Sotiris Vardoulakis  0:08  
Without further ado, I will pass on the chairing of the session to my dear colleague, Dr. Veronica Matthews from the University of Sydney, who gave us this powerful poetry as an opening address and acknowledgement of country. We're really very privileged to have Veronica leading us in this second day of the conference, leading the session and and chairing. And of course, we're very grateful her leadership of the Aboriginal and Torres Strait Islander health group together with the other Aboriginal Elders and leaders in our in our in our consortium. Thank you very much. And over to you, Veronica. 

Veronica Matthews  0:49  
Thanks so much, again, Sotiris. And thank you, Dr Jeanette for your opening. And can I say, I'm really proud that the Aboriginal and Torres Strait Islander knowledge is a cornerstone of this of this network. Following from yesterday's really steering presentations, I do have the great privilege of introducing another stellar lineup of speakers. Again, each, following on from yesterday, each talk will be around 10 minutes. And Daniela, my colleague here will will monitor the chat, so please enter any questions or comments that you may have for the speakers as as you think of them. And we'll ask some of those questions if there is time. So first up, we have the honour of welcoming Professor Kris Ebi, and Kris, I think is joining us from Seattle, if I'm correct. So it's very early in the morning from where you are. So thank you so much for giving us your time. Khris is the Professor at the Centre for Health and the Global Environment at the University of Washington and she is also the chair of HEAL's international reference group. Over to you, Khris.

Kris Ebi  2:12  
Thank you very much. And good morning. Good afternoon. Good evening. It's actually about almost going on 6pm here, so it's not early in the morning. It's thundery outside, so it's getting dark out here. I really appreciate the opportunity to talk with all of you and really enjoyed all of the presentations and the discussions yesterday. So congratulations on a very interesting conference. I'm going to spend a few minutes talking about the future and how we think about the future is important for how we frame the questions that we ask, and the analyses that we do. I put a quote on the slide from Yogi Berra, a well known US baseball player who had an amazing gift for making the highly unusual but usually very spot on statements. I want to start by talking about a way that's been used since 2001, in the Intergovernmental Panel on Climate Change reports, to think about how we can easily convey risks going into the future. This approach goes back to the 1992 article two of the Framework Convention on Climate Change. Article Two states the ultimate goal of the convention is to stabilise greenhouse gas concentrations at a level that would prevent dangerous anthropogenic interference with the climate system. Of course, dangerous is not a scientific term. And there was quite a bit of work then on how does one go about quantifying dangerous. In 2001, the working group 2 contribution to the third IPCC assessment report introduced what's called the reasons for concern framework. That framework is associated with figures that are generally referred to as the burning embers and I'll show you some of the burning embers. These embers have been used in all the subsequent IPCC assessment reports. And asking the question, what is dangerous? There was a comprehensive literature review at the time and thinking about how you can frame dangerous, the authors of that chapter focused on what are termed key vulnerabilities and key risks. And you can see the various elements that went into these definitions. We can talk about these later if you're interested. Based on those definitions, the authors identified five reasons for concern. These are listed at the top: risk to unique and threatened systems. These, for example, are ecosystems that are virtually extinct, they will go extinct with climate change. Extreme weather and climate events. Distributional issues, the inequities of climate change. The global aggregate impacts and then finally, the last reason for concern focuses on large scale singular events, such as melting of the West head Arctic ice sheet. The figure is taken from the IPCC special report on warming of 1.5 degrees. When you look at the figure, the zero line are pre-industrial temperatures, the y-axis shows you increase in global mean surface temperature above pre industrial. The grey bar shows what the temperatures were at the time that the report was conducted. So looking at the literature, at that point in time, there had been about one degree of warming. For the global mean surface temperature, the Earth has now warmed over 1.1 degrees. There's some debate about whether it's already warmed 1.2 degrees. And when you look at the figures where the figure is white, where the Ember is white, it says that for whatever system you're looking at, there's been no impacts that are detectable and attributable to a change in climate. Yellow says that there are changes in the system that can be attributable to climate change with at least medium confidence. Red indicates that the risks are widespread. And purple is very high risks with the possibility of irreversibility. And so when the literature is assessed, the author teams and all of the reviewers that review the chapters, then think about what the literature says about where these transitions occurred. And what can we say with what level of confidence in this case, you see, the high and medium, medium high all are the levels of confidence. So these are what the burning embers look like. They've been quite useful, because as I mentioned, they've been used since 2001. Which means that one can compare over assessment reports. This was a publication last year, looking at the reasons for concern the five of them across. And you can see immediately looking at these, that as climate change has progressed. And as more research has been done, that for all of the reasons for concern, that the risks are now occurring are projected to occur sooner in time where temperature change is a proxy for time, and much more severe. And so this information was critically important for example, the Paris agreement, that as countries began to understand that the science is showing more and more clearly that the risks of climate change are here and now and they're projected to get much worse, the more warming occurs. One of the advances in the IPCC special report on warming of 1.5 degrees was to break apart the reasons for concern into selected natural managing human systems. So for example, the ember on the left is for warm water corals, the conclusion was at 1.5 degrees, about 70 to 90% of warm water corals would be gone. At two degrees, they'd basically all be gone. And this was just looking at the presence or absence of warm water corals, but didn't talk about the immense food security issues that would arise in Australia, in much of the Pacific, in many parts of Asia if you lose warm water corals and lose the fishes that live in them. The only health impact that was included in the set of embers is for heat related morbidity and mortality, you can see that on the right. There just was insufficient information to be able to construct embers for other health outcomes. I want to take a pause for a minute and talk about another important friend in the climate community about thinking about the future and what our world could look like in the future. These are the shared socio-economic pathways and they are a part of a set of tools that are used to think about how changes in the climate, because of greenhouse gas emission pathways, changes in governance because of climate adaptation, mitigation policies, and changes in our development, will interact with a changing climate that will increase resilience or increase vulnerability depending on the pathway. When you look at the health systems and how they could evolve under the SSPs. This is a short list of information for three of the SSPs. There's five, they're along along two axes, worlds with increasing challenges to adaptation, worlds with increasing challenges to mitigation, SSP One is a world aiming to sustainable development, low challenges to adaptation and mitigation. SSP two is a world that continues to muddle through, so do some things well, some things are delayed, we keep going more along less, more or less along the current track. And SSP three is a world for very high challenges to adaptation and mitigation. It's a world that breaks into large world regions and there's little investment in organisations such as the World Health Organisation, making it very difficult for countries to be prepared for the challenges of a changing climate. So that is an aside, a group of us got together and put together burning embers for health. You can see they are for heat, ozone, malaria, diseases carried by Aedes, such as dengue, chikungunya, zika, lyme disease and West Nile fever. We chose these six because these are the six for which there were sufficient numbers of projections to be confident that we could decide where the transitions were from white to yellow to red to purple. And we also took a look at these under the three SSPs. And when you look at each set of embers, the one with high challenges to adaptation and mitigation is on the left. And a world aiming to sustainable development is on the right. When you look at these figures, you can immediately see that each additional unit of warming leads to higher risk and that risk is significantly modified by our development choices. So these figures really show the the interaction between climate and development, and how we have to focus on both if we're going to increase our resilience to a changing climate. I just mentioned we only looked at six sets of health outcomes. This is a very recent analysis, just showing the global distribution of climate change in health studies, and the most common topics by region and possible management options. I'm not going to go through this. It's a very interesting study. But it really illustrates the patchiness of information, and how critically important it is that we have more studies, we've got a much better understanding of the risks that we're going to be facing. In terms of addressing those risks, under the Lancet Countdown, which I hope all of you are familiar with, one of the indicators was national adaptation plans for health. And you can see that in 2021, there was a survey from the World Health Organisation, and only about half of the countries reported that they had a national health and climate change strategy or plan in place. Most of them reported they had just insufficient human and financial resources to be able to work on adaptation to climate change. Looking at the adaptation funds underneath the Framework Convention on Climate Change, only about half of a percent of that funding has gone to health. The other set of choices that we have to make collectively is reducing our greenhouse gas emissions. And one of the great news stories in climate change in health is when you look at the mitigation policies and technologies, and you start estimating the avoided hospitalisations, the avoided premature deaths from exposure to outdoor and indoor air pollution, from people who could engage more in active transport, from changing our diets to only eating as much meat for example, is what doctors recommend. And when you make changes in those areas, and then you value those benefits for health. Those health benefits are larger than the cost of adaptation. And I wanted to make one further point was that as we look into the future, we look at what we need to do in terms of adaptation and mitigation. There's growing work and this is one of several tables that are in IPCC reports, thinking about the synergies and trade offs and how to make sure that we manage the synergies and trade offs so that the synergies are larger than the trade offs. And we do so in a way that promotes all of the SPGs to make sure that we promote health and reduce inequities. With that, thank you very much. I appreciate you listening, and look forward to if there's time for questions. 

Veronica Matthews  15:20  
Thank you so much, Kris. Very sobering predictions, much work to do really to convince the government and powers of either, you know, enabling the right future to be chosen. And, unfortunately, we don't have time currently for questions. So I'll just move to the next presenter. But if you're able to please hang around, and if we do have time at the end, there will be questions then. Thank you. So I'd like to introduce Dr. Matthew Riley. He's the director of climate and atmospheric science at the New South Wales Department of Planning and Industry. DPIE is the principal sponsor of the inaugural, of this inaugural conference. So we're very grateful for their support, and particularly for Matt's leadership. So over to you, Matt.

Matthew Riley  16:17  
Thanks very much, Veronica. And just just checking that you can see my screen. I'm sharing. Yes. Okay. Great. Thank you. Thank you very much. Thank you. It's great to listen to Kris Ebi talk, as well. 

CD  16:41
Matthew, Matthew, could you please just swap your display settings for seeing Presenter View? 

Matthew Riley  16:45 
Sorry about that. (Thank you kindly). Better. Okay, great. Thank you. I'm presenting today from Pannerong Rose Bay. These are the traditional lands of the Gadigal, always was, always will be Gadigal land, unseeded Land of the Eora Nation. Wugul ora, wugul bemul, wugul coe-wing, wugul garrigarang, wugul marri mudjin. One people, One Earth, One sun, one ocean, one big family, in the **Dharug** language. I acknowledge official owners of the lands on which we meet and pay my respects to Elders past, present and emerging and I acknowledge all Aboriginal and Torres Strait Islanders who are with us today. Their stewardship of the land and their curation of knowledge that stretches back 10s of 1000s of years, we have much to learn from you. I've actually changed my presentation slightly a little bit based on some of the things that I heard yesterday, which were a little bit worrying. Because I feel that there's been a massive shift in the way some governments are treating climate change and treating integrated nature of climate change that perhaps hasn't fully been penetrated into the understanding of the very incredible research community. So I'm actually going to focus a little bit on history, not just current policy as well. Then in 2016, the New South Wales government set a target net zero emissions by 2050. That's no small feat coming from a Liberal National Government in 2016. And at the time, it actually went a little bit unheralded. And you may have missed in that, that basically, it said that the Paris agreements would mean that we were there would be a review a ratchet mechanism, that means that emissions reduction targets will likely become more and more ambitious over time. And we all as researchers know that we all as researchers understand that. But I feel sometimes the way the policy can evolve rapidly because we're used to a period of policy stasis, people actually forget that. Within the public sector, we just didn't take that as rhetoric, because it wasn't just rhetoric, we knew there was great intent behind it. So many public servants are working really, really hard taking on board the best scientific and technical advice, including yours, and I'll show a little bit of that later. And in early 2020, we delivered a fully costed-pair plan off the back of that announcement net zero emissions in November 2016. Fully costed plan, the net zero plan stage one, Minister Kean when he released that he once again stated, I firmly believe that action on climate change must be grounded in science, not ideology. Remember, this is coming from a politician, a minister who's now the treasurer of New South Wales. And so in 2021, we set a near term target, once again guided by the science of a 50% reduction in greenhouse gas emissions on 2005 levels by 2030. Again, got a little bit of press about this but I think we've been a bit jaded by the fact that people think that this is rhetoric. It's actually reality. And the reality behind it is just ream upon ream of strategies coming out from governments all around the country, but indeed I'm focusing on New South Wales here that actually implement these desires to have an evidence based policies and strategies to guide our future, embedded across all the strategies that help us live our lives. And I'm not going to call out of them here you can see them. Climate change is embedded in all of these. And it's not just mitigation, in the traditional sense, nor is it just adaptation, in a traditional sense, it is really embedded into the way the government is doing business. And one thing that we may have lost in all of this is, again, driven by the political rhetoric, we've lost focus of the fact that really we want to tackle climate change, or other issues fundamentally because we want to protect people and we want to support thriving lives. And that's just not me saying that. In 2016, when we released our climate change policy framework, with our net zero target, the Premier at the time and the Minister for the Environment at the time, who's now our Attorney General, made this very clear statement: the government makes a priority of improving people's quality of life as we address climate change. That includes reducing the impacts on the cost of living, using energy efficiency and renewable energy to tackle energy, poverty and vulnerability, and helping to improve amenity. It's about protecting people. It's about supporting thriving lives. Indeed, when we released our implementation plan update with our new 2030 target, Minister Kean reiterated this and reiterated the approach that the government takes, the way we approach climate change says a lot about the sort of people we are and the values we hold, about whether we embrace science and evidence over fear and myth, whether we honour our obligations to future generations. No generation owns our planet, our country or our state, we simply hold it for generations yet to come. That's clearly something that traditional Lionel's know quite well. But it is the position of the New South Wales Government. And it has been a constant position for many, many years. Yet, I feel sometimes we don't see that through some of the political rhetoric that surrounds this issue, particularly at a national level. And we are acting on this to demonstrate it is not just rhetoric, this is our projections for renewable energy for the New South Wales. Sorry, this is the Commonwealth's projections for renewable energy in New South Wales by 2030. We're gonna see 84% of energy delivered through renewable sources in New South Wales by 2030. It's gonna be 90% by 2032. I've taken the Commonwealth's predictions here, because I don't want to be seen as parochial. I've got projections that suggest we might get a little bit better than that, and reach those targets a little bit sooner. But again, the private sector will have to come into the party on that, but these changes are locked in. And something that we do miss as well. Okay, is that those changes are not just in our electricity sector. If we look at our electricity vehicle strategy, which was released earlier this year, again, Minister Kean and Minister Constance, EVs are high performing vehicles that are cheaper to run, quieter on the road and do not emit tailpipe or air pollution or greenhouse gas emissions. They also stand to dramatically improve health outcomes for communities, particularly pregnant women and babies, and people with chronic illnesses and the elderly. Again, people would say the electric vehicle strategy has something to do with reducing climate change emissions. It's not. It's about providing a better life for our people, our communities. And it's about protecting health. And we're going to achieve 50% new vehicle sales, EVs by 2030. I actually think we're going to outperform that. Similarly, we've heard a little bit here, and this is wheere I wanted to touch on Kris Ebi spoke a little bit about it. Okay, and it's about benefits reporting. Not only do we have a plan fully costed, that has the best available science, but we have to report on our progress for that plan. And we have to report on things such as how well we are tracking for the other impacts of the plan. Air quality and health benefits, benefits on biodiversity, benefits on water and benefits on soil. So it's about that benefits reporting that Kris Ebi spoke about. We are embedding that into our reporting. And these will be updated and reported on every three years fully, through our state of environment for reporting on every year through our implementation reports. So, just in a short thing. I've changed my presentation because I thought I was going to talk a lot more about actually the science that we're bringing to these decisions, but I felt after what I've heard yesterday I need to step back a little bit and reset a little bit of the politics. Now a little bit about the science. Our politicians, particularly in New South Wales, listen to the evidence, they listen to the science. It's things such as these numbers about the attributable premature deaths from PM2.5 pollution in Sydney each year that actually gets their interest, gets them focused on protecting lives, delivering better outcomes. It's about the fact that we can actually track down emissions, health impacts, the attributable number of deaths from individual power stations that gets people. And also motor vehicles. And I think you can see the evidence embedded in the policies and strategies that the New South Wales Government has delivered. All of these lovely bits of health evidence that are brought together from people such as yourselves, they make a difference, they impact policy, they lead to better outcomes. And we should celebrate that. We should really celebrate that because we have had some very big changes over the past few years. We will see some more changes. And we still need to make sure that we're on song to be able to tackle those changes. And this is where I'll get to just a couple of final little slides, actually some of the mechanics about how we do things. We have quite a well advanced, mature and very high performing integrated climate energy and air quality management and forecasting control system that we use to model just not a short term impacts but long term impacts. We use this system to ensure that we can communicate, we can build collaboration, and we can build that into decision making, and into input into our policy and scenarios and provide information during incidents, think of black summer or currently an incident in the Hunter Valley, a big fire Kerikeri that we're providing forecasting and support for. The government lives this, they really do live this and I use this tool, we use this tool all the time. This tool covers a lot of different areas, I'm going to be very quick and not go through too many but I'm just going to show you that it's not focused just on New South Wales, we need to take into account continental emissions, continental scale changes and continental scale processes. We do this every single day of the year. With that, I'm actually just going to wrap up really, really quickly and talk about how Health Impact Assessments are a critical component of all of those strategies that I put up earlier. We actually embedded into our strategic decision making, we use full health impact assessment pathways, approaches, and many people on this call today have been involved in the work that we've done on this or indeed lead some of the work that we've done on this. And this actually finds itself into our strategies and the cost benefit analysis that we take into our strategies as we tak them through cabinet and actually we secure the money that ensures that we see the future that we all envisage, a better future for New South Wales, a better future for Australia, a better future for the planet. And we can do this working together. We need to understand the effort that's been provided through states and territories. I've seen without New South Wales, he was really nice to see Angie Borne yesterday, indeed, Andrea Hinwood, and Carmel Lawrence talk about the roles of states and territories. We are doing a lot, don't get blinded by the rhetoric, get down into the facts and the details and help to take that work that's already guided where we've gone to on this journey so far. And take us to the next step. Thank you very, very much.

Veronica Matthews  28:13  
Thank you so much, Matt for your passionate presentation and for showing us the leadership of the New South Wales Government. That does give us some hope, you know, the state governments are leading the way. It's quite interesting or perplexing, if you like, know that the same government have the same liberal coalition government, but very, very different responses to climate change. Unfortunately, we have to move on to the next presentation. But if you can stick around, that would be fantastic. Again, my privilege to introduce Professor Fay Johnston from the Menzies Institute of Medical Research at the University of Tasmania, who has a very interesting title presentation: the reflections on Prometheus. Over to you Fay.

Fay Johnston  29:04  
Thanks very much. And I'll just share my screen if you give me a second. There. I think that's working. Great. So thank you. Yes, I'd like to begin by acknowledging the deep history and culture of **literal widow** Tasmania, and the Nuenonne people, the traditional owners and custodians of the land of Nipaluna or Hobart, which is where I am today. And the theme of my talk today is fire. And I especially want to acknowledge the skillful and sustainable use of fire by First Nations people for millennia, both here and elsewhere. So for most of my career, I do tend to see the world through fire a bit, but most of my career I've been thinking about fire and the nexus between health and air quality. And fire is considered to be one of the defining features of humanity that sets sort of people apart from other animals in flora and fauna, apart from some clever birds who can spread embers to catch food. But many, many cultures around the world have got ancient stories about fire and people. And Prometheus is just one of them the story of the Greek Titan God. And it's one that I reflect on quite a lot, because it parallels in so many ways, the journeys of myself and many of my colleagues in study, in understanding fire and air pollution and health. And you may well be familiar with this story. It big, there's various versions of it but in general, it begins when Prometheus, who liked people, and some, in some stories, he actually made people out of clay, and wanted to give them the gift of fire, and he stole it from Zeus, the Greek god Zeus, to give to people. And I'm just trying to change slides. There we go. I hope you're seeing that properly, it's looking a bit funny in my view. So my personal fire story began in the Northern Territory. That's where I began my public health and research career. And it's actually a story about how the sustainable use of this gift of fire can bring health, social and environmental benefits. And one of the first collaborative grants I ever got, the Healthy Country, Healthy People, about 20 years ago, looked at this area, had many collaborators, Aboriginal and non-Aboriginal collaborators who understood country ecology, fire and health. And we learned a lot from this project. We particularly learnt that people who were engaged with caring for country, of which fire is absolutely integral component, whether that be in traditional ways or more contemporary ways, through working as a ranger for example, but we're healthier on a whole range of healthy disease, chronic disease risk, mental health indices. That was part of the PhD of Paul Burgess, who I was working with at the time. We were collaborating with fire ecologists and comparing lands that had continuing caring for country with land where they'd been dispossession and traditional practices had been disrupted. The Country was a whole lot better off in places that were cared for. I mean, that would be totally obvious to any First Nations person here today. We also learnt that under these patterns of burning the air was way cleaner, the small scale patchy burns. And in fact, people far from where the Country was in Darwin, the big city of Darwin, were much better off. And in fact, there's historical records to the 1950s and air quality has been decreasing since the 1950s with disposition and disruption. Air quality has got steadily worse in Darwin. And in fact, that trend is accelerating. Darwin's probably now the most polluted capital city in Australia. And that smok in Darwin is associated with lots of ill health, heart and lung disease and in fact, my PhD began there showing strong links to asthma symptoms, and hospital attendances. But really, the point of this story was the first big lesson for me on fire. And that was that people and fire can sustainably coexist with each other with many benefits for health for the environment. And it's been done for millennia. But there's many ways that we as people use fire isn't always sustainable. The energy, of course, is crucial and simple indoor cooking fires are used right now by around half the world's population who don't have many other options and it's a major source of air pollution and the global burden of disease project estimates, you know, currently it's around two and a half million deaths each year from causes like pneumonia, COPD, heart disease and lung cancer. So it's a current problem. It's been an ancient problem, you know from Egyptian mummies with black anthracotic lungs, skulls showing sinusitis and teeth changes showing epidemics of sinusitis, in fact, during the Dark Ages all attributed to indoor smoke exposure. So an ancient problem also a really modern problem in wealthy communities, rural places, big cities like Sydney. Sydney, 4 or 5% of people will heat with wood but in winter, that small percentage manages to create almost half the particulate emissions in Sydney. Really measurable health impacts. After my time in the Northern Territory, I moved to Tasmania and that's when I really started understanding the issues with wood heaters because of course, I love them. They're great. So warm, we love fire. But I evaluated the buyback scheme in Launceston you can see a before and after photo here. When would he the numbers reduced from 60% to 30%. And confirm that death rates drop when the air gets cleaner. So really the second message for me the big learning, I guess was that we as humans, we can actually choose to change how we use our energy. We can do it for the common good, we can reduce illness and death by doing this. We've done it here in Tassie, a small example. But it's very clear. But nothing is straightforward, right. So this is going back to Prometheus. Prometheus stole the fire and was punished, punished by Zeus for giving it to humans. He was chained to a rock to have his liver forever eaten by an eagle, he was immortal. The liver kept growing back. This never ended, it went on and on. Not only was Prometheus punished, but the humans were punished for accepting the gift. And Zeus punished the humans by creating Pandora: endowed with insatiable curiosity, and when she married the brother of Prometheus, she was given this urn and told never to open it. But she was doomed to open it, she really didn't have much choice in the matter. And of course, when she did open it, all trials and tribulations flew out: war, greed, famine and pestilence. She slammed the lid, but it was too late because almost everything had escaped. So this began, has become known as Pandora's box. It's more used now as a metaphor for unintended consequences. So this brings me to coal. Here are some beautiful coal seams. That was a natural progression for people to move from biomass fuels like wood, particularly as far as got cut down for this energy source, and move on to, you know, fossilised biomass, oil and coal. More stored energy, a fantastic substrate for fire. So then, use of fire took off. And really the beginnings of industrialization went along with that, and coal got used to power the industrial revolution really. Emissions escalated. These images by Monet have been validated but there were times when there was complete light extinction in the middle of the day in London. And their stories from some of the great fogs of those times, of GPs who couldn't find their way to do house calls and had to ask patients who were blind to actually guide them around the city so they could do their work. And then there was another step change which the great pious scholar Stephen Pyne, calls the Pyrrhic transition. And that's James Watt invented the internal combustion engine. That's the picture on the top left there. And what he calls the pyrrhic transition is when we put fire into boxes, as he said, where we can no longer see it, or we used it to make electricity. That's the Hazelwood coal mine power station, coal power station, far from where we are, so we had endless energy without sort of the reality of fire and smoke before us. And of course, energy at an industrial scale brought about huge advances: transport, electricity, communications, healthcare, in every facet of society. And it brought, you know, like the Gremlins in Pandora's box, there were costs multifaceted, widespread, unexpected costs. And one of them is, you know, what I call the smoking transition from ritualistic. Often religious spiritual uses very defined, then came the bonzac machine that could make 120,000 cigarettes in 10 hours. And then we have a massive smoking epidemic globally. And the current estimate from the global burden of disease is 8 million deaths per year. But it wasn't just smoking, nutritional and physical activity transitions, and I look at this picture and just see a totally unbalanced unsustainable relationship with fire, the energy and the mass production of food, the transport of food, the air miles, zero energy in getting to the food, and then the energy in the food. It kind of says it all for the chronic disease epidemic. And along with that, of course, comes pervasive air pollution. This photo shows that that's it doesn't have to be that obvious to be harmful to health. But the global burden of disease estimate is around 4 million deaths globally from outdoor air pollution, outdoor particulate matter. And it's not only the particles of course, it's the gases. So a major product of fire is carbon dioxide. And the earth is hotter than the hotter Earth is supporting more fire and more extreme mega fires. So this is kind of where we're at right now. Very severe fires in forests becoming much more common top top left photo there. Fire storms, fire tornadoes, you know, pyrocaebes. Words we'd never heard of a decade ago are now very common. The bottom right photo is Gondwana Tasmanian vegetation, which usually would only get fire every few 1000 years or so, but being burnt in severe fires, places are drying out that don't normally burn. The photo above is actually planned burn smoke but severe smoke events and then the response, more plan burning and plan burning by certain times and targets comes with its own costs. And then the bottom left photo is using dryness to clear rainforest to repurpose soybeans, palm oil and that's one of the major sources of emissions. Image of an area of Southeast Asia. And it's only a day apart, but the weather changed, it was favourable for fire and you can see all these hotspots. And you can see the big haze, and its fire that's being used to clear and repurpose vegetation. And it's fires that contribute probably 20%, to greenhouse gases, a huge burden of ill health and smoke, that sort of our black summer happens annually for a lot of people in and around the tropics. And about 10 years ago, myself and my team estimated about 10% of all deaths from outdoor air pollution were attributable to fire over and above baseline fire on Earth, such as fires like these driving a lot of it. That estimates been updated recently, it's still around 10% but but a lot higher. So back to Pandora. Pandora's Box sums it all up in terms of an unsustainable coexistence with fire that we have now and unintended, quite terrible consequences. But consolingly, the story didn't quite end there. Because there was one last thing trapped in this box, and it did eventually get released. And that thing was hope. You know, when Hercules saved Prometheus. The question for us is: Do we still have hope? And I think we do but we are hanging on by a thread. And for me, hope involves rethinking combustion, really, it's very simple. It's moving to safe and sustainable relationships with landscape fires, safe and sustainable sources of energy. And I guess what I'd like to say is we do have clear examples around us of both these things, they have been done, they've been done for a long time, and we can draw inspiration from that to get us where we need to go. So thank you, everybody, I'll end there.

Veronica Matthews  41:50  
Thanks so much Fay for a great presentation. I learnt quite a bit about the impact of fire but also great Greek mythology and it was very encouraging to listen to your early experience in the NT and how Aboriginal knowledges can really, you know, we can learn a lot from from those knowledges in terms of minimising the impact of air pollution from bushfire. Again, we have limited time for questions, but please hang around if you can for the end of the session. I'd like to introduce now, Dr. Rebecca Patrick who is the director of Deakin University's Sustainable Health Network and immediate past President and chair of the Climate and Health Alliance. Over to you, Rebecca.

Rebecca Patrick  42:52  
Thanks for Veronica. Just everyone take a breath and pause while I sort this out. I'll change it over. How am I looking Veronica? Okay, great, thank you. I just like to start by Acknowledging Country on Kula nation land today here in Victoria, out in the western metropolitan area of Melbourne. I'd also like to thank the HEAL network for the invitation to speak today on the topic of my interest around climate change and mental health. And so I'm going to step you through some evidence, concepts and links between climate, nature and mental health, both sides of the equation, both the negative and positive aspects of contact with nature. And, importantly, I'd like to highlight some of the thought leaders in organisations where evidence is informing policy programmes and partnerships. Firstly, just some foundation ideas and the way that I build up the equation in terms of talking about the link between climate change and mental health. We know that human health and well being depends on nature and healthy ecosystems. That's why we're here working together. On this slide is an overview of the nature Health Link proposed by a wonderful group of researchers Ming, Ming and Co., who've been looking at these links and compiling the evidence over time. And so in this slide, I'd like to draw your attention to the mental health pathway, where it suggests from the evidence-base that sits behind this, that time in and around nature provides the active ingredients, including such things as natural sounds, sights and opportunities to touch and connect with nature, with the psychological and physiological states and again, highlighting the mental health aspects here, the opportunities for relaxation, or an attention restoration, and importantly sleep. And then further down the pathway, this has the potential to support health outcomes, such as in decreasing anxiety disorders, dereasing depression, decreasing ADHD. So they're the important foundational links between nature and mental mental health. Whereas when we add in the climate equation and working in the opposite direction, we see the negative mental health impacts of environmental and climate disruption. On the middle right hand side of this slide, we see mental health impacts of climate change. The slide also demonstrates importantly, that it's all tangled up. The mental health impacts are tangled up with the confounding factors of physical health, the impacts of climate change, as well as disruption to social and community systems. And here are the terms used to describe the impact of climate change on psychological distress. These are the dimensions of what psychologists, psychiatrists, researchers alike believe is on the rise and will be a major issue globally and locally into the future. And the way that researchers and colleagues like I just suggested is that this is actually a reasonable response for expected set of responses to a deep sense of loss of connection to nature, or worry about the future of our natural environments. And I just like to acknowledge Susie Burke, Helen Berry, and more recently, Fiona Charleston at UQ for some of the seminal work that they've contributed to thinking in this space. And this slide demonstrates that climate change may affect the mental health of individuals and our populations at different time points, both before, in anticipation of climate related events; during an event, where there's a direct impact of climate change on our mental health and well being,; but also long after, in terms of the long term issues related to experiencing climate change over time. Now, I just like to point out some of the evidence, I'm going to quote some of the research that I've been undertaking in collaboration with Monash University colleagues. We recently undertook a nationwide online survey with the aim of which is identified on the slide here. And we, with the support of ABC Science Week, and other collaborators that are involved in this network, we're able to achieve a sample size approximately representative of adults in Australia. And in keeping with what Veronica opened up at the start of the session, instead of flipping to the quant of, I want to start with the qualitative insights that our survey participants shared in the context of that study. In here is a selection of quotes of participants that highlight the themes that came through. And that's around anger, distress, frustration, particularly in relation to government inaction, the impact of vested interests, the fossil fuel industry, insecurity about the future, and concern about children. And of course, there was the element of denial and avoidance. So we had denialists participating in our in our survey as well. So they're just some of the quotes and the voices of people that participated in this study. Now, in terms of the corporate side of the equation here's a very high level summary of some of the key findings. The first of which is the majority of respondents report having a direct experience of climate change in Australia, so the majority of Australians, and this is significant because we know that having an experience matters, individuals that have a direct experience of the phenomena linked to climate change are more likely to be concerned about the issues more certain that it's driven by global heating, and more inclined to undertake sustainable behaviours. The second point here, also says it's suggested that, despite being in the midst of a global pandemic, when the survey was undertaken, three times as many respondents felt that climate change was very much a problem for them personally, over COVID-19. The third point there is around eco anxiety. And here, we found that approximately one in five of the Australian young adults that participated in the survey, were experiencing significant mental health impacts, because of the anxiety related to climate change, with tangible impacts on cognitive and functional impairment affecting work, family, and social life. The fourth point of those participants who reported experiencing a direct experience of climate change, approximately 26% met the screening criteria for PTSD. That's not saying there was PTSD, but the screening criteria was triggered. Again, on the other part of the equation, we asked about coping and hoping. And we found that was people were worried and experiencing these mental health experiences related to climate change, they weren't necessarily seeking traditional mental health care. Rather, they were becoming informed about problems and solutions, they were changing lifestyles to become more sustainable, and also viewing and visiting nature and natural environments to help try to bring down the concern and worry that's associated with climate change. Importantly, not so much from the research that I just quoted, we know from the growing body of studies that have been done so far, that the experience of this climate change mental health link is more common in the priority populations identified in this slide, and the ones bolded here are just a couple of areas that we've been taking a deeper dive into more recently. Now, let's go to the opposite side of the equation, or it's a connected equation, certainly, but the positive health mental health impacts of connection with nature. And here's just a handful of studies that we've worked on with in cahoots with a range of collaborators, researchers and practitioners over time. Firstly, one study from an environmental psychologist we work with at Deakin is that higher contact with nature in childhood predicts lower neuroticism and greater openness in adulthood. Point two in our Field Blue Touchscreen study, we found that people experiencing depression, anxiety or socialisation, when they take part in environmental conservation activities, there's improved mental and physical health outcomes. And then if I skip throughout, down to environmental volunteering, we've measured in a large New South Wales study that people participating in environmental volunteering have that co-benefits opportunity: mental, social, spiritual, physical co-benefits, along with the environmental benefits. Swinging to the back end of my presentation and giving a nod to the thought leadership in Australia, this is only a snapshot. But here's some examples of where the research and evidence that has been generated and will be generated through the HEAL network is informing policy programmes and partnerships. Starting with CAHA as we've highlighted on the immediate past precedent, so this is an easy place to talk about. And Fiona outlined the framework for a national strategy on climate change in health and well being yesterday. And I just want to emphasise that in the 2.0 version of the the new framework, mental health cuts across many of the strategies. For example, investing in further research around population groups, looking at our best investments, fair interventions, and the like. And the cat has just turned up at the door, and she's gonna have to wait for just another minute. Okay. And on this slide, another nod to some of the work with CAHA and wonderful funder that has been supporting climate change work in Australia, the Lord Mayor's Charitable Foundation, who has supported a project on climate change and mental health. And in partnership with DEA, APS PSC, and my own research group, they ran an expert panel on climate change and mental health, and that's up on the slide there. And then more recently, only two days ago, we ran a session called Healthy Minds. Healthy climate: Managing your mental health in a climate crisis. And so that's about acknowledging that as scientists people working in this space, it can take its toll. Having your shoulder to the grind of acknowledging and working on these impacts ourselves, we need to look out and take care of our mental health. And of course, there's a range of peak bodies across Australia that is looking at this connection between climate change and mental health, there's a couple, just a couple of examples here of thought leadership and advocacy and education. We've got doctors for the environment, Australia's recent report on the left, the Australian Health Promotion Association, looking at mental health promotion, and of course, the APS and the incredible resources that they produce to provide guidance in this area. Just two more short slides, Veronica. Psychology for a Safe Climate; they've been recently established to support climate activist practitioners and scientists to help, again, to protect and promote our own mental health and they also provide resources and education to the sector. And again, what underpins this is, is the evidence in the partnership work that HEAL and you know, the whole mothers of this work have contributed to date. And I just want to give a nod to this year they've developed a practitioner network. And finally, ending on an invitation. This climate change, for the climate change and mental health researchers among us, please consider contributing a piece to this upcoming special edition. Myself along with Joe Longman, and also Fiona Charlesworth associate editors on this special edition around climate change and mental health. Thanks. Thanks for having me along. Over to you, Veronica.

Veronica Matthews  56:41  
Thanks so much, Rebecca. I'll let you go rescue your cats who missed out on a fantastic presentation just now. There are a couple of really interesting questions in the chat if you want to check them out. But we do have to move on unfortunately to the, or not unfortunately, it is with great pleasure that we have Professor Tony Capon here with us today. He's been very much a thought leader in the space for a very long time. He's the director of the Monash Sustainable Development Institute. Tony, over to you.

Tony Capon  57:21  
Veronica, terrific to be with you all today. I'm on Wurundjeri Country, here in Melbourne, and I acknowledge Elders past, present and emerging. I'll just share some slides here. And does it look okay to you, Veronica? Yep. Excellent. So my main message is simply, essentially, I've got a singular message today is that human ecology can be really helpful in informing research and action on environmental change and health. And I want to begin with reference to the Rockefeller Foundation Lancet Commission on planetary health back in 2014-15. And this was an idea from Editor-in-Chief of the Lancet, Richard Horton, and the title of that report: Safeguarding human health in the Anthropocene epoch. Very relevant, of course, to the work of the HEAL network. Here you can see a list of the commissioners and at the time, I was directing the Global Health Institute for United Nations University and was greatly honoured to be part of that. They commissioners came from all regions of the world, and a range of disciplines there, they weren't all health people like myself. Importantly, the bottom line on this slide, the work that we did on that commission, very much built on previous work, including the One Health approach to infectious diseases, eco-healthy ecosystems and health work, and notably the Brundtland Commission, here a picture of course of Dr. Gro Brundtland and the report: Our common future back in the 1980s, the report of the World Commission on Environment and Development and Gro Brundtland, originally trained as a medical doctor in Norway, before she went on to be Prime Minister of that country, to chair this commission and later to lead the World Health Organisation. So, the concept of sustainable development is really founded in concern for the health and well being of future generations, as indigenous people have that foundation in knowledge systems. This fellow of course, well known to many of you, Tony McMichael, introduced the term planetary in the context of health with this book: Planetary overload: global environmental change and the health of the human species. Now, many years ago, almost three decades ago. And this, I want to take you to, because Tony's work was fundamental to the Lancet Planetary Health commission, we made that very clear in that report if you've had a chance to look at it. But another person from Canberra who was fundamental to the thinking of the commission, is Stephen Boyden, the human ecologist, from ANU. And you can see here in this piece of writing, by Richard Horton and Selena Lowe that introduced the Planetary Health Commission report, they framed it as planetary health: a new science for exceptional action. And they put right up front that Steven Boyden had helped us unravel these challenges. Now, Stephen, as you can see here, still active publishing in his 90s, an emeritus professor in the ANU Fenner School of Environment and Society, and really an elder from the perspective of Human Ecology. Now, Stephen and Tony were both influenced by Rene Dubos, the microbiologist who wrote a number of really compelling books on this topic, here, just one. And Rene Dubos is credited with introducing the term "Think global, act local". He was at the Rockefeller University in New York for many years, but a good ecological thinker and a human health person, fundamentally important for understanding these challenges. Now, Hippocrates was also an ecological thinker, the father of medicine as a discipline, if you like, and 2000 years ago or more, Hippocrates was writing books like this on his waters and places. So he was talking to his patients, he was thinking about how they lived, and where they lived, and making ecological deductions about the relationships between their circumstances and their health and well being well before we had modern research techniques for doing these things. So we need to reclaim some of this understanding, this fundamental ecological understanding, and bring it to the fore in the work we do. Which brings me to Waiora, a Maori word for well being and healthy waters, which was the framing for the International Union of health promotion and education conference in Rotorua back in 2019. And that framing, promoting planetary health and sustainable development for all the Maori world, Waiora meaning well being and healthy waters, another indigenous perspective, alongside Australian Indigenous perspectives, around the world, indigenous understandings, fundamentally important for the work we do. Good to see that coming to the fore in the HEAL network. Now, let's just drill a bit deeper into Stephen Boyden's work, this fellow from ANU Fenner School, and one of his books, the Biology of Civilization: understanding human culture as a force in nature. Human culture, at the heart of the challenge, current dominant culture, the big problem, changing that culture, the only hope for the future. So, on the left here, human ecology as a way of understanding patterns of health, alongside epidemiology in research, education, policy and practice. We need to bring these things together. And here, Steven Boyden's conceptual framework for the total system and I just want to spend a few minutes of this because it's quite instructive. So on the left here are the cultural system. You can see in this first box, that the the cultural options: our worldview, our knowledge, our beliefs, our priorities, our mindset, if you like, that's the central challenge. Our mindset, our views influence the way we arrange things in society, the economic system we choose: is it a high consumption system? Is it a circular economy? Is it a regenerative economy? Our government regulations, our education system, and what we're learning about in society and across the life course. So culture at the heart of the challenge and what needs to change. Culture influences here in the middle, a range of what we might call biophysical options, or variables. We've heard about some of these today: human population, the numbers of people, that densities, how they grouped together in cities, for example, the things that people are doing collectively, those collective human activities in the language of human ecology, the fuels we're using, how we're manufacturing, how we're farming, and then the individual human activities, sometimes called our lifestyles, our livelihoods, the way we make a living, the way we move across communities across the world. And then box six here, the artefacts are the things we make, from an ecological point of view, the buildings we make the roads, the vehicles, the machines, the vegetable gardens, the farms that we develop. So these are biophysical options, these are things that we can do differently. But all of this interacts with the broader biophysical environment, the rest of the biosphere, if you like, apart from the human dimensions of the biosphere, the atmosphere, ocean. clay and rocks, the physical elements, and the living elements, the plants, the animals, the microbes coming together as soils, for example, oceans, climate, system. So this is a really important overarching framing, we need to understand this better, we need to drill down, do important research projects. But we need to keep our mind on the whole story as well, understanding this cultural system and the biophysical system separately, it can be sub categorised as all of the human bits and the rest of the biosphere. But the bottom line here on this slide is really important too: that the health of humans, the health of all people, of all other animals and living things, natural systems themselves are emergent properties from the way the system functions. And what our task is, is to improve that functioning to optimise for the health of people, and the health of the planet. And that brings me to drilling down to the essence of Boyden's thinking. So all these human activities, everything that we're doing every day on Earth has potential for positive or negative impacts on our health. In public health, we look at behavioural risk factors, we also look at the social determinants of health. These are human activities, that things that we agree to do together, that have potential to support our health, potentially, as a restricted tax system, for example. These are areas where public health researchers often work but health researchers aren't always thinking about the implication of human activities for the health of the planet, environmental impacts of development. This is more of a domain of environmental scientists and ecologists when that's why we need the cross disciplinary work. And what we're focusing on today is what's now called ecological determinants of health, changes to natural systems, whether it's climate change, biodiversity loss, loss of habitat for other species, air pollution, ecosystem degradation. This term ecological determinants of health introduced by the Canadian Public Health Association, some five or so years ago. So the final slide in this little sequence has the arrows going in both directions. And that reminds us for the need for a systems approach systems thinking, integrative thinking, understanding those unintended consequences that were mentioned earlier, from Pandora's Box. Boyden bio-sensitivity triangle. Have a look at this work, because it's profoundly important as we think about these things. So keeping in mind the big picture, but drilling down to understand specific aspects. So here is a link to Stephen Boyden's most recent book from just a few years ago when he was well into his 1990s, into his 90s into his current decade: the Bionarrative: the story of life and hope for the future. And that's a free download from the ANU press. So my final slide before I pass back to you, Veronica, so what? What's the relevance of all of this? I've got five points to make. I'd argue that we need an eco-social approach in the work we do alongside the biomedical. In public health, we were doing quite well addressing social determinants of health, there's still a need for a lot of action on them. But we've got improved understanding because of the work of people like Michael Marmot and here in Australia, Fran Boehm and Sharon Friel, for example. What we need to do is integrate the social with the ecological and the economic and so there's term eco social, which people like Tony McMichael, Colin Butler, and others have been using for some time. Secondly, systems thinking: acknowledging the interdependence of all species on Earth, including those we can't see. We're spending a lot of time at the moment trying to stamp out a virus and that's really important public health action but we mustn't forget that we need trillions of microorganisms every day on our mucosa, in our gut to be healthy and well. So we need to acknowledge interdependence. Thirdly, intergenerational health equity: not just health equity for people currently alive in the world, but thinking legacy, thinking generations ahead, as Indigenous people, dot point four indigenous and local knowledge at transdisciplinary approach, transcending academic disciplines, and valuing know-how, Indigenous know-how, know-how from policy and practice. People like Matt Riley who have a lot to offer in this kind of work. And my final point, a summative point, is perhaps at the foundation of it all, the need to bring a planetary consciousness into the population health research we do, into our education, into our policy work into practice, bring the planet into decision making. Climate change absolutely. But it's not just climate, we need to bring an integrative approach. Thanks very much, Veronica. Back to you. I'll stop sharing now.

Veronica Matthews  1:13:03  
Thank you so much, Tony. It has just started to heavy downpour here so I hope you can hear me okay. (Still. Yeah. Yeah.) Thank you. Really interesting presentation. Thank you for bringing in those points and I hear you know, Aboriginal and Torres Strait Islander knowledges in everything you are saying, the system's thinking. Thank you for introducing the philosophy of Stephen Boyden but fundamentally, you know, coming to the point of having change our way of thinking. Thank you so much for your talk. I'm moving on then to Professor Ying Zhang and Professor Paul Beggs, seniors from the University of Sydney. Paul's from Macquarie University and they're the co chairs of the MJA Lancet Countdown on climate change in Australia to present on the 2021 report. Thanks, Ying. Thanks, Paul. 

Paul Beggs  1:14:05  
Thank you very much, Veronica, and thank you very much for the invitation and opportunity to present today. So Ying and I are doing a joint act. I'll go first and then handover to Ying halfway through. So I'll just acknowledge that I'm presenting on Dharug Country today and I respect the Aboriginal Elders past, present and future. I'll just share my screen with you now. Okay, so um, I should say at the very beginning, Ying and I are presenting on the MJA Lancet countdown on health and climate change in Australia. So we'll talk generally about the research initiative, and in particular about our 2021 report that was launched a few weeks ago. And we're presenting on behalf of the MJA Lancet countdown team. So the MJA Lancet countdown tracks progress on health and climate change in Australia. It was formed in 2017. We were brought together by Professor Tony Capon in Sydney and we are in partnership with the Medical Journal of Australia, the MJA, and the Lancet countdown based in the UK. As I said, we are an interdisciplinary research collaboration and we're very proud of our achievements to date. We've published reports annually in the Medical Journal of Australia since 2018 and we intend to continue publishing those reports tracking progress throughout the country through to the year 2030. The MJA Lancet countdown examines 40 indicators across five broad domains. And you can see those illustrated in the figure on the right. First and foremost, we look at the health impacts of climate change. Equally importantly, we look at their responses to those impacts, health adaptation, and the health benefits of mitigation. And again, importantly, we look at the economic and political context in which those impacts and responses are occurring. For the 2021 report, which you can see the first page of over on the right hand side, we looked at precisely 37 indicators across the five domains. And quite excitingly, this year, we had seven new indicators, so seven of those 37 were new this year. And although seven new indicators three are unique to the Australian report, so we generally adopt the methods of the global Lancet countdown report, but we do our refine of those methods to be focused on Australia. And in some cases, we develop our own indicators. You can see the link to the report there, the DOI address, and the full reference down the bottom of that slide. The report is produced by a large number of climate change and human health experts in Australia. We had 19 experts this year from eight universities, including my own institution, Macquarie University, The University of Sydney, the University of New South Wales, Monash University with Tony Capon and Yuming Guo, the University of Melbourne, Queensland University of Technology, Fay Johnson at the University of Tasmania, and two of our colleagues at University College London in the UK, who work at the Global Lancet countdown Ian Hamilton and Ellis McGushin. And we also like to acknowledge a large number of people that worked on the project that we can't include as authors. And they include colleagues at the Australian Bureau of Meteorology, including Dr. Elizabeth Ebert. So I wanted to spend just a few minutes going through the five domains that we focused on listing the various indicators and pointing out the new and Australian-focused indicators. And just briefly talk about some of the results. So in terms of climate change impacts, exposures and vulnerability, we look at a fairly large list of 10 indicators, as you can see there, two of which were new this year. Very importantly, we've introduced an indicator on Indigenous health and climate change in Australia, which you see the results of over on the left hand side. And we very much focus on the vulnerability and adaptive capacity of Australia's Indigenous peoples, looking at things like existing cardiovascular and respiratory disease, access to health care, and so on. The other new indicator for this year is on health, heat impact of physical and sporting activities where we're working with Professor Oli J at the University of Sydney. Looking at adaptation, planning and resilience for health, we look at a set of seven indicators. And two of those again, new this year, one looking at urban green space and another importantly following the bushfires in 2019-20 looking at bushfire adaptation, so it's very much focused on Australia and it's unique in the world. No other Lancet countdown report looks at bushfire adaptation. And again, you can see the results from that indicator over on the left hand side tracking both aerial and terrestrial firefighting capacity in Australia, with the blue line showing aircraft services to fight bushfires, encouragingly going up over the past decade or so. But when it comes to firefighters on the ground, shown by the red line, a decrease in the number of firefighters in the most recent years for which data is available. Looking at mitigation actions and health co-benefits, again, we've looked at a very long list of 10 indicators, one of which is new, looking at diet and health care benefits, as you can see down the bottom there, and the results shown over on the left hand side is for the sustainability and healthy transport indicator. Showing over the past decade or so, the growth of diesel fuel for transport in Australia, and the very sluggish growth in electricity for transport, shown over on the right hand y axis. Moving on to economics and finance, we look at a set of six indicators. And one of these is looking at employment in renewable energy activities, which you see over on the left hand side. And in the past few years for which data is available, encouragingly the we see growth in this in the number of states and territories and for Australia as a whole. So that's a very good sign in terms of our adoption of renewable energy in Australia, that is creating jobs. But of course, we have a very long way to go. And finally, looking at public and political engagements, we looked at the set of four indicators, as you see there over on right hand side. One of those, which is new this year, and unique to Australia is looking at health and climate change research funding. And you can see in the graph over on the left hand side that grants to, grant applications to the NHMRC, have varied over the past 20 years. So the blue bars show the funded grants and the red bar shows the not funded grants. And the green line is the corresponding success rates over that time period. So certainly at the moment, in terms of the number of grants, I should say, where there are the fairly low success rates. But of course, the NHMRC has put in a very large amount of funding with the HEAL network. So just before I hand over to Ying, the conclusions from this year's report, as you see there: Australians are increasingly exposed to and vulnerable to climate extremes. The continued absence of a national health and climate change plan is a glaring gap, which continues to put the health and lives of Australians at risk. And COP 26 should have been the moment for Australia to showcase a much stronger emissions reduction commitment and a clear transition away from fossil fuels towards renewable energy. The strategies for which could have supported the COVID-19 economic recovery through government support of the renewable energy sector. So I will hand over to Ying.

Ying Zhang  1:23:05  
Thanks, Paul. I'm in Ying Zhang. I'm speaking from the land of Cammeraigal people and pay my respect to their Elders past, present and emerging. Can you hear me okay? Yeah? Good. Each year, we develop a policy brief for Australian policymakers alongside aside the scientific reports. In this year's policy brief we highlight three recommendations: we propose to develop a national heat and health strategy to better coordinate the preparedness and response to heat. We call for more funding and support to ensure Aboriginal and Torres Strait Islander peoples are at the centre of climate and health decision making and implementation. And we strongly recommend more ambitious targets of net zero emission healthcare to accelerate the transition within our health systems. I'd like to point out that the policy brief has been developed not only based on the scientific findings from the countdown reports, but also in consultations with individual experts and stakeholders in the country. You can probably see the logos of the partner organisations on the cover page on the slide. They have formally endorsed this year's policy brief. In addition to the long term support from the RACP, the Australian Medical Association and Australian Medical Students Association. We appreciate new partnerships this year with the Australian Indigenous Doctors Association, the Australian College of Nursing and the Public Health Association of Australia. I'd also like to acknowledge the contribution from Dr. Georgia Barrys, a young, passionate doctor who has contributed to the last four policy briefs as lead author. It's also the capacity building part of the MJA Lancet countdown project. Next please, Paul. Since the publication of the first report, in 2018, the MJA Lancet countdown has achieved tangible impacts through wide engagement. We host a new, host a new launch events and some of you who have contributed or attended our events previously. The reports have extremely high attention scores and attracted extensive media coverage. As an essential part of the Lancet countdown, the reach of the dissemination activities is in the millions of Australians and probably over a billion people internationally. So the research has also fed directly into the NHMRC's on investment in addressing health and environmental change. It has also featured in a few policy briefs, policy documents such as the Climate Health, WA Government inquiry, and the UN 2020 resilience report. And very importantly, our work has mobilised health professionals on climate actions. For example, our work has been the main referenced in the AMA statements that recognise climate change as a health emergency. And as you would agree, that health professionals are increasingly concerned and involved in climate actions, which is also reflected in the COP 26, which just finished last week in Glasgow where health has been a clear and non negotiable focus in climate policies. So we are very much looking forward to new partnerships that the HEAL network could bring. And together we can drive the changes required to protect Australia's health from climate change. Thanks.

Veronica Matthews  1:27:19  
Thanks, Ying. Thanks, Paul. Congratulations, and Tony, congratulations on such a great initiative. And it's really great to see Indigenous health indicators getting into an annual report. There was a quick question though, in the chat, if you don't mind. There was a comment that the unfunded grants is probably not due to the quality of them. But there was a question there whether you looked at ARC grants as well as NHMRC.

Paul Beggs  1:27:49  
I can take that if you like, Ying. No, we haven't looked at ARC grants, there's always scope for us to expand that indicator to look at ARC and other funding types as well in Australia, but at the moment, we've had fairly special access to NHMRC data that we get directly from them. So that's our focus at the moment. But yes, we might expand that indicator into the future.

Ying Zhang  1:28:15  
One of the reasons for not including the ARC data this year is the data was not a very detailed as we would like to include. We actually look at the available data, publicly available data, but we will definitely be working on that in the future. Thanks for the question.

Veronica Matthews  1:28:32  
Thank you. So moving on now then to the last speaker of this session, Dr. Kate, Charlesworth, who's a medical consultant in environmental sustainability within the southeastern Sydney Local Health District, and Kate will describe the planetary health programme within that LHD sorry, the Northern Sydney LHD, which they're setting out Net Zero teams of clinicians and researchers working together towards a target of net zero by 2035. Thanks, Kate.

Kate Charlesworth  1:29:08  
Thanks so much, Veronica. Just sharing my screen. Do you see that okay? Is that okay, Veronica? Yeah, terrific. Thanks so much. And thanks for the invitation. Terrific to join you today. So as Veronica said, basically, I'm a public health physician working in climate risk in the New South Wales Health System. I'm going to talk today about a net zero health system, what that looks like and why carbon's new currency for health care. All right, sorry about my slides. Okay. There we go. So, as everyone on this call would be well aware, climate change is having a potentially catastrophic impact on human health and so as a health system, clearly we will need to be prepared and resilient for these physical climate risks that are impending, you know, even if we stop polluting tomorrow, there are changes locked in obviously for decades. So that's one big task for the whole system prepare for the physical risks. But there's, of course, another whole angle to this. And that is that we also need to prepare to reduce our transition risk. Every sector, education, transport, energy is going to have to get to net zero and the health system will have to do that as well. And as you can see, here, it could be argued, you know, we are, if the health system were a country, it would be the fifth biggest polluter on the planet. And we are major producers of carbon pollution, of air pollution, of plastic pollution, as shown on this title here. So we will have to get, we will have to mitigate our own service and get to net zero. Okay, so to get to a net zero health system, you first need to know what your carbon footprint is. This is the carbon footprint of the National Health Service in England, I used the most up to date and detailed analysis that I've seen, although of course, we've done some similar work in Australia. So you can see there, the green section is travel, that's patient, staff, and visitor travel. So about 10% of the footprint is from travel. The red section is direct delivery of care, it's about a quarter of emissions. And you can see that they are usual suspects: fleet and business travel, water and waste, building energy, but also specific carbon hotspots: anaesthetic gases and Metered Dose inhalers. And then of course, the key point is that the big blue section, the supply chain, is more than 60% of our carbon footprint. That's pharmaceuticals and chemicals, medical devices, equipment, you know, right down to throw food and furniture. So that's, you know, a really important area that's going to have to be addressed. And how do you get to a net zero health system? Well, this again, is modelling from the NHS. I'll talk you through this. So you can see on the x axis you've got time, so from 2008 up to 2050. And then on the y axis, you've got carbon emissions in kilo tonnes of CO2, a carbon dioxide equivalent. You can see that the NHS has made some good progress, and the top dotted-line is projection one, it's doing nothing, business as usual. The bottom dotted line is their projection to their target is to be net zero by 2040. They want to be the first carbon neutral health system in the world. And all the coloured wedges cumulatively add up to that net zero commitment. So the top purple one is decarbonizing the national grid, that's sort of an external thing, then the rest are healthcare related, so digital care, pathway redesign, and low carb models of care. So telehealth is a good example there. Preventive Medicine. Then in the blue section, specific carbon hotspots, anaesthetic gases, low carbon inhalers, nitrous oxide, then in the yellow that's about transport, so shifting to public and active transport, video conferencing, rather than flying to conferences, things like that. Then the next two purple sections that engineering type stuff, solar panels, energy efficiency schemes, LED lights, and so on. And then research innovation and offsetting. So the key point here is that there is no silver bullet. Getting to a net-zero system is going to require changes across pretty much area, every area of the health system. But the clinical stuff is much more important than everyone suspects. This is not just about solar panels. This is about transformational change in models of care and in our procurement and in the very things that we do in healthcare. So Northern Sydney local health district, we now have a board approved target of net zero by 2035. That's going to be announced publicly next week. We have a planetary health framework, we have a planetary health committee which is chaired by a chief executive. And we have five priority domains you can see there with working groups in each of those. And you know, for instance, that the capital works director as the leader of the capital works one, the Health Promotion director is the head of people and places. I'm most involved in models of care. And what we would like to do and what we're starting to do is to set up net zero teams in each sub-service or specialty. And of course, in the longer term, we're going to have to do this in every service. We're going to start with the carbon hotspots initially, with anaesthetics and respiratory medicine. So for instance, this is one of our anaesthetics registrars, Max, who is setting up a net zero team in anaesthetics, and that will be doctors, nurses, pharmacists, allied health staff at all different levels, so senior down to junior staff, paired up with researchers. So we need experts in carbon accounting, and implementation, behavioural science and things. And the task for that team is okay, what does the next zero anaesthetic service look like by 2030 or 2035? Now we're going to need to do a series of projects aligned with that, and evaluate them and then whatever works we scale up and share. In my role now, central statewide role, will be looking to scale up and share those sort of successful models across the state. Some things will be specific to that specialty. For instance anaesthtic gases that talk about specific gases, that some approaches will be generic across specialties. And I think these, this is, when I present to clinicians, this is the most important slide for them in thinking about a net zero, you know, rehab service or respiratory service or whatever. And these are four principles. So the first one is prevention. Okay. And that's because one type of carbon neutral system would be a system in which we didn't have any patients. Okay? Everyone was healthy and well and independent in their homes and their communities. Okay, so prevention is always key. Linked in without patients is self care. So having patients who are more engaged and more involved in their care, peer to peer model, social prescribing, compassionate communities, all that very strong primary community based care. So one interest of linking together. The third principle of it is about minimising wasteful activities. Okay, that's not rubbish bin waste. That's clinical waste. So we know there's significant harms and risks and costs involved in overdiagnosis and overtreatment. And those costs and not just financial cost, but also carbon costs. That's third principle. And then the fourth one is, okay, where we do have appropriate care, where we are providing evidence based effective care, how can we decarbonize that? So a couple of quick examples about those, and that third point. So firstly, we focused on prevention. Next, we reduce low value care. On the low value care, this is paper that we published an MJA a couple of weeks ago. You see on the left there is the pie chart. That's the pie chart showing the Australian healthcare system's carbon footprint divided up into non clinical and clinical care. Clinical care is about 80% of that. We know from the work done by organisations like Wiser Health care, and the literature out there, that have clinical care about 10% is harmful care. That's an investigation, or a procedure, or a test that wouldn't have benefited the patient. The patient ends up actually having a bad outcome. It's harmful care, and then 30% is low value care, overdiagnosis and overtreatment. So over all the clinical care in this country, we are currently wasting more than 10 million tonnes of carbon dioxide equivalent on harmful or low value care. We need to reduce that clearly. And then the fourth one's about low carbon alternatives. And that's because, you know, in the future carbon will be as important as money. It will be like a whole new currency. And health professionals need to understand carbon cost of investigations and tests and procedures that they're ordering. There's a really important role, of course, researching that, and already they're training professionals in that. And this is just one example. This is the carbon footprint of the five most common hospital pathology tests. There is now literature on the carbon costs of everything from cataract surgery to different, you know, childbirth deliveries to reflux treatments. Now, this is a rapidly growing literature base, and we need to be rapidly expanding that. And so on the final slide just in terms of whatever our research needs, clearly all the research around prevention is always critical noise and important consideration, but then about also about reducing low value care, what is the low value care? How can we safely and effectively reduce that? and the sort of implementation behind that as well and the carbon economic costs of that would be really helpful. And carbon accounting, it's going to be a key skill for health professionals and researchers in this space. And we need much, we need much more information about that. In New South Wales Health, we're going to need to understand what is our baseline. How are different hospitals and districts tracking in terms of, you know, reducing their carbon emissions, you know, monitoring and measuring performance and so on. And then of course, about implementations. We have some great ideas about how to switch from anaesthetic gases to others, or media dose inhalers or how do we reduce plastic waste in theatre. We, in theatres, we need to understand actually how can we implement that and there's a lot about behavioural science and implementation science that's important in that. So the are the things, I think that we can work together on. Thanks so much, Veronica.

Veronica Matthews  1:39:04  
Thanks so much, Kate. Fantastic presentation and as you know, a very key area of work for HEAL under the leadership of Alex Barrett and Katie Bell and yourself. Well, we're right bang on time, but we do have time for a couple of questions. If anyone in the audience has a burning question to ask of any of the panellists. Please just unmute yourself and fire away.

Matthew Riley  1:39:43  
Veronica. Can I ask a question of Kate?

Veronica Matthews  1:39:47  
Yes, I can't see you.

Matthew Riley  1:39:50  
It's Matthew Riley. (Oh Matt. Go for it). Great to see the detail that's gone through and I've heard so much about the movement in health in New South Wales. I just want to, I just thought I asked you to comment on getting that top level management buying? And then being able to get what are very busy healthcare professionals to actually come on board as your zero champions. What specific barriers that came up, or what was successful for you, how to overcome them. 

Kate Charlesworth  1:40:23  
In my experience, I've been a sustainable leader in New South Wales Health System for a few years now, in my experience, there's heaps of interest and passionate clinician, you know, a volt, you know, doctors, nurses health professionals out there, but they have been constrained, you know. They're constrained because they see it's not interesting, because it's not a KPI, or because they can't speak to their supplier because there's some sort of obscure procurement policy, or whatever. What I'm so excited about now is that I'm actually now in a statewide central role as well. So I'm hopefully in a position to start looking at those. And look, I mean, the penny is dropping. This climate risk is now one of the secretaries of New South Wales Health top six priorities. And they're setting up, we're setting up a climate risk unit there. And I'm in a system purchasing branch, which is involved in setting up a lot, you know, some of those structures. So I'm hopeful that we can start to remove some of those barriers, because it's just about in some ways, it's just about getting out of the way, and allowing frontline staff who know what needs to happen, who can safely implement a lot of these changes to do that work. So yeah, I agree. It's been pretty frustrating for many of us. But I'm hopeful, I'm hopeful now.

Veronica Matthews  1:41:33  
Thanks, Kate. There is another question that popped up in the chat about the role of service redesign and decentralisation? What role does that have in reducing the climate footprint of health services?

Kate Charlesworth  1:41:50  
In service redesign? So in terms of like, models of care and things, or what was it?

Anthony (Asthma Australia)  1:41:57  
Yeah. Hi, Kate. It's Anthony here from Asthma Australia. Thanks, Veronica, for relaying my message. Yeah. I mean, yeah, just sort of zooming out and going, okay, we can do a lot by improving processes, waste management, whatever resource generation, etc, and within the structures that we have inherited. But is there a way to deliver healthcare in a different, in a different model? So that we're not relying on the big behemoths that, to deliver it, and generate the required the energy and generate the waste?

Kate Charlesworth  1:42:31  
Well, yeah, I mean, you saw. Yeah, I mean, I think the big question is, how do we get better health from less healthcare? You know, that's the big question. And, I mean, in an ideal system, if you were starting again, you'd probably only have, I mean, hospitals are very, in the carbon footprint of Australian Health System, hospitals, a half of it, you know. Whereas primary care and community care a small fraction of that, so yeah for so many reasons we need to be shifting towards stronger primary community based care because it's better for patients, it's more accessible, it's local, it stops people getting sick and ending up in hospital, there's a whole bunch of reasons, this is another reason to do that. And if you're designing a sustainable, you know, have a neutral health system, you'd probably only have, like, I've seen this modelling for the UK, eight big hospitals, where you do only in hospital what you can do in hospital, like the transplants, and heart surgery, that sort of thing. And the rest of it would be much better, you know, primary community cares, community care centres, different completely different models, you know, than the current system. But we can do, I mean, it's interesting, you know, in the Primary Health Networks has done to get involved in this the collaborative commissioning space, you know, the, you know, the shift away towards community care, having specialists go out to communities in general practices. There's things starting to happen, but it has, it needs to happen at scale and at pace. That's the challenge, I think. Yeah. Does that answer your question? Sorry.

Anthony (Asthma Australia)  1:43:56  
Thank you. I don't think easy solution, no easy answer, but I think appreciate your thoughts.

Veronica Matthews  1:44:00  
Thanks, Anthony and thanks again, Kate. I see a number of other questions popping up around the need to develop curriculum materials on the work of HEAL, unfortunately, Tony Capon has had to step away for another meeting so we can't ask him about whether he's given much thought to, you know, to providing some of those materials around planetary health.