The consequences of the terrible bushfires which have swept Australia in recent days bring together two systemic challenges impacting on life as we know it: climate change and an outmoded health system.

The fires make increasingly urgent the need for remastered health and environment approaches that support our health needs now and global wellbeing into the future.

The admirable efforts of GPs, nurses and pharmacists to maintain community-based services in the face of infrastructure and communications breakdowns have revealed just how vulnerable our health care becomes in times of crisis such as those linked to climate change. It also highlights just how important access to familiar and ever-present primary health care services are to the community.

Quite apart from the acute care needed immediately for fire casualties, there are the fresh challenges which fire and smoke pose to services for people with chronic illness, mental health issues and the aged.

The huge and rising cost of health services should energise government and community to act on the evidence before us to improve our own health and that of our environment.

The calamitous scale of the fires and the smoke that has carried hazardous particulate matter to communities hundreds of kilometres distant is a direct reminder, if any were needed, of the extensive reach of climate change harms.

The fires and drought currently engulfing Australia have confronted communities with the dire health consequences of climate change and should spur a community-wide push for an urgent, credible response.

The expert predictions are that climate change is going to get much worse. Without action to arrest it, we will see more and more of these events impacting on people’s health, which will place further pressure on hour already strained health system.

We cannot afford to have our system failing people with chronic illness, mental health and aged care at a time of such heightened need. We have the scientific knowledge, health workforce and resources to guarantee that our health system is world-leading on any measure: clinical outcomes and fair and equal access to services now and into the future.

It is not as if Federal Health Minister, Greg Hunt, is ignoring the need for change in health care.  He has proposed the creation of 10-year plans for primary health care, prevention and mental health and has tasked expert committees to actively work these up. We need to add responses to the public health emergency triggered by climate change into implementation plans.

But all of these spheres have been the subject of countless inquiries, reviews and ministerial task forces over the past two decades by both Coalition and Labor governments. While the policy documents proliferate, the diagnoses continue with little sign of overall remedies. We cannot risk failure to implement.

We need to implement what we know works, such as integrated health and social policy that not only supports care within the community but also promotes wellbeing, through healthy and productive lifestyles. And that is just in the near term - we also need a forward commitment to implement health care delivery that takes full advantage of the new evidence and technologies at our disposal to the benefit of everyone.

At the moment, the bifurcated basis of health and social administration, caused by federal, state and territory split funding, deters joined-up arrangements, so, for instance, integrating hospital and community care, even in the private sector is impeded.

We need to see stronger drive and funding from all levels of government to, for instance, make primary health care an effective first choice for vulnerable people with physical and/or psychiatric conditions. It is wrong that in a nation as prosperous as Australia we have a system which means many people without the means are deprived of care and treatment routinely available to the well-off. The result is often that they may get care that is too late, in a hospital, at hugely more expense to themselves and the taxpayer.

The Consumers Health Forum has for some years advocated for a revamped health system to empower consumers and community-centred arrangements that, by spurring people actively to manage and enhance their own health, will boost national both physical and fiscal wellbeing.

The necessity of vigorous primary health care arrangements, even in relatively small communities, has been shown in recent days as the bush fires cut off power, transport and even phone links. In communities large and small, we will be best served by local health arrangements that are centred around the consumer rather than providers.

Such change requires organisation and challenges to existing culture. Our vision for the 21^st Century is to encourage government support for consumer and community leadership to shape collaboration with providers in developing more effective health care systems.

We have proposed to government measures to improve primary and preventive care such as:

• Targeted support for doctors and nurses to educate patients with chronic conditions to actively manage their own health and to equip those at risk of chronic illness to lower that risk
• Support health providers to engage effectively with parents to support healthy early childhood development, along with a primary health care strategy spearheaded by patient and family-centred health care home arrangements.

Australia has 21^st Century knowledge and capabilities. Now we need more than ever to implement what’s within reach for the good of our health and our world.