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Climate change is one of the greatest global health threats of the 21st century, with its impacts disproportionately affecting at-risk populations. In response, governments worldwide are increasingly integrating health considerations into climate policies. Despite these efforts, there is limited understanding of policymakers’ efforts at subnational levels. In our case study of Victoria, Australia, we explore the degree to which state and local government policymakers incorporate health considerations into climate-related decision-making. Findings highlight current knowledge, attitudes and practices toward the integration of health considerations, as well as barriers, enablers, policymaker needs and future opportunities. Specifically, there is heterogeneity in policy development and planning processes, and barriers include resource constraints, governance and data challenges. Enabling factors include legislative mandates and systems thinking processes. Several needs and opportunities are identified, including improving climate and health knowledge among senior colleagues; providing tangible examples of interventions that result in positive health outcomes; and articulating health, economic and other benefits. While the transferability of our results to other jurisdictions is limited, these insights may have broader relevance for policymakers seeking to embed health in climate mitigation and adaptation efforts globally, particularly in contexts where cross-sectoral collaboration and evidence-informed decision-making are priorities.

Background and objective: On 21 November 2016, parts of Victoria experienced a devastating epidemic thunderstorm asthma (ETSA) event. The aim of this study was to describe the epidemiology and burden of the 2016 ETSA event at MedicineInsight-registered general practices in the Melbourne metropolitan area in Victoria, Australia. Methods: A cross-sectional study was conducted using patient record data from 21-23 November 2016. Codes were developed to identify all patients presenting to MedicineInsight-registered general practices with asthma during the 2016 ETSA event. Results: During the event, there were 787 more asthma-related encounters to MedicineInsight general practices than expected, which represented a 7.1-fold increase (605% increase). Estimates suggest that there were between approximately 8940 and 13,689 more asthma-related encounters than expected across metropolitan Melbourne. Discussion: General practices were significantly affected by the 2016 ETSA event. This work highlights the important part that general practices play in responding to ETSA events and the need for these practices to be prepared to respond.

In November 2016, an unprecedented epidemic thunderstorm asthma event in Victoria, Australia, resulted in many thousands of people developing breathing difficulties in a very short period of time, including 10 deaths, and created extreme demand across the Victorian health services. To better prepare for future events, a pilot forecasting system for epidemic thunderstorm asthma (ETSA) risk has been developed for Victoria. The system uses a categorical risk-based approach, combining operational forecasting of gusty winds in severe thunderstorms with statistical forecasts of high ambient grass pollen concentrations, which together generate the risk of epidemic thunderstorm asthma. This pilot system provides the first routine daily epidemic thunderstorm asthma risk forecasting service in the world that covers a wide area, and integrates into the health, ambulance, and emergency management sector. Epidemic thunderstorm asthma events have historically occurred infrequently, and no event of similar magnitude has impacted the Victorian health system since. However, during the first three years of the pilot, 2017–19, two high asthma presentation events and four moderate asthma presentation events were identified from public hospital emergency department records. The ETSA risk forecasts showed skill in discriminating between days with and without health impacts. However, even with hindsight of the actual weather and airborne grass pollen conditions, some high asthma presentation events occurred in districts that were assessed as low risk for ETSA, reflecting the challenge of predicting this unusual phenomenon.

Cyanobacteria (blue-green algae) are abundant in fresh, brackish and marine waters worldwide. When toxins produced by cyanobacteria are present in the aquatic environment, seafood harvested from these waters may present a health hazard to consumers. Toxicity hazards from seafood have been internationally recognised when the source is from marine algae (dinoflagellates and diatoms), but to date few risk assessments for cyanobacterial toxins in seafood have been presented. This paper estimates risk from seafood contaminated by cyanobacterial toxins, and provides guidelines for safe human consumption.

Background and objective On 21 November 2016, parts of Victoria experienced a devastating epidemic thunderstorm asthma (ETSA) event. The aim of this study was to describe the epidemiology and burden of the 2016 ETSA event at MedicineInsight-registered general practices in the Melbourne metropolitan area in Victoria, Australia. Methods A cross-sectional study was conducted using patient record data from 21-23 November 2016. Codes were developed to identify all patients presenting to MedicineInsight-registered general practices with asthma during the 2016 ETSA event. Results During the event, there were 787 more asthma-related encounters to Medicinelnsight general practices than expected, which represented a 7.1-fold increase (605% increase). Estimates suggest that there were between approximately 8940 and 13,689 more asthma-related encounters than expected across metropolitan Melbourne. Discussion General practices were significantly affected by the 2016 ETSA event. This work highlights the important part that general practices play in responding to ETSA events and the need for these practices to be prepared to respond.