Doctors must 'step up' to confront climate crisis 

When the Australian Parliament recently passed the country’s most significant carbon emissions reduction legislation in over a decade, a notable absence in the debate was the health voice.

From a health perspective, the Safeguard Mechanism, a policy designed to reduce the intensity of emissions by 5% annually from our largest polluters, is essentially a public health policy — a regulatory framework to mitigate climate change by reducing carbon pollution.

Despite climate change being recognised as the greatest health threat of the 21st century, no major health institution or medical college publicly advocated for strengthening the draft reforms first put forward by the government.

These reforms were heavily criticised for being ineffective in delivering real emissions reductions and were subject to intense lobbying by both the fossil fuel industry and civil society groups.

Unlike health care professionals’ resolve in countering the tobacco lobby, we have yet to mount a meaningful challenge against the fossil fuel lobby that also trades in a product that harms and seeks to maintain our addiction to it.

Urgent action needed

The recent release of the Synthesis Report (SYR) of the Intergovernmental Panel on Climate Change (IPCC) Sixth Assessment Report (AR6) on climate change confirms the urgent need for ambitious action to limit global warming.

The report highlights that climate change is already having profound impacts around the globe and these will continue to intensify.

Based on the current combined pledges by countries around the world to reduce their emissions in line with the Paris Agreement, we will exceed 1.5°C of global warming this century and this is likely to be reached in the near term.

Every increment of warming will intensify multiple concurrent hazards, with the people most affected being those least responsible.

The IPCC report makes numerous references to human health, ranging from the effects on mental health from displacement to physical and mental health impacts from heat and extreme weather. Most importantly, it reconfirms that there is no room for new fossil fuel projects – deep and rapid cuts to emissions are required this decade if we are to limit warming to 1.5°C.

The current impact

Climate change-fuelled disasters have already had a profound impact on Australians.

The bushfire season of 2019–20 alone saw 33 people tragically lose their lives. Additionally, the smoke from the bushfires had a number of health impacts.

There was a 50% increase in visits to New South Wales hospital emergency departments for respiratory conditions in the Capital Region (including Bateman’s Bay) during times of peak bushfire activity, and Canberra residents, for a time, experienced the worst air quality in the world.

The sales of asthma reliever medications, including salbutamol, increased markedly in bushfire-affected regions, and 5094 patients accessed almost 19 000 bushfire-related Medicare-subsidised mental health services.

The smoke-related health costs of the 2019–20 bushfires have been estimated to be $1.95 billion. If we do nothing to curb climate change, extreme weather will continue to be costly.

In fact, in Australia, the future costs of natural disasters, which are expected to increase in frequency because of climate change, are modelled to be at least $73 billion annually by 2060, or 4% of the gross domestic product, with current social and health costs of floods representing around 40% of the total costs.

Commercial determinants of health

In light of the climate emergency, the coronavirus disease 2019 (COVID-19) pandemic, and the rising burden of non-communicable diseases, the recent Lancet series on the commercial determinants of health questions whether our current approach to public and planetary health is tenable.

It highlights how major industries and profit-drivers for transnational companies, including those from tobacco, alcohol, ultraprocessed foods, and fossil fuels, seek ever-increasing profits and deliberately undermine social, environmental and health concerns. These four industries alone account for at least a third of global deaths.

To improve health and health equity, the authors of the Lancet article posit that current political, economic and social structures need to change how society defines and measures prosperity.

The authors question how harmful business practices can be regulated and how civil society can advocate for the necessary public policy that will protect health from the actions of vested business interests. They also lay out a change agenda and the role of civil society organisations, including health organisations, to deliver change.

Impact of the fossil fuel industry

It has been reported in the media that the fossil fuel industry continues to exert undue influence on Conference of the Parties (COP) negotiations (here and here).

A study has also shown that at least one fossil fuel company has a history of trying to discredit climate projections.

I strongly argue their influence in maintaining our fossil fuel dependence needs to be challenged.

How can we do this?

Federal government policy on climate change currently does not align with climate science and it needs to step up.

The Safeguard Mechanism needs more stringent limits on the use of carbon offsets.

These should include using a mitigation hierarchy framework with a requirement for facilities covered under the mechanism to first undertake onsite abatement actions, and then be required to use genuine emissions reductions via the Safeguard Mechanism Credits within a carbon credit trading scheme before being able to access offsets via the purchasing of Australian Carbon Credit Units.

We also need environmental laws that properly consider climate impacts.

Our current national environmental laws do not explicitly require decision makers to consider climate change impacts in environmental decision making nor is there an overarching national legal framework, such as a national Climate Change Act. One solution would be a “climate trigger” within the Environment Protection and Biodiversity Conservation (EPBC) Act 1999 whereby if a project’s greenhouse gas emissions were excessive and with unacceptable climate impacts, it could be rejected or conditions be applied.

We need to end public subsidies for fossil fuel industries, which surged to $11.6 billion in 2021–22. And the greenwashing by coal and gas companies that help legitimise them.

Taking a leadership role

We, as health professionals, must take a leadership role. We must take a stand against an industry that places profits well ahead of people or the planet that sustains us and call for stronger regulations against the existential threat of climate change.

We have a duty of care to the patients and communities we serve, as well as to our families, to use our trusted voice to highlight the urgency of action to ensure a liveable planet now and into the future.

Dr Richard Yin is a retired Perth GP and the Deputy Chair of Doctors for the Environment Australia.

The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated. 

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