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Objectives: To assess the population health impact of high temperatures on workplace health and safety by estimating the burden of heat‐attributable occupational injury in Australia. Study design, setting: Retrospective observational study; estimation of burden of occupational injury in Australia attributable to high temperatures during 2014–19, based on Safe Work Australia (work‐related traumatic injury fatalities and workers' compensation databases) and Australian Institute of Health and Welfare data (Australian Burden of Disease Study and National Hospital Morbidity databases), and a meta‐analysis of climate zone‐specific risk data. Main outcome measure: Burden of heat‐attributable occupational injuries as disability‐adjusted life years (DALYs), comprising the numbers of years of life lived with disability (YLDs) and years of life lost (YLLs), nationally, by Köppen–Geiger climate zone, and by state and territory. Results: During 2014–19, an estimated 42 884 years of healthy life were lost to occupational injury, comprising 39 485 YLLs (92.1%) and 3399 YLDs (7.9%), at a rate of 0.80 DALYs per 1000 workers per year. A total of 967 occupational injury‐related DALYs were attributable to heat (2.3% of occupational injury‐related DALYs), comprising 890 YLLs (92%) and 77 YLDs (8%). By climate zone, the heat‐attributable proportion was largest in the tropical Am (12 DALYs; 3.5%) and Aw zones (34 DALYs; 3.5%); by state and territory, the proportion was largest in New South Wales and Queensland (each 2.9%), which also included the largest numbers of heat‐attributable occupational injury‐related DALYs (NSW: 379 DALYs, 39% of national total; Queensland: 308 DALYs; 32%). Conclusion: An estimated 2.3% of the occupational injury burden in Australia is attributable to high ambient temperatures. To prevent this burden increasing with global warming, adaptive measures and industry‐based policies are needed to safeguard workplace health and safety, particularly in heat‐exposed industries, such as agriculture, transport, and construction. [ABSTRACT FROM AUTHOR]

Background With high temperature becoming an increasing health risk due to a changing climate, it is important to quantify the scale of the problem. However, estimating the burden of disease (BoD) attributable to high temperature can be challenging due to differences in risk patterns across geographical regions and data accessibility issues. Methods We present a methodological framework that uses Köppen–Geiger climate zones to refine exposure levels and quantifies the difference between the burden observed due to high temperatures and what would have been observed if the population had been exposed to the theoretical minimum risk exposure distribution (TMRED). Our proposed method aligned with the Australian Burden of Disease Study and included two parts: (i) estimation of the population attributable fractions (PAF); and then (ii) estimation of the BoD attributable to high temperature. We use suicide and self-inflicted injuries in Australia as an example, with most frequent temperatures (MFTs) as the minimum risk exposure threshold (TMRED). Results Our proposed framework to estimate the attributable BoD accounts for the importance of geographical variations of risk estimates between climate zones, and can be modified and adapted to other diseases and contexts that may be affected by high temperatures. Conclusions As the heat-related BoD may continue to increase in the future, this method is useful in estimating burdens across climate zones. This work may have important implications for preventive health measures, by enhancing the reproducibility and transparency of BoD research. [ABSTRACT FROM AUTHOR]

Objective: To explore animal science and veterinary students' and livestock farmers' perceptions concerning Q fever prevention. Design: An online survey with an open‐ended question seeking knowledge and perceptions about Q fever prevention was distributed among participants during March‐September 2019. We applied thematic analysis to identify emerging themes. Setting: Animal science and veterinary students enrolled at the University of Adelaide and members of Livestock South Australia representing cattle, sheep and goat farmers in South Australia. Participants: A total of56 animal science and veterinary students and 154 livestock farmers responded to the open‐ended question. Interventions: Not applicable. Main outcome measures: Perceived challenges and opportunities for a coordinated Q fever prevention approach including human vaccination reported by the participants. Results: Two major themes arose in each group. Students and farmers viewed Q fever vaccination as important. However, excessive cost for students was a barrier and for farmers, it was general practitioners' lack of knowledge of Q fever and access to an accredited immunisation provider. Similarly, both groups highlighted the need for education and increasing public and community awareness of Q fever. Conclusion: Our findings underscore that a sector‐wide approach involving community awareness programmes, education and training for general practitioners, and subsidised vaccination as well as commitment from government and industry partners may contribute to reducing the burden of Q fever among at‐risk populations. [ABSTRACT FROM AUTHOR]

Heatwaves can be a common occurrence in Australia, and the public health impacts can be severe. Heat warnings and interventions are being adopted widely to reduce the preventable health impacts. This study examines the effects of heatwaves on morbidity and mortality in different climatic regions in the state of South Australia, to inform the targeting of heat warnings according to regional needs. Heatwaves were defined using the excess heat factor (EHF), an index based on mean daily temperature indices that quantifies heatwave severity relative to the local climate. In all regions, there were increases in morbidity (daily rates of ambulance call-outs and heat-related emergency presentations and hospital admissions) on heatwave days compared to non-heatwave days, which increased with heatwave severity. This study demonstrates that a consistent measure for heatwave severity, based on EHF, can be used to underpin public health warnings for climatically diverse areas. [ABSTRACT FROM AUTHOR]

Human contact with soil may be important for building and maintaining normal healthy immune defence mechanisms, however this idea remains untested at the population-level. In this continent-wide, cross-sectional study we examine the possible public health benefit of ambient exposures to soil of high cation exchange capacity (CEC), a surrogate for potential immunomodulatory soil microbial diversity. We compare distributions of normalized mean 2011/12–2012/13 age-standardized public hospital admission rates (cumulative incidence) for infectious and parasitic diseases across regional Australia (representing an average of 29,516 patients/year in 228 local government areas), within tertiles of socioeconomic status and soil exposure. To test the significance of soil CEC, we use probabilistic individual-level environmental exposure data (with or without soil), and group-level variables, in robust non-parametric multilevel modelling to predict disease rates in unseen groups. Our results show that in socioeconomically-deprived areas with high CEC soils, rates of infectious and parasitic disease are significantly lower than areas with low CEC soils. Also, health inequality (relative risk) due to socioeconomic status is significantly lower in areas with high CEC soils compared to low CEC soils (Δ relative risk = 0.47; 95% CI: 0.13, 0.82). Including soil exposure when modelling rates of infectious and parasitic disease significantly improves prediction performance, explaining an additional 7.5% (Δ r 2  = 0.075; 95% CI: 0.05, 0.10) of variation in disease risk, in local government areas that were not used for model building. Our findings suggest that exposure to high CEC soils (typically high soil biodiversity) associates with reduced risk of infectious and parasitic diseases, particularly in lower socioeconomic areas. [ABSTRACT FROM AUTHOR]

Abstract: Background: There are ongoing concerns about treatment failure with azithromycin for the treatment of rectal chlamydia. Aim: To investigate treatment efficacy of two treatments for rectal chlamydial infection. Methods: We performed a retrospective analysis of all patients diagnosed with rectal chlamydial infection between 2009 and 2015 in Adelaide, Australia. Patients were treated with either azithromycin (1 g single dose) or doxycycline (100 mg twice a day for 10 days) and returned for repeat testing 14–180 days after treatment commenced. Log‐binomial models were used to estimate the relative risk (RR) of recurrent rectal chlamydia associated with the treatment with azithromycin versus doxycycline. Results: In men, rectal chlamydia prevalence was 6.7%, and in women, it was 8.1%. Of the 526 patients diagnosed with rectal chlamydial infections, 419 (79.7%), 93 (17.7%) and 14 (2.6%) patients were treated with doxycycline, azithromycin or other medication respectively. Of these patients, 173 (41.3%) of 419 doxycycline‐treated patients and 31 (33.3%) of 93 azithromycin‐treated patients were retested between 14 and 180 days after treatment commenced (P = 0.16). Among these patients, the repeat rectal chlamydia test was less commonly positive in those treated with doxycycline (5.8%; 95% confidence interval (CI) 0.03–0.10) compared with those treated with azithromycin (19.4%; 95% CI 0.09–0.36) and (P = 0.01). In the multivariate analysis, azithromycin‐treated patients had a significantly higher risk of a positive test in the 14 and 180 days after treatment commenced (adjusted relative risk (aRR) 2.96, 95% CI 1.16–7.57). Conclusion: The findings suggest that doxycycline may be more effective than azithromycin in treating rectal chlamydial infections. [ABSTRACT FROM AUTHOR]

Exposure to extreme heat is a familiar seasonal experience for many rural communities across Australia, which is projected to increase in frequency and intensity with climate change. This has wide-ranging implications for community health and well-being, livelihoods, recreation, and the natural and built environments. In this study, we have examined how rural and remote communities in South Australia experience and respond to extreme heat, and how this is influenced by physical, social and psychological aspects of place. Interviews with participants across different climatic regions of South Australia were analysed using a broad thematic framework that included physical aspects of place, human activities, social and community aspects, and relationships with place; providing a descriptive account of heat impacts and responses. We further suggest that some narratives expressed the construction of a rural or remote identity, with climate being a part of this relationship; suggesting that place identity may be a subjective aspect underpinning appraisals of extreme heat. We discuss the implications for adaptation choices in a warming climate. [ABSTRACT FROM AUTHOR]

Objectives: Given increasing frequency of heatwaves and growing public health concerns associated with foodborne disease, we examined the relationship between heatwaves and salmonellosis in Adelaide, Australia.Methods: Poisson regression analysis with Generalised Estimating Equations was used to estimate the effect of heatwaves and the impact of intensity, duration and timing on salmonellosis and specific serotypes notified from 1990 to 2012. Distributed lag non-linear models were applied to assess the non-linear and delayed effects of temperature during heatwaves on Salmonella cases.Results: Salmonella typhimurium PT135 notifications were sensitive to the effects of heatwaves with a twofold (IRR 2.08, 95% CI 1.14-3.79) increase in cases relative to non-heatwave days. Heatwave intensity had a significant effect on daily counts of overall salmonellosis with a 34% increase in risk of infection (IRR 1.34, 95% CI 1.01-1.78) at >41 °C. The effects of temperature during heatwaves on Salmonella cases and serotypes were found at lags of up to 14 days.Conclusion: This study confirms heatwaves have a significant effect on Salmonella cases, and for the first time, identifies its impact on specific serotypes and phage types. These findings will contribute to the understanding of the impact of heatwaves on salmonellosis and provide insights that could mitigate their impact. [ABSTRACT FROM AUTHOR]

With warmer weather projections, workplace heat exposure is presenting a growing challenge to workers’ health and safety. Occupational hygienists are the specialist group conducting measurements and providing advice on heat stress management to industry. In order to provide insights into hygienists perceptions on workplace heat exposure, current and future preparedness for extreme heat, and barriers to possible heat adaptation strategies, a self-administered questionnaire survey was conducted during a national conference of the Australian Institute of Occupational Hygienists. Nearly 90% of the 180 respondents were at least moderately concerned about extreme heat and 19% were dissatisfied with current heat stress prevention measures. Barriers recognized by the participants were lack of awareness (68%), insufficient training (56%), unsatisfactory management commitment (52%), and low compliance with prevention policies (40%). The findings suggest a need to refine occupational heat management and prevention strategies. [ABSTRACT FROM AUTHOR]

Introduction. Migrants generally have more favourable mortality outcomes than the Australian-born population. The aim of this study is to update knowledge and inform future research in this field by examining mortality from musculoskeletal conditions, asthma, cardiovascular disease, diabetes mellitus, injuries and mental conditions between 1981 and 2007 among migrants in Australia. Methods. Average annual sex- and age-standardised mortality rates were calculated for each migrant group, period of death registration and cause of death. Results and Conclusions. Mortality rates decreased among most groups for asthma, cardiovascular disease and motor vehicle accidents, with rates diverging in the later time periods. The reverse was true for mental disorders, where Australian-born individuals experienced the greatest increase in mortality. Migrants generally displayed more favourable mortality outcomes than their Australian-born counterparts. Migrants from Southern Europe appeared to have the greatest advantage. However, some migrants appeared to be over-represented in the areas of diabetes, suicide and mental health. [ABSTRACT FROM AUTHOR]

The MJA-Lancet Countdown on health and climate change was established in 2017 and produced its first Australian national assessment in 2018. It examined 41 indicators across five broad domains: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. It found that, overall, Australia is vulnerable to the impacts of climate change on health, and that policy inaction in this regard threatens Australian lives. In this report we present the 2019 update. We track progress on health and climate change in Australia across the same five broad domains and many of the same indicators as in 2018. A number of new indicators are introduced this year, including one focused on wildfire exposure, and another on engagement in health and climate change in the corporate sector. Several of the previously reported indicators are not included this year, either due to their discontinuation by the parent project, the Lancet Countdown, or because insufficient new data were available for us to meaningfully provide an update to the indicator. In a year marked by an Australian federal election in which climate change featured prominently, we find mixed progress on health and climate change in this country. There has been progress in renewable energy generation, including substantial employment increases in this sector. There has also been some progress at state and local government level. However, there continues to be no engagement on health and climate change in the Australian federal Parliament, and Australia performs poorly across many of the indicators in comparison to other developed countries; for example, it is one of the world's largest net exporters of coal and its electricity generation from low carbon sources is low. We also find significantly increasing exposure of Australians to heatwaves and, in most states and territories, continuing elevated suicide rates at higher temperatures. We conclude that Australia remains at significant risk of declines in health due to climate change, and that substantial and sustained national action is urgently required in order to prevent this. [ABSTRACT FROM AUTHOR]

The costs of global warming are substantial. These include expenses from occupational illnesses and injuries (OIIs), which have been associated with increases during heatwaves. This study estimated retrospective and projected future heatwave-attributable OIIs and their costs in Australia. Climate and workers' compensation claims data were extracted from seven Australian capital cities representing OIIs from July 2005 to June 2018. Heatwaves were defined using the Excess Heat Factor. OIIs and associated costs were estimated separately per city and pooled to derive national estimates. Results were projected to 2030 (2016–2045) and 2050 (2036–2065). The risk of OIIs and associated costs increased during heatwaves, with the risk increasing during severe and particularly extreme heatwaves. Of all OIIs, 0.13% (95% empirical confidence interval [eCI]: 0.11–0.16%) were heatwave-attributable, equivalent to 120 (95%eCI:70–181) OIIs annually. 0.25% of costs were heatwave-attributable (95%eCI: 0.18–0.34%), equal to $AU4.3 (95%eCI: 1.4–7.4) million annually. Estimates of heatwave-attributable OIIs by 2050, under Representative Concentration Pathway [RCP]4.5 and RCP8.5, were 0.17% (95%eCI: 0.10–0.27%) and 0.23% (95%eCI: 0.13–0.37%), respectively. National costs estimates for 2030 under RCP4.5 and RCP8.5 were 0.13% (95%eCI: 0.27-0.46%) and 0.04% (95%eCI: 0.66-0.60), respectively. These estimates for extreme heatwaves were 0.04% (95%eCI: 0.02–0.06%) and 0.04% (95%eCI: 0.01–0.07), respectively. Cost-AFs in 2050 were, under RCP4.5, 0.127% (95%eCI: 0.27-0.46) for all heatwaves and 0.04% (95%eCI: 0.01-0.09%) for extreme heatwaves. Attributable fractions were approximately similar to baseline when assuming theoretical climate adaptation. Heatwaves represent notable and preventable portions of preventable OIIs and economic burden. OIIs are likely to increase in the future, and costs during extreme heatwaves in 2030. Workplace and public health policies aimed at heat adaptation can reduce heat-attributable morbidity and costs. [Display omitted] • Limited research on expenses from work injuries and illnesses during heatwaves. • Assessment of heatwave-attributable occupational injuries, illnesses and costs. • Increased injuries and illnesses during heatwaves both retrospectively and future. • Costs increased during heatwaves, with some evidence for projected increases. • Climate adaptation can potentially reduce occupational burden. [ABSTRACT FROM AUTHOR]

Megatrends of urbanisation and reducing contact with natural environments may pose a largely unappreciated risk to human health, particularly in children, through declining normal (healthy) immunomodulatory environmental exposures. On the other hand, building knowledge of connections between environments, biodiversity and human health may offer new integrated ways of addressing global challenges of rising population health costs and declining biodiversity. In this study we are motivated to build insight and provide context and priority for emerging research into potential protective (e.g. immunomodulatory) environmental exposures. We use respiratory health as a test case to explore whether some types and qualities of environment may be more beneficial than others, and how such exposures may compare to known respiratory health influences, via a cross-sectional ecological epidemiology study for the continent of Australia. Using Lasso penalized regression (to interpret key predictors from many candidate variables) and 10-fold cross-validation modelling (to indicate reproducibility and uncertainty), within different socio-geographic settings, our results show surrogate measures of landscape biodiversity correlate with respiratory health, and rank amongst known predictors. A range of possible drivers for this relationship are discussed. Perhaps most novel and interesting of these is the possibility of protective immunomodulatory influence from microbial diversity (suggested by the understudied ‘biodiversity hypothesis’) and other bioactive agents associated with biodiverse environments. If beneficial influences can be demonstrated from biodiverse environments on immunomodulation and human health, there may be potential to design new cost-effective nature-based health intervention programs to reduce the risk of immune-related disease at a population level. Our approach and findings are also likely to have use in the evaluation of environment and health associations elsewhere. [ABSTRACT FROM AUTHOR]

Increased risk of occupational injuries and illnesses (OI) is associated with ambient temperature. However, most studies have reported the average impacts within cities, states, or provinces at broader scales. We assessed the intra-urban risk of OI associated with ambient temperature in three Australian cities at statistical area level 3 (SA3). We collected daily workers' compensation claims data and gridded meteorological data from July 1, 2005, to June 30, 2018. Heat index was used as the primary temperature metric. We performed a two-stage time series analysis: we generated location-specific estimates using Distributed Lag Non-Linear Models (DLNM) and estimated the cumulative effects with multivariate meta-analysis. The risk was estimated at moderate heat (90th percentile) and extreme heat (99th percentile). Subgroup analyses were conducted to identify vulnerable groups of workers. Further, the OI risk in the future was estimated for two projected periods: 2016–2045 and 2036–2065. The cumulative risk of OI was 3.4% in Greater Brisbane, 9.5% in Greater Melbourne, and 8.9% in Greater Sydney at extreme heat. The western inland regions in Greater Brisbane (17.4%) and Greater Sydney (32.3%) had higher risk of OI for younger workers, workers in outdoor and indoor industries, and workers reporting injury claims. The urbanized SA3 regions posed a higher risk (19.3%) for workers in Greater Melbourne. The regions were generally at high risk for young workers and illness-related claims. The projected risk of OI increased with time in climate change scenarios. This study provides a comprehensive spatial profile of OI risk associated with hot weather conditions across three cities in Australia. Risk assessment at the intra-urban level revealed strong spatial patterns in OI risk distribution due to heat exposure. These findings provide much-needed scientific evidence for work, health, and safety regulators, industries, unions, and workers to design and implement location-specific preventative measures. • Western inland regions of Sydney and Brisbane are at greater risk of OI for workers. • Workers in regions with low NDVI and socio-economic status are vulnerable to heat. • Projected climate change (2016–3045, 2036–2065) will heighten heat-related OI risk. • Location-specific risk estimation of OI is crucial to mitigate the impacts of heat. [ABSTRACT FROM AUTHOR]

• We reviewed the association between temperature and Ross river virus infection. • A 1 °C rise in temperature increases the risk of Ross river virus infection by 9%.x0025 • Ross river virus infection was higher in the humid subtropical climate zone. • The evidence could contribute to Ross river virus intervention and control. • Future studies need to account for socio-demographic and environmental factors. Ross River virus (RRV) infection is one of the emerging and prevalent arboviral diseases in Australia and the Pacific Islands. Although many studies have been conducted to establish the relationship between temperature and RRV infection, there has been no comprehensive review of the association so far. In this study, we performed a systematic review and meta-analysis to assess the effect of temperature on RRV transmission. We searched PubMed, Scopus, Embase, and Web of Science with additional lateral searches from references. The quality and strength of evidence from the included studies were evaluated following the Navigation Guide framework. We have qualitatively synthesized the evidence and conducted a meta-analysis to pool the relative risks (RRs) of RRV infection per 1 °C increase in temperature. Subgroup analyses were performed by climate zones, temperature metrics, and lag periods. A total of 17 studies met the inclusion criteria, of which six were included in the meta-analysis The meta-analysis revealed that the overall RR for the association between temperature and the risk of RRV infection was 1.09 (95% confidence interval (CI): 1.02, 1.17). Subgroup analyses by climate zones showed an increase in RRV infection per 1 °C increase in temperature in humid subtropical and cold semi-arid climate zones. The overall quality of evidence was "moderate" and we rated the strength of evidence to be "limited", warranting additional evidence to reduce uncertainty. The results showed that the risk of RRV infection is positively associated with temperature. However, the risk varies across different climate zones, temperature metrics and lag periods. These findings indicate that future studies on the association between temperature and RRV infection should consider local and regional climate, socio-demographic, and environmental factors to explore vulnerability at local and regional levels. [Display omitted] [ABSTRACT FROM AUTHOR]

• Foreign-born workers were less likely to make a repeat claim than native workers. • Foreign-born workers were generally less likely to have time off work. • The time interval of repeat claims was shorter in foreign-born workers. • Repeat claims indicates room for improvement to reduce work-related injuries. Several studies have explored the factors associated with repeat workers' compensation claims, however, none investigated the impact of migration status on repeat claims among injured workers. Using South Australian workers' compensation claims data from 2000 to 2014, generalized estimating equation models were used to compare the differences in repeat claims between foreign-born workers (FBW) and Australian-born workers. Time intervals between repeat claims, compensation costs, and working days lost by region of birth, as well as the change of severity between repeat claims were examined. Amongst 464,596 accepted compensation claims, repeat claims for FBW (50.5%) was lower than that of Australian-born workers (57.4%, incidence-rate ratio, IRR = 0.83, 95% CI 0.82–0.84). However, region-specific analysis showed that European-born migrant workers were 19% more likely to make repeat claims than Australian-born workers (IRR = 1.19, 95% CI 1.17–1.22), including burns, digestive diseases, fractures, infectious diseases, mental disorders, musculoskeletal diseases, and skin injuries. The time interval between repeat claims was shorter for FBW compared to Australian-born workers and compensation payments of repeat claims were higher. Regardless of birth region, time intervals between repeat claims showed a decreasing temporal trend, while it was the opposite in terms of injury severity. Foreign-born workers were generally less likely to make a repeat claim than Australian-born workers, but with birth region differences. This may be attributable to underreporting from some workers. Foreign-born workers were generally less likely to have time off work but the overall costs were higher. These differences should be considered in future injury prevention strategies. [ABSTRACT FROM AUTHOR]

• Work-injury risk increases in hot weather and risk factors require investigation. • We examined stakeholder perspectives to identify work-injury risks in hot weather. • A survey of health and safety representatives examined heat risks and outcomes. • A range of modifiable work and organisational risk factors were identified. • Preventive efforts should encompass heat-related physical injuries as well as illness. Hot weather poses occupational health and safety concerns for people working in hot environments. It is known that work-related injuries increase during hot weather, yet there is an incomplete understanding of the underlying factors. A national online survey was conducted in Australia among health and safety representatives (HSRs) to better understand factors contributing to heat-related injuries in workplaces. Risk factors and preventive measures associated with reported injuries were identified using log-poisson regression models. In total, 222 HSRs completed the survey. Overall, 43% reported that injuries or incidents caused by hot/very humid weather occur sometimes or often in their workplace. Factors found to be associated with reported heat-related injuries included 'the wearing of personal protective equipment (PPE)' which can hinder the loss of body heat, and 'inadequate resources and facilities'. 'Piece-rate workers' and 'new workers' were identified as being at high risk. The most frequently adopted preventive measures for outdoor and indoor workers were the provision of PPE (despite some identified issues) and access to cool drinking water. HSRs reported that less injuries occurred in hot weather among outdoor workers if work was rescheduled to cooler times and shade was provided; and in indoor environments where there was adequate ventilation, heat sources were shielded and workers were able to self-pace. Organisational issues, workplace hazards, personal factors and preventive measures, are all determinants of heat-related injuries in Australian workplaces. Wider adoption of identified prevention measures could reduce the incidence of heat-related injuries in outdoor and indoor workplaces. [ABSTRACT FROM AUTHOR]

(1) Background: High ambient temperatures are associated with increased morbidity and mortality rates, and some evidence suggests that high temperatures increase the risk of road crashes. However, little is known regarding the burden of road crashes attributable to no-optimal high temperatures in Australia. Therefore, this study examined the effects of high temperatures on road crashes using Adelaide in South Australia as a case study. (2) Methods: Ten-year daily time-series data on road crashes (n = 64,597) and weather during the warm season (October-March) were obtained between 2012 and 2021. A quasi-Poisson distributed lag nonlinear model (DLNM) was used to quantify the cumulative effect of high temperatures over the previous five days. The associations and attributable burden at moderate and extreme temperature ranges were computed as relative risk (RR) and attributable fraction. (3) Results: There was a J-shaped association between high ambient temperature and the risk of road crashes during the warm season in Adelaide, and pronounced effects were observed for minimum temperatures. The highest risk was observed at a 1 day lag and lasting for 5 days. High temperatures were responsible for 0.79% (95% CI: 0.15-1.33%) of road crashes, with moderately high temperatures accounting for most of the burden compared with extreme temperatures (0.55% vs. 0.32%). (4) Conclusions: In the face of a warming climate, the finding draws the attention of road transport, policy, and public health planners to design preventive plans to reduce the risk of road crashes attributable to high temperatures.

Background: Studies have shown that dengue virus transmission increases in association with ambient temperature. We performed a systematic review and meta-analysis to assess the effect of both high temperatures and heatwave events on dengue transmission in different climate zones globally., Methods: A systematic literature search was conducted in PubMed, Scopus, Embase, and Web of Science from January 1990 to September 20, 2022. We included peer reviewed original observational studies using ecological time series, case crossover, or case series study designs reporting the association of high temperatures and heatwave with dengue and comparing risks over different exposures or time periods. Studies classified as case reports, clinical trials, non-human studies, conference abstracts, editorials, reviews, books, posters, commentaries; and studies that examined only seasonal effects were excluded. Effect estimates were extracted from published literature. A random effects meta-analysis was performed to pool the relative risks (RRs) of dengue infection per 1 °C increase in temperature, and further subgroup analyses were also conducted. The quality and strength of evidence were evaluated following the Navigation Guide systematic review methodology framework. The review protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO)., Findings: The study selection process yielded 6367 studies. A total of 106 studies covering more than four million dengue cases fulfilled the inclusion criteria; of these, 54 studies were eligible for meta-analysis. The overall pooled estimate showed a 13% increase in risk of dengue infection (RR = 1.13; 95% confidence interval (CI): 1.11-1.16, I 2  = 98.0%) for each 1 °C increase in high temperatures. Subgroup analyses by climate zones suggested greater effects of temperature in tropical monsoon climate zone (RR = 1.29, 95% CI: 1.11-1.51) and humid subtropical climate zone (RR = 1.20, 95% CI: 1.15-1.25). Heatwave events showed association with an increased risk of dengue infection (RR = 1.08; 95% CI: 0.95-1.23, I 2  = 88.9%), despite a wide confidence interval. The overall strength of evidence was found to be "sufficient" for high temperatures but "limited" for heatwaves. Our results showed that high temperatures increased the risk of dengue infection, albeit with varying risks across climate zones and different levels of national income., Interpretation: High temperatures increased the relative risk of dengue infection. Future studies on the association between temperature and dengue infection should consider local and regional climate, socio-demographic and environmental characteristics to explore vulnerability at local and regional levels for tailored prevention., Funding: Australian Research Council Discovery Program., Competing Interests: Declaration of interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

This study aimed to estimate respiratory disease hospitalization costs attributable to ambient temperatures and to estimate the future hospitalization costs in Australia. The associations between daily hospitalization costs for respiratory diseases and temperatures in Sydney and Perth over the study period of 2010-2016 were analyzed using distributed non-linear lag models. Future hospitalization costs were estimated based on three predicted climate change scenarios-RCP2.6, RCP4.5 and RCP8.5. The estimated respiratory disease hospitalization costs attributable to ambient temperatures increased from 493.2 million Australian dollars (AUD) in the 2010s to more than AUD 700 million in 2050s in Sydney and from AUD 98.0 million to about AUD 150 million in Perth. The current cold attributable fraction in Sydney (23.7%) and Perth (11.2%) is estimated to decline by the middle of this century to (18.1-20.1%) and (5.1-6.6%), respectively, while the heat-attributable fraction for respiratory disease is expected to gradually increase from 2.6% up to 5.5% in Perth. Limitations of this study should be noted, such as lacking information on individual-level exposures, local air pollution levels, and other behavioral risks, which is common in such ecological studies. Nonetheless, this study found both cold and hot temperatures increased the overall hospitalization costs for respiratory diseases, although the attributable fractions varied. The largest contributor was cold temperatures. While respiratory disease hospitalization costs will increase in the future, climate change may result in a decrease in the cold attributable fraction and an increase in the heat attributable fraction, depending on the location.

Background: Heat exposure is an important but underappreciated risk factor contributing to cardiovascular disease. Warming temperatures might therefore pose substantial challenges to population health, especially in a rapidly aging population. To address a potential increase in the burden of cardiovascular disease, a better understanding of the effects of ambient heat on different types of cardiovascular disease and factors contributing to vulnerability is required, especially in the context of climate change. This study reviews the current epidemiological evidence linking heat exposures (both high temperatures and heatwaves) with cardiovascular disease outcomes, including mortality and morbidity., Methods: In this systematic review and meta-analysis, we searched PubMed, Embase, and Scopus for literature published between Jan 1, 1990, and March 10, 2022, and evaluated the quality of the evidence following the Navigation Guide Criteria. We included original research on independent study populations in which the exposure metric was high temperatures or heatwaves, and observational studies using ecological time series, case crossover, or case series study designs comparing risks over different exposures or time periods. Reviews, commentaries, grey literature, and studies that examined only seasonal effects without explicitly considering temperature were excluded. The risk estimates were derived from included articles and if insufficient data were available we contacted the authors to provide clarification. We did a random-effects meta-analysis to pool the relative risk (RR) of the association between high temperatures and heatwaves and cardiovascular disease outcomes. The study protocol was registered with PROSPERO (CRD42021232601)., Findings: In total, 7360 results were returned from our search of which we included 282 articles in the systematic review, and of which 266 were eligible for the meta-analysis. There was substantial heterogeneity for both mortality (high temperatures: I 2 =93·6%, p<0·0001; heatwaves: I 2 =98·9%, p<0·0001) and morbidity (high temperatures: I 2 =98·8%, p<0·0001; heatwaves: I 2 =83·5%, p<0·0001). Despite the heterogeneity in environmental conditions and population dynamics among the reviewed studies, results showed that a 1°C increase in temperature was positively associated with cardiovascular disease-related mortality across all considered diagnoses. The overall risk of cardiovascular disease-related mortality increased by 2·1% (RR 1·021 [95%CI 1·020-1·023]), with the highest specific disease risk being for stroke and coronary heart disease. A 1°C temperature rise was also associated with a significant increase in morbidity due to arrhythmias and cardiac arrest and coronary heart disease. Our findings suggest heat exposure leads to elevated risk of morbidity and mortality for women, people 65 years and older, individuals living in tropical climates, and those in countries of lower-middle income. Heatwaves were also significantly associated with a 17% increase in risk of mortality (RR 1·117 [95% CI 1·093-1·141]), and increasing heatwave intensity with an increasing risk (RR 1·067 [95% CI 1·056-1·078] for low intensity, 1·088 [1·058-1·119] for middle intensity, and 1·189 [1·109-1·269] for high intensity settings)., Interpretation: This review strengthens the evidence on the increase in cardiovascular disease risk due to ambient heat exposures in different climate zones. The widespread prevalence of exposure to hot temperatures, in conjunction with an increase in the proportion of older people in the population, might result in a rise in poor cardiovascular disease health outcomes associated with a warming climate. Evidence-based prevention measures are needed to attenuate peaks in cardiovascular events during hot spells, thereby lowering the worldwide total heat-related burden of cardiovascular disease-related morbidity and death., Funding: Australian Research Council Discovery Program., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Objective: To examine the cost benefits of a heat health warning system (HHWS) in South Australia., Methods: Information from key agencies was used to estimate the costs associated with the South Australian HHWS, including for three targeted public health interventions. Health cost savings were estimated based on previously reported HHWS-attributable reductions in hospital and emergency department (ED) admissions and ambulance callouts., Results: The estimated cost for a one-week activation of the HHWS was AU$593,000. Activation costs compare favourably with the potential costs averted through HHWS-attributable reductions in hospital admissions and ambulance callouts with an estimated benefit-cost ratio of 2.0-3.3., Conclusions: On the basis of estimated cost benefit, the South Australian HHWS is a no-regret public health response to heatwaves., Implications for Public Health: As global temperatures rise there are likely to be significant health impacts from more frequent and intense heatwaves. This study indicates that HHWSs incorporating targeted supports for vulnerable groups are likely to be cost-effective public health interventions., (© 2021 The Authors.)

Objective: To examine stakeholder perspectives on the factors of an effective approach to reduce Q fever risk including disease prevention, and the perceived potential benefits of a One Health framework., Methods: Semi-structured interviews were conducted with general practitioners (GPs), veterinarians, government authorities, researchers, and representatives from the farming industry. Transcripts were thematically analysed., Results: Six major themes were identified as key factors underpinning an effective approach to Q fever: understanding Q fever burden; effective surveillance; the role of general practitioners and other stakeholders; barriers and enablers of vaccination; an integrated approach; and increased Q fever awareness. Most participants perceived GPs to play a central role in disease detection, notification, treatment and prevention through health promotion and vaccination, despite GPs acknowledging limited awareness of Q fever. Participants suggested leadership is required from the Department of Health (DoH) to foster inter-sectoral communication and collaboration., Conclusions: A One Health approach holds opportunities for zoonosis prevention. We recommend that medical curricula and professional development be enhanced, zoonosis working group networks strengthened, government-industry partnerships established, and relevant stakeholders included within an integrated program., Implications for Public Health: Updating medical curricula, GP professional development programs and inter-sectoral collaboration led by health departments may reduce Q fever burden., (© 2021 The Authors.)

Unvaccinated animal science and veterinary students are at risk of Q fever, a vaccine-preventable zoonotic disease transmitted from animals to humans. We investigated students' perspectives on Q fever prevention using a One Health approach combining animal, human and environmental health. Animal science and veterinary students enrolled at the University of Adelaide in 2019 were invited to participate in an online survey to explore their perceptions about Q fever and prevention strategies. We undertook descriptive analysis and logistic regression. Overall, 46% of students reported little to no knowledge of Q fever. Over three-quarters of students reported transmission of Q fever via aerosol inhalation and animal culling, whilst other modes including sexual transmission between humans (7%) was poorly identified. The majority of students reported exposure to cattle, sheep and goats. Of those who reported vaccination status, 5% veterinary and 61% animal science students were unvaccinated for Q fever. Challenges concerning vaccination included cost, time and access to healthcare with strategies aimed at promoting awareness, improving healthcare access and subsidized and mass vaccination. Knowledge of Q fever among respondents, particularly about disease transmission was suboptimal. As a key principle to One Health approach, adherence to biosecurity guidelines during contact with animals could potentially reduce zoonoses including Q fever transmission. Improving access to Q fever vaccine for unvaccinated students is a priority. Findings underscore that university policy for Q fever vaccination needs to consider subsidized vaccination for both animal science and veterinary students.

Background: The adverse effects of heat on workers' health and work productivity are well documented. However, the resultant economic consequences and productivity loss are less understood. This review aims to summarize the retrospective and potential future economic burden of workplace heat exposure in the context of climate change., Methods: Literature was searched from database inception to October 2020 using Embase, PubMed, and Scopus. Articles were limited to original human studies investigating costs from occupational heat stress in English., Results: Twenty studies met criteria for inclusion. Eighteen studies estimated costs secondary to heat-induced labor productivity loss. Predicted global costs from lost worktime, in US$, were 280 billion in 1995, 311 billion in 2010 (≈0.5% of GDP), 2.4-2.5 trillion in 2030 (>1% of GDP) and up to 4.0% of GDP by 2100. Three studies estimated heat-related healthcare expenses from occupational injuries with averaged annual costs (US$) exceeding 1 million in Spain, 1 million in Guangzhou, China and 250,000 in Adelaide, Australia. Low- and middle-income countries and countries with warmer climates had greater losses as a proportion of GDP. Greater costs per worker were observed in outdoor industries, medium-sized businesses, amongst males, and workers aged 25-44 years., Conclusions: The estimated global economic burden of occupational heat stress is substantial. Climate change adaptation and mitigation strategies should be implemented to likely minimize future costs. Further research exploring the relationship between occupational heat stress and related expenses from lost productivity, decreased work efficiency and healthcare, and costs stratified by demographic factors, is warranted. Key messages. The estimated retrospective and future economic burden from occupational heat stress is large. Responding to climate change is crucial to minimize this burden. Analyzing heat-attributable occupational costs may guide the development of workplace heat management policies and practices as part of global warming strategies., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: The link between heat exposure and adverse health outcomes in workers is well documented and a growing body of epidemiological evidence from various countries suggests that extreme heat may also contribute to increased risk of occupational injuries (OI). Previously, there have been no comparative reviews assessing the risk of OI due to extreme heat within a wide range of global climate zones. The present review therefore aims to summarise the existing epidemiological evidence on the impact of extreme heat (hot temperatures and heatwaves (HW)) on OI in different climate zones and to assess the individual risk factors associated with workers and workplace that contribute to heat-associated OI risks., Methods: A systematic review of published peer-reviewed articles that assessed the effects of extreme heat on OI among non-military workers was undertaken using three databases (PubMed, Embase and Scopus) without temporal or geographical limits from database inception until July 2020. Extreme heat exposure was assessed in terms of hot temperatures and HW periods. For hot temperatures, the effect estimates were converted to relative risks (RR) associated with 1 °C increase in temperature above reference values, while for HW, effect estimates were RR comparing heatwave with non-heatwave periods. The patterns of heat associated OI risk were investigated in different climate zones (according to Köppen Geiger classification) based on the study locations and were estimated using random-effects meta-analysis models. Subgroup analyses according to workers' characteristics (e.g. gender, age group, experience), nature of work (e.g. physical demands, location of work i.e. indoor/outdoor) and workplace characteristics (e.g. industries, business size) were also conducted., Results: A total of 24 studies published between 2005 and 2020 were included in the review. Among these, 22 studies met the eligibility criteria, representing almost 22 million OI across six countries (Australia, Canada, China, Italy, Spain, and USA) and were included in the meta-analysis. The pooled results suggested that the overall risk of OI increased by 1% (RR 1.010, 95% CI: 1.009-1.011) for 1 °C increase in temperature above reference values and 17.4% (RR 1.174, 95% CI: 1.057-1.291) during HW. Among different climate zones, the highest risk of OI during hot temperatures was identified in Humid Subtropical Climates (RR 1.017, 95% CI: 1.014-1.020) followed by Oceanic (RR 1.010, 95% CI: 1.008-1.012) and Hot Mediterranean Climates (RR 1.009, 95% CI: 1.008-1.011). Similarly, Oceanic (RR 1.218, 95% CI: 1.093-1.343) and Humid Subtropical Climates (RR 1.213, 95% CI: 0.995-1.431) had the highest risk of OI during HW periods. No studies assessing the risk of OI in Tropical regions were found. The effects of hot temperatures on the risk of OI were acute with a lag effect of 1-2 days in all climate zones. Young workers (age < 35 years), male workers and workers in agriculture, forestry or fishing, construction and manufacturing industries were at high risk of OI during hot temperatures. Further young workers (age < 35 years), male workers and those working in electricity, gas and water and manufacturing industries were found to be at high risk of OI during HW., Conclusions: This review strengthens the evidence on the risk of heat-associated OI in different climate zones. The risk of OI associated with extreme heat is not evenly distributed and is dependent on underlying climatic conditions, workers' attributes, the nature of work and workplace characteristics. The differences in the risk of OI across different climate zones and worker subgroups warrant further investigation along with the development of climate and work-specific intervention strategies., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Hot workplace environments can lead to adverse health effects and contribute to a range of injuries. However, there is limited contextual understanding of heat-related injury occurrence. Gaining the perspectives of occupational health and safety professionals (HSPs) may elucidate the issue and inform targeted interventions., Methods: A cross-sectional national online survey was conducted in Australia to characterise HSP perceptions of heat-related injuries; current preventive measures; training, policies and guidelines; and perspectives on barriers for prevention. Results were analysed descriptively and a log-Poisson regression model was used to identify risk factors associated with HSP reported injury occurrence, assessed through prevalence ratio (PR)., Results: Of the 307 HSP survey participants, 74% acknowledged the potential for increased risk of occupational injuries in hot weather. A variety of injury types and mechanisms were reported, including manual handling injuries, hand injuries, wounds or lacerations, and loss of control of power tools. Correlates of reported heat-related injuries included working in the sun without shade [PR: 1.26; 95% CI: 1.07-1.48] and too few rest breaks [PR: 1.28; 95% CI: 1.04-1.44]. Other factors of significance were inadequate hydration; issues with personal protective equipment (PPE) and poor supervision of workers. Only 42% reported that adequate heat training was available and 54% reported the provision for outdoor work to cease in extreme temperatures. It was acknowledged that the frequency of injuries could be reduced with wider adoption of self-pacing, and work/rest regimes. Perceived barriers for prevention included: lack of awareness of physical injury risks, and management concerns about productivity loss and/or deadlines., Conclusion: The findings indicate a range of potentially modifiable work and organisational risk factors such as more suitable PPE and better supervision. More attention to these factors, in conjunction with traditional interventions to reduce heat effects, could enhance injury prevention and labour productivity in people working in hot environments., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Epidemiological evidence has shown an association between exposure to high temperatures and occupational injuries, an issue gaining importance with environmental change. The aim of this study was to better understand contributing risk factors and preventive actions based on personal experiences. Interviews were conducted with 21 workers from five Australian states using a critical phenomenological approach to capture the lived experiences of participants, whilst exploring contextual factors that surround these experiences. Two case studies are presented: a cerebrovascular injury and injuries among seasonal horticulture workers. Other accounts of heat-related injuries and heat stress are also presented. Risk factors were classified as individual, interpersonal and organizational. In terms of prevention, participants recommended greater awareness of heat risks and peer-support for co-workers. Adding value to current evidence, we have provided new insights into the etiology of the health consequences of workplace heat exposure with workers identifying a range of influencing factors, prevention measures and adaptation strategies. Underpinning the importance of these are future climate change scenarios, suggesting that extended hot seasons will lead to increasing numbers of workers at risk of heat-stress and associated occupational injuries., Competing Interests: The authors declare no conflict of interest.

Background: The thermal working environment can have direct and in-direct effects on health and safety. Ambient temperatures have been associated with an increased risk of occupational injuries but it is unknown how the relationship can vary by weather, location and climate., Objectives: To examine the relationship between ambient temperatures and work-related injury and illness compensation claims in three Australian cities: Melbourne and Perth (temperate climate) and Brisbane (subtropical climate) in order to determine how hot and cold weather influences the risk of occupational injury in Australia., Methods: Workers' compensation claims from each city for the period 2005 to 2016 were merged with local daily weather data. A time-stratified case-crossover design combined with a distributed lag non-linear model was used to quantify the impacts of daily maximum temperature (T max ) on the risk of work-related injuries and illnesses., Results: Compared to the median maximum temperature (T max ), extremely hot temperatures (99th percentile) were associated with a 14% (95%CI: 3-25%) increase in total workers' compensation claims in Melbourne, but there were no observed effects in Brisbane or Perth, with the exception of traumatic injuries that increased by 17% (95%CI: 3-35%) during extreme heat in Perth. For extremely low temperatures (1st percentile), there was a protective effect in Brisbane (RR 0.89; 95%CI: 0.81-0.98), while no effects were observed in Melbourne or Perth., Conclusion: The relationship between injury and ambient temperature appears to be variable depending on location and climate. In general, work-related injuries and illnesses appear to be more common at higher temperatures than lower temperatures. Adopting adaptation and prevention measures could reduce the social and economic burden of injury, and formulating effective measures for dealing with high temperatures should be prioritised given the predicted increase in the frequency and intensity of hot weather., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background and Aims: Heatwaves have potential health and safety implications for many workers, and heatwaves are predicted to increase in frequency and intensity with climate change. There is currently a lack of comparative evidence for the effects of heatwaves on workers' health and safety in different climates (sub-tropical and temperate). This study examined the relationship between heatwave severity (as defined by the Excess Heat Factor) and workers' compensation claims, to define impacts and identify workers at higher risk., Methods: Workers' compensation claims data from Australian cities with temperate (Melbourne and Perth) and subtropical (Brisbane) climates for the years 2006-2016 were analysed in relation to heatwave severity categories (low and moderate/high severity) using time-stratified case-crossover models., Results: Consistent impacts of heatwaves were observed in each city with either a protective or null effect during heatwaves of low-intensity while claims increased during moderate/high-severity heatwaves compared with non-heatwave days. The highest effect during moderate/high-severity heatwaves was in Brisbane (RR 1.45, 95% CI: 1.42-1.48). Vulnerable worker subgroups identified across the three cities included: males, workers aged under 34 years, apprentice/trainee workers, labour hire workers, those employed in medium and heavy strength occupations, and workers from outdoor and indoor industrial sectors., Conclusion: These findings show that work-related injuries and illnesses increase during moderate/high-severity heatwaves in both sub-tropical and temperate climates. Heatwave forecasts should signal the need for heightened heat awareness and preventive measures to minimise the risks to workers.

Background: The thermal environment can directly affect workers' occupational health and safety, and act as a contributing factor to injury or illness. However, the literature addressing risks posed by varying temperatures on work-related injuries and illnesses is limited., Objectives: To examine the occupational injury and illness risk profiles for hot and cold conditions., Methods: Daily numbers of workers' compensation claims in Adelaide, South Australia from 2003 to 2013 (n = 224,631) were sourced together with daily weather data. The impacts of maximum daily temperature on the risk of work-related injuries and illnesses was assessed using a time-stratified case-crossover study design combined with a distributed lag non-linear model., Results: The minimum number of workers' compensation claims occurred when the maximum daily temperature was 25 °C. Compared with this optimal temperature, extremely hot temperatures (99th percentile) were associated with an increase in overall claims (RR: 1.30, 95%CI: 1.18-1.44) whereas a non-significant increase was observed with extremely cold temperatures (1st percentile, RR: 1.10 (95%CI: 0.99-1.21). Heat exposure had an acute effect on workers' injuries whereas cold conditions resulted in delayed effects. Moderate temperatures were associated with a greater injury burden than extreme temperatures., Conclusion: Days of very high temperatures were associated with the greatest risks of occupational injuries; whereas moderate temperatures, which occur more commonly, have the greatest burden. These findings suggest that the broader range of thermal conditions should be considered in workplace injury and illness prevention strategies., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: Heatwaves, or extended periods of extreme heat, are predicted to increase in frequency, intensity and duration with climate change, but their impact on occupational injury has not been extensively studied. We examined the relationship between heatwaves of varying severity and work-related injuries and illnesses. We used a newly proposed metric of heatwave severity, the Excess Heat Factor (EHF), which accounts for local climate characteristics and acclimatization and compared it with heatwaves defined by daily maximum temperature., Methods: Work-related injuries and illnesses were identified from two administrative data sources: workers' compensation claims and work-related ambulance call-outs for the years 2003-2013 in Adelaide, Australia. The EHF metrics were obtained from the Australian Bureau of Meteorology. A time-stratified case-crossover regression model was used to examine associations between heatwaves of three levels of severity, workers' compensation claims, and work-related ambulance call-outs., Results: There was an increase in work-related ambulance call-outs and compensation claims during low and moderately severe heatwaves as defined using the EHF, and a non-significant decline during high-severity heatwaves. Positive associations were observed during moderate heatwaves in compensation claims made by new workers (RR 1.31, 95% CI 1.10-1.55), workers in medium-sized enterprises (RR 1.15, 95% CI 1.01-1.30), indoor industries (RR 1.09, 95% CI 1.01-1.17), males (RR 1.13, 95% CI 1.03-1.23) and laborers (RR 1.21, 95% CI 1.04-1.39)., Conclusions: Workers should adopt appropriate precautions during moderately severe heatwaves, when the risks of work-related injuries and illnesses are increased. Workplace policies and guidelines need to consider the health and safety of workers during heatwaves with relevant prevention and adaptation measures.

Climate plays an important role in human health and it is well established that climate change can have very significant impacts in this regard. In partnership with The Lancet and the MJA, we present the inaugural Australian Countdown assessment of progress on climate change and health. This comprehensive assessment examines 41 indicators across five broad sections: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. These indicators and the methods used for each are largely consistent with those of the Lancet Countdown global assessment published in October 2017, but with an Australian focus. Significant developments include the addition of a new indicator on mental health. Overall, we find that Australia is vulnerable to the impacts of climate change on health, and that policy inaction in this regard threatens Australian lives. In a number of respects, Australia has gone backwards and now lags behind other high income countries such as Germany and the United Kingdom. Examples include the persistence of a very high carbon-intensive energy system in Australia, and its slow transition to renewables and low carbon electricity generation. However, we also find some examples of good progress, such as heatwave response planning. Given the overall poor state of progress on climate change and health in Australia, this country now has an enormous opportunity to take action and protect human health and lives. Australia has the technical knowhow and intellect to do this, and our annual updates of this assessment will track Australia's engagement with and progress on this vitally important issue.