Independent expert, Professor Donald Campbell, Professor of Medicine, Southern Clinical School, Monash University and Program Director, General Medicine Program, Monash Health advised theBoard that there were a number of groups that were particularly vulnerable to adverse health effectsfrom smoke and ash from the Hazelwood mine fire, in particular people with pre-existing cardiovascular and respiratory diseases, children and the elderly.16
As outlined in Chapter 4.1 Health and wellbeing – background, a large proportion of people within the Latrobe Valley community falls within one or more of these vulnerable groups.
PRE-EXISTING CARDIOVASCULAR AND RESPIRATORY DISEASES
Professor Campbell advised that people with pre-existing health conditions, including asthma, chronic obstructive pulmonary disease, ischaemic heart disease and congestive heart failure, were at increasedrisk from exposure to PM2.5, carbon monoxide and ozone.17 Also at increased risk were smokers who generally have compromised lung function, and people undertaking vigorous activity.18 Research has shown that individuals with chronic obstructive pulmonary disease have an increased risk of requiring emergency care after exposure to elevated levels of PM2.5.19
Professor Campbell advised that potential adverse health effects for people with pre-existing cardiovascular and respiratory disease range from exacerbation of their condition, hospital admission, stroke, heart attack and in severe cases, death.20
The Board heard from a number of people with pre-existing conditions who were affected by the smoke and ash. Many community members in this group reported an intensification of their symptoms, including increased coughing, breathlessness and lack of energy. Many did not seek additional medical care as they were able to manage their symptoms independently and were aware of the cause. Mr Ray Whittaker of Morwell told the Board: ‘I knew why I was coughing more, it was because of the smoke. I did not need to go to a doctor to be told that.’21
The following submission from a couple in Morwell describes the impact the smoke and ash had on their health and lives:
…[my] husband and I both suffer from and with lung disease, and, while we are both able to control our conditions, have suffered a great deal from the impact of the smoke and ash from the Hazelwood Mine Fire. We were virtually prisoners in our own home for at least seven weeks… I was found to be suffering from a bacterial lung infection deemed to be caused as a result from the contaminated air from the fire. My husband who suffers from asbestosis, also succumbed to five days in bed with a severe fever and coughing fit, attributable, we believe, to the mine fire.
We were unable to enjoy any kind of quality of life during those seven to eight weeks and were frightened to go outside without masks and other face coverings. The impact of this event (the mine fire) has left [me] with a continual cough and exacerbated breathlessness, and [my husband] still has coughing fits and some breathlessness on occasions.22
PREGNANT WOMEN AND UNBORN CHILDREN
Professor Campbell advised the Board that unborn children were particularly susceptible to high doses of carbon monoxide that can lead to low birth weight, premature labour and foetal death.23
Dr Rosemary Lester, Chief Health Officer, told the Board that a pregnant woman’s exposure to elevated levels of fine particles may result in a low birth weight for her baby.24 Dr Lester stated to the Board that this is why she included pregnant women as particularly at risk in her health alert dated 17 February 2014, and in alerts after that date.25
The Board heard from pregnant women who were very concerned about the short and long-term impacts of the smoke and ash on their health and the health of their unborn children. Ms Brooke Burke, Morwell Business Owner, told the Board:
I felt like I was having trouble breathing. I don’t know whether it was a bit of anxiety too because it was a pretty stressful day… and I felt quite light-headed and a bit unusual, but I don’t know whether that was the air or whether it was just me getting a bit worked up, being pregnant.26
Some pregnant women told the Board that although they sought regular medical attention, this did not ease their concerns about their unborn children, as the information provided was insufficient. Ms Wilson told the Board that she regularly attended her general practitioner and the health assessment centre to satisfy herself that she was doing everything she could to protect herself and her unborn child.27
Figure 4.42 A pregnant mother and child in Morwell
Image source Newspix / News Ltd
At community consultations members of the community told the Board that they were concerned about the effect of smoke and ash on children, in particular the potential for long-term adverse health effects.28
Professor Campbell told the Board that children are more vulnerable to the adverse effects of smoke and ash than adults, but that susceptibility gradually decreases as the child grows.29 A child’s body systems are still developing and therefore are more susceptible to damage from airborne contaminants.30 Studies have shown that children who have elevated exposure to particulate matter have increased respiratory problems, including decreased lung function and coughing.31
Dr Lester also provided information to the Board that, whilst there is no clear dividing line, a child’s susceptibility generally decreases as they grow, for example a three year old child would be more vulnerable to the effects of smoke and ash than a five year old child.32 Children are vulnerable because they have higher breathing rates than adults and therefore inhale more pollutants per kilogram of body weight than adults.33 Children also tend to spend greater periods of time outside engaging in physical activities and therefore risk greater exposure to contaminants in the air, such as smoke and ash.34
The Australian Early Development Index, a measure of how young children are developing in communities, demonstrates that prior to the Hazelwood mine fire, the children of Morwell were functioning below the state average in five key areas: physical health and wellbeing, social competence, emotional maturity, language and cognition skills, and communication skills and general knowledge.35 As a result, the children of Morwell were particularly vulnerable to the potential adverse effects of smoke and ash from the mine fire.
A number of children’s services and primary schools were relocated during the mine fire. Further information about the relocation of schools is in contained in Chapter 4.6 Health response.
As detailed in Chapter 4.1 Health and wellbeing – background, the Latrobe Valley and in particular Morwell, has an ageing population. Consequently, a significant proportion of the community were vulnerable to adverse health effects from smoke and ash.
Dr Lester advised the Board that people over 65 years of age generally have a decreased capacity in their heart and lungs so any strain, for example exposure to smoke and ash, puts them at increased risk compared to a healthy young adult.36 Older people are also more likely to have pre-existing cardiovascular and respiratory conditions.
Age alone does not make a person vulnerable to ill health. There is no doubt that many healthy people aged over 65 in Morwell are no more vulnerable than the general population to smoke and ash from the Hazelwood mine fire, and that people under 65 years of age may be more vulnerable than their age suggests. Dr Lester accepted that the use of the age 65 was a relatively arbitrary level.37
LOWER SOCIO-ECONOMIC STATUS
A further potential group of vulnerable people are those of lower socio-economic status.38
Professor Campbell told the Board that whilst he was unable to explain why it is exactly that people of lower socio-economic status are more vulnerable to pollutants, his experience, and epidemiological studies, suggest that they are.39 Professor Campbell hypothesised that this may be due to inadequacy of nutrition during childhood, which results in a greater risk of impaired lung function development. However he was unable to point to a definitive cause.40
Dr Lester told the Board that she was not aware that people who have a lower socio-economic status have a particular vulnerability to pollutants.41