Conclusions and recommendations
Environmental change and human health
1.Without rapid action to curb greenhouse gas emissions and efforts to safeguard the environment we risk causing irreversible damage to the planet. This is already having a significant and growing impact on human health, with impacts set to become more severe. (Paragraph 21)
2.We are concerned that the NHS and the pharmaceutical industry is not sufficiently resourced to deal with these projected changes. Non-communicable diseases (NCDs) kill 41 million people each year, equivalent to 71 per cent of all deaths globally. We note that more people now die from non-communicable diseases than communicable diseases. We also note the recent stalling in life expectancy in the UK as a result of lifestyle changes with increased pressure for NHS resources. Public Health England should broaden its key performance indicators to include climate resilience and adaptation measures to tackle emerging diseases. These should include guidance to general practitioners and the pharmaceutical industry on Lyme disease, malaria, the zika virus and other emerging tropical diseases. We repeat our recommendation from our toxic chemicals report that Public Health England should introduce a comprehensive UK wide human and wildlife bio-monitoring scheme to measure the effects of toxic chemicals. A focus on lifestyle change means that it does not prioritise the impacts that wider economic and ecological changes will have on human health. Secondly, Public Health England must work across Government to advise local Government on the impacts of heat stress and protecting vulnerable communities, particularly the elderly, people living in care homes and those with kidney failure. (Paragraph 22)
3.The NHS has shown some progress in reducing carbon emissions by 18.5 per cent since 2007. It is deeply disappointing that it will miss its Climate Change Act target of a reduction in emissions of 34 per cent by 2020. As the largest employer, and one of the largest consumers of goods and services in the UK, the NHS should bring forward its targets to end the use of coal (2023/24) and oil (2028/29) for primary heating on NHS sites. This target should now be revised to reflect the Government’s commitment to achieve net zero greenhouse gas emissions by 2050 at the very latest. A new pathway for carbon reduction should be developed by April 2020 and communicated to all stakeholders. The NHS’ carbon footprint should be clearly communicated to staff, patients and suppliers, with messages on how they can contribute. (Paragraph 31)
4.Fluorinated gases remain a major problem, with inhalers contributing to over 3 per cent of total annual emissions from the NHS. We reiterate our recommendation that Government should work with medical professionals, pharmacists, the pharmaceutical industry and patients to significantly improve the recycling of Metered Dose Inhalers (MDIs); this makes both environmental and economic sense. We encourage the Government to investigate all the means of removing the barriers to the safe re-use of those valuable quota-restricted gases. The Government should also ensure that by 2020, at least 50 per cent of MDIs are recycled. It should also set out how it will reduce medical waste, such as MDIs, in its waste strategy. (Paragraph 32)
5.We are concerned that, at current rates of progress, the NHS will fall far short of the Committee on Climate Change’s recommendation of 100 per cent of low emission vehicles by 2035 at the latest. The current target of 66 per cent of vehicles being low emission by 2028 is not ambitious enough. The NHS should be taking the lead in the mitigation of climate change, given its size, budget and workforce, particularly when a major impact of climate change is likely to be a deterioration of several measures of population health. The Committee on Climate Change is clear that early uptake of electronic vehicles (EVs) brings co-benefits from reductions in air pollution. NHS direct fleet procurement and “Grey fleet” purchased through tax schemes should prioritise EVs. We recommend that the NHS aligns its plans with the Committee on Climate Change’s cost-efficient path for electric vehicle uptake to benefit from the financial savings and co-benefits (e.g. reduction in air pollution) of earlier EV uptake. (Paragraph 34)
Nature, wildlife and the environment
6.Progress towards meeting the Aichi targets by 2020 falls woefully short, and meeting only five of them will not protect the UK’s precious wildlife and fragile habitats. We recommend that the Government engage with the public on the next set of targets before the 2020 UN Biodiversity Conference and set out clear priorities for action. The targets should be formally reviewed every four years and the Government should task Natural England and devolved administrations with the responsibility for their domestic delivery. (Paragraph 52)
7.The Government’s 25 Year Plan for the environment sets out actions that the Government intends to take but there are no SMART targets against which its performance can be measured. Legislative targets are needed to drive action across Government Departments and not just DEFRA. We reiterate our previous recommendations that the Environment Bill must include a framework for statutory nature and biodiversity targets and interim milestones to be achieved by Government Departments, including by the Treasury, to help them achieve the Greening Government targets. Once these targets have been established through stakeholder collaboration, the Cabinet Office must issue guidance directing Departments to explain how their work programmes will achieve the delivery of these targets in their Single Departmental Plans and the next round of Greening Government Commitments. (Paragraph 55)
8.We are disappointed that Natural England has lost half of its budget over the last 10 years. It needs a rapid increase in funding to achieve current objectives. Any new obligations placed under new legislation should be adequately resourced. The Environment (Principles and Governance) Bill is an opportunity to consider holistically the governance frameworks for planetary health in the UK. We recommend that a principle to achieve a high level of environmental protection is put on the face of the Bill and all public bodies be required to achieve this. The Government provided us with the draft version of the first half of the Environment (Principles and Governance) Bill, on which we reported earlier this year. Much of the detail of the Government’s proposals for environmental protection, such as on biodiversity net gain, will be contained in the second half of the Bill and we urge the Government to make this available to the Committee for pre-legislative scrutiny as soon as possible, especially given the severe environmental and public health risks of a no-deal Brexit on October 31st. (Paragraph 63)
9.The Environment (Principles and Governance) Bill should include provision for new targets to increase green and blue urban infrastructure. Our heatwaves report recommended that the revised National Planning Policy Framework should set a target for councils to achieve, which aims to increase urban green space to 2001 levels, and higher if possible. This should also be included in the revised National Planning Policy Framework to ensure space for nature and people to help adaptation to climate change. (Paragraph 64)
10.In response to this report, the Government should set out the principles behind the design of the new environmental land management schemes, and the ‘public money for public goods’ principle, should the UK leave the EU as set out in the future for food, farming and the environment policy statement. These should include steps to minimise high pesticide use and actions to align land use, food production and mitigation and adaption to climate change. (Paragraph 70)
11.We were told that UK companies currently sell chemicals to countries with no regulation of pesticides whose use is banned here. UK policy should be consistent at home and abroad. In the event we leave the EU, the Government has said it will replicate the EU REACH system. Any new UK regulations should review pesticide laws. In the meantime, the Government should review pesticide export regulations and ensure that UK businesses protect planetary health and do not export toxic chemicals which are driving wildlife loss globally. (Paragraph 71)
Food systems
12.Climate change poses significant risks to international food and water security that may lead to hunger and undernutrition for millions of people. Some commentators have drawn links between food insecurity, political instability and conflict. Others have identified the risk of up to one billion climate refugees by 2050. (Paragraph 83)
13.The Government needs to work with UN bodies and national Governments to ensure the Department for International Development budget helps to guarantee national and international food and water security, environmental protection and climate resilience. (Paragraph 84)
14.We are concerned that the Government is complacent about the risks to food security posed by climate breakdown. The Government is due to publish an updated UK Food Security Assessment by the end of 2019. We recommend that the Government accepts the advice from the Committee on Climate Change about food security risks and set out how it plans to maintain UK food security in a changing climate. Government should publish immediately, in advance of the food security assessment due by the end of 2019, all information relating to food security and cost risks associated with no-deal Brexit. (Paragraph 90)
15.Environmental change is projected to have increasingly major impacts on global food systems which would affect the UK’s food security and ability to deliver healthy, sustainably produced diets. The development of a UK National Food Strategy is an important opportunity to link national food production, international food trade, and environmental protection. The Agriculture Bill should support this by incentivising a switch in UK agriculture towards more sustainably produced food, including agroecological farming methods, bringing about reductions in greenhouse gases associated with UK agriculture. (Paragraph 95)
16.Healthier, more sustainable diets can deliver co-benefits for people and the environment. The Government has a responsibility to raise public awareness of the Eatwell Guide and identify ways to promote the consumption of healthy and sustainable diets, including how they will achieve at least a 20 per cent reduction in meat and dairy consumption as recommended by the Committee on Climate Change’s Net Zero report, and a shift away from intensive livestock production systems. There is a need to coordinate efforts across Government to ensure that healthy and sustainable diets are available and affordable to all in the UK. This should be reflected in the Government’s procurement policies and in the next set of Greening Government Commitments. Food provided by the Government should be “sustainable by default” and comply with the Eatwell Guide recommendations. This could lead to an estimated reduction of 30 per cent in the carbon footprint of the Government’s purchased food. This is an important step in achieving net zero emissions by 2050. (Paragraph 108)
17.Consumer information, including clear labelling, can help shift diets. The Government should expand the restriction of advertising on high fat, sugar and salt products and consider using financial incentives to promote access to, and consumption of, healthy and sustainably produced food. (Paragraph 119)
18.We recommend that the Government establish a National Council for Food Policy similar to the work of the Nordic Council of Ministers - to bring together the bodies responsible for food production, nutrition, public health, citizens representatives, and environmental experts to share data and expertise, and ensure greater alignment around promoting healthy diets from sustainable production. (Paragraph 124)
19.The National Food Strategy and other Government policy actions relating to food and diets, must place equal emphasis on the importance of healthy diets produced sustainably and national food security. Public Health England’s Eatwell Guide should be revised to emphasise foods with lower environmental footprints and make clear recommendations to help the public choose healthy and sustainable diets. To deliver the transformational changes necessary in UK diets the Government should establish a National Food Council as part of its upcoming Environment (Principles and Governance) Bill. It should lead on the roll out of the National Food Strategy. (Paragraph 125)
20.We recommend that the National Food Strategy:
a)Recognises the risks to national food security from the UK importing 40 per cent of the food we consume, and explores policies to mitigate these risks and ensure that the UK delivers healthy diets to all, especially in the event of a no-deal Brexit.
b)Works with farmers, supermarkets and the food industry to deliver transformational shifts in access to and affordability of healthy and sustainable diets.
c)Sets out annual targets to reduce food waste at every level of the food supply chain consistent with the Government’s aim to achieve net zero emissions by 2050 at the very latest. This target should be consistent with SDG 12.3 (reduce food waste) to halve food waste by 2030.
d)Recommends policies made by the Committee on Climate Change including shifts towards lower meat and dairy consumption, to achieve the net zero target. The Strategy should set out how public procurement teams, as well as the food and agriculture industry can deliver this goal.
e)Incentivises production of fruit and vegetables using sustainable methods in the UK to close the fresh fruit and vegetable trade gap and reduce food security risk.
f)Set out clear guidelines for Government procurement of food in schools, hospitals and prisons to be sustainable by default.
g)Alongside this, increase teaching within schools around food production, nutrition, food preparation and the environmental impacts associated with the food system. (Paragraph 126)
Sustainable Cities
21.We look forward to the introduction of air quality legislation as soon as possible, and encourage the Government to draft it with cross-cutting planetary health outcomes in mind. We recommend that any new legislation on clean air brings UK legal limits for air pollution in line with WHO recommended limits (10ug/m³). (Paragraph 138)
22.We recommend that the Government adopts the Committee on Climate Change’s recommendations on off-grid new housing in full. This would include stopping the connection of new homes to the gas grid from 2025. The Government should respond to each recommendation from the Committee on Climate Change’s report on UK housing. (Paragraph 154)
23.We note that the number of energy efficiency installations (e.g. loft and wall cavity insulation) has collapsed since 2012. A new energy efficiency scheme should be developed and implemented by no later than April 2020 to create warmer homes which are cheaper to run. (Paragraph 155)
24.DEFRA should also manage risk of water security in cities and set a default 100 litres per capita per day consumption target for water as recommended by the Committee on Climate Change. (Paragraph 156)
25.Air pollution (indoor and outdoor) from human activity is an increasing concern and harms public health. The Committee on Climate Change Adaptation Sub-Committee has provided expert guidance on ways to strengthen the building regulations for new and existing housing. We welcome the Government’s plans to update the building regulations, including reviewing whether the current enforcement regime is effective. (Paragraph 163)
26.We recommend that the Government’s review of the building regulations takes an integrated approach to ensure that sustainability and public health are properly reflected in any new code. We recommend that, in line with advice from the Committee on Climate Change, the Government change building regulations (specifically part F and L) to mitigate negative impacts of indoor air pollution. (Paragraph 164)
27.Urban green space can improve public health and mental health outcomes, particularly for disadvantaged groups. The National Planning Policy Framework needs to be better updated to promote opportunities for active travel, green spaces and access to healthy, sustainable food in planning authorities’ Local Plans. (Paragraph 172)
28.Green space is proven to reduce the urban heat island effect, reducing the risks from heatwaves. Our 2018 ‘Heatwaves: adapting to climate change’ report recommended that national targets be set to increase urban green space back up to 2001 levels or higher. We repeat this recommendation. (Paragraph 173)
29.Increasing tree planting should be a priority to improve air quality, capture carbon and create green spaces in cities. Whilst we welcome the ‘Urban Tree Challenge Fund’, we note that tree targets are not being met, with only half the target number of trees having been planted in the last five years. The Government should update targets to align with the recommendation from the Committee on Climate Change. The Government should review its Tree Challenge Fund and set out how it will meet the CCC’s target of 30,000 hectares of tree planting a year. Councils should be mandated to state how many trees they will plant per house built with a minimum standard of one tree per house. Green infrastructure should be specified in planning permission. (Paragraph 174)
30.The Government has a responsibility to increase equitable access to healthy, sustainable food for city dwellers. The Government should review its planning policy guidance to measure how well the current restrictions on fast food outlets are working in practice and it should ensure that planning authorities are able to restrict the numbers of fast food outlets without stringent evidence requirements. The Government’s forthcoming National Food Strategy should set out how the Government will work with food providers, including restaurants, fast food outlets and supermarkets to transform the way that people consume food in the UK. (Paragraph 183)
Governance for planetary health
31.To tackle the urgent concerns relating to public health, food security and the environment raised in this planetary health inquiry, strong national and international governance is required. Continuing the global leadership shown by legislating for net zero emissions by 2050, the UK Government should now highlight planetary health at forthcoming international meetings, including the 2020 Conference of the Parties to the Convention on Biological Diversity. As host of the 2020 UN Climate Change Conference (Conference of the Parties) the Government should ensure that planetary health is a key theme of the discussions. (Paragraph 188)
32.We note that Government departments and agencies are increasingly seeking to share data and work together to tackle planetary health concerns. However, more needs to be done. Improving public health in the UK while improving the environment will require significantly improved data sharing and cross-departmental working in the future. (Paragraph 196)
33.To ensure cross-government working we recommend that the Government ensures single point accountability for planetary health at both ministerial and senior civil service levels. The Government should also establish a forum or joint unit to manage planetary health across Government. To support these meetings, health leaders and organisations must be in attendance: the Chief Scientific Advisers, Public Health England and the Chief Medical Officer all have a major role to play in providing advice on this crucial matter. (Paragraph 197)
34.We find it extraordinary that MHCLG had not had a Chief Scientific Adviser for 7 years, especially given that UK buildings are a source of significant harm to public health and make up nearly a third of the UK’s carbon footprint. We note the crucial importance of scientific advice in policy making and support the Chief Scientific Adviser network in their excellent work. We recommend that the Government Chief Scientific Adviser (GCSA) assumes responsibility for oversight of the Chief Scientific Adviser network to ensure that such personnel gaps do not happen again. The GCSA should also ensure that the Government’s digital service makes its data available to researchers to map hunger, obesity and poverty so they can be incorporated into emerging policy solutions. The next round of research funding should include an element of planetary health research to combine the strong evidence base and expertise in this area from the UK research community. (Paragraph 198)
Published: 17 September 2019