Putting health before new coal and gas approvals

Australia’s federal and Queensland governments say they have invested more than $5 billion since 2014 to protect the Great Barrier Reef. Yet in September 2025 the Commonwealth gave final approval for the North West Shelf gas-processing extension, allowing the plant to operate to 2070. The lifecycle emissions enabled by fossil fuel expansion add to the warming driving repeated bleaching. That is an environmental contradiction and a health policy failure. 

The Reef is gravely threatened, but it is not lost. The 2024 mass bleaching event had the largest spatial footprint recorded on the Reef. AIMS’ 2024-25 survey then recorded regional declines in hard coral cover of 14% to 30%, driven mainly by heat stress from the 2024 bleaching event, alongside cyclones and crown of thorns starfish. Considerable coral cover remained in all three regions. A further mass bleaching event occurred in 2025 — the sixth since 2016, but less extensive than 2024 — and the 2025–26 summer brought regional bleaching in the north. This is not a reason for fatalism. It is why every avoidable increment of warming matters. 

A project’s share may be small; its harm can still be substantial 

Project proponents often argue that one project’s emissions are too small relative to the global total to connect with particular consequences. Attribution research now allows that contribution to be estimated. 

A 2025 study used Woodside’s Scarborough gas project as a worked example. The researchers estimated 876 million tonnes of carbon dioxide over the project’s lifetime, including offshore production, onshore processing and domestic and international use. Under the study’s population assumptions, the best estimates were over half a million additional people exposed to unprecedented heat and 16 million additional coral colonies lost across the Reef in each future mass-bleaching event. These estimates are modelled and have wide uncertainty ranges but the near-linear relationship between cumulative carbon dioxide and warming is well established: a project’s contribution is substantial. 

Scarborough alone does not cause a bleaching event. Approving it adds foreseeable harm to events driven by cumulative emissions. That is the kind of contribution a risk assessment should consider. 

Gas approvals are health decisions 

Australian clinicians already see the pathways from climate change to ill health: extreme heat, bushfire smoke, floods, disrupted food and water supplies, infectious disease, injury and mental distress. The MJA–Lancet Countdown documents increasing heatwave exposure while Australia remains dependent on fossil fuels.

Health risks can also occur closer to extraction. A 2025 Australian review found only four Australian studies of gas production. They reported associations with increased hospitalisation for all causes and for circulatory, respiratory, blood and immune conditions, particularly among children, while the authors stressed that Australian human evidence remains scarce. This is not proof that every gas project causes every reported outcome. It does however support the non-negotiable need for precaution, better evidence and independent assessment.

Reef damage also reaches beyond coral. For Traditional Owners, the Reef is part of interconnected natural, spiritual, economic and cultural worlds. It also supports about 77,000 jobs. Culture, identity, work and financial security affect health. Assessment should recognise those connected harms, not only pollution near a project boundary. 

Make health capable of changing the decision 

The Environment Protection Reform Act 2025 includes an “unacceptable impact” test for protected environmental matters, with the remaining assessment and approval reforms due to commence by 1 December 2026. But section 527F does not make death, disease or human health a standalone ground of unacceptability. 

Doctors for the Environment Australia has proposed a health trigger for new coal and gas projects: independent assessment by public-health experts, covering local harms and the climate-mediated effects of full lifecycle emissions, with the Health Minister responsible for the health determination. 

For the government to follow through with their own promises they have made to the Australian public, the policy objective must be no new coal or gas approvals. While governments continue to consider them, a health trigger is a necessary minimum safeguard, not a substitute for that policy. It must cover emissions created when the product is processed and burned, and serious, foreseeable health harm must be capable of producing a refusal. Otherwise it is disclosure, not protection. 

This does not mean switching off every gas use tomorrow. Grattan Institute’s 2026 report Out of Gas says Australian gas use is declining and warns that an unmanaged decline would be costly, chaotic and inequitable. Governments should plan the transition: electrify practical uses, protect low-income households, assist affected workers and regions, manage network retirement, and retain limited gas for genuinely essential uses where alternatives are not yet practical. 

That is a more logical answer to affordability and energy security concerns than locking households into shrinking networks or approving long lived expansion without counting its health costs. Australia Institute polling published by DEA in 2023 found 67% support for requiring governments to consider the health effects of fossil-fuel projects, including majorities of Coalition, Labor, Greens and independent voters. 

The Reef 2050 Plan is under review, and the National EPA began work on 1 July 2026. Health professionals should ask their college or association to endorse the AMA’s call for no new fossil-fuel projects and DEA’s health trigger, then put both requests to Environment Minister Murray Watt and Health Minister Mark Butler. 

Health evidence should be gathered independently, considered before approval and have the ability to change the answer. When a project’s foreseeable consequences include serious, avoidable health harm and further loss from a living World Heritage ecosystem, the approval system must be able to say no. 

Christian Alexander is a Bachelor of Biomedical Science student at Deakin University and a Research & Policy Coordinator and Policy Advisor with the Darling Downs Environment Council. His work focuses on climate, health and environmental policy.

For disclosure, alongside my volunteer role with DDEC, I am an intern with BCSD Australia. I write in a personal capacity, and the views expressed do not represent these organisations or Deakin University.