How floods impact health systems: a scoping review of Australian research

OBJECTIVES: Although the health impacts of floods are well described, there is limited research on how flooding affects health systems, services and the health workforce-despite their central role in mitigating and responding to these impacts. This scoping review examines the nature and extent of existing research evidence on the impact of flooding events on Australia's health system. DESIGN: A scoping review following the Johanna Briggs Institute methodology. DATA SOURCES: MEDLINE, Embase, CINAHL, Scopus, Web of Science, ProQuest Central and PsycINFO were searched through to 22 October 2024. Reference lists of included publications were screened for additional publications. ELIGIBILITY: We included studies that reported any health system or health service disruption associated with flooding in Australia. Disruptions encompassed impacts on hospitals, primary care, health information systems, infrastructure, public health and health promotion activities, and the health workforce. We included peer-reviewed publications, including original research, commentaries, perspectives, editorials, letters to the editor, modelling studies and reviews. Grey literature was excluded. DATA EXTRACTION AND SYNTHESIS: Screening of full texts and data extraction were completed by two independent reviewers. A health system disruption analytical framework was iteratively developed and was used to categorise the findings. RESULTS: Our search identified 6687 publications, of which 28 were included in the final review. 13 publications were original research publications and 15 were commentaries or reviews, with the majority published in the past ten years. Of the publications included, most focused on disruptions to hospital services and transport systems, including a reduction in health workforce availability, primarily due to the latter. Less than one-third reported impacts on health services for socially vulnerable populations. Floods affect multiple levels of the health system, intersecting with impacts across three key domains: infrastructure and health information systems, access to healthcare and the health workforce. CONCLUSIONS: Original research on how floods impact Australia's health system, its services and workforce has been limited, particularly in relation to general practice, allied health and the differential impacts on socially vulnerable populations. Further research is needed to inform targeted disaster preparedness and response strategies and to understand the complex and intersecting impacts. The analytical framework developed in this review provides a way to conceptualise how floods disrupt different components of the health system and offers a foundation for future research and policy development to strengthen system resilience in the face of increasing flood risk.