Croakey readers have until 24 July to provide feedback on a consultation paper informing development of Australia’s long-overdue National Health and Climate Strategy.
The urgent need for implementation and resourcing of the strategy has been underscored by a series of events and findings this week, including an air quality crisis affecting swathes of North America from wildfires in Canada.
Melissa Sweet reports:
The latest iteration of plans for a National Health and Climate Strategy highlights the importance of Indigenous knowledge, health equity, health in all policies, and stepping up communications and engagement.
A consultation paper released this week by the Department of Health and Aged Care is in many respects an improvement on an earlier version which, as Croakey reported last year, did not mention issues such as health equity.
However, there is an astonishing gap in the document (but perhaps not surprising given the commercial determinants of climate politics in Australia).
The term ‘fossil fuels’ is not mentioned once; rather any related discussions are about ‘fuels’, with ‘coal and natural gas’ mentioned once in the 43-page document in the context scope 2 emissions (energy-related indirect emissions) that occur outside of the boundary of an organisation from the generation of electricity consumed by the organisation.
Yet the paper stresses the importance of mitigation, and of health in all policies approaches.
The silence on fossil fuels also undermines the paper’s focus on the importance of effective communications and engagement “with a wide range of stakeholders and the general public to ensure actions to address the health and health system impacts of climate change are widely understood”.
The document notes proposals to “increase public awareness of the health impacts of climate change to empower individuals and communities to take actions to reduce emissions and build climate resilience”.
Australia desperately needs a public health education campaign on climate mitigation and adaptation – but it’s difficult to see how this could be effective if the elephant in the room can’t be named.
Respect for First Nations
The paper says the Department of Health and Aged Care will work with First Nations people to ensure the strategy reflects their voices and expertise, respects First Nations data sovereignty, and upholds First Nations self-determination.
The document recognises the role of colonisation in driving both climate change and health inequities, and stresses the critical role of Indigenous knowledge in informing how Australia can address climate change.
“Embedding First Nations leadership and cultural knowledge within this Strategy will strengthen climate adaptation and emissions mitigation not only for First Nations communities but for all Australians,” it says.
“The Strategy seeks to incorporate the strengths of First Nations cultures, recognising they have continued to evolve and thrive despite the ongoing impacts of colonisation, systemic racism and intergenerational trauma.”
The paper says that for First Nations communities, climate change will exacerbate pre-existing high levels of ill-health; compound existing challenges in accessing safe water and appropriate housing, infrastructure and health services; and affect cultural and spiritual connections to Country.
At-risk groups
The strategy also acknowledges the increased risks from climate change for the elderly, people with disabilities, people with pre-existing health conditions, including people with poor mental health, and for small children and pregnant women.
“Elderly people are particularly vulnerable to climate change due to higher rates of medical comorbidities and physical limitations, and many also live alone or have limited social support networks. This means sudden declines in health, for example from heat stress, may go undetected and lead to increased illness and death,” it says.
People experiencing socio-economic disadvantage and social marginalisation, culturally and linguistically diverse communities and people living in rural and remote areas are also at increased risk.
“Consideration will need to be given to health and emergency responses for people with disability and older people in disaster resilience and recovery situations, including by ensuring First Nations peoples are enabled to recover their connection to culture and Country following climate-related disasters,” says the paper.
The health impacts of climate change are also disproportionately experienced by women, it notes.
“For example, there is significant evidence domestic violence against women and children spikes during and following climate-related disasters and extreme weather events, and there is also an established negative association between smoke inhalation from bushfires and pregnancy.”
The paper notes that many Australians live and work in environments and circumstances that make it difficult to adapt to the health impacts of climate change and exacerbate its impacts.
“In a wide range of workplaces, such as construction and outdoor maintenance, excess heat is becoming a more common occupational health and safety risk.”
Health in all policies
Taking a health in all policies approach is one of four proposed objectives for the strategy. Others are around measuring and reporting on health system greenhouse gas emissions, mitigation to accelerate the reduction of greenhouse gas emissions from the health system, and adaptation, to strengthen the resilience of the health system and communities to anticipate and respond to the health impacts of climate change.
The paper notes that many decisions influencing the social, economic, cultural, environmental, and commercial determinants of health are made outside the health system.
“Many of these decisions not only negatively impact on health and wellbeing, including equity, but also drive climate change, highlighting the importance of developing a holistic response to the health impacts of climate change.”
The strategy aims to establish governance, leadership and accountability mechanisms that support government agencies to recognise and understand the health and health equity impacts of their policies, and find ways to collaborate to design and implement joint public policy for improved health and wellbeing outcomes (for example, using health impact or health lens assessment).
The society-wide National Climate Risk Assessment would facilitate necessary linkages across policy areas by considering systemic risks and grouping them thematically.
Principles
Proposed principles informing the strategy are:
1. First Nations leadership: First Nations knowledge and experience must be central to decision-making on climate and health policy at all levels.
2. Tackling health inequities: A health equity approach recognises some populations are more vulnerable to and have less capacity to adapt to the health impacts of climate change, and that responses to climate change need to take account of disparities in health outcomes.
3. Population health and prevention: The response of the health system, and society more generally, to climate change must be underpinned by a public health perspective. This recognises that prevention of disease and maintenance of good health across the lifespan, in combination with optimal secondary and tertiary prevention, assists both mitigation and adaptation.
4. One Health: The Strategy will be underpinned by the principle of One Health – recognising the connection that exists between the health of people, animals and the environment.
5. Evidence-informed policymaking: The response to climate change must be based on the best available data, evidence and research – but we must also be willing to take action on a prudent and precautionary basis in the face of uncertainty and incomplete information. Where possible, actions should be prioritised based on the principles of cost-effectiveness analysis, considering where resources can be allocated to maximise population health gains, while also taking account of health inequities and rights-based approaches.
6. Partnership-based working across all levels of government and beyond: All levels of government need to work closely with each other, as well as with communities, patients, First Nations, not-for-profit organisations, peak bodies, private industry and education and research institutions to craft and implement a holistic and nationally consistent response to climate change.
Healthcare responsibilities
The paper says that reducing the health system’s greenhouse gas emissions aligns with the health profession’s responsibility to first do no harm.
As well as being harmful, greenhouse gas emissions are associated with other harms including biodiversity loss, pollution and waste, and excessive consumption.
Emissions reductions from the health system will have major health, social, environmental and economic benefits. For example, the electrification of ambulances and hospital transport vehicles would reduce air pollution and hence reduce the exacerbation of respiratory diseases.
The paper says health system emissions reduction strategies should always be undertaken in a manner that does not undermine quality of care. For instance, asthma patients should not be shifted onto lower-emissions inhalers if a higher-carbon option is clinically preferable, while active transport and diversifying from liquid-fuel-generated electricity may be difficult in remote communities.
The document notes that many private providers within the health system (such as private hospitals, specialists, and pathology and diagnostics providers) have also begun committing to targets themselves – for example Ramsay Health Care, the largest operator of private hospitals in Australia, has committed to achieving net zero emissions across its value chain by 2040.
The document also highlights the importance of prevention, and value-based care, including by avoiding overdiagnosis, overtreatment and unnecessary laboratory tests.
Other recommendations include encouraging greater social prescribing, investigating the potential for telehealth and hospital in the home programs to reduce emissions, and for shifting models of care from acute care to primary care and self-care.
The document describes a need to support the health and aged care workforce to further develop the skills and capacity to raise public awareness and understanding of the health impacts of climate change, take action to address these impacts, strengthening the resilience of health services and providing care to affected populations, and lead innovation in reducing health system emissions.
The document highlights the importance of ensuring the health system and workforce is supported to sustainably retain and attract staff into the future, acknowledging the existing and expected future pressures faced by the health workforce – including stresses related to the COVID-19 pandemic, recent climate-related emergencies such as bushfires and floods, and ongoing workforce shortages, including in areas particularly impacted by climate change.
Urgency matters
While the paper gives a solid overview of the health issues at stake, it could do more to convey the urgency of the situation, especially given concerns about Australia’s poor performance at a national level in addressing climate and health policy, and about the Albanese Government’s failure to prioritise climate and health action in its recent budget.
Just consider these recent news items:
• Carbon dioxide levels measured at the National Oceanic and Atmospheric Administration’s Mauna Loa Atmospheric Baseline Observatory peaked at 424 parts per million in May, continuing a steady climb further into territory not seen for millions of years, scientists announced on 5 June.
• The Arctic Ocean could be ice-free in summer by the 2030s, even if we do a good job of reducing emissions between now and then. That’s the worrying conclusion of a new study in Nature Communications, as reported by The Conversation.
• Research into the collapse of earth systems, recently published by Nature magazine and summarised at The Conversation, make it clear we are facing a planetary health emergency. The authors say this is largely “driven by social and economic systems run on unsustainable resource extraction and consumption”.
Milestone
The Climate and Health Alliance (CAHA) has welcomed the release of the consultation on Australia’s first National Health and Climate Strategy.
CAHA Founder and Strategic Projects Director, Fiona Armstrong said in a statement: “This is a huge milestone for climate and health policy in Australia.
“CAHA is completing a comprehensive analysis of the Strategy and will assist our vast network of members and health stakeholders to respond with appropriate feedback.”
Earlier this year, the Assistant Minister for Health and Aged Care, Ged Kearney, and the Assistant Minister for Climate Change and Energy, Senator Jenny McAllister, began the first round of consultations of the strategy through targeted stakeholder roundtables in NSW, Victoria, WA and the ACT.
Consultation workshops are ongoing, with the next ones in Queensland on Friday 9 June and Victoria on Friday 16 June.
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