Energy as a Social and Commercial Determinant of Health: A Qualitative Study of Australian Policy

Document Type : Original Article


1 Stretton Institute, University of Adelaide, Adelaide, SA, Australia

2 Department of Industrial Systems Engineering and Management, National University of Singapore, Singapore, Singapore

3 College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia

4 Uniting Care, Adelaide, SA, Australia


This paper considers energy as a social and commercial determinant of health. Stable access to clean and sustainable energy is integral for human wellbeing yet public health rarely considers its importance.

Using Nvivo qualitative analysis software we analysed all Australian federal, state and territory strategic energy policies covering varying periods between 2016-2030. We defined strategic policy as including the goals, objectives and strategies of the department regarding a specific area of policy responsibility. This criterion excluded documents such as operational guidelines. 36 energy-related policies were analyzed.

While the nature of energy supply is crucial to determining the impact of human and environmental health, our analysis showed that health and wellbeing are only rarely considered in policy. We developed a conceptual framework to guide our work linking energy policy with health. Australia’s continued reliance on fossil fuels evident in the policies poses health risks, especially as climate change threatens physical and mental health. Yet health considerations were mainly absent from the policies. However, some jurisdictions (South Australia and the Australian Capital Territory) had policies encouraging a fast move to renewables. Energy pricing was a key focus in each jurisdiction and had become highly politicalized in the past decade. Little attention was paid to equity considerations in the policies.

Energy policy would be more health promoting if public health perspectives were considered during its development. On the basis of our policy analysis and literature review we conclude with recommendations for healthy energy policy.


  1. Smith KR, Frumkin H, Balakrishnan K, et al. Energy and human health. Annual Rev Public Health. 2013;34:159-188. doi:10.1146/annurev-publhealth-031912-114404
  2. Smith KR, Frumkin H, Balakrishnan K, et al. Energy and human health. Annual Review of public health. 2013;34:159-188.
  3. McMichael A. Climate change and the health of nations: famines, fevers, and the fate of populations. New York: Oxford University Press; 2017.
  4. Watts N, Adger WN, Agnolucci P, et al. Health and climate change: policy responses to protect public health. The Lancet. 2015;386(10006):1861-1914.
  5. Coady D, Parry IWH, Shang B. Energy Price Reform: Lessons for Policymakers. Review of Environmental Economics and Policy. 2018;12(2):197-219. doi:10.1093/reep/rey004
  6. OECD. The Cost of Air Pollution2014. doi:doi:
  7. World Health Assembly. Health, environment and climate change: road map for an enhanced global response to the adverse health effects of air pollution: report by the Director-General. Geneva: World Health Organization; 2018.
  8. Dockery DW, Pope CA. Acute Respiratory Effects of Particulate Air Pollution. Annual Review of Public Health. 1994;15(1):107-132. doi:10.1146/annurev.pu.15.050194.000543
  9. Dannenberg AL, Frumkin H, Jackson RJ, et al. Making Healthy Places: Designing and Building for Health, Well-being, and Sustainability: Island Press; 2012.
  10. Newman P, Beatley T, Boyer H. Resilient Cities. Responsing to peak oil and climate change. Washington, DC: Island Press; 2009.
  11. World Health Organization. Health Impact Assessment Energy. 2021; Accessed 12th May, 2021.
  12. Masson-Delmotte V, P. , Zhai A, Pirani SL, et al., eds. IPCC, 2021: Climate Change 2021: The Physical Science Basis. Contribution of Working Group I to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change Cambridge: Cambridge University Press. ; 2021.
  13. Department of Industry Science Energy and Resources. Australian Energy Statistics, Table O Australian electricity generation, by state and territory, by fuel type, physical units. In: Australian Government, ed. Canberra2021.
  14. Australian Energy Regulator. State of the Energy Market 2020. Melbourne: Australian Competition and Consumer Commission;2020.
  15. Australian Government. Australian Energy Update 2020,2020:p.8.
  16. Cheung G, Davies PJ. In the transformation of energy systems: what is holding Australia back? Energy Policy. 2017;109:96-108.
  17. Warren B, Christoff P, Green D. Australia’s sustainable energy transition: The disjointed politics of decarbonisation. Environmental Innovation and Societal Transitions. 2016;21:1 12.
  18. Byrnes L, Brown C, Foster J, Wagner LD. Australian renewable energy policy: Barriers and challenges. Renewable Energy. 2013;60:711-721. doi:10.1016/j.renene.2013.06.024
  19. Ayling J. A contest for legitimacy: the divestment movement and the fossil fuel industry. Law & Policy. 2017;39(4):349-371.
  20. Blakers A, Lu B, Stocks M. 100% renewable electricity in Australia. Energy. 2017;133:471-482. doi:10.1016/
  21. Finkel A, Moses K, Munro C, Effeney T, O’Kane M. Independent Review into the Future Security of the National Electricity Market: Blueprint for the Future. Canberra: Commonwealth of Australia 2017.
  22. Australia Bureau of Statistics. Household Expenditure Survey, Australia: Summary of Results. Canberra: ABS;2017.
  23. Australian Institute of Health and Welfare. Indigenous Life Expectancy and Deaths Canberra: AIHW;2020.
  24. Corbin J, Strauss A. Basics of qualitative research. California: Sage Publications; 2008.
  25. Liamputtong P, Ezzy D. Qualitative Research Methods. 2nd ed. Melbourne, Australia: Oxford University Press; 2006.
  26. Bowen GA. Document Analysis as a qualitative research method. Qualitative Research Journal. 2009;9(2):27-40. doi:10.3316/QRJ0902027
  27. Baum F, Delany-Crowe T, Fisher M, et al. Qualitative protocol for understanding the contribution of Australian policy in the urban planning, justice, energy and environment sectors to promoting health and health equity. Health Policy. 2018;8(9):e025358. doi:10.1136/bmjopen-2018-025358
  28. World Health Organization, WHO Regional Office for Europe. Report on social determinants of health and the health divide in the WHO European Region: Executive summary. Copenhagen: WHO;2012.
  29. Sharma D. The multidimensionality of electricity reform—an Australian perspective. Energy Policy. 2003;31(11):1093-1102. doi:10.1016/s0301-4215(02)00217-3
  30. Council of Australian Governments. Energy Market Review (Parer Review) Towards a truly national and efficient energy market. Canberra: Dept. of Industry, Tourism and Resources;2002.
  31. South Australia’s Citizens’ Jury on Nuclear Waste. Final Report Adelaide: SA Citizen's Jury on Nuclear Waste;2016.
  32. McGreevy DM, MacDougall C, Fisher DM, Henley M, Baum F. Expediting a renewable energy transition in a privatised market via public policy: The case of south Australia 2004-18. Energy Policy. 2021;148:111940. doi:
  33. The Lancet. The climate emergency: a last chance to act? The Lancet. 2021;398(10311):1541. doi:10.1016/S0140-6736(21)02281-9
  34. O'Kane M. Final Report – Independent Review of Coal Seam Gas Activities in NSW. Sydney: Office of NSW Chief Scientist and Engineer;2014.
  35. Australian Energy Regulator. State of the Energy Market 2021. Melbourne: AER;2021.
  36. McMichael AJ. Globalization, Climate Change, and Human Health. New England Journal of Medicine. 2013;368(14):1335-1343. doi:10.1056/NEJMra1109341
  37. Intergovernmental Panel on Climate Change (IPCC). Climate change 2014: Synthesis report. Geneva: IPCC;2014.
  38. Bacchi C. Analysing policy: What's the problem represented to be? Frenchs Forest, NSW: Pearson Education; 2009.
  39. Ito K, De Leon SF, Lippmann M. Associations between Ozone and Daily Mortality: Analysis and Meta-Analysis. Epidemiology. 2005;16(4):446-457.
  40. Australian Government. Australian Energy Update. In: Department of Industry SEaR, ed. Canberra: Department of Industry, Science, Energy and Resources,; 2020.
  41. Coady D, Parry I, Sears L, Shang B. How Large are Global Energy Subsidies?,. Munich: Center for Economic Studies and ifo Institute (CESifo), ;2016.
  42. Smith KR, Frumkin H, Balakrishnan K, et al. Energy and Human Health. Annual Review of Public Health. 2013;34(1):159-188. doi:10.1146/annurev-publhealth-031912-114404
  43. Sonter LJ, Dade MC, Watson JEM, Valenta RK. Renewable energy production will exacerbate mining threats to biodiversity. Nature Communications. 2020;11(1):4174. doi:10.1038/s41467-020-17928-5
  44. Cianconi P, Betrò S, Janiri L. The Impact of Climate Change on Mental Health: A Systematic Descriptive Review. Frontiers in Psychiatry. 2020;11(74). doi:10.3389/fpsyt.2020.00074
  45. Middleton J, Cunsolo A, Jones-Bitton C, Wright C, Harper S. Indigenous mental health in a changing climate: a systematic scoping review of the global literature. Environmental Research Letters. 2020;15(5). doi:
  46. Liddell C, Morris C. Fuel poverty and human health: A review of recent evidence. Energy Policy. 2010;38(6):2987-2997.
  47. Richardson D. The Costs of Market Experiments: Electricity Consumers Pay the Price for Competition, Privatisation, Corporatisation and Marketization. Canberra: The Australia Institute;2019.
  48. McLoughlin C. Solar panels not benefiting poor who can't afford them, SACOSS says. Vol 2022. 1st August 2017 ed: ABC News; 2017.
  49. International Energy Agency. Net Zero by 2050: A Roadmap for the Global Energy Sector: IEA; 2021: Accessed 21st June 2022.
  50. Zhang K, Batterman S. Air pollution and health risks due to vehicle traffic. Sci Total Environ. 2013;450-451:307-316. doi:10.1016/j.scitotenv.2013.01.074
  51. Karner AA, Eisinger DS, Niemeier DA. Near-roadway air quality: synthesizing the findings from real-world data. Environmental science & technology. 2010;44(14):5334-5344.
  52. Chen H, Kwong JC, Copes R, et al. Living near major roads and the incidence of dementia, Parkinson's disease, and multiple sclerosis: a population-based cohort study. The Lancet. 2017;389(10070):718-726. doi:10.1016/s0140-6736(16)32399-6
  53. Kim KH, Kabir E, Kabir S. A review on the human health impact of airborne particulate matter. Environ Int. 2015;74:136-143. doi:10.1016/j.envint.2014.10.005
  54. Oakes MM, Burke JM, Norris GA, Kovalcik KD, Pancras JP, Landis MS. Near-road enhancement and solubility of fine and coarse particulate matter trace elements near a major interstate in Detroit, Michigan. Atmospheric Environment. 2016;145:213-224. doi:10.1016/j.atmosenv.2016.09.034
  55. Maria Costantini AE, Debra Kaden, Marian Berkowitz, Kelly Pitts, Davida Schiff. Traffic-Related Air Pollution: A Critical Review of the Literature on Emissions, Exposure, and Health Effects. Boston, Massachusetts: Health Effects Institute; January 12, 2010 2010.
  56. Anthony Seaton WM, Kenneth Donaldson, David Godden. Particulate air pollution and acute health effects. Lancet. 1995;345:176-178.
  57. Marshall JD, Brauer M, Frank LD. Healthy neighborhoods: walkability and air pollution. Environmental health perspectives. 2009;117(11):1752-1759.
  58. Schofield R, Walter C, Silver J, Brear M, Rayner P, Bush M. Submission to the Department of Environment and Energy in response to their “Better fuel for cleaner air” discussion paper. 2017.
  59. Davis LW. The Environmental Cost of Global Fuel Subsidies. The Energy Journal. 2017;38:7-27.
  60. Marshall JD, McKone TE, Deakin E, Nazaroff WW. Inhalation of motor vehicle emissions: effects of urban population and land area. Atmospheric Environment. 2005;39(2):283-295.
  61. Connor L, Albrecht G, Higginbotham N, Freeman S, Smith W. Environmental change and human health in Upper Hunter communities of New South Wales, Australia. EcoHealth. 2004;1(2):SU47-SU58.
  62. Higginbotham N, Freeman S, Connor L, Albrecht G. Environmental injustice and air pollution in coal affected communities, Hunter Valley, Australia. Health & Place. 2010;16(2):259-266.
  63. de Leeuw E, Simos J, eds. Healthy Cities: The Theory, Policy, and Practice of Value-Based Urban Planning. New York: Springer-Verlag 2017.
  64. Government of South Australia, World Health Organization. Progresssing the Sustainable Development Goals through Health in All Policies: Case studies from around the world. . Adelaide: Government of South Australia;2017.
  65. Energy Consumers Australia and KPMG. Australia’s Energy Transition: A Snapshot of the Changing Policy Landscape: Energy Consumers Australia;2021.
  66. 350Boorloo:Perth. Captured State: The Influence of the Gas Lobby on WA. Perth: 350Boorloo:Perth;n.d.
  67. West M. The Minerals Council, coal and the half a billion spent by the resources lobby. Michael West Media 2017;2nd October
  68. Knaus C. Fossil-fuel industry doubles donations to major parties in four years, report shows. The Guardian2020.
  69. Rabl A, Drieicer M. Health and environmental impacts of energy systems. International Journal of Global Energy Issues 2002;18(2).
  70. World Health Organization. HJigh Level Coalition on Energy and Health. Accessed 12th May, 2021.

Articles in Press, Accepted Manuscript
Available Online from 07 November 2022
  • Receive Date: 23 February 2022
  • Revise Date: 02 September 2022
  • Accept Date: 06 November 2022
  • First Publish Date: 07 November 2022