The 2023 report of the MJA-Lancet Countdown on health and climate change: sustainability needed in Australia's health care sector.

The MJA-Lancet Countdown on health and climate change in Australia was established in 2017 and produced its first national assessment in 2018 and annual updates in 2019, 2020, 2021 and 2022. It examines five broad domains: health hazards, exposures and impacts; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. In this, the sixth report of the MJA-Lancet Countdown, we track progress on an extensive suite of indicators across these five domains, accessing and presenting the latest data and further refining and developing our analyses. Our results highlight the health and economic costs of inaction on health and climate change. A series of major flood events across the four eastern states of Australia in 2022 was the main contributor to insured losses from climate-related catastrophes of $7.168 billion - the highest amount on record. The floods also directly caused 23 deaths and resulted in the displacement of tens of thousands of people. High red meat and processed meat consumption and insufficient consumption of fruit and vegetables accounted for about half of the 87 166 diet-related deaths in Australia in 2021. Correction of this imbalance would both save lives and reduce the heavy carbon footprint associated with meat production. We find signs of progress on health and climate change. Importantly, the Australian Government released Australia's first National Health and Climate Strategy, and the Government of Western Australia is preparing a Health Sector Adaptation Plan. We also find increasing action on, and engagement with, health and climate change at a community level, with the number of electric vehicle sales almost doubling in 2022 compared with 2021, and with a 65% increase in coverage of health and climate change in the media in 2022 compared with 2021. Overall, the urgency of substantial enhancements in Australia's mitigation and adaptation responses to the enormous health and climate change challenge cannot be overstated. Australia's energy system, and its health care sector, currently emit an unreasonable and unjust proportion of greenhouse gases into the atmosphere. As the Lancet Countdown enters its second and most critical phase in the leadup to 2030, the depth and breadth of our assessment of health and climate change will be augmented to increasingly examine Australia in its regional context, and to better measure and track key issues in Australia such as mental health and Aboriginal and Torres Strait Islander health and wellbeing.

Nutritional, environmental and economic impacts of ultra-processed food consumption in Australia.

OBJECTIVE: To quantify the full life cycle impacts of ultra-processed foods (UPF) for key environmental, economic and nutritional indicators to identify trade-offs between UPF contribution to broad-scope sustainability. DESIGN: Using 24-h dietary recalls along with an input-output database for the Australian economy, dietary environmental and economic impacts were quantified in this national representative cross-sectional analysis. Food items were classified into non-UPF and UPF using the NOVA system, and dietary energy contribution from non-UPF and UPF fractions in diets was estimated. Thereafter, associations between nutritional, environmental and economic impacts of non-UPF and UPF fractions of diets were examined using a multi-dimensional nutritional geometry representation. SETTING: National Nutrition and Physical Activity Survey 2011-2012 of Australia. PARTICIPANTS: Respondents (n 5344) aged > 18 years with 1 d of 24-h dietary recall data excluding respondents with missing values and outlier data points and under reporters. RESULTS: Australian diets rich in UPF were associated with reduced nutritional quality, high greenhouse gas emissions, energy use, and increased employment and income associated with the food supply chains. The environmental and economic impacts associated with the UPF portion of diets become more distinct when the diets are standardised to average protein recommendation. CONCLUSION: Increased consumption of UPF has socio-economic benefits, but this comes with adverse effects on the environment and public health. Consideration of such trade-offs is important in identifying policy and other mechanisms regarding UPF for establishing healthy and sustainable food systems.

Physical and virtual nutrient flows in global telecoupled agricultural trade networks.

Global agricultural trade creates multiple telecoupled flows of nitrogen (N) and phosphorus (P). The flows of physical and virtual nutrients along with trade have discrepant effects on natural resources in different countries. However, existing literature has not quantified or analyzed such effects yet. Here we quantified the physical and virtual N and P flows embedded in the global agricultural trade networks from 1997 to 2016 and elaborated components of the telecoupling framework. The N and P flows both increased continuously and more than 25% of global consumption of nutrients in agricultural products were related to physical nutrient flows, while virtual nutrient flows were equivalent to one-third of the nutrients inputs into global agricultural system. These flows have positive telecoupling effects on saving N and P resources at the global scale. Reducing inefficient trade flows will enhance resource conservation, environmental sustainability in the hyper-globalized world.

Nutrient-sensitive approach for sustainability assessment of Australian macronutrient dietary recommendations.

BACKGROUND: Dietary guidelines that form the basis for food and nutrition policies in most countries are focused mainly on the social dimensions of health. Efforts are needed to incorporate environmental and economic sustainability. As the dietary guidelines are formulated based on nutrition principles, understanding the sustainability of dietary guidelines in relation to nutrients could support the better incorporation of environmental and economic sustainability aspects into dietary guidelines. OBJECTIVES: This study examines and demonstrates the potential of integrating an input-output analysis with nutritional geometry to assess the sustainability of the Australian macronutrient dietary guidelines (AMDR) relating to macronutrients. METHODS: We used daily dietary intake data of 5345 Australian adults from the most recent Australian Nutrient and Physical Activity Survey 2011-2012 and an input-output database for the Australian economy to quantify the environmental and economic impacts associated with dietary intake. Then, we examined the associations between environmental and economic impacts and dietary macronutrient composition using a multidimensional nutritional geometry representation. Thereafter, we assessed the sustainability of the AMDR regarding its alignment with key environmental and economic outcomes. RESULTS: We found that diets adhering to the AMDR were associated with moderately high greenhouse gas emissions, water use, cost of dietary energy, and the contribution to wages and salaries of Australians. However, only about 20.42% of respondents adhered to the AMDR. Furthermore, high-plant protein diets adhering to the lower limit of recommended protein intake in the AMDR were associated with low environmental impacts and high incomes. CONCLUSIONS: We conclude that encouraging consumers to adhere to the lower limit of the recommended intake of proteins and meeting the protein requirement through protein-dense plant sources could improve dietary environmental and economic sustainability in Australia. Our findings provide a means of understanding the sustainability of dietary recommendations concerning macronutrients for any country where input-output databases are available.

Global Embodied Energy Flow and Stock Analysis with Endogeneous Fixed Capital.

Fixed capital stock functions as an embodied energy storage system that connects economic activities which do not happen simultaneously. This paper constructs a dynamic energy input-output model to analyze embodied energy flows and stocks along both temporal and spatial dimensions from 2000 to 2014. The results show that 2043 exajoule of embodied energy was stored in the global fixed capital stock in 2014, which was about three times the world's direct energy use. Compared with those in developed countries, the gaps between the dynamic energy footprints and the traditional ones were larger in fast-developing countries. Net embodied energy usually flowed from high-intensity economies to lower-intensity economies, and around 10% of the energy embodied in trade came from depreciation. The dynamic embodied energy indicators provide information for improving energy efficiency and mitigating corresponding problems from the perspective of consumption.

The 2022 report of the MJA-Lancet Countdown on health and climate change: Australia unprepared and paying the price.

The MJA-Lancet Countdown on health and climate change in Australia was established in 2017 and produced its first national assessment in 2018 and annual updates in 2019, 2020 and 2021. It examines five broad domains: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. In this, the fifth year of the MJA-Lancet Countdown, we track progress on an extensive suite of indicators across these five domains, accessing and presenting the latest data and further refining and developing our analyses. Within just two years, Australia has experienced two unprecedented national catastrophes - the 2019-2020 summer heatwaves and bushfires and the 2021-2022 torrential rains and flooding. Such events are costing lives and displacing tens of thousands of people. Further, our analysis shows that there are clear signs that Australia's health emergency management capacity substantially decreased in 2021. We find some signs of progress with respect to health and climate change. The states continue to lead the way in health and climate change adaptation planning, with the Victorian plan being published in early 2022. At the national level, we note progress in health and climate change research funding by the National Health and Medical Research Council. We now also see an acceleration in the uptake of electric vehicles and continued uptake of and employment in renewable energy. However, we also find Australia's transition to renewables and zero carbon remains unacceptably slow, and the Australian Government's continuing failure to produce a national climate change and health adaptation plan places the health and lives of Australians at unnecessary risk today, which does not bode well for the future.

Carbon Emissions of the Tourism Telecoupling System: Theoretical Framework, Model Specification and Synthesis Effects.

The flows of people and material attributed to international tourism exert a major impact on the global environment. Tourism carbon emissions is the main indicator in this context. However, previous studies focused on estimating the emissions of destinations, ignoring the embodied emissions in tourists' origins and other areas. This study provides a comprehensive framework of a tourism telecoupling system. Taking China's international tourism as an example, we estimate the carbon emissions of its tourism telecoupling system based on the Tourism Satellite Account and input-output model. We find that (1) the proposal of a tourism telecoupling system provides a new perspective for analyzing the carbon emissions of a tourism system. The sending system (origins) and indirect spillover system (resource suppliers) have been ignored in previous studies. (2) In the telecoupling system of China's international tourism, the emission reduction effect of the sending system is significant. (3) The direct spillover system (transit) and indirect spillover system's spatial transfer effects of environment responsibility are remarkable. (4) There is a large carbon trade implied in international tourism. This study makes us pay attention to the carbon emissions of tourists' origins and the implied carbon trading in tourism flows.

The potential for indoor fans to change air conditioning use while maintaining human thermal comfort during hot weather: an analysis of energy demand and associated greenhouse gas emissions.

BACKGROUND: Increasing air conditioner use for cooling indoor spaces has the potential to be a primary driver of global greenhouse gas emissions. Moving indoor air with residential fans can raise the temperature threshold at which air conditioning needs to be turned on to maintain the thermal comfort of building occupants. We investigate whether fans can be used to reduce air conditioner use and associated greenhouse gas emissions. METHODS: We developed an integrated framework, featuring a dynamic adaptive thermal comfort model with a geographical information system-based spatially gridded map of Australia, further complemented with census data. We assessed the change in energy use and associated greenhouse gas emissions for five scenarios of air conditioner and fan use: an air conditioner-only scenario (no fans); and four fan-first scenarios with fans operating at speeds of 0·1 m/s, 0·3 m/s, 0·8 m/s, and 1·2 m/s, with air conditioning used only once the upper temperature threshold for thermal discomfort is exceeded. For each day of the selected case study year, we estimated the upper temperature limit for thermal comfort and the number of hours in which air conditioning would be switched on. FINDINGS: The thermal comfort threshold was increased by the use of fans compared with air conditioner use alone. We found that widespread indoor fan use had the potential to reduce energy demand and greenhouse gas emissions attributable to air conditioner use, without compromising thermal comfort. Taking an annual perspective, the use of fans with air speeds of 1·2 m/s compared with air conditioner use alone resulted in a 76% reduction in energy use (from 5592 GWh to 1344 GWh) and associated greenhouse gas emissions (5091 kilotonnes to 1208 kilotonnes). INTERPRETATION: A common strategy to cope with hot weather is the use of air conditioners, which feed a cycle of high electricity consumption, often delivered by fossil fuel power stations that in turn contribute to further increases in emissions. Moving air with electric fans could serve as a sustainable alternative, reducing air conditioner use and associated greenhouse gas emissions without sacrificing thermal comfort. FUNDING: Australian Research Council, New South Wales Department of Planning, Industry and Environment, and The University of Sydney.

Nutrient-sensitive approach for sustainability assessment of different dietary patterns in Australia.

BACKGROUND: Understanding the relation between sustainability and nutrients is important in devising healthy and sustainable diets. However, there are no prevailing methodologies to assess sustainability at the nutrient level. OBJECTIVES: The aim was to examine and demonstrate the potential of integrating input-output analysis with nutritional geometry to link environmental, economic, and health associations of dietary scenarios in Australia with macronutrients. METHODS: One-day dietary recalls of 9341 adult respondents (age ≥18 y) of the latest available cross-sectional National Nutrition and Physical Activity Survey-2011/12 of Australia were integrated with the input-output data obtained from the Australian Industrial Ecology Virtual Laboratory to calculate the environmental and economic impacts of dietary intakes in Australia. Australian adults' dietary intakes were classified into 3 dietary scenarios: "vegan," "pescatarian," and "omnivorous." Then, the relations between nutritional, economic, and environmental characteristics of the 3 dietary scenarios were demonstrated with the diets' macronutrient composition in a multidimensional nutritional geometry representation to link the sustainability indicators with macronutrients. RESULTS: Nutrient density and economic and environmental indicators increased as the percentage of energy from proteins increased and decreased as the percentage of energy from fats increased for the 3 dietary scenarios, except for the nutrient density and water use of the "vegan" dietary scenario. Energy density increased as the percentage of energy from fats increased and decreased as the percentage of energy from proteins increased for "pescatarian" and "omnivorous" dietary scenarios. In the "vegan" dietary scenario, nutrient density and water use increased as the percentage of energy from proteins increased; however, these decreased as the percentage of energy from carbohydrates increased, instead of fats. CONCLUSIONS: The study presents a new approach to analyzing the relations between sustainability indicators, foods, and macronutrients and establishes that proteins, irrespective of the source of protein, are driving dietary environmental and economic impacts.

Global food-miles account for nearly 20% of total food-systems emissions.

Food trade plays a key role in achieving global food security. With a growing consumer demand for diverse food products, transportation has emerged as a key link in food supply chains. We estimate the carbon footprint of food-miles by using a global multi-region accounting framework. We calculate food-miles based on the countries and sectors of origin and the destination countries, and distinguish the relevant international and domestic transport distances and commodity masses. When the entire upstream food supply chain is considered, global food-miles correspond to about 3.0 GtCO2e (3.5-7.5 times higher than previously estimated), indicating that transport accounts for about 19% of total food-system emissions (stemming from transport, production and land-use change). Global freight transport associated with vegetable and fruit consumption contributes 36% of food-miles emissions-almost twice the amount of greenhouse gases released during their production. To mitigate the environmental impact of food, a shift towards plant-based foods must be coupled with more locally produced items, mainly in affluent countries.

Impacts of climate change and extreme weather on food supply chains cascade across sectors and regions in Australia.

Disasters resulting from climate change and extreme weather events adversely impact crop and livestock production. While the direct impacts of these events on productivity are generally well known, the indirect supply-chain repercussions (spillovers) are still unclear. Here, applying an integrated modelling framework that considers economic and physical factors, we estimate spillovers in terms of social impacts (for example, loss of job and income) and health impacts (for example, nutrient availability and diet quality) resulting from disruptions in food supply chains, which cascade across regions and sectors. Our results demonstrate that post-disaster impacts are wide-ranging and diverse owing to the interconnected nature of supply chains. We find that fruit, vegetable and livestock sectors are the most affected, with effects flowing on to other non-food production sectors such as transport services. The ability to cope with disasters is determined by socio-demographic characteristics, with communities in rural areas being most affected.

The 2021 report of the MJA-Lancet Countdown on health and climate change: Australia increasingly out on a limb.

The MJA-Lancet Countdown on health and climate change in Australia was established in 2017, and produced its first national assessment in 2018, its first annual update in 2019, and its second annual update in 2020. It examines indicators across five broad domains: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. Our special report in 2020 focused on the unprecedented and catastrophic 2019-20 Australian bushfire season, highlighting indicators that explore the relationships between health, climate change and bushfires. For 2021, we return to reporting on the full suite of indicators across each of the five domains and have added some new indicators. We find that Australians are increasingly exposed to and vulnerable to excess heat and that this is already limiting our way of life, increasing the risk of heat stress during outdoor sports, and decreasing work productivity across a range of sectors. Other weather extremes are also on the rise, resulting in escalating social, economic and health impacts. Climate change disproportionately threatens Indigenous Australians' wellbeing in multiple and complex ways. In response to these threats, we find positive action at the individual, local, state and territory levels, with growing uptake of rooftop solar and electric vehicles, and the beginnings of appropriate adaptation planning. However, this is severely undermined by national policies and actions that are contrary and increasingly place Australia out on a limb. Australia has responded well to the COVID-19 public health crisis (while still emerging from the bushfire crisis that preceded it) and it now needs to respond to and prepare for the health crises resulting from climate change.

Hot weather and heat extremes: health risks.

Hot ambient conditions and associated heat stress can increase mortality and morbidity, as well as increase adverse pregnancy outcomes and negatively affect mental health. High heat stress can also reduce physical work capacity and motor-cognitive performances, with consequences for productivity, and increase the risk of occupational health problems. Almost half of the global population and more than 1 billion workers are exposed to high heat episodes and about a third of all exposed workers have negative health effects. However, excess deaths and many heat-related health risks are preventable, with appropriate heat action plans involving behavioural strategies and biophysical solutions. Extreme heat events are becoming permanent features of summer seasons worldwide, causing many excess deaths. Heat-related morbidity and mortality are projected to increase further as climate change progresses, with greater risk associated with higher degrees of global warming. Particularly in tropical regions, increased warming might mean that physiological limits related to heat tolerance (survival) will be reached regularly and more often in coming decades. Climate change is interacting with other trends, such as population growth and ageing, urbanisation, and socioeconomic development, that can either exacerbate or ameliorate heat-related hazards. Urban temperatures are further enhanced by anthropogenic heat from vehicular transport and heat waste from buildings. Although there is some evidence of adaptation to increasing temperatures in high-income countries, projections of a hotter future suggest that without investment in research and risk management actions, heat-related morbidity and mortality are likely to increase.

Reducing the health effects of hot weather and heat extremes: from personal cooling strategies to green cities.

Heat extremes (ie, heatwaves) already have a serious impact on human health, with ageing, poverty, and chronic illnesses as aggravating factors. As the global community seeks to contend with even hotter weather in the future as a consequence of global climate change, there is a pressing need to better understand the most effective prevention and response measures that can be implemented, particularly in low-resource settings. In this Series paper, we describe how a future reliance on air conditioning is unsustainable and further marginalises the communities most vulnerable to the heat. We then show that a more holistic understanding of the thermal environment at the landscape and urban, building, and individual scales supports the identification of numerous sustainable opportunities to keep people cooler. We summarise the benefits (eg, effectiveness) and limitations of each identified cooling strategy, and recommend optimal interventions for settings such as aged care homes, slums, workplaces, mass gatherings, refugee camps, and playing sport. The integration of this information into well communicated heat action plans with robust surveillance and monitoring is essential for reducing the adverse health consequences of current and future extreme heat.

International spillover effects in the EU's textile supply chains: A global SDG assessment.

Successful implementation of the Sustainable Development Goals (SDGs) requires world countries to account for actions that inadvertently generate negative impacts on other countries. These actions/effects are called 'spillovers', and can hinder a country's SDG progress. In this work, we analyse negative social spillover effects, focussing specifically on the occupational health and safety aspects of workers in textile supply chains. We select two indicators: fatal accidents and non-fatal accidents that take place in global supply chains for satisfying consumption of textile products (such as clothing, leather products) by European Union (EU) countries. Specifically, we scan global supply chains originating in countries outside of EU for meeting the demands of its citizens. To this end, we employ a well-established technique of multi-regional input-output analysis, featuring information on 15,000 sectors for 189 countries, to scan international supply chain routes that are linked to consumption of textile products by EU countries. Our findings suggest that Italy, Germany, France, Spain, Poland, Belgium and Portugal are collectively responsible for about 80% of both fatal- and non-fatal accidents that are attributed to the EU's consumption-based footprint. These findings not only call for a need for coherent SDG policies that consider spillover effects, but also the need for these effects to be included in EU's strategic instruments and policy-related tools.

Impact on carbon emissions of online study for a cohort of overseas students: A retrospective cohort study.

Background: One of the benefits of online education is the potential reduction in carbon emissions through the decrease in travel to attend a university in person. We estimated the savings in CO 2 emissions of an international cohort of master's students who studied fully online from their home countries, rather than travelling to the UK and living there while attending university. Methods: The city and country of residence of a cohort of students who first enrolled in the fully online Peoples-uni/Manchester Metropolitan University Master of Public Health programme between the second semester of 2011 and the first semester 2013 were recorded. Total difference in emissions was calculated by adding the estimated aviation emissions between Manchester, UK and the cities where students resided, to the difference in per capita emissions between the country of origin and the UK for the time that the student would have spent in Manchester, based on the semester in which they first enrolled. Results: 128 students enrolled from 70 cities in 30 countries. 93 students were from a range of African countries and 18 from the Indian sub-continent. Flights to and from Manchester were estimated to have accounted for 114,553kg of CO 2 and living in Manchester for the duration of their course compared with staying in the home country would have been equivalent to 854,904kg of CO 2. The combined net savings was 969,457kg of CO 2. Conclusions: A small cohort of overseas students, largely from Africa and India, studied online rather than attending university in the UK. The likely saving by this small cohort of nearly a million kg of CO 2 emissions offers an indication of the potential environmental benefits of offering university education online to overseas students.