Hopefully, some nimble-footed researchers are gearing up to seize the opportunity (perhaps not quite the right word) afforded by the flooding that is now devastating Queensland and parts of NSW and WA.

Media reports sounding the alarm about snake infestations prompted Croakey to do a quick search regarding what might be expected as the short and long-term health effects of the deluges.

One of the recurring themes from relevant articles seems to be the lack of evidence in this area, especially about the longer-term health impacts and how to prevent/manage them. Yet flooding is among the most common types of natural disasters and is predicted to become more frequent and intense as a result of climate change.

Our dry continent has contributed to the international literature on the health impacts of flooding – a study investigating the impact of the 1974 floods in Brisbane is widely cited. (Not surprisingly perhaps, the evidence emerges largely from the wealthier countries although they are less likely to be flood-hit).

I wasn’t able to source the full article but here is the abstract.

Med J Aust. 1976 Dec 18-25;2(25-26):936-9.

The Brisbane floods, January 1974: their impact on health. (Abrahams MJ, Price J, Whitlock FA, Williams G.)

In the 12 months following the Brisbane flood of 1974, 234 flooded families (695 persons) and 163 non-flooded families (507 persons) were interviewed to ascertain changes in health status. We found that the number of visits to general practitioners, hospitals and specialists were all significantly increased for flooded persons in the year following the flood. Persistent psychological symptoms, which included irritability, nervous tension and depressed mood, predominated in those seeking medical care, and the consumption of sleeping tablets and psychotropic drugs rose. Increased psychological symptoms were significantly more common in female than in male flood victims and significantly more common in both sexes than increased physical complaints. There was no increase in mortality after the flood. The incidence of psychiatric symptoms was directly related to dissatisfaction with help received.

Meanwhile, this article, published in the BMJ in 2000 after widespread flooding in England and Wales, notes that deaths and injuries not only result from the physical characteristics of the event but are also determined by the prevailing socioeconomic and health conditions of the community and any endemic infectious diseases.

Deaths are most often due to drowning hypothermia, electrocution, burns, and carbon monoxide poisoning (associated with the use of petrol powered electric generators and pressure washers in poorly ventilated areas indoors).

The risk of injuries doesn’t abate with the floodwaters. The number of orthopaedic injuries associated with flooding in North Carolina in 1999 increased steadily over time and peaked several weeks after the event as people returned to their homes to clean and make repairs.

This paper also noted that people affected by flooding are more likely to present to acute medical care facilities for skin rashes and exacerbation of asthma and for outpatient medical needs, such as dialysis or refills of prescriptions or oxygen.

It also says:

People affected by floods are often apprehensive about the potential, long term adverse effects of exposure to contaminants, mould, and toxic substances that may be present in their homes after clean up. Unfortunately there are no data that address these concerns.

The long-term effects of flooding on psychological health may perhaps be even more important than illness or injury. For most people the emotional trauma continues long after the water has receded. Making repairs, cleaning up, and dealing with insurance claims can be stressful. If there is a lack of support during the recovery process, stress levels may increase further.

Research from the United States indicates that providing increased social support can significantly lower illness burdens after natural disasters. Flood victims frequently report feeling depressed and isolated, and being evacuated from home and losing personal possessions may undermine people’s sense of place as well as their sense of attachment and self-identity.

The article also says that health care providers need to be aware of the increased medical and mental health needs of people who have experienced floods, which may continue for months and possibly years after the event. For some providers this may not be an easy task because a flood may also have a direct impact on staff and healthcare facilities.

Indeed. In fact, Croakey happened to be speaking to Dr Bruce Chater, a GP from the central Queensland town of Theodore, and his wife Anne and other colleagues on unrelated matters just before Christmas. They subsequently spent much of the Christmas period on unsuccessful attempts to protect their surgery. A photo is in circulation showing the waters lapping at the level of Chater’s desk. Presumably, a number of health services will need to rebuild while trying to provide care in coming weeks and months. What a tough start to the year. (Update: Meanwhile, another GP in the nearby town of Emerald has told 6Minutes of his “heartbreak” after discovering his surgery submerged in water. Dr Imran Hussain has lost patients’ records, computers and medical equipment.)

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Resources for GPs

Meanwhile, the RACGP has assembled resources that may be useful for GPs dealing with the aftermath of flooding.

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Global Health Impacts of Floods: Epidemiologic Evidence

This 2005 article also notes the “surprisingly limited evidence base” about the health effects of floods, and identifies a number of specific knowledge gaps.

It says:

Evidence on public health interventions (e.g., the need for measures to reduce the spread of infectious disease, dealing with mental health impacts, targeting of vulnerable groups) appears particularly limited. We found no studies on the effectiveness of public health measures, including early warning systems. Nonetheless, the wide range of risks to health and well-being, both physical and mental, is understood, though there remains scientific uncertainty about the strength of association and public health burden for specific health effects. The immediate risks of trauma and death are generally clear, but it seems that longer-term impacts, specifically on mental well-being, are often underestimated and probably receive too little attention from public health authorities.

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Lessons from New Orleans and the UK

This 2008 article in the Journal of Public Health investigates the health impacts of Hurricane Katrina in New Orleans, and concludes that: “Dealing with, and mitigating the short- and long-term health impacts of flooding is likely to be a key public health challenge for the 21st Century.”

It also cites a review of lessons in flood planning and management, arising from the 2007 floods in the UK. It says the review:

…concluded that although there was little evidence of the long-term health effects and impact of flooding, the limited evidence available suggested that there are significant short- and long-term impacts on psychosocial health. Data from Hull found that 70% of those who had been flooded and moved out of their homes reported health problems, both physical and mental. Of those affected by floods overall, 64% said that their health had been adversely affected, most commonly with stress, anxiety and depression, but also with a range of conditions, including dermatitis, worsening asthma, arthritis and chest infections. Children moving out of their home were more likely to suffer emotional health problems.

The Review has recommended that monitoring of the impact of flooding on the health and well being of the people and actions to mitigate and manage the effects should form a systematic part of the work of local Recovery Co-ordinating Groups, and that local responses need to ensure that health and well-being support is readily available to those affected by flooding. Additionally, it recommends that community networks, effective tools in reducing the psychosocial impact, need to be actively supported at local level. The Review specifically highlighted the need for consistent guidance about living or moving back into a damp home, given the psychological and physical ill health effects of having to stay out of one’s home.

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Please note: this blog is the result of a very quick search; if there are better, or more up-to-date references, please post the details below. Thanks, Melissa.

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Update, 12 Jan

A Rockhampton-based psychologist offers advice for how to help people during and after floods. Kevin Ronan, Chair of the Australian Psychological Society’s Disaster Reference Group, advises:

• Promote a sense of safety and calm, while at the same time being willing to provide comfort and empathy for people’s distress and loss. Staying connected to support networks following a disaster has been identified as a critical part of people getting back to normal.

• People often need repeated, simple and accurate information on how to access necessities.

• Survivors are likely to need contact that is predictable, familiar and respectful. Some people need to share stories and emotions, and should be listened to, but in a way that does not encourage disclosure beyond the level at which they feel comfortable. Others may not want to talk about it at all, and this is also OK: it is not useful, and is perhaps even harmful, to press people to talk about their experiences if they don’t wish to in this initial stage.

• There is no right or wrong way to feel.  People cope well when they believe they have the ability to manage a stressful event, so remind people of their own coping skills, strengths and resilience. Giving practical suggestions that steer them towards helping themselves and others can be very useful.

• Pay attention to children’s needs: Children are a particularly vulnerable group following a disaster.

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