The Agents of Climate Justice in Healthcare.

People who use languages other than English (defined as those whose primary language identity is something other than English)1 comprise nearly 9% of the US population.2 Sixty percent of children who are first- or second-generation immigrants (1 or more parents born outside of the United States) have at least 1 caregiver who use languages other than English.3 These caregivers and their children experience health and health care disparities, including worse health care access, lower health care quality, and higher experiences of adverse medical outcomes.4,5 To address these disparities, health care systems must implement a language justice approach,6 whereby the responsibility of provision of linguistically affirming services is shouldered by health care systems rather than patients, and where language services are seamlessly interwoven into all parts of a patients' health care experience.In this edition of Hospital Pediatrics, Luercio et al take a step to further elucidate how best to implement language justice in health care settings by conducting interviews around inpatient hospital communication challenges and opportunities with Spanish-speaking parents of children with medical complexity (CMC) and hospital staff members.7 Trust emerged as a cross-cutting facilitator to optimal communication. Trust in the medical system is critical and deeply interwoven with improved health care access, quality, and health outcomes.5,8 However, mistrust of health care is often well justified because of historical and current day harm perpetrated against marginalized communities, including families who use languages other than English. Trustworthiness, or actions taken by health care clinicians and systems to show they are deserving of trust, is an important paradigm shift9,10 and aligned with a language justice approach.Luercio et al noted how participants shared that caregivers would ask for interpreters if not provided. To foster trustworthiness, health care systems should implement strengths-based and affirming strategies to identify patients who use languages other than English and provide them with linguistically affirming services. Universally screening all families on registration with a question such as "What language would you like for your care today? We have free and confidential interpreter services available" will ensure that families do not need to advocate for language services and that they will receive services seamlessly throughout their health care experience. Individuals within a family may have different language identities (ie, the child, caregivers); therefore, in pediatric settings, it is critical to ask and document each caregivers' (and for children and adolescents, the patient's) language identity.11Use of certified, professional interpreters is required in health care settings under Title VI of the Civil Right Act, Executive Order 13166, and Section 1557 of the Affordable Care Act. However, similar to other studies, Luercio et al uncovered the use of "workarounds" when language services are unavailable or underused, including ad hoc interpreters, families being asked to use English, or use of nonverbal cues. Ad hoc interpreter use (eg, bilingual staff, use of family members) is associated with suboptimal communication,12 which can be particularly dangerous for CMC who have lower reported health-related quality of life,13 independent of language. It may also be traumatizing for the family member who interprets (eg, interpreting for a sibling's care) or for the person themself (eg, a survivor of partner violence having their abusive partner interpret). Past studies have also demonstrated how clinicians may use their language skills, even if they are not fluent,14 or may attempt to speak in English with a person who uses languages other than English. Language is complex; although some caregivers may be able to use English in some contexts, it may not be the primary language identity they wish to use when they are in a health care setting or at their most vulnerable. Systems-level solutions are needed to ensure provision of linguistically affirming services, such as universal training for all staff, interpreters being part of mock codes (as it may be harder to remember to use linguistically affirming services during emergencies), review of all clinical protocols and policies to ensure inclusion of provisions around language justice, and integration of language documentation in the electronic medical record.Another systems-level opportunity is hiring and training a culturally diverse and multilingual workforce. Although Luercio et al found that interpreters were highly acceptable, families also desired linguistically concordant staff. Physician–patient language concordance is associated with increased patient satisfaction, patient–physician trust, and medication adherence.15,16 Although ethnoracial concordance is important, language concordance among non-Hispanic White health care workers can still be impactful. The call for workforce diversity is not new and takes time, resources, and long-term investment to recruit, retain, and promote culturally and linguistically diverse staff. High school and university pipeline programs for individuals from racial and ethnic populations underrepresented in medicine, as well as bilingual individuals can foster support and mentoring for those interested in the health care field. Health care training should more broadly offer language courses and assessments to support interest in multilingual learning among medical students, physicians, nurses, medical assistants, and social workers (eg, Clínica Hispana de Cuidados de Salud-CHiCoS program).17Language is integrally intertwined with culture, as shown in this study where participants highlighted their experiences with cultural stereotyping, leading authors to urge cultural humility when serving immigrant, refugee, and families speaking languages other than English. Cultural humility shifts away from considering culture in a superficial or stereotypical way, and instead recommends active listening, power sharing, and continuously understanding how a family's lived experience may impact their health-related decision making.18 Cultural humility also prioritizes the strength and beauty of culture and language, rather than viewing these concepts from a deficits-based lens and highlights the heterogeneity of lived experiences rather than seeing cultural groups as a monolith. In addition to culture, health care systems must consider the intersecting impacts of structural oppressions on families who use languages other than English. Upward of 4 million US children have at least 1 parent without documentation, who may be fearful to apply for public benefits such as supplemental nutrition, Women, Infants, and Children program, subsidized housing, and social security disability insurance for their CMC.19 These intersecting vulnerabilities may create compounding challenges for families in accessing health care and achieving optimal health underscoring the urgent need for health care systems to create healing-centered spaces that address structural violence.Luercio et al also highlighted the important opportunities and challenges offered by technology to provide linguistically affirming services. Health care has experienced rapid innovation in the past decade, catalyzed by the COVID-19 pandemic, including the advent of telemedicine and the increased use of the patient portal for medical communication. These innovations, although helpful for some, may be widening health care disparities. For example, studies have shown that caregivers who use languages other than English are less likely to access telehealth services compared with caregivers who use English.20 Written communication is now a common way for patients to interact with the health care system, through patient messages, review of notes or patient instructions, and visit reminders. There is currently inconsistent translation of patient-facing written materials and limited options for clinicians to translate patient instructions in real time.21 Providing equitable access to telemedicine services and written health care materials may be even more critical for families with CMC, who need to attend health care visits more frequently and may have more complicated discharge instructions. One consideration mentioned in the article is use of artificial intelligence (eg, Google Translate) to serve as a real-time translator. A 2023 review of machine learning tools for health outreach and communication with communities who use languages other than English showed that more than half presented mixed or inclusive results regarding accuracy and readiness of machine learning for the dissemination of public health information.22 An article from 2021 examining accuracy of Google Translate in translating medication directions and counseling found varying accuracy among Arabic, simplified Chinese, and Spanish translations, with 29% of the inaccuracies considered highly clinically significant or potentially life threatening.23 Although current evidence does not support use of artificial intelligence to augment translation services in health care settings, further work in collaboration with artificial intelligence experts is needed to determine how to develop systems that can promote language justice while also ensuring thriving and longevity for the translator workforce.A critical aspect and innovation of this work is "centering on the margins" or amplifying the voices of families who use languages other than English in policy, practice, and research.24 Past studies have shown that participants who use languages other than English are often excluded from pediatric health research25 and pediatric clinical trials.26 Research representation is a powerful tool to amplify the voices of communities through science, disrupt health disparities, and foster trustworthiness of health care. Research must also align with a language justice approach, ensuring optimal spoken, written, and signed communication with participants in all phases of the research process, including reporting participants' primary language in publications.6,27 Research with participants must particularly consider equitable inclusion of families with intersecting vulnerabilities (such as caregivers of CMC) and must be conducted in partnership with families and culturally affirming community based organizations.Language justice in health care and research is an essential step toward disrupting health disparities and promoting equity for communities who use languages other than English. Pediatric health care systems have an urgent responsibility to implement evidenced-based, equity-centered practices and policies that foster trustworthiness, provide linguistically affirming services, leverage health care innovations, and promote a thriving workforce of bilingual and bicultural clinicians, interpreters, and translators. Language justice, as a critical aspect of health equity and justice, cannot be an afterthought and must be intentionally incorporated into health care and research to radically change the health care experience for families and promote lifelong thriving for CMC.

Abnormal Justice

Aim: The social determinants of health are crucial for understanding the factors that influence social justice in healthcare. Besides medical care, factors such as housing, education, employment, and income disparities need to be considered for a healthy life. The aim of this review is to examine justice and inequalities in the healthcare sector within the context of public health nursing. Method: Literature search was conducted between December 01, 2023, and January 31, 2024, using the English translations of key terms such as "health sector," "justice," "inequalities," "public health nursing," or "health" and "social justice" and "inequities" in Google Scholar, Medline, Pubmed, and Sciencedirect search engines. Results: Justice in the healthcare sector is defined as the absence of systematic differences in health or its fundamental indicators among social groups with different levels of social advantage or disadvantage within a society. This implies equal access to healthcare services for every individual and the absence of unjust distribution of health opportunities, ensuring no barriers to health access. The focus should be on preserving the health of everyone in society, not just individuals. The goal of justice in the healthcare sector is to eliminate barriers preventing access to health resources and services for everyone as a whole. Data indicate numerous attitudes and reasons contributing to social justice inequalities in the healthcare sector. Conclusion: Public health nurses focus on addressing the social determinants of health and aim to eliminate health inequalities through leadership, interdisciplinary collaboration, advocacy, education, and care roles. By actively contributing at these levels, public health nurses can strengthen the healthcare system and work towards a better future.

This chapter examines the imperfect nature of the health care system in the United States, with particular emphasis on the gap between political ideals and current political praxis. It considers the tension between the ideal of the individual as an autonomous economic and political agent, and the ideal of a collective distributive justice that fairly and equally benefits all. The myth propelling the preeminence of the individual is that each could succeed, if he or she really tried; hence, public support for universal benefits such as health care is an undue burden on achievers. The chapter suggests that the America within which the debate over health care reform occurred in 2009–2010 is a very different place than it was in 2000. It also looks at Medicare and its impact on the 2009–2010 health care debate and concludes by proposing an alternative reading of responsible political agency in relation to health care justice.

Frustrated by perceived federal reticence to act on the growing scientific evidence of climate change, state governments and environmentalists are increasingly turning their attention to the courts. Broad consensus has developed about the reality and seriousness of global warming, but neither the Bush administration nor Congress has yet responded with meaningful action. The result is a situation that is ripe for litigation. Plaintiffs have emerged, suing corporations on the grounds that their greenhouse gas emissions are causing undue harm and suing governments for failing to regulate the corporations. In addition, industry has responded with countersuits of its own.

Mental health and climate change: tackling invisible injustice

The Use of Articles 2 and 8 ECHR in Climate Change Litigation in the Aftermath of the Urgenda Ruling

Climate change represents a global crisis that transcends borders, affecting every nation and community as climate justice gains prominence and seeking remedies to address climate-related issues becomes crucial. Environmental Public Interest Litigation (EPIL) has emerged as a potent instrument to hold governments and corporations accountable for their contributions to climate change and its consequences. This article explores the theories that underpin climate justice, examines the practical applications of EPIL worldwide, and delves into the intriguing prospect of adopting the Chinese mode of EPIL in transnational climate disputes. As one of the world's largest economies and greenhouse gas emitters, China plays a pivotal role in the global fight against climate change. This article explores how climate justice can be pursued in China through the avenue of EPIL. It examines the underlying theories that support the concept of climate justice, delves into the practical applications of EPIL in the realm of climate change, analyzes China's climate legislation and relevant judgments, and discusses the enforcement challenges and prospects for advancing climate justice through EPIL in the Chinese context. The 21st century has witnessed an unparalleled awakening to humanity's environmental challenges, particularly the global climate change crisis. As the adverse impacts of climate change become increasingly evident, the urgency to address its consequences has led to the concept of climate justice. Climate justice acknowledges the disproportionate burden of climate change on marginalized communities and future generations, emphasizing the need for equitable and sustainable solutions. EPIL has emerged as a legal strategy to uphold climate justice, aiming to bring about systemic change by leveraging the power of the courts to protect the environment and human rights. The urgency of addressing climate change has made it a defining challenge of our era. Its implications extend beyond national borders, affecting ecosystems, economies, and vulnerable populations worldwide. Climate justice underscores the ethical responsibility to address climate change's disproportionate impacts on marginalized communities and future generations. An important and developing area of environmental law is the use of litigation to seek climate justice. There is an immediate and critical need for strong legal frameworks to tackle the growing threat of climate change and global warming to ecosystems and at-risk populations. A strong theoretical basis for comprehending and progressing climate litigation is provided by concepts like public nuisance, public trust, and human rights. Cases like Milieudefensie et al. [3] in Europe show how lawsuits are being used more and more to enforce climate pledges and rectify environmental damage, while environmental public interest litigation in China has made great strides in holding entities responsible for ecological damage. Establishing more thorough international frameworks and extending these legal procedures outside domestic contexts will be the task going forward. To overcome these restrictions and promote a more united global response to climate change, regional treaties and transnational climate litigation like the ones proposed for ASEAN could be crucial.

BR Cluster facilities have historically recorded peak total greenhouse gas (GHG) emissions of ~1.1 million tons CO2e in 2019. A higher power consumption and large routine flaring are the biggest contributors in GHG emissions. This paper describes an effective integrated pathways undertaken through decarbonization roadmap, Flaring Abatement Initiatives and Energy Efficiency Initiatives to reduce the GHG emission footprints. These initiatives and roadmap contribute towards a greener hydrocarbon industry and helps in combating climate change. BR cluster has identified an innovative pathway to achieve 50% emission reduction by 2030 and Net Zero Emissions by 2050 by utilizing numbers of technologies and initiatives to reduce GHG emissions. Wide ranging initiatives are identified and deployed with help of new technologies includes flare reduction, flare gas recovery for power generation, facilities and Water Reservoir Management (WRM) energy efficiency improvements, novel solution for water treatment and nature-based solutions for carbon abatement. A novel solution for flare Gas reduction is achieved with help of new technologies (flare gas recovery for power generation, and upgrade of control) to recover routine flaring volumes and phased out Fuel gas consumption. As a result of the deployed technologies and initiatives, BR facilities recently achieved ∼64% reduction in flaring and overall ∼42% drop in GHG emissions. This significant reduction achieved by divert the flare gas from Early Development Field projects to power generation for field operations. From 2030 onwards, all routine flaring will be eliminated as gas is used for power generation. Several initiatives were implemented across the cluster to improve surface and subsurface equipment reliability/energy efficiency, includes export pump trimming, control valve modification, stop recycling, solar ESP, Electrical Submersible Progressing Cavity Pump Permanent Magnetic Motor (ESPCP PMM) and conversion gas lift to ESP. These implemented initiatives have contributed to GHG emission reduction by 642 ktCO2e. A novel solution for water treatment and disposal was executed in R field to utilize and phase-out the disposed water produced from Rima station to utilizing the water for agriculture and wildlife protection and saves the environment from GHG emissions associated to Deep water Disposal (DWD) power consumption. The reduction achieved in power consumption is 5.1 MW, with a reduction in GHG emissions of more than 86 ktCO2e. In line with the decarbonization pathway, total GHG emission is predicted to further reduce and reach 423 ktCO2e (60% lower) by 2030 and 200 ktCO2e (82% lower) by 2044. This paper shows Innovative pathways to decarbonization by implementing advance emission reduction Technologies that’s help to achieve cluster emission goals for energy efficiency and emissions reduction. BR cluster decarbonization pathway, learnings and approach could be replicated elsewhere in the Hydrocarbon industry thereby contributing to a cleaner energy for the planet.

How can university scholars and community activists effectively collaborate to produce generative, empowering, and materially impactful knowledge and actions concerning climate change and climate justice? In this paper, we report on a collaborative effort between climate justice non-governmental organizations (NGOs) and university faculty and students to conduct research to produce innovative ideas and insights about just transitions in California and to support social movement campaigns aimed at actually reducing greenhouse gas emissions by keeping fossil fuels in the ground. This collaboration was jointly initiated by faculty and students at a California university alongside leaders of local social movement organizations dedicated to climate justice, as a response to several proposed development projects that would expand oil extraction and fossil fuel use in that state. We argue that these efforts produced a climate justice gestalt that serves to amplify our productivity, power, and impact well beyond what any single partner could do separately or individually with respect to addressing climate injustices in our region. This is our plan for addressing climate change from an anti-authoritarian, participatory approach that will speak to new developments in the scholarship on climate and environmental justice studies and collaborative research methods.

In the aftermath of the catastrophic 2019–2020 bushfires, the corona virus disease of 2019 pandemic and recent devastating floods in New South Wales and Queensland, Australians voted for climate action in the 2022 Federal election, and a new Climate Change Bill1 has already passed the House of Representatives. Climate change is recognised by scientists, public health experts, Indigenous leaders, economists and the Australian public at large as the most pressing issue at our doorstep.2-5 As we consider the veracity of net zero emission election commitments and the architecture of a post-pandemic recovery in Australia, we use science, public health expertise and a common chronic condition to explain the links between key issues and outline a road map for action in Australia. In this commentary, we highlight current evidence on the relationships between climate change, air pollution, fossil fuel use and their associated impacts on public health. We use asthma as a case study to examine the economic and human health burden arising from this climate-air pollution-fossil fuel triad. Australia's dependence on fossil fuels and gaps in energy policy are underscored as drivers of negative climate and public health outcomes. We provide a roadmap for action consisting of a mandate for: rapid de-carbonisation of Australia's energy systems; adoption of a healthcare without harm framework; and preparing public health systems to prevent and control asthma exacerbations. Climate change is the greatest threat to public health of the 21st century.6 The planet has warmed significantly over the past century by on average 0.8°C, largely as a result of increased global emissions of carbon dioxide and other greenhouse gases (GHG).7 Human activity and fossil fuel-based, carbon intensive energy systems have contributed substantially to global heating. Climate change is having profound effects on weather systems, exemplified by the increased frequency and duration of extreme weather events including floods, drought and bushfires. Climate change also adversely impacts on atmospheric air quality and air pollution.1 The relationship between climate change and air quality is bi-directional: climate change can exacerbate or increase existing air pollutants (e.g., atmospheric heating increases ground level ozone); air polluting emissions influence the climate (e.g., release of carbon-based materials such as black soot have a heating effect); several sources of air pollution are sources of GHGs (e.g., methane locks heat in the atmosphere, triggering climate change). Incomplete combustion of fossil fuels is a primary source of air pollutants (e.g., particulate matter [PM]2.5) and is harmful to human health.8 Higher temperatures and carbon dioxide levels arising from climate change also increase airborne allergenic pollens contributing to allergic asthma.9 The energy sector is the largest contributor to GHG emissions in Australia.8 Australia's primary energy consumption is dominated by fossil fuels (i.e., coal 40%, oil 34% and gas 22%)10 and its electricity system is founded on centralised, carbon-intensive coal-fired generation. Australia's coal burning (and exports) contributes to climate change and air pollution and hence health impacts. Every step of coal's lifecycle produces air pollutants that affect human health. Burning coal produces fly ash and particulate matter (PM2.5), which lodge in the lungs, causing irritation and inflammation.11 Transport (energy) is the second largest source of emissions after electricity production.12 The road transport sector, including passenger and commercial vehicles, is reliant on petroleum-based fossil fuels and is a significant contributor to air pollution in cities and regions.13 For example, petrol and diesel emissions arising from road traffic are a major culprit in asthma exacerbations: Nitrogen dioxide (NO2) exposure and living in close proximity to a major road are associated with an increase in the likelihood of asthma in children and adults.14, 15 Asthma is one of the most common and costly of all chronic disease conditions affecting more than 260 million people globally, and both its prevalence and incidence is strongly associated with air quality and atmospheric pollution16 In 2021, 2.7 million people (10.7%) of the Australian population had asthma, making it a common non-communicable disease17 and accounting for 417 deaths in 2020.18 Nationally, there were over 37 000 hospitalisations with asthma as the principal diagnosis in 2016 and around 2% of all general practitioner encounters were for asthma, representing the 14th most common reason for a general practitioner consultation in that year.19, 20 As asthma is a lifelong condition, the costs associated with the condition are high, both to the individual as well as to the health service, where it accounts for $770 million in direct expenditures annually.19 Studies of coal mine fires and coal town residency illuminate the fossil fuel, air pollution and asthma relationship. The Hazelwood coal mine fire in the Latrobe Valley, Victoria in 2014 created plumes of smoke and ash with high PM2.5 for 45 days. Guo et al.21 found increased risks of all-causes, respiratory diseases, and asthma related emergency presentations and hospital admissions. Casey et al.11 found living near coal-fired power plants is linked to higher rates of respiratory disease and increased asthma exacerbations, while shutting down a coal plant or upgrading emission controls decreases inhaler use, emergency department visits and hospitalisation for asthma among local residents. Gas has also been associated with childhood asthma: one study of Australian children reported the population attributable fraction for childhood asthma associated with household gas stoves (which release PM2.5, NO2) for childhood asthma was approximately 12%, corresponding to over 2700 disability adjusted life years.15 Climate change is increasing the frequency and intensity of bushfires in Australia. Smoke from bushfires is a major risk factor for asthma exacerbations: the 2019–2020 summer bushfires have been linked to 429 premature deaths, more than 2000 hospitalisations for respiratory health issues and 1500 emergency department presentations with asthma.235 The health-related economic costs of the 2019–2020 bushfires was estimated AU$1.95 billion, with the majority due to the economic costs of premature mortality associated with the bushfires; AU$25 million of healthcare costs, $24 million for cardiovascular and respiratory hospitalisations, and AU$1 million for asthma emergency department attendances.22 Climate change effects allergic diseases.23 Thunderstorm asthma is an allergic asthma response to airborne allergenic pollens that rupture due to osmotic shock following a thunderstorm event, and thereby allowing smaller allergenic sub-pollen particles to reach the lower airways to trigger the potentially deadly allergic response24 (see Figure 1). In November 2016, the phenomenon of thunderstorm asthma caused 10 deaths in Australia and more than 3300 ED presentations.19, 24 Several studies have shown that plants growing in highly polluted air produce more allergenic pollen.25 When combined with pollen rupture, it results in a volatile mix that turns such pollens into ‘biological time bombs’. Knox et al.26 have shown that the major allergen of rye grass pollen has the capacity to directly interact with diesel exhaust carbon particles (DECP). They assert allergen-loaded DECP has the capacity to penetrate the lower airways and prompt an episode of asthma. Figure 1 describes the relationship between air pollution, climate change, fossil fuels and thunderstorm asthma as a public health issue. Healthcare—one of the world's largest industries—contributes to climate change and air pollution. The Australian healthcare system is responsible for ~7% of national GHGs.27 In the United States, one study has estimated that healthcare-related air pollution was responsible for 9% of respiratory disease burden from PM emissions.28 Similar estimates of disease impact are not available locally, but Australian healthcare is responsible for around 3% of national PM footprint.29 Paradoxically, some asthma treatments are significant contributors to GHGs. Metered-dose inhalers for asthma contribute an estimated 3.9% of the total carbon footprint of the UK National Health Service,30 due to the extremely potent GHGs used as propellants in some delivery systems. Australian estimates are not available, but the same products are widely used in this country. This scenario demonstrates perverse feedback loops—air pollution and climate change drive each other, and both drive increasing asthma incidence through various pathways, while treating asthma can itself further drive climate change through GHG emissions. This is a critical decade. Linear, single issue and reductionist approaches will not cut through the complex public health challenges arising from the climate change, air pollution and fossil fuel triad. Here we offer the new federal government and health sector a three-point roadmap for action. The roadmap highlights key public health-oriented interventions, which will prevent health-harming emissions, promote a healthy recovery from the pandemic and help Australians prepare for increasing asthma prevalence due to environmental triggers. Australia remains heavily dependent on fossil fuels and is unlikely to keep its commitments to the Paris Agreement to which it is a signatory. Since 1990, there has only been a 10% reduction in the share of electricity generation produced from non-renewable fuels (89.9% in 1990 to 80.2% in 2019) with more than half of total generation still reliant on coal.31 Stopping fossil fuel development and decarbonising energy systems are the most urgent and far reaching challenges of this decade.32 To prevent health harming air polluting emissions and to meet the goals of the Paris Agreement, Australia requires a coherent and timely policy framework that enables disinvestment in fossil fuels and a rapid transition to renewable energy. Central to this policy framework are climate change mitigation targets—an essential upstream and long-term public health strategy for managing the underlying causes of the increasing bushfire risk and thunderstorm asthma. This critical, foundational government policy framework will also support emission reduction efforts within the Australian healthcare sector.33 Action must be taken now, as limiting global heating to 1.5°C will require deep emissions reductions of at least 45% from 2010 levels by 2030.7 Australia's healthcare sector needs to reduce its total emissions to net zero. By 2030, an 80% reduction in emissions is required for healthcare to help meet the 1.5°C Paris Agreement commitments and minimise the predicted catastrophic public health consequences of climate change.33, 34 Australian hospitals and health systems must implement interventions which will decarbonize healthcare delivery to ‘first do no harm’ whilst maintaining and improving health. Healthcare systems can take cost-effective action to transition toward zero emissions energy, buildings, travel and transport, waste management as well as low emissions pharmaceuticals, sustainable food system ectera.35 There are multiple health service level examples of successful action (see Global Green and Health Hospitals36) and state and territory government policy leadership can support compliance and implementation. Substitution of high emission products with more climate friendly alternatives and incentivising the production of green medications is another key strategy. This is particularly relevant to asthma medication. Alternative delivery mechanisms to metered dose inhalers without the high global heating potential propellants, such as dry powder based inhalers, are available and suitable for the majority of patients.35 Wilkinson et al.30 study found that switching to low global warming potential asthma inhalers has co-benefits for reducing GHGs and drug costs. Many peak health and medical bodies have declared a climate emergency. We support the call by Australia's peak associations including Doctors for the Environment Australia, Australian Medical Association, Royal Australian College of Physicians and the Climate and Health Alliance for the establishment of an Australian Sustainable Healthcare Unit to lead and coordinate initiatives and collaboration nationwide.33 Australia's recent bushfire smoke-related and thunderstorm asthma epidemics were climate change and air pollution driven disasters of national and/or state level significance. Both events tested public health system preparedness and responsiveness and capacity to prevent and control environmental health hazards. We support the Royal Commission into National Natural Disaster Arrangement's recommendations, specifically those pertaining to community education, air quality and health.37 Further, we endorse Vardoulakis et al.'s38 perspective that consistency of air quality information and related public health advice across jurisdictions in Australia is essential. We support their call for an independent national expert committee on air pollution and health protection to be established to support environmental health decision making in Australia. Likewise, the impact of climate change (longer pollen seasons, more extreme weather events) on asthma prevalence and severity needs to prioritised in public health planning and surveillance efforts. Notably, the current National Asthma Strategy (2018) is mute on climate change and air pollution. Australians voted for action on climate change in the 2022 federal election. The evidence is clear, we need rapid transition from fossil fuel toward renewable-energy powered systems, including net zero healthcare systems, which will provide benefits for public health, climate and economy. Yet, it remains to be seen whether the pace of change envisaged in the Climate Change Bill 2022 is sufficiently fast, or whether new coal and gas generation and mining projects will be phased out. Continued failure to rapidly act on the climate-air pollution-fossil fuel triad in Australia is likely to result in increased asthma prevalence and severity and exert an inexorable toll on the health, social and economic wellbeing of future generations. Asthma is just the tip of the iceberg. Health and medical groups have a key role in helping chart a new course with the incoming federal government to avert the cascading impacts of this ubiquitous climate-driven public health crisis. Open access publishing facilitated by Deakin University, as part of the Wiley - Deakin University agreement via the Council of Australian University Librarians. None. The authors declare no conflicts of interest except Rebecca Patrick. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

When we remove all the dynamics that encase the health care system, it becomes apparent that the patient-health care professional relationship is in essence the foundation of health care. Crucial questions must be answered in order to fully understand the boundaries of the association between these two key role players, doctor and patient. Does this relationship only exist in hospital corridors, or does it extend further into patients’ lives? Are health care workers obliged to play multiple roles of advocate, social worker and advisor to their patients? In order to answer these questions and explore other relevant issues this essay will probe socio-economic factors affecting the role that might be expected of a professional, especially in the context of South African communities in the era of HIV/AIDS and economic uncertainty.

This paper will explore the application of an account of justice in health and health care to the special case of children. It is tempting to hold that children require no special treatment in an account of just health care; justice requires guaranteeing access to at least basic health care services to all persons, whatever their age group, within the constraints of a society's resources. However, I will argue that for a number of reasons we need to address what justice requires specifically for children from the health care system, even if the answer must be embedded within a general account of justice in health and health care.

The aim of the paper is to identify common elements and differences in the policies of the countries towards the achievement of the Paris Agreement on Climate (PAC) targets. The introductory part of the paper highlights the complexity, characteristics and importance of climate change as a global problem, and suggests the methodological approach. The central part of the paper is devoted to addressing the theoretical and normative aspects of ?climate justice?. The issue of ?equitable? participation of countries in the fight against climate change (so-called climate justice) is discussed, and, above all, the participation of states in reducing greenhouse gas (GHG) emissions. The relationship of countries to climate change is considered by assessing their share of global GHG emissions and the climate vulnerability index, on the one hand, and the targets they have set for reducing GHG emissions under the PAC, on the other. Countries are grouped into five groups: countries surrounding the Republic of Serbia (RS), countries whose emission indicators are similar to those of the RS, countries with the largest GHG emissions, countries with the smallest GHG emissions, and countries most vulnerable to climate change. In conclusion, it can be said that a double discrepancy (the discrepancy between the global target and the national targets and within the national targets) exists. In addition, certain common elements in the national targets for reducing GHG emissions also exist. However, due to the lack of uniformity in the way the GHG emission reduction targets are indicated, drawing firm conclusions is not reliable. At the same time, this leaves some room for a more flexible relationship in defining the national goals of the RS, with reservations about the obligations associated with the EU membership candidacy.

SummaryThe MJA–Lancet Countdown on health and climate change in Australia was established in 2017 and produced its first national assessment in 2018 and annual updates in 2019, 2020, 2021, 2022 and 2023. It examines five broad 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. In this, the seventh report of the MJA–Lancet Countdown, we track progress on an extensive suite of indicators across these five domains, accessing and presenting the latest data and further refining and developing our analyses. We also examine selected indicators of trends in health and climate change in New Zealand.Our analyses show the exposure to heatwaves is growing in Australia, increasing the risk of heat stress and other health threats such as bushfires and drought. Our analyses also highlight continuing deficiencies in Australia's response to the health and climate change threat. A key component of Australia's capacity to respond to bushfires, its number of firefighting volunteers, is in decline, dropping by 38 442 people (17%) in just seven years. Australia's total energy supply remains dominated by fossil fuels (coal, oil and natural gas), and although energy from coal decreased from 2021 to 2023, energy from oil increased, and transport energy from petrol grew substantially in 2021–22 (the most recent year for which data are available). Greenhouse gas emissions from Australia's health care sector in 2021 rose to their highest level since 2010.In other areas some progress is being made. The Australian Government completed the first pass of the National Climate Risk Assessment, which included health and social support as one of the eleven priority risks, based in part on the assessed severity of impact. Renewable sources such as wind and solar now provide almost 40% of Australia's electricity, with growth in both large‐scale and small‐scale (eg, household) renewable generation and battery storage systems. The sale of electric vehicles reached an all‐time high in 2023 of 98 436, accounting for 8.47% of all new vehicle sales.Although Australia had a reprieve from major catastrophic climate events in 2023, New Zealand experienced cyclone Gabrielle and unprecedented floods, which contributed to the highest displacement of people and insured economic losses over the period of our analyses (ie, since the year 2010 and 2000 respectively).Nationally, regionally and globally, the next five years are pivotal in reducing greenhouse gas emissions and transitioning energy production to renewables. Australia is now making progress in this direction. This progress must continue and accelerate, and the remaining deficiencies in Australia's response to the health and climate change threat must be addressed. There are strong signs that Australians are increasingly engaged and acting on health and climate change, and our new indicator on health and climate change litigation in Australia demonstrates the legal system is active on this issue in this country. Our 2022 and 2023 reports signalled our intentions to introduce indicators on Aboriginal and Torres Strait Islander health and climate change, and mental health and climate change in Australia. Although the development of appropriate indicators is challenging, these are key areas and we expect our reporting on them will commence in our next report.