Paul J Beggs’s research while affiliated with Macquarie University and other places

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, 2022 and 2023. 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 seventh 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. We also examine selected indicators of trends in health and climate change in New Zealand. Our analyses show the exposure to heatwaves is growing in Australia, increasing the risk of heat stress and other health threats such as bushfires and drought. Our analyses also highlight continuing deficiencies in Australia's response to the health and climate change threat. A key component of Australia's capacity to respond to bushfires, its number of firefighting volunteers, is in decline, dropping by 38 442 people (17%) in just seven years. Australia's total energy supply remains dominated by fossil fuels (coal, oil and natural gas), and although energy from coal decreased from 2021 to 2023, energy from oil increased, and transport energy from petrol grew substantially in 2021–22 (the most recent year for which data are available). Greenhouse gas emissions from Australia's health care sector in 2021 rose to their highest level since 2010. In other areas some progress is being made. The Australian Government completed the first pass of the National Climate Risk Assessment, which included health and social support as one of the eleven priority risks, based in part on the assessed severity of impact. Renewable sources such as wind and solar now provide almost 40% of Australia's electricity, with growth in both large‐scale and small‐scale (eg, household) renewable generation and battery storage systems. The sale of electric vehicles reached an all‐time high in 2023 of 98 436, accounting for 8.47% of all new vehicle sales. Although Australia had a reprieve from major catastrophic climate events in 2023, New Zealand experienced cyclone Gabrielle and unprecedented floods, which contributed to the highest displacement of people and insured economic losses over the period of our analyses (ie, since the year 2010 and 2000 respectively). Nationally, regionally and globally, the next five years are pivotal in reducing greenhouse gas emissions and transitioning energy production to renewables. Australia is now making progress in this direction. This progress must continue and accelerate, and the remaining deficiencies in Australia's response to the health and climate change threat must be addressed. There are strong signs that Australians are increasingly engaged and acting on health and climate change, and our new indicator on health and climate change litigation in Australia demonstrates the legal system is active on this issue in this country. Our 2022 and 2023 reports signalled our intentions to introduce indicators on Aboriginal and Torres Strait Islander health and climate change, and mental health and climate change in Australia. Although the development of appropriate indicators is challenging, these are key areas and we expect our reporting on them will commence in our next report.

A major bushfire occurred during January 2013 near the towns Forcett and Dunalley in southeast Tasmania, Australia. Several records were broken by this wildfire, in terms of impacts to eco-systems, infrastructure and lives, and it was the first pyrocumulonimbus documented in Tasmania. The Australian Bureau of Meteorology high-resolution regional reanalysis for Tasmania (BARRA-TA), with 1.5-km spatial resolution, together with in-situ observations, was applied to reconstruct the wildfire event. The antecedent climatic conditions in Tasmania included a large increase in fuel load due to abundant rain one to two years before the event, followed by a heatwave during the summer of 2012/13. In the three periods we identified during the event reconstruction, the second period was the most dramatic, in which a low-level jet was directed downslope in southeast Tasmania to accelerate the fire spread. The BARRA-TA reanalysis revealed the mesoscale features occurring during the fire event additional to the climatic conditions and synoptic patterns documented in past studies. These include a cold front that crossed the fireground during the third period, and thus played a different role compared with some past extreme fire events in terms of airmass lifting and wind direction change. Moreover, mid-level moisture advected into the area was conducive to pyroconvection development.

Background Globally, many pollen monitoring networks provide the community with daily pollen information, but there are limited data on health consumer uses and benefits. This research investigated why individuals in the community access pollen information, how they use it, and the perceived benefits. Methods In‐ and post‐pollen season surveys (2017–2018 and 2018–2019) enquired about symptoms, diagnoses, symptom management, access, benefits and usefulness of pollen information provided by the AusPollen Partnership. Open text responses were examined by thematic analysis. Theme frequency and quantitative data were compared across pollen seasons, within and after the season, and between respondents with and without access to AusPollen information. Results Surveys were completed 4044 times by 3604 individuals who predominantly self‐reported severe and frequent allergic rhinitis symptoms. Local AusPollen information was accessible to 84.6% of participants, and was reportedly used for preparation and planning (34.6%), guiding activities (32.9%), and medication decisions (28.2%). When asked how pollen information helped, similar themes were evident; but 16.1% also mentioned safety for themselves and others. However, secondary analysis of survey responses indicated that self‐reported medication use did not differ between those with or without access to pollen information or between time points surveyed. Suggestions for improvement included extended duration (16.4%), wider geographic range (13.5%), and information on other taxa (17.2%). Conclusion There was a perceived need for localised, detailed and timely pollen information by people with pollen allergy. Whilst responses suggested this helped inform behaviours linked to allergen avoidance, further education strategies on allergic rhinitis control are needed to support patients who self‐manage their condition.

Given the significant role climate plays in phenology the chapter gives an overview of each country’s climate. It provides details on citizen science—historical and current, horticulture, pollen, phenocams, and land surface phenology. The chapter highlights that with the use of alternative data sources such as government records, naturalist diaries and newspapers there is a rich data source available. Access to, and collation of, these records is fundamental to detect phenological trends and to project future changes. However, these are in hard-copy form and making them accessible will require a major investment from government.

Aerobiology is the study of organic particles such as bacteria, fungal spores, pollen grains, and viruses, which are passively transported by the air. An important aspect of aerobiology is the timing of the presence of these organic particles in the atmosphere. Focusing on airborne pollen, this chapter explores aerobiological monitoring, data, and networks, climate and weather as drivers of spatial and temporal variations in airborne pollen, the pollen season, the utility of modeling and remote sensing in understanding and forecasting airborne pollen, applications of airborne pollen phenology, and the impacts of climate change on pollen seasons. While each wind-pollinated plant taxa typically releases its pollen into the atmosphere at a particular time each year, there can be significant interannual variability in this timing, and climate change is causing long-term changes in the timing and often increases in the duration of the pollen season. Given the importance of airborne pollen phenology to both natural and human systems, including human health, recent advances in monitoring (automation), remote sensing, and modeling need to be accompanied by significant increases in the geographic coverage of monitoring around the world.

Background Contemporary airborne pollen records underpin environmental health warnings, yet how pollen monitoring networks are sustained is poorly understood. This study investigated by whom and how pollen monitoring sites across the globe are managed and funded. Methods Coordinators listed in the Worldwide Map of Pollen Monitoring Stations were invited to complete a digital questionnaire designed to survey the people and organisations involved, types, and duration of funding sources, as well as uses, purpose, and sharing of pollen information. Quantitative data were analysed by descriptive statistics and open text responses were examined by qualitative thematic analysis. Results Eighty-four of 241 (35%) coordinators from 37 countries responded. Universities (42%) and hospitals/health services (29%) were most commonly responsible for monitoring. Most sites involved employees (87%) in pollen monitoring, of whom many were part-time (41%) or casual (11%), as well as students (29%) and volunteers (6%). Pollen monitoring was additional to core duties for over one-third of sites (35%), and 25% reported pollen monitoring was an in-kind contribution. Whilst funding for pollen monitoring was often sourced from government agencies (33%), government research grants (24%), or non-government grants (8%), 92% reported more than 1 funding source, and 99% reported dependence on “partnerships or grants requiring co-contributions”, indicating a complex resourcing structure, of short duration (median 3 years). Common reasons why airborne pollen was monitored included clinical allergy, population environmental health, aerobiology and forecasting. Climate change, research, and social duty were also referenced. Conclusions Aerobiological monitoring is currently sustained by complex, insecure, and insufficient resourcing, as well as reliance on volunteerism. There are multiple direct, health-related, and other important uses of aerobiology data, that are aligned to multiple dimensions of sustainability. Evidence from this study can be used to inform the design of strategies to sustain the generation of aerobiology data.

Executive summary Despite the initial hope inspired by the 2015 Paris Agreement, the world is now dangerously close to breaching its target of limiting global multiyear mean heating to 1·5°C. Annual mean surface temperature reached a record high of 1·45°C above the pre-industrial baseline in 2023, and new temperature highs were recorded throughout 2024. The resulting climatic extremes are increasingly claiming lives and livelihoods worldwide. The Lancet Countdown: tracking progress on health and climate change was established the same year the Paris Agreement entered into force, to monitor the health impacts and opportunities of the world’s response to this landmark agreement. Supported through strategic core funding from Wellcome, the collaboration brings together over 300 multidisciplinary researchers and health professionals from around the world to take stock annually of the evolving links between health and climate change at global, regional, and national levels. The 2024 report of the Lancet Countdown, building on the expertise of 122 leading researchers from UN agencies and academic institutions worldwide, reveals the most concerning findings yet in the collaboration’s 8 years of monitoring. The record-breaking human costs of climate change Data in this year’s report show that people all around the world are facing record-breaking threats to their wellbeing, health, and survival from the rapidly changing climate. Of the 15 indicators monitoring climate change-related health hazards, exposures, and impacts, ten reached concerning new records in their most recent year of data. Heat-related mortality of people older than 65 years increased by a record-breaking 167%, compared with the 1990s, 102 percentage points higher than the 65% that would have been expected without temperature rise (indicator 1.1.5). Heat exposure is also increasingly affecting physical activity and sleep quality, in turn affecting physical and mental health. In 2023, heat exposure put people engaging in outdoor physical activity at risk of heat stress (moderate or higher) for a record high of 27·7% more hours than on average in the 1990s (indicator 1.1.2) and led to a record 6% more hours of sleep lost in 2023 than the average during 1986–2005 (indicator 1.1.4). People worldwide are also increasingly at risk from life-threatening extreme weather events. Between 1961–90 and 2014–23, 61% of the global land area saw an increase in the number of days of extreme precipitation (indicator 1.2.3), which in turn increases the risk of flooding, infectious disease spread, and water contamination. In parallel, 48% of the global land area was affected by at least 1 month of extreme drought in 2023, the second largest affected area since 1951 (indicator 1.2.2). The increase in drought and heatwave events since 1981–2010 was, in turn, associated with 151 million more people experiencing moderate or severe food insecurity across 124 countries assessed in 2022, the highest recorded value (indicator 1.4.2). The hotter and drier weather conditions are increasingly favouring the occurrence of sand and dust storms. This weather-environmental phenomenon contributed to a 31% increase in the number of people exposed to dangerously high particulate matter concentrations between 2003–07 and 2018–22 (indicator 1.2.4). Meanwhile, changing precipitation patterns and rising temperatures are favouring the transmission of deadly infectious diseases such as dengue, malaria, West Nile virus-related illness, and vibriosis, putting people at risk of transmission in previously unaffected locations (indicators 1.3.1–1.3.4). Compounding these impacts, climate change is affecting the social and economic conditions on which health and wellbeing depend. The average annual economic losses from weather-related extreme events increased by 23% from 2010–14 to 2019–23, to US$227 billion (a value exceeding the gross domestic product [GDP] of about 60$835 billion in potential income losses (indicators 1.1.3 and 4.1.3). Low and medium HDI countries were most affected by these losses, which amounted to 7·6% and 4·4% of their GDP, respectively (indicator 4.1.3). With the most underserved communities most affected, these economic impacts further reduce their capacity to cope with and recover from the growing impacts of climate change, thereby amplifying global inequities. Concerningly, multiple hazards revealed by individual indicators are likely to have simultaneous compounding and cascading impacts on the complex and inter-connected human systems that sustain good health, disproportionately threatening people’s health and survival with every fraction of a degree of increase in global mean temperature. Despite years of monitoring exposing the imminent health threats of climate inaction, the health risks people face have been exacerbated by years of delays in adaptation, which have left people ill-protected from the growing threats of climate change. Only 68% of countries reported high-to-very-high implementation of legally mandated health emergency management capacities in 2023, of which just 11% were low HDI countries (indicator 2.2.5). Moreover, only 35% of countries reported having health early warning systems for heat-related illness, whereas 10% did so for mental and psychosocial conditions (indicator 2.2.1). Scarcity of financial resources was identified as a key barrier to adaptation, including by 50% of the cities that reported they were not planning to undertake climate change and health risk assessments (indicator 2.1.3). Indeed, adaptation projects with potential health benefits represented just 27% of all the Green Climate Fund’s adaptation funding in 2023, despite a 137% increase since 2021 (indicator 2.2.4). With universal health coverage still unattained in most countries, financial support is needed to strengthen health systems and ensure that they can protect people from growing climate change-related health hazards. The unequal distribution of financial resources and technical capacity is leaving the most vulnerable populations further unprotected from the growing health risks. Fuelling the fire As well as exposing the inadequacy of adaptation efforts to date, this year’s report reveals a world veering away from the goal of limiting temperature rise to 1·5°C, with concerning new records broken across indicators monitoring greenhouse gas emissions and the conditions that enable them. Far from declining, global energy-related CO2 emissions reached an all-time high in 2023 (indicator 3.1.1). Oil and gas companies are reinforcing the global dependence on fossil fuels and—partly fuelled by the high energy prices and windfall profits of the global energy crisis—most are further expanding their fossil fuel production plans. As of March, 2024, the 114 largest oil and gas companies were on track to exceed emissions consistent with 1·5°C of heating by 189% in 2040, up from 173% 1 year before (indicator 4.2.2). As a result, their strategies are pushing the world further off track from meeting the goals of the Paris Agreement, further threatening people’s health and survival. Although renewable energy could provide power to remote locations, its adoption is lagging, particularly in the most vulnerable countries. The consequences of this delay reflect the human impacts of an unjust transition. Globally, 745 million people still lack access to electricity and are facing the harms of energy poverty on health and wellbeing. The burning of polluting biomass (eg, wood or dung) still accounts for 92% of the energy used in the home by people in low HDI countries (indicator 3.1.2), and only 2·3% of electricity in these countries comes from clean renewables, compared with 11·6% in very high HDI countries (indicators 3.1.1). This persistent burning of fossil fuel and biomass led to at least 3·33 million deaths from outdoor fine particulate matter (PM2·5) air pollution globally in 2021 alone (indicator 3.2.1), and the domestic use of dirty solid fuels caused 2·3 million deaths from indoor air pollution in 2020 across 65 countries analysed (indicator 3.2.2). Compounding the growth in energy-related greenhouse gas emissions, almost 182 million hectares of forests were lost between 2016 and 2022 (indicator 3.4), reducing the world’s natural capacity to capture atmospheric CO2. In parallel, the consumption of red meat and dairy products, which contributed to 11·2 million deaths attributable to unhealthy diets in 2021 (indicator 3.3.2), has led to a 2·9% increase in agricultural greenhouse gas emissions since 2016 (indicator 3.3.1). Health systems themselves, although essential to protect people’s health, are also increasingly contributing to the problem. Greenhouse gas emissions from health care have increased by 36% since 2016, making health systems increasingly unprepared to operate in a net zero emissions future and pushing health care further from its guiding principle of doing no harm (indicator 3.5). The growing accumulation of greenhouse gases in the atmosphere is pushing the world to a future of increasingly dangerous health hazards and reducing the chances of survival of vulnerable people all around the globe. Health-threatening financial flows With the availability of financial resources a key barrier to tackling climate change, a rapid growth in predictable and equitable investment is urgently needed to avoid the most dangerous impacts of climate change. A growing body of literature shows that the economic benefits of a transition to net zero greenhouse gas emissions will far exceed the costs of inaction. Healthier, more resilient populations will further support more prosperous and sustainable economies (indicators 4.1.2–4.1.4). However, although funding to enable potentially life-saving climate change adaptation and mitigation activities remains scarce, substantial financial resources are being allocated to activities that harm health and perpetuate a fossil fuel-based economy. The resulting reliance on fossil fuel energy has meant many countries faced sharp increases in energy prices following Russia’s invasion of Ukraine and the resulting disruption of fossil fuel supplies. To keep energy affordable to local populations, many governments resorted to increasing their explicit fossil fuel subsidies. Consequently, 84% of countries studied still operated net negative carbon prices (explicit net fossil fuel subsidies) in 2022, for a record high net total of $1·4 trillion (indicator 4.3.3), with the sums involved often comparable to countries’ total health budgets. In addition, although clean energy investment grew by 10The resulting expansion of fossil fuel assets is increasingly jeopardising the economies on which people’s livelihoods depend. On the current trajectory, the world already faces potential global income losses ranging from 11$164·5 billion—a value that will increase if coal investments persist (indicator 4.2.3). The prioritisation of fossil fuel-based systems means most countries remain ill-prepared for the vital transition to zero greenhouse gas emission economies. As a result of an unjust transition, the risk is unequally distributed: preparedness scores for the transition to a net zero greenhouse gas economy were below the global average in all countries with a low HDI, 96% of those with a medium HDI, and 84% of those with a high HDI, compared with just 7% of very high HDI countries (indicator 4.2.4). Defining the health profile of people worldwide Following decades of delays in climate change action, avoiding the most severe health impacts of climate change now requires aligned, structural, and sustained changes across most human systems, including energy, transportation, agriculture, food, and health care. Importantly, a global transformation of financial systems is required, shifting resources away from the fossil fuel-based economy towards a zero emissions future. Putting people’s health at the centre of climate change policy making is key to ensuring this transition protects wellbeing, reduces health inequities, and maximises health gains. Some indicators reveal incipient progress and important opportunities for delivering this health-centred transformation. As of December, 2023, 50 countries reported having formally assessed their health vulnerabilities and adaptation needs, up from 11 the previous year, and the number of countries that reported having a Health National Adaptation Plan increased from four in 2022 to 43 in 2023 (indicators 2.1.1 and 2.1.2). Additionally, 70% of 279 public health education institutions worldwide reported providing education in climate and health in 2023, essential to build capacities for health professionals to help shape this transition (indicator 2.2.6). Regarding the energy sector, the global share of electricity from clean modern renewables reached a record high of 10·5% in 2021 (indicator 3.1.1); clean energy investment exceeded fossil fuel investment by 73% in 2023 (indicator 4.3.1); and renewable energy-related employment has grown 35·6% since 2016, providing healthier and more sustainable employment opportunities than those in the fossil fuel industry (indicator 4.2.1). Importantly, mostly as a result of coal phase-down in high and very high HDI countries, deaths attributable to outdoor PM2·5 from fossil fuel combustion decreased by 6·9% between 2016 and 2021 (indicator 3.2.1), showing the life-saving potential of coal phase-out. Important progress was made within international negotiations, which opened new opportunities to protect health in the face of climate change. After years of leadership from WHO on climate change and health, its Fourteenth General Programme of Work, adopted in May, 2024, made responding to climate change its first strategic priority. Within climate negotiations themselves, the 28th Conference of the Parties (COP28) of the United Nations Framework Convention on Climate Change (UNFCCC) featured the first health thematic day in 2023: 151 countries endorsed the COP28 United Arab Emirates Declaration on Climate and Health, and the Global Goal on Adaptation set a specific health target. The outcome of the first Global Stocktake of the Paris Agreement also recognised the right to health and a healthy environment, urging parties to take further health adaptation efforts, and opened a new opportunity for human survival, health, and wellbeing to be prioritised in the updated Nationally Determined Contributions (NDCs) due in 2025. The pending decision of how the Loss and Damage fund will be governed and the definition of the New Collective Quantified Goal on Climate Finance during COP29 provide further opportunities to secure the financial support crucial for a healthy net zero transition. Although still insufficient to protect people’s health from climate change, these emerging signs of progress help open new opportunities to deliver a healthy, prosperous future. However, much remains to be done. Hanging in the balance With climate change breaking dangerous new records and emissions persistently rising, preventing the most catastrophic consequences on human development, health, and survival now requires the support and will of all actors in society. However, data suggest that engagement with health and climate change could be declining across key sectors: the number of governments mentioning health and climate change in their annual UN General Debate statements fell from 50% in 2022 to 35% in 2023, and only 47% of the 58 NDCs updated as of February, 2024, referred to health (indicator 5.4.1). Media engagement also dropped, with the proportion of newspaper climate change articles mentioning health falling 10% between 2022 and 2023 (indicator 5.1). The powerful and trusted leadership of the health community could hold the key to reversing these concerning trends and making people’s wellbeing, health, and survival a central priority of political and financial agendas. The engagement of health professionals at all levels of climate change decision making will be pivotal in informing the redirection of efforts and financial resources away from activities that jeopardise people’s health towards supporting healthy populations, prosperous economies, and a safer future. As concerning records continue to be broken and people face unprecedented risks from climate change, the wellbeing, health, and survival of individuals in every country now hang in the balance.