At the end of 2019 and into 2020, catastrophic fires in Australia consumed homes, lives, wildlife and land. Just as the fires subsided, Australia, like the rest of the world, faced another emergency — the COVID‐19 pandemic.1 It is instructive to reflect on lessons from the health disasters of the past year.
Following publication of The Lancet Countdown on health and climate change,2 the Medical Journal of Australia (MJA)–Lancet Australian Countdown on health and climate change was published in December 2020.3 This annual report on health and climate change in Australia is in its third year and comprises the efforts of five Australian institutions, in collaboration with University College London, facilitated by a partnership between The Lancet and the MJA.3 All three reports make sobering reading.3,4,5 2019 was Australia’s hottest and driest year on record, with average temperatures 1.52°C above normal and mean rainfall 40% below the 30‐year average before 1991.3 Australia’s 2019–20 bushfires burned 10 million hectares, directly killed 33 people and destroyed more than 3000 homes.6 Smoke engulfed major capital cities, including Sydney and Melbourne, and smoke exposure caused an estimated 417 excess deaths and over 3000 hospital admissions.3,7,8 The catastrophe laid bare how extreme heat is a severe health risk.9 The ecological damage of the bushfires was enormous;6 almost 3 billion animals were killed or displaced, and natural systems of biodiversity and species were harmed, perhaps irreparably.6 Severe storms and floods followed the fires, bringing further damage. Insured losses from disaster events totalled AU$3.7 billion in 2019, with bushfires accounting for $2.2 billion, although the total costs of the so‐called Black Summer fires could be much higher.3
The devastation of the bushfires led the Australian Government to establish the Royal Commission into National Natural Disaster Arrangements. The final report of the Royal Commission in October 2020 identified climate change as a major driver and acknowledged the risk of increasing extreme weather events.6 However, the Royal Commission’s scope was limited to disaster management (mitigation, preparedness, response and recovery) and did not discuss root causes of climate change such as the fossil fuel industry’s grip on Australia’s energy infrastructure, economy, political will and public discourse. Australia has no decisive national plan to address climate change and its health consequences.3 The Australian Government is a signatory to the Paris Agreement, but has declined to affirm net zero carbon emissions by 2050 — or by any date — unlike the UK and the EU; China has also committed to this goal by 2060.
Unlike this inadequate approach to the climate crisis, Australia’s response to COVID‐19 was rapid and effective, despite facing the pandemic while the last bushfires still burned.10,11 Strong community engagement with public health measures enabled effective management of the first and second waves, making Australia’s, together with those of New Zealand and parts of Asia, among the more successful responses to COVID‐19.12 Key to this success was the valuing by governments of science and data to guide decision making. The pandemic forced politicians from across the Australian political divide to prioritise the evidence and expertise of the medical, scientific and public health communities over the voices of conservative commentators, business leaders and politicians. Tough political decisions were made for the sake of the nation’s health. This bipartisan, science‐based approach is a model for the future management of climate change, if implemented alongside an appropriate national plan.
Australia’s First Nations people, who are at increased risk of poorer health outcomes than the general population in a pandemic, have provided exceptional leadership in their response to COVID‐19, resulting in low rates of virus transmission thus far.13,14 The country’s Indigenous populations are also disproportionately vulnerable to future climate change natural disasters.6 Since the traditional owners of Australia’s land are effective, resilient caretakers of the country and experts in land and fire management, the Royal Commission recommended federal, state and territory governments learn from and engage with their expertise.6
As another initiative capitalising on local expertise, The Lancet Countdown’s regional report in partnership with the MJA has led to improved performance indicators for climate change. For example, the Australian Countdown reports3,4,5 developed the wildfire (bushfire) indicator, which the Countdown is now adopting globally. These data have encouraged more direct engagement with Australian policy makers and health professionals, and provided direct funding guidance to Australia’s National Health and Medical Research Council (NHMRC), which is expected to translate into funding changes in 2021.15 Australia’s leading medical and nursing bodies have recognised climate change as a health emergency.8 Governments of states and territories have committed to zero net carbon emissions by 2050, with climate change adaptation plans incorporating the health sector and investment in renewable energy.3,16
With the unprecedented disasters of 2020, public sentiment in Australia has shifted, as more people realise climate change is here now, with impacts for all. In November, the Climate Change (National Framework for Adaptation and Mitigation) Bill 2020 was introduced into the Australian federal Parliament by the independent Member of Parliament Zali Steggall, with wide public support, including from the Australian Medical Association and more than 100 major businesses.17 The outcome of the 2020 US election and the environmental platform of the incoming administration of Joe Biden coincides with a more positive stance in Australian politics towards addressing climate change.18
In the MJA–Lancet Countdowns,3,4,5 Australia embraced the importance of local data, local experts and local stories. A regional China Countdown report is also being published in parallel this year,19 and in 2021, there will potentially be Countdown collaborations for the EU, South America, the US, and Small Island Developing States.
Looking forwards, Australia should as a priority establish a National Health and Climate Change Centre within the Australian Government Department of Health to develop a National Plan for Health and Climate Change with real‐time monitoring. As well as preparing to manage climate‐related health sequelae, Australia’s health sector should commit itself nationally to zero net carbon emissions by 2040 in line with the National Health Service in the UK, preferably with the states and territories responsible for implementing evidence‐based interventions.20 Reducing unnecessary medical tests and procedures will serve to reduce carbon emissions, health care costs and harmful outcomes.21 Research funded by the NHMRC and the Medical Research Futures Fund should guide better ways to efficiently reduce the carbon footprint of Australia’s health care services. Australia has an obligation under the Paris Agreement to submit enhanced nationally determined contributions by the end of 2020. We recommend that the Australian Government agree to a target of a 50% reduction in carbon emissions by 2030, which is what is likely required to limit global warming below 1.5°C.3,4,5 The Australian Government needs to recognise that fossil fuels are no longer a sound investment and join with other jurisdictions that are committed to shifting completely to renewable energies to make that sector the most cost‐effective for jobs and energy security.
In Australia the crises of 2020 were unprecedented, shocking and predictable. We remain hopeful all Australian governments will aspire to the leadership shown nationally with the COVID‐19 pandemic and effectively deal with climate change now, understanding the major health risks of neglecting this issue. We anticipate health and corporate leaders, as well as leaders across other sectors, will continue to drive change. Interrogating successes and failures nationally in the MJA–Lancet annual Australian Countdown provides a robust model for monitoring and positive change. The flow on benefits to health and wellbeing, the economy and society from such change will be enormous.
This article is co-published in The Lancet.22
Provenance: Commissioned; not externally peer reviewed.
- 1. Talley NJ. Health and medicine in a pandemic year: moving from “the winter of despair” to “the spring of hope”. Med J Aust 2020; 213: 484–488.
- 2. Watts N, Amann M, Arnell N, et al. The 2020 report of the Lancet Countdown on health and climate change: responding to converging crises. Lancet 2021; 397: 129–170.
- 3. Zhang Y, Beggs P, McGushin A, et al. The 2020 special report of the MJA–Lancet Countdown on health and climate change: lessons learnt from Australia’s “Black Summer”. Med J Aust 2020; 213: 490–492. https://www.mja.com.au/journal/2020/213/11/2020-special-report-mja-lancet-countdown-health-and-climate-change-lessons
- 4. Zhang Y, Beggs PJ, Bambrick H, et al. The MJA–Lancet Countdown on health and climate change: Australian policy inaction threatens lives. Med J Aust 2018; 209: 474. https://www.mja.com.au/journal/2018/209/11/mja-lancet-countdown-health-and-climate-change-australian-policy-inaction
- 5. Beggs PJ, Zhang Y, Bambrick H, et al. The 2019 report of the MJA–Lancet Countdown on health and climate change: a turbulent year with mixed progress. Med J Aust 2019; 211:490–491.e21. https://www.mja.com.au/journal/2019/211/11/2019-report-mja-lancet-countdown-health-and-climate-change-turbulent-year-mixed
- 6. Royal Commission into National Natural Disaster Arrangements. Royal Commission into National Natural Disaster Arrangements report. Canberra: Commonwealth of Australia, 2020: https://naturaldisaster.royalcommission.gov.au (viewed Nov 2020).
- 7. Borchers Arriagada N, Palmer AJ, Bowman DM, et al. Unprecedented smoke‐related health burden associated with the 2019–20 bushfires in eastern Australia. Med J Aust 2020; 213: 282–283. https://www.mja.com.au/journal/2020/213/6/unprecedented-smoke-related-health-burden-associated-2019-20-bushfires-eastern
- 8. Vardoulakis S, Jalaludin BB, Morgan GG, et al. Bushfire smoke: urgent need for a national health protection strategy. Med J Aust 2020; 212: 349–353. https://www.mja.com.au/journal/2020/212/8/bushfire-smoke-urgent-need-national-health-protection-strategy
- 9. Carey MG, Monaghan MP, Stanley FJ. Extreme heat threatens the health of Australians. Med J Aust 2017; 207: 232–234. https://www.mja.com.au/journal/2017/207/6/extreme-heat-threatens-health-australians
- 10. Talley NJ. SARS‐CoV-2, the medical profession, ventilator beds, and mortality predictions: personal reflections of an Australian clinician. Med J Aust 2020; 212: 302–303. https://www.mja.com.au/journal/2020/212/7/sars-cov-2-medical-profession-ventilator-beds-and-mortality-predictions-personal
- 11. Dalton CB, Corbett SJ, Katelaris AL. COVID‐19: implementing sustainable low cost physical distancing and enhanced hygiene. Med J Aust 2020; 212: 443–446. https://www.mja.com.au/journal/2020/212/10/covid-19-implementing-sustainable-low-cost-physical-distancing-and-enhanced
- 12. Toole M. Of all the places that have seen off a second coronavirus wave, only Vietnam and Hong Kong have done as well as Victorians. The Conversation 2020; 25 Oct. https://theconversation.com/of-all-the-places-that-haveseen-off-a-second-coronavirus-wave-only-vietnam-and-hong-kong-havedone-as-well-as-victorians-148520 (viewed Nov 2020).
- 13. Crooks K, Casey D, Ward JS. First Nations peoples leading the way in COVID‐19 pandemic planning, response and management. Med J Aust 2020; 213: 151–152. https://www.mja.com.au/journal/2020/213/4/first-nations-peoples-leading-way-covid-19-pandemic-planning-response-and
- 14. COVID‐19 National Incident Room Surveillance Team. COVID‐19 Australia: epidemiology report 29. Fortnightly reporting period ending 8 November 2020. Comm Dis Intel 2020; https://doi.org/10.33321/cdi.2020.44.87.
- 15. National Health and Medical Research Council. NHMRC’s role in addressing health implications of environmental change. Canberra: NHMRC, 2019. https://www.nhmrc.gov.au/research-policy/research-priorities/nhmrcs-role-addressing-health-implications-environmental-change (viewed Nov 2020).
- 16. Sutton B, Mulvenna V, Voronoff D, Humphrys T. Acting on climate change and health in Victoria. Med J Aust 2020; 212: 345–346. https://www.mja.com.au/journal/2020/212/8/acting-climate-change-and-health-victoria
- 17. Malos A, Dennis‐Ryan A. Zali Steggall’s new climate change bill comes just as economic sectors step up. The Conversation 2020; 10 Nov. https://theconversation.com/zali-steggalls-new-climate-change-billcomes-just-as-economic-sectors-step-up-149728 (viewed Nov 2020).
- 18. Galloway A. Scott Morrison says world should focus on environment in wake of pandemic. Sydney Morning Herald 2020; 23 Nov. https://www.smh.com.au/politics/federal/scott-morrison-says-world-shouldfocus-on-environment-in-wake-of-pandemic-20201123-p56gz0.html (viewed Nov 2020).
- 19. Cai W, Zhang C, Suen HP, et al. The 2020 China report of the Lancet Countdown on health and climate change. Lancet Pub Health 2021; 6: e64–e81.
- 20. Torjesen I. NHS aims to become world’s first “net zero” health service by 2040. BMJ 2020; 371: m3856.
- 21. McAlister S, Barratt AL, Bell KJ, McGain F. The carbon footprint of pathology testing. Med J Aust 2020; 212: 377–382. https://www.mja.com.au/journal/2020/212/8/carbon-footprint-pathology-testing
- 22. Talley NJ, Stanley F, Tamara L, Horton R. Health and climate change MJA–Lancet Countdown report: Australia gets another failing grade in 2020 but shows signs of progress. Lancet 2020; https://doi.org/10.1016/S0140-6736(20)32632-5 [online ahead of print].
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.