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Child Health and Survival in a Changing
Climate: Vulnerability, Mitigation,
and Adaptation
15
Briony Towers, Kevin Ronan, and Mayeda Rashid
Contents
1 Introduction .................................................................................. 280
2 Child Vulnerability to the Health Impacts of Climate Change . .. .. .. .. .................... 281
2.1 Drought ................................................................................ 281
2.2 Floods .................................................................................. 282
2.3 Tropical Storms ........................................................................ 283
2.4 Heat Waves ............................................................................ 283
3 Vector-Borne Diseases . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ........... . . . . .. .. .. .. .. .. .. .. .. .. .. 284
3.1 Malaria ................................................................................. 284
3.2 Dengue ................................................................................. 285
4 Waterborne Diseases ........... . . . . . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ............ . . . . . .. . 286
5 Respiratory Illnesses ......................................................................... 286
6 Key Uncertainties and Knowledge Gaps ................................................... 287
7 Protecting Child Health and Survival in a Changing Climate . . . . . . . . . . . . . .. . . . . . . . . . . . . . . 289
7.1 Climate Change Mitigation . ......... . . . . . .. .. .. .. .. .. .. .. .. .. .......... . . . . . .. .. .. .. . 289
7.2 Climate Change Adaptation ........................................................... 292
8 Conclusion ................................................................................... 296
References....................................................................................... 297
B. Towers (*)
Centre for Risk and Community Safety, RMIT University, Melbourne, VIC, Australia
e-mail: briony.towers@rmit.du.au
K. Ronan
School of Human, Health and Social Sciences, CQUniversity, Rockhampton, NSW, Australia
Department of Health and Human Services, CQUniversity Australia, North Rockhampton, QLD,
Australia
e-mail: K.Ronan@cqu.edu.au
M. Rashid
School of Human, Health and Social Sciences, CQUniversity, Melbourne, VIC, Australia
e-mail: mayeda.rashid@cqu.edu.au
#Springer Science+Business Media Singapore 2016
N. Ansell et al. (eds.), Geographies of Global Issues: Change and Threat,
Geographies of Children and Young People 8, DOI 10.1007/978-981-4585-54-5_34
279
Abstract
The effects of climate change include increased frequency and intensity of
extreme weather events as well as adverse changes in air pollution, increased
spread of climate-sensitive disease, and heightened food insecurity. All of these
effects are predicted to have a significant impact on global mortality and mor-
bidity, and the available evidence indicates that children are most at risk. In order
to protect child health, immediate action to both mitigate further climate change
and adapt to existing and expected impacts is required. This chapter reviews the
existing literature on the health impacts of climate change on children. It identifies
children as key stakeholders in action and decision-making for mitigation and
adaptation at a variety of scales. It also highlights how child participation in
research, policy, and practice will increase the effectiveness and sustainability of
solutions for addressing the health impacts of climate change. The chapter
concludes with a call for the climate change community to make a more concerted
effort to incorporate the needs and capacities of children into its core agenda.
Keywords
Children •Health •Climate change •Hazards •Disasters •Mitigation •Adapta-
tion •Child rights •Child participation
1 Introduction
In the Climate Change 2014 Synthesis Report, the Intergovernmental Panel on
ClimateChange(IPCC)confirms that human influence on the climate system is
clear and growing, with impacts observed across all continents and oceans (IPCC
2014). The report states that many of the observed changes since the 1950s are
unprecedented over decades to millennia, and it is now 95 % certain that humans
are the main cause. In addition, the report finds that the more human activities
disrupt the climate, the greater the risks of severe, pervasive, and irreversible
impacts for people and ecosystems and long-lasting changes in all components
of the climate system. The effects of climate change include increased frequency
and intensity of extreme weather events as well as adverse changes in air pollution,
increased spread of climate-sensitive disease, and heightened food insecurity
(Smith et al. 2014; Watts et al. 2015). All of these effects are predicted to have a
significant impact on global mortality and morbidity, and it is increasingly recog-
nized that children are most at risk (Sheffield and Landrigan 2011;WHO2009a;
Xu et al. 2012).
This chapter presents a focused discussion of child health and climate change. It
first reviews the existing research on child vulnerability to both extreme weather
events and climate-sensitive disease and finds that while numerous uncertainties and
knowledge gaps need to be addressed, urgent action to protect child health is
required. It then explores the two major pathways for action –climate change
mitigation and climate change adaptation. Throughout the chapter, the importance
280 B. Towers et al.
and value of child participation in knowledge generation and decision-making are
emphasized. While children are often viewed as helpless victims of climate change,
who rely on others for their health and survival, an emergent literature is highlighting
children’s capacities for contributing to sustainable and effective action at the global,
national, and local level. The chapter concludes with a call for an increased focus on
child health across research, policy, and practice and a recommendation for increased
child participation across these three domains.
2 Child Vulnerability to the Health Impacts of Climate
Change
The health impacts of climate change include increased morbidity and mortality due
to more frequent and intense extreme weather events such as heat waves, floods,
droughts, and tropical cyclones (Smith et al. 2014; Watts et al. 2015). They also
include increasing incidences of climate-sensitive disease such as malaria, dengue
fever, diarrhea, and respiratory illness (Smith et al. 2014; Watts et al. 2015). Due to a
variety of physiological, behavioral, and social characteristics, extreme weather
events and climate-sensitive diseases tend to impact most heavily on children, so it
is likely that a substantial proportion of the morbidity and mortality burden due to
climate change will be borne by this group (Sheffield and Landrigan 2011; WHO
2009a). In the absence of future projections that focus specifically on children, this
section combines data from existing climate change scenarios, future projections of
population health, and the current state of child health to highlight child vulnerability
to the full range of extreme weather events and climate-sensitive diseases.
2.1 Drought
While a lack of observational data precludes definitive statements about causality,
there is mounting evidence that climate change is increasing both the likelihood and
intensity of drought events around the world (Smith et al. 2014; Watts et al. 2015).
Since 1950, some regions have experienced longer, more intense droughts, and
current projections indicate that droughts will continue to intensify throughout the
twenty-first century (IPCC 2012). This is expected to significantly reduce yields of
staple crops and drive up food prices (Smith et al. 2014; Nelson et al. 2009). In
low-income countries, this will ultimately affect food availability and access, which
will, in turn, exacerbate rates of undernutrition (Stanke et al. 2013).
The World Health Organization (2009a) asserts that undernutrition in developing
countries constitutes the largest single negative impact of climate change and that
children will be worst affected. Nelson et al. (2009) estimate that by 2050, declining
food security in developing countries will increase child undernutrition by 20 %
relative to a world with no climate change, which equates to an additional 25 million
children affected. Across the developing world, the impacts of undernutrition on
child mortality and morbidity are profound (Black et al. 2013; WHO 2009a).
15 Child Health and Survival in a Changing Climate: Vulnerability, Mitigation... 281
In 2011, undernutrition was the cause of 3.1 million child deaths or 45 % of all child
deaths (Black et al. 2013). In children aged under 2 years, undernutrition also causes
stunting (low height for age), a permanent condition which impedes physical,
cognitive, and psychomotor development (Black et al. 2013). Several longitudinal
studies show that stunting before the age of 3 years predicts poorer cognitive and
educational outcomes in later childhood and adolescence and reduced economic
productivity in adulthood (Grantham-McGregor et al. 2007; Black et al. 2013). It
also has intergenerational effects –the offspring of stunted women typically have a
lower birth weight which makes them more susceptible to various forms of illness
and disease (Grantham-McGregor et al. 2007). It is estimated that by 2050, declining
food security and nutrition may increase severe stunting by up to 55 % in
sub-Saharan Africa and 61 % in South Asia which has serious implications for the
acquisition of human of capital in these regions (Lloyd et al. 2011).
2.2 Floods
At the global level, floods are the most frequently occurring type of natural hazard
and have the largest impact in terms of both fatalities and people affected (Doocy
et al. 2013). Between 2010 and 2015, flood events caused 33,616 deaths and affected
over 1.5 billion people (CRED 2015). Under most climate change scenarios, more
frequent intense rainfall events are expected in most parts of the world, causing more
frequent riverine floods in small catchments (IPCC 2012). It is also expected that
increasing heat waves, glacial retreat, and/or permafrost degradation will affect high
mountain phenomena such as slope instabilities, mass movements, and glacial lake
outburst floods (IPCC 2012). It is also very likely that mean sea level rise will
contribute to upward trends in extreme coastal high water levels and tidal flooding
(IPCC 2012). On this basis, a dramatic increase in flood-related health impacts are
expected, unless serious adaptation measures are taken (Smith et al. 2014; Watts
et al. 2015).
The immediate health impacts of floods include drowning, injuries, and water-
and vector-borne diseases, while the longer-term impacts include mental health
issues, malnutrition, and poor birth outcomes (Alderman et al. 2012; Smith
et al. 2014). Although these impacts have been observed in both high- and
low-income countries, it is clear that the latter bear the global burden of flood-
related mortality and morbidity (Alderman et al. 2012). While flood fatality reports
are rarely disaggregated by age (Doocy et al. 2013), there is growing evidence that
children are at a heightened risk. In an epidemiological study of the 1993 flood
disaster in Sarlahi, Nepal, Pradhan et al. (2007) found that the risk of death for those
aged between 2 and 9 years was twice that of those aged 15 years and older.
Additionally, the risk of death for preschool-aged girls was one and half times that
for preschool-aged boys. Children are also more likely to contract and succumb to
the waterborne diseases that proliferate in flooded communities, and in regions
where food security is volatile, flood-related destruction of crops and livestock can
increase rates of child undernutrition and stunting (Fischer-Walker et al. 2014).
282 B. Towers et al.
2.3 Tropical Storms
Since 1990, tropical storms have killed over 300,000 people (CRED 2015). The
deadliest events have all occurred in Southeast Asia: in 2008, Cyclone Nargis in
Myanmar killed 138,666; the 1991 cyclone in Bangladesh killed 138,886; and in
2013, Super Typhoon Haiyan in the Philippines killed 4354 (CRED 2015). While
climate change is not expected to affect the frequency of tropical storms, it will
increase cyclone precipitation rates and maximum wind speed, creating the condi-
tions for more destructive events (IPCC 2012). In addition, sea level rise, coupled
with a likely increase in cyclonic wind speed, will exacerbate storm surge and
increase the magnitude of coastal inundation (IPCC 2013). Using a spatially explicit
mortality model of 577 coastal cities in 84 different countries, Dasgupta et al. (2009)
modeled 1-in-100-year storm-surge events accounting for 1 m sea level rise and a
10 % increase in cyclone intensity. Across the 84 countries, it was projected that by
2100, an additional 52 million people and 30,000 km
2
will be affected by coastal
inundation.
Like floods, tropical cyclones adversely affect mortality and morbidity through
drowning, injuries, and infectious diseases, and there is some evidence that children
are at an increased risk (Chowdury et al. 1993). In an epidemiological study of the
1991 cyclone disaster in Bangladesh, Chowdury et al. (1993) found that three
quarters of fatalities were children under 15 years of age. They also found that
among children under 5 years of age, the death rate for females was 15 % higher than
their male counterparts. While not statistically significant, this finding does raise
questions about the protections afforded to girls during a disaster event. However,
the evidence of children’s increased risk is equivocal. For example, in an analysis of
hospitalizations for injuries following Typhoon Rananim, which struck the coast of
China in 2004, the rate of injuries increased according to age (from 20 per 100,000
for those <20 years of age to 75 per 100,000 for those >70 years) (Gong et al. 2007).
Other population-based studies that disaggregate fatalities by age are scarce, and
hence, it is not possible to clearly delineate children’s risk relative to other age
groups. However, given their increased vulnerability to the disease outbreaks and
food shortages that commonly proceed major storm events, it can be reasonably
expected that they bear a disproportionate share of the mortality and morbidity
burden.
2.4 Heat Waves
While definitions of a heat wave vary, it can generally be defined as “a period of at
least 3 days where the combined effect of excess heat and heat stress is unusual with
respect to the local climate”(Nairn and Fawcett 2013, p. 13). According to the IPCC,
it is very likely that there has been an overall increase in the number of warm days
and nights at the global scale, and it is more likely than not that anthropogenic
climate change is the cause of this increase (IPCC 2014). Christidis et al. (2012)
concluded that it is extremely likely (probability greater than 95 %) that
15 Child Health and Survival in a Changing Climate: Vulnerability, Mitigation... 283
anthropogenic climate change at least quadrupled the risk of extreme summer heat
events in Europe in the decade 1999–2008. In terms of future projections, it is very
likely that the length, frequency, and intensity of warm spells or heat waves will
increase over most land areas (Smith et al. 2014; IPCC 2013), and by the end of the
twenty-first century, a 1-in-20-year annual hottest day is likely to become a 1-in-2-
year annual extreme in most regions (IPCC 2013).
Heat waves are a significant threat to human health and they typically increase the
overall death rate of a population (Smith et al. 2014). The European heat wave of
2003 caused an estimated 22,000–70,000 deaths, with 14,800 deaths in France alone
(IPCC 2007; Kravchenko et al. 2013). While the majority of epidemiological studies
find that the elderly have the highest mortality risk, there is emerging evidence that
infants and young children are also vulnerable (Xu et al. 2014). Kysely and Kim
(2009) found that during the South Korean heat wave of 1994, mortality in children
aged 0–14 years increased by 27.5 % which was the largest relative increase of any
age group. Hajat et al. (2005) found that during a period of high ambient temperature
in Delhi, children younger than 15 years old accounted for 48 % of deaths.
According to the 2011 census (Government of National Capital Territory of Delhi
2012), children under 15 account for just 26 % of Delhi’s overall population which
would suggest that this age group was disproportionately represented in the fatality
data.
3 Vector-Borne Diseases
3.1 Malaria
Malaria is among the most widespread diseases in the world (WHO 2014a). In 2013,
an estimated 198 million cases of malaria led to 584,000 deaths (WHO 2014a). The
burden of disease is heaviest in Africa, where an estimated 90 % of malaria deaths
occur, and in children under aged 5 years, who account for 78 % of all deaths
globally (WHO 2014a). Children under 5 are highly susceptible to the disease
because they have not yet developed the naturally acquired immunity that results
from repeated infections (Doolan et al. 2009). For children who survive the disease,
neurological and cognitive development can be severely affected. Recent evidence
from Uganda suggests that asymptomatic malaria infection is related to lower
sustained attention and abstract reasoning abilities (Nankabirwa et al. 2013). Mean-
while, cerebral malaria can lead to acquired language disorders and neurological
disorders including epilepsy and cerebral palsy (Idro et al. 2010). Although morbid-
ity and mortality is most concentrated in children under 5, research suggests that
infection in school-age children results in increased school absenteeism, repetition of
school years, and increased dropout rates (Thuilliez et al. 2010; Zuilkowski and
Jukes 2014).
Climate conditions affect the survival and reproductive rates of malarial mosqui-
toes and also affect the life cycle of the parasitic protozoa responsible for malaria,
which in turn influences the distribution, abundance, intensity, and annual temporal
284 B. Towers et al.
patterns of mosquito activity (particularly biting rates) (Yu et al. 2015; Watts
et al. 2015). Holding socioeconomic development constant, Béguin et al. (2011)
estimate that predicted increases in temperature and precipitation will result in a
geographic expansion of malaria, increasing the global population at risk from 4.61
billion in 2030 to 5.20 billion in 2050. Thus, in regions where climate is currently the
limiting factor, there will be a likely increase in the incidence of the disease (Watts
et al. 2015; Yu et al. 2015). Expansion into previously non-endemic regions is a
major concern because levels of naturally acquired immunity will be much lower
than in endemic regions (Béguin et al. 2011; Yu et al. 2015). While research is yet to
specifically examine how these changes will affect children, the existing evidence
indicates that they will bear a substantial proportion of the disease burden (Doolan
et al. 2009).
3.2 Dengue
Dengue is the most rapidly spreading mosquito-borne viral disease in the world
(WHO 2015). Over the past 50 years, there has been a 30-fold increase in global
incidence, and there has been a significant expansion of the geographic area affected
(WHO 2015). While dengue cases are often underreported or misclassified, esti-
mates indicate that dengue transmission is ubiquitous throughout the tropical regions
of the Americas and Asia (Bhatt et al. 2013). It is also estimated that risk in Africa,
though more unevenly distributed than in other tropical regions, is much more
widespread than suggested previously. One global estimate indicates 390 million
dengue infections per year, of which 96 million manifest clinically (Bhatt
et al. 2013). As with malaria, climate change is expected to drive a geographic
expansion of dengue. Hales et al. (2002) estimate that by 2055, population growth
alone will increase the population at risk to 3.2 billion people (34 % of the global
population), but the additional influence of climate change will increase the popu-
lation at risk to 4.1 billion people (44 % of the global population).
The dengue virus causes a spectrum of clinical disease ranging from dengue
fever –usually characterized by arthralgia, myalgia, and headache –to the more
serious dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS), both
of which can be fatal (Bhatt et al. 2013; Hammond et al. 2005). In addition to
socioeconomic factors, age is thought to be a major determinant for more serious
forms of dengue (Kyle and Harris 2008). Most epidemiologic studies find that
children under age 15 are at increased risk for both DHF and DSS which may be
due to their increased capillary fragility and decreased tolerance for insult to
microvascular integrity (Kyle and Harris 2008). In a 3-year hospital-based study in
Nicaragua (Hammond et al. 2005), the incidence of the disease was highest in
children aged 5–9 years old (58 % of all cases). Moreover, infants aged 0–11 months
and children aged 4–6 years were significantly more likely than adults to develop the
more serious clinical manifestations of DHF and DSS. Over the course of the study,
children were also more likely to succumb to the disease and accounted for 77 % of
the 13 dengue-related deaths. Thus, as climate change drives an increase in the
15 Child Health and Survival in a Changing Climate: Vulnerability, Mitigation... 285
population at risk of contracting dengue fever, it is likely that children will bear a
substantial proportion of the disease burden.
4 Waterborne Diseases
Waterborne diseases caused by viruses, bacteria, and protozoa are spread through
contaminated drinking water or recreational water and most commonly result in
diarrhea (Schuster-Wallace et al. 2014). Among children under 5, diarrhea continues
to be the second most common cause of mortality globally and accounts for at least
11 % of the mortality burden (UNICEF 2012). In 2010 alone, nearly 801,000
children under 5 succumbed to diarrhea, mostly in developing countries (UNICEF
2012). Children under 2 are particularly vulnerable with 72 % of diarrheal deaths
occurring within the first 2 years of life (Fischer-Walker et al. 2013). Children are
especially vulnerable to diarrheal disease because they must consume more water
per body mass than adults, which results in greater exposure to waterborne patho-
gens (Fischer-Walker et al. 2013; Bennett and Friel 2014). Once exposed, children’s
immature immune systems are less able to resist infection, while their small body
size means that they become dangerously dehydrated very quickly (Bennett and
Friel 2014).
The waterborne pathogens that cause diarrheal disease are highly sensitive to
meteorological conditions (Moors et al. 2013; Fischer-Walker et al. 2013). There is
general consensus that climate change will result in a substantial increase in the
incidence of diarrheal disease, and both WHO and the IPCC have identified this as
one of the most important future health effects of climate change (WHO 2009a;
Smith et al. 2014). Climate projections for assessing the global risk of diarrhea as a
result of higher temperatures have estimated an increase of 8–11 % by the 2030s
(Kolstad and Johansson 2011). However, other modeling demonstrates that increases
are spatially variable. Applying climate projections for Northern India in 2040,
Moors et al. (2013) found that increases ranged from no change in the northwest
to 13 % in the Ganges River basin to 21 % in the high mountain regions of the
Himalayas. In a country where 200,000 children die of diarrhea every year, this
represents a major public health concern (Liu et al. 2012).
5 Respiratory Illnesses
Respiratory illnesses, such as pneumonia, are the leading cause of death in children
(WHO 2014b; UNICEF 2006). Globally, over two million children die of pneumo-
nia every year, accounting for 20 % of all child deaths (UNICEF 2006). While most
healthy children can fight pneumonia infection with their own defenses, children
with compromised immune function are at a higher risk of contracting the disease
and of succumbing to complications. Children suffering from undernutrition are at a
particularly high risk, and 44 % of pneumonia deaths in children are attributed to
undernutrition (Paynter et al. 2010,2013). Susceptibility is also exacerbated by
286 B. Towers et al.
overcrowded living conditions and indoor air pollution caused by cooking and
heating with coal and other biomass fuels, such as wood or dung (WHO 2009a).
For this reason, children in developing countries bear a substantial proportion of the
global disease burden of pneumonia. For example, in 2011, sub-Saharan Africa
accounted for 43 % of all global pneumonia deaths in children aged under 4 years,
while Southeast Asia accounted for 35 % (Fischer-Walker et al. 2013). Despite the
impacts of pneumonia on child mortality, little attention is given to the disease, and
for this reason it is often referred to as the “forgotten killer”(UNICEF 2006).
It is well established that pneumonia follows seasonal patterns –in temperate
settings, the incidence increases in the winter months, while in tropical settings,
incidence increases during the rainy season (Paynter et al. 2013). In the Gambia,
for example, the incidence of clinical pneumonia in children was 409 (per 1000
person years) in the rainy season; 243 in the hot, dry season; and 160 in the cool,
dry season (Paynter et al. 2010). While future projections are currently lacking,
Paynter et al. (2010) assert that climate change will increase the incidence of
childhood pneumonia in tropical settings and propose three mechanisms through
which this would occur: (1) more time indoors or undercover because of increased
rainfall will increase crowding and exposure to particulate matter from burning
coal and biomass; (2) the stability of the virus in aerosols might increase in higher
humidity; and (3) undernutrition caused by decreased food security will increase
susceptibility to infection. However, all three mechanisms, and their relationship
to the incidence of pneumonia in children, are yet to be subjected to empirical
scrutiny.
6 Key Uncertainties and Knowledge Gaps
While available evidence indicates that children will be among the worst affected by
the health impacts of climate change, there are several knowledge gaps and uncer-
tainties concerning the precise nature of children’s exposure and vulnerability
(Sheffield and Landrigan 2011). Across the broader literature on the health impacts
of climate change, the only study that specifically models impacts on children is
Nelson et al.’s(2009) global projection for child undernutrition. A major barrier to
projecting future impacts on children is a lack of global and national data on child
morbidity and mortality due to climate-sensitive diseases and extreme events (WHO
2009a; Xu et al. 2012). While morbidity and mortality data does exist, it is rarely
disaggregated by age, and this is impeding the development of future projections that
specifically address child morbidity and mortality under future climate change
scenarios.
A major step forward in this domain is the Global Initiative on Children’s
Environmental Health Indicators (CEHIs), an initiative led by the World Health
Organization aimed at improving the assessment of children’s environmental health,
monitoring the effects of interventions to improve children’s health in relation to the
environment and reporting on the state of children’s environmental health (WHO
2009b). The initiative has three key objectives: (1) develop and promote the use of
15 Child Health and Survival in a Changing Climate: Vulnerability, Mitigation... 287
children’s environmental health indicators; (2) improve the assessment of children’s
environmental health and monitor the success or failure of interventions; (3) and
provide data to inform policymakers and to allow measurement of the effectiveness
of policies and programs to improve environmental conditions for children (WHO
2009b). Importantly, the indicators incorporate all of the major health impacts of
climate change, including perinatal diseases, respiratory diseases, diarrheal diseases,
insect-borne diseases, and physical injuries. However, the extent to which the CEHIs
have translated into operational monitoring and surveillance programs is unclear. In
most countries there are no good registers of environmentally determined diseases in
children, and increased political will and financing are required to ensure this occurs
(WHO 2010).
Another issue with the CEHIs is that children are categorized into two main
groups of 0–4-year-olds and 5–14-year-olds (Xu et al. 2012). However, these
broad categorizations fail to reflect the heterogeneity of children’s exposures and
vulnerabilities within these groupings. Levels of exposure and vulnerability for a
5-year-old are likely to differ to those for a 14-year-old and likewise for a 1-year-old
as compared to a 4-year-old. Thus, there is an ongoing need for research that
disaggregates the broad category of “children”at a higher level of precision and
increases understanding of the specific health risks that apply to children of different
ages. There is also a need to better understand the social determinants of children’s
exposure and vulnerability to climate-related health risks. While it is clear that
poverty and inequality are major determinants of child health and survival (WHO
2009b), there is a need for rigorous research on how individual characteristics such
as race, class, gender, and disability influence children’s vulnerability to both
extreme events and climate-sensitive disease. Such information would help to ensure
that resources are allocated to those children who are most at risk. It would also
provide an evidence base for addressing the underlying causes of child morbidity
and mortality in high-risk groups.
Importantly, this research endeavor will need to provide children with genuine
opportunity to actively participate in the process of knowledge and data generation.
At present, the bulk of research on children’s exposure and vulnerability to the health
impacts of climate change is being conducted from the perspectives of adults. As a
consequence, children have become what anthropologist Charlotte Hardman (1973)
refers to as a “muted group.”This dominance of adult voices most likely stems from
the long-held assumption that children are unreliable or incompetent informants of
their own knowledge and experiences (James and Prout 2004). Over the last decade,
however, leading scholars of childhood have concluded that delimiting the emer-
gence of children’s own knowledge and experience through the use of adult-centered
positivistic methodologies not only creates a false picture of children’s experiences
but serves to underestimate their competence and agency (Boyden 2003). The
adoption of inductive, hermeneutical methodologies that enable children to articulate
their experiences from their own perspectives will enhance understanding of the
actual and expected impacts of climate change on child health and provide a more
rigorous evidence base for the development of policy and programming that meets
children’s needs.
288 B. Towers et al.
7 Protecting Child Health and Survival in a Changing
Climate
Although current knowledge is characterized by numerous gaps and uncertainties,
this must not be seen as a reason to delay action on protecting child health and
survival. On the contrary, the potential risks to child health posed by climate change
require the application the “precautionary principle”which states that “Where there
are threats of serious or irreversible damage, lack of full scientific certainty shall not
be used as a reason for postponing cost-effective measures to prevent environmental
degradation”(UNCED 1992, Principle 15). Action to protect child health and
survival is supported by Article 24 of the United Nations Convention on the Rights
of the Child which clearly states that children have the right to the enjoyment of the
highest attainable standard of health and to facilities for the treatment of illness and
rehabilitation of health (United Nations 1989). Also relevant in this context is Article
27 which states that children have the right to a standard of living that is good
enough to meet their physical and mental needs (United Nations 1989). In the
context of climate change, Pursuing the full implementation of this right requires
immediate and drastic actions to both reduce greenhouse gas (GHG) emissions
(climate change mitigation) and to assist communities to cope with and adapt to
the actual and expected consequences of increasing temperatures (climate change
adaptation).
7.1 Climate Change Mitigation
Climate change mitigation refers to efforts to reduce or prevent greenhouse gas
(GHG) emissions (Smith et al. 2014). Mitigation can mean using new technologies
and renewable energies, making older equipment more energy efficient or changing
management practices or consumer behavior (IPCC 2014). Protecting carbon sinks
like forests and oceans are also elements of mitigation (IPCC 2014). Substantial
emission reductions over the next few decades can reduce climate risks in the
twenty-first century and beyond, increase prospects for effective adaptation, reduce
the costs and challenges of mitigation in the longer term, and contribute to climate-
resilient pathways for sustainable development (IPCC 2014). The IPCC states with
high confidence that without additional efforts to reduce GHG emissions beyond
those in place today, population growth and economic activities will lead to an
increase in global mean surface temperature of up to 4.8 C in 2100 (IPCC 2014).
The risks associated with temperatures at or above 4 C include substantial species
extinction, global and regional food insecurity, consequential constraints on com-
mon human activities and potentially catastrophic effects on human health in both
developing and developed nations (IPCC 2014; WHO 2009a; Watts et al. 2015).
Among the scientific community, there is general agreement that the catastrophic
impacts of climate change can be avoided if the global temperature rise is kept to no
more than 2 C above preindustrial levels (IPCC 2014; Watts et al. 2015). This will
require substantial emission reductions over the next few decades and near-zero
15 Child Health and Survival in a Changing Climate: Vulnerability, Mitigation... 289
emissions of greenhouse gases by the end of the century (IPCC 2014). Implementing
such reductions poses substantial technological, economic, social, and institutional
challenges at both national and international levels and involves some level of risks
due to adverse side effects (i.e., devaluing of fossil fuel assets and reduced revenues
for fossil fuel exporters) (IPCC 2014). However, these risks do not involve the same
possibility of severe, widespread, and irreversible impacts as risks from climate
change (IPCC 2014). In addition to preventing catastrophic climate change, reducing
greenhouse gas emissions will have major “co-benefits”across different sectors,
including public health (IPCC 2014; Watts et al. 2015; WHO 2009a). The public
health co-benefits of mitigation exist across five main categories, all of which have
particular relevance to protecting child health:
•Household energy. In developing countries, enabling households to move from
inefficient burning of coal and biomass fuels for domestic use to cleaner sources
of energy would significantly reduce greenhouse gas emissions and would also
reduce the estimated two million annual deaths from indoor air pollution (WHO
2009a).
•Electricity generation. A shift toward renewable energy sources for electricity
generation would cut greenhouse gas emissions as well as reduce the current 1.2
million annual deaths from outdoor urban air pollution (WHO 2009a).
•Urban transport systems. Promotion of safe and sustainable public transport
systems would dramatically cut carbon emissions and would also help to reduce
the 3.2 million annual deaths from noncommunicable diseases associated with
physical inactivity. It would help to reduce the 1.3 million annual deaths from
road traffic accidents (WHO 2009a). A chapter in this volume by Paul Tranter and
Scott Sharpe reflects in more detail on this issue and its relevance to children.
•Food and agriculture. The food and agriculture sector contributes about 10–12 %
of global greenhouse gas emissions, with additional contributions from associated
land-use change (e.g., deforestation) (Watts et al. 2015; IPCC 2014). Moderating
meat consumption and increasing intake of foods that are lower on the food chain
has the potential both to enhance health and reduce greenhouse gas emissions
(Smith et al. 2014; WHO 2009a).
Taken together, these health co-benefits have the potential to offset a large part of
the financial cost of GHG emission reduction policies (WHO 2009a). Several cost-
benefit analyses show that shifts to a low-carbon economy are paid for by subsequent
improvements in public health. In a cost-benefit analysis of the United States Clean
Air Act, every dollar invested in implementation generated 42 dollars in societal
gains, a large proportion of which was gained through health benefits (EPA 2011).
The 2007 IPCC report also showed that the costs of many climate change mitigation
interventions would be partly or wholly compensated for by the associated health
benefits (IPCC 2007). While this point is rarely raised in debates about the econom-
ics of climate change mitigation, it offers a way of securing a broad and inclusive
platform of public and political support for action (Bennett and Friel 2014; Watts
et al. 2015). As such, the health community should play a more active role in the
290 B. Towers et al.
design of greenhouse gas mitigation policies: failure to select the most health-
enhancing actions for mitigation would be a lost opportunity for present and future
generation and would reduce the return on investment in low-carbon and renewable
energy sources (WHO 2009a; Watts et al. 2015).
Another way of securing support for climate change mitigation is by representing
it in ways that anchor it in positive emotions and by framing it in ways that connect
with people’s core values and identities (Watts et al. 2015; Markowitz and Shariff
2012). A leading example involves framing climate change as an issue of
intergenerational justice (Gibbons 2014; see also Davies et al. in this volume). The
principle of intergenerational justice argues that there should be distributive justice
between generations and that the rights of generations should be considered equal
over time (Stone and Lofts 2009). Gibbons (2014) has argued that children alive
today and those not yet born have a claim to climate justice, both within their own
countries and internationally. This claim is currently being tested in a range of
countries, where lawyers are working with children and youth to advance of a
variety of science-based legal actions to compel government action on climate
change (Children’s Climate Trust 2015). While the outcomes of these cases are
still pending, they have done much to increase public discussions of
intergenerational justice and the moral rights of children and youth in present and
future generations.
Principles of intergenerational justice have also been used to increase child
representation and participation in global negotiations on climate mitigation.
Intergenerational justice requires that agreements for mitigation ensure not only
that the rights of future generations are fulfilled but also that the decision-making
process includes the views of children (Walden et al. 2009). Importantly, children’s
right to be heard in global climate negotiations is upheld by Article 12 of the United
Nations Convention on the Rights of the Child which clearly states that children
have a right to participate in decision-making that affects them (UN 1989). In the
lead up to the United Nations Framework Convention on Climate Change (UNFCC)
15th Conference of the Parties (COP15) in 2010, international child-rights advocates
called on decision-makers to acknowledge children as official stakeholders, provide
formal mechanisms for children and youth to participate in formal negotiation
processes, and contribute to decision-making on climate change (Walden
et al. 2009).
In response to this call, the UNFCCC secretariat granted a provisional constitu-
ency status to youth aged between 15 and 24 years old (UNFCCC 2012). As reported
by the UNFCCC (2012), this constituency, referred to as YOUNGO (Youth
Non-Governmental Organizations), has provided a conduit for the exchange of
official information between young people and the secretariat; assisted the secretariat
in ensuring effective participation by youth appropriate to an intergovernmental
meeting; coordinated young people’s interaction at sessions including convening
constituency meetings and organizing meetings with officials; and provided logisti-
cal support to youth during sessions (UNFCCC 2012). In practical terms, YOUNGO
is given the opportunity to address the plenary, high-level segment of a COP, make
submissions (individual youth organizations can also do so), attend workshops, and
15 Child Health and Survival in a Changing Climate: Vulnerability, Mitigation... 291
meet with officials of the convention such as chairs of the subsidiary bodies and the
COP Presidency (UNFCCC 2012). However, academic literature on the adequacy or
efficacy of these processes is lacking. To date, no published studies critically
evaluate children’s experiences of participating in these processes or the extent to
which children’s views have informed actions and outcomes. It is also worth noting
that the YOUNGO constituency is for 15–24-year-olds, and, hence, there is no
formal mechanism for the participation of younger children. In this respect, fulfilling
Article 12 of the UNCRC is an ongoing project.
7.2 Climate Change Adaptation
In parallel to mitigation, adaptation is regarded as an integral part of climate policy
(IPCC 2014). The emphasis on adaptation is partially due to the time lag between
current emissions and the projection of increased greenhouse gas concentrations in
the atmosphere (IPCC 2014). Even if greenhouse gas emissions were to halt
immediately, temperatures would be expected to rise by over 0.6 C in this century
(WHO 2009a). If the world was to place a high priority on shifting to sustainable and
renewable energy over the next several decades, temperatures are still expected to
rise by 1.8 C (likely range: 1.1–2.9 C) (WHO 2009a). There is scientific consensus
that even a 2 C rise will result in insecurity for millions of people in terms of food,
water, and shelter, with all of the attendant risks for child health (Smith et al. 2014).
Thus, strategies that facilitate adaptation and build resilience are required. In the
climate change literature, adaptation refers to “the process of adjustment to actual or
expected climate and its effects, in human systems in order to moderate harm or
exploit beneficial opportunities, and in natural systems human intervention may
facilitate adjustment to expected climate change”(Watts et al. 2015, p. 15). Resil-
ience, meanwhile, refers to “the capacity of a system to absorb disturbance and
reorganise while undergoing change, so as to still retain essentially the same
function, structure, identity and feedbacks”(Watts et al. 2015,p.15).
Over the last decade, adaptation and resilience have received substantial attention
in both policy and research, and more recently adaptation and resilience for human
health have emerged as a focal point in the adaptation discourse (Bowen and Friel
2012; Watts et al. 2015). However, despite their well-documented vulnerability to
the health impacts of climate change, children have not featured prominently in such
literature (Xu et al. 2012). Yet, adaptations to climate change will be less than
adequate if they fail to take account the particular vulnerabilities of children, the
protective factors that can best support their resilience and their capacities to
contribute to adaptation (Mitchell and Borchard 2014).
As several authors point out, there are strong synergies between what children
need to thrive and become healthy adults and the adaptations that are required to
reduce the health risks of climate change (Bennett and Friel 2014). The social and
economic determinants of child mortality and morbidity are well known and include
poverty, hunger, and lack of access to clean water and sanitation (WHO 2009a;
Sheffield and Landrigan 2011). Over the last 15 years, since the inception of the
292 B. Towers et al.
Millennium Development Goals (MDGs), major progress has been made across
these areas: the number of people living in extreme poverty has been halved; the
number of undernourished people has fallen from 23.3 % to 12.9 %; the number of
people using an improved drinking water source has increased from 76 % to 91 %;
and the number of people practicing open defecation has been reduced significantly
(UN 2015). However, as highlighted in the final report for the MDGs, progress
has been uneven, and in developing regions significant inequities exist between the
poorest and richest households and between rural and urban areas (UN 2015).
While protecting child health will require a significant reduction in these
inequities, climate change is expected to exacerbate them even further (Bennett
and Friel 2014).
Climate change will strain health systems of those countries that already face the
public health challenges of poor health infrastructure, poverty, and inequality (Watts
et al. 2015). Populations that do not have access to good quality health care and
essential public health services are more likely to be adversely affected by climate
variability and climate change (Frumkin and McMichael 2008). Therefore, strength-
ening of public health systems needs to be a central component of adaptation to
climate change (Watts et al. 2015; WHO 2009a; Smith et al. 2014). In regions where
the health impacts of climate change are expected to be most severe, broadening the
coverage of available health programs and interventions would greatly improve
current child health status and, combined with forward planning, would increase
adaptive capacity for dealing with future challenges (WHO 2009a). This will require
significant investment, particularly in developing countries. Watts et al. (2015) argue
that donor countries have a responsibility to support measures which reduce the
impacts of climate change on human health and build adaptive capacity. Given the
increased vulnerability of children, beneficiary countries also have a responsibility to
prioritize investment in health services that address the current and future health-care
needs of this group (WHO 2009a).
Many of the most important adaptive actions for protecting child health are public
health interventions of proven effectiveness. For example, malaria interventions are
highly effective and affordable (WHO 2009a). The main interventions comprise
vector control (which reduces transmission by the mosquito vector from humans to
mosquitoes and then back to humans), achieved using insecticide-treated mosquito
nets (ITNs) or indoor residual spraying (IRS); chemoprevention (which prevents the
blood stage infections in humans); and case management (which includes diagnosis
and treatment of infections) (WHO 2009a). In sub-Saharan Africa, ITNs are esti-
mated to reduce malaria mortality rates by 55 % in children under 5 years of age
(WHO 2014a). Their public health impact is due to a reduction in malaria deaths and
to reductions in child deaths from other causes that are associated with, or exacer-
bated by, malaria (e.g., acute respiratory infection, low birth weight, and malnutri-
tion) (WHO 2009a). Chemoprevention is particularly effective in pregnant women
and young children, and WHO (2009a) estimates that seasonal malaria chemopre-
vention for children aged 3–59 months could avert millions of cases and thousands
of deaths in children living in areas of highly seasonal malaria transmission in
Africa’s Sahel subregion.
15 Child Health and Survival in a Changing Climate: Vulnerability, Mitigation... 293
Climate change adaptation also requires strengthening health systems to deal with
the predicted increases in the intensity and frequency of extreme weather events.
Acute shocks such as natural disasters and disease epidemics can overload the
capacities of health systems in even the most developed nations (WHO 2009a).
There is an urgent need to increase the capacity of health systems to ensure that
people are better protected from the increasing hazards of extreme weather events
(WHO 2009a). Approaches to the health management of extreme weather events
involve improving forecasting and early warning systems, predicting possible health
outcomes, contingency planning, and identifying the most vulnerable (i.e., children)
(Watts et al. 2015). Despite their well-documented vulnerabilities to extreme events
and the associated health impacts, children are often overlooked in disaster risk
management policies and plans. The US National Commission on Children and
Disasters (2010) found that very few states had school evacuation and family
reunification plans, and only 6 % of hospital emergency departments had supplies
and equipment to treat children. In Australia, a recent analysis of local government
emergency management plans found that the needs of pets and livestock were
mentioned more regularly than the needs of children (Save the Children 2013).
Access to education also has a major role to play in building adaptive capacities.
Toya and Skidmore (2007) found a significant role for education in reducing
vulnerability to hazard impacts, and Watts et al. (2015) assert that education levels
are important in the ability of societies to cope with extreme events. Educating girls
appears to be particularly beneficial, and there is some evidence that education levels
of women are a critical factor in reducing household vulnerability to death and injury
in weather-related disasters (Toya and Skidmore 2007). This evidence is consistent
with an extensive literature documenting the effects of female education on
community-level social capital and health-related indices, such as life expectancy
(King and Mason 2001). As Blankespoor et al. (2010) note, educating young women
and girls is also one of the major determinants, if not the major determinant, of
sustainable development. Curricula that provide the requisite knowledge and skills
for effective adaptation are also essential (Anderson 2010). While progress is being
made in this domain (e.g., Selby and Kagawa 2013; Kagawa and Selby 2010), the
work remains ad hoc, and climate change education is rarely identified as a key
priority in national or local adaptation plans. If present and future generations are to
find effective and sustainable solutions for adaptation, a more systematic approach to
climate change education is required (Kagawa and Selby 2010; Selby and Kagawa
2014).
The fundamental importance of climate change education is highlighted in the
rapidly expanding literature on community-based climate change adaptation which
emphasizes the fundamental importance of public participation in the design and
implementation of adaptation activities at the local level (Reid et al. 2009). A
burgeoning literature demonstrates that for solutions to be effective and sustainable,
they must be informed by the knowledge and experience of local people (Schipper
et al. 2014). There is also growing evidence that children’s participation in
local adaptation activities not only protects child health and survival but provides
benefits to entire communities (Mitchell and Borchard 2014; Tanner et al. 2009;
294 B. Towers et al.
Tanner 2010; Mitchell et al. 2008). Mitchell and Borchard (2014) cite several
compelling anecdotal examples, including one from Kenya, where school children
have learned about the impacts of climate change on water and food security and
have grown vegetables in “gunny sacks”(large bags used to transport grain), which
uses less water than traditional methods; they have also experimented with drought-
tolerant crops and shared the results with transitioning pastoralists.
A growing body of academic research has emphasized children’s capacities for
participating in climate change adaptation (Tanner 2010; Tanner et al. 2009; Mitchell
et al. 2008). This research has contributed to a fundamental “shift in the narrative,”
from children as passive victims of climate change to children as active agents of
change (Tanner 2010). Drawing on a suite of participatory action research (PAR)
projects in the Philippines and El Salvador, Tanner et al. (2009) identify five core
domains in which children can participate in climate change adaptation:
•Assessing risk and risk reduction activities
•Designing and implementing projects
•Communicating risks and risk management options to their households and
communities
•Mobilizing resources and people
•Constructing social networks and social capital
A more recent study by Haynes and Tanner (2013), conducted in the Philippines,
provides further evidence of children’s capacities for participating across these core
domains. Utilizing participatory video (PV) methods, this study involved children
and youth (13–18 years old) in identifying local climate risks, researching the
underlying social and political risk drivers, producing short films to communicate
their findings to local decision-makers and community members, and participating in
follow-up workshops to develop community-based strategies for adaptation.
Through the PV process, one particular group of children discovered that chromite
mining was exacerbating the health impacts of extreme rainfall events and flooding
in their village. Not only was chromite mining contaminating flood waters and
causing skin disease, but water-filled mining pits were providing breeding grounds
for mosquitoes and increasing the risk of malaria. Their film revealed that chromite
mining was a divisive issue in the community between those who were benefiting
from the mining and those who were exposed to the risks but received no benefits.
Following a local screening of the film, the children organized a community meeting
to openly discuss the various issues, and as a result local officials banned mining
close to the village and pledged to rehabilitate old mining pits. In a region where
climate change is expected to increase the frequency and intensity of extreme rainfall
events, preventing the contamination of flood waters and eradicating mosquito
breeding sites is an essential adaptation measure.
While the available evidence provides support for child participation in climate
change adaptation, there is an urgent need for increased research outputs. As
Mitchell and Borchard (2014) point out, there is no solid evidence base proving
that what has worked in a growing number of cases is more broadly applicable,
15 Child Health and Survival in a Changing Climate: Vulnerability, Mitigation... 295
translatable to other regions, or sustainable in the absence of direct project support.
There is also a distinct need for research that focuses on younger children. To date,
the majority of published studies involve older children and youth aged between
11 and 18. Yet, it would appear that it is younger children and infants who are most
vulnerable to both extreme events and climate-sensitive disease. While the partici-
pation of infants will obviously be constrained by their still developing cognitive and
communication abilities, it is generally agreed that school-age children are capable
of engaging in the research process, so long as child-friendly research methods are
employed (Eder and Fingerson 2002).
8 Conclusion
This chapter has reviewed the available literature on the health impacts of climate
change on children and the various pathways toward protecting child health and
survival. There is a general scientific consensus that climate change will cause an
increase in the frequency and intensity of extreme weather events (i.e., heat wave,
flood, drought, tropical cyclone) and exacerbate the spread of climate-sensitive
diseases (i.e., malaria, dengue, pneumonia, diarrhea). It is also widely understood
that climate change will lead to an increase in mortality and morbidity, particularly in
developing countries where exposure is highest and vulnerability is most entrenched.
While the available evidence indicates that children will be most severely impacted,
a lack of data on child mortality and morbidity is impeding the development of
mathematical models for reliable estimates under various climate change scenarios.
Of particular importance is the need to disaggregate data at a level of precision that
can account for physical, behavioral, and social heterogeneity of childhood. Where
child health data is being collected, it is most commonly grouped into 0–4-year-olds
and 5–14-year-olds. These categories are insufficiently fine-grained for fully under-
standing the distinct exposures and vulnerabilities at different stages of child devel-
opment. There is also a need to better understand children’s environmental health
from their own perspectives, especially with regard to how their daily activities and
routines influence their exposure and vulnerability.
However, the lack of definitive estimates of impacts for the various stages of
childhood should not delay action on climate change mitigation and adaptation to
protect child health and survival. Rather, the potential risks to child health and
associated consequences for the acquisition of human capital would seem to require
the application of the “precautionary principle.”Importantly, many climate change
mitigation measures have major co-benefits for public health in general and child
health, in particular. Framing mitigation policy in terms of health co-benefits and as
an issue of intergenerational justice is more likely to secure public support for the
kind of drastic actions that are needed to avoid catastrophic climate change. Princi-
ples of intergenerational justice also require that children and young people are
provided with opportunities for genuine participation in the development of climate
policy. While recent efforts have ensured that there are formal mechanisms for youth
to participate in international climate change negotiations, children under the age of
296 B. Towers et al.
15 have not been afforded the same opportunities. Yet, they are the ones who are
most vulnerable to the health impacts of extreme events and climate-sensitive
disease and thereby have the strongest claim to climate justice. Upholding children’s
rights to participate in decision-making that affects them requires the implementation
of formal mechanisms for the participation of younger children as well youth.
Children must also be provided with increased opportunities to participate in
climate change adaptation. While it is often assumed that children are helpless
victims of extreme events and disease, it is increasingly recognized that they have
an essential role to play in adaptation research, policy, and practice. Historically,
children’s exposure and vulnerability to extreme events and climate-sensitive disease
have been studied from the perspectives of adults, and children’s needs and capac-
ities have not been ranked as a high priority in adaptation planning. However, it is
becoming increasingly clear that when children have an opportunity to participate in
knowledge generation and the development of adaptation solutions, the entire
community benefits. Yet, child-centered adaptation research remains very much a
niche topic in the wider adaptation literature. If current and future generations of
children are to be protected from the health impacts of climate change, the climate
change community will need to make a more concerted effort to incorporate the
needs and capacities of children into its core agenda. Not only will this provide a
stronger basis for solutions that are sensitive to the realities of children’s everyday
lives, it will also ensure that broader measures for mitigation and adaptation do not
impact adversely on their health and survival.
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