Health is not just the presence or absence of disease or injury — it is a state of wellbeing and is situated not in our health-care system but within our relationship to communities and our environment. This is the overarching theme within the recent consultation paper for the Development of the National Preventative Health Strategy in considering the future health of all Australians.
Improvements in health in the 21st century can be traced not just to developments in medicine and technologies but also to developments in general social conditions — housing, food supply and quality, water and sanitation.
These measures have reduced the prevalence of infectious diseases that once dominated our disease burden. However, over the past 50 years we have seen a rise in other chronic conditions, so called non-communicable diseases (NCDs), which are a result of lifestyle and the environment.
These are mainly cardiovascular diseases, lung diseases such as those related to smoking and asthma, diabetes, dementia and cancer. NCDs are now responsible for the greatest burden of disease both in Australia and elsewhere, accounting for up to 70% of all deaths globally.
Behaviours such as smoking, physical inactivity, unhealthy diets and the harmful use of alcohol all increase the risk of NCDs. The underlying causes often lie within our communities: the way our cities and neighbourhoods are planned; environmental factors such as air quality; availability and access to healthy food choices; health education and literacy; and safe environments for physical activity in our communities. Creating supportive and enabling environments for health is critical in addressing the epidemic of NCDs.
Beyond our communities, our health is contingent on our relationship to the natural world.
The most recent report of the 2019-2020 mega-fires in Australia highlights the enormous health impacts of this single environmental catastrophe which affected nearly 80% of Australians.
The smoke-related health costs were calculated to be AU$ 1.95 billion, a sum driven by an estimated 429 smoke-related premature deaths, 3230 hospital admissions for heart and lung disorders and over 15,000 emergency visits for asthma.
Thirty-three lives were lost directly in the fires and it is likely that the mental health impacts and costs, if one considers estimates from prior bushfires, will be significant and protracted.
As bushfires become more frequent and intense with a hotter climate, there is growing and well-founded concern that the associated health impacts will also increase. Similarly, we can expect the health burden from other extreme weather events to rise over time.
Extreme heatwaves are associated with significant rises in mortality and emergency presentations — an excess of 374 deaths was observed during a four-day period when temperatures exceeded 40C in Victoria in 2009. Without mitigation and adherence to 1.5 -2°C Paris targets, CSIRO models predict that by 2050 Darwin will experience six months of the year of daily temperatures exceeding 35°C. Another study has suggested that cities such as Melbourne and Sydney can expect to see temperatures in excess of 50C by 2040.
Climate change has been recognised as a health issue for some time. The eminent medical journal The Lancet as far back as 2009 described climate change as the greatest threat to our health in the 21st century.
Australia, though, has been a laggard in its response to this public health crisis.
The post-COVID recovery offers a unique opportunity to address climate change as well as reconstructing our cities as places of well-being.
In an unprecedented action, medical colleges representing 75% of all doctors and the AMA issued a joint statement to the Prime Minister in August urging for a health-centred economic recovery. They called for a transition away from fossil fuels, both coal and gas, to renewables; investment in projects and technologies that preserve our natural environment; spending on green infrastructure to support active forms of transport; and investment in public transport and a transition towards electric vehicles.
Surprisingly, there was no mention of climate change in the recent consultation paper for the Development of the National Preventative Health Strategy. As a result, numerous health organisations have signed a joint statement to Health Minister Greg Hunt calling for climate change to be a key part of the strategy.
The government has also ignored calls to commit to net-zero emissions by 2050 so that Australia can contribute its fair share of the heavy lifting to limit warming to 1.5 degrees. Instead, it has backed a “gas-led recovery”, which will create more greenhouse gases and exacerbate the conditions that brings drought, extreme heat, coral bleaching, drying rivers, and bushfires like we experienced last summer. Gas is just another fossil fuel, and if we are to do our part in addressing climate change along science-based timelines, we need to end its use as quickly as possible.
In a future where climate change looms large as a threat to health and where our primary disease burden is shaped by lifestyle and environment, shouldn’t we place health front and centre of our COVID-19 economic recovery and dare to reimagine our cities and energy systems, that our children might have a healthy future?
As governments around the world look for ways to cut greenhouse gases, and energy systems undergo a profound shift away from fossil fuels towards renewables as reported this week by the International Energy Agency, a healthy future is becoming not a matter of if but when.
Will Australia be part of this future?