The 2024 report of the MJA–Lancet Countdown on health and climate change: Australia emerging as a hotspot for litigation

In reply:

We thank Thakur and Mathew for their comments1 in response to the 2024 MJA–Lancet Countdown report on health and climate change.2 We agree there is a need for better environmental monitoring in remote First Nations communities, and that without this, climate‐related exposures and impacts on health in such communities are difficult to assess. Although this is an important data gap in Australia, there are many others here and elsewhere. For example, as highlighted in the recent inaugural small island developing states (SIDS) Lancet Countdown report, low data availability is one of the key challenges in measuring and tracking climate change and health impacts in these highly vulnerable nations,3 including our SIDS neighbours in the Pacific.

While it is crucial that we develop meaningful indicators to track the impacts of climate change on health of First Nations peoples and communities, such impacts are complex and the development of indicators challenging. The MJA–Lancet Countdown previously developed an Indigenous health and climate change indicator that focused on tracking climate health vulnerabilities: prevalence of cardiovascular and long term respiratory conditions, rates of household overcrowding, and lack of access to primary care providers.4 However, recognising that these are indirect measures and are underpinned by non‐Indigenous concepts of health and wellbeing, the MJA–Lancet Countdown collaboration now includes three Indigenous researchers who are developing an indicator using Aboriginal and Torres Strait Islander‐driven and governed datasets that better describe the interconnectedness between cultural and environmental domains and wellbeing.5 Indeed, there is a need, globally, for broader integration of Indigenous knowledge into health and climate change policy making.6,7

Further, it is important to assess and track not only health impacts but also the broader context in which these are occurring and the adaptation and mitigation responses to them. Our reports have repeatedly highlighted other important data gaps relevant to the health of remote First Nations communities and climate change. For example, while Australia generally is making good progress in the uptake of clean household energy (ie, rooftop solar and battery systems), a lack of data persists on energy access in remote and Indigenous communities, which limits insights into clean energy adoption in these areas.2