Climate health inquiry: where sustainability, public health law and climate action intersect

The origins, scope and significance of the 2019–2020 Climate Health Western Australia Inquiry

Societal action has not proved timely or sufficient, both globally and in Australia, to counter the evident public health threat from climate change.1

A special report from the Intergovernmental Panel on Climate Change has emphasised the criticality of climate action in the next 10 years.2 A recent Australian study has estimated that the health sector contributes around 7% of all greenhouse gas emissions.3

The Climate and Health Alliance — a coalition of individual and organisational stakeholders from across the health sector — developed a framework for a national strategy on climate and health in 2017,4 but it has not been adopted by the Commonwealth government, making action at the state‐ and territory‐level even more important in a federal system.

Western Australia is geographically Australia's largest state, with significant mineral reserves, renewable energy sources and rich biodiversity. However, the region is vulnerable to climate change, with a steady decline in rainfall in the southwest, drying interior areas, lengthening fire season, exposure to cyclones and extreme weather events, and a rate of sea‐level rise almost three times the global average.5 The state government has committed to addressing risks and seizing the opportunities that climate change poses and to transition to a low carbon economy by 2050.5

In 2008, the first climate change adaptation report in Australia specific to the health sector was produced in WA;6 it demonstrated the applicability of a formal health impact assessment approach. However, there has been a policy hiatus since then and no concerted effort to reduce the health sector's greenhouse gas emissions. To remedy this, in 2019, the WA Minister for Health instigated the Climate Health WA Inquiry.

A new public health Act

The Public Health Act 2016 (WA)7 was a milestone for modern public health legislation in WA, replacing the Health Act 1911 (WA)8 and providing a flexible and proactive framework for the regulation of public health. In pursuit of the objects of the Act, regard must be had to five principles (Box).

All five principles, including sustainability, are applicable to protecting the environment and responding to climate change. This is consistent with the evolution of public health law from its original focus on sanitation and hygiene to modern challenges from a range of emergencies and communicable and non‐communicable diseases.9

In addition to these principles, a number of specific parts of the Public Health Act 2016 (WA) may be particularly relevant to future public or private health sector action on climate change.

In the Public Health Act 2016 (WA), Part 5 (“Public health plans”) tasks the Chief Health Officer with preparing a state public health plan identifying needs, objectives, policy priorities and risks that local governments need to consider in developing their own local public health plans.

Part 6 (“Public health policies”) and Part 7 (“Public health assessments”) of the Act may underpin health impact and vulnerability assessments. Part 11 (“Serious public health incident powers”) and Part 12 (“Public health emergencies”) may be used to manage public health risks (eg, drinking water contamination or air pollution) arising from a natural disaster or extreme weather event, the risk of which is elevated from climate change. Part 15 (“Inquiries”) allows the Chief Health Officer to conduct an inquiry into any matter relating to public health, on their own initiative or at the request of the Minister for Health, and was used to initiate the Climate Health WA Inquiry.

All Australian states and territories have modernised their public health legislation over the past 25 years: Tasmania and the Australian Capital Territory in 1997, Queensland in 2005, Victoria in 2008, New South Wales in 2010, and South Australia and the Northern Territory in 2011. WA legislation is most similar to that in South Australia. Victoria has recently identified climate change as one of four focus areas in its state public health plan,10 which could be a model for other jurisdictions.

A recent article summarised the enforcement powers available to appointed public health officers in public health Acts across Australia and suggested they could be used further upstream to limit greenhouse gas emissions.11

Sustainable health review

The WA Sustainable Health Review (SHR) ran from mid‐2017 to early 2019. It was tasked with recommending directions to develop a more sustainable health system for WA12 and was informed by widespread consumer, staff and stakeholder consultation.

The SHR had a four‐pillar approach to sustainability: patient experience, cost and waste reduction, staff engagement, and quality, safety and population health. It stated upfront that “Resources are not simply financial: they include people and the environment”.

The SHR organised a Climate and Sustainability Forum and in its final report made 30 recommendations,13 one of which was that the health system should reduce its environmental footprint, with mitigation and adaptation strategies put in place to respond to the health impacts of climate change. This recommendation had three components:

• reduction in environmental footprint (energy, waste, emissions and consumables), driven locally but coordinated on a system‐wide basis, guided by the National Health Service model in the United Kingdom;14
• transparent public reporting on the WA health system's environmental footprint by July 2020; and
• establishment of an inquiry under the Public Health Act 2016 (WA).

Climate Health WA Inquiry

In announcing the inquiry, the WA Minister for Health highlighted the impacts of changing climatic conditions and the associated financial and non‐financial costs, both within and external to the health system.15 The Minister then wrote to all health service provider boards encouraging them to join the Global Green and Healthy Hospitals network (www.greenhospitals.net).

The Chief Health Officer appointed the first author (TW) to conduct the inquiry, with the following broad aims: to review the current planning and response capacity of the health system in relation to the health impacts of climate change, and to make recommendations for improvement with respect to climate change mitigation and public health adaptation strategies. The inquiry will include the mental and physical health impacts of climate change. The complete terms of reference are available on the inquiry website.16

In contrast to a standard review, an inquiry is a fact‐finding process in which attention is first given to asking the right questions to the right people. The inquiry team will select experts from WA, Australia and other countries, taking into account the best science and evidence base.

The Climate Health WA Inquiry will be modelled on a parliamentary inquiry, with three phases: a call for written submissions, public consultations in regional and metropolitan areas across the state and targeted consultations with vulnerable groups, and formal public hearings.

One key feature is that the inquiry is place‐based. There is extensive international and national literature about climate change in general, and climate–health links in particular.1 There are fewer studies that focus on the subnational or regional levels. There are multiple local descriptions of problems or actions, but they are difficult to find and aggregate for decision making.

The challenge is to demonstrate the current and future environmental and health impacts across the very different regions of WA (tropical north to temperate south, coastal to inland communities), and the associated vulnerabilities.

Active engagement of the community is vital to enable place‐based stories to be heard. The inquiry will consult specifically with Aboriginal individuals and organisations, who have demonstrated successful stewardship of country over hundreds, indeed thousands, of generations. Other priority stakeholders include: public and private health services, primary and community care, non‐government organisations, consumer and civil society groups, professional organisations, local government, culturally and linguistically diverse communities, students and youth, and aged, disability and homeless groups. This breadth of stakeholder engagement reflects the wide impact of the issues.

The public nature of the inquiry means there is a high value placed on communication and transparency, and an opportunity to raise public awareness through the process. Submissions and transcripts of hearings will be made available online.16 The final report and recommendations are due to the Minister in March 2020. After the Minister's consideration, the report will be tabled in Parliament and thereby made public.

Conclusion

The sustainability principle has been written into modern Australian health legislation, and requires that social, economic and environmental factors be considered in public health decision making. Furthermore, there are a range of specific principles, provisions, powers and plans in public health legislation which can be applied to promote sustainability and deal with the causes or consequences of environmental challenges, including climate change. Health services and health systems can be seen as truly sustainable if they address environmental and financial challenges.

The Climate Health WA Inquiry is, to our knowledge, the first statutory inquiry anywhere in the world focused on the health impacts of climate change.

Our task is to create a practical path forward for the health sector in WA, consistent with the size and timeframe of the challenge provided. The inquiry findings will form the basis of a new, coordinated health and climate change framework for WA.15 Its recommendations will also be aligned with the proposed State Climate Policy — a roadmap for planning and investment across all sectors of the economy.5

If the report can successfully localise the impacts, engage the public and prioritise actions needed in one Australian state, it will have broader national and global significance as a model for regional inquiries and reports.