The 2023 report of the MJA-Lancet Countdown on health and climate change: sustainability needed in Australia's health care sector

The 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 and 2022. 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 sixth 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. Our results highlight the health and economic costs of inaction on health and climate change. A series of major flood events across the four eastern states of Australia in 2022 was the main contributor to insured losses from climate-related catastrophes of $7.168 billion - the highest amount on record. The floods also directly caused 23 deaths and resulted in the displacement of tens of thousands of people. High red meat and processed meat consumption and insufficient consumption of fruit and vegetables accounted for about half of the 87 166 diet-related deaths in Australia in 2021. Correction of this imbalance would both save lives and reduce the heavy carbon footprint associated with meat production. We find signs of progress on health and climate change. Importantly, the Australian Government released Australia's first National Health and Climate Strategy, and the Government of Western Australia is preparing a Health Sector Adaptation Plan. We also find increasing action on, and engagement with, health and climate change at a community level, with the number of electric vehicle sales almost doubling in 2022 compared with 2021, and with a 65% increase in coverage of health and climate change in the media in 2022 compared with 2021. Overall, the urgency of substantial enhancements in Australia's mitigation and adaptation responses to the enormous health and climate change challenge cannot be overstated. Australia's energy system, and its health care sector, currently emit an unreasonable and unjust proportion of greenhouse gases into the atmosphere. As the Lancet Countdown enters its second and most critical phase in the leadup to 2030, the depth and breadth of our assessment of health and climate change will be augmented to increasingly examine Australia in its regional context, and to better measure and track key issues in Australia such as mental health and Aboriginal and Torres Strait Islander health and wellbeing.

Climate Change Adaptation Methods for Public Health Prevention in Australia: an Integrative Review

PURPOSE OF REVIEW

Climate change poses a serious threat to human health and well-being. Australia is not immune to the public health impacts and continues to be underprepared, putting the population health at risk. However, there is a dearth in knowledge about how the Australian public health system will address the impacts of climate change.

RECENT FINDINGS

This integrative review synthesises tools, frameworks, and guidance material suitable for climate change adaptation from a preventive public health perspective. The literature search was conducted in electronic databases MEDLINE, PubMed, CINAHL, and Web of Science. Of 4507 articles identified, 19 articles met the inclusion criteria that focused on operational methods in public health and excluded the clinical context and reactive disaster response approaches. This review revealed that Australia is ill-prepared to manage climate change adverse health impacts due to ineffective adaptation strategies. The review highlights that Australia urgently requires effective adaptation strategies such as undertaking a National Adaptation Plan process and an improved understanding in managing complex health risks. Taking this action will strengthen the public health system and build health resilience especially for vulnerable populations. These findings will help understand and develop of the necessary adaptive strategies in Australia.

Tracing the barriers to decarbonising ophthalmology: A review

As climate change demands increasingly urgent mitigation of greenhouse gas emissions, the health sector needs to do its part to decarbonise. Ophthalmologists share concerns about climate change and seek opportunities to reduce their environmental impact. When measuring the footprint of ophthalmology, major contributions are from patient travel to clinics, and from the large amounts of single-use disposable materials that are consumed during surgeries and sterile procedures. Ophthalmic services in India have already demonstrated systems that consume far fewer of these products through efficient throughput of patients and the safe reuse of many items, while maintaining equivalent safety and quality outcomes. Choosing these low-cost low-emission options would seem obvious, but many ophthalmologists experience barriers that prevent them operating as Indian surgeons do. Understanding these barriers to change is a crucial step in the decarbonisation of ophthalmology and the health sector more broadly.

Don't forget the veggies! Identifying and addressing a lack of vegetable education in physiology

Ninety-five percent of Westerners do not consume the recommended daily vegetable intake, exacerbating the incidence of obesity, malnutrition, and nutritional deficiencies such as fiber. This article reviews the literature from PubMed, ERIC, and Web of Science, as well as Internet sites and government resources, to identify what should be considered important inclusions relating to dietary vegetable (including legumes and pulses) intake content in university physiology subjects. The primary aim is to advance the competency relating to good nutrition knowledge for future health professionals to enable them to guide and counsel patients and clients toward better health. A review of the literature provides scant nutritional content relating to vegetable intake, particularly across physiology subjects and health professional programs in general. A review of country dietary guidelines yielded discrepancies and ambiguity around recommended daily vegetable intake, including what constitutes essential vegetables. Educators responsible for embedding nutritional information in the curriculum would therefore be challenged to find reliable, evidence-based resources. Adding quality curriculum content on the importance of vegetable intake also promotes some of the Sustainable Development Goals (SDGs), including SDG 2 (Zero Hunger), thereby contributing to SDG 3 (Good Health and Well-Being). This article offers recommendations on how to embed content relating to the importance of dietary vegetables for good health and guidance for educators of health professions programs wanting to improve their curriculum content relating to adequate nutrition.NEW & NOTEWORTHY Is nutritional literacy an important concept in physiology? This article identifies a paucity of content and addresses the need for vegetable intake education.

Climate change, environmental extremes, and human health in Australia: challenges, adaptation strategies, and policy gaps

Climate change presents a major public health concern in Australia, marked by unprecedented wildfires, heatwaves, floods, droughts, and the spread of climate-sensitive infectious diseases. Despite these challenges, Australia's response to the climate crisis has been inadequate and subject to change by politics, public sentiment, and global developments. This study illustrates the spatiotemporal patterns of selected climate-related environmental extremes (heatwaves, wildfires, floods, and droughts) across Australia during the past two decades, and summarizes climate adaptation measures and actions that have been taken by the national, state/territory, and local governments. Our findings reveal significant impacts of climate-related environmental extremes on the health and well-being of Australians. While governments have implemented various adaptation strategies, these plans must be further developed to yield concrete actions. Moreover, Indigenous Australians should not be left out in these adaptation efforts. A collaborative, comprehensive approach involving all levels of government is urgently needed to prevent, mitigate, and adapt to the health impacts of climate change.

Global issues, local action: exploring local governments use of research in "tackling climate change and its impacts on health" in Victoria, Australia

BACKGROUND

Local government plays an important role in addressing complex public health challenges. While the use of research in this work is important, it is often poorly understood. This study aimed to build knowledge about how research is used by investigating its use by local government authorities (LGAs) in Victoria, Australia in responding to a new legislative requirement to prioritise climate and health in public health planning. The role of collaboration was also explored.

METHODS

Informed by Normalization Process Theory (NPT), this study adopted multiple research methods, combining data from an online survey and face-to-face interviews. Quantitative data were analysed using descriptive statistics; thematic analysis was used to analyse qualitative data.

RESULTS

Participants comprised 15 interviewees, and 46 survey respondents from 40 different LGAs. Research was most commonly accessed via evidence synthesis, and largely used to inform understanding about climate and health. When and how research was used was shaped by contextual factors including legislation, community values and practical limitations of how research needed to be communicated to decision-makers. Collaboration was more commonly associated with research access than use.

CONCLUSIONS

Greater investment in the production and dissemination of localised research, that identifies local issues (e.g. climate risk factors) and is tailored to the communication needs of local audiences is needed to foster more impactful research use in local public health policy.

Extramural US Federal Research Grants For Health Outcomes Associated With Climate Change Inadequate, Too Narrow In Focus

Climate change causes and exacerbates disease, creates and worsens health disparities, disrupts health care delivery, and imposes a significant disease burden in the US and globally. Critical knowledge gaps hinder an evidence-based response and are perpetuated by scarce federal research funds. We identified and described extramural US federal research funding (that is, grants provided to organizations and institutions outside of federal agencies) that both addressed health outcomes associated with climate change and was awarded between 2010 and 2020. During this eleven-year period, 102 grants met our criteria, totaling approximately $58.7 million, or approximately $5.3 million per year (2020 adjusted US dollars). Federal investments in climate change and health research during this period failed to address the breadth of climate-sensitive exposures, health outcomes, and impacts on vulnerable populations. Moving forward, in addition to increasing investment in climate and health research across all known hazards, critical attention should be placed on vulnerable populations and health equity. To achieve this, increased federal research coordination and cooperation are needed, as well as a mechanism to track this funding.

Impacts of Climate Change on Health and Health Services in Northern New South Wales, Australia: A Rapid Review

Climate change is exposing populations to increasing temperatures and extreme weather events in many parts of Australia. To prepare for climate challenges, there is a growing need for Local Health Districts (LHDs) to identify potential health impacts in their region and strengthen the capacity of the health system to respond accordingly. This rapid review summarised existing evidence and research gaps on the impact of climate change on health and health services in Northern New South Wales (NSW)-a 'hotspot' for climate disaster declarations. We systematically searched online databases and selected 11 peer-reviewed studies published between 2012-2022 for the Northern NSW region. The most explored health outcome was mental health in the aftermath of floods and droughts, followed by increased healthcare utilisation due to respiratory, cardiovascular and mortality outcomes associated with bushfire smoke or heat waves. Future research directions were recommended to understand: the compounding impacts of extreme events on health and the health system, local data needs that can better inform models that predict future health risks and healthcare utilisation for the region, and the needs of vulnerable populations that require a whole-of-system response during the different phases of disasters. In conclusion, the review provided climate change and health research directions the LHD may undertake to inform future adaptation and mitigation policies and strategies relevant to their region.

Australian young people's perceptions of the commercial determinants of the climate crisis

There is increasing public health focus on how corporate practices impact population health and well-being. While the commercial determinants of the climate crisis pose serious threats to human and planetary health, governments largely seek to balance climate action with economic imperatives. Global stakeholders recognize that young people have important voices in influencing climate responses. However, few studies have investigated young people's perceptions of the commercial determinants of the climate crisis. A qualitatively led online survey of n = 500 young Australians (15-24 years) investigated their understanding of corporate responses to the climate crisis, factors that influenced these responses and strategies to respond. A reflexive approach to thematic analysis was used. Three themes were constructed from the data. First, young people perceived that corporate responses to the climate crisis focussed on soft options and lacked meaningful action. Second, they stated that these responses were largely influenced by economic imperatives rather than planetary health, with policy levers needed to implement environmentally responsible corporate practices. Third, young people perceived that systems needed change to create demand for a cleaner environment, leading to improved practices. Young people have a clear understanding of the commercial determinants of the climate crisis and associated threats to population health. They recognize that corporate practices (and consumer demand) will not change without significant policy and structural change. Public health and health promotion stakeholders should work alongside young people to influence decision-makers to address harmful corporate behaviours.

Homesickness at Home: A Scoping Review of Solastalgia Experiences in Australia

Solastalgia is a term used to describe the pain and distress experienced by those witnessing their home environments destroyed or changed in unwelcome ways. Solastalgia is expected to become more prominent as climate change worsens and transforms landscapes. This scoping review examines and maps the existing literature on solastalgia in Australia, particularly focusing on Aboriginal and Torres Strait Islander experiences. Four focus questions guided the review to explore how solastalgia is conceptualized, highlight risk and protective factors, and identify strategies for addressing solastalgia. Eighteen papers met the criteria for inclusion. Overall, our results show a minimal evidence base on solastalgia in Australia with an even greater gap in exploring solastalgia from Aboriginal and Torres Strait Islander perspectives. A strong connection to home environments was suggested as both a risk and protective factor for experiencing solastalgia. Aboriginal and Torres Strait Islander peoples are considered at risk due to intimate connections to home environments, and since the invasion, have experienced mental distress resulting from significant, damaging changes to landscapes and home environments. We recommend further exploration of lived experiences of solastalgia across a greater diversity of Australian contexts, particularly amongst Aboriginal and Torres Strait Islander peoples, including a focus on practical implications.