The Fossil Fuel Non‐Proliferation Treaty: what it is, its importance for health, and why Australia should endorse it

Climate change — driven primarily by the extraction and burning of fossil fuels — is profoundly affecting our health. Some impacts are direct and immediate, such as from worsening heatwaves and extreme weather events.1 Others are indirect and more complex, including changes to the social determinants of health and the distribution of infectious diseases, and increased water and food insecurity. The risks associated with climate change are not being felt equally, and it is the most disadvantaged people and countries (who have generally contributed the least to climate change) that are disproportionately exposed and vulnerable.2

The 29th Conference of the Parties to the United Nations Framework Convention on Climate Change (UNFCCC), COP29, was recently held in Baku, Azerbaijan. COP is the UNFCCC's decision‐making body, most notably responsible for the Paris Agreement, which aims to limit global warming to 1.5°C or well below 2°C.3 Azerbaijan is a major oil and gas producer with plans for expansion, which contradicts the urgent need to phase out fossil fuels in accordance with the Paris Agreement.4 This is the third consecutive year that COP has been hosted by a country with significant fossil fuel interests, and fossil fuel lobbyists at COP29 outnumbered delegates from the ten most climate‐vulnerable countries combined.5 Given the prominence of fossil fuel producers in the UNFCCC process, a further mechanism is needed to manage the phasing out of fossil fuels.

Achieving the goals of the Paris Agreement requires rapid reductions in greenhouse gas (GHG) emissions in all sectors.6 However, current mitigation plans make it likely that warming will exceed 1.5°C this century.6 To prevent the most devastating and inequitable health impacts, we must rapidly reduce GHG emissions — and phase out fossil fuels.

Based on the extensive evidence of the health impacts of climate change, and the health benefits of phasing out fossil fuel extraction and use, this perspective article argues that Australia should endorse the Fossil Fuel Non‐Proliferation Treaty (FFNPT) as an act of public health. We outline the health impacts of climate change, discuss what the FFNPT seeks to achieve, its alignment with public health, and how Australia's support for the treaty could strengthen its bid to host COP31.

The health impacts of climate change

The world is not on track to meet the goals of the Paris Agreement. The sixth assessment report of the Intergovernmental Panel on Climate Change, released in 2023, found that GHG emissions are the highest they have ever been and that, in the last decade (2011–2020), the mean global surface temperature reached 1.1°C above the 1850–1900 baseline.6 The 2023 annual mean temperature hit a record high of 1.45°C above pre‐industrial times.7 This is having devastating impacts on human health.

The Lancet Countdown tracks the health impacts of climate change, highlighting in its most recent report that the threat to health is unprecedented, with ten out of 15 climate‐related health indicators reaching record levels, such as heat‐related mortality, heat stress during outdoor physical activity and work, and poorer quality sleep.7 There are also health impacts from increases in extreme weather events, the spread of infectious diseases, and food insecurity.7 The Oceania report of the Lancet Countdown, published in the MJA, and the World Health Organization (WHO) COP29 report on climate change and health, reached the same conclusion as the global Lancet Countdown report.1,8 In Australia, rising temperatures have led to more frequent, intense and prolonged heatwaves, which pose serious health risks. Heatwaves are estimated to have caused more deaths in Australia since 1900 than all other natural hazards combined.9

What is the Fossil Fuel Non‐Proliferation Treaty?

The FFNPT is a proposed international agreement to stop the global expansion of new coal, oil and gas projects and equitably phase out existing fossil fuel infrastructure, complementing the Paris Agreement.10,11,12 The FFNPT is based on three pillars: non‐proliferation, fair phase‐out, and just transition. The non‐proliferation pillar aims to prevent the expansion of fossil fuel production, potentially through a global public register to track fossil fuel reserves and regular assessments by bodies such as the International Energy Agency.13 The fair phase‐out pillar focuses on reducing fossil fuel production while minimising negative impacts on economies and communities, such as through extraction limits and eliminating fossil fuel subsidies.11

The just transition pillar, grounded in the Common but Differentiated Responsibilities and Respective Capabilities principle, calls for countries with the capacity and historical responsibility for the causes of climate change, and who have benefited most from fossil fuels, to lead the transition.14 The treaty would recognise the current reliance of low income countries on fossil fuels for their economic development and seek to provide financial and technical support to help them transition to low carbon energy. This assistance could include measures such as job creation, compensation for displaced workers, and regional development funds.15 A global transition fund could provide this support, with funds coming from redirected fossil fuel subsidies or a global carbon tax.11 A just transition must also address the extraction of critical minerals needed for renewable infrastructure, ensuring that the health inequities of workers and communities near fossil fuel extraction sites are not repeated at critical mineral extraction sites.16

The treaty is currently supported by 16 nation states (including 11 Pacific Island countries) and endorsed by more than 300 health institutions, including the WHO.10 The Australian Government does not currently support the FFNPT, which is likely influenced by Australia's position as one of the world's largest exporters of coal and gas.1

At COP29, Australia said it would commit to opening no new coal power plants in its next Nationally Determined Contribution, due to be released in 2025.17 Australia's ageing fleet of coal‐fired power plants will not be replaced on retirement, as clean energy sources — primarily wind, solar and storage — are now more cost‐effective. As a high income country that has benefited from fossil fuels for decades, Australia has the resources and responsibility to lead the clean energy transition and support low income nations in their own transitions.

Reducing fossil fuels is an act of public health

Fossil fuels are the primary driver of climate change, contributing to 67% of global GHG emissions.7 Fossil fuel combustion releases GHGs, which trap heat in the atmosphere, causing global warming. Major fossil fuel companies are expanding their production plans, putting the world on track to exceed emissions compatible with 1.5°C of warming by 189% by 2040.7 This growth in fossil fuel production undermines the Paris Agreement and endangers human health and survival.

Fossil fuel projects also contribute to disease by contaminating air and waterways with harmful chemicals. Indigenous populations, such as Aboriginal and Torres Strait Islander peoples, face significantly higher health burdens from these exposures, due to their proximity to extraction sites and higher rates of pre‐existing health conditions such as respiratory and cardiovascular diseases.18,19 These communities are also among the most severely affected by the climate crisis.20 Without careful planning and implementation, climate change adaptation and mitigation strategies may inadvertently deepen existing inequities, further marginalising already vulnerable populations.21

Reducing fossil fuel extraction is critical not only for mitigating climate change but also for reducing the health risks associated with fossil fuel use. Global health leaders have asserted the need to phase out fossil fuels “in the name of health”.22 Health organisations are advocating for fossil fuels to be treated as a public health issue, drawing parallels between the climate crisis and the tobacco epidemic.23 As with tobacco companies, coal, oil and gas companies have been aware of the dangers of their products for decades, yet have actively sought to downplay these risks and create public uncertainty.24 Similar to the WHO Framework Convention on Tobacco Control, the proposed FFNPT would be an evidence‐based international agreement to regulate substances — coal, oil and gas — that are widely recognised as harmful to human health.8,25,26

Shifting from fossil fuels to renewable energy sources that generate little to no air pollution and have significantly smaller environmental impacts would improve health outcomes. Strengthening global efforts to achieve the Paris Agreement goals can prevent 1.18 million annual deaths from air pollution alone.27 Economic savings from avoided climate change‐related illnesses can be reinvested into health initiatives, further enhancing public health. Although technologies such as carbon capture and storage have been proposed to mitigate the impacts of fossil fuels, such technologies would delay the urgent transition to clean energy required to reduce emissions.15 Even with carbon capture and storage, fossil fuel extraction and combustion will continue to harm public health.

For these reasons, we view endorsement of the FFNPT as important for promoting public health. Health care professionals should take leadership in this effort, as demonstrated by the Royal Australasian College of Physicians’ commitment to eliminate all financial holdings in fossil fuels.28 Supporting this treaty is not just an environmental imperative; it is a commitment to ensuring equitable health outcomes now and in the future.

A crucial opportunity ahead

With Australia tipped to co‐host COP31 in 2026 with Pacific Island countries, many of which support the FFNPT, there is an opportunity to demonstrate solidarity with our Pacific neighbours. After years of climate change inaction under the former Coalition government, the current Labor government has legislated its commitment to cutting emissions by 43% by 2030, aiming for net‐zero emissions by 2050.29 Australia has also increased its share of renewable energy in electricity production from 17% in 2018 to 36% in 2022, with a goal of 82% to come from renewable sources by 2030.1

However, recent analysis suggests that Australia needs to achieve an approximate 70% reduction in emissions by 2030 to reach net zero by 2050.30 Pacific Island nations have urged Australia to strengthen its climate ambitions, with some Pacific leaders opposed to co‐hosting COP31 without an Australian pledge to end fossil fuel subsidies and halt fossil fuel projects.31 By endorsing the FFNPT, Australia could signal its readiness to take meaningful action against climate change and avoid its worst health impacts.

Endorsing the FFNPT is more than just a climate strategy for Australia; it represents a vital step towards advancing global health justice and fostering regional solidarity.