Australia's political engagement on health and climate change: the MJA-Lancet Countdown indicator and implications for the future.

Abstract

Urgent and sustained political engagement is needed to address the health impacts of climate change Recent extreme weather events and natural disasters in Australia, such as the 2019–2020 Black Summer bushfires and catastrophic floods throughout 2021–2022, have resulted in considerable negative impacts for community and individual health and wellbeing. As Australia increasingly faces devastating weather events and natural disasters associated with climate change, strong political engagement by governments is necessary to implement effective policies that address the health impacts of climate change. However, whereas countries around the world are taking action to mitigate climate change, Australia lags, ranking 59/64 in the Climate Change Performance Index.1 Australia's political engagement on health and climate change is particularly poor. An international comparison of country engagement on climate and health found that Australia's engagement with the health impacts of climate change relates primarily to disaster response, and impacts in Pacific Island nations — not in its own communities.2 Additionally, Australia makes no reference to health in its contribution pledge to the United Nations Framework Convention on Climate Change, and to date is one of few countries lacking a national health and climate change strategy.3 However, there are signs of improvement, with climate change featuring in the National Preventive Health Strategy 2021–2030, and the new federal government announcing the development of a National Health and Climate Strategy.4, 5 Many health bodies have been active on this issue and continue to lobby successive governments about impacts of climate change on health.6, 7 The MJA–Lancet Countdown on health and climate change in Australia assesses Australia's political engagement on this issue in our parliaments and bureaucracy (indicator 5.3 of the 2022 report).8 For the purposes of this article, political engagement refers only to parliamentary and government engagement, and excludes broader engagement from the media, industry, the research sector, civil society, and public discourse. Our analysis offers deeper insights into the results of the MJA–Lancet Countdown indicator from several of Australia's leaders in the field of climate change and health, including four MJA–Lancet Countdown co-authors. It discusses the implications of current political engagement and proposes strategies for external stakeholders to encourage increased political engagement. Overcoming current obstacles to political engagement is vital to Australia's health and wellbeing, and is critically time-sensitive given the accelerating pace of climate change and fast-approaching critical thresholds. The MJA–Lancet Countdown measures political engagement using parliamentary websites for the Commonwealth of Australia and all eight states and territories to search for bills, legislation, committees and inquiries relating to climate change and health. The results of the 2021 and 2022 MJA–Lancet Countdowns (which assessed political engagement in the preceding year — 2020 and 2021, respectively), revealed a bleak picture at the national level, but there is promise from some state and territory governments.8, 9 In 2020, no national parliamentary documents discussed climate change and health .9 There were only three bills introduced to the Australian Parliament that referred to climate change and health; however, the linkage was not explicit and only one bill passed into law. Unfortunately, the Recycling and Waste Reduction Act 2020 has minimal focus on health, and in practice has had limited change, particularly given it has not been supported by more substantial legislative frameworks.10 Also of note, independents and minor parties introduced bills, attempting to put the issue on the political agenda in the absence of government engagement. Some bills were referred to parliamentary committees and others did not reach the floor for parliamentary debate. At a federal government departmental level, only one document relevant to health mentioned that climate change contributed to disasters such as bushfires, floods and cyclones, albeit briefly in the introduction.11 At state and territory level, parliamentary engagement across the jurisdictions was also relatively low and consistent with national engagement. However, there was more of an explicit focus on the health impacts of climate change. For example, New South Wales held an inquiry into the 2019–2020 Black Summer bushfires with a focus on health (https://www.dpc.nsw.gov.au/assets/dpc-nsw-gov-au/publications/NSW-Bushfire-Inquiry-1630/Final-Report-of-the-NSW-Bushfire-Inquiry.pdf); South Australia held an inquiry into the South Australian Public Health Act 2011 with a focus on climate change (https://www.parliament.sa.gov.au/committees/sdc); and Western Australia introduced climate and health relevant bills before parliament. Additionally, departmental engagement was much higher compared with the national level. All state and territory governments had strategies, plans or policies relating to climate change that had clear linkages to health, and/or public health policies with clear linkages to climate change. Some jurisdictions also had regional and local level strategies. The political engagement of some health departments went further than merely identifying linkages between health and climate change; for example, the creation of a specific climate health adaptation plan in Queensland; an inquiry into climate change and health in WA; and a roundtable on climate change and health in Tasmania.12-14 Victoria also started consultations on a Health and Human Services Climate Change Adaptation Action Plan.15 During 2021 there was some improvement from the previous year, with increased engagement across all parliaments.8 Unfortunately, this engagement remained superficial, with very few making climate change and health a primary focus of bills or inquiries. At a national level, eight bills were introduced to the Australian Parliament that referred to health and climate change. Only two passed into law, with neither making the Australian Government (including the executive, ministers and departments) responsible for explicitly addressing the impact of climate change on health.16, 17 There was also an increase in engagement from the government itself, although independents and minor parties were still introducing a major proportion of relevant bills with a clear focus on climate health. The number of chamber documents (eg, notice papers, votes and proceedings) referencing climate health also increased, with one explicitly calling on the government to “urgently develop a ‘National Strategy on Climate Change, Health and Well-being’, which is supported by more than 50 health, social welfare and conservation groups”.18 Again, in 2021, as was seen in 2020, state and territory political engagement was more apparent and better targeted than that of the federal parliament and government. Ten bills and twelve inquiries explicitly referenced climate change and health; for example, the NSW inquiry into health outcomes and access to health and hospital services in rural, regional and remote NSW referenced floods, bushfires and drought (https://www.parliament.nsw.gov.au/lcdocs/inquiries/2615/Report%20no%2057%20-%20PC%202%20-%20Health%20outcomes%20and%20access%20to%20services.pdf); the Victorian Inquiry into the Health Impacts of Air Pollution referenced climate change (https://new.parliament.vic.gov.au/4af06f/contentassets/bfbcb6bd449c4785840cb65d65f28a4c/health-impacts-of-air-pollution-victoria.pdf); and the SA Inquiry into Urban Green Spaces referenced health, climate change and heat (https://www.parliament.sa.gov.au/committees/sdc). Political engagement is an important component of a functioning democracy such as that of Australia; it is through political engagement that the will of the public or citizenry can be expressed through elected representatives and decision makers.19 It is also through political engagement that meaningful systemic action can take place to address complex issues like climate change and health. Yet, the political environment, including political ideologies and corporate political activity, impacts political engagement, which in turn affects the level and nature of policy implementation.20 This has resulted in varying degrees of engagement across the jurisdictions and different engagement strategies being employed. Here, we first discuss the implications of the results from the past two years (2020 and 2021). Opportunities arising from the current situation are considered in the following section. Explicit linkages between climate change and health have been severely lacking in terms of legislative responses. The previous conservative Liberal–National Coalition governments (2013–2022) downplayed the health impacts of climate change, and avoided the use of climate change terminology when discussing the health, social and economic impacts of extreme weather events. For example, there was a concerted effort from the then federal government to avoid linking the 2022 floods and 2019–2020 bushfires with climate change, discrediting the scientific evidence and dismissing the advice of agency experts.21, 22 Additionally, the climate linkages to the COVID-19 pandemic appear to have been ignored, given that many of the causes of climate change also increase the risk of pandemics.23, 24 The COVID-19 pandemic presented an opportunity for politicians to engage on broader climate change and health issues, but this was not realised. The global pandemic temporarily shut down the normal operation of the Australian Parliament in 2020. Limited political engagement during that period could be partly attributed to the pandemic. However, political engagement on health and climate change at the national level has historically been poor.25, 26 Despite a wealth of evidence on the health impacts of climate change, there appears to be a disconnect, with the two issues remaining siloed in parliament and the bureaucracy. This is also evident in the recent National Climate Resilience and Adaptation Strategy 2021–2025, where health is mentioned sparingly and is lacking a strong focus in the strategy.27 Also missing from parliamentary debate were several major international climate change events in 2021 that explicitly addressed health issues, including COP26 and the Intergovernmental Panel on Climate Change report. Unfortunately, Australian Government representation and response to these events was poor, with limited commitment, and criticised locally and internationally.28 Because of the lack of federal government engagement during 2020 and 2021, minor parties and crossbench independents in both houses of parliament attempted some engagement on climate change and health. However, these attempts were unsuccessful, with bills not passing parliament. Bills put forward by the crossbench and minor parties require majority support to be successfully passed, which is unlikely without one or both major parties. Under the constitution, the Commonwealth has responsibility for trade and commerce, international borders and quarantine, whereas health and public health services remain state and territory responsibilities. This could partly explain why there has generally been increased engagement at state and territory level on health and climate change. However, the Commonwealth role in funding and regulation has effectively meant shared and overlapping responsibilities for health. As such, Commonwealth engagement is critical for achieving meaningful and coordinated action. Unfortunately, this has not occurred. There was greater engagement from state and territory governments with all jurisdictions having policies or strategies linking climate change and health. Some governments were more engaged and have developed specific action plans or reports with clear recommendations for action on health and climate change. This type of engagement is transitioning political commitment from one of mere linkages and rhetoric to something more system wide.29 Although there were some pieces of legislation introduced, some state and territory governments chose to use policy, rather than legislation, to explicitly engage with climate and health issues. This is a strategy to retain policy oversight and avoid negotiating legislation through a potentially unsupportive parliament. It reflects what has historically been occurring in alcohol and food policy, where lack of federal action resulted in state and territory governments acting largely through policy instruments rather than legislative means.30 Although the MJA–Lancet Countdown does not measure the engagement of thousands of local governments across the country, it is important to note the vital role local governments play in addressing climate change and health challenges. Local governments have delegated responsibility for many public health issues (eg, environmental health, food safety, and water quality), and other areas related directly or indirectly to climate change and health (eg, urban planning and development). Some examples of local government action are discussed below. Although beyond the scope of this MJA–Lancet Countdown indicator, we cannot ignore the role of vested corporate interests and political ideologies in influencing policy. Australia's decades of stagnated climate policy have been characterised by what some believe is a toxic political environment involving the promulgation of disinformation in the media.31 Influential industry associations have been identified as having a negative impact on Australia's climate policy, with one analysis finding that 75% of the groups assessed took positions against climate regulations while promoting a pro-fossil fuel agenda.32 Countering and negating this undue industry influence is paramount. Climate change is the defining issue of our time and its impact on health is far reaching and growing.33 There are global recommendations for governments to act on climate change and health (Box 1).34, 35 Health professionals who are concerned about the health impacts of climate change can support evidence-informed engagement at the political level and advocate for these and other recommendations. Below, we outline some of these opportunities, including targeted actions detailed in Box 2. There are capacity building opportunities for organisations and individuals. Doctors for the Environment Australia and the Climate and Health Alliance have developed resources to support advocacy regarding the health impacts of climate change. Organisations such as For Purpose, Common Cause Australia, and Sydney Policy Lab also offer training in policy and advocacy, coalition building, values-based messaging and campaigning. It will be important to find political champions within government and crossbench. However, it is likely that some numbers may still be needed from the Opposition, and it will be important to find aligned members of the Liberal–National Party Coalition. Targeting MPs whose seats were severely impacted by recent climate events is one strategy. New data on health impacts of the floods and bushfires will be important to demonstrate a need for action to protect Australian communities. Policy request: A national strategy on climate change and health, supported by new legislation that considers and addresses the health impacts of climate change. Writing to and building relationships with the relevant portfolio holder is the best way to get an issue on the agenda. It is also important to communicate with portfolios that might be more broadly affected by the health impacts of climate change. Majority numbers are required in Cabinet to agree on policy, and in Parliament to pass legislation. It is also important to raise concerns with the Opposition to encourage bi-partisan support, or to have them push a legislative agenda if there is an unsupportive government. Policy request: Update public health acts or relevant environment and climate change legislation to ensure there is a clear and explicit focus on the health impacts of climate change. Embedding responses to the impact of climate change on health in local urban development policy is critical. It will be important for all levels of government to collaborate and invest in evidence-based policy on health and climate change. Policy request: Review and update local laws and policies. Lobby state government for climate adaptation funding. Some actions include creating greener spaces, trees for shade and cooling, requirements for energy efficient new developments, and developments that encourage walking and cycling. Australia's federal election in May 2022 resulted in a change of government, the first in nearly a decade. Climate change was one of the defining issues of the election.37 A new federal government and an increase in electoral support for minor parties and independents has already presented opportunities for increased political engagement on climate change and health. In November 2022, the Albanese Labor Government confirmed they would develop Australia's first National Health and Climate Strategy, following on from pre-election commitments made in Opposition.5 This new political environment is likely to provide more opportunities for health professionals to make submissions and lobby MPs and ministers in raising the ambition of the strategy and associated policies, or to increase consideration of health in climate-related legislation. Consultations and inquiries also often receive media coverage, which can increase impact, including for climate and health research. New agendas are being formed and new legislation is being drafted that health professionals and constituents may be able to influence. The Labor Government, with the support of the Greens, Independents and select Liberal MPs, has passed new climate legislation with emission reductions targets: the Climate Change Act 2022 and the Climate Change (Consequential Amendments) Act 2022.38, 39 The recently proposed wellbeing budget is another positive announcement that could see the prioritisation and funding of climate and health policy.40 A wellbeing budget takes a sustainable approach to economic development by prioritising wellbeing over exponential growth, creating an economy that addresses social, environmental and health needs.41 However, even with a change of government, there will likely continue to be a concerted effort from the fossil fuel industry and other corporations to undermine climate action. State and territory governments have jurisdiction over policy and regulatory frameworks for health, environment and emergency services. Advocates can seek amendments to existing policies, such as including health considerations in climate change legislation, or having regard to climate change in health legislation. Public health acts have been updated in WA, Victoria and SA to include environmental health provisions. It is through these provisions that the WA Department of Health initiated the Climate Health WA Inquiry,42 and SA state and local government public health plans are required to consider climate change impacts. Many states are facing climate-related disasters. Parliaments are reflecting on these events and looking for prevention and mitigation strategies via inquiries. These present an opportunity for individuals and community groups to share their stories and for health and climate change advocates to raise their issues, present evidence, and contribute to improved strategies. For example, the final report of the 2022 NSW Flood Inquiry indicated failures in urban development planning and capability gaps within responsible agencies, including the operational response during flood rescues and the recovery response, which were traumatising for impacted communities.43 Some local government areas will be more severely affected by climate events. For example, the densely populated areas of Western Sydney have repeatedly been impacted by severe heatwaves, flooding, and air pollution. Many local councils are acting on climate and health issues and are often working in partnership with state governments or non-government organisations to develop action plans (in some places, required through public health legislation) or research programs regarding adaptation.44-47 Yet, many councils across Australia have not properly considered the impacts of climate change on the health and wellbeing of their communities. As the custodians of urban development policy, they are well placed to take direct action in areas where it is most needed. However, advocates should be mindful that many councils, particularly regional councils, have very limited resources. Another major barrier for local governments to make sound, evidence-based policy on climate change and health is pressure from industry, including developers.12 Undue corporate influence is occurring at all levels of government, and is hampering evidence-based policy. It will be critical for advocates to highlight industry's vested interests and demonstrate to their local councils the necessity of good policy on health and climate to future-proof their communities. There are a growing number of non-government organisations, research institutes and peak bodies actively advocating for action on health and climate change, including the Climate and Health Alliance, Australian Medical Association, Public Health Association of Australia, Doctors for the Environment Australia, Royal Australasian College of Physicians, the George Institute for Global Health, and the Healthy Environment and Lives network. Many of these organisations and groups have employed a range of advocacy strategies including developing climate change and health policy guidance, preparing climate change impact statements, writing submissions to inquiries, running public campaigns, highlighting industry conflicts of interest, and lobbying MPs and ministers. Advocacy by health groups was critical in influencing the 2022 federal election.48 There is a wealth of evidence on effective advocacy strategies and the importance of relationships, coalition building, coordinated messaging, and networks.49, 50 New organisations can add their voices to the cause. Diverse representation from within the health sector is important. However, to demonstrate the depth and diversity of community concern about climate change and health, networks need to be widened and coordinated engagement sought from individuals and organisations working in human rights, education, the environment, social services, and other areas beyond health. This has been critical to success in achieving policy change and countering corporate political activity on other public health issues.49 It is promising that political engagement on climate change and health is increasing across Australia. However, it is important to support continued political engagement and ensure a transition to a sustained and embedded level of commitment by all levels of government. We need explicit references to climate change and health in legislation and policy documents. This is necessary as it expresses societal needs and values, and guides decisions and behaviours while also supporting actions in a strategic way.19 Advocates should also be mindful of and continue to draw attention to and challenge the vested corporate interests undermining much needed policy change. Without greater political engagement on this issue and subsequent investment in policy and legislative change, Australia will continue to see a growing health burden as climate-related health disasters (eg, heatwaves, bushfires, floods, disease vectors, and air pollution) increase in frequency and severity. Climate and health advocates, including health professionals, can employ a range of strategies to support increased political engagement, and sustain action on this important health issue. No relevant disclosures. Not commissioned; externally peer reviewed.