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At the beginning of the new millennium, Australia's cities and their peri-urban and rural hinterlands were in the midst of a worsening drought. Having developed in the mid-1990s, the Millennium Drought finally broke in 2010, at least in south-eastern Australia. It was the most severe drought experienced in southern Australia since instrumental records began in the early twentieth century, thanks to a combination of natural variability and anthropogenic climate change. The urgency of water restrictions and supply augmentation that had characterised the drought years gave way to more pressing matters of the electoral cycle. As Australian cities continue to grow, it remains be seen as to whether plans to shape the urban form as a water catchment of its own materialise beyond model suburbs and local initiatives and what their implementation might mean for the water infrastructure and cultures of the past.
After World War II, Australians and new migrants rushed to build their dream home and garden. As housing estates proliferated in the suburbs, local authorities struggled to keep pace with increasing demand for water supply and sewerage connection. In all five cities, suburbs were constructed with no roads, kerbing and channelling, or sewerage. New subdivisions had reticulated water, but manual night cart collection continued in some suburbs and septic tanks were common until sewer lines were built. As the housing stock increased and septic systems were replaced with reticulated sewerage, water supplies were stretched beyond capacity. Authorities turned to the well-worn path of dam construction to increase supply, but when consumption exceeded capacity, especially in hot, dry seasons, unpopular water restrictions were implemented, with hoses and sprinklers banned. The sight of green suburban lawns turning brown undermined the myth of unlimited supply at the turn of a tap, but expectations were reinstated as soon as it rained.
Both Indigenous and non-Indigenous Australians have learnt to cope with climate variability in meeting water needs over a range of time-scales. The five cities are locations that Aboriginal people cared for and maintained relationships with water over tens of thousands of years, knowledge of which is maintained today. In the face of a changing climate and continuing population growth, the five cities face challenges in developing and maintaining sustainable and equitable approaches to water provision and management. Each response to water management problems is shaped by path-dependent effects of earlier decisions and the ‘wicked’ nature of problems that defy simple solutions. The five cities are marked by climatic diversity, and all are at least partly built on floodplains. Each has a distinct relationship with the natural water of its hinterland and the proximity of ocean outlets for sewage disposal.
As Australian cities face uncertain water futures, what insights can the history of Aboriginal and settler relationships with water yield? Residents have come to expect reliable, safe, and cheap water, but natural limits and the costs of maintaining and expanding water networks are at odds with forms and cultures of urban water use. Cities in a Sunburnt Country is the first comparative study of the provision, use, and social impact of water and water infrastructure in Australia's five largest cities. Drawing on environmental, urban, and economic history, this co-authored book challenges widely held assumptions, both in Australia and around the world, about water management, consumption, and sustainability. From the 'living water' of Aboriginal cultures to the rise of networked water infrastructure, the book invites us to take a long view of how water has shaped our cities, and how urban water systems and cultures might weather a warming world.
The diverse water systems and ecologies of the places that would become Australia’s capital cities sustained Aboriginal peoples for thousands of years because of two key factors: Aboriginal knowledge of water and associated wetland and riparian ecologies, and respect for life-sustaining water as a central tenet of Aboriginal cultures. For millennia, and often enduring in the wake of the violent rupture of colonisation, Aboriginal peoples understood the affordances and risks of different forms of water and preserved these understandings in robust oral traditions. This enabled them to follow seasonal abundances of water and avoid its seasonal hazards. For all Australian Indigenous cultures, water is a storied medium that connects the past and present in the ‘long now’: a living and lively substance that sustains their Country.
In the first half of the twentieth century, the replacement of labour-intensive methods of obtaining household water and disposing of wastes by networked infrastructure made possible a change in Australian housing layouts. The informal, mixed-use cottage gave way to the ‘bungalow’ with more specialised interior spaces and internal bathrooms, allowing rising living standards in working-class households. The extension of networked water supplies and sewerage, and increasing lot sizes with more space for gardens and lawns increased per capita water consumption in the five cities. To improve the sanitary condition of the ‘respectable’ working-class, State governments intervened in housing markets by providing access to low-cost suburban housing, but disparities in domestic water facilities persisted, with much of the inner city housing stock lacking internal bathrooms, laundries, toilets, hot water services, and taps. At the end of World War II, the five cities faced serious housing shortages, and with rising prosperity came strong demand for new suburban housing.
White settlers domesticated water by shaping and regulating natural water features into systems of dams, piped networks, and waste disposal facilities. Clean water is a common resource when there is no restriction on its use, and each use of the resource makes less available to others. Overuse of common water resources was an early feature of the five cities, and effective solutions were the product of democratic institutions that empowered citizens to take collective action and express demands for improved infrastructure. In Sydney, Melbourne, and Adelaide, sanitary reform through investment in networked water infrastructure in response to the threat of cholera was underway by the mid-nineteenth century; the development of effective sewerage was delayed by the costs of extension across large metropolitan areas and the fragmentation of political authority between local councils. The smaller cities, Brisbane and Perth, were slower to invest, and water supplies continued to be unreliable and subject to pollution from cesspits. By the start of the twentieth century, variations in water infrastructure systems reflected the path-dependent nature of earlier solutions, which would constrain the options available to future decision makers.
The signs of climate change continue to signal themselves through increased weather extremes. These events have major implications for the continued reliable supply of fresh water and safe removal of waste. As the limits to the environment become increasingly obvious and pressing, these constraints will serve as a significant challenge for future generations. In the past 200 years, Australians have learned a great deal about the fragility of their environment and the need to work within its limits – the wisdom of the country's first peoples still has much to teach us in our future responses to change.
In the wake of the ‘golden age’ of economic growth in the early 1970s, public provision of urban infrastructure came under the close scrutiny of governments seeking to reduce the size of their bureaucracies in the face of expanding budgets, rising prices, and increasing unemployment. Australian governments and water utilities followed the UK and USA by introducing price mechanisms to attain more efficient water use. This coincided with severe droughts that affected urban water supplies and led state governments to impose residential water restrictions, save for Brisbane, where catastrophic floods in 1974 reminded residents of their vulnerability to the elements. Growing concern for the environment, as well as the implications of environmental degradation for human health, meant that the sights, smells, and sounds of the Australian suburbs were on the eve of change. The use of suburban waterways as drains for industrial and domestic waste would no longer be tolerated, as local residents campaigned to protect built and natural environments from pollution and development projects. Such health and ecological concerns collided with the neoliberal reform agenda of the 1990s, when newly restructured water utilities faced a series of crises in their provision of water and disposal of wastes.
In the first half of the twentieth century, Australian metropolitan water authorities faced the challenge of keeping up with rising demand for water and sewerage. State governments could draw on income tax revenue to fund infrastructure projects and subsidise water authorities, but the demands and expectations of new suburban households resulted in periodic water shortages and a reliance on septic tanks and pan collection in unsewered areas. Because water demand is habitual and culturally determined, governments responded to these shortages by imposing water restrictions and investing in large storage works. Each of the five cities was supplied with safe water at the end of World War II, but the provision of sewerage was uneven. Brisbane and Perth lagged; Sydney and Melbourne’s sewerage systems would struggle to cope with new demands in the post-War boom period.
Background:Clostridioides difficile infection (CDI) is the most common healthcare-associated infection (HAI) in the United States. Healthcare facility-onset (HO) CDI reporting is a laboratory-identified (LabID) event and does not rely on symptoms. Inappropriate testing can lead to overdiagnosis in patients who are colonized, especially in those receiving promotility agents. Approximately 45% of HO-CDI cases at our institution occurred in the setting of laxative use in 2019. We assessed the effectiveness of an electronic medical record (EMR) “hard stop” in reducing inappropriate CDI testing and its impact on HO-CDI rates. Methods: We conducted a pre–post quasi-experimental retrospective study comparing test order rates per 1,000 patient days, CDI rate per 1,000 patient days, and standardized infection ratio (SIR) in the preintervention period (January 2018–December 2019) to the intervention period (April 2020–September 2021), at a 5-hospital healthcare system in southeastern Michigan. In February 2020, we implemented a hard stop in Epic that was triggered >3 days after admission for the following criteria: patients <1 year of age; repeated testing within 7 days, and receipt of promotility agents within 48 hours. After discontinuing the promotility agents for at least 48 hours, providers were allowed to place an order if diarrhea persisted. The medical director of infection prevention and control or designee had the ability to override the hard stop when deemed necessary after reviewing the case upon provider request. All orders expired after 24 hours if a specimen was not collected. We retrospectively reviewed the number of overrides after the intervention to determine the positivity rate. Results: Our CDI rates per 1,000 patient days were 3.21 in the preintervention period and 1.48 in the postintervention period, a 54% reduction (Fig. 1). The test order rates were 119.4 in the preintervention period and 87.7 in the postintervention period, a 26.5% reduction (Fig. 2). The SIR decreased from 0.542 in the preintervention period to 0.361 in the postintervention period, a 33% reduction (95% CI, 0.54–0.82; P = .0001). After the intervention, 299 patients had an override. Of these, samples from 218 patients (72.9%) were negative, 50 orders (16.7%) were cancelled, and 28 samples (9%) were positive. Conclusions: Diagnostic stewardship, utilizing an electronic hard stop, was effective in reducing inappropriate C. difficile testing in the setting of promotility agents without delaying diagnosis of HO-CDI. This strategy combined with standard best practices can significantly reduce HO-CDI rates.