Recording: Planetary health

Descriptive transcript

Thank you very much for joining us for today's event.

Firstly, I'd like to acknowledge that we're all on the traditional lands of First Nations people and this land was never ceded. In chairing this panel discussion today, I'm currently speaking to you from the Faculty of Law in beautiful Building 2 on the City campus. I want to acknowledge the Gadigal people of the Eora Nation upon whose ancestral land the City campus sits. As a member of an educational institution, I'd also like to acknowledge the Gadigal people as the original custodians of the knowledge of this land. As a lawyer, I'm very aware of the role of law in the original act of dispossession and the harms that have taken place since. At the same time, it's important to recognise that law has a key role to play in the work that still needs to be done to repair past harms and, indeed, those that are still ongoing. I'm very grateful to work in a law school where my colleagues are engaged in this work.

As we turn to the focus of today's discussion, I think it's also important to reflect on the fact that inequalities in global systems, in international political and economic relations, and the unequal causes and effects of climate change have their origins in the global colonial practices of which the colonisation of Australia was a part.

Now, I'd like to introduce myself. I'm Michael Thomson, and I'm a Professor of Health Law and Director of Law Health Justice, where we've co-organised today's event. It's a genuine pleasure to be joined by Sharon Friel, who is a Professor of Health Equity at the Australian National University, and two of my UTS colleagues, Elna Tulus and Jason Prior. I'll introduce each of these in turn in just a moment.

But of course, first, we have some housekeeping. Today's event is, of course, being live captioned. To view the captions, click on the CC button that you'll see in the control panel at the bottom of your screen, or you can click on the link that's now in the chat. If you have questions during today's event, and I'm sure there will be many, please type them into the Q&A box, which you'll also find in the Zoom panel at the bottom of your screen. You can upvote questions others have asked, which I think is a really handy way of doing this. Please do try and keep your questions relevant to the focus of today's discussion. Also, please try and keep them brief. That will make my job much easier.

So now on to today's discussion. The planet is facing multiple crises. 2023 was the hottest year since records began in 1880. Ten of the hottest years that the planet has experienced have taken place since 2010. Periods of drought have been followed quickly by periods of flooding, and in New South Wales we obviously know this well. Last year, wildfires swept across continents simultaneously, and we're now living with record levels of food insecurity, escalating biodiversity loss, and a widening gap between rich and poor, both between countries and within countries.

So how do we understand and respond to these alarming trends? We increasingly understand how human health is reliant on planetary health. Human health and thriving communities depend on planetary health, flourishing natural systems, and the wise stewardship of natural resources.

I'm really looking forward to our panel discussion, and I'd like to start by introducing Sharon, who will give a short keynote to kick off our discussion today. Sharon is an Australian Research Council Laureate Fellow, Professor of Health Equity, and Director of the Planetary Health Equity Hothouse at the Australian National University. Her work focuses on the governance of planetary, social, and commercial determinants of health inequities. She's a Fellow of the Academy of Social Sciences of Australia and the Academy of Health and Medical Sciences of Australia. I'm sure many of you will know Sharon from the significant contributions that she's made to our understanding of the global social injustice of health inequalities. Welcome, Sharon, and thank you for joining us today.

Thank you very much, Michael. It's really lovely to be here. I'm joining you from the lands of the Ngunnawal people, and I'm in Canberra. As you said, Michael, the unceded lands of First Nations people, and I pay my respects to Elders past and present.

My task is to give some preliminary remarks and provocations around these sorts of issues. I've broken it up into three pieces. The first is that connection. With the climate change that we are experiencing that Michael has just referred to, what does that mean in terms of social inequalities, and what does that mean for people's health and health inequities? We speak about this as planetary health equity – the equitable enjoyment of good health in a stable earth system. All of that, of course, is at risk. I would say we have a planetary health equity crisis right now.

So how does climate change affect our health? There are lots of different ways that happens. Temperatures are going up. With that, we're experiencing more heat stress, more heat exhaustion, heatstroke. All of this is also related to cardiovascular diseases, to kidney diseases. I should have prefaced my remarks by saying the front end is all the facts of despair. We will get to hope shortly, but let me start with the facts of despair.

But climate change also affects our health in other ways – through air pollution as well. Dirtier air, ozone interactions, dirtier air is linked to much higher hospital admission rates for people who are asthmatic, people who suffer from cardiac or pulmonary diseases. So those sorts of health relationships. In a slightly broader sense, as the land and the sea undergo all sorts of rapid changes associated with climate change, the animals that live on and in the land and the sea are going to disappear if they don't adapt, and if they don't adapt quickly enough. So for things like the pollinators, the bees, if they disappear, then that, of course, has massive implications for food security, for example. So that's another way that climate change is interacting and affecting our health.

We've seen already the very acute and chronic impacts on mental health from climate change – both the experience of climate change events, and then the anxiety about future climate change and the associated events has very immediate impacts on our mental wellbeing. But that accumulation over time, we know and we're seeing in the data, having impacts for chronic mental ill-health as well.

So these sorts of pathways through to different health outcomes – everybody is experiencing it. I don't believe that nobody is affected by all of this, but it's happening very unequally. So people and nations who are poorer, the elderly, people living with particular disabilities, people who experience social marginalisation on an ongoing basis – the data shows us that these are the communities, the populations, who are least able to adapt to the changing climate. They're the populations who are unable to escape the floods, the fires, the heat. They're the populations who are most likely to live in dwellings and environments that amplify those heat or flooding events.

So really what we're seeing is climate change exacerbating the existing social and health inequities. Really exacerbating that. And I give the example of Lismore. In 2022, 82% of the population living in the flood area of Lismore were in the most socially disadvantaged neighbourhoods. In 2017, with the Northern Rivers floods, which included Lismore, it was the same communities in 2017 and in 2022. So there was nothing that had really changed for those communities in terms of their underlying social conditions. That was a failure of social policy to address what we refer to in public health as the social determinants of health and health inequities. And then you get the added effects of climate change exacerbating those physical and mental health effects.

So if we want to see a healthy and equitable future, we've got to address social inequities as well as addressing climate change. I would argue that planetary health equity is a massive opportunity, a really massive opportunity, for climate stabilisation, for social equity and for good health outcomes, but it means we've got to think across sectors to do that.

So addressing planetary health equity means mitigation – mitigation of climate change. We were having a discussion just before about is it mitigation of the health impacts or something else. Climate change mitigation is, as far as I'm concerned, one of the biggest preventive health measures that exists. And if we want to mitigate further climate change, we've got to address the global consumptogenic system, as we refer to it in the Hothouse.

So what do I mean by the consumptogenic system? These are the common drivers of climate change, of inequality and poor health. The consumptogenic system is this web of institutions, of policies, of commercial activities, of institutional and social norms and behaviours that bake in, that incentivise, that reward the excessive extraction, production and consumption of fossil fuel goods and services. Obviously, incredibly harmful for the environment and often very bad for human health and certainly very unequally distributed.

I think there's three systems or domains embedded within there that create real problems but also real opportunities: the economic system, the energy system and the food system. If we were to think about a recalibration within those three systems – because they contribute very significantly to driving emissions and other environmental harms – then we would go a long way to do something about planetary health inequities.

So there's real possibilities to do that, and I hope this is coming to the slightly more hopeful side of things. There's the role of different actors – so this is the governance of the consumptogenic system and the governance of that in a way that transforms or changes that system towards planetary health equity outcomes, not planetary health inequities.

So the role of the state is fundamentally important. The state has to play a big role in all of this. Imagine public policy that optimises the climate, the social and the health outcomes. Imagine if we had a COP – so this is a plug for the Australian desire to play a leadership role in COP31 with Pacific countries, countries across the Pacific region. Imagine those ministries, those state leaders, saying the agenda for COP31 would be a strong focus on the social and health principles and goals, with a diversity of knowledges and particularly First Nations knowledge driving that agenda. That would be a marvellous leadership demonstration from the state, particularly in Australia.

We also have the opportunity of rethinking the economic system. Here in Australia, for example, we have the Measuring What Matters, the wellbeing economy discussion. Who knows whether that's going to really take off, but that, in essence, is a new policy idea, a new policy paradigm for economic policy. One of the things we're doing in the Hothouse is examining whether this wellbeing economy turn has purchase for redressing this consumptogenic system. So let's see.

But, of course, fundamentally, I think the big question of why this consumptogenic system exists, why it's not changed, is because of power, and the power inequities that are absolutely entrenched in that consumptogenic system. Because, of course, the interests, the commercial interests – the conservative elites do very well out of business as usual. They do really well out of that consumptogenic system. They're working really hard to control the narratives – economic growth, economic profits. That's the goal rather than the economy in service of people and the planet. They're setting the rules of the game, so the very fact that the economic system, the trade system, the investment system, the food system is basically ruled by the interests of the conservative elites and the corporations is really problematic from a planetary health equity perspective. And, of course, what that is doing is it's underwriting the norms, the social and the political norms, of what might be expected within society.

But there is hope. We see a turn happening, I think, in terms of market activity. So the B Corps, for example – again, I'm not convinced that these new forms of sustainable business models are the be-all and end-all, but that it's an opportunity. We're seeing ethical investors starting to say, "No, we don't want investment in new fossil fuel projects." We need the big institutional investors to be saying exactly that. At the moment, it's still on the fringes, but that's happening. So that will make a shift in the market arena.

And then, really importantly – and I'll finish with this – is the importance of what I call the influencers, the strategic mobilisation across civil society, across the public, pushing up, not pushing down to community, but pushing up. That says, "You, the state, have absolute responsibility for looking after the public welfare and for protecting the environment, and you, the market, are here to serve not just your profit interests but you have made promises through your environment, social, governance indicators to actually look out for these other principles." So civil society and the coalitions of networks really is vitally important. So I'll finish my remarks there, Michael, and hopefully that's just some provocations for the wider panel discussion.

Thank you very much, Sharon, and thank you in particular for ending on a hopeful note in what can be quite a difficult conversation. I look forward to exploring those issues in the discussion we will have in a moment. But first, I'd like to introduce our other panel members.

Elna Tulus is a PhD candidate here in the Faculty of Health. Her research on the sustainability of the global food systems questions its consequences for public health. Using the case study of Australian wheat and Indonesian instant noodles, she investigates how the transformation of food production has resulted in a change in dietary patterns towards ultra-processed foods, and then these have resulted in a significant increase in non-communicable diseases. Welcome. Thank you for joining us, Elna.

Thank you, Michael.

Sorry, I'll just introduce Jason and then we'll come back. Professor Jason Prior is Professor of Planning, Health and the Environment in the UTS Institute for Sustainable Futures. He's recognised as an expert working across environment, planning, human and planetary health. Jason wears many hats, including lead of the Healthy Populations and Environments Platform in the Sydney Partnership for Health, Education, Research and Enterprise, and he also convenes the Climate Change and Health Collaborative in INSIGHT, the university's new exciting health institute. Welcome to you as well, Jason.

So I've got questions. I've got the privilege of having questions for everyone before we open up the discussion more broadly to our audience.

So I'm going to start with a question for you, Sharon, and thank you so much for your compelling account of the relationship between global systems, planetary health and the impact on human health. I really valued the attention that you paid to the inequalities of impacts and the ties that we clearly see to social inequalities there.

Today, the discussion is really focused on climate change, but I wanted to ask you a question that moves us slightly out of that but allows us to look at these core drivers. So we increasingly hear not just of climate change, but of the triple environmental crisis – so we bring climate change together with loss of biodiversity and pervasive pollution. So can I just ask you, in terms of your analysis, are the drivers for each of these elements of the crisis the same?

Yeah, I mean, I think they're similar. There are probably some important points of difference. Most of my knowledge is in the climate change space. But if you think of some of that biodiversity loss and then that excessive pollution that you mentioned – with some of the biodiversity loss, a lot of that is land clearing. Why is land clearing happening? It's partly due to some of the big food corporations and partly for particular crop-growing purposes. So you've kind of got a common element of some of those corporate practices there. Same with pollution. You've got the fossil fuels sitting behind as a core component of that pollution, whether the pollution comes through the production phase or whether it comes into the cars driving about. So I do think there are some real common drivers across those areas.

One of the things I would love to see is – there's movement happening. There's the biodiversity framework that's in play, global framework, and then we've got the climate change through the UNFCCC. Wouldn't it be fantastic if those communities were talking much more closely to each other to address those common drivers? And then the same – I see a wee bit more of it into the pollution area. So, yeah, I'm not anti-business, but some of the corporate practices, you'll observe them across those three issues.

Thank you. So there's something in that consumptogenic core that seems to be driving each of those elements.

Yeah, I think so.

Thank you. Elna, and I think this is something that maybe you'll pick up in some ways. In your research, you take this fascinating and ubiquitous case study, the instant noodle, and you use it to highlight how food production patterns can drive ill health and health inequities. I wonder if you could tell us just a little bit more about your amazing research. And I'm particularly interested in the causes of the causes, to use a public health phrase. So what are the determinants of such changes in production patterns?

Thank you, Michael. Following on from what Sharon just mentioned about the biodiversity loss, the opening of land for food production, if we just look at instant noodles, the two key ingredients – palm oil and wheat – demonstrates just that. So the transformation of production over years actually has shifted how we consume.

My research looks broadly into how historically, for example, wheat came to Australia in the First Fleet and it became an economic driver for the country. So by 1956, for example, Australia had become one of the four largest exporters of wheat in the world. And that period is really important in the 1950s to 70s because it's during the Cold War.

What happened was the invention of instant noodles, which came from Japan, became an opportunity for companies, countries and companies to open up in areas such as Southeast Asia that had communist influence. And so the US was donating wheat at the time using Public Law 480, and the donation of wheat to Indonesia actually helped the production and the establishment of instant noodles. They actually opened up the world's biggest mill in Jakarta at the time in 1971.

So over time, the consumption, including food insecurity, because palm oil plantation had been introduced by Dutch colonisers back in the 1800s, the land wasn't available for people to grow food. So all these palm oil plantations, you have people consuming instant noodles and it's cheap, it's tasty. And Indonesia is now the second world's largest consumer of instant noodles. And it correlates regarding the non-communicable diseases – high stroke, diabetes, heart issues.

And I'd love to come back to what Sharon mentioned earlier regarding the power that was entrenched. If we look at wheat exporting countries, the eight largest wheat exporting countries basically cover over 75% of the value of wheat around the world. So countries like Indonesia and many of the Southeast Asian countries are very vulnerable because they can't grow wheat. The climate is not suitable. So they become import dependent.

Thank you very much for that, Elna. It's such an important and interesting case study. It takes us quite a way to looking at the complex determinants, particularly the political determinants there and then global trade patterns. Thank you.

Jason, I know that you work across architecture, planning, environment, human and planetary health. In terms of your work on architecture and planning and bringing this to planetary health – and this isn't supposed to be a bleak question, honestly – but have we reached that stage where what we're doing is climate mitigation or climate adaptation, or can we still improve planetary health through the choices that we make around the built environment?

I think the answer I would have is yes to the second question, which is I think there is still a need to improve mitigation and adaptation within the built environment to address particularly how our environment improves not only human health but planetary health, and they're both totally interconnected and we can't separate either of them.

We only have one planet, and cities, which are our dominant built form, are actually now our dominant habitat, and those cities are one of the largest emitters. So how we build, design and construct those cities actually can have a significant impact on the planet. So it's cyclical, the response, in a sense.

What I would say is I suppose where a lot of my work has focused is on built environment interventions for human and planetary health but working, trying to integrate health into the climate change adaptation and mitigations that's occurring within the built environment to give a greater understanding of the benefit of these mitigations and adaptations.

And I think what we have to remember is that human-generated climate change is caused by adverse direct impacts of heat waves, which impact on our environment, and our built environments can very much mitigate and allow people to adapt, for example, to those sort of direct impacts like heat waves.

For example, frequency of storms and intensities, which Sharon mentioned a minute ago – Lismore is a key example. And I think something we have to continue to remember is that where a person lives is very much determined by environmental justice principles and people are located in different locations. So, for example, someone living in the east of Sydney has access to sea breezes, while someone in the west of Sydney doesn't, and the temperatures, when they escalate, escalate much higher. So the extremes are much more in certain locations. That's one example. Lismore, the example which Sharon gave a minute ago, is a perfect example of where people are located in terms of zoning and those sorts of things.

What I would say is that it's really important for architects and planners and others – so whilst the health sector has a key role to play in addressing health effects, other professions like the built environment professions, like designers, architects, planners, can also continue to play a key role, and they need to, because the environment is the thing that mitigates how we are affected and, in the long term, how we emit and can decarbonise our environment.

It's always important to think about in these professions, and there's increasing thinking in these professions about this, and increasing work between the health sector and the built environment sector on actually addressing these concerns.

A good example of that is – there's multiple ways we can both adapt our built environment. So an example of an adaptation is by increasing and greening and blueing our cities, we can reduce the heat impact and insulate people from those impacts. So that's adaptation, but we don't want to stop there because if we continue to adapt, the problem just escalates.

So what we want to simultaneously be doing with our built environments is mitigating as well, doing mitigating interventions. So a good example there, which most people can engage in, is integrated transport planning, for example. So we can develop our environment so it encourages people to do active transport, which has co-benefits for health: one, it helps us reduce our carbon footprint; two, it gives people exercise, physical exercise.

And then under both those headings of examples of adaptive interventions and mitigating interventions, there's multiple that can be applied to cities. And these are necessary because, in the end, the health system, the planning or development system – the health system won't be able to cope with all the consequences of climate change alone. It needs the other systems, the built environment systems and other systems, to be adapted to actually help us cope with the changes that are coming our way – and are already here, I would like to emphasise. So that's what I would say at this point. So I think it's a lot about how we slowly move towards all these different professions moving towards co-producing responses, not just independently.

Thank you very much, Jason. That was a really interesting and helpful overview of what's a complex and developing area. There's some really nice, I think, global examples of where some of that is working very successfully, particularly around transport, I think, encouraging people to look at alternative travel that has those health benefits.

OK, so two public health experts, an architect and a lawyer sit around a virtual table. So not the beginning of a dubious joke, but a reflection on the interdisciplinary nature of the problem that we're addressing – so the interdisciplinary nature of health inequities and of our concern. Recently, The Lancet argued that without effective action, health inequities are likely to become one of the defining social injustices of the 21st century. So it's a pressing problem, and understanding it and responding to it requires an interdisciplinary approach. And this is a question to each of you. What are the problems and the limitations of such an interdisciplinary project? So who's going to take my difficult question?

I can go first and suggest – I'll go with an example recently. I suppose coming back to the point I was just making a minute ago, there needs to be a lot more cross-sectoral leadership and integration to address these problems. No singular area or sector can address it independently, and that, again, is scaled up to a global context. It needs everyone to be playing in the field and addressing the issue for it to be addressed.

A good example of that – but the challenges that we face in this area are that the challenges, as was said previously, are not equally – the impacts on our health are not equally distributed. So, for example, recently in the SPHERE, Sydney Partnership for Health, Education, Research and Enterprise, in the platform, there's many different projects that have been starting to focus on these areas. And one which I thought was an interesting reference in this case is one which was led by Fiona Hague, which was developing a climate change inequality health impact assessment for health services.

And, for example, what we need to do is we need to be looking at the relationship between particular environments, particular environmental contexts, populations and health effects, and actually we need to be working at locally but thinking globally simultaneously.

But we cannot address these challenges without actually having the appropriate tools. And I think things like health impact assessments, which are carried out by local health districts on climate impacts, is a valuable starting point for these sorts of things. So we need to have the appropriate tools to do that and to address those challenges. If we look at something like local health districts just in New South Wales in Australia, they're all very diverse. Sydney has several local health districts, and they have various populations that really need to be understood, and how they will be affected, and then have that impact assessed. So that's what I would say.

Michael, I'll go next. I think the international trade has shifted how local agriculture in many countries to the point where it weakens – farmers can't compete with cheap imports, for example. So many countries have become import dependent, and you have powerful countries and corporations that really control international trade. And this is very particular for food, particularly for staples of all types of food. That really influences the affordability, accessibility, availability of food. And what is really wicked about instant noodles is that it's so tasty, it's so cheap, and so accessible. And the flavours of the sachets have been modified to target the audience, the consumers. And that association, that cultural association with the food, makes it really difficult for right to food, right to nutrition, right to health, from advocacy from that area. Because it's very difficult to peel away from what people are associated with. And I think that's the area, I think, where instant noodles is highlighting the issue that the global food system is actually a determinant of health.

Thank you very much, Elna.

Yeah, a few takes on the question, Michael. So within a – to me, a kind of an interdisciplinary, and then a kind of intersectoral response, but an interdisciplinary response, and just sort of reflecting on many years of trying to do that type of work. So there's a real – so there's a hierarchy of disciplines, there's a hierarchy of evidence, there's a hierarchy of – yeah, I'll just stick with those two hierarchies. And so that means that there's particular types of evidence from particular types of disciplines that gets privileged in this discussion.

I've said publicly before, and I'll say it again, this is not an epidemiological problem to be solved by epidemiological data. This is a political problem to be solved by social science data. But even that remark is, I think, insufficient. I think it's a combination of all of the above. But the privileging of certain types of knowledge into addressing this problem of climate change and health as the biggest 21st century challenge, that's one of the problems that I see of real interdisciplinary work.

The intersectoral nature of it – so I'm sometimes torn between, imagine, you know, Jason, you were speaking about the planners or the lawyers, imagine planners doing planning really well. And then there's the question of what does well mean? But, you know, planners doing planning really well would have all sorts of positive implications for health and the environment. But that's, you know, that's within the sector of planning. That, of course, doesn't happen all the time, and it certainly doesn't happen across other sectors.

And the challenge, I think, is when the sectoral goals are so diametrically opposed. So we've done a lot of work on trade and health, and really the goals are, you know, the work with the food systems and trade, you know, it's often so diametrically opposed that you don't get that comfort of knowing that if a sector does what it's doing, what it does really well, you'll get these positive benefits as well. So what is that? I don't entirely know what that means.

And then the third thing that I would say is we've got to stop focusing on just the problem; stop describing the problem, researching the problem, explaining the problem. What I would love us to see more, certainly within the academy, is understanding what it is that enables the change to happen. We know that for decades we've known these health inequities exist. We've known what drives these health inequities. Yes, we can get much finer resolution, absolutely, but we kind of know these drivers. Let's stop researching these drivers.

Let's understand. My final remark is interdisciplinary work, I don't think is problematic. I think we just do it. I don't take the premise of the question. What's the problem or the challenges with it? It's just let's just do it, in the same way that doing any kind of sectoral work or disciplinary work has got strengths and weaknesses, challenges inherent to it as well.

Thank you very much and thank you to everyone for those answers.

Sharon, I'm just going to stick with you for another question. So the Planetary Health Equity Hothouse has been up and running now for, I think, just over a year, perhaps.

Al