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Child health: How climate change will affect it

Climate change concept. Copyright: nitsuki / 123RF Stock Photo
Climate change is having a considerable deleterious effect on child health worldwide – with India feeling the strain acutely.

“A child born today will experience a world that is more than four degrees warmer than the pre-industrial average, with climate change impacting human health from infancy and adolescence to adulthood and old age,” reads a report published yesterday by The Lancet Countdown on Health and Climate Change – lending a chilling insight into the effects of our changing climate on child health. 

The report “represents the findings and consensus of 35 leading academic institutions and UN agencies from every continent.” Its conclusions are clear, perhaps best expressed in one sentence: “children are among the worst-affected by climate change.” For India, there are numerous takeaways from the report. 

“For an emerging and growing economy like India, the detrimental effects of a changing climate on the health of our current and future generations of children can have serious consequences for our demographic dividend,” Dr Poornima Prabhakaran, an author of The Lancet Countdown report and Deputy Director, Centre for Environmental Health at the Public Health Foundation of India (PHFI), told Health Issues India

The plethora of effects to which children are vulnerable include compromised food security, rising rates of infectious diseases such as diarrhoea and dengue fever, and extreme weather events such as heatwaves and flooding. “Increasing climatic suitability for disease pathogens like the diarrhoea-causing Vibrio cholerae and the mosquito-borne diseases like dengue and malaria can affect children at all ages,” notes Dr Prabhakaran.

Indeed, the report notes that “nine of the ten most suitable years for the transmission of dengue fever on record [occurred] since 2000…similarly, since an early 1980s baseline, the number of days suitable for Vibrio (a pathogen responsible for part of the burden of diarrhoeal disease) has doubled, and global suitability for coastal Vibrio cholerae has increased by 9.9 percent.” India witnessed in excess of 67,000 dengue fever cases as of October 13th this year. Acute diarrhoeal disease, meanwhile, is the most common infectious disease outbreak in the country and, worldwide, is the second-leading cause of death among children below the age of five years. 

Schoolchildren eat in the Radhu Khandu village of Sikkim. Among the negative effects of climate change on child health is its exacerbation of malnutrition due to its impact on food security.

That climate change is aggravating these conditions presents an obstacle towards the efforts of the Government of India to tackle them and encapsulates the problems climate change poses to child health. Malnutrition is another issue exacerbated by climate change. The report notes that “downward trends in global yield potential for all major crops tracked since 1960 threaten food production and food security, with infants often the worst affected by the potentially permanent effects of undernutrition.” India is no stranger to the woes of malnutrition, with malnourishment responsible for seven lakh child deaths in 2017. This accounts for 68 percent of total child mortality in India. 

“Undernutrition overwhelmingly affects children younger than age five years, causing intrauterine growth restriction, stunting, severe wasting, micronutrient deficiencies, and poor breastfeeding,” the report notes. With crop production affected to the tune of six percent, 3.2 percent, 7.4 percent and 1.3 percent respectively for maize, winter wheat, rice, and soybean for each 1 °C increase in global mean temperatures, the urgency of limiting global temperature increases in-line with the Paris Agreement on climate change – to which India is a signatory – has been highlighted. Undernutrition is a major public challenge and with climate change exacerbating the issue, the vitality of a robust response to the problem for the sake of child health and nutrition is patent. 

Indeed, the effects on food security can serve to exacerbate India’s dual burden of malnutrition – the coexistence in significant numbers of obesity and undernourishment within the country. “The impacts on crop duration and yield can exacerbate the undernutrition problem that is already so prevalent in major parts of the country even as the resultant food and nutrition insecurity can accelerate a shift to processed foods,” explains Dr Prabhakaran. “This feeds the other end of the malnutrition spectrum and the global syndemic of undernutrition, overnutrition and climate change.”

The report also goes into detail on the effects of severe weather events. On the subject of heatwaves, the report notes that such events are on the rise, with an uptick in 2018 at the global level. India drove this in part, with the report noting that “the increase in heatwave exposure events (220 million, which is eleven million more than the 2015 record) was due to a series of heatwaves across India (45 million additional exposures.” Indeed, the 2008-17 decade stood at India’s hottest on record. On April 26th this year, India was home to the fifteen hottest cities in the world. 

Such weather events are extremely damaging to health, with the report explaining “the pathophysiological consequences of heat exposure in humans…include heat stress and heat stroke, acute kidney injury, exacerbation of congestive heart failure, and increased risk of interpersonal and collective violence.” Of the effects on child health, the report notes that “during periods of extreme heat, young children have a greater risk of electrolyte imbalance, fever, respiratory disease, and kidney disease.” This is to say nothing of other vulnerable populations, such as the elderly and outdoor workers. Of the latter, as a case in point, workers in Kerala were allowed a three-hour siesta earlier this year to help them cope with the effects of extreme heat. Such are the health effects of extreme heat, more than 22,000 people have died as a result of heatwaves since 1992. 

Scenes from the Bandipur National Park wildfires of 2019. Wildfires are increasing in prevalence. Image credit: Naveen Nkadalaveni [CC BY-SA 4.0 (]
Heatwaves are not the only extreme event on the rise. Wildfires are increasing in prevalence, the report warns. Over the course of 2015 to 2018, “a mean increase of 464,032 person-days exposed to wildfire per year” was recorded according to the report, with India accounting for the most: “a maximum increase of nearly 21,807,000 days” was observed in the country. As the report notes, “the health effects of wildfire range from direct thermal injuries and death, to the exacerbation of acute and chronic respiratory symptoms due to exposure to wildfire smoke.” 

In February, it was reported that forest fires had tripled in India in the preceding four months, heavily concentrated in just five southern states which accounted for one-third of the total number of blazes. Between 2015 and 2017, forest fires increased by 125 percent with an annual cost of Rs 1,176 crore and a substantial loss of life. In 2015, almost 18,000 deaths were recorded as a result of wildfires.

For flooding, “the average number of extreme rainfall events in the 2000-18 period reveals that South America and southeast Asia are experiencing the largest increases.” This year, India witnessed a monsoon season where rains reached a 25-year high and led to substantial loss of life. This is to say nothing of the spurt in vector-borne diseases and water-borne diseases due to flooding, as well as other infections caused the clustering of displaced persons in relief camps allowing for communicable pathogens to spread easily – yet another way in which climate change is affecting the spread of infectious diseases.

This comes even as “death from diarrhoeal diseases and protein-energy malnutrition has declined considerably over this period [1990-2017] in…Africa, southeast Asia, and Eastern Mediterranean.” Even with such diseases on the decline in the region, they are continued blights on public health in India and account for numerous deaths. India has set itself targets for the eradication of numerous diseases such as malaria (a disease also known to spike during periods of flooding due to an increase in breeding populations of mosquitoes). Indeed, a malaria-free world is attainable. By 2030, India wishes to be rid of the disease. However, climate change poses a clear threat towards the realisation of this target. 

On the reverse of flooding, drought is also a major consequence. By 2050, India is expected to face a major water scarcity crisis. Already one billion Indians live without access to water for at least one part of the year. Approximately 42 percent of the land in India is threatened by drought – an area home to approximately 500 million people. This state of affairs carries numerous implications, including the effect on agriculture and crop yield – a driver of malnutrition in the country. 

A thermal powerplant situated @ 20 kms away of raichur [own work, CC license]. Energy infrastructure example.
The Raichur Thermal Power Station, a coal-fired power plant in the Raichur district of Karnataka. Coal needs to be phased out the report emphasises. Image credit: Tanzeel Ahad [CC BY-SA 3.0 (]
What the report makes clear is that the world cannot sustain what it terms a ‘business as usual’ approach. This “trajectory will result in a fundamentally altered world…without accelerated intervention, this new era will come to define the health of people at every stage of their lives.” 

The indicators the report describes reflect “a world struggling to cope with warming that is occurring faster than governments are able, or willing to respond.” The renewable energy sector globally is growing, which is one cause for optimism. Yet fossil fuels continue to be a significant feature of energy infrastructure across the globe. In fact, “overall, CO2 emissions from fossil fuels have risen by 2.6 from 2016 to 2018. Concerningly, the previous downward trend in coal supply has reversed, with a 1.7 percent increase recorded in total primary energy supply from 2016 to 2018.”

The phasing out of coal is essential to effect a reduction in carbon intensity of the energy infrastructure to near-zero by 2050. And whilst there is some cause for optimism, “coal continues to be the second largest contributor to global primary energy supply (after oil) and the largest source of electricity generation (at 38 percent, compared with gas, the next highest at 23 percent. Most of the growth in TPES [total primary energy supply] of coal has been in Asia, notably China, India, and southeast Asia.” Indeed, in India, 36,158 coal-burning power plants are under construction Health Issues India reported earlier this year. This is even as the country invests in renewables – with green energy projected to account for fifty percent of India’s energy output by 2030. 

“Several encouraging trends continue,” the report does note, “such as reductions in investment in new coal capacity and a fall in coal as a share of total electricity generation.” The report also notes that “in 2018…investment in new coal-fired electricity generating capacity continued the downward trend observed since 2011. Notably, this decline was mostly due to reduced investment in the same countries that increased their coal TPES in 2018 (China and India), providing hope for coal phase-out.” 

Despite these trends, “eight of the ten hottest years on record have occurred in the past decade. Such rapid change is primarily driven by the combustion of fossil fuels, consumed at a rate of 171,000 kg of coal, 11,600,000 litres of gas, and 186,000 litres of oil per second. Progress in mitigating this threat is intermittent at best, with carbon dioxide emissions continuing to rise in 2018. Importantly, many of the indicators contained in this report suggest the world is following this “business as usual” pathway.”

The report reflects the clear need for enhanced action on climate change, with current progress not up to scratch and more action required for the sake of child health and wellbeing and the health of the planet as a whole. Business as usual is unsustainable, the report emphasises. Given the effects on the country’s environment, its health, and its economy, India has much to learn from the report and much action to begin to take. 

“The climate crisis is one of the greatest threats to the health of humanity today, but the world has yet to see a response from governments that matches the unprecedented scale of the challenge facing the next generation,” said Lancet editor-in-chief Dr Richard Horton. “With the full force of the Paris Agreement due to be implemented in 2020, we can’t afford this level of disengagement. The clinical, global health and research community needs to come together now and challenge our international leaders to protect the imminent threat to childhood and lifelong health.”

“There is a new sense of urgency given the impacts of climate change across the lifecourse of every child,” concludes Dr Prabhakaran – one “that warrants a collective integrated response from all stakeholders.”

“The 2019 report of the Lancet Countdown on health and climate change” can be accessed here.

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