The past 12 months have seen the Covid-19 pandemic ravish societies and economies the world over. Throughout this period, the twin challenges of the climate and ecological crises have continued to build momentum as extreme weather events, from floods in the UK to wildfires in Australia, wreak havoc on lives, homes and livelihoods. Much has been made of the link between the Covid-19 pandemic and the climate emergency. Both commenters and researchers alike have drawn attention to the manner in which systemic shocks can exacerbate existing inequalities, impacting disproportionately on poor and marginalised individuals and communities; those who belong to the most disadvantaged sections of society have been the same people most likely to be subject to the sharp end of the stick when it comes to the impacts of the pandemic.
Meanwhile, over the same time period, the wealthiest individuals within our societies have increased their net worth by over $1 trillion. Later this year, the UK will be hosting the COP26 Climate Change Conference, which commentators suggest constitute the most important talks in decades. There is strong expectation on both the UK Government and devolved nations (especially Scotland where the talks are to be held) to demonstrate that they are taking action to meet their legally binding carbon emission reduction targets (net-zero by 2050 in the UK, 2045 in Scotland) in a manner which maximises the development of a sustainable and healthy approach to economic development.
Within this context, a timely report has been published by the ‘UK Health Expert Advisory Group’, titled ‘Sustainable Health Equity: Achieving a Net Zero UK’. The report builds an extremely strong case for embedding concerns for public health and wellbeing at the centre of climate change decision-making, an approach that has the potential to tackle deeply embedded inequalities across social, economic, and environmental spheres. This briefing will begin with an overview of the five key themes of the report, following this the implications for local government will be considered. To conclude, the comment section will discuss the opportunities and challenges related to embedding improved public health and well-being outcomes within post-Covid sustainable economic models, including where the general public can play their part.
‘Sustainable Health Equity: Achieving a Net Zero UK’
UK Health Expert Advisory Group (UKEAG) were formed by the Committee on Climate Change (CCC) in 2020 to ‘advise on developing an approach to assessing the health impacts of setting the sixth carbon budget covering 2033-2037’. Their most recent report, ‘Sustainable Health Equity: Achieving a Net Zero UK’, is centred around five key themes which constitute major opportunities to align future climate action with improved public health and wellbeing outcomes, they are: outdoor air pollution; housing and buildings; sustainable diets; transport; a sustainable and healthy economic model. Although it is beyond the scope of this brief to relay the entirety of this comprehensive report, those who do wish to engage with the document in full can access it here.
Outdoor air pollution
Poor air quality can harm health significantly. According to the UKEAG, air pollution ‘is associated with heart disease and stroke, as well as exacerbating respiratory conditions such as asthma, chronic obstructive pulmonary disease, lower respiratory tract infections and carcinomas of the respiratory tract. Particulates are estimated to cause around 29,000 deaths in the UK each year and up to 40,000 deaths when nitrogen dioxide exposure is also included’.
The report’s recommendations to tackle air pollution are centred around supporting ‘a just energy transition that minimises air pollution from all sources’. They include a number of regulatory and fiscal interventions, ranging from prohibiting future installation of wood stoves (particularly in urban areas) to investment in re-training and efforts to diversify affected local economies with a just transition for workers (prior to closure of fossil fuel industry sites).
The authors take care to note that whilst co-benefits to health from reduced air pollution will depend upon the future make-up of the energy mix, ‘low Greenhouse gas (GHG) scenarios that rely on increased use of domestic biofuels and biomass to replace fossil fuels will bring lesser health gains than if these fuels play a smaller role’.
Housing and construction
Cold homes are associated with a significant number of negative health outcomes, including respiratory infections (which are the leading cause of excess winter mortality in England) and circulatory diseases. According to the UKEAG, the experience of living in a cold home has also been linked to negative mental health in adults, with worries about debt, affordability, and negative impacts on health all contributing to mental stress. On the other hand, the UKEAG highlight research demonstrates that ‘warm homes have been found to contribute to reductions in the incidence of cardiovascular disease, cardiopulmonary disease, lung cancer and childhood asthmas and improved mental health and well-being’.
The report’s recommendations to improve the quality of housing and buildings is focused around designing and retrofitting homes to be energy efficient, climate-resilient and healthy. Several regulatory interventions are cited as possessing the potential to meet this challenge including the need for an ambitious target for the number of existing homes to be upgraded each year with energy efficiency and ventilation improvements, as well as the revision of building standards to become near zero or zero carbon with flexibility to adapt to regional needs.
The authors take care to highlight how approaches to retrofit need to be tailored to specific properties and regions, as opposed to undertaking a one-size-fits-all approach. Furthermore, attention is given to mitigating against overheating homes through the use of ventilation and passive cooling technologies; this will become more important, especially in vulnerable urban areas, as global average temperatures increase and extreme weather events (including heatwaves) grow in frequency. See LGIU’s briefing on climate-proofing housing here.
The sustainable diets section of the report begins by stating that: ‘there is a growing evidence base to inform the general principles for a healthy and environmentally sustainable diet. However, in many respects, food systems globally are increasingly unhealthy and unsustainable’. According to the UKEAG, ‘to reform the entire food system to achieve healthy and more sustainable average diets is a complex subject that will be more thoroughly addressed in the forthcoming National Food Strategy’. Instead, they focus on ‘primary objectives to reduce diet-related GHG emissions from the production and consumption of food while promoting equitable availability of healthy diets’.
Overall, this is a busy section with lots of important information across both environmental and health spheres which are too numerous to cover in their entirety, however, attention is drawn to inequalities of diet, risk factors for morbidity associated with poor diet, and agriculture as a major contributor to pollution and environmental degradation. According to the authors, the environmental impact of food systems, unequal and poor UK diets, the obesity epidemic and food waste are all interlinked issues that require joined-up government action.
With regards to interventions, the UKEAG state that: ‘there is no one single approach to both reducing the GHG emissions from food systems and improving health by improving diets. A combination of approaches is required, including: adapting livestock practices, educational interventions and enacting behavioural change to reduce meat consumption and food waste, increasing the nutritional value of food, increasing the consumption of minimally processed plant-based proteins, and solutions addressing fair distribution of food resources’. Read LGIU’s briefing on diet’s role in tackling climate change here.
The transport section begins by highlighting that the sector is the largest source of carbon dioxide emissions in the UK, whereby in 2019 surface transport accounted for 24 per cent of emissions and aviation and shipping a further 10 per cent. The report highlights that uptake of Electric Vehicles (EVs) and a modal shift away from private ownership of vehicles are the two most likely options for decarbonisation of transport. According to the authors: ‘legal duties to reduce emissions from vehicles will go some way to reducing air pollution from transport, but more ambitious policies are required to drive a modal shift towards behavioural changes and increased use of walking, cycling and public transport’.
The authors are keen to stress that increased active travel offers more public health benefits than relying on a transition to EV vehicles alone (which will still produce non-tail-pipe emissions even if they are powered by renewable energy). Beneficial health impacts may include reduced risk of cardiovascular disease, diabetes, musculoskeletal health, cancer, and poor mental health and well being. Moreover, the authors cite research that suggests ‘encouraging active travel may also play a role in a wider approach to reducing obesity – based on country-level evidence that obesity rates are increasing in countries where active travel is declining’. Read LGIU’s briefing on urban planning to tackle obesity here.
The UKEAG offer a number of recommendations for regulatory and fiscal intervention. These are too numerous to relay in full here (see report) but include legislation for urban planning models that reduce journey distances by encouraging localised amenities to reduce routine journey distances and replacement of the predict and provide model of national road investment with a process that incentivises investment in walking and cycling routes.
A sustainable and healthy economic model
The sustainable and healthy economic model section of the report begins by stating that ‘the UK’s current economic approach, like many other Western economies, will not lead to a net-zero future within the timescale required to achieve the aims of the Paris Agreement’. The authors go on outline the health-driven case for a more equitable economic model by highlighting that, ‘in the last decade in the UK, the rich have become richer and as a result, the rich have also become healthier’.
Framed around the notion of developing healthy and sustainable models of work, this section of the report is packed-full of insightful (and critical) contributions which draw attention to the fact that, as of yet, inclusive growth and a sustainable recovery have not been at the heart of the UK Governments plans for economic rebound. The authors draw attention to the massive, no strings attached, bailouts for high polluting organisations with poor track records of looking after their employees. However, the UKEAG also note that, despite this, ‘there is potential to guide the huge injection of public resources into the economy required for the recovery, to achieve employment, health, environmental and socioeconomic benefits through an integrated approach’.
There are numerous regulatory and fiscal interventions recommended by the UKEAG concerning how to work towards a sustainable and healthy economic model, perhaps most notably further investigation of the 4-day week and adoption of the Well-being-Years metric. In addition, the authors cite the principles developed by the Committee on Climate Change (see here for full list), which they state are likely to be good for work and jobs as well as for climate change mitigation; these range from using climate investments to support economic recovery and jobs to ending economic short-termism and the maximisation of economic efficiency over the resilience of communities.
Implications for local government
There are key implications for local government from the Sustainable Health Equity report. First and foremost, the UKEAG report tactfully demonstrates that embedding health and wellbeing at the centre of climate change decision making can yield an enormous number of co-benefits across multiples spheres. Local authorities have an opportunity to take on a leadership role (as they have done with the Covid-19 response) and support more inclusive, healthy, and sustainable local economic growth. For example, this could include prioritising local infrastructure investment in projects with the potential to yield the most co-benefits across environment, public health and well-being like: active travel, access to green space, community or municipal allotments, community wealth building, procurement and housing retrofit. Furthermore, it is worth noting that the UKEAG draw attention to how diverging regional demands will necessitate flexibility; in other words, complimentary climate, well-being and public health policy actions at local levels always sits within the context of place and do not lend themselves to a one size fits all national approach. This should be remembered at decision points and project funding by all public services. i
The UKEAG report on Sustainable Health Equity is a timely and much-welcomed piece of work. It builds an extremely strong case for embedding public health and wellbeing at the centre of climate change decision-making. After many months of doom and gloom, it is heartening to be reminded of the potential human gains to made from tackling climate and ecological imperatives at their roots. Furthermore, by engaging with topics which powerful interests spend a lot of money lobbying against (namely sustainable diets and sustainable economic models), the authors ensure health, well-being and climate action is contextualised within a more representative suite of potential interventions than business-as-usual interests would have us believe. We do not have to continue as we have. We can be healthier and happier as both peoples and planet. With this in mind, it is encouraging to see that public support for a COVID-19 recovery favours measures that consider health and well-being to a much greater extent than measures which favour economic growth alone.
Of all the recommendations and interventions suggested within, I want to draw particular attention to metrics. According to the authors, national governments should consider adopting Well-being-Years (WELLBYs) or an equivalent metric to measure impacts on health and wellbeing and ensure that health considerations are incorporated into decision-making in a consistent and transparent manner’. This is particularly important as without a legitimately recognised way of measuring the impacts of potential policies on health and wellbeing, it remains unlikely that policymakers and will embrace the approach.
I’d like to finish with a quote from the authors, a comment which was informed by their evidence and research and which rings true now more than ever: ‘in the UK a new economic model is needed post-Brexit and as a result of the Covid-19 pandemic: an economic model that does not emphasise the benefits of increasing GDP and infinite growth, but one that is more sustainable and equitable’.
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