Identification of the need for action on planetary overload and ecosystem damage spans decades.1,2 In the complex world of increasing global population, increasing resource and energy use, waste production, emerging limitations to resource availability and worsening damage to the ecosystem functions on which human survival are founded, our energy source choices are contributing excess greenhouse gases to the atmosphere that drive a cascade of ocean acidification, global warming and climate change.3

Del Weston called for decisive action in this journal.4 The cover of the February 2013 issue highlights the problem. Yet our response lags behind the necessity.

Case for action on energy

  1. Top of page
  2. Case for action on energy
  3. Role of Public Health
  4. Strategic focus on energy corporations?
  5. Conclusion
  6. References

The actual and potential global warming health effects are well documented. These include an amplification of a host of existing issues and can be considered in three groups (Figure 1).5,6


Figure 1. Health effects of global warming.

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First are the direct effects: increased deaths and morbidity from heat waves and injuries from more severe or frequent weather events, compounded by sea level rise and population shifts. Next are the secondary, indirect effects from ecosystem changes in natural cycles and functions. These include the changed range and timing of infectious diseases; changed temperature, rainfall and evaporation effects on plants additional to those from increased atmospheric CO2 concentrations; sequelae from changes in micro-biota influencing soil fertility; and changed insect ecology that will effect crop fertilisation and pest prevalence and behaviour. All of these are likely to synergistically reduce agricultural output and quality resulting in food insecurity. The economic and social consequences of these and other systemic effects will reduce both capacity to respond, including health system capacity, and psychosocial wellbeing.7–15

The international scientific and political consensus is that to minimise climate disruption, average global temperature should not increase beyond two degrees centigrade (20C)16 above pre-industrial levels. More recently, concerns that the planet is probably going to exceed this 20C guardrail, with consequent serious adverse effects on the economy, wellbeing and health – unless very urgent action is taken – has been expressed by the World Bank.17 Both the World Bank and the International Energy Agency18 call for rapid de-carbonisation of the energy sector to avoid this.

The Climate Commission's Critical Decade 2013 report19 sets out the updated scientific basis for action and concludes:

“The carbon budget is clear and compelling. To stay within the 20C limit, the trend of increasing global emissions must be slowed and halted in the next few years and emissions must be trending downwards by 2020 at the latest. Investments in and installations of renewable energy must therefore increase rapidly. And, critically, most of the known fossil fuel reserves must remain in the ground.”

The carbon budget is a concept based in the realisation that it is the cumulative stock of greenhouse gases (GHGs) in the atmosphere that forces total biosphere warming. The budget refers to the volume of GHGs that can be emitted to drive a particular amount of warming. Different groups working on budgets use different starting points, and some use CO2 while others use carbon, so each produces a seemingly different cumulative budget. However, the outcome is consistent even if numbers vary – total global warming depends on total emissions. Conversely, the probability of reaching a particular level of warming will dictate the budget to be chosen.

The most recent Intergovernmental Panel on Climate Change (IPCC) report estimates that, to have a 50% probability of not exceeding 20C relative to 1861–80, humanity can emit less than 1,210 gigatonnes of carbon (GtC). A 66% (that is, better) probability of avoiding 20C has a budget of 1,000 GtC. If non-CO2 forcings are included, the numbers are 840 and 800 GtC.20 Emissions to 2011 were 531 (446–616) GtC. At current emission trajectories it is likely we will pass 20C in the 2040s.21 Further, emissions and rates of emissions are increasing,22 so the probability of passing the 20C guardrail is high.17

Because of the magnitude of adverse effects on human society and health, and the limited timeframe that the science is suggesting we have to take remedial action, excess greenhouse gas emissions constitute a public health emergency that is unusual in its urgency, breadth and duration of effects, but its slow pace of onset.

Human society needs to both reduce overall demand for energy by primary demand reductions (less energy use, less consumption, more active forms of transport) and by dramatic improvements in the efficiency of systems and appliances, and simultaneously transition away from fossil fuel use to renewable energy sources. Plans for such energy transitions exist, for example, those of the ClimateWorks Australia and the Beyond Zero Emissions/Energy Research Institute, which provide examples of how this could be done with existing technology, if political will was present.23,24

Role of Public Health

  1. Top of page
  2. Case for action on energy
  3. Role of Public Health
  4. Strategic focus on energy corporations?
  5. Conclusion
  6. References

If the public health community is to be relevant to the management of this set of wicked problems, then we must actively do public health with the degree of response commensurate to what is required.25 Our response needs to draw on the whole gamut of public health practice, from noting and monitoring the problems, educating the public, the health professions and decision takers and forging alliances with others taking action, to advocating for a full range of institutional responses from social marketing through policy development to legislation.26 We must engage with the complexity and systemic nature of this crisis not only with warnings, but also with offering hope by explaining the benefits of action.27

However, this greenhouse gas driven environmental emergency is different in both timing and magnitude to those we are accustomed to. The timeframe of emergence is decadal and the consequences will play out over decades to centuries. Recognising both the eventual magnitude of these consequences for health, wellbeing and society, which may even include extinction of the human species, and the urgency with which the science suggests we act to minimise these threats and manage the risks, our response needs to be prioritised more akin, for instance, to threatening pandemics than road safety.

Further, giving priority to action on global warming will still have to be balanced with the need to continue to address the whole range of immediate and ongoing public health issues confronting us, such as road safety and the socially and economically determined drivers of modern chronic disease.

Fortunately, action addressing GHG emissions and the socially determined modern lifestyle risk factors and illnesses, such as obesity and diabetes, overlap – both require addressing fundamental flaws in our modern economic and political systems. These systems are characterised by an overproduction-consumption nexus, emphasis on individualist personal freedom and a free market focus. Core to this is the rise of a corporate culture manifest by behaviour that focuses on influencing government to relax regulation that protects society and the environment, externalising their risks and costs to society and the environment, and marketing goods and services under the illusion of consumer sovereignty, all with the emphasis on generating growth and profits rather than service. This influence of corporations over our social and political space results in environmental damage, increasing inequality, reduced social wellbeing, and the ‘lifestyle’ diseases.28–32 In essence, therefore, our response should include making governments more democratically accountable to their citizens in order to more effectively regulate corporate behaviour.33

In relation to global warming, while our response needs to incorporate the full public health toolkit, a focus on corporate behaviour as a key driver of the system permits a particularly strategic set of actions. The corporations primarily driving greenhouse gas emissions are energy businesses with an interest in fossil fuels. Globally, they have stocks of coal, gas and oil equivalent to 2795 GtCO2 (note CO2 not carbon). That is about five times the current 565 Gt CO2 budget allowance34 and, as Bill McKibben puts it in Do the Maths, their express aim is to put this into the atmosphere. This underpins their share price and their capacity to borrow money.35

Specifically, the public health movement needs to recognise the similarities to classical public health campaigns on social harms: the old public health response with sanitation to prevent infectious diseases, and the new public health response to the tobacco, food and alcohol industries. Accordingly, we need to oppose the expansion of the fossil fuel industry and push for an orderly yet rapid energy transition to renewable sources. Despite the urgency, a rapid but orderly planned transition will minimise the distress and social and economic disruption that comes from such extensive change.

We need to be adding our voice to that of other health organisations such as Doctors for the Environment Australia and the Australian Medical Association. We also need to be inviting members of public health organisations and academic institutions to join activities already underway to begin this socioeconomic transition.

Strategic focus on energy corporations?

  1. Top of page
  2. Case for action on energy
  3. Role of Public Health
  4. Strategic focus on energy corporations?
  5. Conclusion
  6. References

In a more traditional vein, investigating and informing decision makers, the public and the health professions about the direct and indirect effects of fossil fuel use is still important. Explaining that the economic costs of fossil fuel emissions are externalised by industry and society generally and that this results in direct and longer-term costs being borne by society and government is important, so that public and decision makers understand the consequences of our choices about energy source. The Climate and Health Alliance, of which the Public Health Association of Australia is a member, has set up a collaboration to investigate and publicise how energy choices affect health.36 Doctors for the Environment Australia (see: is active in education about the health effects of fossil fuel use and working with local groups who are wanting information about fossil fuel developments in their regions. Advocating for a realistic price on carbon is required, to drive innovation toward changing our energy systems to less carbon intensive ones, with renewable energy being the least carbon-producing.

In acting specifically to limit GHG emissions, an extension to the usual set of public health responses outlined above is required. Two broad proposals are being suggested. One set of activities, recognising the combined ethical problems and heightened financial risk from impending financial fragility of investments in the fossil fuel industry, is seeking to have social institutions – including universities, governments, superannuation schemes and other large financial players – divest themselves of fossil fuel investments and invest instead in socially and environmentally safe energy options. This both deprives fossil fuel energy companies of finance and begins to remove their social licence.

Becoming involved in activity such as the divestment campaign ( and Asset Owners Disclosure Project ( for organisations and individuals would help. Health organisations can look at and act on their own portfolios. This also will help drive expansion of renewable energy assets. The role of the successful divestment campaign against companies investing in apartheid South Africa is one example of such an action. These are personal and institutional public health activities.

Secondly, stepping beyond this level of action is protest using non-violent direct action (NVDA), also known as civil disobedience, as a tactic to bring about change. NVDA is suggested because of the potential severity of consequences from and urgency of the situation, and the glacial pace of societal response. Such action may be required to both publicise the matter and force government to carry out its public health protection responsibility. Gandhi's resistance to the British occupation of India is the prime example of effective NVDA. In Australia, more recent action against US military bases provides another example.

This proposition is contentious both for individuals and for organisations. Numerous valid reasons exist not to participate in NVDA for individuals (life stage, career, employment situation) and organisations (credibility, contractual relationships). It is always up to an individual or organisation to weigh up and balance these reasons with the ethics and urgency of the situation facing our species. However, it must be recognised that unless the realistic transition to renewable energy and associated measures begins soon, the consequences for public health will be enormous. Consequently, the public health community needs to consider all options available to it.


  1. Top of page
  2. Case for action on energy
  3. Role of Public Health
  4. Strategic focus on energy corporations?
  5. Conclusion
  6. References

In order that we can tell our grandchildren that we really tried to conserve a habitable planet for them and their grandchildren, rapid action to transition from fossil fuel energy to renewables is needed. Since regulating corporations, the de-financing of the fossil fuel industry and maintaining a price on carbon to internalise costs are key factors in driving this change, the public health community must, in addition to their traditional roles, become active in social and political movements to these ends. Action is needed by individuals and by organisations – starting now. While many important foci for public health action exist, minimising the risks from greenhouse gas emissions is the most immediate and over-riding. Without mitigating greenhouse emissions, any advances on other important public health fronts are likely to be lost in the ensuing socioeconomic disruption. It is time to do public health.


  1. Top of page
  2. Case for action on energy
  3. Role of Public Health
  4. Strategic focus on energy corporations?
  5. Conclusion
  6. References
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