Health co-benefits of climate change action in Italy
Authors: Paolo Vineis, Marina Romanello, Paola Michelozzi, Marco Martuzzi
Journal: The Lancet Planetary Health (2022)

The climate breakdown is increasingly affecting the health of people around the world. As weather extremes intensify, the global health burden of unhealthy diets, sedentary lifestyles, and air pollution increases too. Against this backdrop, overstretched health systems can take stock of the co-benefits that a low carbon transition could deliver if health is prioritised in climate policies.1Romanello M van Daalen K Anto JM et al.Tracking progress on health and climate change in Europe.Lancet Public Health. 2021; 6: e858-e865Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar Yet, as pointed out in a recent commentary,2Salas RN Miller J Neira M Health at COP26: just the beginning.BMJ. 2021; 375n2960Google Scholar the UN Climate Change Conference (COP26) in Glasgow, UK, put little focus on health-related goals. Similarly, health is often disregarded in countries' nationally determined contributions and in national climate policies. The dissociation between public health policy and climate action translates into millions of avoidable adverse health outcomes and deaths each year. For example, reducing greenhouse gas emissions also reduces the effect of air pollution, which is the largest environmental cause of disease and mortality in Europe in terms of measurable effect. Italy is no exception to this issue. Although Italy developed both short-term and, more recently, long-term policies aimed at climate change mitigation,3Ministry for Ecological TransitionProposta di piano per la transizione ecologica.https://www.programmazioneeconomica.gov.it/tag/proposta-di-piano-per-la-transizione-ecologica/Date: Aug 2, 2021Date accessed: March 19, 2022Google Scholar health is still underrepresented in Italy's climate policies. However, change might be underway. The proposal of the Ministry for Ecological Transition plan released in August, 2021 mentioned the health co-benefits of climate action for the first time, and called for a health in all policies approach.3Ministry for Ecological TransitionProposta di piano per la transizione ecologica.https://www.programmazioneeconomica.gov.it/tag/proposta-di-piano-per-la-transizione-ecologica/Date: Aug 2, 2021Date accessed: March 19, 2022Google Scholar The health community in Italy is also becoming increasingly engaged with climate change. Since 2004, the Italian Ministry of Health (MoH) has implemented a national programme for the prevention of heat-related health effects, which to date includes 52 major cities and 93% of the residents aged 65 years and over. The Italian programme represents an important example of an integrated approach to prevent the effect of heat on people's health, targeted at susceptible subgroups.4Michelozzi P de' Donato FK Bargagli AM et al.Surveillance of summer mortality and preparedness to reduce the health impact of heat waves in Italy.Int J Environ Res Public Health. 2010; 7: 2256-2273Crossref PubMed Scopus (54) Google Scholar In 2019, a document of a working group of Consiglio Superiore di Sanità(the strategic advisory board of the MoH), led by one of us and including the current Minister of Ecological Transition, stressed the need to consider health co-benefits in all climate policies.5Vineis P Beagley J Bisceglia L et al.Strategy for primary prevention of non-communicable diseases (NCD) and mitigation of climate change in Italy.J Epidemiol Community Health. 2021; 75: 917-924Crossref PubMed Scopus (2) Google Scholar In 2020, the 5-year National Prevention Plan of the MoH was approved, addressing climate and health among its core objectives.6National Prevention Plan of the Ministry of HealthPiano Nazionale della Prevenzione 2020–2025. Ministero della Salute, Rome2020https://www.salute.gov.it/imgs/C_17_notizie_5029_0_file.pdfDate accessed: March 19, 2022Google Scholar Building on those efforts, and acknowledging the importance of taking stock of the health implications of progress towards the Paris Agreement goals, the Italian National Institute of Health (NIH) adopted and improved upon the standardised and peer-reviewed metrics of the Lancet Countdown on Health and Climate Change, an international research collaboration monitoring the health effects of climate change and the health benefits of climate action. Data from 17 Lancet Countdown indicators were extracted at a national or subnational level, and these data were complemented by the incorporation of national statistics where possible. This analysis enabled the development of figures that allow international comparison, benchmarking, and progress monitoring. These findings were summarised in a document published by the NIH.7Vineis P Alfano R Ancona C et al.Mitigation of climate change and prevention of diseases in Italy: the co-benefits policy—a contribution to COP-26.https://tinyurl.com/2nudjf86Date: 2021Date accessed: March 19, 2022Google Scholar The overall picture depicted by the exercise revealed two key findings.6National Prevention Plan of the Ministry of HealthPiano Nazionale della Prevenzione 2020–2025. Ministero della Salute, Rome2020https://www.salute.gov.it/imgs/C_17_notizie_5029_0_file.pdfDate accessed: March 19, 2022Google Scholar Firstly, climate change is already affecting the health of Italian people—between 2010 and 2020, there was a yearly average of almost 100 million more person-days of heatwave exposure than between 1986 and 2005, and heatwaves lead to a quantifiable burden of mortality and morbidity in Italy each summer; 2·3% of the total deaths observed in 2015 were attributable to heat exposure; twice the land surface was affected by at least one month of drought in 2020 than in 1950, putting food and water security at risk (figure); and changes in climatic conditions are affecting the environmental suitability for infectious disease transmission.7Vineis P Alfano R Ancona C et al.Mitigation of climate change and prevention of diseases in Italy: the co-benefits policy—a contribution to COP-26.https://tinyurl.com/2nudjf86Date: 2021Date accessed: March 19, 2022Google Scholar The second key finding is that a more ambitious mitigation response could result in substantial gains for human health. The continued use of fossil fuels is still contributing to high concentrations of air pollution, which resulted in Italy having the second highest number of deaths attributable to PM2·5 exposure in the EU in 2019.6National Prevention Plan of the Ministry of HealthPiano Nazionale della Prevenzione 2020–2025. Ministero della Salute, Rome2020https://www.salute.gov.it/imgs/C_17_notizie_5029_0_file.pdfDate accessed: March 19, 2022Google Scholar Italy still sourced 6% of its electricity from coal in 2018, and fossil fuels still accounted for 96% of all the energy used for road travel in 2017. At the average annual decarbonisation rate observed between 2015 and 2020, it would take Italy several decades to fully decarbonise its energy system. Slow progress towards decarbonisation might be partly due to the continued use of public funds to subsidise fossil fuel burning—in 2018, Italy dedicated the equivalent to 4·77% of its national health budget to this purpose. Regarding the food system, greenhouse gas emissions related to consumption of animal products represented 82% of all emissions coming from the agricultural products consumed in Italy in 2018. The Lancet Countdown modelling estimates that the associated red meat consumption contributed to more than 16 000 deaths.7Vineis P Alfano R Ancona C et al.Mitigation of climate change and prevention of diseases in Italy: the co-benefits policy—a contribution to COP-26.https://tinyurl.com/2nudjf86Date: 2021Date accessed: March 19, 2022Google Scholar These findings informed the formulation of policy recommendations to promote and maximise health gains from climate action, included in the document referred to previously (panel).6National Prevention Plan of the Ministry of HealthPiano Nazionale della Prevenzione 2020–2025. Ministero della Salute, Rome2020https://www.salute.gov.it/imgs/C_17_notizie_5029_0_file.pdfDate accessed: March 19, 2022Google Scholar With this approach, Italy exemplifies the potential for countries to adopt and improve upon the standardised, global metrics of the Lancet Countdown, guiding policy makers in ensuring the Paris Agreement indeed becomes the "most important public health agreement of the century".8United Nations Framework Convention on Climate ChangeThe Paris Agreement is a health agreement.https://unfccc.int/news/the-paris-agreement-is-a-health-agreement-whoDate: 2018Date accessed: February 24, 2022Google ScholarPanelPolicy recommendations to promote and maximise the health gains from climate action in ItalyImprove interaction between health and environment authorities; ensure that the health benefits and effects of climate change policies are taken into consideration in their development, and that policies with potential health co-benefits are prioritisedAccelerate action on climate change mitigation policies that reduce air pollution in urban areas; this should include promoting road travel decarbonisation in urban centres by incentivising active travel and public transportation, and disincentivising the use of private vehiclesDeliver rapid decarbonisation of the energy system; promptly eliminate the use of coal, and provide financial incentives for the uptake of clean, renewable sources of energyStop subsidising fossil fuels; urgently eliminate fossil fuel subsidies, and redirect funds into activities that promote health, wellbeing, and equity, including through measures to minimise the effects of subsidy elimination on the most vulnerable groupsPromote shifts to healthy, low-carbon diets, such as that put forward by the EAT-Lancet Commission, with particular emphasis on reducing red meat consumptionEnsure that the use of COVID-19 fiscal stimulus funds supports decarbonisation and health protection for Italian populations now and in the future, in line with WHO's prescriptions for a healthy, green recovery, and with the goals of the Paris Agreement Improve interaction between health and environment authorities; ensure that the health benefits and effects of climate change policies are taken into consideration in their development, and that policies with potential health co-benefits are prioritised Accelerate action on climate change mitigation policies that reduce air pollution in urban areas; this should include promoting road travel decarbonisation in urban centres by incentivising active travel and public transportation, and disincentivising the use of private vehicles Deliver rapid decarbonisation of the energy system; promptly eliminate the use of coal, and provide financial incentives for the uptake of clean, renewable sources of energy Stop subsidising fossil fuels; urgently eliminate fossil fuel subsidies, and redirect funds into activities that promote health, wellbeing, and equity, including through measures to minimise the effects of subsidy elimination on the most vulnerable groups Promote shifts to healthy, low-carbon diets, such as that put forward by the EAT-Lancet Commission, with particular emphasis on reducing red meat consumption Ensure that the use of COVID-19 fiscal stimulus funds supports decarbonisation and health protection for Italian populations now and in the future, in line with WHO's prescriptions for a healthy, green recovery, and with the goals of the Paris Agreement We declare no competing interests.