Ignorance is not bliss - Why improving rural residents' health literacy for smoke exposure will not be enough

  • Woman with mask
Charles Sturt University
Andrea Crampton, Associate Head of School, School of Biomedical Sciences

With the nation’s capital having the worst air quality on the planet several times during the 2019-2020 summer, air quality is something politicians cannot ignore. The recently announced $5 million in Australian Government funding for smoke exposure research is undoubtedly a positive step towards improving our ability to assess health impacts and enhance preparedness for future events.  In this professional commentary, I suggest rural reality limits the applicability of research for rural populations.

While the quick allocation of funding considers the long-term physiological and mental impacts, and will undoubtedly benefit rural communities through workforce planning and resource allocation, the funding foci may not meet the immediate needs of rural residents.  Next summer, prior to research completion, and during winter, those newly sensitised to biomass smoke may experience respiratory symptoms from wood heaters and will continue experiencing health risks and impacts.

It was welcoming to see the Australian Medical Association support the goal of improving community health literacy, a process enabling people to accurately and contextually apply relevant health information. However, health literacy is dependent upon access to reliable information, and this is where the rural/urban divide becomes a health inequity issue. Air quality monitoring is a state responsibility, with each state having public communication webpages reporting current air quality that for most locations includes reporting PM2.5 levels as a rolling average across 24 hours. Careful inspection of these webpages reveals how few rural areas have access to air quality data and do not receive as much information as metropolitan areas. Thus, air quality indicators and/or sudden changes that would enable a health literate person to manage their exposure are not available to most rural residents.

Why does this matter? PM2.5 is a key trigger for smoke-sensitive populations. Therefore, it is much harder to plan activities for sudden changes with only rolling 24 hour averages (the only information provided in most states) rather than hourly readings, and impossible in the absence of any data. Rural Victorians also lack accessible data, but have the advantage that the state EPA provides regional four-day air quality forecasts. NSW only gives next-day air quality forecasts in Sydney. A more in-depth exploration, utilising high scientific and digital literacy, of the NSW air quality site reveals somewhat hidden information of hourly PM pollution data from rural locations, but unlike the main site, there is no colour coding to help people identify safe verses unsafe levels.

In the absence of scientific data, people are advised to use their senses and, if they smell or see smoke, to take action accordingly. Actions include staying indoors, using an air purifier, or going to places with industrial air conditioning, like malls and cinemas. This is often not possible for rural residents. Many rural stores are unlikely to stock air purifiers and reaching regional centres, which may not have malls or cinemas, may require extended travel through hazardous air, plus private transportation. In some areas, only hospitals or RSL clubs can provide suitable air refuge. Therefore, even if given greater knowledge on how to understand air quality data and recommendations, many rural residents will still be unable to exercise adequate health literacy actions.

Therefore, before we investigate air quality health literacy, we first need to support rural health services through accurate data provision and rural communities through refuge access resourcing, such as air purifier provision and/or access to local areas with suitable air quality control.  Then, activities building individuals’ health literacy, in a manner appropriate for the information and resources available, can be continued.

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