Making climate change a national health priority: Australia's first National Health and Climate Strategy

Climate change poses profound and urgent challenges to the health and wellbeing of people in Australia. With an average of 1.51°C of warming since records began,1 the health impacts of climate change are already being felt across Australia.2 Meanwhile, the health system itself is responsible, either directly or indirectly, for around 5.3% of Australia's greenhouse gas emissions.3 There is a clear need for Australia to achieve “healthy, climate‐resilient communities, and a sustainable, resilient, high‐quality, net zero health system.”3 This vision is outlined in Australia's first National Health and Climate Strategy (hereafter, the Strategy), proudly launched in December 2023 by the Honourable Ged Kearney MP, Assistant Minister for Health and Aged Care. In this perspective article, we review the Strategy's origins, development, and key features; discuss the challenges that must be tackled in the coming years; and highlight the leadership role that health professionals can play in the response to climate change.

More than a decade in the making

The National Health and Climate Strategy is built on decades of outstanding Australian work on climate change and human health. Australians have been at the forefront of climate and health research for more than thirty years, and have been pioneers in drawing the global health community's collective attention to the impacts of climate change on human health and wellbeing. We acknowledge the many individuals and organisations who have persistently advocated for human and planetary health for over a decade, and welcome their ongoing contributions and leadership in this space.4,5

Following the establishment of the National Health, Sustainability and Climate Unit in December 2022 by the Albanese government, the Department of Health and Aged Care worked with hundreds of stakeholders to scope, develop and agree on the Strategy. Several key themes emerged over the course of public consultation throughout 2023, including:

• that good climate policy is good health policy, in that many of the same policy measures will protect the health of both people and planet;
• the need for a Health in All Policies approach, to ensure the Strategy addresses key health‐determining sectors;
• the importance of applying a health equity lens where relevant, so that initiatives to achieve net zero and climate resilience address health disparities;
• the importance of promoting good health and preventing disease in reducing health system demand and ameliorating climate impacts on population health;
• the need for action at all levels of government; and
• the vital role played by frontline health professionals in driving innovation to improve the quality, resilience and sustainability of Australian health care.

Consultation also highlighted the need to enable and embrace leadership on climate and health policy by First Nations people. Stakeholders spoke of the opportunities inherent in holistic partnerships with First Nations communities to improve health, reduce emissions and foster climate resilience. They also highlighted that First Nations peoples’ deep and nuanced knowledge — developed over tens of thousands of years of close observation and sustained custodianship of Country — is not only crucial in addressing the impacts of climate change on First Nations peoples’ health, but also can improve health and build climate resilience for all people in Australia.

A sustainable, climate‐resilient, high quality, net zero health system

At the heart of the Strategy is an ambitious agenda to transform Australia's health system into one that is sustainable and climate resilient while improving care quality and health outcomes. The Australian Government recognises that insights and leadership from health professionals will be crucial to achieving this agenda.

On health system decarbonisation, at the time of writing the Australian Government was working to publish baseline emissions estimates for the Australian health system, and to develop a net zero implementation guide for the Australian health system in collaboration with the Monash Sustainable Development Institute and state, territory and local health service partners. In the future, a key focus in our emissions reduction efforts will be supporting the provision of appropriate care and tackling unwarranted variations in care delivery. This will help to ensure that clinical care is of benefit to patients, and to avoid over‐investigation, overdiagnosis and overtreatment. The Strategy will also guide work to design interventions — in close collaboration with health professionals and consumers — that reduce emissions while maintaining or improving care quality. Fortunately, improving care quality and reducing emissions often go hand in hand. For example, improving objective diagnosis of asthma, education on inhaler technique, and increasing use of preventive inhalers can help to improve health outcomes while reducing emissions from respiratory inhalers containing greenhouse gases.6

On health system resilience, the Strategy recognises the need to build capacity to anticipate, understand, plan for, and respond to escalating climate impacts on health, wellbeing, and delivery of care. At a national level, this will involve an in‐depth consideration of climate impacts on health and health systems as part of the National Climate Risk Assessment, and development of a Health National Adaptation Plan to provide an overarching framework for nationally consistent health‐related adaptation. The Australian Government is also developing guidance and tools to support health system climate risk assessments and adaptation planning at a local level.

In addition, a voluntary pilot of new safety and quality standards on environmental sustainability and climate resilience for health service organisations is currently being administered by the Australian Commission on Safety and Quality Health Care.7 The pilot aims to help embed the principles of environmental sustainability and climate resilience in care delivery and governance, and will inform the next edition of the National Safety and Quality Health Service Standards, which is due for release in 2027.

Healthy, resilient communities

Crucially, the Strategy reaches beyond the traditional confines of the health system, and seeks to promote health, sustainability and climate resilience across a variety of health‐determining sectors. Many of the negative impacts of climate change on health will occur via impacts on the wider determinants of health, so it is critical that policies to ameliorate health impacts encompass these upstream drivers. Further, as measures to reduce greenhouse gas emissions from sectors beyond the health system will have significant health co‐benefits, there is an important role for the health sector to ensure these co‐benefits are considered in policy and decision making. We hope the Strategy will provide a platform from which to ensure that the health co‐benefits of emissions‐reducing policies are considered and accounted for in the years ahead.

The Strategy's Health in All Policies approach is embodied in a wide range of cross‐government initiatives at the intersection of climate change and human health planned for the years ahead. For example, in recognition that housing is a key determinant of health and wellbeing, the Strategy includes a commitment to consider the health benefits of climate‐resilient housing in developing the National Housing and Homelessness Plan. Given that population health would be improved markedly by widespread uptake of more environmentally sustainable diets,8 work is underway with the National Health and Medical Research Council to consider sustainability in the updated Australian Dietary Guidelines. The built environment is an important source of health systems emissions, and also a strong mediator of climate impacts on health, so the Strategy will promote the consideration of health and climate resilience in future updates to the National Construction Code.

Where to from here?

In her speech launching the Strategy at the 28th Conference of the Parties (COP28), Assistant Minister Kearney noted that its release, “highlights a beginning, and ahead of us lies the journey of delivering its ambitious program of work.”9 In 2024, the National Health, Sustainability and Climate Unit has taken some of the first steps on that journey. Work has commenced on 31 of the 49 actions within the Strategy, with 12 of those 31 actions completed or in the final stages of completion. Planning has also commenced to deliver a further 14 actions.

In addition to publishing baseline health system emissions estimates, the Australian Government will shortly be publishing new academic research about opportunities to reduce waste and make food more sustainable in the Australian health system. We have also been working with industry, clinicians, patients and other stakeholders to reduce emissions from respiratory inhalers and anaesthetic gases. Several state health systems have already shown leadership by removing the high emissions anaesthetic gas desflurane from their medicines formularies, while organisations such as Asthma Australia and the National Asthma Council have laid the groundwork for optimising asthma inhaler use for better asthma and climate outcomes, including with the National Sustainable Asthma Care Roadmap.10 Meanwhile, the interim Australian Centre for Disease Control, the Australian Commission on Safety and Quality in Healthcare, and the Council of Presidents of Medical Colleges have released a joint statement in which they agreed to work together to develop low‐emissions models of care, and to mobilise and support the health workforce to lead the health system response to climate change.11

In implementing the Strategy, we expect to encounter challenges. These challenges include the need to resist siloed thinking and working to make the Strategy's Health in All Policies approach a practical reality. To help achieve this, we have established governance structures that will support multidisciplinary, cross‐portfolio collaboration to deliver the Strategy's vision. Another key challenge will be achieving an appropriate level of national and international consistency, while also balancing the unique needs and circumstances of different jurisdictions. Many states, territories and local governments have led the way in health system decarbonisation and climate resilience to date. In implementing the Strategy, we will be looking to learn from and build on their innovation and progress, and seeking to add value to existing approaches.

A key domain for Commonwealth leadership will be supporting international collaboration, particularly in areas that require changes to global supply chains and manufacturing practices. On Earth Day this year, the Australian Government announced that it has joined a collaboration with the United States and United Kingdom to align health system procurement standards to support decarbonisation.12 Commitment to this collaboration was reiterated at COP29 in Baku, Azerbaijan.13 Australia is also engaged with efforts to develop new international standards for measuring the environmental impacts of health technology products.

The role of clinicians

Frontline clinicians were instrumental in the Strategy's development, and will be even more crucial in its implementation. A net zero, climate‐resilient health system must have as its bedrock a motivated, innovative, and upskilled workforce, that can translate the Strategy's vision and objectives into reality on the ground. Achieving such transformative change will require effective coupling of “top‐down”, government‐led initiatives with “bottom‐up” innovation and reform.

The Strategy highlights a few examples of clinician‐led initiatives that have already achieved exceptional outcomes for patients and the planet, and embody the creativity, care and collaboration that will be needed in the years ahead. For example, a team in the Royal Melbourne Hospital Emergency Department implemented a campaign to reduce unnecessary arterial blood gas and coagulation profile testing, which resulted in over 1200 unnecessary blood tests being avoided each month, with annual cost savings of $240000 and emissions reductions of 900kg carbon dioxide equivalent (CO₂e).3 We heard about dozens of inspiring frontline initiatives — and even more exciting ideas — such as this throughout Strategy consultations, and aim to support those on the frontlines to consolidate and expand their outstanding work. We have been impressed and inspired by clinicians’ incredible passion for addressing climate change, and will work to support their longstanding, vital leadership towards a net zero, climate‐resilient health system in the years ahead.

The National Health and Climate Strategy sets an ambitious strategic direction for climate change and health policy in Australia. The Australian Government will lead the implementation of the Strategy over the next five years, and continue to pursue the Strategy's vision of “healthy, climate‐resilient communities, and a sustainable, resilient, high‐quality, net zero health system” over the coming decades. This work is a shared responsibility of every health professional and every part of the health system. We look forward to working collaboratively with stakeholders, including frontline health practitioners, to realise this vision in the years ahead.