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The Climate Change Commission’s (the Commission’s) draft report (the Report) and recommendations provide a useful pathway towards achieving the New Zealand Government’s commitment of net zero emissions by 2050.[[1]] But the Commission’s draft advice does not adequately consider how climate change actions could produce health co-benefits or potentially exacerbate existing health inequities. The evidence for mitigation-related health co-benefits is substantial.[[2,3]] Indeed, extrapolating recent international evidence[[4]] to the New Zealand context suggests that climate change mitigation could ultimately prevent thousands of premature deaths per year in coming decades. This impact could be through dietary changes, increased active transport and reductions in air pollution. Unfortunately, the Commission makes no such quantitative estimates of the health impacts of its proposed policies, thus overestimating cost relative to the benefits of climate action. This omission is despite extensive international work and local research documenting the likely high magnitude of these health co-benefits. In this viewpoint, we assess how the Commission has considered health co-benefits in the key response domains and provide evidence that could be used to improve its response.

Food environment and dietary patterns

The Report is largely focused on the industrial “food production” system and does not mention the word “diet” (eg, human diet) despite the huge potential co-benefits from a move towards more plant-based diets.[[5]] It notes that “Transitioning to a low emissions economy will require New Zealanders to change some aspects of their lives,”[[1]] yet reducing consumption of meat and dairy is omitted from the examples provided. New Zealand research demonstrates a shift towards more plant-based diets could lower greenhouse emissions, improve health, lower costs to the public and lower healthcare costs.[[6–8]] One New Zealand study demonstrated that, if New Zealanders adopted the New Zealand Dietary Guidelines, diet-related emissions would reduce by 4–42%, depending on the degree of dietary change and food waste minimisation.[[7]] The estimated lifetime health gains for the current New Zealand population were 1.0–1.5 million quality-adjusted life-years, and the estimated healthcare system cost-savings were NZ$14–20 billion. Another New Zealand study showed the large health gains and cost-savings from a modelled junk food tax and a saturated fat tax,[[9]] with some of these benefits arising from reductions in meat consumption. Finally, the health co-benefits of improved diets also include potential reductions in health inequities as Māori and Pasifika disproportionately suffer chronic diseases (cardiovascular disease, diabetes and some cancers) related to New Zealand’s obesogenic food environment.

Plant products typically produce far fewer greenhouse gas emissions compared to animal products.[[10]] Indeed, New Zealand meat and dairy products still produce approximately five times the greenhouse gas emissions per gram of product of the highest plant-based emitter, rice.[[7]] Plant-based milk and meat, which is becoming increasingly price competitive, is estimated to contribute around 4% of the greenhouse gases per unit of protein and use less land and water compared to meat and dairy.[[11]]

The Report also says that “red meat and dairy products from Aotearoa are already some of the least emissions intensive in the world.”[[1]] However, the lifecycle assessment for lamb and beef emissions have point estimates that fall within the confidence internals of global averages, suggesting there is no statistically meaningful difference between New Zealand and the international pattern of global emissions for lamb and beef.[[7]] Further, such comparative analyses can be misleading because they typically don’t consider that dairy and meat production still generate the largest dietary emissions by far, as well as having other land-use consequences (eg, the native bush that was removed to allow for livestock grazing). For example, one New Zealand Government report noted that “The exclusion of carbon losses arising from forest harvesting, deforestation and scrub clearance has a significant impact on the overall estimate of net emissions and removals.”[[12]] The ideal analysis of agriculture/food impacts should also account for the carbon costs of using coal in the milk drying processes often used in New Zealand, which was not considered in one study of the carbon footprint of New Zealand milk.[[13]] Finally, greater independence from industry-produced or funded livestock lifecycle assessments is required to ensure the validity of the results.

Physical activity benefits from active transport

The Report states: “There are significant co-benefits from increasing alternative types of transport. In particular, walking and cycling benefit health.”[[1]] Two New Zealand publications on the benefits of active transport for health are referred to in the Report.[[14,15]] But, considering that this might be the second most important area for health gain, there is still a marked lack of detail on these benefits.[[4]] This deficit includes the minimal consideration of increased use of electric bikes, despite their rapid uptake in many cities internationally. Other relevant New Zealand-based modelling work was not mentioned. For example, this other work reported that switching short vehicle trips to walking and cycling could generate large healthcare cost-savings (range: NZ$127 million to NZ$2.1 billion) and reduce greenhouse gas emissions by up to 194 kilotonnes CO2e/year.[[16]] Another modelling study that considered health aspects of bicycling (relating to physical activity, injury and air pollution) reported that “transforming urban roads over the next 40 years, using best practice physical separation on main roads and bicycle-friendly speed reduction on local streets, would yield benefits 10-25 times greater than costs.”[[15]] Improved walking and cycling infrastructure would particularly improve transport options for Māori, Pasifika and low-income New Zealanders.[[16]]

International and local examples show that a rapid and substantial mode shift towards active and public transport is highly achievable.[[17,18]] For example, an evaluation of New Zealand’s “model communities” found a 30% net increase in active transport in intervention cities compared with control cities over a three-year period.[[19]] Yet this potential is not reflected in the Report’s mode shift assumptions, which are modest (“walking, cycling and public transport can be increased by 25%, 95% and 120% respectively by 2030”).[[1]] Instead, the Report puts emphasis on the electrification of New Zealand’s transport fleet, a strategy that will not increase physical activity or address other problems associated with car-dependency, such as the safety of children and other vulnerable road users, traffic congestion, cost of road maintenance or use of valuable urban land for storing cars.[[20]]

Benefits from reduced air pollution

Another co-benefit of using less fossil fuel for energy, heating and transportation that only received brief mention in the Report is improved health from reduced air pollution. The Report refers to one New Zealand study on the harm from air pollution to health, which estimated particulate matter emissions cause adverse health outcomes, including over a thousand premature deaths, with a cost of NZ$8 billion per year.[[21]] The Report also mentions further government encouragement for working-from-home arrangements, which may reduce air pollution from commuter traffic. Nevertheless, there is still a marked lack of detail in this important area for health co-benefits. Two other relevant papers were not mentioned: one on the association between air pollution and mortality for New Zealand,[[22]] and the other on the impact of the COVID-19 lockdown on improved air quality in New Zealand, which highlights the potential gains that can be made,[[23]] Fortunately, New Zealand estimates of health impacts attributable to ambient air pollution are currently being updated and can be included in future reporting.

Health inequities

The Report is reasonably good at considering some aspects of inequities—but these are predominantly around income inequality. The Report notes the health impacts of climate change would likely be spread unevenly across the population, with more vulnerable groups being more exposed.[[1]] It includes a vision of ensuring the low emissions transition takes opportunities to reduce inequities and consider intergenerational equity. However, the Report does not fully outline the potential of climate actions to reduce existing health inequities by reducing exposures disproportionately borne by disadvantaged groups (eg, cold, damp homes, poor food environments, air pollution and traffic injuries). This gap is despite existing health inequities being of major concern from the perspective of preventable health loss, an ethical perspective and a Te Tiriti o Waitangi (Treaty of Waitangi) perspective.

Other health co-benefits

The health co-benefits presented above are not an exhaustive list. In Appendix Table 1, we outline other health co-benefits that are also important from health, social and cultural perspectives. These co-benefits include: (i) improved health from warmer and drier homes (with improved house designs and increased use of insulation); (ii) improved cardiovascular and mental health from reduced noise pollution (with a shift to electric vehicles, increased use of rail and shipping for freight and any reduction in air transport); (iii) improved water quality from increased reforestation and livestock reductions (reducing nitrates and enteric pathogens from livestock agriculture); (iv) improved mental health, reduced injury and improved physical health and wellbeing from more compact cities and less urban sprawl (less commuting time, better access to central city services via walking and cycling).

Our recommendations to the Commission

Health co-benefits should be used to explicitly frame the Commission’s final report. The advantage of this approach is that it identifies meaningful value for the public and it is likely to create better support for action.[[24]] The idea that we can reduce emissions and simultaneously improve wellbeing (often with immediate and local effect) is far more appealing than a technical and sectoral approach to reducing emissions. Furthermore, the Commission should include reducing health inequities as a co-benefit. To assist them in this work, the Commission should include both public health expertise and Māori health expertise among its commissioners.

Health and other co-benefits should also be quantified and included in cost–benefit analyses of proposed emission-reduction strategies. Given the likely size of the health and societal wellbeing co-benefits of taking actions to reduce New Zealand’s emissions, we think it is quite possible that a full cost–benefit analysis that includes these components would be positive. This conclusion makes arguing about whether or not the economic impact is under 1% of GDP (as the Climate Change Commission has estimated) somewhat superficial and premature. Indeed, there is a need for a full cost–benefit analysis that captures the co-benefits we have outlined. New Zealand researchers have already conducted health and economic analyses on various interventions that involve emissions reductions and health co-benefits.[[7,15,16,25]] The challenge now is to integrate such findings with the higher-level economic modelling performed by the Commission to produce more comprehensive understanding of the likely impacts on society as a whole. There should also be consideration of whether GDP is the appropriate metric to be considering as the outcome of modelling. Recognising the limited nature of GDP, the New Zealand Treasury has already moved towards a wellbeing framework.[[26]] The Commission’s modelling also needs to consider the wider range of outcomes that are important to people. The Commission should consider ways to minimise any strategies that could exacerbate health inequities and develop compensatory mechanisms to counter these (eg, expanding winter heating subsidies and home insulation subsidies for those at risk of fuel poverty).

The Commission also needs to do more to ensure that the government’s Treaty of Waitangi obligations are met in all the domains covered. The sector-specific plans to reduce emissions within the Report do not reflect the values of He Ara Waiora, the analytical framework to improve Māori wellbeing that the Commission states it used to inform their work. The Commission needs to develop more meaningful and enduring partnership with Māori to fully embed these values in their work.

The Commission should also build on the experience of New Zealand’s successful response to the COVID-19 pandemic. This response to another major global health threat has shown the benefits of rapid, science-informed, vigorous government action (albeit with some aspects being far from optimal,[[27,28]] such as increased psychological stress for some[[29]] and uneven economic shocks to particular communities). A key aspect of the response was the successful communication of the need for collective action for the long-term good of all—a message that is also relevant to climate action and one New Zealanders have shown willingness to respond to. Ultimately, the COVID-19 response demonstrated how a collective response can achieve both public health and economic benefits.[[30]]

Lastly, the Commission’s final report should explain how these health co-benefits are likely to generate major cost-savings (eg, by reducing healthcare costs and improving productivity from improved health). Therefore, the overall impact on the New Zealand economy of responding to climate change may be much less than estimated by the Commission. Indeed, in the long run, the economic issues of countries responding to climate change pale into insignificance compared with the potentially catastrophic disruptions to planetary systems and human societies that uncontrolled climate change could cause.

Appendix

Appendix Table 1: Our analysis of the coverage of health co-benefits in the Climate Change Commission Report not covered in the main text. View Appendix Table 1.

Summary

Abstract

Aim

The Climate Change Commission’s draft report and recommendations provide a pathway towards achieving the New Zealand Government’s commitment to net zero emissions by 2050. However, the Commission has not adequately considered the health co-benefits of climate change mitigation. In this viewpoint, we assess how the Commission has considered health co-benefits in the key response domains. Extrapolating UK evidence to the New Zealand context suggests climate change mitigation strategies that reduce air pollution, transition the population towards plant-based diets and increase physical activity via active transport could prevent thousands of deaths per year in coming decades. Substantial health co-benefits would also arise from improved housing, cleaner water, noise reductions, afforestation and more compact cities. The Commission’s draft report only briefly mentions many of these health co-benefits, and some are completely absent. We recommend the Commission’s final report: (i) use health co-benefits as an explicit frame; (ii) ensure the government’s Treaty of Waitangi obligations are met in all the domains covered to maximise benefits for Māori health and wellbeing; (iii) build on the successful COVID-19 response that demonstrated rapid, science-informed and vigorous government action can address major global health threats; (iv) include both public health expertise and Māori health expertise among its commissioners; (v) explain how health co-benefits are likely to generate major cost-savings to the health system.

Method

Results

Conclusion

Author Information

Tim Chambers: Department of Public Health, University of Otago, Wellington. Simon Hales: Department of Public Health, University of Otago, Wellington. Caroline Shaw: Department of Public Health, University of Otago, Wellington. Michael Baker: Department of Public Health, University of Otago, Wellington. Jude Ball: Department of Public Health, University of Otago, Wellington. Christine Cleghorn: Department of Public Health, University of Otago, Wellington. Nick Wilson: Department of Public Health, University of Otago, Wellington.

Acknowledgements

A short version of this document was published in The Conversation and benefited from editorial input from this publication. Between the submission and publication of this article, the Commission’s final advice to the government was released. The final report put greater emphasis on active transport and made greater acknowledgement of the potential health co-benefits of climate action. Yet these benefits were not incorporated into financial modelling. The potential cost-savings from diets less reliant on animal products remain absent in the final report. There remains a lack of public health expertise among the commissioners, and attention to Treaty of Waitangi obligations and health equity impacts is insufficient. We cover these issues in more detail on the Public Health Expert Blog: https://blogs.otago.ac.nz/pubhealthexpert/health-co-benefits-need-to-be-adequately-considered-in-the-climate-change-commissions-final-advice/

Correspondence

Tim Chambers, Department of Public Health, University of Otago, Wellington

Correspondence Email

tim.chambers@otago.ac.nz

Competing Interests

Caroline Shaw declares funding from the Health Research Council outside the submitted work. Christine Cleghorn declares a financial relationship with Horticulture NZ outside the submitted work.

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The Climate Change Commission’s (the Commission’s) draft report (the Report) and recommendations provide a useful pathway towards achieving the New Zealand Government’s commitment of net zero emissions by 2050.[[1]] But the Commission’s draft advice does not adequately consider how climate change actions could produce health co-benefits or potentially exacerbate existing health inequities. The evidence for mitigation-related health co-benefits is substantial.[[2,3]] Indeed, extrapolating recent international evidence[[4]] to the New Zealand context suggests that climate change mitigation could ultimately prevent thousands of premature deaths per year in coming decades. This impact could be through dietary changes, increased active transport and reductions in air pollution. Unfortunately, the Commission makes no such quantitative estimates of the health impacts of its proposed policies, thus overestimating cost relative to the benefits of climate action. This omission is despite extensive international work and local research documenting the likely high magnitude of these health co-benefits. In this viewpoint, we assess how the Commission has considered health co-benefits in the key response domains and provide evidence that could be used to improve its response.

Food environment and dietary patterns

The Report is largely focused on the industrial “food production” system and does not mention the word “diet” (eg, human diet) despite the huge potential co-benefits from a move towards more plant-based diets.[[5]] It notes that “Transitioning to a low emissions economy will require New Zealanders to change some aspects of their lives,”[[1]] yet reducing consumption of meat and dairy is omitted from the examples provided. New Zealand research demonstrates a shift towards more plant-based diets could lower greenhouse emissions, improve health, lower costs to the public and lower healthcare costs.[[6–8]] One New Zealand study demonstrated that, if New Zealanders adopted the New Zealand Dietary Guidelines, diet-related emissions would reduce by 4–42%, depending on the degree of dietary change and food waste minimisation.[[7]] The estimated lifetime health gains for the current New Zealand population were 1.0–1.5 million quality-adjusted life-years, and the estimated healthcare system cost-savings were NZ$14–20 billion. Another New Zealand study showed the large health gains and cost-savings from a modelled junk food tax and a saturated fat tax,[[9]] with some of these benefits arising from reductions in meat consumption. Finally, the health co-benefits of improved diets also include potential reductions in health inequities as Māori and Pasifika disproportionately suffer chronic diseases (cardiovascular disease, diabetes and some cancers) related to New Zealand’s obesogenic food environment.

Plant products typically produce far fewer greenhouse gas emissions compared to animal products.[[10]] Indeed, New Zealand meat and dairy products still produce approximately five times the greenhouse gas emissions per gram of product of the highest plant-based emitter, rice.[[7]] Plant-based milk and meat, which is becoming increasingly price competitive, is estimated to contribute around 4% of the greenhouse gases per unit of protein and use less land and water compared to meat and dairy.[[11]]

The Report also says that “red meat and dairy products from Aotearoa are already some of the least emissions intensive in the world.”[[1]] However, the lifecycle assessment for lamb and beef emissions have point estimates that fall within the confidence internals of global averages, suggesting there is no statistically meaningful difference between New Zealand and the international pattern of global emissions for lamb and beef.[[7]] Further, such comparative analyses can be misleading because they typically don’t consider that dairy and meat production still generate the largest dietary emissions by far, as well as having other land-use consequences (eg, the native bush that was removed to allow for livestock grazing). For example, one New Zealand Government report noted that “The exclusion of carbon losses arising from forest harvesting, deforestation and scrub clearance has a significant impact on the overall estimate of net emissions and removals.”[[12]] The ideal analysis of agriculture/food impacts should also account for the carbon costs of using coal in the milk drying processes often used in New Zealand, which was not considered in one study of the carbon footprint of New Zealand milk.[[13]] Finally, greater independence from industry-produced or funded livestock lifecycle assessments is required to ensure the validity of the results.

Physical activity benefits from active transport

The Report states: “There are significant co-benefits from increasing alternative types of transport. In particular, walking and cycling benefit health.”[[1]] Two New Zealand publications on the benefits of active transport for health are referred to in the Report.[[14,15]] But, considering that this might be the second most important area for health gain, there is still a marked lack of detail on these benefits.[[4]] This deficit includes the minimal consideration of increased use of electric bikes, despite their rapid uptake in many cities internationally. Other relevant New Zealand-based modelling work was not mentioned. For example, this other work reported that switching short vehicle trips to walking and cycling could generate large healthcare cost-savings (range: NZ$127 million to NZ$2.1 billion) and reduce greenhouse gas emissions by up to 194 kilotonnes CO2e/year.[[16]] Another modelling study that considered health aspects of bicycling (relating to physical activity, injury and air pollution) reported that “transforming urban roads over the next 40 years, using best practice physical separation on main roads and bicycle-friendly speed reduction on local streets, would yield benefits 10-25 times greater than costs.”[[15]] Improved walking and cycling infrastructure would particularly improve transport options for Māori, Pasifika and low-income New Zealanders.[[16]]

International and local examples show that a rapid and substantial mode shift towards active and public transport is highly achievable.[[17,18]] For example, an evaluation of New Zealand’s “model communities” found a 30% net increase in active transport in intervention cities compared with control cities over a three-year period.[[19]] Yet this potential is not reflected in the Report’s mode shift assumptions, which are modest (“walking, cycling and public transport can be increased by 25%, 95% and 120% respectively by 2030”).[[1]] Instead, the Report puts emphasis on the electrification of New Zealand’s transport fleet, a strategy that will not increase physical activity or address other problems associated with car-dependency, such as the safety of children and other vulnerable road users, traffic congestion, cost of road maintenance or use of valuable urban land for storing cars.[[20]]

Benefits from reduced air pollution

Another co-benefit of using less fossil fuel for energy, heating and transportation that only received brief mention in the Report is improved health from reduced air pollution. The Report refers to one New Zealand study on the harm from air pollution to health, which estimated particulate matter emissions cause adverse health outcomes, including over a thousand premature deaths, with a cost of NZ$8 billion per year.[[21]] The Report also mentions further government encouragement for working-from-home arrangements, which may reduce air pollution from commuter traffic. Nevertheless, there is still a marked lack of detail in this important area for health co-benefits. Two other relevant papers were not mentioned: one on the association between air pollution and mortality for New Zealand,[[22]] and the other on the impact of the COVID-19 lockdown on improved air quality in New Zealand, which highlights the potential gains that can be made,[[23]] Fortunately, New Zealand estimates of health impacts attributable to ambient air pollution are currently being updated and can be included in future reporting.

Health inequities

The Report is reasonably good at considering some aspects of inequities—but these are predominantly around income inequality. The Report notes the health impacts of climate change would likely be spread unevenly across the population, with more vulnerable groups being more exposed.[[1]] It includes a vision of ensuring the low emissions transition takes opportunities to reduce inequities and consider intergenerational equity. However, the Report does not fully outline the potential of climate actions to reduce existing health inequities by reducing exposures disproportionately borne by disadvantaged groups (eg, cold, damp homes, poor food environments, air pollution and traffic injuries). This gap is despite existing health inequities being of major concern from the perspective of preventable health loss, an ethical perspective and a Te Tiriti o Waitangi (Treaty of Waitangi) perspective.

Other health co-benefits

The health co-benefits presented above are not an exhaustive list. In Appendix Table 1, we outline other health co-benefits that are also important from health, social and cultural perspectives. These co-benefits include: (i) improved health from warmer and drier homes (with improved house designs and increased use of insulation); (ii) improved cardiovascular and mental health from reduced noise pollution (with a shift to electric vehicles, increased use of rail and shipping for freight and any reduction in air transport); (iii) improved water quality from increased reforestation and livestock reductions (reducing nitrates and enteric pathogens from livestock agriculture); (iv) improved mental health, reduced injury and improved physical health and wellbeing from more compact cities and less urban sprawl (less commuting time, better access to central city services via walking and cycling).

Our recommendations to the Commission

Health co-benefits should be used to explicitly frame the Commission’s final report. The advantage of this approach is that it identifies meaningful value for the public and it is likely to create better support for action.[[24]] The idea that we can reduce emissions and simultaneously improve wellbeing (often with immediate and local effect) is far more appealing than a technical and sectoral approach to reducing emissions. Furthermore, the Commission should include reducing health inequities as a co-benefit. To assist them in this work, the Commission should include both public health expertise and Māori health expertise among its commissioners.

Health and other co-benefits should also be quantified and included in cost–benefit analyses of proposed emission-reduction strategies. Given the likely size of the health and societal wellbeing co-benefits of taking actions to reduce New Zealand’s emissions, we think it is quite possible that a full cost–benefit analysis that includes these components would be positive. This conclusion makes arguing about whether or not the economic impact is under 1% of GDP (as the Climate Change Commission has estimated) somewhat superficial and premature. Indeed, there is a need for a full cost–benefit analysis that captures the co-benefits we have outlined. New Zealand researchers have already conducted health and economic analyses on various interventions that involve emissions reductions and health co-benefits.[[7,15,16,25]] The challenge now is to integrate such findings with the higher-level economic modelling performed by the Commission to produce more comprehensive understanding of the likely impacts on society as a whole. There should also be consideration of whether GDP is the appropriate metric to be considering as the outcome of modelling. Recognising the limited nature of GDP, the New Zealand Treasury has already moved towards a wellbeing framework.[[26]] The Commission’s modelling also needs to consider the wider range of outcomes that are important to people. The Commission should consider ways to minimise any strategies that could exacerbate health inequities and develop compensatory mechanisms to counter these (eg, expanding winter heating subsidies and home insulation subsidies for those at risk of fuel poverty).

The Commission also needs to do more to ensure that the government’s Treaty of Waitangi obligations are met in all the domains covered. The sector-specific plans to reduce emissions within the Report do not reflect the values of He Ara Waiora, the analytical framework to improve Māori wellbeing that the Commission states it used to inform their work. The Commission needs to develop more meaningful and enduring partnership with Māori to fully embed these values in their work.

The Commission should also build on the experience of New Zealand’s successful response to the COVID-19 pandemic. This response to another major global health threat has shown the benefits of rapid, science-informed, vigorous government action (albeit with some aspects being far from optimal,[[27,28]] such as increased psychological stress for some[[29]] and uneven economic shocks to particular communities). A key aspect of the response was the successful communication of the need for collective action for the long-term good of all—a message that is also relevant to climate action and one New Zealanders have shown willingness to respond to. Ultimately, the COVID-19 response demonstrated how a collective response can achieve both public health and economic benefits.[[30]]

Lastly, the Commission’s final report should explain how these health co-benefits are likely to generate major cost-savings (eg, by reducing healthcare costs and improving productivity from improved health). Therefore, the overall impact on the New Zealand economy of responding to climate change may be much less than estimated by the Commission. Indeed, in the long run, the economic issues of countries responding to climate change pale into insignificance compared with the potentially catastrophic disruptions to planetary systems and human societies that uncontrolled climate change could cause.

Appendix

Appendix Table 1: Our analysis of the coverage of health co-benefits in the Climate Change Commission Report not covered in the main text. View Appendix Table 1.

Summary

Abstract

Aim

The Climate Change Commission’s draft report and recommendations provide a pathway towards achieving the New Zealand Government’s commitment to net zero emissions by 2050. However, the Commission has not adequately considered the health co-benefits of climate change mitigation. In this viewpoint, we assess how the Commission has considered health co-benefits in the key response domains. Extrapolating UK evidence to the New Zealand context suggests climate change mitigation strategies that reduce air pollution, transition the population towards plant-based diets and increase physical activity via active transport could prevent thousands of deaths per year in coming decades. Substantial health co-benefits would also arise from improved housing, cleaner water, noise reductions, afforestation and more compact cities. The Commission’s draft report only briefly mentions many of these health co-benefits, and some are completely absent. We recommend the Commission’s final report: (i) use health co-benefits as an explicit frame; (ii) ensure the government’s Treaty of Waitangi obligations are met in all the domains covered to maximise benefits for Māori health and wellbeing; (iii) build on the successful COVID-19 response that demonstrated rapid, science-informed and vigorous government action can address major global health threats; (iv) include both public health expertise and Māori health expertise among its commissioners; (v) explain how health co-benefits are likely to generate major cost-savings to the health system.

Method

Results

Conclusion

Author Information

Tim Chambers: Department of Public Health, University of Otago, Wellington. Simon Hales: Department of Public Health, University of Otago, Wellington. Caroline Shaw: Department of Public Health, University of Otago, Wellington. Michael Baker: Department of Public Health, University of Otago, Wellington. Jude Ball: Department of Public Health, University of Otago, Wellington. Christine Cleghorn: Department of Public Health, University of Otago, Wellington. Nick Wilson: Department of Public Health, University of Otago, Wellington.

Acknowledgements

A short version of this document was published in The Conversation and benefited from editorial input from this publication. Between the submission and publication of this article, the Commission’s final advice to the government was released. The final report put greater emphasis on active transport and made greater acknowledgement of the potential health co-benefits of climate action. Yet these benefits were not incorporated into financial modelling. The potential cost-savings from diets less reliant on animal products remain absent in the final report. There remains a lack of public health expertise among the commissioners, and attention to Treaty of Waitangi obligations and health equity impacts is insufficient. We cover these issues in more detail on the Public Health Expert Blog: https://blogs.otago.ac.nz/pubhealthexpert/health-co-benefits-need-to-be-adequately-considered-in-the-climate-change-commissions-final-advice/

Correspondence

Tim Chambers, Department of Public Health, University of Otago, Wellington

Correspondence Email

tim.chambers@otago.ac.nz

Competing Interests

Caroline Shaw declares funding from the Health Research Council outside the submitted work. Christine Cleghorn declares a financial relationship with Horticulture NZ outside the submitted work.

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The Climate Change Commission’s (the Commission’s) draft report (the Report) and recommendations provide a useful pathway towards achieving the New Zealand Government’s commitment of net zero emissions by 2050.[[1]] But the Commission’s draft advice does not adequately consider how climate change actions could produce health co-benefits or potentially exacerbate existing health inequities. The evidence for mitigation-related health co-benefits is substantial.[[2,3]] Indeed, extrapolating recent international evidence[[4]] to the New Zealand context suggests that climate change mitigation could ultimately prevent thousands of premature deaths per year in coming decades. This impact could be through dietary changes, increased active transport and reductions in air pollution. Unfortunately, the Commission makes no such quantitative estimates of the health impacts of its proposed policies, thus overestimating cost relative to the benefits of climate action. This omission is despite extensive international work and local research documenting the likely high magnitude of these health co-benefits. In this viewpoint, we assess how the Commission has considered health co-benefits in the key response domains and provide evidence that could be used to improve its response.

Food environment and dietary patterns

The Report is largely focused on the industrial “food production” system and does not mention the word “diet” (eg, human diet) despite the huge potential co-benefits from a move towards more plant-based diets.[[5]] It notes that “Transitioning to a low emissions economy will require New Zealanders to change some aspects of their lives,”[[1]] yet reducing consumption of meat and dairy is omitted from the examples provided. New Zealand research demonstrates a shift towards more plant-based diets could lower greenhouse emissions, improve health, lower costs to the public and lower healthcare costs.[[6–8]] One New Zealand study demonstrated that, if New Zealanders adopted the New Zealand Dietary Guidelines, diet-related emissions would reduce by 4–42%, depending on the degree of dietary change and food waste minimisation.[[7]] The estimated lifetime health gains for the current New Zealand population were 1.0–1.5 million quality-adjusted life-years, and the estimated healthcare system cost-savings were NZ$14–20 billion. Another New Zealand study showed the large health gains and cost-savings from a modelled junk food tax and a saturated fat tax,[[9]] with some of these benefits arising from reductions in meat consumption. Finally, the health co-benefits of improved diets also include potential reductions in health inequities as Māori and Pasifika disproportionately suffer chronic diseases (cardiovascular disease, diabetes and some cancers) related to New Zealand’s obesogenic food environment.

Plant products typically produce far fewer greenhouse gas emissions compared to animal products.[[10]] Indeed, New Zealand meat and dairy products still produce approximately five times the greenhouse gas emissions per gram of product of the highest plant-based emitter, rice.[[7]] Plant-based milk and meat, which is becoming increasingly price competitive, is estimated to contribute around 4% of the greenhouse gases per unit of protein and use less land and water compared to meat and dairy.[[11]]

The Report also says that “red meat and dairy products from Aotearoa are already some of the least emissions intensive in the world.”[[1]] However, the lifecycle assessment for lamb and beef emissions have point estimates that fall within the confidence internals of global averages, suggesting there is no statistically meaningful difference between New Zealand and the international pattern of global emissions for lamb and beef.[[7]] Further, such comparative analyses can be misleading because they typically don’t consider that dairy and meat production still generate the largest dietary emissions by far, as well as having other land-use consequences (eg, the native bush that was removed to allow for livestock grazing). For example, one New Zealand Government report noted that “The exclusion of carbon losses arising from forest harvesting, deforestation and scrub clearance has a significant impact on the overall estimate of net emissions and removals.”[[12]] The ideal analysis of agriculture/food impacts should also account for the carbon costs of using coal in the milk drying processes often used in New Zealand, which was not considered in one study of the carbon footprint of New Zealand milk.[[13]] Finally, greater independence from industry-produced or funded livestock lifecycle assessments is required to ensure the validity of the results.

Physical activity benefits from active transport

The Report states: “There are significant co-benefits from increasing alternative types of transport. In particular, walking and cycling benefit health.”[[1]] Two New Zealand publications on the benefits of active transport for health are referred to in the Report.[[14,15]] But, considering that this might be the second most important area for health gain, there is still a marked lack of detail on these benefits.[[4]] This deficit includes the minimal consideration of increased use of electric bikes, despite their rapid uptake in many cities internationally. Other relevant New Zealand-based modelling work was not mentioned. For example, this other work reported that switching short vehicle trips to walking and cycling could generate large healthcare cost-savings (range: NZ$127 million to NZ$2.1 billion) and reduce greenhouse gas emissions by up to 194 kilotonnes CO2e/year.[[16]] Another modelling study that considered health aspects of bicycling (relating to physical activity, injury and air pollution) reported that “transforming urban roads over the next 40 years, using best practice physical separation on main roads and bicycle-friendly speed reduction on local streets, would yield benefits 10-25 times greater than costs.”[[15]] Improved walking and cycling infrastructure would particularly improve transport options for Māori, Pasifika and low-income New Zealanders.[[16]]

International and local examples show that a rapid and substantial mode shift towards active and public transport is highly achievable.[[17,18]] For example, an evaluation of New Zealand’s “model communities” found a 30% net increase in active transport in intervention cities compared with control cities over a three-year period.[[19]] Yet this potential is not reflected in the Report’s mode shift assumptions, which are modest (“walking, cycling and public transport can be increased by 25%, 95% and 120% respectively by 2030”).[[1]] Instead, the Report puts emphasis on the electrification of New Zealand’s transport fleet, a strategy that will not increase physical activity or address other problems associated with car-dependency, such as the safety of children and other vulnerable road users, traffic congestion, cost of road maintenance or use of valuable urban land for storing cars.[[20]]

Benefits from reduced air pollution

Another co-benefit of using less fossil fuel for energy, heating and transportation that only received brief mention in the Report is improved health from reduced air pollution. The Report refers to one New Zealand study on the harm from air pollution to health, which estimated particulate matter emissions cause adverse health outcomes, including over a thousand premature deaths, with a cost of NZ$8 billion per year.[[21]] The Report also mentions further government encouragement for working-from-home arrangements, which may reduce air pollution from commuter traffic. Nevertheless, there is still a marked lack of detail in this important area for health co-benefits. Two other relevant papers were not mentioned: one on the association between air pollution and mortality for New Zealand,[[22]] and the other on the impact of the COVID-19 lockdown on improved air quality in New Zealand, which highlights the potential gains that can be made,[[23]] Fortunately, New Zealand estimates of health impacts attributable to ambient air pollution are currently being updated and can be included in future reporting.

Health inequities

The Report is reasonably good at considering some aspects of inequities—but these are predominantly around income inequality. The Report notes the health impacts of climate change would likely be spread unevenly across the population, with more vulnerable groups being more exposed.[[1]] It includes a vision of ensuring the low emissions transition takes opportunities to reduce inequities and consider intergenerational equity. However, the Report does not fully outline the potential of climate actions to reduce existing health inequities by reducing exposures disproportionately borne by disadvantaged groups (eg, cold, damp homes, poor food environments, air pollution and traffic injuries). This gap is despite existing health inequities being of major concern from the perspective of preventable health loss, an ethical perspective and a Te Tiriti o Waitangi (Treaty of Waitangi) perspective.

Other health co-benefits

The health co-benefits presented above are not an exhaustive list. In Appendix Table 1, we outline other health co-benefits that are also important from health, social and cultural perspectives. These co-benefits include: (i) improved health from warmer and drier homes (with improved house designs and increased use of insulation); (ii) improved cardiovascular and mental health from reduced noise pollution (with a shift to electric vehicles, increased use of rail and shipping for freight and any reduction in air transport); (iii) improved water quality from increased reforestation and livestock reductions (reducing nitrates and enteric pathogens from livestock agriculture); (iv) improved mental health, reduced injury and improved physical health and wellbeing from more compact cities and less urban sprawl (less commuting time, better access to central city services via walking and cycling).

Our recommendations to the Commission

Health co-benefits should be used to explicitly frame the Commission’s final report. The advantage of this approach is that it identifies meaningful value for the public and it is likely to create better support for action.[[24]] The idea that we can reduce emissions and simultaneously improve wellbeing (often with immediate and local effect) is far more appealing than a technical and sectoral approach to reducing emissions. Furthermore, the Commission should include reducing health inequities as a co-benefit. To assist them in this work, the Commission should include both public health expertise and Māori health expertise among its commissioners.

Health and other co-benefits should also be quantified and included in cost–benefit analyses of proposed emission-reduction strategies. Given the likely size of the health and societal wellbeing co-benefits of taking actions to reduce New Zealand’s emissions, we think it is quite possible that a full cost–benefit analysis that includes these components would be positive. This conclusion makes arguing about whether or not the economic impact is under 1% of GDP (as the Climate Change Commission has estimated) somewhat superficial and premature. Indeed, there is a need for a full cost–benefit analysis that captures the co-benefits we have outlined. New Zealand researchers have already conducted health and economic analyses on various interventions that involve emissions reductions and health co-benefits.[[7,15,16,25]] The challenge now is to integrate such findings with the higher-level economic modelling performed by the Commission to produce more comprehensive understanding of the likely impacts on society as a whole. There should also be consideration of whether GDP is the appropriate metric to be considering as the outcome of modelling. Recognising the limited nature of GDP, the New Zealand Treasury has already moved towards a wellbeing framework.[[26]] The Commission’s modelling also needs to consider the wider range of outcomes that are important to people. The Commission should consider ways to minimise any strategies that could exacerbate health inequities and develop compensatory mechanisms to counter these (eg, expanding winter heating subsidies and home insulation subsidies for those at risk of fuel poverty).

The Commission also needs to do more to ensure that the government’s Treaty of Waitangi obligations are met in all the domains covered. The sector-specific plans to reduce emissions within the Report do not reflect the values of He Ara Waiora, the analytical framework to improve Māori wellbeing that the Commission states it used to inform their work. The Commission needs to develop more meaningful and enduring partnership with Māori to fully embed these values in their work.

The Commission should also build on the experience of New Zealand’s successful response to the COVID-19 pandemic. This response to another major global health threat has shown the benefits of rapid, science-informed, vigorous government action (albeit with some aspects being far from optimal,[[27,28]] such as increased psychological stress for some[[29]] and uneven economic shocks to particular communities). A key aspect of the response was the successful communication of the need for collective action for the long-term good of all—a message that is also relevant to climate action and one New Zealanders have shown willingness to respond to. Ultimately, the COVID-19 response demonstrated how a collective response can achieve both public health and economic benefits.[[30]]

Lastly, the Commission’s final report should explain how these health co-benefits are likely to generate major cost-savings (eg, by reducing healthcare costs and improving productivity from improved health). Therefore, the overall impact on the New Zealand economy of responding to climate change may be much less than estimated by the Commission. Indeed, in the long run, the economic issues of countries responding to climate change pale into insignificance compared with the potentially catastrophic disruptions to planetary systems and human societies that uncontrolled climate change could cause.

Appendix

Appendix Table 1: Our analysis of the coverage of health co-benefits in the Climate Change Commission Report not covered in the main text. View Appendix Table 1.

Summary

Abstract

Aim

The Climate Change Commission’s draft report and recommendations provide a pathway towards achieving the New Zealand Government’s commitment to net zero emissions by 2050. However, the Commission has not adequately considered the health co-benefits of climate change mitigation. In this viewpoint, we assess how the Commission has considered health co-benefits in the key response domains. Extrapolating UK evidence to the New Zealand context suggests climate change mitigation strategies that reduce air pollution, transition the population towards plant-based diets and increase physical activity via active transport could prevent thousands of deaths per year in coming decades. Substantial health co-benefits would also arise from improved housing, cleaner water, noise reductions, afforestation and more compact cities. The Commission’s draft report only briefly mentions many of these health co-benefits, and some are completely absent. We recommend the Commission’s final report: (i) use health co-benefits as an explicit frame; (ii) ensure the government’s Treaty of Waitangi obligations are met in all the domains covered to maximise benefits for Māori health and wellbeing; (iii) build on the successful COVID-19 response that demonstrated rapid, science-informed and vigorous government action can address major global health threats; (iv) include both public health expertise and Māori health expertise among its commissioners; (v) explain how health co-benefits are likely to generate major cost-savings to the health system.

Method

Results

Conclusion

Author Information

Tim Chambers: Department of Public Health, University of Otago, Wellington. Simon Hales: Department of Public Health, University of Otago, Wellington. Caroline Shaw: Department of Public Health, University of Otago, Wellington. Michael Baker: Department of Public Health, University of Otago, Wellington. Jude Ball: Department of Public Health, University of Otago, Wellington. Christine Cleghorn: Department of Public Health, University of Otago, Wellington. Nick Wilson: Department of Public Health, University of Otago, Wellington.

Acknowledgements

A short version of this document was published in The Conversation and benefited from editorial input from this publication. Between the submission and publication of this article, the Commission’s final advice to the government was released. The final report put greater emphasis on active transport and made greater acknowledgement of the potential health co-benefits of climate action. Yet these benefits were not incorporated into financial modelling. The potential cost-savings from diets less reliant on animal products remain absent in the final report. There remains a lack of public health expertise among the commissioners, and attention to Treaty of Waitangi obligations and health equity impacts is insufficient. We cover these issues in more detail on the Public Health Expert Blog: https://blogs.otago.ac.nz/pubhealthexpert/health-co-benefits-need-to-be-adequately-considered-in-the-climate-change-commissions-final-advice/

Correspondence

Tim Chambers, Department of Public Health, University of Otago, Wellington

Correspondence Email

tim.chambers@otago.ac.nz

Competing Interests

Caroline Shaw declares funding from the Health Research Council outside the submitted work. Christine Cleghorn declares a financial relationship with Horticulture NZ outside the submitted work.

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