Download Climate change: The implications for child health in Australasia

doi:10.1111/j.1440-1754.2010.01699.x
ANNOTATION
Climate change: The implications for child health in Australasia
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Jamie Hosking,1 Rhys Jones,2 Teuila Percival,3 Nikki Turner4 and Shanthi Ameratunga1
1
Section of Epidemiology and Biostatistics, 2Te Kupenga Hauora Māori, 3Pacific Health Section and 4Department of General Practice and Primary Health Care,
Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
Abstract: Children are particularly vulnerable to the health effects of climate change, the biggest global health threat of the 21st century.
However, the worst effects on child health can be avoided, and well-designed climate policies can have important benefits for child health and
equity. We call on child health professionals to seize opportunities to prevent climate change, improve child health and reduce inequalities, and
suggest useful actions that can be taken.
Key words:
child; climate; ethics; socioeconomic factors; world health.
Climate change has been described as ‘the biggest global health
threat of the 21st century’.1 The implications of climate change
for children, given their particular vulnerabilities, are especially
concerning.
According to the Intergovernmental Panel on Climate
Change, the warming of the climate system is unequivocal, and
very likely (>90% probability) to be because of human greenhouse gas emissions. While not all of the risks of climate change
can now be avoided, a combination of measures to prevent
warming and adapt to a warmer climate can significantly reduce
these risks.2 This august body of scientists calculates that highincome countries such as Australia and New Zealand need to
reduce emissions by 25–40% by 2020, and 80–95% by 2050,
compared with 1990 emission levels, to limit the average global
temperature rise to around 2°C.3 A 2°C rise is considered the
‘guard rail’ beyond which climate change effects become more
dangerous.4 The risk of ‘tipping points’, which could trigger
more rapid warming or lead to disproportionately large adverse
effects on humanity, is of particular concern.1 Furthermore,
while a rise of no more than 2°C is described by some as a ‘safe
threshold’, important risks to health are predicted even below
this threshold.1
An increasing awareness of these effects has seen climate
change move from a mainstream topic of scientific interest to
a mainstream health concern. In October 2009, the World
Medical Association’s Declaration of Delhi called for doctors to
take action to prevent the serious consequences of climate
change.5 The American Academy of Pediatrics published a
policy statement on climate change in 2007.6 Since then, leaders
of other medical professional bodies around the world have
called for political action on climate change.7 As World Health
Organization Director-General Margaret Chan has written, ‘the
issue now is not whether climate change is occurring, but how
we can respond most effectively’.8
We review the potential effects of climate change and climate
policies on child health, and discuss the implications for child
health professionals.
Child Health Impacts of Climate Change
Key Points
1 Climate change is now recognised as a major health issue.
2 Children are likely to be particularly vulnerable to the effects of
climate change.
3 Climate change policies can have associated co-benefits that
improve child health and reduce inequalities. However, input
from health professionals is needed to support the choice of
effective policies for children.
Correspondence: Prof Shanthi Ameratunga, Deputy Head – School of
Population Health, Faculty of Medical & Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. Tel: +64 9373 7599
ext 86534. Fax: +64 9373 7503. email: [email protected]
Conflict of interest: All authors are members of OraTaiao: New Zealand
Climate and Health (http://www.nzchg.webs.com).
Accepted for publication 3 January 2010.
The health effects of climate change are expected to take many
pervasive forms. While a few are positive (e.g. reduced mortality
from reduced cold exposure), the overall effects are predicted to
be negative, with significant threats to many basic needs for
health and survival, including water, food and shelter. Important communicable diseases such as malaria are likely to become
more common in some areas, while changes such as rising sea
levels will displace large number of people in some countries.1
Pacific island nations in our region are at high risk, with lowlying, small islands such as Tuvalu, Kiribati and Tokelau especially vulnerable.
Access to safe water supplies can be threatened by more
frequent droughts, flooding as a result of heavy rainfall events
and increasing groundwater salinity as a result of rising sea
levels.1 Food supplies are likely to be affected by water shortages
as well as by extreme weather events such as droughts and
flooding. Local constraints imposed by these weather-related
Journal of Paediatrics and Child Health 47 (2011) 493–496
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disasters and resulting water and food shortages may lead to the
displacement of populations and promote conflict over these
increasingly scarce resources.1
Bunyavanich et al.9 have identified multiple pathways, from
metabolic to behavioural, that make children vulnerable to the
effects of climate change. For example, children’s relatively
higher water intake predisposes them to dehydration, while
spending more time outdoors increases children’s vulnerability
to thermal extremes. Children are also particularly vulnerable to
the effects of natural disasters.9
Potential Health Co-benefits of
Climate Policies
While climate change itself poses serious risks to health, climate
change policies can have positive spin-off effects on health, or
‘co-benefits’.10 Several of these co-benefits are of considerable
importance to child health.
The most important climate policy co-benefits differ substantially between rich and poor countries. Globally, indoor air
pollution from cooking is a major cause of disease burden,
especially for children. Providing clean-burning cooking stoves
could improve health in low-income countries while reducing
emissions.10
A low-carbon transport system, based on walking, cycling and
public transport, could improve physical activity levels and
reduce air pollution in most countries, with benefits for child
respiratory health and obesity rates.10 Household energy efficiency improvements, such as insulation, can reduce respiratory
illness,10 a leading cause of child hospitalisation.11
A compelling feature of these health co-benefits is that they
can be immediate, tangible, local and relatively predictable. For
instance, more active transport in Australia and New Zealand
can lead to immediate improvements in physical activity for
children, whereas the climate benefits, while important, are
indirect and delayed. Climate change thus provides an important opportunity for health practitioners to advance initiatives
such as healthier transport and housing, which are necessary for
both climate and health reasons.
The health co-benefits of climate change policies are not automatic. Although increased fuel prices are likely to encourage
walking and cycling, in isolation such a policy could increase
road traffic injuries by increasing the exposure of more vulnerable road users to unsafe road environments. In contrast, implementing traffic calming measures could reduce road traffic
injuries among all road users, while also promoting walking and
cycling. Without health input into climate policy development,
opportunities to improve climate and health simultaneously
may be overlooked.
change, as they lack the infrastructure to withstand its effects,
and lack the resources needed to invest in adaptation measures.1
This mismatch between the benefits and harms of emissions is a
key global justice issue.
While indigenous peoples of the world have made little contribution to causing climate change, they are at increased risk
from its effects.12 Indigenous children already experience much
worse health outcomes than non-indigenous children, and
exclusionary social policies are at the root of these pervasive
and unjust disparities.13 Equitable climate change policies will
require a commitment to indigenous rights, prioritising support
for indigenous populations to effectively adapt to climate
change, as well as ensuring that climate change policies do not
further disadvantage indigenous people or indigenous children.
Climate change also raises intergenerational equity issues.
While the children of today bear no responsibility for its causation, they are set to inherit a global environment that will
expose them to serious risks and dramatically limit their ability
to live full, healthy lives.
The children of Pacific island countries and territories already
face the negative effects of climate change, with inundation of
coastal areas, loss of fresh water supplies, decreased biodiversity
and increases in weather extremes and disasters. They are also
limited in adaptation capacity through their small physical size,
limited natural and other resources, isolation and poor infrastructure.14 Despite the inequity in negative effects experienced
and resources to adapt, Pacific island countries are already
developing adaptation plans and strategies.15
Both climate change and climate policies may increase
household costs. Projected increases in global food scarcity are
likely to drive up food prices,1 compounding the already large
global burden of malnutrition and the associated risks for child
physical and intellectual development.9 Indeed, in 2008,
climate-related factors contributed to a dramatic spike in
global food prices, likely to have driven millions more into
food insecurity.1 Fuel price rises are also likely to increase
the cost of transport, limiting access to important health
determinants such as employment, health care and social
services.
These price rises will be felt most by low-income households,
among whom children are disproportionately represented.11
Avoiding further increases in social and health inequalities that
disadvantage children will require specific intervention strategies, such as promoting urban design that reduces the need to
travel, providing affordable, convenient public transport, and
ensuring access to healthy and affordable food. Broader macroeconomic strategies to reduce the expected inequitable impact
on the poorest also need to be considered, for example, taxation
and redistribution policies.16
A Call to Action
Climate Change and Equity
Historically, fossil fuel energy has contributed to human development and improved health and survival. However, these benefits have largely been restricted to rich countries, while the
adverse effects of the resulting emissions are global. Indeed,
poor countries will be disproportionately harmed by climate
494
Climate change is undeniably a major threat to our health and
well-being. However, much can and should be done to avoid the
worst effects of climate change on the health of children today
and the generations to come. As previously discussed, several
actions, including promoting healthier transport and housing,
and ensuring food security for low-income families, can both
Journal of Paediatrics and Child Health 47 (2011) 493–496
© 2010 The Authors
Journal of Paediatrics and Child Health © 2010 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
J Hosking et al.
Table 1
Climate change: implications for child health
Actions child health professionals can take on climate change
1. Get informed, read and discuss. For an entertaining approach, watch the film ‘The Age of Stupid’.17
2. Advise patients. Consider potential climate change issues in your advice for patients: for example, encourage safe walking and cycling rather than
driving, or encourage parents and children to grow food at home.
3. Reduce our personal emissions. Reduce flying and driving, and walk and cycle more. Improve home energy efficiency (e.g. better insulation) and
reduce your intake of animal products. These can also benefit your own health. Visit 10:10 for ideas (http://www.1010uk.org).
4. Reduce our professional emissions. Take the same measures professionally as you do personally, and encourage your organisation to adopt
climate-friendly policies and processes.
5. Advocate for climate action. Speak, write and make submissions in favour of strong local, national and global policies to fight climate change. This
includes strong, responsible emissions reduction targets – for example, at least 40% reductions below 1990 levels by 2020 for developed countries.18
Call for child health impact assessment of new and existing national policies, including climate policies.
6. Join a climate and health NGO. These include OraTaiao: NZ Climate and Health (http://www.nzchg.webs.com), Doctors for the Environment Australia
(http://www.dea.org.au) and the Climate and Health Council (http://www.climateandhealth.org).
7. Mobilise colleagues. Encourage child health professional bodies to publicly support strong climate action. Support and encourage colleagues in
climate action. Advocate for climate change to be part of paediatric and child health training curricula.
8. Collaborate locally. Contribute to local projects to reduce emissions, by working with organisations such as schools, childcare centres and other
community groups.
9. Provide assistance. Our Pacific neighbours will be among the worst hit by climate change. Advocate for governments to provide funding and other
resources to help low- and middle-income countries in the region to adapt. Contribute your own funds, time and professional skills to respond to the
needs of these countries, to mitigate the risks as well as minimise the impact of disasters when these occur.
List adapted from several sources.6,18,19,20
NGO, non-governmental organisation.
As the World Medical Association states, physicians have a
responsibility not just for individual patients, but for the health
of all people.5 The current situation – particularly in the context
of inadequate policy responses,2,18 – provides an important
opportunity for medical practitioners to act and be heard. Such
action is essential to ensure that our local, national and global
responses to climate change are commensurate with the scale of
the threat, and to ensure that child health and equity receive the
consideration they warrant in climate policies.
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Smokestacks, Greymouth, NZ by Jayne Antony
improve child health and mitigate the risks of climate change.
Drawing on approaches advocated by several leading authorities, we outline some key steps that child health professionals
could take (Table 1).
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Journal of Paediatrics and Child Health © 2010 Paediatrics and Child Health Division (Royal Australasian College of Physicians)