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Latest national climate and health stocktake underscores this doctor’s plea for health sector action

Below are two articles: a short overview of the 2023 MJA–Lancet Countdown report released this week, followed by a call to climate health action from Dr George Crisp, a GP in Perth.

Beneath his article are links to more climate and health news and events.


“Unreasonable and unjust”

Melissa Sweet writes:

The sixth annual stocktake of climate change and health developments in Australia reveals some incremental gains, but overall underscores the glaring inadequacy of mitigation and adaptation efforts, especially in the health sector.

The 2023 MJA–Lancet Countdown report shows that Australia’s health sector emissions increased between 2019 and 2020, with a 30 percent increase in total emissions to 2020, and a 28 percent increase in per capita emissions.

Australia is ranked eleventh highest in the world for its healthcare greenhouse gas emissions on a per capita basis, the authors reported.

“There is an urgent need to act to ensure implementation of concrete actions and commitments for carbon reduction practices in the health sector,” they said.

The report is well-timed to add weight to a campaign by health and medical organisations that is lobbying for federal budget funding to implement the long-overdue National Health and Climate Strategy.

Looking beyond the health sector, the report says Australia is lagging other countries in shifting to renewable energy and that “a substantial acceleration of the coal phase‐out is crucial if Australia is to transition to a lower carbon economy”.

“Overall, the urgency of substantial enhancements in Australia’s mitigation and adaptation responses to the enormous health and climate change challenge cannot be overstated.

“Australia’s energy system, and its healthcare sector, currently emit an unreasonable and unjust proportion of greenhouse gases into the atmosphere.”

The 2023 MJA–Lancet Countdown report tracks indicators across five domains: health hazards, exposures and impacts; adaptation, planning and resilience for health; mitigation actions and health co‐benefits; economics and finance; and public and political engagement.

The authors acknowledge the need to do better in reporting on Indigenous health and climate change, and are working on developing an indicator in line with Indigenous Data Sovereignty principles that reflects concepts valued by Aboriginal and Torres Strait Islander people.

“Most importantly, utilising Aboriginal and Torres Strait Islander driven and governed datasets will change the narrative on Indigenous health and wellbeing and contribute to shared learning to address climate change impacts and adaptation,” say the authors.

Key findings include:

  • In 2021, 48,937 people were forcibly displaced by weather‐related disasters in Australia, including floods (42,139), storms (5,569), and bushfires (1,229). There is an upward trajectory in weather‐related displacement, even adjusting for population increase.
  • Based on 2022 population data, 167,743 people in Australia live less than one metre above sea level, an increase of almost 4,000 on the number in our previous annual report. Coastal adaptation strategies include protection of vulnerable areas, accommodation of risks through enhanced coping capacity, and retreat of populations will become more urgent.
  • Although National Aerial Firefighting Centre aircraft services have increased since 2007–08, from just over 30 to the current 161, the number of volunteer firefighters and support staff in Australia has decreased since 2015–16 and is currently at its lowest point since the Productivity Commission started reporting on this area of government services in 2009–10.
  • The overall trend shows an increase over time in the exposure to very high or extremely high bushfire danger, with average annual exposure in the past ten years (2013–2022) considerably increasing to 33.6 days per person from 27.5 days per person in the previous ten years (2003–2012).
  • Media coverage of health and climate issues is increasing, according to analysis of 13 Australian national and regional major newspapers and ABC online news and transcripts. However, there is little mention of the co‐benefits of climate change mitigation and less focus on more disadvantaged or more marginalised groups.
  • The number of scientific publications on health and climate change in Australia continued to surge in 2022. The researchers identified 407 new scientific publications in 2022, a 75 percent increase from 2021 (233). In contrast, the global number of scientific papers on health and climate change dropped by eight percent in the same period. Most of the studies focused on health impact assessments and fewer studies on co‐benefits and community level adaptation. Less than two percent of the studies focused on Indigenous people.
  • While the national parliament showed limited evidence of engagement with climate change as a health issue in 2022, state and territory parliaments were more engaged.

A duty of care

Writing from Western Australia, where homes were destroyed this week during a bushfire emergency warning south of Perth, Dr George Crisp urges medical colleagues to push harder for the phase out of fossil fuels.

George Crisp writes:

As doctors we are ethically and professionally bound to act in a medical emergency; in fact, failing to respond can result in disciplinary action.

A duty of care is the legal obligation or responsibility to take all reasonable steps to avoid causing foreseeable harm to another person….

A breach of duty of care is when that legal obligation to protect the wellbeing and safety of others is not upheld and somebody is injured or harmed

In the case of someone collapsing in front of us, the response and urgency of action is both self-evident and something that we explicitly are trained to do.

But some emergencies are not as dramatic and urgency less obvious due to their slower evolution.

The Australian Medical Association (AMA), like other comparable medical organisations, declared climate change a health emergency in 2018. The rational is that deaths and health impacts are occurring, and that without urgent action climate change will continue to escalate resulting in increasingly unmanageable health impacts and suffering.

There are numerous and compounding environmental, social, and economic pathways related to; increasing exposure to heat extremes, more severe and frequent floods and bushfires, more intense storms, worsened air quality, changing patterns of infectious diseases, compromised nutrition, displacement, and migration of populations.

Existing health threats and health inequities will be greatly amplified without deliberate systemic action to stop this.

All the threats that confront us – depletion of biodiversity and rising extinction, growing marine dead zones, freshwater and food insecurity, regional political instability, (mental health crisis) – climate change is a risk or threat multiplier.

And all these things affect and compromise our mental health and growing moral distress.

Dr George Crisp

So, what does emergency action in this setting really look like?

The first steps in a medical emergency involve “D” – looking for danger – and then calling for help (if there is no “R”, response).

In this setting we, health professionals, who have the knowledge and expertise to understand and interpret the dangers posed by climate change and, with that understanding, are the people who are best placed to communicate the nature of this health problem and preventive action.

Adaptation is urgently needed to manage health effects, but adaptations will never be able to keep up or cope with greater impacts, particularly as they undermine the provision of health care and vital infrastructure.

We must address the cause of the problem and that is oil coal and gas.

Burning these fossil fuels accounts for over 70 percent of our greenhouse gas emissions (as well as toxic air pollution that kills over eight million people each year). The only way to prevent escalating health impacts that will occur as we pass 1.5 and 2C is to rapidly phase out the use of these fossil fuels. There is no other way.

The fossil fuel companies are doing precisely what the tobacco companies did once they knew the dangers of their products – hid the truth and promoted doubt, and lobbied decision makers not to regulate and made large political donations.

In response to the dangers of smoking, the medical profession responded to this health threat by calling out these bad actors and their misinformation, by lobbying governments and informing their patients.

We have a duty of care and quite clearly that means we must act to call out the companies that are knowing jeopardising our future health, call out (and vote out) policy makers who are dodging their responsibility to protect the health and security of their citizens, call out the media who have misinformed or failed to convey the information that has been available to them.

Climate change is a far more serious and insidious health problem than tobacco use. It will affect everyone and is highly iniquitous – disproportionately affecting those who have contributed the least to the problem and are the most vulnerable in society.

As a profession we have recognised the danger for well over a decade and we have responded. AMA, Doctors for the Environment Australia, and the Climate and Health Alliance (CAHA) have repeatedly called on our policy makes to listen and to take appropriate action. But they have either not listened or greatly overstated any insufficient actions they have taken.

Remember, this is an emergency, and the response must be proportionate.

It cannot be left to a few; it will take all of us.

There are many important roles and action we can participate in:

Doctors are advocates for health, so we must become advocates for action on the biggest threat to human health.

We can call your elected representative, ask them why they have not acted, tell them it is their duty to do so. Vote for candidates that will vote for those that will ban new development and phase out coal oil and gas. Or explain to others why you will vote for planetary health.

The recent Tasmanian election is a good example of the need for action. Most politicians ignored it and those that did speak were ignored by the media. We can change this!

You can write to your paper; explain why as a doctor you cannot remain quiet. Discuss why fossil fuels are more damaging than smoking with your friends, families.

Make your practice more environmentally friendly. Believe me, it does work as a talking point with your patients and communities.

An increasing number of scientists and medics are resorting to public protest and other activism. Our standing can change public perception of the need for and importance of action.

Fires destroyed homes and property south of Perth this week. Image from ABC TV, March 2024

More climate and health news

The World Health Organization has released a toolkit to support health professionals’ communications on climate change.

The International Court of Justice has authorised the World Health Organization, at its request, to participate in the advisory proceedings on the Obligations of States in respect of Climate Change.

The National Health and Medical Research Council has issued a targeted call for research grant applications for a total $5 million pool. Deadline is 1 May.

“Proposed research projects will identify key areas of vulnerability and effective interventions to improve health outcomes and reduce health inequities in Australi