This year, ten days of extreme heat in Europe killed roughly 2,300 people, severe flooding on the New South Wales coast left more than 48,000 stranded, and wildfires in Los Angeles destroyed at least 16,000 homes and other buildings.

Events such as these signal what climate scientists have long warned: climate-related extremes are becoming more frequent and intense.

Poor housing can leave us more vulnerable to the effects of climate change. So in today’s warming world, it’s increasingly important our homes and our housing system are climate resilient. This means they must protect us from heatwaves, floods and bushfires, and keep out air pollutants. And the housing system must function to provide affordable and secure housing.

Location is important too. Australia’s first National Climate Risk Assessment, released this week, estimates 8.7% of residential buildings are in very high-risk areas (prone to hazards). This proportion is projected to increase to 13.5% by 2090 in a scenario with a high global warming level.

Housing and health are inextricably linked. In a new paper published in the Lancet Public Health, my colleagues and I identify several ways climate change affects our homes, and in turn, our health.

On a basic level, housing shields us from the elements. But when we look at the bigger picture, resilient housing and housing systems have a key role to play in helping us face the challenges of climate change.

How does climate change affect our homes and our health?

Climate change can lead to deterioration in the indoor conditions in our homes.

For example, extreme temperatures can compromise air quality by making building materials more likely to degrade and generate pollutants. Particulate matter and other hazardous air pollutants from bushfire smoke can infiltrate indoor environments. Both of these processes can contribute to poor indoor air quality. This is not to mention that extreme heat outside can lead to unbearable temperatures indoors.

Meanwhile, floods, storms and cyclones can cause structural and water damage to homes. This can expose occupants to toxins, for example from contaminated water, and increase the risk of allergic reactions, respiratory problems, and infectious diseases (such as water-borne and mosquito-borne diseases).

Climate change and housing security

The risks associated with climate change can also influence housing security and affordability.

Both housing insecurity and unaffordability are significant predictors of poor mental health and wellbeing, and both are already significant problems independent of climate change.

But a changing climate exacerbates these problems. Equally, the housing crisis leaves us more vulnerable to climate change.

Climate-related disasters put a strain on housing costs and general cost-of-living pressures. Residents may need to pay for maintenance and repairs alongside their mortgages and rental payments. Meanwhile, increasing extreme weather events push insurance premiums higher. All this puts pressure on housing affordability.

Extreme temperatures also increase the risk of energy poverty. Not being able to adequately heat or cool a home can negatively affect both physical and mental health for its occupants.

What’s more, climate-related disasters can drive forced relocation, with flow-on effects to health and wellbeing through disruption to family life, loss of income, gender-based violence, social disconnection, and reduced access to services.

Notably, the effects of climate change reduce the supply of affordable housing, especially affordable rentals, which are more likely to be damaged or lost from hazards, for example due to lower structural quality. Lower-income renters as a result find it harder to compete for the remaining stock.

There are also other examples showing the effects of climate change on housing are inequitable, with the consequences flowing disproportionately to less advantaged groups.

When areas with low climate risk become more desirable, this can drive up housing and other costs in an area. Climate “gentrification” can displace low-income households to higher risk and less protected areas. We’ve seen this happen in countries including the United States and Denmark.

What does climate-resilient housing look like?

Housing needs to protect people from the growing risks posed by climate change. In a physical sense, this means it must be robust enough to bear more intense weather conditions, be energy efficient, and have good thermal performance that allows for both ventilation and climate control.

To achieve this, climate-resilient housing should include features such as:

• well-constructed foundations, walls and roofs
• ventilation and insulation
• energy-efficient cooling and heating
• exterior shading and roof reflectivity
• building materials that are fire- and heat-resistant.

Building codes need to be cognisant of the changing climate, while existing housing may need to be upgraded.

We’ve seen some signs of progress. For example, updates to the National Construction Code in recent years have accounted for the increasing impact of climate change, by raising energy efficiency and thermal performance standards, among other measures.

There is also a need for stronger tenant protection policies. Rental housing is disproportionately of poor quality, yet it houses a large portion of the more vulnerable people in the population. Minimum standards for rental housing must be climate resilient.

But housing people well isn’t just a question of the physical construction of homes.

Climate-resilient housing should be affordable, secure and provide residents the chance to access opportunities for work, education and social connection that sustain wellbeing.

So much public discussion has focused on the need to meet housing supply targets, but we can’t forget that people need to be housed well to flourish.

This article is part of a series, Healthy Homes.

Ang Li, ARC DECRA and Senior Research Fellow, NHMRC Centre of Research Excellence in Healthy Housing, Melbourne School of Population and Global Health, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Spinal cord stimulators are electrical devices that are surgically implanted in the body to treat long-term pain. They have a battery pack and leads that deliver electrical impulses directly to the spinal cord. The devices are thought to work by providing electrical impulses that interfere with how the brain senses pain.

Spinal cord stimulators are mainly used to treat chronic back pain, especially when other less invasive treatments have not worked. They also aim to reduce people’s reliance on risky pain medicines. These include opioids, which research shows are ineffective and harmful for low-back pain.

But research, including our own, shows spinal cord stimulators work no better than a placebo. And they can also carry risks.

Do they work?

In a 2023 Cochrane review, researchers reviewed data from 13 randomised controlled trials on low-back pain and found no benefits in the short and medium term. These international reviews draw together the most robust evidence to provide a detailed summary of what we know on a particular topic.

Only one of the trials in the review tested efficacy in the longer term (six months). That trial found no benefits of spinal cord stimulation.

An earlier Cochrane review looked at the evidence of spinal cord stimulation for chronic pain in general, including for neck pain. Reviewers looked at 15 randomised controlled trials and couldn’t be certain about its benefits, largely due to the quality and reliability of the available trials.

Are there side effects?

Aside from disappointing results for pain relief, there are risks and side effects to consider.

We co-authored an analysis of 520 adverse events reported to Australia’s Therapeutic Goods Administration (TGA). We found 79% of reported events were rated as severe, with 13% life-threatening. The same research found 80% of events required surgery to correct.

Our recent analysis in the Medical Journal of Australia looked at data from private health insurers. These cover 90% of spinal cord stimulation implants in Australia. Five major insurers, which covered 76% of privately insured people, contributed de-identified data.

We found about one-quarter of people who had a spinal cord stimulator implanted needed corrective surgery afterwards. These surgeries occurred within a median of about 17 months. This indicates these surgeries are not routine or expected interventions, such as to replace batteries, which are meant to last five to ten years.

Our previous research shows the sorts of reasons for corrective surgery. These include to replace a malfunctioning device, or the person was in more pain, had an infection, or a puncture of the delicate tissues covering the spinal cord.

However, even our latest findings are likely to underestimate the risk of these devices.

Sometimes the lead delivering the electrical current moves away from the spinal cord to elsewhere in the body. This requires surgery to reposition the lead, but does not necessarily require new hardware, such as a brand new lead. So this type of corrective surgery is not counted in the data from the private health insurance companies.

How much does it cost?

We found spinal cord stimulators cost about A$55,000 per patient, including the device, its insertion, and managing any associated additional surgeries.

For people who only had a “trial” – where the leads are implanted temporarily but the battery pack remains outside the body – this cost was about $14,000 per patient.

These figures do not include any out-of-pocket costs.

What do regulators say about the devices?

In 2022 the TGA began a review of spinal cord stimulators on the market because of safety and performance concerns.

As a result, several devices were removed from the Australian Register of Therapeutic Goods – that is, they were banned from use in Australia, but existing stock could still be used.

The rest of the devices had conditions imposed, such as the manufacturers being required to collect and report safety data to the TGA at regular time points.

Should I do my own online research?

Yes, but be careful. Unfortunately not all online information about spinal cord stimulators is correct.

Look for sites independent of those who manufacture or implant these devices.

Government agencies, health departments and universities that have no financial interests in this area may be a better option.

The Cochrane Library is also a reliable and independent source for trustworthy health information.

What shall I ask my doctor?

The Australian health department provides useful advice for consumers about medical implants.

It says medical implants “are considered higher-risk therapeutic goods, and the decision to get one should not be taken lightly”. It recommends asking your health professional these questions:

• do I really need this medical implant?
• what are the risks/benefits?
• is the medical implant approved?
• where can I get more information?
• what happens if I experience an adverse event?

What else could I do for my back pain?

There are other treatment options that are effective and have fewer risks than spinal cord stimulation.

For example, education about how to manage your pain yourself, exercise, cognitive behavioural therapy (a type of psychological therapy), and non-steroidal anti-inflammatory medicines (such as ibuprofen) all have solid evidence to back them. All offer benefits that are not outweighed by their potential risks.

Australian research has shown other types of therapy – such as sensorimotor retraining and cognitive functional therapy – are also effective. You can discuss these and other options with your health professional.

Spinal cord stimulation is a good example of a treatment that got ahead of the evidence. Although the devices have been around since the 1960s, we’ve only had reliable trials to test whether they work in recent years.

Everyone wants to find ways to help people with chronic pain, but we must ensure medical care is grounded in reliable science.

Caitlin Jones, Postdoctoral Research Associate in Musculoskeletal Health, University of Sydney and Christopher Maher, Professor, Sydney School of Public Health, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.