Planetary health indicators for the local level: opportunities and challenges in applying the happy planet index in Victoria,Australia

Abstract

The United Nations Sustainable Development Goals, New Urban Agenda and Paris Agreement on Climate Change are blueprints for health promotion action that mandate human health is linked inextricably to the health of the environment. In the Anthropocene, new indicators are required to promote community engagement with, and measurement of, healthy and sustainable wellbeing for people and planet. This study explored the need for a metric such as the Happy Planet Index that explicitly links human health to health of the environment for a local level scale in Australia. The project arose from an international coalition of health promoters advocating for ‘planetary health’ approaches. Qualitative description methods guided the study design involving key informant interviews (n = 17) and four focus groups (n = 27 participants) with health and/or sustainability academics, practitioners and policy-makers. Document analysis of health and environment indices and policy mandates augmented the analysis. Qualitative content analysis techniques were used to analyse the findings. There was strong interest for a local level composite indicator, such as a rescaled Happy Planet Index (life expectancy × life satisfaction × equity adjustment/ecological footprint) for use at a local level. The value of a composite index was: its ability to promote community engagement with planetary health thinking; an advocacy tool for joint health and sustainability policy; to justify programs on health and environmental co-benefits; and to provide a mechanism for correlative comparisons between local governments and national comparisons. However, disciplinary silos currently limit partnerships for health promotion and planetary health and a local composite index could help bridge these divides.

Keywords

environment wellbeing planetary health Happy Planet Index indicators

Introduction

The planet has entered the Anthropocene, an era marked by colossal human-induced damage to the Earth’s natural systems (1,2). Humans are degrading and depleting key resources such as forests and waterways that are central to wellbeing and survival of humans and other species (1,3). The Anthropocene is a combined human and ecological health issue that compromises health and the sustainability of societies now and in the future (4,5). Emerging from the Lancet and Rockefeller Foundation report (6), Planetary Health is a field of inquiry that brings human health and sustainability imperatives together. Planetary Health seeks to promote ‘the health of human civilization and the state of the natural systems that define the safe environmental limits within which humanity can flourish’ (7).

International agreements such as the United Nations Sustainable Development Goals (SDGs), and the Paris Agreement on Climate Change (PACC) provide longer-term direction for achieving more healthy and sustainable nations and addressing challenges of the Anthropocene. These global agreements are marked by a shift in emphasis from economic development (e.g. measured by gross domestic product (GDP)) toward broader societal progress indicators including quality of life, environmental sustainability and health equity (1,8). In this new worldview, progress is weighted more evenly toward balancing priorities of human health with that of the environment, where economic growth is not the central indicator. These ‘think global, act local’ mandates require a co-benefit approach to policy and programme design, and subsequent measurement of impact on cross-cutting themes. Using the SDGs as an example, this could include, but is not limited to, Goal 3 – good health and wellbeing; Goal 10 – reduced inequalities; and Goal 13 – climate action.

Over time, the field of health promotion has affirmed its commitment to ‘protecting the natural environment (9)’ based on the understanding that ‘people form an integral part of the Earth’s ecosystem. Their health is fundamentally interlinked with the total environment’ (10). Proponents of the ecological determinants in health promotion (6,11) and planetary health (5,12) have championed the need for health policy and programme indicators of progress to incorporate sustainable development and environmental outcomes alongside social and economic determinants (13).

The local or community level has been pinpointed by health promotion experts (13,14) as the scale most amenable for health promotion interventions and measurement of ‘global to local mandates’ for planetary health. There is evidence of increased engagement with co-benefit health and sustainability policy and programmes in a burgeoning field of planetary health research that documents health promotion efforts at a local scale (14 –16). For example, in Victoria (Australia) – the project setting for this paper – the formerly named Department of Health and Human Services has mandated climate change as a priority health action area in local government within the Municipal Public Health and Wellbeing Planning framework. However, there is still much work to be done on designing planetary health indicators and measures of success in Victoria and other Australian jurisdictions (13,14).

Global mandates have seen a proliferation of single and composite indicators for measuring cross-cutting health, sustainability and equity priorities. The relative value, technical descriptions and limitations of planetary health indices are discussed elsewhere (see (17)). One limitation is that most indicators assign a weighting to inputs that allows one domain to be prioritised over another (e.g. human health weighted more highly than health of the environment). This means there is inherent values system bias for measuring success, which in turn creates barriers to progressing co-benefit planetary health actions. A composite indicator, rather than single indicator, offers the most promise for linking human wellbeing with the health of the environment and hence measuring progress on planetary health (17). A composite indicator gathers data from multiple dimensions and merges them into a single indicator and hence can simultaneously combine key indices and can control for value system bias. However, many existing composite indicators are either calculated at a national or regional scale and are therefore not scalable to local level or they do not include vital ‘environmental’ measures, that is, greenhouse gas emissions. For example, Australian composite indicators such as the Healthy Liveable Cities Liveability Index (18) operate at the local scale but lack an emphasis on vital environmental statistics. The MJA–Lancet Countdown (19) provides a national assessment on health and climate change, examining 41 indicators across five domains including climate change, health co-benefits and public engagement. Whilst the indicators are of direct relevance to planetary health, the scale is too distant to local level planning and measurement work.

Given the immense challenges of the Anthropocene, the link between human wellbeing and the health of the environment, and the need for new measures of progress, this paper describes the findings of a project that explored the need for, and barriers and enablers of, enacting a local level composite index that links human health to health of the environment in Victoria, Australia. Anchored in a planetary health view and inspired by the ‘one planet’ approach set out by Hancock et al. (5), it uses the Happy Planet Index (HPI = life expectancy × life satisfaction × equity adjustment/ecological footprint (20)) as an example of a composite indicator that links human wellbeing with the health of the environment to examine the issues involved in developing and rescaling indicators to a local level. The aim of this project was to explore the need for a metric such as the HPI that explicitly links human health to health of the environment for a local level scale in Australia. The project arose from an international coalition of health promoters advocating for planetary health approaches.

Methodology

The study was guided by principles of participatory research and adopted qualitative description research design. Participatory research is often qualitative in nature, action and change-oriented in purpose and characterised by collaboration with those affected by the issue, such as practitioners and health professionals (21). Specifically, a qualitative description approach was utilised as it is valuable for answering questions of relevance to practitioners and policymakers (22,23).

The project was delivered in three phases. Phase 1 involved desktop document analysis – scoping review of international literature to identify relevant indexes (see 17) and review of Victorian Municipal Public Health and Wellbeing Plans (n = 79) for evidence of where local government were making links between human health and the health of the environment. Phase 2 involved primary qualitative data collection and is described in this paper. The final phase (not reported here) involved pilot testing a revised local level HPI with data from five local government areas.

Aligning with a participatory approach, the project was supported by a Project Reference Group including academics, government and private industry representatives. Ethics approval for this research was granted by Deakin University Human Research Ethics Advisory Group (Project No. HEAG-H 60_2017).

Participants and recruitment

A total of 44 participants were recruited based on being a ‘local expert’ or ‘data expert’ in the areas of health and/or sustainability. Local experts (n = 25) included practitioners and managers working in local government (e.g. employees working in health promotion or environment roles) and community agencies (e.g. community health service or not-for-profit agencies). Data experts (n = 19) included health and sustainability scholars, social statisticians and health and environmental managers working in academia, statistical agencies or state government organisations. In this exploratory project, a small sample size was purposefully selected that did not include decision makers, and all participants were from Victorian organisations, except one, who was with a national agency that services Victoria. Purposeful sampling strategies, specifically criterion and snowball techniques, were used to select participants (24). Potential participants were initially identified from among the research team’s professional contacts and/or through the document analysis.

Participants self-selected to an individual interview or focus group according to availability and preference. Recruitment for focus groups involved an emailed workshop flyer targeted toward a mix of ‘local experts’ and ‘data experts’ from the research team’s networks and following a search of organisational websites in Phase 1. Participants registered to attend a 90-min face-to-face workshop with a planetary health presentation by an international health promotion expert. The presentation was followed by break outs into four focus group sessions.

Data collection and analysis

A mix of interviews and focus groups were offered for their different benefits including participant variety, representation and amount of detail elicited (25). A total of 17 stakeholders participated in individual interviews and 27 participants were involved in a focus group. Semi-structured individual interviews were undertaken face-to-face (n = 13) or by telephone (n = 4). Supplemental Table S1 identifies the nature and scope of the different interview questions by participant type.

Focus groups were used to highlight perceptions, and attitudes towards the concept of joint indicators and the idea of a local level indicator that binds human health to health of the environment. Supplemental Table S1 describes the participants for each focus group.

The interviews and focus groups were recorded using Audionote software on smart devices and saved in accordance with ethical requirements. The interview and focus group recordings were transcribed, with the resulting transcripts loaded into NVivo 11 for analysis of key themes.

In keeping with qualitative description, a thematic analysis strategy was used (22). The analysis followed the four stages inherent to this strategy: decontextualisation (i.e. creating coding lists combining inductive and deductive strategies); recontextualisation (i.e. comparison with the original data); categorisation (triangulation by investigators) and compilation (drawing conclusions and member checking) (26). To ensure rigour and in keeping with the participatory approach, the researchers performed member checking by returning to the informants and presenting a summary of preliminary findings (26).

Results

The findings are presented in two major themes: (a) interest in and potential uses of a local index that combines human health with health of the environment; and (b) barriers and enablers to designing and using a local index such as the HPI. Key Informants are identified by contextual pseudonyms (e.g. KI (local government), and focus groups are labelled as FG1, FG2, FG3 and FG4, with participants numbered (e.g. P1).

Interest in and potential uses of a local level index

Local experts saw value in a localised HPI or similar joint index for communicating the links between health and environment as well as progressing their work on addressing the effects of climate change and public health issues:

[I]t’s useful because it tries to bring those two things [human health and the environment] together, and we don’t have that and that’s probably a gap (KI (local government)).

Participants recognised there are increasing numbers of policy mandates that recognise the link between human health and the environment such as Victorian councils’ Municipal Public Health and Wellbeing Plans. However, it was felt that the link between human health and environment is not cemented in public consciousness. A representative of an environmental organisation felt that a local HPI or similar could be a useful tool:

Research that we’ve done is that the Victorian community clearly does not see the connection between health and climate change... Something like this actually puts climate change or ecological footprint into a more relevant package (FG2, P1).

Similarly, the ability of the index to promote conversations about the interdependence of health and the environment was highlighted:

If people can think local about sustainability in their area and the links between health and sustainability, a device that makes it graphic for them and that helps them to think globally. That’s... the most obvious reason for doing something like this (FG3, P1).

Participants generally felt that a localised HPI or similar could be a very effective tool for supporting community engagement and advocacy at the local level, as demonstrated by the following comment:

The best placed agencies for delivering things like retrofit programs, particularly for low-income households is local scale government. Whether that’s community coalitions or community groups or local government or whatever sort of government structure that is (FG2, P2).

It was discussed that advocacy could lead to positive policy and funding outcomes:

It [a localised HPI] would strengthen the argument to show the connection between health and nature, which would then lead to policy change and to funding... Because we don’t have a lot of time,... it would help to justify and give weight to the urgency of this work (FG2, P3).

In terms of policy and program development, there was interest in how a rescaled HPI or similar local index could be useful in the development of Municipal Public Health and Wellbeing Plans:

We have now legislative requirement to consider climate change in the health and wellbeing plan. All councils across Victoria would be grappling with how do we actually do this effectively... and this [HPI] could support that (KI, local government).

Community health participants recognised that current siloing of health and environmental issues in practice but expressed interest in piloting a rescaled HPI or similar index at a community level:

We can really find a very practical community-based approach or use for the index (KI (community health).

These discussions also highlighted the potential to undertake a ‘bottom up’ and/or settings-based approach to rescaling the HPI or similar index. For instance, rather than using existing data sets, the community could be engaged in generating new community level data to populate the HPI or similar formula. A community designed local HPI, with locally defined inputs, would support place-based planning and could sit alongside the standardised local HPI that works across jurisdictions.

Participants noted there was value in using a rescaled HPI or similar to make comparisons between local government areas, with participants seeing value in local councils being able to compare ‘like with like’.

It would definitely be useful and no doubt Councillors and residents and staff would all be interested in how we compare to other Councils (KI, local government)).

There was also a perceived value in making comparisons between local, national and global scores. This information could make visible, activities that are obscured in aggregated reporting:

National data can block or conceal the extremities that are happening within larger countries. Whereas regional data really focusses down on what is immediately happening within that region. And then it’s critically important for comparisons within that nation itself and then globally as well (FG2, P4).

Barriers and enablers to a local index

This study identified both barriers and enablers to creating a composite health and environmental index including rescaling the HPI, or similar index, to a local level. These include data availability along with social and political issues. Table 1 presents themes with supporting quotes and implications for action.

Table 1.

Barriers and enablers to rescaling the HPI or similar to a local level.

Barrier	Description of sub-theme	Indicative quote(s)	Implications
Availability of ecological footprint data	Obtaining local level ecological footprint data is currently impractical because of inadequate data and lack of council resources. Application of carbon consumption data can act as a proxy to give an indication of embedded ecological demand and to engage community.	“We’re not going to do an ecological footprint... That would take a lot... it’s a very complex thing... A simple measure like the carbon as we’re already doing it as part of our compact of mayors [Global Covenant of Mayors for Climate and Energy], is much more attractive to us” (KI (local government)).	In the absence of ecological footprint data, carbon emissions as a proxy for ‘environment’ is recommended.
Availability of carbon emissions data	Local councils are not reporting on their carbon emissions in a comparable way, and at present, they are not mandated to report on the carbon emissions generated at the local level. These issues need to be addressed for a rescaled HPI or similar index.	Theme identified in phase 1 – document analysis. “If we went to another consultant to do our community emissions for us under the same protocol, there’d be a strong chance that that would then fluctuate again, because they might calculate it differently at the back end” (KI (local government)).	Standardised approach to calculating carbon emissions would advance the field in Australia.
Capacity within local council for generating the index	Local councils have many reporting requirements and the addition of indicators is not something they generally have the resources for.	“...Under-resourced councils, they can’t go and get their own data, they haven’t got the resources” (KI (local government).	A localised HPI would need to draw from existing or routinely collected and accessible data.
Criticisms of the index	Criticisms stem from a distrust of the methodology or a disagreement with the lack of weighting for human health and environmental health. There is a need to reiterate that the index is meant to offer inspiration and aspiration that will encourage policy and practice changes around sustainable wellbeing.	“...Right now it’s just equally weighted. It’s like everything is just equally weighted, but some things do matter more than others and we know that” (FG4, P1).	Methodological considerations including weighting issues need to be addressed to ensure credibility and acceptability of localised HPI.
Human health and health of the environment silos	Although the links between human health and health of the environment are beginning to be made, silos still exist between health and environmental practitioners.	“It’s still very siloed, and within the same organisation you can have the data being collected but not connected” (KI (community health)).	Data linkage initiatives could support the development of a localised HPI.
Enabler	Description of sub-theme	Indicative quote(s)	Implications
Interest in the HPI index or similar	Study participants from health, sustainability and environment could see value in the HPI’s community engagement potential and usefulness as a comparative tool across councils.	“It would definitely be useful and no doubt Councillors and residents and staff would all be interested in how we compare to other Councils” (KI (local government).	A localised HPI has relevance to current local government thinking and potential for action in Australia.
Consistency and availability of health data	Both life expectancy and life satisfaction data are available at appropriate scales and are collected consistently in Victoria.	Theme identified in Phase 1 – document analysis.	Health data is available to commence calculation of a localized HPI.
Mandates for climate change on local councils	The HPI aligns to current government frameworks, therefore strengthening the rational for rescaling the HPI.	Theme identified in Phase 1 – document analysis “Our policy objectives were just to reduce our carbon emissions both within our council and our community, and implement a series of strategies to do that, and monitor performance against a range of data sets in order to determine how we were progressing...So, it evolves in response to the Climate Change Act” (KI (local government)).	A localized HPI could be used as a measure in local government climate change and health initiatives as part of four yearly Municipal Public Health and Wellbeing Plans as directed by the Victorian Public Health and Wellbeing Plan 2019–2023 and the Victorian Public Health and Wellbeing Framework
Global imperative for local carbon data accounting.	The Global Covenant of Mayors for Climate and Energy is an international alliance of cities and local governments. It exists to promote and support voluntary action to tackle climate change and move to a low emission, resilient society.	Theme identified in Phase 1 – document analysis.	Local councils can participate in the Global Covenant of Mayors for Climate and Energy

HPI, happy planet index.

Discussion

This study suggests that, in Victoria, Australia, there is interest among health and sustainability practitioners and policy-makers for a local level planetary health composite index. The value of such an index was its perceived ability to promote understanding of the link between human health and health of the environment, support community engagement and action, instigate co-benefit policy and program development and provide a comparative measure of progress. However, interest in the development of a local index was dependent on whether the index could intersect easily with current local government directives, and hence not require additional resources to calculate, and the availability of reliable, comparable and consistent data sources.

With respect to data availability for a localised HPI, the study confirmed there are appropriate data for inputting. However, a lack of consistent local, regional and national data sources for appraising the health of the environment creates challenges for policy and practice in Australia. Unlike vital human health statistics, there does not appear to be consensus on quantifiable vital ‘health of the environment’ statistics. This is despite the availability of numerous environmental data points, for example, data generated by the Global Covenant of Mayors for Climate and Energy (27), which can be incorporated into various computational models. On the other hand, subjective wellbeing and life expectancy health indicators are more readily accessible, suggesting greater historical focus on measuring human health and wellbeing (e.g. Department of Health and Human Services (28)). While this is a positive legacy of health promotion, it does not help to progress efforts for integrated measurement at the nexus of health and sustainability. In their Victorian Public Health and Wellbeing Outcomes Framework, the DHHS (28) recognise the importance of ‘environmental indicators for human health’, ‘resilient and liveable communities’ as well as ‘environmental sustainability and quality’. However, none of these indicators have current measures and have been marked as ‘measure detail to be determined (28)’.

That state-level policy directives struggle to establish meaningful measures to capture human health and wellbeing within environmental contexts is testimony, not only to the complexity of combined measures, but to the need for indices that capture the intricate relationship between human wellbeing and health of the environment. This current project takes meaningful steps towards the development of such a measure confirming the need, relevance, use and viability of such an index for health and sustainability practitioners. Moreover, study participants endorse a health/environment co-benefit index as a valuable conduit for both engaging with community in mutual health and environment activities, as well as co-creating relevant indices for its measurement.

This study affirmed research that there is significant value in indices that go beyond GDP to assess the success and health status, of a nation, or local area (1,8,29). The acceptance of global agreements such as the SDGs show clearly that there is growing demand for integrated measurement systems of human wellbeing and health of the environment alongside reduced inequalities, etc. The need for integrated systems of measurement has been recognised within health promotion (30 –32) and, more recently, with the 23rd World Conference on Health Promotion. Likewise, community-defined measures of success must form part of a nested system of measurement (Supplemental Figure S1) to support local communities to ‘think global, act local’. Bottom-up or locally defined indicators help foster community engagement in health and sustainability issues of local relevance and can work in concert with other standardised measures, such as a local HPI. Such an approach is consistent with the tenets of health promotion (9) and is ubiquitous in the remit of health promoters’ everyday negotiations between procedural and cooperative approaches to health promotion (33).

Supplemental Figure S1 offers a conceptualisation of a nested system of mutually reinforcing directives and measurement across global, national and local scales and in relation to SDG 3 health, SDG 10 inequities and SDG 13 climate. Each directive or measurement system (white boxes) forms part of a framework for linking goals and highlights how a localised HPI contributes to their achievement. Figure S1 demonstrates that the SDGs have a connection with the PACC, through SDG 13 (double arrowed line) and that the localised HPI (dashed line from global HPI to local HPI) can inform progress on the SDGs and hence the PACC targets. Elements that ‘feed in’ to the proposed local HPI (e.g. life satisfaction life expectancy, Socio-Economic Indexes for Areas (SEIFA), and community scale greenhouse gas emissions) relate directly to SDGs 3, 10 and 13. The national MJA-Lancet Countdown report (19) on climate change and health and the state level Victorian Public Health and Wellbeing Outcomes Framework (28) both offer a directive for the local HPI to be operationalised. Moreover, the Victorian Climate Change Act (34) provides additional impetus for measurement, recording and action on climate change at multiple jurisdiction levels.

Thus, the project offers a preliminary model of undertaking health and sustainability measurement. Being a novel and interdisciplinary engagement of stakeholders around a common set of concerns with planetary health, the exploring of innovation and appetite in new measurement approaches made connections between a global concept and local practice.

New insights on the opportunities and challenges are provided; with some solutions to those challenges and acknowledgement of the particularities of the stakeholders involved. Further research is required to incorporate proxy ecological footprints at the local level, considering the inherent complexities, as noted by Steinmann et al. (35).

To the authors’ knowledge, the project is the first attempt in Australia at investigating the value of the HPI at a local level. It is limited to the level of an exploratory project, with a small non-representative sample size. The study has not explored Aboriginal and Torres Strait Islander perspectives and, importantly, Indigenous ways of defining and measuring success (e.g. 36). This field of inquiry is moving rapidly, as environmental imperatives, such as bushfires and global pandemics, compel urgent action by statutory authorities. For example, the (then) DHHS, has now provided a compendium for local government to facilitate action on climate change which supports steps to develop local level indicators (37). The use of the HPI as the exemplar composite indicator during the interviews and focus group may have biased responses and innovation in thinking.

Conclusion

Key advances in public health, which have greatly improved the health and wellbeing of communities and are simultaneously cognisant of the environment, have invariably been initiated at the local level (5). The ‘one planet’ approach asserts the primacy of a planetary health view that instigates action, and measurement, at the local or community level. Findings from this study indicate that a cascading scale of covenants in multiple jurisdictions provide support and guidance for the development of local level indicators for measuring ecological/carbon use that can be coupled with local level wellbeing indicators for promoting health and sustainability co-benefits. Suggestions have been advanced for adapting current carbon measures (e.g. 27), or innovating community-initiated measures to provide action on climate change and population health.

This current research reinforces the need for a locally scaled approach to obtaining information on ecological footprint or carbon use as well as health and wellbeing indicators. This will provide governments, as well as health and sustainability practitioners, with a planetary health profile for their locality, a measure for adjacent community comparisons and mandate for planetary health action for human/environment co-benefits. Considering the foundation of the Ottawa Charter addresses building healthy public policy by strengthening community action (9), a locally scaled planetary health indicator is well positioned to inform that action.

Supplemental Material

sj-docx-1-ped-10.1177_17579759211038367 – Supplemental material for Planetary health indicators for the local level: opportunities and challenges in applying the happy planet index in Victoria, Australia

Supplemental material, sj-docx-1-ped-10.1177_17579759211038367 for Planetary health indicators for the local level: opportunities and challenges in applying the happy planet index in Victoria, Australia by Rebecca Patrick, Claire Henderson-Wilson, Justin Lawson, Teresa Capetola, Amy Shaw, Mia Davison and Alison Freeman in Global Health Promotion

Supplemental Material

sj-docx-2-ped-10.1177_17579759211038367 – Supplemental material for Planetary health indicators for the local level: opportunities and challenges in applying the happy planet index in Victoria, Australia

Supplemental material, sj-docx-2-ped-10.1177_17579759211038367 for Planetary health indicators for the local level: opportunities and challenges in applying the happy planet index in Victoria, Australia by Rebecca Patrick, Claire Henderson-Wilson, Justin Lawson, Teresa Capetola, Amy Shaw, Mia Davison and Alison Freeman in Global Health Promotion

Footnotes

Acknowledgements

The authors would like to thank the study participants for their contributions to the interviews and focus group activities.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Rebecca Patrick

Justin Lawson

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