and because clients’ health is so dilapidated because of their
situation,sleepingroughetc…thatcanbeveryrisky(N15).”
BUSHFIRES Rural participants reported that as a result of bushfire exposure, homeless clients
experienced burns, respiratory illness associated with smoke inhalation, and death.
Beingcutoffbybushfiresfromaccessingmedicalcarewashighlightedasanimportant
healthriskforsickclientsrequiringregularfollowup.
FLOODS Participantsexplainedthatstormeventswereoftenassociatedwithcoldtemperatures
and flooding, which together had adverse effects on health. Clients were reported to
frequentlybecomewet,togetherwiththeirpossessions,andoncetheydid“…theycan’t
getdrysotheysleepintheirwetclothes...(N12)”whichwasreportedtohave“hugehealth
implications(N9).”Clients were also reported to experience more frequent insect bites
andsubsequentskininfectionsfollowingheavyrainandfloods.
Particularreferencewas madeto agroupof marginalresidentsofacaravanparkthat
wascompletelyfloodedwhowereall“oldermenwitharangeofhealthissues”suchthat
“theeffectsofthefloodsimpactedontheirgeneralphysicalhealthandwellbeing(N8).”
MENTAL HEALTH AND SUBSTANCE ABUSE Multiple rural participants described bushfires and floods leading to deterioration in
mentalhealthaswellasexacerbationofdrugandalcoholproblems.Somepeoplewho
are homeless or made homeless by these events responded by “withdrawing from
community,isolation,depression...wecertainlywouldhavemadeemergencycallstoarea
mentalhealthforpeoplewhoweresuicidal“(N11).
“(Thefloodshave)hadacompoundingeffectforpeoplewhoalreadyhadfragilemental
health. It has an impact on pre‐existing anxiety, depression and the likelihood that
peoplemightreturntobehaviorsthatpreviouslytheyhaddealtwithsuccessfully,such
asuseofdrugsandalcohol(N8).”
10 Cumulative impacts were noted. Repeated exposure to extreme weather events was
reportedtoexacerbatementalhealthproblemsinruralareasaffectedbydrought,flood
andfireintherecentyears.
Severalurbanparticipantsdescribedthatextremeheatconditionsexacerbatedmental
health and substance abuse problems. Risks were reported to be particularly high for
thosewhoarealone.
“Inroominghousesinparticularsubstanceabuseisaseriousproblemandpeoplewho
(are) drinking heavily aren’t necessarily synced‐in to how hot they are and are much
more likely to become dehydrated. And that we believe is the cause of many of those
deaths…(N10)”
Given the complexity of health and welfare problems experienced by people
experiencing homelessness, separating out extreme weather impacts may be
problematic.Howeveracommonthemewasofextremeweatherhavinga“magnifying
effect”,exacerbatingalreadyhighlyprevalenthealthproblems.
DETERMINANTS OF HEALTH Participantswereaskedaboutarangeofdeterminantsofhealth,includingfood,water
and shelter. Sixteen participants answered that extreme weather events had affected
their clients’ ability to meet their basic needs of food, water and shelter. Inability to
accesssafeaccommodationwasamajorconcern,withextremeweatherincreasingthe
scarcity of already limited housing. Recent bushfires and floods destroyed a large
number of homes resulting in increased demand for a reduced supply of housing. In
some cases the inability to find secure housing became prolonged, with clients
remainingintemporary andinsecurehousing overtwo years aftertheBlackSaturday
fires.Peoplewholackedinsurance,financialandsocialresourcesorwhowerealready
inmarginalhousingwerereportedtofaceanelevatedriskofprolongedhomelessness.
“After Black Saturday everybody was homeless…It was so devastating there was no
accommodationleftinpockets.Therewasnotasinglepublicbuilding,norashelteror
boarding house…If people don’t have a good back up plan, or money or family or
connections to community then that’s just the natural progression into the services
sector(N11)”.
“Theyhavenomeanstomoveonfromthatsituation…they’reinwhatisbecomingnow
achronichomelessness(N9).”
“Somepeoplelivingincaravanparkshadinvestedalloftheirsavingsinacaravanora
car and insurance would not pay for that…Some people have returned to rough
sleeping…soatthelocalcaravanparkpeopleactuallylosttheircaravan,losttheircars,
solosteverything…”
11 Diversion of public and temporary housing to accommodate those made homeless by
these events added substantial delays of up to twelve months for those on existing
waitinglistsforhousing.
“Ourhousingstock,whetherit’spublichousingorprivate,it’smarginalanyway,soany
reductionishuge,it’sgoingtohaveanimpact.(N8)”
Inurbanareas,participantsreportedthatextremeweatherevents,suchasheatwaves,
createhazardousconditionsforthoseonthestreetandstayinginroominghouses.They
highlightedaseverelackofacoolandshelteredspaceaccessiblebyhomelesspersons,
whoweredescribedashighly“visible”andfrequentlymovedonfromthesespaces,such
asshoppingcenters.
“Itistoohotduringthedayduringaheatwaveandthentheonlyotheroptionisday
centers, which mostly only stay open until 2pm… so (during) the most hot part of the
daythereisnoplacetogo,thereisnoshelter.(N13)”
Participants reported air‐conditioning was commonly not installed in both rooming
houses and public housing, although it was available in public housing for those who
qualified.Roominghousesweredescribedas“reallyhotplaces”withadditionalconcerns
that“ahighlevelofviolenceorintimidation(N9)”maypreventpeopleopeningupliving
spacesforventilation.
Transportationwasanimportantissueaffectingclients’abilitytoaccessfood,waterand
shelter, particularly in rural areas, where people were vulnerable to being cut off by
floods or bushfires and lacked personal transport and the resources to stock up on
essentials.Extremeheatandrainmadeitmoredifficulttobemobile,withmanyclients
reliantonwalkingastheironlymeansoftransport[25].Someurbanparticipantsalso
notedclientshaddifficultyaccessingdrinkingwater.
VULNERABILITY TO EXTREME WEATHER IMPACTS Despite also reporting “resilience” and “resourcefulness”, participants described
homelessclientsas highlyvulnerabletohealthimpactsfollowing exposureto extreme
weather events. This was largely attributed to the high prevalence of individuals with
multipleriskfactorsincludinghighratesofphysicalandmentalillness,pooraccessto
and engagement with health care and other services and increased environmental
exposure to extreme weather. Additional factors reported to increase vulnerability
included advanced age, youth, substance use, poor cognitive or life skills, impaired
mobility as well as lack of access to accommodation meeting the minimum standard,
socialsupports,transportandheatingandcoolingfacilities.
“…Underlying risk factors that put you at high risk in those situations anyway, those
things tend to be higher in a population of people who are homeless. If you have
multipleofthoseriskfactorsandyouarehomelessyouareatextremelyhighrisk(N9).”
12 Advanced age was an important factor contributing to increased vulnerability. Mental
illness contributed to poor coping strategies, such as walking all day during extreme
heat, without necessarily being aware of hydration, or inappropriate clothing for
weatherconditions.Inappropriatedresswasalsoreportedtooccurbecauseoftheneed
forhomelessindividualstosafeguardclothingbywearingit.
People experiencing homelessness were reported to face additional barriers to coping
withextremeheatsuchasdiscriminationandalackofdisposableincometoaccesscool
refuges.
“Howdoyougoswimmingifyoudon’thavebathersormoney?…Howdoyougotothe
pictureslikeotherpeopleifyoudon’thavemoneytogetin?(Majorcitycentre)isair‐
conditionedasashoppingcentre,butthereisasensethatyouarenotwelcomeifyou
don’thavemoneyinyourpockettospend(N17).”
IMPACTS OF EXTREME WEATHER ON CAPACITY FOR SERVICE PROVISION The majority of participants (thirteen) reported that extreme weather events had
impactedupontheabilityoftheirorganisationtoprovideservicestohomelessclientsat
leastmoderately.Ofthefourwhoansweredthatithadnotimpactedagreatdeal,three
indicatedtheirorganisationshadnotbeendirectlyaffectedbyamajorevent,whileone
indicatedahighleveloforganisationalpreparedness.
Sixteen participants reported increased demand for services during extreme weather
events and an increased workload. Additional tasks included ensuring clients are
bushfire ready and providing additional outreach services during heat waves to
distributewater,fansandtargetedhealthmessages.
“We get pretty inundated during summer because they (homeless clients) just need
respitefromtheheat(N14).”
Some participants reported that homelessness support organisations diverted
significant resources following the Black Saturday and the 2010/2011 floods to assist
thelargegroupofpeoplenewlymadehomelessandthatthiscompromisedtheabilityto
supportexistingclients.
“When there are more people accessing agencies like ourselves, our attention gets
directedawayfromthem(existingclients)(N2).”
Participantsreportedinsomecasesthattheeffectsofbushfires,floodsandextremeheat
on services’ buildings and infrastructure had restricted operations. Staff from locally
based organisations might be individually affected by extreme events and this might
further reduce the capacity of services to respond. For some, the need to protect staff
safetyduringextremeweathereventsfurtherrestrictedservicecapacity,whilstothers
reportedminimalimpactoncapacity:
13 “HavingtobalanceOHSofstaffwithourdutyofcaremeansthatwedohavetomake
compromisesaboutthelevelofservicesthatwewouldliketoprovideandfeelthatwe
oughttobeproviding.Anditcomesatatimewhenitwouldbeevenmorecriticalfor
ourclientstobeabletoaccesstheservices(N10).”
CLIMATE CHANGE AND THE HOMELESSNESS SECTOR Almost all (sixteen) participants responded that climate change was relevant for the
homelessnesssector.Theynotedhighlevelsofvulnerabilityamongstthehomelessdue
to exposure to weather, increased extreme weather events potentially decreasing
housing stocks, rising costs of living and rising temperatures hazardous to health. In
contrast,lessthanhalf(seven)indicatedthatclimatechangehadbeenincorporatedinto
theplanningoftheirorganisation.
EMERGENCY RESPONSE, RECOVERY AND COMMUNICATION A range of issues were identified as important in determining the adequacy of
emergency support for the homeless population. Insufficient supply of housing and
accommodationandtheabsenceofcoolandshelteredspacesininnerMelbournewere
consistently highlighted as important deficiencies. Emergency planning and co‐
ordination with other local services were important determinants of the ability to
implementaneffectiveresponse.Manycommentedontheneedtoimprovetheday‐to‐
daycapacityofthehomelessnessservicessectorinordertoincreasesurgecapacity:
“A lot of it is about how do you build that stuff into communities before these things
happen…(N9)”
Other factors identified as important determinants included enforcing housing
standards, access to low cost insurance, funding, human resources, material aid,
targeted communication for homeless populations, flexibility of service delivery with
outreachservicesandincreasedopeninghoursandprovisionofhealthcareservicesand
transportoptions.
DISCUSSION Thisstudyprovidespreliminaryevidencethatextremeweatherisimpactingadversely
on the health and welfare of homeless people in Victoria, and is likely to continue to
challenge effective service provision to this highly vulnerable group. Extreme weather
events,suchasextremeheat,bushfireandflood,weredescribedashavinga“magnifying
effect” on highly prevalent existing physical and mental health problems among the
homelesspopulation.Importantdeterminantsofhealth,suchastheabilitytoaccesssafe
housing, shelter, water and transport are also adversely affected. Extreme weather
eventswerereportedtoincreasethedemandforhomelessnesssupportservices,whilst
alsocreatingadditionalbarrierstothedeliveryofservices.
Studyparticipantsdescribedarangeofissueswithemergencyresponse,recoveryand
communicationinrelationtotheneedsofthehomelesspopulationarisingfromextreme
14 weather. Funding, housing, cool and sheltered places and outreach capacity were
consistentlydescribedasimportantareasofdeficiency,whilstemergencypreparedness
and coordinated planning with other local agencies were variable across services and
geographic locations. Inadequate support during the recovery period was reported to
leadmorepeopletoenteralonger‐termstateofhomelessness.
While risk factors in the wider population for morbidity and mortality from extreme
weather, particularly heat, have been described, the strong alignment of these risk
factorswiththecharacteristicsofhomelesspopulationshasnotalwaysbeenrecognised.
Chronicdiseaseprevalenceandseverity,suchascardiovascularandrespiratorydisease
and mental illness tend to be greater in homeless populations and these issues
combinedwithelevatedratesofsubstanceabuseandlackoffinancialresources,social
support and adequate shelter greatly accentuate the risk of adverse impacts from
extremeweather.Inaddition,residenceininnerurbanareas,wherealargeproportion
of the homeless population live, further intensifies risk as a result of increased air
pollutionandurbanheatislandeffects[5,26].
Extremeheatexacerbatingchronicdiseaseandmentalillnesshasbeenwelldescribed.
Having a psychiatric illness may triple the risk of death from extreme heat [26].The
health risks associated with the consumption of alcohol and illicit drugs, particularly
heavyconsumption,areknowntoincreaseduringextremeheatevents[27].Highrates
of respiratory illness may increase the risk of respiratory morbidity associated with
exposure to bushfire smoke amongst the homeless population [28]. An increased
incidence of common infections may occur following floods, including respiratory and
dermatologicalproblems[29,30].Bushfire and floodevents havebeenassociatedwith
increased mental illness, including depression and anxiety as well as post‐traumatic
stress and substance use disorders [29,30,31]. Flooding can disproportionately affect
thehomelessastheyoccupymoremarginalareas(suchascaravanparks)andmayhave
reduced opportunities for transport away from affected sites [29]. During Hurricane
KatrinaintheUSA,forexample,poorandmarginalisedpeopleweremostaffected,and
followingthisevent,thehomelesspopulationofNewOrleansnearlydoubled[5].
Ourfindingsareconsistentwithevidenceshowingextremeweathereventscontribute
to poor health by triggering or prolonging homelessness and exacerbating poverty,
mental health problems and the effects of physical injuries and chronic disease
[5,26,29,32,33]. Living in precarious housing has previously been found to have a
negative impact on health [9,32] and the housing shortage in Australia is expected to
steadily increase [34]. The elderly are particularly vulnerable to the health stressors
associated with homelessness as well as extreme weather events, with the strongest
evidence relating to the impact of extreme heat [2,4,7,11]. The increasing ageing
population, housing shortage and effects of climate change on extreme weather mean
that the vulnerability of the elderly homeless to weather extremes is likely to become
increasinglypertinent.
The specific needs of the homeless population may be ignored in climate change
adaptationanddisasterplanning.Thereissomeevidenceofasiloedapproachregarding
15 homeless populations in disaster response planning, with climate change a neglected
areainnationalandstatehomelessnessagendas[13,23,35].
This study identified that public facilities and services in the areas of transport, water
andshelter,maybeinsufficienttomeettheneedsofthemostvulnerableduringextreme
weather events. Ensuring access to cool spaces has been established as an effective
strategy to reduce the health impacts of extreme heat [26]. However, there remains a
lack of cool spaces in the city accessible to the homeless population. Greater access to
sheltered spaces would also help people experiencing homelessness to avoid health
impactsassociatedwithextremelywetandcoldconditions[10].Mobilityandaccessto
transportalsoaffecthealthoutcomesassociatedwithextremeweather[7,10,26,36].
AstudyofprimaryhomelessnessandextremeweatherinAdelaidefoundthatamajor
problemwasclient’sinabilitytogetdry,aswasalsoreflectedinourstudy.Therewere
similarfindingstooursintermsoftheimpactsofextremeheatonhealth,andbarriers
to adaptation such as poor access to drinking water and security and police moving
peopleonwhentryingtoaccesscoolspaces[14].Therearemanydocumentedcasesof
substandardconditionsincityboardinghouses[37],whichoftenpreventresidentsfrom
reducingtheirriskfromextremeheat.
.
Proactive and targeted communication and outreach services have been identified as
important strategies to ensure the safety of marginalised populations, including the
homeless,duringextremeweatherevents[21,38].Manyparticipantsreportedaneedto
increase outreach services, but also identified barriers to doing so, including a lack of
funding and staff, and hazards associated with extreme weather. Surge capacity of
homelessness services to meet increasing needs of clients may increasingly be a
problem under climate change. Early intervention to assist people who are newly
homeless to exit homelessness has been established to be cost‐effective, whilst those
who remain homeless for prolonged periods often require greater assistance over
extendedperiodsatmuchgreaterexpense[20].
Althoughmoststaffmembersinterviewedthoughtclimatechangewasrelevanttotheir
sector, only a minority indicated that climate change had been incorporated into
organisational service planning. This may indicate a lack of awareness, capacity or
merelytheunderstandableneedtofocusonshort‐termimperatives.
CONCLUSIONS Extreme weather can both increase the rate of homelessness and worsen the plight of
those already experiencing homelessness. This study provides some evidence that
extremeweatheriscurrentlyimpactingadverselyonthehealthandwelfareofhomeless
persons in Victoria and is likely to further challenge the provision of services to this
population.Thecapacityofrelevantservicestocopewiththeescalatingriskofextreme
weather under climate change, and increasing service demands, require further
evaluation.Climatechangeneedstobeintegratedinhousingandhomelessnessresearch
16 and policy agendas, and the needs of the homeless population must be addressed in
climatechangeadaptationandemergencyplanning.Aswetransitiontoamoreextreme
climate, it is vital that services are sufficiently resourced to respond to the needs of
peopleexperiencinghomelessnesswhoareamongstthemostvulnerableinoursociety.
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