Impacts of Climate Change on Inequities in Child Health

Disparities in the impact of heat wave definitions on emergency department visits during the first year of life among preterm and full-term infants in California

INTRODUCTION

Heat waves will be aggravated due to climate change, making this a critical public health threat. However, heat wave definitions to activate alert systems can be ambiguous, highlighting the need to assess a range of definitions to identify those that contribute to the most adverse health outcomes. Additionally, children are highly susceptible to the impacts of heat waves, especially infants, despite the lack of focus on this subpopulation. We aimed to assess the relationship between 30 heat wave definitions and the first all-cause emergency department (ED) visits for California infants. We also examined modification of this relationship by preterm birth status and demographic characteristics to identify possible health disparities.

METHODS

Live-born, singleton deliveries from the Study of Outcomes in Mothers and Infants born in 2014-2018 were included. Thirty heat wave definitions were assessed based on temperature metrics (minimum/maximum temperatures), thresholds (90th; 92.5th; 95th; 97.5th; 99th percentiles), and duration (1-; 2-; 3-days). A time-stratified case-crossover design assessed heat wave impacts on ED visits using infants with a warm season ED visit (May-October) within the first year of life (n = 228,250). Effect modification by preterm birth status, age, sex, race/ethnicity, education, and delivery payment type was also investigated.

RESULTS

Infants demonstrated increased risk of an ED visit with exposure to all heat definitions. The 3-day minimum temperature 99th percentile definition had the highest adjusted odds ratio (AOR: 1.14; 95% CI: 1.05-1.23) for the total population. Term infants were more affected by some heat waves than preterm infants. Effect modification was additionally identified, such as by maternal education.

DISCUSSION

This study provides insight on the heat wave definitions that lead to adverse health outcomes and the identification of the most susceptible infants to these impacts, which has implications on heat-related interventions.

Planetary health: an imperative for pediatric radiology

The global temperature has been increasing resulting in climate change. This negatively impacts planetary health that disproportionately affects the most vulnerable among us, especially children. Extreme weather events, such as hurricanes, tornadoes, wildfires, flooding, and heatwaves, are becoming more frequent and severe, posing a significant threat to our patients' health, safety, and security. Concurrently, shifts in environmental exposures, including air pollution, allergens, pathogenic vectors, and microplastics, further exacerbate the risks faced by children. In this paper, we provide an overview of pediatric illnesses that are becoming more prevalent and severe because of extreme weather events, global temperature increases, and shifts in environmental exposures. As members of pediatric health care teams, it is crucial for pediatric radiologists to be knowledgeable about the impacts of climate change on our patients, and continue to advocate for safe, healthier environments for our patients.

The impact of anthropogenic climate change on pediatric viral diseases

The adverse effects of climate change on human health are unfolding in real time. Environmental fragmentation is amplifying spillover of viruses from wildlife to humans. Increasing temperatures are expanding mosquito and tick habitats, introducing vector-borne viruses into immunologically susceptible populations. More frequent flooding is spreading water-borne viral pathogens, while prolonged droughts reduce regional capacity to prevent and respond to disease outbreaks with adequate water, sanitation, and hygiene resources. Worsening air quality and altered transmission seasons due to an increasingly volatile climate may exacerbate the impacts of respiratory viruses. Furthermore, both extreme weather events and long-term climate variation are causing the destruction of health systems and large-scale migrations, reshaping health care delivery in the face of an evolving global burden of viral disease. Because of their immunological immaturity, differences in physiology (e.g., size), dependence on caregivers, and behavioral traits, children are particularly vulnerable to climate change. This investigation into the unique pediatric viral threats posed by an increasingly inhospitable world elucidates potential avenues of targeted programming and uncovers future research questions to effect equitable, actionable change. IMPACT: A review of the effects of climate change on viral threats to pediatric health, including zoonotic, vector-borne, water-borne, and respiratory viruses, as well as distal threats related to climate-induced migration and health systems. A unique focus on viruses offers a more in-depth look at the effect of climate change on vector competence, viral particle survival, co-morbidities, and host behavior. An examination of children as a particularly vulnerable population provokes programming tailored to their unique set of vulnerabilities and encourages reflection on equitable climate adaptation frameworks.

Child-focused climate change and health content in medical schools and pediatric residencies

Anthropogenic climate change-driven primarily by the combustion of fossil fuels that form greenhouse gases-has numerous consequences that impact health, including extreme weather events of accelerating frequency and intensity (e.g., wildfires, thunderstorms, droughts, and heat waves), mental health sequelae of displacement from these events, and the increase in aeroallergens and other pollutants. Children are especially vulnerable to climate-related exposures given that they are still developing, encounter higher exposures compared to adults, and are at risk of losing many healthy future years of life. In order to better meet the needs of generations of children born into a world affected by climate change, medical trainees must develop their knowledge of the relationships between climate change and children's health-with a focus on applying that information in clinical practice. This review provides an overview of salient climate change and children's health topics that medical school and pediatric residency training curricula should cover. In addition, it highlights the strengths and limitations of existing medical school and residency climate change and pediatric health curricula. IMPACT: Provides insight into the current climate change and pediatric health curricular opportunities for medical trainees in North America at both the medical school and residency levels. Condenses climate change and pediatric health material relevant to trainees to help readers optimize curricula at their institutions.

Climate change vulnerability, and health of women and children: Evidence from India using district level data

OBJECTIVE

To understand how climate change vulnerability is associated with women and children's health (WCH) at the district level in India.

METHODS

The district-specific climate change vulnerability index was mapped to the district level NFHS-5 data (N = 674). Fractional regression and spatial analyses were performed to examine the strength of association and the presence of geographic clustering.

RESULTS

Bivariate analysis revealed that the levels of WCH indicators were lower in districts with a high vulnerability index than in those with a low vulnerability index. Multivariable analyses suggested that with a 1% increase in the vulnerability index, the proportion of modern contraceptive use was reduced by 0.22, four or more prenatal care visits by 0.14, postnatal care by 0.11, and full immunization by 0.12; whereas wasting and underweight proportions increased by 0.07 and 0.10, respectively. The spatial analysis found that in about 70-118 districts, mostly in eastern India, where climate vulnerability was high the WCH outcomes were also poor.

CONCLUSION

There is a macro-level association between climate change vulnerability and WCH, as districts that had high levels of climate change vulnerability also performed poorly in WCH. There is a need for an integrated approach that considers geography-specific climate change threats to develop health programs.

Climate Risks and Truncated Opportunities: How Do Environmental Challenges Intersect with Economic and Social Disadvantages for Rohingya Adolescents in Bangladesh?

Integration of environmental, economic, and social approaches to development is crucial to achieve the United Nations Sustainable Development Goals. Global evidence reflects that this integration is often imbalanced, with development policies and programs in many low- and middle-income countries placing greater emphasis on economic needs than environmental vulnerabilities. Drawing on qualitative research undertaken in mid-2021, this article explores how limited integration of environmental, economic, and social aspects has affected the development of Rohingya refugee adolescents who were forcibly displaced from Myanmar to the Cox’s Bazar district of Bangladesh. Cox’s Bazar is one of the most climate-vulnerable areas in Bangladesh and is subject to extreme rainfall, landslides, and flash floods. The article highlights the ways in which Rohingya adolescents are highly vulnerable to both the direct and indirect consequences of these environmental conditions due to poverty, and inadequate housing infrastructure and water, sanitation, and hygiene facilities. It discusses the ways in which these environmental challenges intersect with socioeconomic disadvantage, especially limited education, skills development, and livelihood opportunities for young people, which are in turn compounded by limited voice and agency, and a dearth of security and protection measures. For some Rohingya adolescent girls and boys, the findings suggests that these multi-dimensional vulnerabilities place them at risk of exploitation by traffickers, smugglers, extremist groups, and criminals. The article concludes by highlighting the importance of explicitly integrating environmental aspects into policy and programs that support Rohingya adolescents to develop their full capabilities, and encouraging their meaningful participation in policy dialogues and accountability processes.

Demographic perspectives in research on global environmental change

The human population is at the centre of research on global environmental change. On the one hand, population dynamics influence the environment and the global climate system through consumption-based carbon emissions. On the other hand, the health and well-being of the population are already being affected by climate change. A knowledge of population dynamics and population heterogeneity is thus fundamental to improving our understanding of how population size, composition, and distribution influence global environmental change and how these changes affect population subgroups differentially by demographic characteristics and spatial distribution. The increasing relevance of demographic research on the topic, coupled with availability of theoretical concepts and advancement in data and computing facilities, has contributed to growing engagement of demographers in this field. In the past 25 years, demographic research has enriched climate change research-with the key contribution being in moving beyond the narrow view that population matters only in terms of population size-by putting a greater emphasis on population composition and distribution, through presenting both empirical evidence and advanced population forecasting to account for demographic and spatial heterogeneity. What remains missing in the literature is research that investigates how global environmental change affects current and future demographic processes and, consequently, population trends. If global environmental change does influence fertility, mortality, and migration, then population estimates and forecasts need to adjust for climate feedback in population projections. Indisputably, this is the area of new research that directly requires expertise in population science and contribution from demographers.

Climate Change and Child Health Inequality: A Review of Reviews

There is growing evidence on the observed and expected consequences of climate change on population health worldwide. There is limited understanding of its consequences for child health inequalities, between and within countries. To examine these consequences and categorize the state of knowledge in this area, we conducted a review of reviews indexed in five databases (Medline, Embase, Web of Science, PsycInfo, Sociological Abstracts). Reviews that reported the effect of climate change on child health inequalities between low- and high-income children, within or between countries (high- vs low-middle-income countries; HICs and LMICs), were included. Twenty-three reviews, published between 2007 and January 2021, were included for full-text analyses. Using thematic synthesis, we identified strong descriptive, but limited quantitative, evidence that climate change exacerbates child health inequalities. Explanatory mechanisms relating climate change to child health inequalities were proposed in some reviews; for example, children in LMICs are more susceptible to the consequences of climate change than children in HICs due to limited structural and economic resources. Geographic and intergenerational inequalities emerged as additional themes from the review. Further research with an equity focus should address the effects of climate change on adolescents/youth, mental health and inequalities within countries.

The Impact of Rainfall Variability on Diets and Undernutrition of Young Children in Rural Burkina Faso

Background: Climate change and consequent increases in rainfall variability may have negative consequences for the food production of subsistence farmers in West Africa with adverse impacts on nutrition and health. We explored the pathway from rainfall through diet up to child undernutrition for rural Burkina Faso. Methods: The study used data of a dynamic cohort with 1,439 children aged 7-60 months from the Nouna Health and Demographic Surveillance Site (HDSS) for 2017 to 2019. We assessed data on diets, height, weight, household characteristics, and daily precipitation (from 1981 to 2019). Principal component analysis was used to identify distinct child dietary patterns (Dietary Pattern Scores, DPS). These were related to 15 rainfall indicators by area to obtain a precipitation variability score (PVS) through reduced rank regression (RRR). Associations between the PVS and anthropometric measures, height-for-age (HAZ), and weight-for-height (WHZ), were examined using multi-level regression analysis. Results: Stunting (HAZ < -2) and wasting (WHZ < -2) were seen in 24 and 6% of the children. Three main dietary patterns were identified (market-based, vegetable-based, and legume-based diets) and showed mixed evidence for associations with child undernutrition. The RRR-derived PVS explained 14% of the total variance in these DPS. The PVS was characterized by more consecutive dry days during the rainy season, higher cumulative rainfall in July and more extremely wet days. A 1-point increase in the PVS was associated with a reduction of 0.029 (95% CI: -0.06, 0.00, p < 0.05) in HAZ in the unadjusted, and an increase by 0.032 (95% CI: 0.01, 0.06, p < 0.05) in WHZ in the fully adjusted model. Conclusion: Rainfall variability was associated with dietary patterns in young children of a rural population of Burkina Faso. Increased rainfall variability was associated with an increase in chronic undernutrition, but not in acute undernutrition among young children.

Preparing children for climate-related disasters

Climate-related disasters affect different dimensions of children's health and well-being both directly and indirectly. Reducing children's vulnerability and exposure to climate-related disasters is crucial to protect them against risks. Children as climate-change agents and future leaders at local, national and international level can obviously contribute to reduce vulnerabilities in families and communities and transfer knowledge to them. Moreover, children can advocate for climate change mitigation. In the long term, participation of children in the climate change mitigation programmes may lead to fewer disasters and, consequently, less risk to their health. As government policies have failed to fully address and respond to the drivers of climate-related disasters, disasters preparedness and education for children should be considered an essential activity to protect children from disaster's risks. Main factors in shaping children's behaviour and response to disaster are increasing the risk perception and knowledge of the children. When a child perceived likelihood, susceptibility and severity of a disaster (such as earthquake), then they would be able and willing to learn how to prepare for that. So far, disaster education programmes for children have mostly relied on offline school-based training. Different innovative approaches can be applied to continue education within online and digital formats including virtual reality, digital games and online platforms. However, an advocacy support by influential entities such as companies engaged in entertainment industry is required to raise the awareness of public and particularly the children about disaster preparedness.

The International Society for Children's Health and the Environment Commits to Reduce Its Carbon Footprint to Safeguard Children's Health

The Lancet Countdown and the 2018 Intergovernmental Panel on Climate Change declared that the worst impacts of climate change are and will continue to be felt disproportionately by children. Children are uniquely vulnerable to the consequences of climate change, including heat stress, food scarcity, increases in pollution and vector-borne diseases, lost family income, displacement, and the trauma of living through a climate-related disaster. These stressors can result in long-lasting physical and mental health sequelae. Based upon these concerns associated with climate change, the International Society for Children's Health and the Environment developed a statement about ways in which the Society could take action to reduce its contribution of greenhouse gas emissions. The objective of this article is to report our Society's plans in hopes that we may stimulate other scientific societies to take action. https://doi.org/10.1289/EHP6578.

MI-Environment: Geospatial patterns and inequality of relative heat stress vulnerability in Michigan

Heat stress causes morbidity and mortality and is increasing with climate change. Heat stress can pose particular challenges in northern regions not well adapted to heat. To assist decision makers, we identified the relative vulnerability of census tracts within Michigan to factors that increase exposure to heat stress or reflect susceptibilities in the population based on a California heat vulnerability index. In the MI-Environment assessment, we used a Geographic Information System (GIS) to combine future ensemble climate model projections to create a total of 9 geospatial and demographic variables. As part of a broader planned cumulative environmental exposure assessment, the statewide heat vulnerability index (HVI) maps display the location and relative magnitude of exposure on three metrics: built environment (Place), future expected long-term temperature averages (Temperature), and population susceptibility (People). We observed varied and distinct patterns for each of the three component indices. We assessed how equitably those exposures are distributed by racial and socioeconomic factors. This analysis showed that each of the component indices and the aggregate HVI are disproportionately distributed along racial and socioeconomic lines in Michigan. Census tracts with higher percentages of people of color had larger exposure to HVI factors with a deviation from equity of -0.115 [95% CI -0.108, -0.122]. Similarly, for census tracts with higher percentage of people experiencing poverty, the deviation from equity was -0.101 [95% CI -0.094, -0.107]. The MI-Environment visualization tool can help communities prepare for climate change and resolve inequities by identifying census tracts with the most vulnerable residents and highest potential exposures.

The Extreme Climate Event Database (EXCEED): Development of a picture database composed of drought and flood stimuli

The present study introduces the Extreme Climate Event Database (EXCEED), a picture database intended to induce emotionally salient stimuli reactions in the context of natural hazards associated with global climate change and related extreme events. The creation of the database was motivated by the need to better understand the impact that the increase in natural disasters worldwide has on human emotional reactions. This new database consists of 150 pictures divided into three categories: two negative categories that depict images of floods and droughts, and a neutral category composed of inanimate objects. Affective ratings were obtained using online survey software from 50 healthy Brazilian volunteers who rated the pictures according to valence and arousal, which are two fundamental dimensions used to describe emotional experiences. Valence refers to the appraisal of pleasantness conveyed by a stimulus, and arousal involves internal emotional activation induced by a stimulus. Data from picture rating, sex difference in affective ratings and psychometric properties of the database are presented here. Together, the data validate the use of EXCEED in research related to natural hazards and human reactions.

Climate Change and Children's Health: A Commentary

This commentary describes the likely impacts on children's health and wellbeing from climate change, based on the solid science of environmental child health. It describes likely climate change scenarios, why children are more vulnerable than older people to these changes, and what to expect in terms of diseases (e.g., infections, asthma) and problems (e.g., malnutrition, mental illness). The common antecedents of climate change and other detrimental changes to our society mean that in combatting them (such as excessive consumption and greed), we may not only reduce the harmful effects of climate change but also work towards a better society overall—one that values its children and their futures.