Abstract
Background: Catastrophic flooding in the Northern Rivers of NSW in Australia in 2022 had a devastating impact on the health and wellbeing of the local population, with thousands still homeless and others recovering from post-traumatic stress disorder (PTSD) more than three years on. 64 primary health care services were impacted affecting access to health care for an estimated 200,000 people.
There is a need to prepare communities for the health impacts of climate change, with more frequent and severe weather events yet to come. Building resilient communities relies on having a resilient health system. National and international evidence highlights the critical role of primary care in disaster management. Primary care does not have a clear, mandated role in disaster management in Australia.
Approach: Healthy North Coast, delivering the Primary Health Network program on behalf of the Australian Government, experimented with innovative climate change adaptation strategies to support general practices, pharmacies and community mental health services during the crisis response and recovery stages of the 2022 Northern Rivers floods. The value of primary care was demonstrated when hospital services were stretched beyond capacity. General practices and pharmacies were supported to re-open, stay open and offer their staff rest and recovery. Recovery activities included providing wellbeing support to primary health care services as well as infrastructure grants to rebuild. Surveys were collected capturing service impacts, workforce needs and clinician preferences for support. Healthy North Coast is working to prepare services for future events by building business continuity through capacity building, training and place-based resilience building and integration strategies. Preparedness was recently tested during Ex-Clone Alfred in 2025.
Results: Minimal primary health care services have closed since the flooding event, despite 83% of service owners being concerned about fatigue and burn out immediately after the event. Over 2,500 clinicians and frontline support staff received workforce wellbeing supports. More than 500 clinicians attended education and training specifically related to flood recovery, trauma informed care and PTSD.
Implications: Evidence demonstrates the importance of joined-up planning and strong, established relationships to enable service continuity and access in the time of a disaster. Strong local relationships across the health sector were a major contributor to the success of the health response in 2022. Placed-based flexibility was a key element to successful initiatives. Research is underway to explore the quantitative impact of primary health care services on hospital emergency department presentations.
The majority of health services needed during and after a disaster can and should be managed in a community setting, saving precious hospital resources for life-threatening presentations. Disaster management approaches need to be trauma informed and prioritise the building of community resilience, connection and mental health literacy – thereby reducing the severity of disaster related trauma and length of time it takes to recover. Primary health care services need to be enabled to assist with this within disaster management frameworks.