Measuring and monitoring child health and well-being—an integral part of the climate change agenda

Introduction—direct and indirect effects of climate change on child health and well-being

Climate change has far-reaching consequences for all aspects of human society (Romanello et al. 2023). Children are uniquely vulnerable to climate change for a multitude of physiological and developmental reasons as well as because of distinctive behaviors such as outdoor play that increase their exposure to climate-related stressors (EPA 2023). Several reviews have summarized the multiple direct and indirect pathways through which climate change negatively affects child health and well-being (Arpin et al. 2021, Helldén et al. 2021, United Nations International Children's Emergency Fund 2021, Orun 2022, Perera and Nadeau 2022, Ahdoot et al. 2024, Etzel et al. 2024, Paz 2024, Proulx et al. 2024, United Nation's International Children's Emergency Fund 2024, Weeda et al. 2024) (Table 1; Supplementary Table S2, Supplementary Figure S1). The evidence suggests that climate change impacts on children accumulate over their life course with both short- and long-term detrimental effects, including those that occur in utero that are linked with women's exposures to excessive heat and experiences of stress due to climate change events during pregnancy (Yarlagadda 2023, Etzel et al. 2024, Proulx et al. 2024). The risks of climate change are not evenly distributed, as countries that emit the lowest greenhouse gas emissions are often the most affected, thereby increasing inequities (Intergovernmental Panel on Climate Change 2024). Climate change also exacerbates child health inequities within countries, increasing the likelihood that children in the most disadvantaged conditions will be left further behind and perpetuating intergenerational cycles of poverty (Arpin et al. 2021, Ahdoot et al. 2024). Children in low-income communities, e.g., are more likely to be homeless or live in houses that are poorly constructed, leaving them exposed to extreme heat, vector-borne diseases, flooding, and air pollution (Williams et al. 2021).

Table 1.

Impacts of climate change on child health and well-being by nurturing care framework domain.

Domain	Impacts
Good health (physical and mental)	Increased extreme heat exposure. Infants and young children are less able to regulate their body temperature and are more prone to dehydration, increasing their vulnerability during heatwaves. Extreme heat exposure can impact sleep patterns, kidney, liver, and respiratory function and increase the risk of heat stroke and death. Changes in range and seasonal length for vector-borne diseases. More children could be exposed to vector-borne diseases, such as malaria, dengue, Lyme disease, amongst others. Children are more susceptible to contracting and suffering severe consequences from these infections. Increased risk of flooding and other climate-related hazards. A higher proportion of deaths from drowning occur among children, and floods can increase children's exposure to waterborne pathogens and mold. Experiences of floods, landslides, and other climate-related hazards can have profound physical and mental health impacts, including post-traumatic stress on children. Increased exposure to aeroallergens and reductions in air quality. Infants and children are at higher risk of respiratory infections, asthma, and allergy induced illnesses. Exposure to poor air quality has also been linked to reduced child linear growth. Playing outdoors in poor air quality can also lead to negative short- and long-term health effects. Disruption of transport systems affecting access to care and logistics and supply chains. Extreme weather events can cause transportation delays or destroy infrastructure, negatively affecting care-seeking, access to essential and emergency child health services, and availability of essential medicines and equipment. Increased burden on health systems. Overwhelmed health systems in the wake of climate change-related events may result in poor service quality and cause delays in children receiving needed care. Increasing health inequities Children in poor-resource settings are more vulnerable to experiencing negative health effects related to climate change, exacerbating health inequalities.
Adequate nutrition	Food insecurity. Crop failures, loss of livestock, and rising food prices due to drought and severe weather events increase the risk of food insecurity, economic shocks, reduced dietary diversity, and child malnutrition including stunting and wasting. Food-borne pathogens. Higher temperatures increase the risk of food-borne pathogens, such as salmonella, Escherichia coli, and Vibrio pathogens, increasing risks of childhood diarrhea and vomiting.
Responsive caregiving	Heat-related disruption to caregiving practices. Heat-related caregiver or child fatigue or discomfort may disrupt caregiver feeding practices and child eating behaviors. Caregiver perceptions related to the need for water may disrupt breast or formula feeding for infants. Environmental stressors related to climate change may affect breastfeeding duration and women's access to support services, including lactation consultants. Reduced caregiving and family functioning. Poor caregiver mental health due to experience of climate change-related disasters and loss of resources can result in reduced responsive caregiving and family functioning, with negative effects on child health and development. Children are dependent upon caregivers to protect them from environmental conditions. Disruptions in caregiver responsiveness can increase children's exposure risks as well as their risk of post-traumatic stress after experiencing disasters. Loss of resources due to climate change impacts may force caregivers to change livelihoods, including emigration or taking jobs that require leaving children alone or with other caregivers for extensive periods of time.
Security and safety	Destruction of the natural environment. Climate change impacts can devastate the natural environment, reducing outdoor spaces where children can safely play, access to safe water and sanitation, and access to secure housing. Limited outdoor playtime can lead to insufficient physical activity, which may contribute to health issues, such as contributing to becoming overweight and obesity. Catastrophic economic impacts on households. Loss of livelihoods due to climate change can increase children's risk of poverty, lack of access to food, social, education, and health care services. Children in families forced to emigrate may experience multiple hardships during migration journeys and upon reaching new destinations (e.g. human trafficking; exploitation; statelessness). Domestic violence. Severe weather events impact family functioning and livelihoods, which could increase children's exposure to domestic violence.
Opportunities for learning	Decreases in school attendance and performance, increases in school closures. Rising temperatures and weather events can directly or indirectly result in reduced access and/or disruptions to education services including pre-primary and primary school. Extreme heat exposure can impair learning and cognition. Heat-related disruptions to daily routines of sleeping, eating, and playing outdoors with peers may deny children opportunities for learning and exploration. Displacement. Climate related displacement and mass migration can result in children missing out on education for extensive periods of time.

Climate change effects, such as rising temperatures, reductions in air quality, rising sea levels and salination, and extreme weather in the form of floods, droughts, wildfires, and windstorms can all impact child health directly as well as indirectly (i.e. through changes in seasonal patterns that may lengthen and expand exposure to allergens and vector-borne pathogens and through destruction or disruption of health systems, education systems, social protection services, transportation networks, water and sanitation systems, and other infrastructure) (Yarlagadda 2023, Lusambili et al. 2024, Paz 2024, UNICEF 2024, Weeda et al. 2024). Table 1 synthesizes key climate change impacts on child health and wellbeing by the five dimensions of the nurturing care framework (https://nurturing-care.org/), including good health, adequate nutrition, responsive caregiving, security and safety, and opportunities for learning. Some impacts described vary depending upon the age and development of the child, with infants at greater risk from extreme heat and disruptions to breastfeeding and older children more exposed to hazards from playing outdoors.

Addressing gaps in the inclusion of children in climate change related frameworks, policies, and plans

In 2015, 196 Parties adopted the Paris Agreement, a legally binding international treaty that commits nations to combat climate change and protect the right to health (https://unfccc.int/process-and-meetings/the-paris-agreement). Yet, according to the Intergovernmental Panel on Climate Change, the world is not on track to keep global heating under 1.5°C by 2030 (World Health Organization UNICEF UNFPA, 2023, Romanello et al. 2024) and World Meteorological Organization data indicates that 2024 was the hottest year on record with the global mean near-surface temperature 1.55°C ± 0.13°C above the 1850–1900 average (World Meteorological Organization 2025). Evidence from the Lancet Countdown on Health and Climate Change indicates that oil and gas companies are further reducing their compliance with the Paris Agreement, increasing the likelihood of continued warming (Romanello et al. 2023). The United Nations Children's Emergency Fund estimates that this lack of progress has placed half of the world's children at extreme risk of exposure to climate hazards and reduced access to essential health, nutrition, and social services (Proulx et al. 2024).

In 1989, almost all countries adopted the Convention on the Rights of the Child, obligating them to protect and fulfill children's rights including their right to a clean, healthy, and sustainable environment (https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-rights-child). However, few climate change policies, frameworks, or response plans at global, regional, or country level mention child health or include comprehensive child-specific adaptation measures (Helldén et al. 2021, Intergovernmental Panel on Climate Change 2023, Cerna-Turnoff et al. 2024, Zangerl et al. 2024) and just a fraction (2.4%) of climate finance from sentinel multilateral climate funds support projects incorporating a child-responsive lens (United Nations International Children's Emergency Fund 2021). At the 77th World Health Assembly in 2024, a new resolution was passed calling for intersectoral and integrated approaches to mitigate climate change impacts on health (https://apps.who.int/gb/ebwha/pdf_files/WHA77/A77_R14-en.pdf). Although the resolution mentions a focus on equity and vulnerable populations, children are noticeably absent. It is not only a moral imperative and a justice issue to correct the omission of children in climate mitigation and adaptation strategies, but it is also essential for their survival and for developing resilient and healthy societies. Countries should also consider including strategies to address climate change-related effects such as services for children suffering from exposure to excessive heat and air pollution in costed child health, early childhood development, and nutrition plans.

A critical step to integrating child health and well-being into climate change response efforts is incorporating metrics on child health into global, regional, national, and local climate change situation assessments and monitoring frameworks. Twenty core standardized impact and outcome-level indicators that serve as markers of where progress is occurring and where there are gaps in improving child health and well-being have been recommended for monitoring and accountability purposes (Requejo et al. 2022). These indicators (Supplementary Table S2) can be used as a starting point to answer questions around changes in child mortality, children's nutritional and developmental status, care-seeking patterns and intervention coverage levels due to climate-related events across locations, populations, and over time. Regular collection, reporting, and analysis of data on these indicators can also inform the development of appropriately tailored climate change response strategies that benefit children. Multisectoral collaboration across health, education, nutrition, environment, housing, and social protection is essential to ensure these indicators are meaningful, actionable, and responsive to the complex realities children face.

This set of core metrics should be accompanied by a robust research agenda to further elucidate the direct and indirect pathways via which climate change impacts child health and well-being and to develop complementary input, output, and process type indicators (e.g. financial inputs, human resources, measures of the implementation of policies and programs) that would strengthen monitoring and accountability efforts on child health and well-being as climate change effects unfold. Evidence reviews on the impact of climate change on child health also list the need for more research on the attributable fraction of climate change to child deaths and disability, differential impacts of climate change on specific child population and age groups (e.g. children under the age of 2, children ages 5–9, children from different ethnic, religious, and income backgrounds), the impact of climate change on children's education, and on understanding the depth of children's experiences of eco-anxiety and mental health consequences from living through extreme weather events (Intergovernmental Panel on Climate Change 2023, Etzel et al. 2024, Lusambili et al. 2024, Proulx et al. 2024, Weeda et al. 2024). Children living in poverty are at particularly high risk for health and developmental consequences associated with climate-related exposures, which are likely to continue to evolve. Household-level factors including access to safe water and sanitation, food insecurity, and poverty also need to be taken into consideration for assessing climate change effects on children. Such research could address gaps in understanding the links between climate change and child health and development and help countries proactively develop climate mitigation and adaptation strategies that take into consideration children's special biological, developmental, and social needs, while addressing inequities.

Conclusion

Climate change poses an existential threat to humanity, with children poised to suffer disproportionately because of their unique vulnerabilities, and because they will be exposed to multiple consequences of climate change over their lifetime that can cause immediate as well as cumulative and compounding negative effects. Given that children are the future and that approximately 25% of the world's population was under 15 years of age in 2023 (United Nations 2024, Zangerl et al. 2024), it is appalling that children are severely underrepresented in global and country climate change frameworks. One straightforward step to correcting this oversight is to include recommended indicators on child health and well-being into these frameworks and to invest in country health information systems so countries can regularly collect, analyze, report, and act on them (Romanello et al. 2021). Greater investments in research that address gaps in the knowledge base on pathways via which climate change impacts child health and well-being should be prioritized to inform the development of effective response efforts targeted at children and a comprehensive monitoring framework. This research should include exploring data collection modalities that are feasible for country implementation and that provide timely information for monitoring, planning, and resource allocation purposes. Such activities would help all stakeholders deliver on their commitments to create a world where children can survive and thrive, a task that requires urgent attention. Recent shifts in the global architecture including eroding commitment to addressing climate change and precipitous declines in international assistance for child health make it even more imperative to generate evidence on climate change effects on children's lives so that all stakeholders understand what is at stake now and for future generations.

Supplementary data

Supplementary data is available at Health Policy and Planning online.

Author contributions

J.R., R.W., M.L., I.C.T., S.M.B., S.H., J.S. contributed to the conception and design of the article, J.R. drafted the article and led on analysis and interpretation, all authors contributed to critical revision of the article, all named authors approved the paper prior to submission.

Reflexivity statement

The authors represent a range of expertise in child health including clinicians and measurement experts with a balance between senior and mid-career professionals. The authorship list is inclusive of perspectives from diverse world regions and balanced in terms of gender.

Ethical approval

Ethical approval for this type of study is not required by our institutes.

Funding

There was no funding for this paper.

Data availability

No data was used for this commentary.