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 [ACT]) 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. Annu Rev Public Health. 2013;34:159-188. doi:1146/annurev-publhealth-031912-114404
  2. McMichael A. Climate Change and the Health of Nations: Famines, Fevers, and the Fate of Populations. New York: Oxford University Press; 2017.
  3. Watts N, Adger WN, Agnolucci P, et al. Health and climate change: policy responses to protect public health. Lancet. 2015;386(10006):1861-1914. doi:1016/s0140-6736(15)60854-6
  4. Coady D, Parry IWH, Shang B. Energy price reform: lessons for policymakers. Rev Environ Econ Policy. 2018;12(2):197-219. doi:1093/reep/rey004
  5. Organisation for Economic Co-operation and Development (OECD). The Cost of Air Pollution: Health Impacts of Road Transport. OECD Publishing; 2014. doi:1787/9789264210448-en
  6. 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.
  7. Dockery DW, Pope CA 3rd. Acute respiratory effects of particulate air pollution. Annu Rev Public Health. 1994;15:107-132. doi:1146/annurev.pu.15.050194.000543
  8. Dannenberg AL, Frumkin H, Jackson RJ, et al. Making Healthy Places: Designing and Building for Health, Well-Being, and Sustainability. Washington, DC: Island Press; 2012.
  9. Newman P, Beatley T, Boyer H. Resilient Cities: Responding to Peak Oil and Climate Change. Washington, DC: Island Press; 2009.
  10. World Health Organization. Health Impact Assessment Energy. 2021. Accessed May 12, 2021.
  11. Masson-Delmotte V, Zhai P, Pirani A, et al. IPCC, 2021: Climate Change 2021: The Physical Science Basis. Cambridge: Cambridge University Press; 2021.
  12. Department of Industry Science Energy and Resources. Australian Energy Statistics, Table O Australian electricity generation, by state and territory, by fuel type, physical units. Canberra: Australian Government; 2021.
  13. Australian Energy Regulator. State of the Energy Market 2020. Melbourne: Australian Competition and Consumer Commission; 2020.
  14. Australian Government. Australian Energy Update 2020. Australian Government; 2020. p. 8.
  15. Cheung G, Davies PJ. In the transformation of energy systems: what is holding Australia back? Energy Policy. 2017;109:96-108. doi:1016/j.enpol.2017.06.056
  16. Warren B, Christoff P, Green D. Australia’s sustainable energy transition: the disjointed politics of decarbonisation. Environ Innov Soc Transit. 2016;21:1-12. doi:1016/j.eist.2016.01.001
  17. Byrnes L, Brown C, Foster J, Wagner LD. Australian renewable energy policy: barriers and challenges. Renew Energy. 2013;60:711-721. doi:1016/j.renene.2013.06.024
  18. Horne A. Election 2019: How Bob Brown and his anti-Adani convoy green-anted Labor in Queensland. The New Daily. May 19, 2019.
  19. Yosufzai R, Baker N. The Adani mine was a key factor in the government’s election win. Now what? SBS News. May 23, 2019.
  20. Composition of Trade Australia 2017-2018. Canberra: Department of Foreign Affairs and Trade, Commonwealth of Australia; 2019 .
  21. Ayling J. A contest for legitimacy: the divestment movement and the fossil fuel industry. Law Policy. 2017;39(4):349-371. doi:1111/lapo.12087
  22. Blakers A, Lu B, Stocks M. 100% renewable electricity in Australia. Energy. 2017;133:471-482. doi:1016/
  23. 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.
  24. Australian Bureau of Statistics (ABS). Household Expenditure Survey, Australia: Summary of Results. Canberra: ABS; 2017.
  25. Australian Energy Regulator. State of the energy market 2021, Canberra: Commonwealth of Australia; 2021.
  26. Australian Institute of Health and Welfare (AIHW). Indigenous Life Expectancy and Deaths. Canberra: AIHW; 2020.
  27. Corbin J, Strauss A. Basics of Qualitative Research. California: SAGE Publications; 2008.
  28. Liamputtong P, Ezzy D. Qualitative Research Methods. 2nd ed. Melbourne, Australia: Oxford University Press; 2006.
  29. Bowen GA. Document analysis as a qualitative research method. Qual Res J. 2009;9(2):27-40. doi:3316/qrj0902027
  30. 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. BMJ Open. 2018;8(9):e025358. doi:1136/bmjopen-2018-025358
  31. 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.
  32. Sharma D. The multidimensionality of electricity reform—an Australian perspective. Energy Policy. 2003;31(11):1093-1102. doi:1016/s0301-4215(02)00217-3
  33. 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.
  34. New Deomcracy (2016) South Australian Citizens’ Jury on Nuclear Waste, Final Report.
  35. 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(Pt A):111940. doi:1016/j.enpol.2020.111940
  36. The Lancet. The climate emergency: a last chance to act? Lancet. 2021;398(10311):1541. doi:1016/s0140-6736(21)02281-9
  37. O'Kane M. Final Report – Independent Review of Coal Seam Gas Activities in NSW. Sydney: Office of the NSW Chief Scientist & Engineer; 2014.
  38. Australian Energy Regulator (AER). State of the Energy Market 2021. Melbourne: AER; 2021.
  39. McMichael AJ. Globalization, climate change, and human health. N Engl J Med. 2013;368(14):1335-1343. doi:1056/NEJMra1109341
  40. Intergovernmental Panel on Climate Change (IPCC). Climate Change 2014: Synthesis Report. Geneva: IPCC; 2014.
  41. Bacchi C. Analysing Policy: What's the Problem Represented to Be? Frenchs Forest, NSW: Pearson Education; 2009.
  42. Ito K, De Leon SF, Lippmann M. Associations between ozone and daily mortality: analysis and meta-analysis. Epidemiology. 2005;16(4):446-457. doi:1097/01.ede.0000165821.90114.7f
  43. Australian Government. Australian Energy Update. Canberra: Department of Industry, Science, Energy and Resources; 2020.
  44. Coady D, Parry I, Sears L, Shang B. How Large Are Global Fossil Fuel Subsidies? Munich: Center for Economic Studies and Ifo Institute for Economic Research (CESifo); 2016.
  45. Sonter LJ, Dade MC, Watson JEM, Valenta RK. Renewable energy production will exacerbate mining threats to biodiversity. Nat Commun. 2020;11(1):4174. doi:1038/s41467-020-17928-5
  46. Cianconi P, Betrò S, Janiri L. the impact of climate change on mental health: a systematic descriptive review. Front Psychiatry. 2020;11:74. doi:3389/fpsyt.2020.00074
  47. Middleton J, Cunsolo A, Jones-Bitton A, Wright CJ, Harper SL. Indigenous mental health in a changing climate: a systematic scoping review of the global literature. Environ Res Lett. 2020;15(5):053001. doi:1088/1748-9326/ab68a9
  48. Liddell C, Morris C. Fuel poverty and human health: a review of recent evidence. Energy Policy. 2010;38(6):2987-2997. doi:1016/j.enpol.2010.01.037
  49. Richardson D. The Costs of Market Experiments: Electricity Consumers Pay the Price for Competition, Privatisation, Corporatisation and Marketization. Canberra: The Australia Institute; 2019.
  50. McLoughlin C. Solar Panels Not Benefiting Poor Who Can't Afford Them, SACOSS Says. ABC News. 31, 2017.
  51. International Energy Agency (IEA). Net Zero by 2050: A Roadmap for the Global Energy Sector. IEA; 2021. Accessed June 21, 2022.
  52. Zhang K, Batterman S. Air pollution and health risks due to vehicle traffic. Sci Total Environ. 2013;450-451:307-316. doi:1016/j.scitotenv.2013.01.074
  53. Karner AA, Eisinger DS, Niemeier DA. Near-roadway air quality: synthesizing the findings from real-world data. Environ Sci Technol. 2010;44(14):5334-5344. doi:1021/es100008x
  54. 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. Lancet. 2017;389(10070):718-726. doi:1016/s0140-6736(16)32399-6
  55. Kim KH, Kabir E, Kabir S. A review on the human health impact of airborne particulate matter. Environ Int. 2015;74:136-143. doi:1016/j.envint.2014.10.005
  56. 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. Atmos Environ. 2016;145:213-224. doi:1016/j.atmosenv.2016.09.034
  57. Maria Costantini AE, Kaden D, Berkowitz M, Pitts K, Schiff D. Traffic-Related Air Pollution: A Critical Review of the Literature on Emissions, Exposure, and Health Effects. Boston, Massachusetts: Health Effects Institute; 2010.
  58. Seaton A, MacNee W, Donaldson K, Godden D. Particulate air pollution and acute health effects. Lancet. 1995;345(8943):176-178. doi:1016/s0140-6736(95)90173-6
  59. Marshall JD, Brauer M, Frank LD. Healthy neighborhoods: walkability and air pollution. Environ Health Perspect. 2009;117(11):1752-1759. doi:1289/ehp.0900595
  60. Schofield R, Walter C, Silver J, Brear M, Rayner P, Bush M. Submission on the “Better Fuel for Cleaner Air” Discussion Paper. Melbourne: Clean Air and Urban Landscapes Hub, Melbourne Energy Institute; 2017.
  61. Davis LW. The environmental cost of global fuel subsidies. Energy J. 2017;38(1):7-27. doi:5547/01956574.38.SI1.ldav
  62. Marshall JD, McKone TE, Deakin E, Nazaroff WW. Inhalation of motor vehicle emissions: effects of urban population and land area. Atmos Environ. 2005;39(2):283-295. doi:1016/j.atmosenv.2004.09.059
  63. 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. doi:1007/s10393-004-0053-2
  64. 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. doi:1016/j.healthplace.2009.10.007
  65. de Leeuw E, Simos J. Healthy Cities: The Theory, Policy, and Practice of Value-Based Urban Planning. New York: Springer-Verlag; 2017.
  66. Government of South Australia, World Health Organization. Progressing the Sustainable Development Goals through Health in All Policies: Case Studies from Around the World. Adelaide: Government of South Australia; 2017.
  67. Energy Consumers Australia, KPMG. Australia’s Energy Transition: A Snapshot of the Changing Policy Landscape. Energy Consumers Australia; 2021.
  68. 350 Boorloo Perth. Captured State: The Influence of the Gas Lobby on WA. Perth: 350 Boorloo Perth;
  69. West M. The Minerals Council, Coal and the Half a Billion Spent by the Resources Lobby. Michael West Media; 2017.
  70. Knaus C. Fossil-Fuel Industry Doubles Donations to Major Parties in Four Years, Report Shows. The Guardian; 2020.
  71. Rabl A, Dreicer M. Health and environmental impacts of energy systems. Int J Glob Energy Issues. 2002;18(2-4):113-150. doi:1504/ijgei.2002.000957
  72. World Health Organization. High-Level Coalition on Health and Energy. Accessed May 12, 2021.
  • Receive Date: 23 February 2022
  • Revise Date: 02 September 2022
  • Accept Date: 06 November 2022
  • First Publish Date: 07 November 2022