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.
• The Australian Government will work to improve and promote mental health initiatives aimed at increasing social community connectedness to help build longer-term resilience in communities before, and after, climate-related disasters and extreme weather events. This will help to address a wide range of mental health impacts of climate change, as well as support and complement the implementation of the National Disaster Mental Health and Wellbeing Framework.
• The Australian Government will work with relevant stakeholders to build workforce capacity to prevent, identify, and respond to the mental health and wellbeing impacts of climate change, including by exploring options for training in climate change and mental health.
• The National Health and Medical Research Council will engage with the Australian Government to consider economic, social, and environmental sustainability in the updated Australian Dietary Guidelines, including Australia’s commitment to the Sustainable Development Goals, the Paris Agreement and net zero emissions by 2050. The updated Australian Dietary Guidelines are expected to be published by 2026
• The Australian Government will work with states, territories, and the Australian Building Codes Board to progress opportunities to embed sustainability and climate resilience principles in the National Construction Code, and in doing so will consider the health impacts of climate change.
• The Australian Government, in collaboration with states and territories, will deliver a National Housing and Homelessness Plan that will outline a shared vision to inform future housing and homelessness policy in Australia. In developing this plan, the Government will consider the health benefits of climate-resilient housing.
• The Australian Government will seek to engage relevant agencies across all levels of government to promote active travel. This will support and complement implementation of the National Preventive Health Strategy 2021-2030.
• The Australian Government will engage with states, territories and relevant stakeholders to support and mobilise the health workforce to build a sustainable and climate-resilient health system, with a focus on: incorporating sustainable healthcare and climate resilience principles in health professional training curricula and accreditation processes, including through quality improvement processes; exploring options for developing and providing Continuing Professional Development and other training opportunities in sustainable and resilient healthcare for the health workforce.
• The Australian Government will commission and publish a report scanning current research activities in Australia pertaining to health and climate change. The report will identify gaps in the literature, with a view to informing the prioritisation of future research funding.
• The National Health and Medical Research Council is developing a Targeted Call forResearch focusing on strengthening the evidence base for Australian climate-related health impacts and effective interventions to improve health outcomes. The Call is planned for 2024 with an indicative funding allocation of $5 million over 5 years from the Medical Research Endowment Account.
• The Australian Government will design and deliver public-facing guidance on ways to reduce the emissions footprint of health and aged care, and opportunities to improve resilience to the health impacts of climate change.
• The Australian Government will review climate and health governance structures in consultation with states and territories and consider how to enhance cross- jurisdictional collaboration, as well as collaboration across the wider climate and health stakeholder community.
Responses
Professor Sharon Friel, ARC Laureate Fellow and Professor of Health Equity, Director of the Planetary Health Equity Hothouse, ANU
It is great to finally have a health and climate strategy for Australia. This provides an important signal from government that these issues are connected and require action. The Strategy also provides an authorising environment and framework for the bureaucracy to now work through.
It is also excellent to see health equity and a right to health so centrally positioned.
However, as a wealth of evidence tells us, addressing health inequities and health inequities related to climate change requires structural action not just adaptation that is about helping communities to survive – important as that is. Sadly objective 4 in the strategy (the health in all policies objective) misses the opportunity to really tackle the common structural drivers of health inequities and climate change – to do that would require climate change mitigation across sectors, especially energy. Which of course means no more fossil fuels.
Energy policy is health policy. Equity-focused energy policy will reduce health inequities in Australia and globally. The only mitigation focus in the health and climate strategy is in the health care system. Good but certainly not sufficient.
If the science wasn’t clear about the urgency of bold and courageous action, I would say this is a good first step. But we don’t have time for incremental changes when it comes to climate change.
I urge Ministers Kearney and Butler to use the health and climate strategy to help their Ministerial colleagues see that their actions really matter for human health and health equity, and the choices that Cabinet and Minister Bowen make will determine the health, wellbeing and ultimately survival of Australians and our regional neighbours.
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Statement by Australian Medical Association: No new fossil fuel projects, no fossil fuel money in politics
In a statement released the day before the strategy, the AMA called for no more fossil fuels projects to be approved, and for an end to donations from the fossil fuel industry to political parties and for fossil fuel subsidies to be transitioned to renewable energy.
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Dr Elizabeth Deveny, CEO of Consumers Health Forum of Australia.
CHF welcomes the Australian Government’s National Health and Climate Strategy. We know that the changing climate is impacting people’s health. We also know that we all need to do more to reduce emissions, including the health sector.
The impacts climate change has on people’s health is something that is frequently raised with us. It also seems to be an area that the wider Australian community is thinking and interested in. This interest and the need to act is not going to go away. Consumers want to know what governments, clinicians and consumers can do to build health resilience as the climate continues to change.
We are still working through the strategy to understand the particulars and how they relate to consumers, but given the interest in this issue, we have today asked Assistant Minister Kearney to speak to the CHF membership early next year about the government’s strategy.
CHF is pleased to see that one of the strategies core objectives is to take a whole-of-government approach which recognises the relationship between health and climate outcomes.
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Adjunct Professor Janine Mohamed, CEO of the Lowitja Institute, in comments made at COP28
Climate change is having significant and disproportional impacts on Aboriginal and Torres Strait Islander peoples and it is important to empower our peoples’ leadership.
Climate change is an intensification of colonisation as it threatens cultural heritage and traditional knowledge, impacting on the social and cultural determinants of health. It disrupts the strong connections that Aboriginal and Torres Strait Islander peoples have to communities, cultures, ceremonies and languages, which significantly impacts on health and wellbeing.
Nation states must fully implement the UNDRIP and support Indigenous workforces who are at the forefront of climate mitigation and adaptation. Australia should establish an Aboriginal and Torres Strait Islander Coalition on climate and health in Australia, to ensure the empowerment of Aboriginal and Torres Strait Islander leadership domestically.
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Statement by Doctors for the Environment Australia: The National Health and Climate Strategy is an important step, but to protect lives we must quit fossil fuels
“The Strategy adopts a Health in All Policies approach, recognising the interconnectedness between the health of humans, animals and the environment. To truly realise this vision we must stop making the problem worse, we must quit coal and gas for the health of people and planet.”
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Statement by Asthma Australia welcoming the strategy’s release and the transition to quality, low-carbon asthma care
The National Health and Climate Strategy includes a broad vision that gives voice to the importance of the health and wellbeing of Australians against the impacts of climate change.
Asthma Australia particularly welcomes the recognition in the Strategy of the importance of quality housing to populations vulnerable to the effects of climate change, which reflects the organisation’s recommendation that improving housing conditions should be a priority in the Strategy.
“People increasingly need to shelter from climate change events in their homes, particularly those vulnerable to hazards such as bushfire smoke, including people with asthma. However, we know from Asthma Australia’s research that homes are often not healthy places for people with asthma.”
Asthma Australia has, however, expressed disappointment over the Strategy’s lack of commitment a national air quality education campaign, a need recognised by the Royal Commission into National Natural Disaster Arrangements after 80 per cent of the Australian population was exposed to bushfire smoke for extended periods.
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Statement by Australian Healthcare & Hospitals Association welcoming the strategy
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