Before COVID-19, when few of us truly understood the might of public health legislation, the Western Australian Government had looked to public health powers as a tool to address the impacts of climate change. Following the Sustainable Health Review which considered the approach to be taken by the WA health system to deliver 'patient-first, innovative and financially sustainable care', the WA Minister for Health announced an inquiry into the impacts of climate change on health in Western Australia in March 2019 (Inquiry). The inquiry was headed by then Chief Health Officer, Professor Tarun Weeramanthri.
The Inquiry's Final Report was published in December 2020 and, as a sign of its innovation, declares that to its knowledge, "this is the first statutory inquiry anywhere in the world focused on the health impacts of climate change". As the Inquiry was convened under Part 15 of the Public Health Act 2016 (WA), it was conducted within the context of the broad objectives of the Act which include to not only promote and improve public health, but also to protect individuals and communities from public health risks.
The term 'public health risk' is broadly defined to mean a risk of harm to "... the health of individuals in the context of the wider health and wellbeing of the community" together with safeguards and policies designed to protect and improve the health of individuals and communities. A key feature of the Act is the five principles which administrators, such as the Chief Health Officer, must consider when performing their functions (section 3(3)). In particular, the Act refers to public health practices recognising the environmental needs of future generations (Sustainability Principle) and that lack of scientific certainty should not be used as a reason to postpone measures to prevent or control a public health risk (Precautionary Principle).
According to Dr Sarah Joyce, Project Director for the Inquiry and winner of the Churchill Fellowship in 2020, one of the most significant health risks from climate change facing Australians is heat stress and indeed, the last decade was the hottest on record for Australia, with the temperature almost 1° Celsius above average. As Dr Joyce explains: "The heat affects our ability to regulate our body temperature which can lead to cramps, exhaustion, heat stroke, and hyperthermia as well as exacerbate existing health issues such as heart disease and diabetes. The impacts are often underestimated by the public, but more people have died because of extreme heat events in Australia than from all other natural disasters combined."
Dr Joyce believes that the principles of public health can address both known and emerging risks from climate change. For example, a strong focus on prevention through the reduction of greenhouse gas emissions, the use of legislative and regulatory levers to manage climate-related risks, strengthening surveillance and early warning systems to inform government responses, and focussing on population-based interventions which provide the maximum benefit for the largest number of people.
The use of health impact assessments, a familiar public health tool, provide a structured process to consider a broad range of factors in the physical and social environment that impact on health and wellbeing and can be used to identify, prepare for, and manage the health effects of climate change.
So is there any difference in looking at climate change from a public health perspective? After all, addressing the impacts of climate change is already part of the policy matrix for other WA authorities. For example, consider the Greenhouse Gas Emissions Policy for Major Projects issued by the WA Government in August 2019 which outlines the Government's approach to approving major projects that have been assessed under Part IV of the Environmental Protection Act 1986 (WA) in the context of an aspirational target of net zero emissions by 2050.
This policy was followed by the Greenhouse Gas Emissions Environmental Factor Guideline issued by the Environmental Protection Authority in April 2020 which gives further guidance on how greenhouse gas emissions are to be reported and managed in the context of environmental impact assessment. While the Guideline is currently under review, it has already been applied to projects assessed under Part IV with some being required to prepare and maintain Greenhouse Gas Management Plans as conditions of implementing the project.
According to Dr Joyce, there is a difference using a public health approach: "Public health is fundamentally about protecting and improving the health of people and their communities. We know that climate change affects our health both directly, by the increased intensity and frequency of extreme weather events such as prolonged heatwaves, floods and bushfires and indirectly through air pollution, changes in the spread of infectious diseases, threats to food production and drinking water quality, and effects on mental health. There are known, effective public health responses for many of these impacts but the scope and complexity of climate change is compounding these issues."
That infrastructure decisions will now be modelled by the findings of the Sustainable Health Review and the Inquiry is emphasised by the inaugural draft State Infrastructure Strategy recently released for public comment. A major focus of the draft strategy is "improving the resilience of existing infrastructure to adapt to the impacts of climate change".
This reluctance to dive into the provision of infrastructure and focus on prevention so as to avoid the demand for further infrastructure keenly reflects what Dr Joyce sees as the key priority in the fight against climate change: "The longer it takes to reduce emissions, the greater the adaptation we will need to protect the population from climate change and its consequences, and the costlier such efforts will become. Therefore, it is critical for the WA Government to urgently address the causes of climate change while also planning for the increasing health impacts we can expect to see over the coming decade."
By looking at climate change not merely as an environmental issue related to major projects, but also, in terms of the effect on the health of individuals, the human effects of climate change and an obligation towards individuals comes into focus. The key now is how this health focus will shape policy decisions and implementation for other government decision-makers.
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