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Review of Health and Climate Change Literature Report

To inform City of Melbourne Zero

Net Emissions Strategy

28 June 2018

Report prepared by

Fiona Armstrong, Founder and Executive Director, Climate and Health Alliance

Acknowledgements

With thanks to Annabelle Workman and Rebecca Patrick for reviewing the draft and final report, and to Sue Cooke for editing.

Contents

Executive Summary 4

1. Definitions 4

2. Purpose of the report, review method, and rationale 5

2.1 Purpose 5

2.2 Method 6

2.3 Rationale 6

2.3.1 The evidence 6

2.3.2 International covenants 6

2.3.3 Health as a climate change communications ‘frame’ 7

3. Introduction and Background 7

3.1 Risks to health from climate change 7

3.2 Direct impacts: Extreme weather events 9

3.2.1 Heatwaves 9

3.2.2 Floods and storms 10

3.3 Indirect health impacts: ecosystem-mediated and human institution-mediated risks 10

3.3.1 Air pollution and aeroallergens 10

3.3.2 Infectious and vector-borne diseases 10

3.3.3 Food and water security 10

3.3.4 Mental illness and stress 11

3.3.5 Occupational health risks 11

3.3.6 Damage and displacement 11

4. Health co-benefits associated with climate change interventions 12

4.1 Climate mitigation and adaptation strategies with health co-benefits 12

4.1.1 Transport 15

4.1.2 Buildings 16

4.1.3 Energy 17

4.1.4 Food 18

4.1.5 Green infrastructure, including parks and gardens 20

4.1.6 Healthcare 21

5. Implications and opportunities for City of Melbourne 22

6. Recommendations and Conclusion 23

6.1 Key recommendations: 23

6.2 Further considerations 24

6.2.1 Research 24

6.2.2 Integrating mental health 25

6.2.3 Health Impact Assessment 25

6.2.4 Governance to support policy integration 25

6.2.5 Assessing upstream emissions 25

7. Conclusion 25

8. References 26

Appendix A 34

Executive Summary

This report provides an overview of the evidence in relation to the health co-benefits associated with climate mitigation and adaptation strategies. It is intended to inform the City of Melbourne about the health and social benefits available from the implementation of initiatives to achieve its net zero emissions goal.

There are many benefits for the health and wellbeing of the population associated with strategies to reduce greenhouse gas (GHG) emissions. These health co-benefits, which either reduce current health threats or lead to improvements in current health status, can be realised at a local scale, and often in a very short time frame (days, weeks and months) whilst the climate benefits accrue in the longer term (years, decades and centuries).

Health co-benefits arise from a range of strategies to reduce emissions in a number of sectors. Reducing emissions in energy and transport sectors can reduce air pollution, which can lead to immediate improvements in cardiovascular and respiratory health, and results in fewer heart attacks and asthma attacks, and fewer hospitals admissions. Reducing the carbon intensity of our diets and food systems can also decrease heart disease, help avoid obesity and diabetes, and reduce the incidence of bowel cancer. Investing in green infrastructure lowers greenhouse gas emissions, and leads to positive improvements in mental, physical and social health.

These are just some of the opportunities that are currently under-recognised in the actions that individuals, communities, cities, states and nations are taking to act on climate change. While major emissions reduction targets may be set by national governments in accordance with international agreements, much of the effort to deliver the requisite emissions reductions will occur at the subnational and city level. A net zero emissions strategy for the City of Melbourne can achieve much more than just emissions reductions if carefully targeted interventions are used (see Appendix A for current initiatives in other jurisdictions).

While there are health co-benefits associated with both climate mitigation and adaptation strategies, the bulk of the literature reviewed here is in relation to the co-benefits associated with climate mitigation. Many climate adaptation and climate mitigation strategies can be mutually reinforcing and are generally considered to be most effective when pursued simultaneously (Landauer, 2015).

In additional to health and climate benefits, many climate mitigation and adaptation strategies also offer economic savings from avoided ill-health and productivity gains. These savings can often offset the costs of implementing the policy, and in some cases, the savings vastly outweigh the costs, offering health-climate-economic benefits: a win-win-win scenario. As such, the benefits of emissions reduction should be an integral inclusion as part of the systematic assessment and development of net zero emissions strategies.

There is more to do to evaluate the specific economic opportunities associated with health co-benefits associated with zero net emissions strategies proposed for the City of Melbourne. However, the evidence of the health co-benefits from climate mitigation is sound, and there should be no delay in seeking to implement initiatives to capitalise on the evidence outlined in this report.

Definitions

Ancillary benefits - the secondary or supplementary positive effects that a policy or measure aimed at a particular objective might have 

Co-benefits - the positive effects that a policy or measure aimed at one objective might have on other objectives (IPCC, 2014b, page 14). For example, the health and economic benefits achieved through reducing greenhouse gas emissions.

Climate action – action taken to mitigate or adapt to climate change either by reducing greenhouse gas emissions to prevent worsening climate harm, or adapting to those changes which are unavoidable. 

Climate adaptation – the process of adapting to climate change in order to better cope with, manage or adjust to its impacts including changing conditions, stress, hazard, risk, or opportunity. This can happen at household, community, group, sector, region, or country levels.

Climate mitigation - includes actions taken globally, nationally and individually to limit changes in the global climate caused by human activities. Mitigation activities are designed to reduce greenhouse emissions and/or increase the amount of greenhouse gases removed from the atmosphere.

Climate altering pollutants – include greenhouse gases such as carbon-dioxide, methane, nitrous oxide, ozone, chlorofluorocarbons (CFCs) and hydrofluorocarbons and other climate pollutants like black carbon.

Greenhouse gases – the main greenhouse gases are carbon-dioxide, water vapour, methane, nitrous oxide, ozone, chlorofluorocarbons and hydrofluorocarbons (HFCs). Greenhouse gases trap heat in the atmosphere and the increasing levels in the atmosphere since pre-industrial times are responsible for the enhanced greenhouse effect or global warming.

Green infrastructure - the network of natural landscapes and features in urban settings. It can include parks and gardens, urban forests, street verges and footpaths, sports and recreational facilities, green roofs and walls.

Health - The World Health Organisation defined health in 1948 as a "State of complete physical, mental, and social wellbeing, and not merely the absence of disease or infirmity."

The 1986 Ottawa Charter for Health Promotion held that health is "The extent to which an individual or group is able to realize aspirations and satisfy needs, and to change or cope with the environment. Health is a resource for everyday life, not the objective of living; it is a positive concept, emphasizing social and personal resources, as well as physical capacities."

Health promotion - is the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions.

Morbidity - the incidence of disease: the rate of illness (as in a specified population or group)

Mortality - the number of deaths in a population or group in a given time or place

Preventable deaths - Avoidable and preventable deaths refers to deaths from conditions that are considered avoidable given timely and effective action including disease prevention and population health initiatives.

Social benefit - The increase in the welfare of a society that is derived from a particular course of action. Some social benefits, such as greater social justice, cannot easily be quantified.

Purpose of the report, review method, and rationale

1 Purpose

The purpose of this report is to:

provide an overview of the literature on health co-benefits associated with strategies implemented for climate adaptation and mitigation goals; and

inform the City of Melbourne about the possible health and social benefits available to the city and its inhabitants from the implementation of measures to put Melbourne on a path to net zero emissions by 2050.

2 Method

A desktop review was conducted of the literature on the evidence of health and social co-benefits associated with climate mitigation and adaptation strategies. Relevant literature from 2008-2018 was identified by searching electronic databases and search engines using a range of search terms related to ‘climate mitigation’ and ‘climate adaptation’ and ‘health co-benefits’. The term co-benefits are sometimes used interchangeably with “additional benefits” or “ancillary benefits” or “win-win-win scenarios”, so these search terms were also used. It was supplemented by studies recommended by policy and academic experts in the field. It included peer reviewed studies which described or evaluated health impacts in relation to climate mitigation or adaptation measures or assessed potential health impacts. Studies that considered co-benefits for health associated with active, public and low emissions transport, low carbon diets, energy efficiency in homes and buildings, low emissions energy sources, low carbon healthcare, and green infrastructure, including parks and gardens were also sourced. Studies were included if they were peer reviewed or were considered reputable grey literature from research institutions, governments or non-government organisations. A total of 124 studies were used for the report. The literature was analysed according to themes included in the report contents.

3 Rationale

1 The evidence

The health and social co-benefits of climate mitigation and adaptation strategies can help create additional motivation to take action towards the net zero emissions goal. The evidence reveals economic savings associated with health co-benefits can outweigh the cost of the measures themselves. The literature demonstrates that integrated policies (that consider the implications for a number of sectors and stakeholders) provide opportunities to enhance positive social, environmental and human health outcomes. Importantly, many health co-benefits associated with climate mitigation strategies are realised in short timeframes (days, months and years, depending on the intervention), while the climate benefits accumulate in the longer term (Remais, 2014).

2 International covenants

The potential for health co-benefits from climate mitigation and adaptation has been recognised in the Intergovernmental Panel on Climate Change Fifth Assessment Report and codified in the UNFCCC Paris Agreement (Smith, 2014; UNFCCC 2015). Health and wellbeing and climate action are also mutually reinforcing and complementary goals in the Sustainable Development Goals (SDGs).

As a party to the Paris Agreement, Australia has an obligation to consider its citizens’ right to health in the context of climate policy, and to consider the potential for health co-benefits in climate mitigation strategies. This provides an important framework for sub-national (including local) governments to use to guide decision-making and prioritisation of strategies in their efforts to contribute to the implementation of the Paris Agreement.

3 Health as a climate change communications ‘frame’

Health is an important ‘frame’[1] when communicating about climate change: research from the Centre for Climate Change Communication at George Mason University shows when climate change is presented as a health issue, people are much more likely to consider it in a personal context, as an individual threat and something that is understandable and directly relevant to them (Maibach 2010). When the health co-benefits are part of the climate change narrative, this has even more impact – and leads to stronger support for climate mitigation and adaptation strategies (Maibach 2010; Myers, 2012). Importantly, a health frame around climate change communications also has strong appeal across all audience spectrums (ranging from those ‘alarmed’ about climate change, to those that are ‘dismissive’), regardless of political leaning (Myers, 2012). This demonstrates that a health lens provides a way to communicate about climate change in a way that can bypass otherwise partisan and politically hostile debate (Myers, 2012; Bain, 2015).

Research by Sustainability Victoria shows 78% of Victorians are concerned about climate change, with 38% concerned about its impact on health and quality of life (Sustainability Victoria, 2016/17). Insights from psychological science suggest policymakers seeking to improve climate policy outcomes should: emphasise climate change poses current, local and personal risk; and that individuals and the wider community can make a difference; define and communicate social norms (i.e. what others are doing); and highlight what can be gained from immediate action, while linking to valued longer term goals (van der Linden, 2015).

Further, the evidence suggests that personal perception of risk, linked to health, is a powerful influence on behavioural change (Petrovic, 2014).

This points to an important opportunity for the City of Melbourne to use health as a communications vehicle to engage people more deeply in the City’s climate change mitigation and adaptation plans, and to use the health co-benefits framing as a positive opportunity and trigger for action.

Introduction and Background

1 Risks to health from climate change

Climate change is recognised as a profound threat to the health and wellbeing of people in Australia and around the world, and left unchecked, threatens to undermine the health gains associated with the last 50 years of global development (Watts, 2015). The economic costs associated with the adverse health and social costs of climate change are frequently unrecognised, but are often immense: for example, the costs associated with deaths and injuries, mental stress, worsening chronic illness, domestic violence, and unemployment associated with the 2001 floods in Qld amounted to AUD$7.4 billion. This exceeded the AUD$6.7 billion worth of combined costs of damage to homes, infrastructure, businesses, agricultural production, and the emergency response (Deloitte Access Economics, 2016).

As well as the health costs of climate change, there are significant immediate and costly negative health impacts associated with air pollution - released by the same combustion processes that produce greenhouse gas emissions (Watts, 2017; Roy, 2017). Air pollution presents both a personal toll as well as a significant impact on the economy: a 2017 report estimates the present human and economic cost of air pollution in just 41 OECD and BRIICS countries[2] is around 3.2 million deaths and USD$5.1 trillion annually (Roy, 2017). Globally, the World Health Organisation (WHO) estimates 7 million deaths occur each year as a result of exposure to dangerous air pollution (WHO, 2018). As the OECD report shows, this is not just a risk for developing nations: 91% of the world’s population lives in places where air quality exceeds the WHO guideline limits (WHO, 2018). It is estimated that the annual death toll from urban air pollution in Australia is 3,000 (AIHW, 2016).

Leading climate change and health researcher Professor Tony McMichael describes climate change as a complex phenomenon which can alter the rate, range and patterns of injury, illness, and death, but emphasises:

“…it is not the climate itself that affects human health; rather, the health consequences result from the environmental, ecological and social impacts of a changing climate.” (McMichael, 2011).

The most negative direct impacts on health from climate change include deaths, injuries, and illnesses associated with heatwaves, floods, bushfires and severe storms (McMichael, 2011). Indirect impacts are mediated by environmental or ecosystem factors such as deaths and illnesses related to increases in air pollution, exposure to vector-borne, or food- and water-borne diseases. Further indirect effects arise from: socio-economic and mental health issues associated with trauma and displacement following extreme weather events; poor nutrition associated with declining agricultural production; and exposure to violence and conflict (Workman, 2018). There is an increased risk of cardiovascular and respiratory illness linked with declining air quality and increased aeroallergens associated with climate change (D’Amato, 2013). Indirect risks also include threats to nutritional status associated with impacts on food supply and water security, and threats to personal and community security related to economic instability, migration and conflict (intergroup and interpersonal) (Hsiang, 2013; Butler, 2016).

The extent to which people’s health is affected by climate change depends on many factors, including their current health status, age and gender, socio-economic status, and access to social services, infrastructure and support, including healthcare (Smith, 2014). Figure 1 below highlights how climate change impacts on human health as a “threat multiplier” in that it amplifies or increases pre-existing health threats or problems (CDPH, 2018; Kjellstrom, 2013).

Figure 1: Impact of Climate Change on Human Health and Exacerbation of Existing Inequities

(Adapted from CDC, J. Patz by California Department of Public Health)

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The impact of climate change on human health and exacerbation of existing inequities are:

More extreme weather

o Degraded living conditions & social inequities

Exacerbation of existing social and health inequities and vulnerabilities

o Changes in vector ecology

Malaria, dengue, encephalitis, hantavirus, Rift Valley fever, Lyme disease, chickungunya, West Nile virus.

Rising sea levels

o Air pollution and increasing allergens

Asthma, cardiovascular disease, respiratory allergies

o Water quality impacts

Cholera, cryptosporidiosis, Campylobacter, leptospirosis, harmful algal blooms

Increasing CO2 levels

o Water and food supply impacts

Malnutrition, diarrheal disease

o Severe weather

Injuries, fatalities, loss of homes, mental health impacts

Rising temperatures

o Extreme heat

Heat-related illness and death, cardiovascular failure

o Environmental degradation

Forced migration, civil conflict, mental health impacts, loss of jobs and income

2 Direct impacts: Extreme weather events

Some of the direct risks to health from extreme weather events associated with climate change relevant to the City of Melbourne include heatwaves, floods and storms.

Extreme weather events such as floods, storms, extreme precipitation, droughts, and bushfires are increasing in frequency, duration and intensity (Black, 2015; Lewis, 2014; Steffen, 2017). These put people at risk of injury, illness and death through direct trauma and exposure to air-borne (e.g. smoke haze) and water-borne (e.g. contaminated stormwater) pollutants. Physical displacement, mental health impacts and post-traumatic stress associated with extreme weather all place increased demand on health, emergency and community services (State Government of Victoria, 2009, 2014; Banham, 2018; Curtis, 2017; Mallon, 2013). Extreme events also pose a threat to health services infrastructure, operations and service continuity, as well as to the health workforce, posing further risks to the community if services are inaccessible, unable to function, or not fully staffed (Carthey, 2009).

1 Heatwaves

Rising global average temperatures are giving rise to more frequent and intense heatwaves (Patrick, 2015). This is exacerbated for city dwellers by the urban heat island event, whereby cities can be 5-11 degrees Celsius hotter than surrounding areas (Patrick, 2015). Heatwaves already cause more deaths in Australia than bushfires, cyclones, earthquakes, floods and severe storms combined (Hughes, 2016). Deaths from heatwaves primarily occur as a result of myocardial infarction (heart attack), respiratory failure, and heat stroke (McMichael, 2011). Socially disadvantaged communities (e.g. those on lower incomes) and people with existing physical (e.g. heart disease, obesity, multiple sclerosis) or mental illness, the very old and the very young, and those living alone are most at risk of negative health impacts from extreme heat (Norton, 2015).

2 Floods and storms

Severe floods in Australia in recent years highlight that many urban and rural communities are vulnerable to the damaging effects of floods and severe storms. Floods affect health through drownings, injuries, and the spread of disease through contamination of floodwaters with environmental toxins or infectious diseases (Smith, 2014). Severe storms and flash flooding can cause fatalities and injuries, as well as disrupt transport systems, and contribute to power outages (Wales, 2012). Flooding and storms can have serious impacts on mental health, with people whose homes and properties are inundated with flood waters being two to five times more likely to report mental health impacts (psychological distress, anxiety, and depression) than those not flooded (Paranjothy, 2011; Smith, 2014).

3 Indirect health impacts: ecosystem-mediated and human institution-mediated risks

Indirect impacts on human health and wellbeing linked to climate change include influences on ecosystems such as increased risk of exposure to infectious and vector borne diseases; food and water borne infections; as well as air pollution and aeroallergens (Smith, 2014; Workman, 2018). Other indirect effects involve health impacts associated with droughts and crop failures, as well social impacts, such as population displacement related to prolonged drought or sea level rise (Smith, 2014).

1 Air pollution and aeroallergens

Many processes that create greenhouse gas emissions also produce local air pollution harmful to human health. Pollutants produced by burning coal, oil and gas for electricity, heat and transport are associated with an elevated risk of heart attacks, strokes, and respiratory diseases, including lung cancer (Smith, 2013). The pollutants abundant in urban air pollution associated with health harms include particulate matter (PM), nitrogen oxide (NOx) and ground level ozone (D’Amato, 2013; Dean, 2018). The City of Melbourne periodically experiences air pollution which poses a serious health risk for residents, workers, and tourists (Cunningham, 2017). A recent report from the Victorian Auditor-General’s Office suggests a lack of air monitoring equipment may mean air pollution poses a more serious threat to the people of Melbourne than is currently realised, with exceedances in pollutant concentrations occurring more frequently than EPA reports suggest (VAGO, 2018). Increases in temperatures associated with climate change are also linked to increased production of aeroallergens, which contribute to respiratory problems, such as the severe thunderstorm asthma event in Victoria in 2016 (Tofa, 2017), which caused the deaths of nine people and a massive surge in demand for emergency services and medical care (State of Victoria, 2017a).

2 Infectious and vector-borne diseases

As temperatures rise, so too does the number, range and resilience of various food-, water-, and vector-borne pathogens (Smith, 2014; AAS, 2015). Food-borne illnesses such as gastroenteritis are caused by bacteria such as campylobacter and salmonella which occur more readily with warmer temperatures (Hall, 2011; Smith, 2014). Given around there are already around 10,000 episodes of gastroenteritis leading to about 80 hospitalisations in Australia every day, more frequent heatwaves will put hundreds more people in Melbourne at risk of food related illness (Voice, 2015). Rising temperatures are also associated with increased exposure to vector-borne diseases, including mosquito-borne viruses such as dengue and Ross River fever. The range of these vectors is expected to increase across Australia under climate change scenarios (Kjellstrom, 2009; Smith, 2014).

3 Food and water security

Reduced rainfall and drought related to climate change poses a range of risks related to human health and wellbeing. Reduced environmental flows in rivers can lead to declining water quality (Kjellstrom, 2009), loss of aquatic biodiversity, and reductions in available water to support agriculture, threatening food security – all of which have flow on effects for human health (Wales, 2012). Inequitable access to water may exacerbate existing health inequalities, while declining water availability may impact water quality and reduce crop yields, leading to higher food prices and limiting food options (Hanjra, 2010).

4 Mental illness and stress

Environmental and climatic changes contribute to a diverse range of mental health impacts. These include mental stress related to economic and emotional pressures associated with increasingly frequent and severe climate change-related disasters, including droughts (Hanigan, 2012; Climate Institute, 2011). An emerging mental health risk is a sense of despair and hopelessness related to inadequate societal responses to the threat of climate change (Hayes, 2018). Other impacts include exacerbations of psychiatric disorders during heatwaves (Hanse, 2008). Research reveals worry and distress about the future in relation to climate change, and anxiety and depression related to inaction, constitutes both a negative health impact, as well as a basis for action (Berry, 2018).

5 Occupational health risks

In addition to the adverse effects of heat waves, hotter temperatures also pose occupational health and safety risks (Varghese, 2018). The sheer volume of workers entering the City of Melbourne during weekdays increases the local air temperature in the city (Klein, 2017). Hotter temperatures associated with climate change can pose serious occupational risks, particularly for outdoor workers, and those working in indoor non-cooled environments (Hanna, 2011; Singh, 2013), such as manufacturing, bakeries, laundries, and restaurant kitchens (Varghese, 2018). Occupational heat stress is associated with an increase in workplace injuries, with hot conditions contributing to discomfort, fatigue, and reduced concentration and alertness (Varghese, 2018). Reduced work capacity related to occupational heat stress carries a significant economic toll and is already associated with lost productivity costing $6.2 billion per annum in Australia (Zander, 2015).

6 Damage and displacement

Sea level rise and drought both pose threats to the population in Victoria and have implications for the City of Melbourne (Wales, 2012). Several coastal municipalities are at risk of inundation associated with sea level rise, posing risks to property and associated economic and social costs (Warren-Myers, 2018; Wales, 2012). Forced displacement from homes and properties in low lying and coastal communities in the face of inundation associated with sea level rise, and from regional communities in the context of persistent drought, will bring a range of health challenges in the future, including psycho-social ill-health (Schwertle, 2017).

Health co-benefits associated with climate change interventions

The good news is that there are many health co-benefits associated with strategies that reduce greenhouse gas emissions. Provided these strategies are developed with the potential health benefits (and risks) in mind, they offer enormous potential to improve the general health and wellbeing of the population, as well as to provide economic benefits, since the cost savings from avoided ill-health and productivity gains often exceed the costs of policy implementation (Watts, 2017; Thompson, 2014; Landrigan, 2018).

Co-benefits (or ‘ancillary benefits’ as they are sometimes known) refer to the additional benefits that accrue from actions or strategies designed or implemented for a different purpose. This report provides an overview of the literature in relation to health co-benefits (improvements in health outcomes, or reductions in health risks) associated with climate adaptation or mitigation measures designed to reduce greenhouse emissions or to limit other risks associated with climate change. These offer a win-win scenario – both reducing emissions and delivering health benefits. Carefully designed strategies can deliver a triple win as they can also deliver (often substantial) economic savings.

Health co-benefits arising from climate adaptation and climate mitigation strategies can often help address existing health challenges, such as preventable lifestyle diseases (cardiovascular disease, obesity, Type 2 diabetes), as well as respiratory diseases linked to air pollution (asthma, lung cancer), and mental health (stress, anxiety and depression). Health and social benefits also arise when climate strategies positively impact on the social determinants of health – those wider forces that shape the conditions of daily life – economic factors, social and environmental conditions, education, cultural influences, gender equity and personal autonomy.

While there remains some uncertainty about the longer-term climate outcomes in relation to climate change mitigation and adaptation actions, there is a high level of certainty in relation to the health co-benefits that accompany them and the time frame within which they can be realised (Workman, 2018).

The co-benefits approach offers enormous advocacy potential as it positions climate action in the context of the positive outcomes that can be realised locally, and in the short term, while the climate benefits accumulate over a longer time scale. It provides the opportunity to elevate particular policy goals higher on the political agenda as the positive co-benefits ‘story’ can help overcome political opposition and increase policy acceptability in the community (Mayrhofer, 2016).

Health is already a key message in climate advocacy campaigns, as many health and environmental advocates recognise both the threat to health and the opportunity to positively engage communities associated with integrating climate change and health strategies and communications (EJA, 2017; ACF, 2018; PHAA, 2014).

1 Climate mitigation and adaptation strategies with health co-benefits

This review provides insights into the potential health co-benefits and positive social benefits accompanying economic savings associated with integrated climate change and health policies.

The evidence reveals that there are significant health co-benefits associated with climate adaptation and mitigation policies in relation to transport, buildings, energy, food, green infrastructure and healthcare.

These benefits arise from adaptation and mitigation actions which reduce or help avoid adverse health impacts and provide a strong rationale and motivation, in addition to the climate benefits, for the net zero emissions goal.

Figure 2: Health and climate: co-benefits, British Medical Journal, 2016

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Health and climate: co-benefits:

Reduced climate change Indirect benefits:

o Fewer deaths and injuries from extreme weather events

o Less skin cancer from UV radiation

o Reduced spread of vector-borne diseases in new areas

Reducing climate change also leads to further benefits downstream.

Example interventions:

These interventions have benefits both for health and reducing climate change (also known as mitigation).

o Produce more renewable energy (benefits: few fossil fuels used)

o Improve insulation in homes (benefits: less noise, reduced heat in urban areas)

o Encourage use of lower emission vehicles (benefits: fewer fossil fuels used, improved outdoor air quality, reduced heat in urban areas)

o Promote active transport (benefits: fewer fossil fuels used resulting in less noise)

o Reduce solid fuels used for cooking (benefits: fewer cooking fuels, fewer fossil fuels used)

o Less food from animal sources (benefits: reduced livestock product, less deforestation, few methane emissions)

o Encourage locally produced fruit and vegetables (benefits: local fruit and vegetables, few fossil fuels used)

Health benefits that can be derived from the above interactions:

o Better mental health

o Fewer deaths from extreme heat

o Less cardiovascular disease

o Less respiratory disease

o Lower rates of cancer

o Lower rates of obesity

Credit: The diagram was designed by Will Stahl Timmins, content by Nick Watts, with thanks to Soledad Cuevas, Duncan Jarvies, John Waring. The British Medical Journal and UK Health Alliance on Climate Change.

Table 1: Summary of key health co-benefits across sectors

|Sector |Mitigation or adaptation initiative |Key health co-benefits |

|Transport |Increased active / public transport; replacement of |Reduced prevalence of cardiovascular and respiratory |

| |diesel/petrol vehicles with clean-powered electric |illness, type 2 diabetes, dementia and cancer |

| |vehicles | |

|Buildings |Improving energy efficiency in buildings, improved |Reduced risk of heart disease, strokes, injuries, |

| |insulation and natural ventilation; designing for |asthma and other respiratory diseases; improved |

| |physical activity and social interaction |mental health and psychological well-being; reduced |

| | |visits to GPs, fewer hospitalisations and days off |

| | |work or school |

|Energy |Substituting fossil fuels with renewable energy for |Potential for thousands of avoided premature deaths |

| |electricity and transport |nationally, substantial savings for healthcare |

| | |budgets |

|Food |Increasing proportion of plant-based products in diets; |Reduced ischaemic heart disease, obesity and bowel |

| |local food production; avoiding overconsumption |cancer; improved community resilience, improved |

| | |psychological wellbeing |

|Green infrastructure |Increased urban tree canopy, parks and gardens, green |Reduced respiratory disease (from improved air |

| |roofs |quality); better overall health, reduced stress, and |

| | |an enhanced sense of personal wellbeing; reduced heat|

| | |stress; positive mental health |

|Healthcare |Reducing healthcare waste through recycling and low |Reduced environmental pollutants; improved air |

| |carbon procurement; improved energy efficiency; |quality; reduced morbidity and mortality; improved |

| |encouraging active transport / clean power vehicles; |physical and mental health; reduced healthcare costs |

| |delivering healthcare at home; investing in renewable | |

| |energy | |

Sources: Jarratt, 2012; Remais, 2014; Chapman, 2088, Milner, 2012; WHO, 2011; Urge-Vorsatz, 2012; Buonocore, 2015; Thompson, 2014; Okvat; 2011; Patrick, 2015; Friel, 2013; Haines, 2010; Demuzere, 2014; Bowen, 2015; Townsend, 2010; Sarajevs, 2011; Tallis, 2011; Eckelman, 2016; Pencheon, 2009; McGain, 2010; Naylor, 2012, Sherman, 2016.

1 Transport

In Australia, the transport sector accounts for 16% of total greenhouse gas emissions, of which 10% comes from light vehicles (Climate Change Authority, 2018). In addition to greenhouse gases, the combustion of fossil fuels for transport also produces harmful local air pollutants, the annual health costs of which has been estimated at USD$5.8 billion in Australia (OECD, 2014).

A number of international studies have investigated the health benefits associated with climate change strategies involving urban transport. Strategies to expand and promote public transport offer a range of health co-benefits associated with a reduction in air pollution, traffic injuries, noise, congestion and physical activity (Kwan, 2016).

Further, strategies to reduce emissions from transport frequently lead to improvements in air quality, due to reduced cardiovascular and respiratory disease (eg heart attacks, strokes, asthma, lung cancer) (IARC, 2013; Remais, 2014) and reduced hospitalization and emergency room visits for cardiovascular and respiratory diseases (McKinley, 2005). The increased physical activity associated with expanded public transport options can also reduce premature mortality (early deaths) and morbidity (illnesses) (McKinley, 2005). More stringent air quality guidelines for cities in Australia would lead to significant co-benefits and therefore more stringent mitigation targets could deliver significant health and economic co-benefits (Dean, 2018).

1 Active transport offers lower emissions and improved health

A study which modelled four different transport policy scenarios in European cities (Creutzig, 2012) found synergistic health and social gains and significant emissions reductions are possible if city infrastructure is adapted for pedestrians, cyclists, and efficient public transport. In larger cities (> one million people), increasing the modal share of public transport to beyond 50% offers the most viable option for health and climate gains, while smaller cities (where shorter trips are possible) can achieve emissions reductions through a modal shift to more than 50% walking and cycling (Creutzig, 2012). The nature of the surrounding built environment (i.e. whether or not it is conducive to walking), access to transit stations, and local culture and climate influence people’s willingness to walk to catch public transport (Kwan, 2016).

Comprehensive policy packages that combine ‘push’ (pricing disincentives for cars, infrastructure changes to discourage traffic), and ‘pull’ factors (encouraging public transport, increasing active transport infrastructure), along with fuel efficiency standards and urban planning levers offer the biggest health co-benefits and emissions savings, according to Creutzig (2012). This is supported by a systematic review of the literature by Quam (2017), which reinforces that a combination of initiatives to increase public and active transport and cleaner operating vehicles offers the best opportunities to reduce greenhouse gas emissions and achieve positive health outcomes.

Active transport options also help address the health burden of preventable chronic illnesses associated with sedentary lifestyles (Larouche, 2012). A 2010 study of the potential effect of increased walking and cycling in urban areas in England and Wales found reductions in the prevalence of type 2 diabetes, dementia, ischaemic heart disease, cerebrovascular disease, and cancer related to increased physical activity (Jarrett, 2012). These health improvements were estimated to deliver savings of UK£17 billion within 20 years for the National Health Service – funds that could either reduce pressure on healthcare budgets or be made available to fund additional health services (Jarrett, 2012). A study from New Zealand found that shifting just 5% of shorter trips in urban settings ( ................
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