National Centre for Epidemiology & Population Health, Australian National University, Canberra, ACT, Australia.
Julalikari Council Aboriginal Corporation, Tennant Creek, NT, Australia.
Lancet Planet Health. 2023 Aug;7(8):e684-e693. doi: 10.1016/S2542-5196(23)00138-9.
Climate change is increasing heat-associated mortality particularly in hotter parts of the world. The Northern Territory is a large and sparsely populated peri-equatorial state in Australia. The Northern Territory has the highest proportion of Aboriginal and Torres Strait Islander people in Australia (31%), most of whom live in remote communities of over 65 Aboriginal Nations defined by ancient social, cultural, and linguistic heritage. The remainder non-Indigenous population lives mostly within the two urban centres (Darwin in the Top End region and Alice Springs in the Centre region of the Northern Territory). Here we aim to compare non-Indigenous (eg, high income) and Indigenous societies in a tropical environment and explore the relative importance of physiological, sociocultural, and technological and infrastructural adaptations to heat.
In this case time series, we matched temperature at the time of death using a modified distributed lag non-linear model for all deaths in the Northern Territory, Australia, from Jan 1, 1980, to Dec 31, 2019. Data on deaths came from the national registry of Births, Deaths and Marriages. Cases were excluded if location or date of death were not recorded or if the person was a non-resident. Daily maximum and minimum temperature were measured and recorded by the Bureau of Meteorology. Hot weather was defined as mean temperature greater than 35°C over a 3-day lag. Socioeconomic status as indicated by Index of Relative Socioeconomic Disadvantage was mapped from location at death.
During the study period, 34 782 deaths were recorded; after exclusions 31 800 deaths were included in statistical analysis (15 801 Aboriginal and 15 999 non-Indigenous). There was no apparent reduction in heat susceptibility despite infrastructural and technological improvements for the majority non-Indigenous population over the study period with no heat-associated mortality in the first two decades (1980-99; relative risk 1·00 [95% CI 0·87-1·15]) compared with the second two decades (2000-19; 1·14 [1·01-1·29]). Despite marked socioeconomic inequity, Aboriginal people are not more susceptible to heat mortality (1·05, [0·95-1·18]) than non-Indigenous people (1·18 [1·06-1·29]).
It is widely believed that technological and infrastructural adaptations are crucial in preparing for hotter climates; however, this study suggests that social and cultural adaptations to increasing hot weather are potentially powerful mechanisms for protecting human health. Although cool shelters are essential during extreme heat, research is required to determine whether excessive exposure to air-conditioned spaces might impair physiological acclimatisation to the prevailing environment. Understanding sociocultural practices from past and ancient societies provides insight into non-technological adaptation opportunities that are protective of health.
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气候变化导致与热相关的死亡率上升，尤其是在世界上较热的地区。北领地是澳大利亚一个位于赤道附近的、地广人稀的州。北领地拥有澳大利亚最高比例的原住民和托雷斯海峡岛民（31%），其中大多数居住在 65 个原住民部落的偏远社区中，这些社区由古老的社会、文化和语言遗产定义。其余的非原住民人口大多居住在两个城市中心（北部地区的达尔文和中部地区的爱丽丝泉）。在这里，我们旨在比较热带环境下的非原住民（如高收入人群）和原住民社会，并探索对热的生理、社会文化以及技术和基础设施适应的相对重要性。
在本病例时间序列研究中，我们使用改进的分布式滞后非线性模型，根据澳大利亚北领地 1980 年 1 月 1 日至 2019 年 12 月 31 日期间的所有死亡病例，匹配死亡时的温度。死亡数据来自国家出生、死亡和婚姻登记处。如果位置或死亡日期未记录，或者此人不是居民，则排除病例。气象局测量和记录每日最高和最低温度。炎热天气定义为 3 天滞后期内平均温度高于 35°C。根据死亡地点的相对社会经济劣势指数来表示社会经济地位。
在研究期间，共记录了 34782 例死亡；排除后，共有 31800 例死亡纳入统计分析（15801 例原住民和 15999 例非原住民）。尽管大多数非原住民的基础设施和技术得到了改善，但在研究期间，他们的耐热能力并没有明显下降，在最初的 20 年（1980-1999 年；相对风险 1.00 [95%CI 0.87-1.15]）中没有与热相关的死亡，而在随后的 20 年（2000-2019 年；1.14 [1.01-1.29]）中则有。尽管存在明显的社会经济不平等，但原住民的耐热死亡风险（1.05 [0.95-1.18]）并不高于非原住民（1.18 [1.06-1.29]）。
人们普遍认为，技术和基础设施的适应是为更热的气候做准备的关键；然而，这项研究表明，对日益炎热天气的社会和文化适应是保护人类健康的潜在强大机制。虽然在极端高温期间，凉爽的避难所是必不可少的，但需要研究确定过度暴露在空调环境中是否会损害对当前环境的生理适应。了解过去和古代社会的社会文化实践，为保护健康的非技术适应机会提供了深入了解。
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