From science to policy: Development of a climate change adaptation plan for the health and wellbeing sector in Queensland, Australia

Highlights

• We present a multi-disciplinary collaborative approach for developing a regional scale climate adaptation plan with the health and wellbeing sector.

• This includes an innovative engagement and policy mapping strategy.

• We demonstrate the application of this approach for developing climate change adaptation plan for health and wellbeing sector in Queensland, Australia.

• We find that direct engagement between various key stakeholders is a critical element of translating scientific evidence of climate change impacts on human health into a regional adaptation policy for the health and wellbeing sector.

Abstract

The science of climate change and its impacts on health makes it clear that human health and wellbeing will be increasingly negatively impacted as a result of climate change. The health and wellbeing sector must respond to these growing pressures in order to continue to provide safe, quality care. Adaptation and mitigation policies need to be developed at different scales, including at a regional government level. Numerous challenges exist; for example, the necessity for collaboration between multiple agencies across scales, the tailoring of policies to the health issues specific to regions, and constraints on existing regional and local resources and adaptive capacities, to name a few.

This paper presents a multi-disciplinary collaborative approach used to develop a regional scale climate adaptation plan with the health sector. Starting from a scientific understanding of climate change impact on the health sector in Queensland, Australia, the approach used an innovative engagement strategy to a) better understand awareness of relevant stakeholders about current and future climate change impact on the health of the population and on service provision, b) identify on-ground barriers to effective adaptation faced by the sector stakeholders, c) identify opportunities and benefits which would arise from adaptation, and d) identify what conditions or support stakeholders required to overcome those barriers, take advantage of opportunities, and achieve benefits from adaptation. Analysis of these findings guided the development of specific policy directions for the sector.

We found direct engagement between various key stakeholders such as health service providers (e.g. hospitals), critical infrastructure providers, academics, local government authorities, and sub-sectors such as aged care and early childhood care facilities, was a critical element of translating scientific evidence of climate change impacts on human health into a regional adaptation policy for the health and wellbeing sector. The resulting policy, grounded in the reality and experience of health and wellbeing sector stakeholders, reflects their insights and concerns, and served to develop a level of sectoral ‘ownership’ (not ‘top-down’ imposition) which will be important for its successful ongoing development and implementation.

Introduction

Climate change is already exacerbating existing public health challenges and will continue to affect human health and wellbeing over coming decades (Watts et al., 2018). Climate change impacts on human health and wellbeing are direct, such as morbidity and mortality resulting from increased frequency and intensity of extreme events such as heatwaves, violent storms, droughts, floods, cyclones etc. as well as indirect, such as deteriorating air quality, a range of insect-, food- and waterborne diseases, risks to food and water supply and the mental stress these risks brings (Sheehan et al., 2017; IPCC, 2014; Watts et al., 2015). In addition, climate change is affecting the infrastructure required to ensure health and wellbeing of our communities (Loosemore et al., 2011), and the capacity of the emergency services that play a critical role in supporting communities and healthcare services during extreme events (Loosemore et al., 2013; Tonmoy et al., 2019).

Although some degree of effort has been made to reduce global emissions and mitigate effects of climate change, a certain degree of change is locked into the climate system given the long life span of carbon dioxide in the atmosphere (IPCC, 2018), therefore adaptation of our health and wellbeing sector to future climate change is critical (Portier et al., 2017; Patz et al., 2014; McMichael et al., 2006).

Health impacts of climate change are most often felt at a local scale (e.g. individual and community health, wellbeing and living conditions are affected), therefore adaptation is often seen as the responsibility of ‘local authorities’ such as hospitals, aged care facilities etc. (Austin et al., 2019). Recent legal opinion in Australia by Hutley and Davis (2016) suggested that directors of a company (e.g. private hospital, private aged care facility) can be personally held liable in court if they fail to take steps in relation to a foreseeable climate-related risk that causes harm to the company. However, individual organisations within this sector often do not have sufficient resources or in-house knowledge to understand the risks of climate change, and to plan and implement climate change adaptation options. Organisations within the health sector are often ‘stretched’, dealing with existing priorities and challenges, and do not plan for the longer term (Nalau et al., 2015; Roser-Renouf et al., 2016). Therefore guidance and policy direction is required from higher levels of government (regional/state or federal) (Austin et al., 2018).

The health and wellbeing sector as defined by the Queensland Government in relation to the adaptation planning process described in this paper included services focused on the health and wellbeing of the community such as hospitals, primary healthcare, public and community health, aged care, early childhood education and care (hereafter called childcare), mental health, disability and other support services.

Development of regional scale policy for the health and wellbeing sector is challenged by factors such as being applicable to a diverse group of organisations and stakeholders (public and private) with varying levels of access to, and awareness of scientific information on how climate change will impact on their organisations, or awareness of litigation risk arising from failing to taking climate risk into consideration. There is low awareness of available adaptation options and their costs or benefits. This challenge is exacerbated by the multidisciplinary nature of actors in the health and wellbeing sector and also by its interdependency with other sectors and services (e.g. critical infrastructure such as power supply, water supply, transportation to support day to day activities of hospitals and other health-care settings, the emergency management sector etc.). Therefore, policy-makers must engage with these diverse organisations and interdependent sectors stakeholders to better understand their awareness of relevant climate change information, interdependencies and barriers to adaptation planning. Information gathered through such engagement can help governments develop locally relevant and specific policy directions. However, the absence of any lead agency at the federal level to ensure there is national coordination of health sector adaptation policies is a problem for Australia and a policy gap in many countries (Huang et al., 2011).

A number of efforts have been made to understand climate change impacts on the health sector (e.g. Portier et al. 2017; Confalonieri et al., 2015; McMichael et al., 2006), barriers and opportunities of adaptation for the health sector (e.g. Huang et al., 2011; Austin et al., 2019; Paterson et al., 2012; Austin et al., 2018), and reporting on adaptation progress of local scale public health organisations (e.g. Lisa Brown, 2016; Sheehan et al., 2017; Roser-Renouf et al., 2016). However, development of regional scale government policy for the health and wellbeing sector through stakeholder engagement has been very limited. Among very few examples, A Framework for a National Strategy on Climate, Health and Well-being for Australia was published by the Climate and Health Alliance (CAHA) in 2017 based on consultation with a range of health and wellbeing stakeholders at a national level (Horsburgh et al., 2017). Hess et al. (2014) discussed public health adaptation planning at the federal government level in the United States mainly focusing on identifying climate sensitive operations of the US health sector. Austin et al. (2015) investigated public health sector adaptation across different levels of governments (Federal to Local) in Canada and concluded that apart from Quebec, other states are in their infancy in terms of developing adaptation policy for the public health sector.

In this paper, we demonstrate an innovative engagement process used to develop climate change adaptation policy with the health and wellbeing sector of the State of Queensland, Australia. We overview current understanding of climate change impacts on the health and wellbeing sector in Queensland, and outline:

• the process followed to develop policy directions;

• outcomes of the engagement process including policy directions developed by analysing and mapping major themes from the stakeholder findings; and

• broader implications of our findings for adaptation planning by the health and wellbeing sector.