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Doctors must take a leadership role in urging governments to take stronger action on climate change, writes Dr Richard Yin.
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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Fantastic article. Undoubtedly, the biggest child health issue of our time.
Fantastic article clearly outlining the need for stronger advocacy from health professionals on a global public health issue. We must act here, in Australia, to reduce the impact on not only our own future patients but those in areas of the world who will be even more severely affected by the worst impacts of climate change.
I am concerned but sadly not surprised to read how effective propaganda has been on those with a literacy level required to read the MJA.
Australian coal is not the “cleanest”. The testing facilities responsible for these claims have been involved in faked reports for decades.
The additional emissions involved in refining and transporting our fossil fuels around the world gives us a disproportionately larger impact. We create more emissions just to refine our exported gas than we create from our total national domestic use. The Minerals Councils love to spin this nonsense.
Our Environmental Protection laws are some of the weakest on the planet. This is why we are world leaders on biodiversity losses, mammal extinctions, land clearing rates and destruction of indigenous heritage sites. And that’s just the damage we allow within the rules. This ignores the immense number of breaches of weak pollution limits that are met with $15,000 fines, and are factored into the cost of doing business. Most fossil fuel companies donate more to politics than they pay in fines.
The fact that we even have climate change deniers in the comments is a reflection of how serious this issue is.
The time for slow progressive change and reform was 10 – 20 years ago, and the majority of the health professional chose neoliberalism, personal wealth accumulation, business growth and ignored the numerous warnings.
A rebellion is building to the entire ecological systems that have failed us. Medical colleges don’t need to start advocating, they missed that chance, they need to pick a side.
Revolution, or collapse.
Richard Yin’s article clearly explains we are now in the age of consequences from human impacts on the climate systems, and doctors are seeing those consequences manifest in acute and chronic mental and physical disease. It is thoroughly irrational to continue to subsidise fossil fuels, the combustion of which is fuelling the climate crisis as global carbon dioxide goes past 420 ppm.
Thanks for an incisive view of our current predicament, including the new thinking of the commercial determinants of health. For too long corporations and governments have not prioritised health and especially prevention of avoidable harms. Rather than dealing with health separately in our siloed approach to government, health should be represented in every department so that impacts on our future wellbeing and thriving can be accounted for.
I couldn’t have said it better myself. Health professionals took a stand with tobacco because the health impacts of smoking are undeniable. The health impacts of climate change are also undeniable. Is it simply a lack of climate health knowledge within the health sector? Or a reflection of the health sectors’ narrow view of our responsiblities and an indication that its time to shift our understanding and perspective to align with what is called for in 21st century healthcare…
Richard Yin’s article provides yet another reminder that we are in a crisis and that doctors cannot look away. We must never sacrifice the doctor-patient relationship but we must also look to a broader duty of care, as Richard outlines.
There is evidence that most doctors care about climate change and most medical colleges and other organisations recognise this climate health emergency. All of us need to reflect on how we can act, individually and collectively, to ensure that a strong health message contributes to urgent change. It will be hard to look away when our children, grandchildren and great grandchildren ask us how we acted at this critical time.
I would in particular welcome a statement from the Australian Faculty of Occupational and Environmental Physicians with respect to the health benefits and detriments of the fossil fuel industry. I derive much of my income from coal producers, and yet I believe in the need for climate action and the need to reduce our carbon footprints. I have worked ‘at the coalface’ of the environment v fossil fuel argument for a long time. From a global perspective, Australia is probably the safest coal producer in the world, and produces some of the cleanest burning foal in the world. So if the world must use coal to make the steel that makes our cars, fridges, building infrasturcture, electrical wire etc etc for the time being, then let it be Australian Coal made by Australian based companies, shaped by Australian Industrial Relations legislation and Australian Environmental Laws, informed by all of the arguments for fair dealings and constraint our democracy can muster, while the world speeds the transition to renewables. BUT I am less enamoured of the development of other industries in the energy and renewables sector. For example, I’d really like to help develop an informed position statement on the effect of introducing fracking operations onto land used for food or feed production; or the effect of offshore drilling exploration and wind farms on the fishing industries, and the health of the marine environment.
Great to hear Dr Yin showing how we can work to address the most important public health issue of our time. Leadership is needed from all sectors.
Hello Richard , Australia contributes just over 1% of global emissions (and falling) , We have one of the highest population uptakes of renewable energy technologies on the planet. Australia has abundant supplies of natural gas which is widely recognised as an essential transition energy source to a renewable energy future – without the development of this resource we and the world will be ever more and longer reliant on coal fired power generation. It is fraught and potentially problematic to attribute a particular natural disaster to “climate change” , this wide brown land has had many catastrophic bush fires some of the worst pre dating any possibility of fossil fuel burning induced climate change. None of this means we should do nothing but we should not get ahead of ourselves or the major planetary polluters – to do so simply harms our economy our people and our country for zero global benefit .
Thought-provoking article… I hope our profession can take a stand against the influence of fossil fuel companies as happened with tobacco companies, especially given the environmental and public health effects are far more devastating and impossible to avoid