Role of Health Equity in the Climate Action Plans of London Boroughs: A Health Policy Report

BackgroundThe World Health Organisation has declared climate change the biggest menace to global health in the 21st century. The health consequences of climate change are well documented. It is also established that vulnerable groups disproportionately bear the effects of climate change. Climate inaction or inequitable climate action can worsen the prevailing health inequalities. Thus, there is an urgent need to implement effective and equitable strategies to minimise the adverse effects and maximise the co-benefits of climate action. The United Kingdom envisions becoming a net-zero carbon country by 2050. The Mayor of London declared a climate emergency in 2018 and aims to make London a carbon-neutral city by 2030. As a result, the London boroughs have published their climate action plans (CAPs) outlining their adaptation and mitigation strategies. But due to a lack of proper guidelines and framework, the plans vary considerably and how health equity is embedded into these documents is currently unknown. This project aims to explore the extent to which health issues are addressed through the CAPs of the London boroughs and if health inequities would be reduced through the greenhouse gas mitigation strategies in the transport sector. MethodsA narrative review of publicly available CAPs of all the London boroughs was conducted to identify if the following 5 health impacts were addressed: food insecurity, vector-borne diseases, respiratory diseases, heat-related, and extreme weather events-related health outcomes. Due to time and resource constraints, health equity implications in vulnerable groups (like the elderly, children, the disabled, and low socioeconomic status) were analysed only in the transport strategies outlined in the CAPs of 10 boroughs. The 3 transport-related strategies - active travel, public transport use, and healthy land use-were selected for major co-benefits. To understand the role of health and equity through climate action, 8 key officials (public health consultants and climate officers) from 7 different local authorities were interviewed. These semi-structured interviews were recorded and thematically analysed using a framework method. FindingsIn the 28 CAPs analysed, the health issues were variably addressed. Of the 28 boroughs, 2 mentioned all the health issues listed above, 9 CAPs did not mention any, and the rest noted a few. Most boroughs have focused on equitable transport strategies with maximum health benefits like active travel and other less beneficial options like the electrification of vehicles. But they do not make the best use of communicating the co-benefits. The implications of these transport strategies on vulnerable groups were also variably assessed. The interviews revealed that some councils aimed to improve health and equity through the climate agenda. Still, current practices do not prioritise the role of health in climate action, nor is climate change a public health priority. RecommendationsThe recommendations made to the Greater London Authority (GLA) and the local councils are to increase the public health capacity in local climate action, produce climate change related public health evidence, creation of climate change dashboard for public health practitioners, communicate the co-benefits of climate action to the stakeholders, immediate formulation & implementation adaptation strategies, and evaluate the process & impacts of the current CAPs. Further, when developing the CAPs, incorporating Win-Win strategies that capitalise on the health and other co-benefits and communicate the economic and wider social gains of the strategies to the public and other stakeholders. LimitationsThe main limitation of this report is that only the publicly available CAPs were reviewed; however, there may be the existence of other specific documents (such as air quality or heatwave action plans) which have extensively addressed the health and equity issues. The findings and recommendations are based on the review of the CAPs and interviews conducted. But the evaluation of the implementation of the CAPs was beyond the scope of this report. Further, there is the potential for single researcher bias as the interviews were conducted and analysed by one person.