Editorial for IJMHN: An application of the ‘one health’ approach for extreme weather events and mental health: Can the adoption of a ‘one health’ approach better prepare us for the predicted drought in parts of rural Australia?

Abstract

Rural communities are at high risk from the impacts of extreme weather events and climate variability. The impacts of extreme weather events such as floods, droughts and bushfires affect rural communities through numerous interconnected relationships (Skinner, 2022). Skinner (2022) argues that a better understanding of the interconnection between human and animal health and the environment is needed. This understanding may be enhanced by the application of a ‘One Health’ approach, which has recently been defined as ‘an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals, and ecosystems. It recognizes the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and interdependent’ (OHHLEP et al., 2022, p.2). This ‘One Health’ approach identifies that not only is the health of the environment and land, and the health of humans and animals intrinsically interconnected, but also recognises that working on one of these elements has the potential to improve the other when the interconnectedness is acknowledged (Skinner, 2022). The responsibility for the future of human health is not only the remit of health professionals; rather, the future health of people and the planet requires a transdisciplinary and multi-sectoral collaboration to confront threats to ecosystems and health (OHHLEP et al., 2022). Until recently, the One Health approach has been predominantly focused on understanding and preventing the transmission of diseases between animals and humans within the environment (Skinner, 2022). However, the recent global priority of implementing One Health action plans specifies the first action area as ‘enhancing One Health capacities to strengthen health systems’ (World Health Organisation [WHO], 2022, p. 21). While this action area prompts systemic thinking about health service delivery with consideration of the environment and animals, the dominant application remains at the intersection of veterinary and medical sciences. This editorial applies the WHO (2022) action item of ‘enhancing One Health capacities to strengthen health systems’ (p. 21) to mental health, with the specific application of extreme weather events and the associated impacts on the mental health of rural communities. This editorial considers how a ‘One Health’ approach to rural mental health may help us to better understand the interaction between the environment, and human and animal health, and prepare us to better respond to future events.

The planet appears to be under high stress with more frequent, intense and widespread extreme weather events (Longman et al., 2023). The current climate drivers (e.g. El Nino and negative Indian Ocean Dipole index) are generally associated with increased frequency, duration and intensity of compound drought and heatwaves and a higher risk of bushfires, alongside widespread environmental and socioeconomic harm (Reddy et al., 2022). This outlook predicts another extremely dry season in Australia, and it is anticipated that there will be more frequent and severe droughts in the future (Hanigan & Chaston, 2022), which exacerbate the impacts and distress experienced by rural communities (Cianconi et al., 2020). These extreme weather events disproportionately impact rural Australians, and the impacts may be cumulative, escalating or interactive for those who are dependent on the land (Rice & Usher, 2023, in review).

Rural Australians depend on the land for their livelihood and the ongoing sustainability of their communities. Environmental hazards, such as drought, are known risk factors for the onset or exacerbation of mental health distress in rural communities (Cianconi et al., 2020). The weather is a determinant of mental health for farmers and rural communities (Rice & Usher, 2023, in review), and drought can lead to broader risks to mental health for rural people due to disruption of ecological and socioeconomic systems causing crop and livestock failure, increased workload on farmers, financial hardship, lack of water, lack of resources (Vins et al., 2015), population decline, disruption of social connections, and trauma related to damage to livestock, crops, soil and native vegetation (Berry et al., 2008). These impacts may be interacting and cumulative (Rice & Usher, 2023, in review), and have serious consequences for human health and mental health. For example, the experience of drought has been related to mental health issues such as distress, depression (Austin et al., 2018; Hanigan et al., 2018; O'Brien et al., 2014; Powers et al., 2015) and suicide (Hanigan et al., 2012; Hanigan & Chaston, 2022). High rates of negative mental health impacts related to drought have been identified in previous studies, especially for farmers and those engaged in agriculture, but also for rural communities more broadly (Edwards et al., 2015), and longer-term mental health effects of drought have been observed (Luong et al., 2021).

Notably, suicide rates in rural areas have been found to escalate during drought conditions, in contrast to an urban cohort showing no increase in suicide risk during drought (Hanigan & Chaston, 2022). The drought and suicide predictive models developed by Hanigan and Chaston (2022) estimated an increase in suicide rates among males in rural New South Wales in 2000–2099, especially in cases where farming males' identities are tied to the productivity of their farms. The authors suggest that drought is related to an increase in suicide rates in rural areas through an interrelationship between socioeconomic hardships experienced by farmers and farming communities, whereby the loss of farming revenue leads to downturns in the local community where the whole community may be affected. In addition, the authors recognise the toll of local environmental degradation related to drought, and the need to sell or kill starving animals or destroy or witness the destruction of crops on farmers and the wider community (Hanigan & Chaston, 2022). These models appear consistent with a One Health approach.

The One Health approach recognises this interconnectedness between human health, animal health and the health of the environment. A One Health approach has been applied in the understanding of zoonotic diseases and preventing the spread of disease between animals and humans, although it extends beyond this by incorporating environmental aspects and emphasising interwoven systemic dependency (WHO, 2022). It has been acknowledged that this approach is consistent with the Indigenous people of Australia's long-standing recognition of the importance of connection to the country on health and well-being (Skinner, 2022). Furthermore, the intrinsic connection promoted by the One Health conceptualisation may be akin to the profound emotional and psychological attachment farmers have with their farms and the land (Ellis & Albrecht, 2017). The One Health approach is integrative and unifying and encourages us to look beyond isolated relationships and discrete symptomology and to acknowledge the interdependence of people, animals and their environment systemically (WHO, 2022). This approach is global, holistic, multi-disciplinary and inclusive across geography and culture (OHHLEP et al., 2022), both in terms of practices (e.g. Indigenous land management) and the impacts (e.g. vulnerable groups). Beyond risk minimisation, a One Health approach is oriented to holistic and systemic prevention and healing, providing optimism and direction for points of intervention.

Extreme weather events disrupt this symbiosis, and the increased frequency, severity and duration of such events may prevent recovery (Longman et al., 2023) and a return to homeostasis. Applied to drought, the One Health approach links distress in the environment to distress for those who live and depend on the land as well as animals. The recent experience of the 2017–2020 drought caused devastating impacts to the economy and the lives of rural people of Australia and culminated in the unprecedented magnitude and devastation of the Black Summer Bushfires (Niggli et al., 2022). Many of the people who were impacted by this extended drought are now braced for, or already immersed in, the next season of drought and its impacts. The experience of multiple events is likely to have a compound effect, with interacting, escalating and cumulative impacts (Rice & Usher, 2023, in review). As a ‘slow moving disaster’ (p. 10), drought has devastating impacts on farm ecosystems and production (e.g. livestock or crops) as well as the well-being of individuals and communities (Cianconi et al., 2020). A One Health approach offers a lens to understand this interaction, and recognise the intrinsic interrelatedness of the environment and humans, highlighting the importance of working together to reduce environmental harm, and move towards holistic and systemic prevention and healing.

The One Health approach is unifying and integrative and promotes an understanding of the dependence and symbiosis of people, the environment and animals, in practice and research. This approach seeks multi-disciplinary applications, across healthcare, mental health and beyond. The One Health approach is consistent with the mental health competency of cultural responsiveness and encourages reflexivity, whereby each person needs to examine ‘who I am in response to this information’ (Smith et al., 2022, p. 3). This reflexive approach for mental health practitioners, including nurses, highlights the need for self-reflection and also for holistic and systemic conceptualisation and an integrative understanding of each person within the broader context of their community and the environment. This lens requires an assessment of an individual within their context, including an evaluation of environmental aspects, not only in the search for distress or trauma but also for loss of restoration and well-being.

Resources need to be allocated to promote well-being of rural people within the current and predicted ongoing climate variability. Given the lack of recovery time between extreme weather events, the mental health focus needs to be on adaptation (Longman et al., 2023), in addition to targeted services during times of drought. These are times of severe stress for farmers and rural communities, and access to adequate resources and support services are needed to assist them manage the impacts of environmental events. In addition, rural Australians often have concerns about seeking help, along with elevations in stigma and stoicism, and help-seeking has been noted to reduce in times of drought (Austin et al., 2018). Given this, effective models of rural mental health delivery need to be developed, including strategies to reduce stigma, promote mental health awareness and literacy, and increase help-seeking behaviour. Innovative models of care need to be developed from the foundation of rural Australian people's needs and preferences, as well as ensuring services are accessible, acceptable and culturally responsive. Furthermore, these models of care need to be effectively delivered across the vast regions of rural Australia and need to be tailored to the unique geographic, environmental, climatic and cultural Australian landscape.

In addition, all mental health professionals, in both urban and regional areas, need to be trained to understand and assess the holistic aspects of rural people's lives that are related to their well-being. The One Health approach provides a lens to develop this understanding, and to recognise the multi-level and interwoven impacts of extreme weather events on people, the environment and animals. This approach implicates mental health professionals to assess the individual person within their environment and work towards holistic intervention. This holistic intervention requires adequate resources to be available for allocation towards adaptation, both psychologically and environmentally. The One Health approach identifies that through intervention on environmental levels (e.g. farming assistance and adaptation), rural people are likely to experience mental health benefits. Beyond healthcare practitioners, the One Health approach has implications for all people worldwide and encourages a focus on sustainability, promoting prevention, affirmative action and reparation.