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The National Health and Climate Strategy could be transformational, if these concerns are addressed

More than six years after a framework for a national strategy on health and climate change was put forward by health and medical organisations, the Australian Government has launched the country’s first National Health and Climate Strategy.

As reported earlier this week, Assistant Health and Aged Care Minister Ged Kearney launched the long-awaited strategy on the inaugural health day at the COP28 meeting in Dubai, flanked by some of the First Nations and other health experts who had contributed to its development.

The strategy sets a benchmark for many other policy documents in centring the expertise and concerns of First Nations peoples. It acknowledges the importance of working across policy areas in partnership with First Nations people to address the impact of climate change on the social and cultural determinants of health.

The foreword by Ministers Mark Butler and Kearney stresses the need “to elevate the leadership, wisdom and knowledge of First Nations people in the response to the health impacts of climate change”, and to look “to First Nations people’s holistic understanding of health and ongoing custodianship of the land and seas as we work toward building a healthy and sustainable future for all”.

The strategy commits the Government to working in partnership with First Nations communities and the Aboriginal community-controlled health sector to:

• Identify options to support the capacity of Aboriginal Community Controlled Health Services to participate in place-based climate risk assessment and adaptation planning and emergency preparedness, response and recovery for climate-related disasters.

• Address the impacts of climate change on First Nations food security and the health of First Nations people, including through the National Strategy for Food Security in Remote First Nations Communities.

• Work in partnership with the National Aboriginal and Torres Strait Islander Housing Association to promote the importance of high-quality, climate-resilient housing in reducing the negative health impacts of climate change on First Nations communities.

• Include a health perspective in the First Nations Clean Energy Strategy, including by exploring opportunities to improve access to affordable and reliable power through renewable energy  for First Nations housing and health infrastructure.

Gaps and commitments

While a momentous leap forward from the barren wasteland years of climate health policy under the former LNP Government, many have observed the document’s glaring silence on the most critical climate health call to action: the urgent need to phase out of fossil fuels. It’s a call that has been widely reiterated this week by many health leaders, including the World Health Organization and others at the COP.

And while the strategy takes a comprehensive, holistic approach to recommending climate health-promoting changes across many sectors, including healthcare, there are no details on how these actions will be funded, and of the structural changes that will be needed to drive them, especially the commitment to Health in All Policies.

Nonetheless, as the list below shows, the strategy makes concrete commitments to a number of actions, summarised below (so that Croakey readers can help monitor progress and accountability on these pledges).

•  The Australian Government will undertake a National Health Vulnerability, Capacity and Adaptation Assessment, starting with an analysis of the health and social support system, within the National Climate Risk Assessment.

• The Government will develop a National Health Adaptation Plan as part of the National Adaptation Plan, expected to be published by the end of 2024. The National Climate Risk Assessment and the National Adaptation Plan are both led by the Department of Climate Change, Energy, the Environment and Water.

•  The Government will develop guidance and implementation support tools in partnership with states, territories, Aboriginal Community-Controlled Health Services and other relevant stakeholders to enable state and territory health systems, local health systems, Aboriginal Community-Controlled Health Services and hospitals to undertake climate risk assessment and develop adaptation plans in a nationally consistent way.

•  Comprehensive local and regional risk assessments and adaptation plans, developed in consultation with local communities and priority populations, will be crucial in effectively addressing climate-related risks to health and wellbeing. The geographic, demographic, and meteorological diversity of Australia means that climate and health risk profiles will differ significantly between regions and localities, requiring tailored and place-based responses to address risks. The wide variation in health system capacity and capability across Australia needs to be accounted for in risk assessments and adaptation plans.

• The Australian Government will consider the impact of climate change in implementing the National Preventive Health Strategy 2021-2030, recognising the role of preventive health in reducing demand on carbon-intensive health services and therefore reducing greenhouse gas emissions from the health system, and building population and health system resilience to the health impacts of climate change and extreme weather events.

• The Government will work with relevant stakeholders to explore options for developing a framework for routine data collection, monitoring and reporting on the impacts of climate change on population health and health system functioning.

• The Government will work with states and territories to develop an ‘all hazards’ National Health Emergency Response Plan, which will consider health emergencies for climate-related disasters and extreme weather events. It will update and consolidate existing health emergency response plans to provide a single source document to guide Australia’s response to, and recovery from, emergency incidents of national significance.

•  The Government will work with relevant stakeholders to strengthen the resilience and availability of primary care during and after climate-related disasters and extreme events by strengthening the role of Primary Health Networks in emergency preparedness and response. Primary Health Networks will be supported to consider climate risks in the health needs assessment process and in planning and commissioning of local health services, to strengthen their functions in emergency preparedness, response and recovery, and to have a role in local incident response/command governance structures for climate-related emergencies.

• The Government will improve aged care emergency preparedness and response capability, working in conjunction with the Aged Care Quality and Safety Commission, and to identify early risks to aged care residents from surveillance, monitoring and reporting of extreme weather events.

• From July 2024, the new Aged Care Act will give effect to a strengthened set of Aged Care Quality Standards, which will include requirements for providers for (a) emergency and disaster management, and (b) managing environmental risks relevant to care and services for older people.

• From 2024, the Australian Government will introduce the National Aged Care Design Principles and Guidelines, which will include considering environmental sustainability and options for climate resilience when designing aged care homes.

• The Government will publish baseline emissions estimates for the health system (inclusive of health and aged care) in 2024 and will seek to publish regular emissions estimates thereafter to track progress in emissions mitigation efforts.

• The Government will work together with state and territory health departments to align emissions estimation approaches by state and territory health systems, leveraging, to the extent possible, National Greenhouse Accounts methods and frameworks and data already reported by states and territories through their own reporting mechanisms.

• The Australian Government will seek to negotiate a national emissions reduction trajectory for the Australian health system. It will encompass all levels of the health system (inclusive of aged care) and will encompass scope 1, scope 2 and scope 3 emissions.

• By 2025, the Australian Government will develop a health system decarbonisation roadmap encompassing all levels of the health system (inclusive of aged care). The roadmap will encompass scope 1, 2 and 3 emissions as well as patient travel, and will be developed in alignment with the Australia-wide Net Zero 2050 plan and state and territory strategies and plans.

•  In 2024, the Australian Commission on Safety and Quality in Health Care will, with input from the Australian Government and states and territories, pilot the Environmental Sustainability and Climate Resilience Healthcare Module – a framework of action focused on environmental sustainability and building climate resilience. Implementation of the Module will inform action in future national safety and quality standards developed by the Commission.

• The Australian Commission on Safety and Quality in Health Care will develop guidance for health service organisations’ governing bodies and leadership teams on the delivery of appropriate, high value care, focusing on reducing unwarranted healthcare variation and low value care.

•  The Australian Government will work with professional bodies to develop and pilot a framework for mapping emissions hotspots across patient care pathways of clinical specialties and the National Health Priority Areas to identify opportunities to reduce emissions while optimising patient care. This will build on the framework planned for development by the National Health Service in England.

•  The Australian Government will consider expanding the use and public reporting of National Australian Built Environment Rating System for public hospitals and residential aged care; and developing and implementing National Australian Built Environment Rating System tools for private hospitals and medical centres.

• The Australian Government and the Australian Building Codes Board will work together to consider possible changes to the commercial building energy efficiency requirements in the National Construction Code. The changes are intended to support the Government’s energy and greenhouse gas policies, including the 2050 net zero target. If agreed by Building Ministers, the new requirements will apply to hospitals and other health and aged care facilities.

• The Australian Government and the Council of Ambulance Authorities will work together to promote knowledge sharing and data collection among state and territory ambulance services and other patient transport providers, also drawing on international experience, to adopt best practices in reducing emissions from ambulance services and to measure and report on progress.

•  The Government will work with the Australian and New Zealand College of Anaesthetists, the Australian Society of Anaesthetists and states and territories to significantly reduce use of desflurane, including by agreeing a date by which its use will be phased out.

•  The Government will work with the Australasian College for Emergency Medicine, the Australian and New Zealand College of Anaesthetists, the Australian Society of Anaesthetists, the Australian Nursing and Midwifery Federation, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, states, territories, industry and suppliers to improve patient care, protect health care staff and reduce greenhouse gas emissions from nitrous oxide gas, both by reducing wastage from leaks and venting and by educating on appropriate use.

• The Australian Government will work with Asthma Australia, National Asthma Council of Australia, Lung Foundation of Australia, Thoracic Society of Australia and New Zealand, Royal Australian College of General Practitioners and industry to improve respiratory health outcomes and reduce greenhouse gas emissions from respiratory inhalers.

•  The Australian Government will commission and publish a review of how sustainability is currently considered in state and territory policies on food access, availability and procurement in hospitals, and may consider relevant policies internationally. This review could inform guidance on food provision with the public hospital system.

• The Australian Government will commission and publish a review of the potential ways in which health and aged care waste can be reduced, reused, refurbished, recycled, replaced and segregated and how these changes can be implemented. This review will then feed into the green procurement and sustainable resource use guidelines and further resources for health and aged care facilities and staff.

• The Australian Government will develop guidelines on green procurement and sustainable resource use in consultation with states, territories, industry and suppliers.

• The Australian Government will, in consultation with industry and other relevant stakeholders, review options for including public reporting and consideration of environmental impacts, starting with greenhouse gas emissions, of health technologies, in collaboration and alignment with international best practice in comparable jurisdictions.

• In working to decarbonise health system supply chains, the Australian Government will work with the international collaboration between the English National Health Service and the United States Department of Health and Human Services to develop aligned procurement requirements to decarbonise health system supply chains.

• The Australian Government is considering options for how its next Nationally Determined Contribution under the United Nations Framework Convention on Climate Change, due for submission in 2025, could highlight health.

• The Australian Government will work with states and territories to develop and publish a National Heat-Health Action Plan which promotes a nationally consistent approach to minimising the health impacts of heat.

• The Australian Government will work together with states and territories to address the risks and health impacts of reduced air quality driven by climate change, as part of wider work to increase knowledge, awareness, and capacity to respond to the risks and health impacts of air pollution.

• It is anticipated that the Australian Centre for Disease Control will work with jurisdictional stakeholders to enhance Australia’s communicable disease surveillance, prevention, and response capabilities, reflecting the impacts of climate change on communicable disease emergence and transmission. This is expected to include establishing governance and operational structures to coordinate, promote, support, and assess the adoption of One Health principles across all levels of Australian government.