Postindustrial human activity has contributed to rising atmospheric levels of greenhouse gases causing global warming and climate change. The adverse effects of climate change affect children disproportionately, especially in the developing world. Urgent action is necessary to mitigate the causes and adapt to the negative effects of climate change. Paediatricians have an important role in managing the effects of climate change on children and promoting sustainable development.
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‘It's very important to understand that climate change is not just another issue in this complicated world of proliferating issues. Climate change is THE issue which, unchecked, will swamp all other issues’ – Ross Gelbspan, author of Boiling Point
Over the last century the earth has warmed rapidly and human activity is implicated as a major contributor to this warming. Industrialisation, urban development and high energy consumption lifestyles are the key drivers. The exponential rise in world population and growing demands on energy production have led to increasing greenhouse gases (GHG) emission and global warming.1 A rise of 2°C above pre-industrial temperatures is predicted to be the critical temperature beyond which there is a risk of irreversible changes to the earth's climate and ecosystems (figure 1).2
The adverse health effects of climate change disproportionately affect children, women and vulnerable populations.1 Children particularly are affected due to their unique physiological, social and emotional needs. Children under 5 years of age suffer more than a third of the ill effects of diseases due to environmental factors.3 The brunt of this is borne by children growing up in poor countries.
Causes of climate change
The causes of climate change are diverse and influenced by natural events and human activity. Figure 2 illustrates the greenhouse effect. The main anthropogenic contributions to the rising GHG levels include burning fossil fuel, livestock farming, industrial activity and deforestation.
The effects of climate change and child health implications
The discernible effects of human induced global climate change (HIGCC) include progressive warming of the earth's surface, rising sea levels, changing precipitation patterns and changing ecosystems. The increasing incidence of extreme weather events is also a likely consequence, although the links are harder to substantiate. Predictions are that temperatures and sea level will continue to rise throughout the 21st century even if emissions are abruptly reduced to zero.1
Future extreme weather events are predicted to be more frequent and intense.1 Current estimates suggest 66.5 million children were affected annually between 1990 and 2000.4 Direct effects on children include extreme heat and sun exposure causing heat stroke, exhaustion, electrolyte imbalance and future risk of skin cancer.5 Floods constituted 43% of the extreme weather events between 1992 and 2001.6 Currently, 46 million people worldwide are affected directly or indirectly by flood related events. This is expected to double with each 0.5 m rise in sea level.3 Coastal submersion leads to excessive salination of arable land and drinking water sources, resulting in decreasing food production and increasing migration. Floods, droughts and extreme weather events increase the risk of death, malnutrition, injury, infectious diseases and post-traumatic mental health problems in children.7 Children can lose care givers or family bread winners, resulting in long-term disruption to their education.
Ecosystem changes resulting from climate change are diverse. There are changes in the density and range of species, migration patterns, flowering, egg laying and genetic frequency shifts.8 Waterborne illnesses show an increased incidence and hospitalisation rates of children with diarrhoea increased by 8% per 1°C rise in temperature.9 Vector hosts are affected by changes in temperature, humidity and rainfall. Malaria is an example of climate change notably affecting the host vector pattern. It is estimated that 60% of the world's population will be living in potential malaria transmission zones by the end of this century10 due to expansion of the territorial range of host mosquitoes.11 Children will be disproportionately affected as nearly 75% of malaria mortality occurs in the under-5s.
With increasingly warm and humid climates, the distribution and density of plants, fungi and moulds that produce aeroallergens are increasing. In the developing world, children are exposed to high concentrations of air pollutants as a consequence of burning biomass and fossil fuel indoors.12 Air pollution and aeroallergens are contributing to increased hospital use from respiratory illnesses and can contribute to premature death.13
The consequences of HIGCC on child health are grave (figure 3). It affects access to food, safe water, sanitation and human habitation and results in changing patterns of disease and mortality. The resultant poverty and lack of basic life necessities can lead to increased human migration and armed conflict. Children caught in this web of poverty, exploitation and lack of security can experience long-term psychological morbidities. An insight into the effects of HIGCC on resource poor populations can be obtained from the Oxfam study in Bolivia which highlights the progressive food and water shortages, increasing malaria, forest fires and increasing extreme weather events affecting the indigenous people.14
Interventions to address the causes and effects of climate change rely on effecting behavioural change, applying technological advances and determined political action.
Population control is a priority. In the last 200 years the world population has increased from 1 billion to nearly 7 billion, and is expected to reach 9 billion by 2050.15 This exponential expansion is a major contributor to the rise in GHG from growing energy and food demands. To achieve food and energy sustainability the world has to immediately halt and, if possible, roll back this expansion.
International awareness of global warming led to the Kyoto protocol (1997) which agreed binding emission cuts of approximately 5% from 1990 levels by 2012.16 The EU committed to an 8% reduction target, but the largest emitter in 1990, the USA, was a non-signatory. The targets were set based on the principle of common but differentiated responsibility which takes into account historical emission contributions and the development needs of poorer countries. The principle relies on rich developed nations taking responsibility for agreeing to deep and binding emission cuts and being held accountable for their actions. Despite high expectations, the United Nations Framework Convention on Climate Change (UNFCC) Copenhagen Summit in 2009 disappointingly failed to achieve an international consensus on binding emission reduction targets after 2012.17 The Copenhagen Accord merely agreed to set voluntary non-binding individual national targets. These targets fall far short of the emission cuts required to restrict the temperature rise to below the critical 2°C level. The marginalisation of the poorer nations in Copenhagen led Bolivia to organise the alternative Cochabamba summit. The People's Agreement of Cochabamba (2010) called for the protection of the Rights of Mother Earth and a binding emission target of at least a 50% reduction between 2013 and 2017.18 However, such hopes were unfulfilled at the UNFCC Conference of Parties in Cancun (December, 2010) as neither binding nor substantial emission reductions were agreed. Instead there was affirmation of the weak Copenhagen targets and the establishment of a $100 billion Climate Finance Fund to assist poor countries, although the funding sources remain uncertain.19
Currently, the world's highest emitters are China, USA, EU countries, Russia, India and Japan.20 The world's top 10 emitters account for two-thirds of the total emissions.20 Present US per capita emission is more than double that of the UK and 20 times that of Sub-Saharan countries.21 These enormous levels of consumption, fed by ever increasing consumerism, are unsustainable. Delivering climate justice must be at the heart of any post-2012 agreement to tackle climate change. This can only be achieved if rich countries commit to large emission cuts and ensure a massive transfer of resources and technology to vulnerable countries. Studies show that comparable measures of happiness and well-being are achievable in lower carbon societies; increasing material wealth in rich nations makes relatively little difference to well-being.22 Life expectancy figures across developed nations show no notable improvement with increasing per capita carbon consumption.22 The solution therefore lies in achieving a sustainable balance which meets our present needs without compromising the earth's ability to meet the needs of coming generations.
Such a model of sustainable development would have significant co-benefits.23 24 Green transport systems would encourage walking and cycling and reduce accidents. Reduced red meat consumption and greater consumption of fresh locally grown fruits and vegetables would promote a healthier lifestyle. The resultant drop in obesity rates would have a positive effect on the rates of diabetes, heart disease, strokes and cancer. Urban greening, less atmospheric pollution and reduced noise pollution would improve mental health, reduce rates of depression and enhance community cohesion.23 24 Sustainable development can save money through reducing waste, using resources more efficiently and reducing dependency on scarcer resources. Emphasis should be placed on contraction and convergence, whereby rich countries rapidly reduce emissions and poor countries increase emissions to achieve health and development gain. This could provide sustainable development opportunities for the world's poorest countries and promote equality between nations. Greater equality will discourage status competition and encourage the development of cohesive, sociable and sustainable societies.22
The Intergovernmental Panel on Climate Change (IPCC) has promoted various mitigation and adaptation strategies to combat climate change. It has produced scientific reports and convened working groups assessing the causes, effects and potential solutions.1 Mitigation efforts focus on diminishing atmospheric levels of GHG by reducing production, for example, by burning less fossil fuel, and aiding removal of carbon dioxide, for example, by reforestation. Recent advances in alternative energy sources such as concentrated solar power and carbon capture technologies,2 are promising. Adaptation measures are aimed at identifying and implementing steps to manage the potential consequences of climate change in any community. Measures range from preventive interventions, like developing drought resistant crops, to long-term planned disaster risk reduction.2
Healthcare settings have large carbon footprints and should lead by example. Procurement (59%), that is, buying goods and services, building energy use (24%) and travel (17%) all contribute to the large carbon footprint of the UK National Health Service (NHS).25 Marginal abatement cost curves show which measures are likely to be most effective and the costs involved.25 Interestingly, the most efficient measures, for example, Combined Heat and Power source (CHP), save both energy and money. Staff awareness and involvement is crucial to success. The NHS Sustainable Development Unit (http://www.sdu.nhs.uk) provides training materials and tools which allow individuals and organisations to calculate and reduce their footprint. The current 10:10 Health campaign calls on every health worker to cut their carbon emissions by 10% by the end of 2011. Taking small steps of 10% cuts annually is more manageable and sustainable than a large cut over a short period. If all healthcare staff signed up to this and lobbied their organisations to do the same, there would be a huge collective impact (box 1).
The Royal College of Paediatrics and Child Health has taken a lead in raising climate change awareness and developed College policy in this area.26 Paediatricians should influence their patients and communities in adopting low carbon lifestyles, encourage sustainable development and promote the co-benefits of a sustainable lifestyle. The direct and indirect effects of climate change on children will bring challenges of changing disease patterns. Paediatric training needs to reflect this and incorporate management of anticipated disease patterns, principles of disaster management and advocacy for sustainable development.
‘Climate change is the biggest global health threat of the 21st century’ – The Lancet/UCL Commission27
Climate change is adversely affecting the children of today and will jeopardise the futures of tomorrow's children unless we act now. Unchecked population growth, consumerism, self-interest and lack of political will for substantive action has brought us to this crisis point. The potential consequences of inaction are grave. We all need to take urgent and responsible action, personally and collectively, to stop the progress of climate change and combat its ill effects.
Box 1 Ten ways to make an impact
Switch off! Reduce electricity consumption in the home and office.
Switch to a sustainable energy source for your home/organisation if possible.
Use energy efficient appliances, for example, low energy light bulbs.
Support sustainable food production; buy local produce, eat less red meat.
Insulate your home and support home insulation.
Recycle, recycle and recycle. Minimise waste.
Reuse things whenever possible. Repair and reuse when safe to do so.
Reduce car and air travel; walk, bike or use public transport when feasible.
Use video/web conferencing for meetings; consider telephone clinics and paperless correspondence.
Promote and advocate sustainability within your community and organisation.
‘The good news is we know what to do. The good news is we have everything we need now to respond to the challenge of global warming. We have all the technologies we need; more are being developed. And as they become available and become more affordable when produced in scale, they will make it easier to respond. But we should not wait, we cannot wait, we must not wait’– Al Gore, environmental activist, host of the film An Inconvenient Truth and ex-US Vice President
The authors would like to acknowledge permission granted by the IPCC to reproduce graphs and to United Nations Environment Programme/GRID-Arendal for figures and illustrations.
Competing interests None.
Provenance and peer review Commissioned; externally peer reviewed.
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