How can the green agenda help the health agenda? – with Dr Fiona Godlee and Professor Andy Haines Episode 13 of the Health Foundation podcast

Jennifer Dixon: For nearly three decades, the UN has been bringing together almost every country on earth for global climate summits called COPs or Conference of the Parties. In that time, climate change has gone from being a fringe issue to a global priority. This month sees the UK along with Italy as a partner host the 26th UN Climate Change Conference - COP26 - in Glasgow. Back in 2015 at COP21 The Paris Agreement, a legally binding international treaty on climate change was adopted by 196 countries. Its goal is to limit global warming to well below two preferably to 1.5 degrees Celsius compared to pre industrial levels. And to achieve this countries are aiming for net zero carbon emissions by mid century, countries also pledged to make at least $100bn investment every year to deliver on these aims, particularly helping poorer countries. So the Paris Agreement was about the what to achieve, delivery is the main subject of COP26. And countries will be showing what they're doing. The UK has a good story to tell so far. For example, in 2019, it became the first major economy in the world to pass laws to bring all of its greenhouse gas emissions to net zero by 2050. Now everyone knows making progress on net zero will be very challenging. Climate change is a complex problem. Improving health is also a complex system problem needing long term policy commitment and action, particularly if the goal is to improve healthy life expectancy and reduce inequality. So what can we learn from efforts and progress so far on climate change? Can we apply these to improve health? And are they linked, can going and greener actually improve the health of people in the UK? So with me today to discuss all of this are Dr Fiona Godlee, who is editor in chief of the British Medical Journal, a post she's held with distinction since 2005. She's also on the board and executive committee of the Climate and Health Council and the UK Health Alliance on climate change. And many of you will have seen that last month, the BMJ joined 232 other international medical journals in publishing an editorial calling for emergency action by governments to tackle the 'catastrophic harm to health from climate change'. And with Fiona is Professor Andy Haines, who is professor of environmental change and public health at the London School of Hygiene and Tropical Medicine. Andy has long experience of being a member of major international and national committees on health, in particular on climate, including the UN intergovernmental panel on climate change. So a very big welcome to you both. Thanks for joining.

Andy Haines: Thank you.

Fiona Godlee: Thanks Jennifer.

Jennifer Dixon: So perhaps I can first ask a more general question, what is the main objective of COP26? And what do you think success would realistically look like? Or maybe in other words, will COP26 be any cop? Perhaps Fiona first?

Fiona Godlee: Well, the I think we have to say that it's great that countries are coming together on this incredibly crucial issue. And you know, putting people on the spot putting countries on the spot, we obviously must think that's a good thing. But there are also all sorts of reasons why we need to manage our expectations that, you know, will all countries turn up, will all countries turn up with, you know, really ambitious plans? is this going to be more words and not enough action? We've just got to really, really push hard to try to make sure that those plans are ambitious, and that they're really ones that will be followed through on.

Jennifer Dixon: Thank you. How about you, Andy?

Andy Haines: Well, obviously, it's very, very important that governments do meet regularly and do put forward the nationally determined contributions as they're called under the Paris Agreement. But there are significant concerns, I think about just that the rate of change the pace of change towards a net zero carbon economy. And that's exemplified by a report that just came out the other day, which I've just been having a look at called the production gap, which is produced by the UN Environment Programme and a number of other key players. And what that tells us is that government's still plan to produce more than double the amount of fossil fuels in 2030, than what would be consistent with this goal of limiting temperature increase to 1.5 degrees above pre industrial levels, indeed it emphasises the fact that G20s – the big economies – have directed more new funding to fossil fuels than clean energy since the beginning of the COVID-19 pandemic. Largely, of course, for domestic purposes, and, but in contrast, they have significantly decreased new international public finance for fossil fuel production, so there's slightly mixed signals. But all in All, unfortunately, this target of 1.5 degrees is rapidly receding from our grasp. And indeed, I think we'll be lucky to stay below two degrees centigrade based on the reality of what's actually happening on the ground. Nevertheless, it underlines really the importance of having this dialogue in Glasgow, enhancing the ambitions of a range of countries and holding them to account.

Jennifer Dixon: So it's largely a sort of transparency conference, I presume, showing what people are doing and trying to muster more commitment and energy and sharing good practice. Is that right?

Fiona Godlee: Yeah, I would say so. And also, you know, this very important thing about mobilising the money. The idea that, you know, the developed countries, we've got much more historical responsibility for existing carbon emissions and temperature rises, and therefore, you know, carry most of the need to fund what is going to be an expensive business. I mean, not that there's any choice, I would say, I think most of us, there's no choice, but we have to do this, because otherwise there will be no planet to spend the money on. So the idea that developed nations are going to try and mobilise this 100 billion dollars per year by 2020, and trillions more in terms of private and public sector finances to, to really make the important shifts that are needed to a low carbon economy. So I think that that's the, as you say, transparency around the actual actions, but also this combined effort this combined push from from the richer nations to put their money where their mouths are.

Jennifer Dixon: Should we just turn a little bit closer to the UK now and look at its broad strategy that it has to achieve net zero? I mean, clearly, we've had this law in 2019, which binds the UK to achieve net zero by 2050. And then we've also had quite a lot of strategic documents, haven't we, we've had the 10 point plan for a green Industrial Revolution. And we've had also plans being produced by various departments. And then we have the climate change committee that produces carbon budgets and recommends pathways for reduction of emissions. But I just wondered what both of your view about how well developed the strategy is overall in the UK, the government's strategy, and and what you think the key elements are?

Andy Haines: Well, of course, as you say, we've got this 10 point strategy. And we've just seen the document published, the net zero strategy, which is about building back better and greener, and so on. And there are a number of strengths to that. I mean, the UK has, as you know, largely phased out coal over recent decades, we have very little left in the system now unless the government gives permission for this new coal mine to be opened, there has been an increase in offshore wind. And the first point in the strategy is about scaling up offshore wind, to 40 gigawatts by 2030, which obviously, would be a large capacity, also driving the growth to the low carbon hydrogen economy. Obviously, hydrogen is generally a clean fuel, although there are some issues around it depending on how it's generated. And then we come to nuclear power, which is still controversial in some people's eyes, but they do suggest a commitment to delivering new and advanced nuclear power. One of the objectives of that is to generate less nuclear waste and to be safer. The aim of accelerating the shift to zero emission vehicles, and that will have some benefits from reduced air pollution. Point five, I think its an interesting one, it's about green public transport, quite ambitious plans, perhaps not ambitious enough to support buses, cycling and walking. And that's where we could get particularly big healthcare benefits.

Jennifer Dixon: I don't know the extent to which you either view have looked across government and to look at all the initiatives or strategies to see how they stack up. I mean, there is quite a lot of work by different departments. But how knitted together, is it? Or is it still a bit sort of opportunist across government?

Fiona Godlee: Well, I think you hit upon a real problem. And probably it's true in many countries, but certainly in the UK, one does get this sense, the cross departmental function is not great. You know, giving with one hand and taking away with another and there will be many people working within the civil service and also within parliament who are deeply committed to you know, wanting to bring down emissions. Then you have new money just announced for things like heat pumps etc... for housing, a small amount in the scheme of things you might argue but you know, still really good but then suddenly the granting scheme for insulating homes was scrapped. I don't know where that would have come from, from the treasury, or whatever. So the idea of an overarching strategy or at least a sense that there is everyone working hand in hand on this doesn't come across incredibly strongly, I think. And there is, I think a concern that I gather that a lot of the UK strategy is based on technical fixes, gizmos, carbon capture, and the reliance on this shift to electric, which is quite a long way off in terms of the structural infrastructure that needs to be in place for big shift to electrify transport, etc. And there isn't that much more sort of fundamental shift to, for example, really great public transport that will get people out of their cars and not buying new cars. So the sort of societal shift that is needed. You don't get the sense that that is really being discussed or considered.

Jennifer Dixon: There was a very interesting report last year from the Prime Minister's Council for Science and Technology, Patrick Vallance is one of the co-chairs, and they were pointing out how they thought the government could use a more 'disciplined and rigorous whole systems approach' to deliver a better transition towards net zero emissions target. And a couple of things, there were better data to understand progress and interactions across different bits of government. But the most important thing was strengthening the governance team frameworks and leadership structures across central government. And they pointed to the newly formed Cabinet Committee on climate change, which could help but they suggested a really more rigorous systematic approach, which I thought was very helpful. And I don't know what happened to that. Do you happen to know Andy?

Andy Haines: Well, I did read that, those recommendations and I fully applauded them. And indeed, we've echoed some of those recommendations in the recent report we've just written with the Royal Society and the Academy of Medical Sciences, which makes the really important point that many of these strategies to decarbonize the economy will also improve health in the near term through increased physical activity and more healthy diets and reduced air pollution, for example. So yes, I think there's still been limited progress on actually developing a systems approach. And that's really important, because if you don't have a systems approach, you can have unintended adverse consequences. And you can also fail to achieve the kind of synergies between different sectors that you might be able to if you had a more integrated approach, so I think there's still quite a lot more work needed on that. One sector, which I think hasn't received enough attention is, of course, the whole food systems and agriculture sector, there is obviously quite a lot of evidence that moving towards more predominantly plant based diets would reduce the environmental footprint of the food system, and also, obviously improve health as well. And yet, we haven't seen the progress that we might like to see. We are seeing spontaneous changes in diet already, a paper just come out actually has shown that reductions in meat consumption over recent years about 17%. So that's just based on voluntary changes in diet. But there does need to be a much more integrated approach to food systems agriculture, and greenhouse gas emissions if we're really going to achieve net zero by 2050.

Jennifer Dixon: Yes and in fact, there was the National Food Strategy wasn't there published not so  long ago, and we had our podcast on that a couple of podcasts ago, people will remember who are regular listeners, and it was a very interesting Farm to Fork sort of review. And I don't think the government's responded to that yet. So I haven't seen it anyway.

Fiona Godlee: I think we got a kind of rather dismissive response initially from Boris Johnson, just saying, Well, you know, so I think that's another example of, of, you know, if we're going to put climate change and saving the environment at the top of our priority list, which it seems to me, to be essential, then all of these things are going to need to be seen through that lens from now on, when we say, you know, what will be the implications? Why should we really act on this, the food strategy being one thing, because of the benefits, it will provide not only in climate, but in terms of the health of the population?

Jennifer Dixon: Yes, yes. I mean, I asked this question about how systematic things are across government, because it really seems like a mirror image for any policies to improve health. Health is not yet in all policies. So I think there's quite interesting parallels. If you really want to make inroads on improving health and reducing inequalities, there needs to be a kind of almost similar whole systems action that governments don't usually do so well, do they? Because that's not what they've focused on in the past. So I think the next thing is just really just to quickly touch on the progress that we've made in the UK. Are we on track to achieve our target? And Andy, you mentioned the UN report just published. And I noticed the UK CCC report this year, which says that the government has made, 'historic climate promises in the past year for which it deserves credit However, it's been too slow to follow these with delivery'. That was the bottom line. Is that your understanding Andy?

Andy Haines: That's my understanding as well that the UK is not on track to meet the fourth and fifth carbon budgets, although it's done very well, up to now predominantly by taking coal out of its energy system, obviously, increasing renewable energy. The objective really is to move towards heat pumps over coming years. But delivering that will not be simple. And the amounts of money being put up at the moment are not sufficient really to kind of transform the situation, although of course it's a start. So yes, I think there is quite a big implementation gap at the moment. And that's what we need to focus on, is getting beyond the kind of declarations of intent to the actual activities. And that means we need careful monitoring appropriate metrics that measure greenhouse gas emissions, not just carbon dioxide, but also methane and some of the other smaller greenhouse gases that contribute to climate change. But also from our perspective, in the health- public health sector, we need to also monitor the benefits to human health from reduced air pollution, increased physical activity, healthier diets, warmer homes, etc. And those monitoring systems are not really properly linked up at present. So we're not enjoying, if you like the benefits of integrated policies across those different sectors, and being able to demonstrate them to the public.

Jennifer Dixon: And that demonstration is very important for accountability. Let's move on to specifically health and climate and the link to inequalities. Could you both first, just summarise for us what you think the main direct and indirect impacts of climate change on health are, and particularly in the UK population?

Fiona Godlee: It's very interesting when you talk about these things, and people immediately think you're going to be talking about malaria and disease related issues. And it takes them a while to think well, well no we're talking about impact on people, extreme weather events, and floods and droughts and refugees, you know, conflict and people being shoved out of their homes and all of those more sort of geopolitical, if you like events that are a result of climate stress and environmental stress. And then as Andy has been writing very evocatively about, about the difficulty of just extreme heat on people's ability to live and work in certain parts of the world. So on a global level, it's very much about just sheer climatic environment that is going to become inhospitable to human life. And that's going to have enormous impact on us as a world. But then, within the sort of developed nations, we are increasingly recognising the impact of the burning of fossil fuels on people's health in relation to chronic disease, cardiovascular disease, lung disease, cancer, obesity, dementia, mental health, child's development, intra-uterine development, the evidence is really building that air pollution and environmental pollution more generally, is having long term serious consequences to people's health and well being. And I think that's where talking about climate change as if it's something happening or the climate emergency happening, you know, in faraway countries to people who we know not all of it is very important that we make clear that's not the case that it is actually impacting on, on those of us who have historic responsibilities for these carbon emissions. And on the positive front that decarbonizing our society, encouraging active travel, plant based foods, and just a more active and less high carbon intensity lifestyles is going to have huge benefits on people's health and wellbeing. So that that's the kind of messaging we need to get across. And air pollution is a useful, troubling byproduct of burning of fossil fuels, which helps people to really focus their minds on why this is affecting people in the UK now.

Jennifer Dixon: And, Andy, would you add anything to that?

Andy Haines: We tend to think of disruption to food supply as being an issue which will affect predominantly low income tropical and subtropical regions as a result of climate change. But you know, the UK is also importing an increasing proportion of its fruit and vegetables from climate vulnerable countries over the last few decades, and so that means that if those countries or when those countries are affected by climate change, and it disrupts the production of fruit and vegetables in those countries that we will also be affected by increasing food prices, particularly for these commodities like fruit and vegetables, which as we know, are very important for our health. The other one is around the inequalities in impacts of climate change on human health and that's also in the UK. So for example, if you look at London, heat exposure in London is higher in those parts of London, where you have more people on low incomes, for example, more people who don't speak English as a first language. And one of the reasons for that is because there's less green space, green space helps to cool cities. We know that cities are generally hotter than the surrounding countryside. So they amplify the effects of climate change.

Jennifer Dixon: Yes. And presumably also pollution in cities as well in those particular areas, people living by roads, and so on, as well. Now Andy, you referred to the report that you co-wrote for the Academy of Medical Sciences, and also the Royal Society, which was published not too long ago. And there was a really interesting section there on the benefits to health for mitigating climate change. What do we have to gain from all the efforts for green and what might be the gain for health?

Andy Haines: Well, let's take transport systems, for example. Greater use of public transport is usually associated with increased physical activity. So on average, people might walk, perhaps an extra on average 17 minutes a day, something of that order, if they use public transport compared with a private car. And we know that physical inactivity, sedentarism, is an important risk factor for a range of non communicable diseases like diabetes and others. So if we can increase the use of public transport as we emerge from COVID. Also of course, walking and cycling, which the government says it does want to do, but is putting limited funds into, then that will yield large benefits to human health, particularly as a result of increased physical activity. Obviously there might be a byproduct as well of reduced air pollution. A paper we wrote some years ago suggested that if you could get the population of urban England and Wales walking and cycling like the population of Copenhagen, which as you know is a very active population indeed, then that could reduce the incidence of a number of chronic diseases like diabetes, heart disease, of course, stroke, some types of cancer, and so on. And that could in turn, reduce the costs on the NHS by we estimated about £17bn over a period of 20 years or so increasing over time, because there's obviously a bit of lag for these benefits to sort of phase in. And there are others as well. We've mentioned dietary change, obviously reduced air pollution from burning of fossil fuels, warmer houses, you know, we know that the UK has high levels of winter mortality, and even higher numbers of cold-related mortality if you include those deaths that occur outside the winter season. So there's a potential benefit there from warmer houses. But there is a trick and there is a sting if you like in the tail, because if you just insulate houses, and you don't pay attention to ventilation, you can increase exposure to household air pollution. So that could offset and negate some of the benefits. And it just really reinforces the importance of designing these strategies carefully, looking at the potential unintended adverse consequences, and designing them to maximise their health benefits.

Jennifer Dixon: There's a huge R&D agenda here, isn't there, to be able to monitor much more closely and in a more sophisticated way, some of the costs and benefits of all of these options for mitigation that might then galvanise further action towards net zero. That's an enormous task, isn't it, when you think of the research and development infrastructure in the country that is still working towards being multidisciplinary, but that's what's needed, isn't it?

Andy Haines: It is really, and of course, it has to engage a number of disciplines outside of traditional public health disciplines. So we need an increasingly, we are, you know, working with people who are specialists in land use, soil science, atmospheric chemists, energy specialists, housing, built environment, a whole range of different social scientists to understand better behaviour change, including economists, but also social psychologists and others. So it really is a very exciting time. But the moment I would say that the research funds that have gone into this have been really quite limited. We're still rather stuck in our siloed ways of research funding, and we need to really join up the research agenda across government, which of course, is the aspiration. We also need to evaluate strategies to adapt to climate change, whether it be through better housing that reduces the indoor heat loading without necessarily resorting to air conditioning, heatwave early warning systems, disease early warning systems and so on. These all need proper evaluation to ensure that they're having the desired impact.

Jennifer Dixon: Looking at the government strategies to date on net zero, explicit account of health, climate change and health, for example in the Green Industrial Revolution 10 Point Plan document, health doesn't feature as highly as it could or should. Why do you think that is? Is it because there is a lack of data on the co-benefits? Or is there a kind of blind spot when it comes to health?

Fiona Godlee: It feels to me like a blind spot. I don't know is Andy will agree. Certainly, you know, in the early report, Nick Stern all those years ago produced this very important report on the economics of tackling climate change, and health I think didn't get a single mention. In the previous COPs, if you look through the paperwork, the agenda has very little if any mention of health. And one of the sort of aims of some of the work that the BMJ and The Lancet, and Andy's been a really important player in that, has been to try to raise the health agenda in relation to climate change. And the reasons for doing that are obviously because tackling climate change presents the potential for really substantial health benefits. And also, I think, because health is the thing that pulls people together. I mean, you only have to look at the pandemic, how suddenly health and disease have become the entire conversation in the last 18 months. And people, you know, obviously, for good reason are interested in their health and their children's health, and their unborn children's future health. So it's a very powerful lens through which to try to make this of immediate importance to people, instead of it being about melting icebergs, which may seem a long way off. So I think there is a blind spot, and part of the efforts that various of us will be trying to make at COP in Glasgow, is to make sure that the health angle is absolutely front and central.

Andy Haines: Yes, I've just been looking at this net zero strategy, which came out the other day, Build Back Greener from the government, and I did a quick word search. Health is mentioned 47 times actually in the document, I haven't gone through a detailed analysis of where it comes up. But it's still my impression that it's mentioned as a kind of peripheral issue rather, and not really embedded in the kind of central core of the strategy. So there doesn't seem to be, as far as I can see on my quick read, a commitment to really monitor the kind of health benefits arising from the net zero strategy, and also to tackle any potential disbenefits or trade offs that might arise through badly implemented policies. And I suppose we would like to see much greater emphasis on an economy which really promotes and improves health, rather than an economy which is focused just on tackling disease, which as we know is costly and also increasingly difficult in an ageing population.

Jennifer Dixon: There are quite a lot of international organisations now from the OECD to the World Bank, for example, that think of prosperity in a much wider way than traditionally is normally thought. So you've probably heard of these things called the four capitals. So prosperity is economic capital, green capital, social capital and human capital, which includes health capital. And I think it's understood that those four are deeply interlinked. So it's important to make progress on all, which makes the whole thing more complicated. But given all these efforts on climate, the green capitals sort of bucket, if you like, what are the lessons that you think, the positive lessons that we might have to further health more directly and including reducing inequalities, given stalling life expectancy and the growing gap that we've seen in the last 10 years?

Fiona Godlee: My sense is that one of the key shifts is acknowledging that interdependency. I mean, when you list those things, economic, green, social, human, it's a list of four things but they are so closely intertwined. And through the pandemic there's really interesting attempts to dichotomize economy versus health, economy versus wellbeing. I mean, we're talking here, aren't we, about human flourishing and all of those things are the underpinning for societies that allow individuals and communities to thrive. And, you know, the evidence that unequal societies are bad for health, but they're also bad for everything else. Obviously if you're at the top of an unequal society, you might think you're doing great, but actually we know that that's not the case that overall, you know, the quality of life of a society really does matter. And I think that's what the pandemic has shown us. And that's what this climate crisis is showing us. That we should be striving for greater equality in order that all can flourish. And that requires us to be in balance with our natural environment and to protect that environment, that biodiversity does matter for humanity. We can't see ourselves in isolation from it.

Jennifer Dixon: Thank you and Andy, points of learning from the green agenda for health?

Andy Haines: Well, I really agree with what Fiona said. But I would add a few other reasons for cautious optimism. One, of course, is the rapidly declining price of renewable energy, clean, renewable energy, which is obviously good for the climate and good for our health because it doesn't produce the kind of air pollutants that fossil fuels produce when we burn them. And we're also realising that one of the reasons that fossil fuel energy is still competitive is because it's subsidised, essentially. We don't pay the full economic costs, we don't pay the cost of the air pollution or the climate change and so on. So one of the important lessons, I think, is that our economy needs to be reoriented, refocused, which takes into account these so called externalities that the economists talk about, and ensure that we don't advertently or inadvertently subsidise our own destruction, if you like. And that will help to drive us towards a healthier and more sustainable economy. The second point of optimism, I think, is really youth. I mean, young people are much, much more engaged now in this agenda, and are really seeing it as a major priority. I think that's also occurring in the health professions. And that surely is a good sign. We can't underestimate the influence of the health professions, they're still amongst the most trusted professions of any, in many, many countries in the world. And here in the UK, of course, the NHS is showing great leadership in committing to decarbonise itself, to reduce its direct emissions to zero by 2040, and indirect emissions by 2045. So the real challenge, as Fiona has said, is how humanity can flourish within these planetary boundaries that we have to live in, because we live in a small planet. And we have to avoid breaching those planetary boundaries, whether they be the climate, or biodiversity, or freshwater, whatever they are. So really, we need to put this at the centre of our economy. Health and sustainability really need to be the key driving forces of our whole economic model, rather than just being attached to metrics like GDP, for their own sake, which can lead us in the wrong direction.

Jennifer Dixon: Andy just referred to the NHS, we won't cover the NHS in this particular podcast, because we're covering its approach to net zero in a webinar that we're going to hold soon. But given the wonderful talent on the shop floor of the NHS in particular, and the motivation of clinicians towards the green agenda, as Andy has mentioned, I wonder if you can just say a little bit more about the progress you think that's being made, for example, in the specialties or by the colleges and by the grassroots NHS to help?

Fiona Godlee: I'm really glad you're doing the thing on the greener NHS because it's a fantastic initiative with a lot of support from government and it's an international leader, and terribly important because health care needs to stop contributing to the problem that it's going to have to eventually be part of the solution for. The role of clinicians is key. And what we've seen over recent years is an increasing number of doctors and nurses and hospital managers seeing this being a key part of their role, reducing carbon emissions, looking for greener solutions to things and really, you know, in whatever way they can, big or small, trying to be part of this new movement. So what we're finding in each of the many specialisms in health care are ways in which doctors can make a difference. They can do that by reducing, for example, the number of procedures they perform if there are unnecessary procedures that they're aware of. And the pandemic has shown that, in fact, there's quite a lot of medical excess that's been going on, people who find that they don't need an operation, if they're left on the list for slightly longer, not that one wants to have waiting lists, but that shows there is medical excess. There are ways of treating people through lifestyle change, rather than through medicine. And then if you can reduce the number of procedures, can you also reduce the actual carbon impression of those procedures. And there are many, many examples which the greener NHS can encapsulate. And the purpose of engaging clinicians in this is to really begin to show them how innovative they can be as practitioners, as leaders in their own organisations and as role models for society at large, as a trusted voice saying, you know, we all need to play our part. And I think we are really seeing that shift. And that's a source of great optimism.

Jennifer Dixon: And of course, some recent polling that we've produced, shows that the public don't really get the NHS' role in achieving net zero and may not really understand yet the implications that achieving net zero might have on the way that care is organised. So I think there's probably a big role looming for the clinical professions to lead that discussion and reassure the public.

Fiona Godlee: I think that's right, and also try to reassure people that this isn't about reducing the quality of care. In many instances it would be about increasing the quality of care, or the patient centeredness. And you know, this isn't about cutting cost, it's about changing the way we deliver health care and at the same time improving the quality. Those two things can go hand in hand. And I think that's absolutely part of the underlying principles for this important movement.

Jennifer Dixon: We haven't yet mentioned local government and I noticed that the Local Government Association says that local councils have the powers over or can influence one third of the emissions in the area. So I just wondered if you had any final remarks about the energy and progress being taken by local government on this at a very local level?

Andy Haines: Yeah, there are big opportunities, as you say, for local governments to act because they do have levers to influence a substantial portion of greenhouse gases, as you mentioned. So the kinds of activities that are taking place, obviously around transport, for example making walking and cycling easier and safer, sustaining and improving public transport access. In some cases, obviously, they control quite a lot of housing stock still, they can influence it. So warmer houses, more energy efficient houses, but as I mentioned earlier, this needs to be accompanied by appropriate ventilation. Diet and food consumption, obviously, they do have some influence in terms of where food establishments are opened up, for example, in local government institutions, perhaps in schools as well. So they can influence food policies and what people are consuming. So there's quite a lot of things that can be done by local government. And I think we are seeing quite a lot of innovation by public health departments around the country. And it's really important, I think, that there's a culture of kind of learning from each other. So there's real opportunity now for mutual learning around the UK and obviously sharing good practice internationally as well. We need to capitalise on the kind of wave of enthusiasm and activity that is occurring at all levels really, from the local to the global, in order to kind of accelerate the changes that we all want to see.

Jennifer Dixon: Yes, that's wonderful. So that's a wonderful place to end. I'm very, very grateful to you both for your contributions. So we must leave it there for today. A very big thank you to Fi and Andy for giving us your time today and your insights. And I hope all of you listening have had your appetite whetted for COP26. And also perhaps beginning some thoughts on how we can learn from the climate agenda when we're thinking about how we improve the health of the nation going forwards. So for the links to key reading on the things we discussed today, as ever, please find them in our show notes wherever you find this podcast. Next month we'll return to the National Health Service and ask the question: is general practice a bigger risk to government than hospital waiting lists? Look forward to seeing you then.

• The Health Foundation (2021) What do the public think about the NHS and climate change?.
• UN Environment Programme (2021) The production gap 2021
• Academy of Medical Sciences and the Royal Society (2021) Climate change and health
• HM Government (2021) Net Zero Strategy: Build Back Greener 
• HM Government (2020) The Ten Point Plan for a Green Industrial Revolution
• Council for Science and Technology (2020) Achieving net zero carbon emissions through a whole systems approach
• Nicholas Stern (2006) The Economics of Climate Change: The Stern Review