is defined by the United Nations as long-term weather alterations, including
temperature, wind, and precipitation patterns. The United Nations Conference of
Parties (COP) summit gathers experts and political leaders from around the
world to discuss pressing environmental challenges and formulate climate
adaptation strategies. On my way to attend COP27, which took place in Sharm
Elsheikh in Egypt last year, I was among a delegation of health researchers
facing the question of “What will health researchers be doing at COP?”. Their
query may seem oblivious at first, but there is a valid reason why people
wonder about the presence of health professionals in COP. Historically, health has
not been a focus in climate discussions. Although the presence of the World
Health Organization (WHO) and its participation in COP conferences has
increased in recent years, the prioritization of relevant health topics remains
inadequately addressed, despite the substantial health costs of climate change.
common misconception is that climate change poses a risk to “future” health and
well-being, but the reality is that millions of people around the world have
been and continue to suffer from health consequences that are directly
attributable to climate change, including chronic morbidity and premature
mortality. The WHO estimated that environmental conditions are responsible for
13 million deaths each year, which is predicted to increase to a quarter
million annual deaths by 2050.1
unprecedented move, Dr. Sultan Al Jaber, the President-Designate of COP28, has
affirmed that health will form an integral part of the COP28 agenda this year.
A Conference Day will be dedicated to discussing the impacts of climate change
on health at the highest level, sending an ambitious and courageous message
that recognizes the need to address the critical connection between climate
change and health. Additionally, a notable aspect of the COP28 announced agenda
is the presentation of a thematic program that highlights the
interconnectedness of health and other sectors concerning climate change. The
agenda also emphasizes “cross-cutting themes” such as technology, innovation,
finance, inclusion, and frontline communities, which form key action areas,
offering potential impactful opportunities towards improved climate adaptation.2-5
Health in the era
of climate change
The direct and
indirect health impacts of climate change are mediated through intense extreme
weather events such as heatwaves, flooding, droughts, and heavy rainfall. The
consequences of these events threaten social and economic ecosystems,
challenging the overall health and well-being of nations worldwide. While
current and future generations of children lack the power and agency to
influence the drivers of climate change, they bear the highest disease burden
attributable to the climate crisis. In this insight piece, the observed and
projected health effects of climate change are outlined, with an emphasis on
climate change-associated morbidity and mortality in children.
The incidence and extent of wildfires have been consistently increasing over the last decade.
implications of extended droughts and heatwaves have been identified as key
drivers of the increasing trends of fire weather. Future projections estimate
an increase in fire risk by 600% for every 1 Celsius annual increase in average
temperatures.6 Global predictions indicate an increase of 30% by
2050.7 Additionally, the warmer temperatures not only mean more
fires but also longer episodes of fire weather.6,7 The prolonged
durations of wildfires result in more smoke that is currently responsible for
up to 50% of atmospheric pollution particles,8 drastically
compromising air quality. Exposure to air pollution, often defined as exposure
to particular matter (PM2.5), Ozone, and nitrogen dioxide (NO2), has
detrimental effects on human health outcomes. According to the World Health
Organization, over 40% of the world population is exposed to high levels of air
pollution, which is responsible for 7 million deaths each year.9
exposure patterns and intensity of aeroallergens, which are air-borne
substances that trigger allergies, constitute another source of air pollution
concerns. Climatic variations trigger changes in aeroallergens’ concentrations
and seasonality. Exposure to aeroallergens can exacerbate respiratory
complications through mild and severe allergic responses and conditions.
Similarly, other air pollutants such as Ozone also compromise individuals’
capacities to manage their respiratory disorders, whether it is asthma,
conjunctivitis, or atopic dermatitis.10
the respiratory system, air pollution can impact people of all ages. However,
children bear an unacceptably high disease burden due to air pollution, which
is responsible for one in ten deaths in children under five years of age.1,11
It is not exactly clear how air pollutants impact children’s organs; recent
publications proposed various mechanisms, including genetic and epigenetic
factors.12 The effects of air pollution impact a child before they
are born. Through maternal exposure, air pollution can compromise fetal
development, leading to adverse birth outcomes, including preterm birth and low
birth weight. Adverse birth outcomes have been well-established as markers of
later morbidity and mortality. Recent estimates indicate that air pollution
causes 20% of all neonatal mortality.13
air pollution continues to take place across the life stages of a growing
child. In their early years, children grow rapidly, and their heights and
weights increase to meet their genetic potential and have optimal growth.
Accordingly, children breathe, eat and sleep more for their size to fulfill the
needs of their growing brains and bodies. By breathing at a faster rate,
children’s exposure to air pollutants is heightened.13 Today, more
than 90% of the world’s children breathe toxic air every day.11 The
disease burden from air pollution in children is most commonly characterized by
higher rates of respiratory diseases, including asthma and pneumonia.10,11,14
Research has linked increased exposure to smoke from wildfires to asthma and
asthma attacks.14,15 Additionally, changes in temperatures have been
linked to an increased incidence of pneumonia, which is the third-top killer
among children under five years of age.14,16,17
physical health, air pollution has been associated with adverse neurological
development. Research findings reported an increased risk of autism and
attention deficit hyperactivity disorder (ADHD) among exposed children.10,18,19
Accordingly, these health conditions compromise the child’s ability to focus
and lead an active life, resulting in various negative social, emotional, and
academic impacts. Similarly, asthma has been identified as the most common cause
of absence from school among children, disrupting children’s learning process.15,20
Moreover, according to a study, 61% of parents of asthmatic children identified
asthma as a barrier for their children to be involved in sports activities.20
A qualitative analysis that interviewed primary school children with asthma
indicated that asthmatic children experienced negative social experiences and
bullying. Accordingly, impacted children experience higher rates of depression
and social isolation. These adverse social effects are compounded by children’s
inability to freely engage in social and leisure pursuits, further compromising
sources responsible for greenhouses, such as transportation, industries, and
energy use, are also key contributors to air pollution. Accordingly,
decarbonization actions leading to better air quality will aid in reversing the
health challenges facing children. A modeling study that estimated the impact
of removing all combustion-related emissions on child health outcomes in 16
cities indicated a substantial reduction in asthma rates and adverse birth
outcomes by 22% and 10%, respectively.22
defined by a prolonged period of abnormally high temperatures, which are often accompanied
by high levels of humidity. The incidence, intensity, and duration of heatwaves
have been on the rise. Future projections of global average temperature
indicate an increase of at least 2 degrees Celsius,10,23 and these
temperature changes are recognized as a direct effect of climate change. The
number of individuals exposed to heatwaves has been estimated to be around 125
million over the past two decades.23 Heatwaves affect all age groups
and are considered to be one of the most dangerous weather changes. Exposure to
heatwaves can result in serious illness and death; morbidity from heatwaves is
often characterized by kidney illness, heat strokes, dehydration, and
infectious diseases.10,23,24 The consequences of heatwaves on human
health are observed all over the world, even in regions with naturally cooler
climates, as seen in the 2003 heatwave in Europe, where 70,000 people died.23
However, areas with high levels of poverty experience a higher burden of
heatwaves due to various reasons, including the built environment, where homes
are often made with cheaper materials that are conductors of heat, such as
corrugated iron sheets. Also, to further minimize building costs, most
buildings in these environments have no windows, which leads to poor airflow.24
The effects of heatwaves in poor-resource settings are also exacerbated by the
prevalent water crisis.26
Among the key
risk groups for heatwaves are mothers and children. The younger the child, the
more susceptible they are to morbidity and mortality due to heatwaves.10,24-30
Among children, heatwaves pose greater morbidity and mortality risks for
infants (0-2 years of age), compared to other age groups. Exposure to extreme
heat during pregnancy compromises the health of both mother and baby. The mother’s
body, during pregnancy, undergoes metabolic and cardiovascular adaptations to
best support the growth of the fetus. Although the specific physiological
mechanisms remain unclear, heat exhaustion increases the risk of premature
delivery, low birth weight, and congenital anomalies, among other complications
dehydration is a common challenge facing women living in hot climates,
negatively impacting pregnancy and breastfeeding experiences.24
Breastfeeding has been associated with positive physical, cognitive, and
immunological effects in children, providing optimal levels of essential
nutrients to promote growth and well-being.31 As breast milk is
mainly composed of water, maternal dehydration can significantly hinder milk
production. The decreased milk supply challenges the infant’s ability to
receive adequate intake to have sufficient nourishment. Additionally, mothers
suffering from dehydration are also at risk of experiencing fatigue and headaches,
which can challenge a mother’s overall ability to attend to her child’s needs.31-34
The effects of
heatwaves on mothers and children are exacerbated by limited availability and
access to water. Furthermore, in areas most affected by climate change, water
intake is affected not only by water scarcity but also by water safety concerns.24-25
Findings from African nations indicated that while pregnant women often need to
commute for hours to access the nearest water source, they may abstain from drinking
water due to water contamination concerns.24-25 Low water intake
during pregnancy results in fatigue and dehydration, which are associated with
an increased need for cesarean delivery and a higher risk of adverse birth
outcomes, including stillbirth and low birth weight. Additionally, water
contamination poses serious threats to newly born and growing children. As
children grow, their bodies rely on nutritional sources to support growth
processes, including brain development, physical growth, and overall
well-being. Water consumption is key for children’s well-being and survival, as
dehydration in children has been recognized as a risk factor for infant and
rainfall is a direct climate change consequence that can either result in
floods or droughts. The environmental changes attributable to altered rainfall
have been associated with an increased risk for infectious diseases.10
The distribution of disease-carrying insects such as malaria, ticks, and dengue
has been shown to change. Due to weather changes, insects can expand their
geographical range, increasing their presence in areas where they are already
prevalent as well as in new areas. Evidence from various countries in Africa
indicates an increased transition rate of malaria in areas affected by
temperature and rainfall changes. According to the Centers for Disease Control
and Prevention (CDC), Malaria is currently among the top ten causes of
mortality in children, responsible for 7% of child deaths worldwide.16
Recent projections indicate that without the necessary climate adaptation
strategies, malaria under-five mortality is expected to rise by 15%. In
addition, weather changes have also been shown to favor the spread and
transmission of viruses and parasites that are responsible for an array of
infectious diseases 10.
poses great health challenges by increasing the risk of infectious water and
food-borne diseases. When exposed to such diseases, children experience
prolonged diarrheal episodes causing loss of body water and nutrient content
that is substantial for their size. Such episodes are life-threatening.10,16,24
According to the CDC, one in nine children die of diarrheal diseases, making it
the second global killer in children below five years of age. Moreover, water
contamination alone accounts for 88% of diarrhea-attributable deaths, with
dehydration being a key risk factor for death from diarrhea.16
surviving diarrheal diseases are often left with undernutrition. Without timely
medical care and adequate nutritional support, malnourished children can become
wasted and stunted, which are markers of compromised growth that can lead to
irreversible adverse growth.10,16,24 Additionally, a recent
publication from the World Health Organization-coordinated Global Rotavirus and
Pediatric Diarrhea Surveillance Networks indicated that wasted and stunted
children are put at greater risk of death from diarrheal diseases, highlighting
the vicious cycle of malnutrition and diarrhea facing children in impacted
changes in rainfall patterns have increased the rate and duration of droughts,
a widely prevalent consequence of climate change. Droughts are characterized by
prolonged periods of dry weather and no or minimal precipitation. In periods of
drought, there is an imbalance between water evaporation and precipitation.
This imbalance introduces a range of adverse effects on human activities due to
a shortage in water supply and significantly reduced agricultural productivity.36,37
Through restricting households’ access to water resources for basic needs,
droughts act as a risk factor for dehydration, undernutrition, and infectious
diseases. Previous findings from the African region indicated that changes in
rainfall patterns are directly reflected in child mortality rates, whereby an
increased incidence of droughts is found to be correlated with a higher
mortality risk in children. Additionally, droughts put a serious strain on
individuals’ mental well-being.10,16,24
One of the most
critical effects of droughts on human health is their influence on human
nutritional status through compromising agricultural productivity. Agricultural
droughts significantly reduce soil quality by depleting its moisture content,
which is influenced by the availability of water for irrigation. Droughts also
make crops more susceptible to insect and fungal infestations, resulting in
crop failure and, thus, reduced yields for human and animal consumption.
Livestock farming is also heavily impacted by agricultural droughts. Water
scarcity influences farmers’ ability to feed their livestock, which in turn
impacts the animals’ weight and milk production.36,37 These
challenges may force farmers to slaughter or sell their animals, causing a
significant loss of financial security.
crops and livestock productivity directly impact the livelihoods of farmers and
their communities by introducing food shortages. A decrease in agricultural
supply impacts the availability and accessibility of safe and nutritious food
sources, which act as key determinants of food insecurity that can lead to
hunger. A recent United Nations (UN) report indicated an alarmingly increasing
trend in world hunger, with 828 million individuals experiencing hunger in
2021, showing an increase of 46 million people since 2020.38,39
Future projections indicate that 8% of the world’s population will be
experiencing hunger in 2030. The disparity in the distribution of climate
change effects is reflected in the variations of food insecurity and hunger
levels across regions. In 2021, 20% of the African population experienced
hunger, compared to 9% in Asia, with the lowest levels observed in Europe and
North America at less than 3%.38,39 This highlights that regions
around the world have been unequally burdened by weather changes that are
affecting agricultural productivity and hence food availability and
accessibility. Individuals experiencing hunger or food insecurity are more
likely to experience a range of physical and mental health complications, as
outlined in the next section of this insights piece.40,41
epidemic and the climate crisis
within the context of the obesity epidemic adds an additional layer of
complexity to the current health status of the world’s population. The
multifactorial etiology of obesity has made it difficult to directly attribute
obesity cases to climate change. However, recent obesity trends have emphasized
the need to identify the mechanisms by which weather effects impact human diets
and physical activity levels to guide public health action.
Due to climatic
effects on temperature and rainfall patterns, individuals relying on
subsistence farming experience fluctuations in their food production.10,37
With an increased incidence and longer periods of droughts, reliance on
rain-fed agriculture comes with unpredictable risks of food shortage, leaving
impacted communities with food insecurity threats. Food insecurity is defined
by the Food and Agriculture Organization of the United Nations as lacking
“regular access to enough safe and nutritious food for normal growth and
development and an active and healthy life”.38 Thus, the
unpredictable food supply experienced by communities heavily affected by
climate change increases the risk of food insecurity for everyone.
consistent intake of nutritious foods helps individuals maintain healthy eating
habits, which is a key determinant for overall physical and mental health. On
the other hand, food insecurity has been established as a risk factor for an
array of non-communicable diseases (NCDs), including obesity, cardiovascular
diseases, and diabetes. Non-communicable diseases are responsible for 74% of
global deaths each year.42 When individuals are unable to access
healthy food options, they consume a diet that is characterized by a
low-nutrient and high-energy content.43,44 While such a diet is low
in essential micronutrients, it can significantly increase individuals’ intake
of saturated fats, sugars, and salt. This puts consumers at risk of becoming
overweight and obese. In 2022, more than 1 billion people were obese, and this
number is predicted to continue to increase. 42 By leading to
obesity and high blood pressure, an unhealthy diet acts as the leading risk
factor for the top causes of mortality globally. According to the World Health
Organization, 19% of worldwide deaths are attributed to high blood pressure,
followed by increased blood glucose and obesity. 42
in childhood leads to adverse growth and developmental outcomes that result in
life-long morbidity and mortality.37,43-46 Food insecurity is a risk
factor for undernutrition. Today, 149 million children under five years of age
are stunted due to undernutrition, and 45 million suffer from wasting, which is
described by the World Health Organization as “the deadliest form of
malnutrition” that increases the child’s risk of death by 12 times.39,47
Moreover, current generations of children also experience high rates of excess
weight, with 39 million children being overweight.48 This well-known
double burden of malnutrition, which is characterized by the simultaneous
occurrence of undernutrition and overnutrition (obesity),49,50 has
drastic health implications for children by compromising children’s ability to
grow to reach their genetic potential and have optimal physical and
issue of unhealthy diets, sedentary lifestyles have been associated with an
increased risk of metabolic complications, including obesity, diabetes, and
cardiovascular diseases. Almost 1 million individuals die due to lack of
physical activity every year.42 With increased urbanization,
families are generally less active. In addition, climatic effects such as
heatwaves, wildfires, and heavy rains all influence people’s ability to engage
in outdoor activities. This is especially concerning for children, given the
restrictions imposed by weather changes on playing outside with their age
counterparts, resulting in overall sedentary behavior. Lack of physical
activity is a key risk factor for overweight and obesity in both children and
adults. Sedentary lifestyles also amplify mental health concerns.15,51,52
climate and mental health
change-related weather changes and natural disasters are associated with
various implications for mental health. Exposure to natural disasters can
affect individuals’ livelihoods, causing major challenges, including loss of
life and destruction of built environments (e.g., homes and hospitals). These
events often result in displacement and forced migration, imposing an array of
mental challenges such as stress, depression, and anxiety. Additionally,
research findings have indicated that individuals who have been exposed to
natural disasters can suffer from post-traumatic stress disorder (PTSD).10,53
Although knowledge of the long-term mental health implications of climate
change is lacking, some evidence suggests a link between long-term exposure to
natural disasters and suicide.53,54
quality has also been directly associated with compromised mental well-being.
As individuals are forced to stay indoors in order to avoid smoke from
wildfires, they are more likely to experience isolation and depression.18,19
Altered rainfall patterns and heatwaves also disrupt essential services and
daily routines, which in turn impact mental health outcomes.53,54
the financial and emotional loss due to natural disasters and the unequal
distribution of climate change burden may introduce and fuel social conflicts,
which can negatively impact the social cohesion of communities and reduce their
sense of security, further amplifying the development of mental health
complications among impacted individuals.53
additional indirect effects of weather changes on mental health due to an array
of climate-associated consequences, including, but not limited to, hunger,
unfavorable working conditions, food insecurity, lack of access to clean water,
migration, and increased spread of infectious diseases. These events cause
financial uncertainties, deterioration of physical health, and food and water
safety concerns that can result in anxiety, fear, and trauma. The implications of
climate change for mental health are especially critical considering the
already high global burden of morbidity due to mental illnesses. It is
estimated that one billion people suffer from mental health challenges, with
only one in every four affected individuals in low- and middle-income settings
having access to adequate support.55
social, and financial implications of climate change are unequally distributed,
with certain groups being disproportionally affected.56-64 This is
due to certain areas being geographically disadvantaged. For example, regions
closer to the equator are more vulnerable to intense weather changes, while
coastal areas are impacted by the rise in sea levels and its repercussions.
Sandstorms and wildfires impact some regions more than others due to variations
in proximity to deserts and forests. Besides geographical location, social and
economic development are also key factors in defining climate change risks and
consequences in certain regions.
disparities heavily intersect with already existing health inequalities that
are characterized by an unequal distribution of health and disease due to
social and economic gaps.59-61 Communities in poor-resource settings
are faced with numerous challenges in accessing basic resources, including
healthcare services. Individuals with existing health conditions due to lower
socioeconomic status are more likely to bear a disproportionally high disease
burden due to being in climate-impacted areas. Marginalized communities are
more vulnerable to environmental risks and natural disasters as their climate adaptation
capacities, and resilience are largely compromised due to restricted resources.
Accordingly, these communities are more likely to experience climate-related
social and health consequences such as heat-related illnesses, food insecurity,
and food- and water-borne diseases.10,56-59 They are also more
susceptible to moving into poverty and experiencing hunger due to forced
migration, displacement, water scarcity, and loss of livelihoods. These events
directly increase and compound morbidity and mortality risks among impacted
also discriminates against population sub-groups that are naturally more
vulnerable to adverse health outcomes, including children, pregnant women, and
the elderly. While there has been a steady increase in publications measuring
climate change impacts on vulnerable groups such as children, most
country-specific research (41% of all publications between 2000 and 2019) was
conducted in high-income countries. Hence, even though low- and middle-income
countries suffer great challenges from climate change, only 12% of published
studies were specifically focused on examining climate change effects in
low-income countries. Reported findings also indicate that the majority of
studies disregarded any variation due to sex, with only 30% of all publications
considering sex-specific implications. This is especially concerning as “the
climate crisis is not gender neutral.”59
disproportionally impacted by weather changes as they are more dependent on natural
resources for survival. In many cultures, women are expected to secure food and
water for household consumption. Accordingly, they are often heavily involved
in agricultural work, making the agriculture sector the main employment sector
for women. With climatic changes negatively impacting agricultural
productivity, most women are threatened with losing their primary source of
income. This acts as a major stressor for women who need to find alternative
ways to secure income, food, and other basic needs. The growing pressure and
uncertain working conditions impact women’s risk of physical and mental issues
due to poor nutrition, heavy labor, and stress. 59 Climate-induced
health risks are greater for pregnant women. Research findings indicate that
varying climate change effects increase the risk of adverse pregnancy and birth
outcomes among impacted women.59,65
The role of the
years, numerous voices from around the world have called for making COP a
health COP, recognizing the importance of growing the influence of health
sectors in climate conversations. International health organizations consider
climate change to be the biggest health threat humans have ever faced. The
inclusion of health professionals in the development of climate adaptation
strategies ensures that health priorities are well-defined within the context
of the climate crisis and that climate action serves the most vulnerable
populations.66,67 Accordingly, various opportunities can be realized
through the inclusion of healthcare leaders and professionals in climate
1. to identify the mechanisms by which climate change impacts human health
2. to make climate change part of health discussion with impacted populations
3. to gain and provide insights from other fields to better anticipate collaboration venues
4. to promote climate action and educate the general public
5. to help formulate health-centered policies
6. to better prepare the healthcare systems and their response capacities
7. to reconsider the sector’s emission contributions and harness improvement opportunities
8. to better identify research priorities
9. to improve the system’s preparedness to
deal with emerging climate-related disorders
crisis is a health crisis. Climate change threatens physical, mental health and
psychosocial well-being. So far, the consequences of climate change have taken
a disproportionally high toll on human health. However, individuals, including
political leaders and policymakers, often fail to recognize the vital link
between climate change and health and its immense impacts on individuals’
survival and well-being. While all ages bear an unacceptably high morbidity and
mortality burden due to climate change, children experience far worse outcomes.
In their response to the climate crisis, governments around the world should
integrate climate considerations with public health programs for physical and
mental health outcomes while also keeping human health at the core of climate
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