Global systematic review of how climate change degrades the wellbeing and health of Indigenous children

Abstract

Background

Climate change worsens global health, with Indigenous children among the most vulnerable. Despite increasing research on climate-related health impacts, Indigenous children’s unique vulnerabilities remain underrepresented. This is the first review to synthesise systematically the global evidence on how climate change impacts the health of Indigenous children.

Methods

We consolidated reported health outcomes directly caused by climate change in Indigenous children. We adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and followed a reflexive framework that considered researcher positionality, Indigenous definitions of health, and ongoing Indigenous engagement. We did a systematic search of five databases on 2 March 2025 and collaboratively screened eligible studies on climate-related health outcomes in Indigenous children and pregnant women, assessing them using the mixed-methods appraisal tool. A convergent integrated synthesis approach mapped exposure-outcome patterns and guided a theme-based narrative analysis. Meta-analysis was not feasible due to study heterogeneity.

Results

Fifty-three studies met inclusion criteria, comprising 16 qualitative, 23 quantitative non-randomised, 6 quantitative descriptive and 8 mixed-method designs. Five main health outcomes emerged: (i) psychosocial and cultural wellbeing, (ii) malnutrition, (iii) infectious diseases, (iv) perinatal health, and (v) morbidity and mortality. Reflecting the interconnected and relational nature of Indigenous health conceptualisations, most studies addressed multiple climate exposures and outcomes. Psychosocial and cultural wellbeing was the most cross-cutting theme, interconnected with all other health domains. Heat exposure and seasonal and hydroclimatic variability were the most frequently linked climate exposures.

Conclusions

Indigenous children across diverse contexts are experiencing adverse climate-related health outcomes. Our review consolidates the evidence base to inform culturally grounded, strengths-based responses that engage Indigenous Knowledge systems and younger generations. Advancing this field requires more geographically diverse, disaggregated, and methodologically rigorous research.

Supplementary information

The online version contains supplementary material available at https://doi.org/10.1186/s12992-026-01235-7.

Background

The World Health Organization has identified climate change as the greatest health threat of the 21st Century, emphasising that immediate and coordinated global action is imperative to protect population health [1]. According to the latest assessment report by the Intergovernmental Panel on Climate Change, ‘climate change’ refers to variation in climatic properties that typically persist for decades or longer [2]. The United Nations Framework Convention on Climate Change attributes these changes in global atmospheric composition to both natural climate variability and direct and indirect human activities [3].

The 2023 Lancet Countdown report outlined that insufficient global progress towards limiting global temperature rise is evident in the ongoing escalation of adverse climate change-related health impacts [4]. That report also highlighted that these health impacts are unequally distributed across demographic groups [4]. Among these, Indigenous children experience heightened and overlapping vulnerabilities to climate change-related health outcomes [5]. As both children and Indigenous Peoples, this demographic intersection amplifies pre-existing structural and social factors, rendering Indigenous children uniquely susceptible to both climate-change exposures and reduced access to effective responses [5].

The higher climate-health vulnerability of Indigenous Peoples arises because of the complex interplay and cumulative impact of factors such as historical marginalisation, displacement from land, the removal of children from families, the fragmentation of culture and language, intergenerational trauma associated with colonisation, differential exposure to environmental hazards, socio-economic inequities, higher prevalence of chronic diseases, and more limited access to health services [6, 7].

The high climate-health vulnerability of children stems from formative development periods in utero and early childhood, and relatively higher exposure to pollutants per unit body mass [8]. Additionally, developmental, behavioural and social factors, including maladaptive health behaviours, limited autonomy in decision-making, and prolonged lifetime exposure to climate risk factors can further exacerbate their risk [8].

Recognising Indigenous children’s heightened vulnerability to climate-related health impacts, the United Nations Permanent Forum on Indigenous Issues in its seventh session called for greater global awareness of these challenges for Indigenous children and youth [9]. International human rights commitments reinforce this focus. Article 24 from the United Nations Convention on the Rights of the Child affirms every child’s right to the highest attainable standard of health [10], and the United Nations Declaration on the Rights of Indigenous Peoples upholds Indigenous Peoples’ rights to good health, cultural preservation, and environmental protection [11]. Despite these intersecting rights frameworks, research on Indigenous children’s unique climate-related health vulnerabilities remains scarce [12].

To inform future research and policy, a systematic review was required to amalgamate current evidence of climate change-induced health outcomes for Indigenous children globally. We therefore examined the existing literature to answer the research question: What are the impacts of climate change on the health outcomes of Indigenous children globally? Our specific objectives are to (i) identify, appraise critically, and synthesise peer-reviewed scientific studies examining the relationship between climate-change exposures and health outcomes in Indigenous children globally; (ii) identify and analyse the range of climate-change exposures and associated health outcomes reported in the included studies; (iii) identify major gaps in current research and provide recommendations for future research; and (iv) establish an evidence base to inform strategic and practical responses.

Methods

Research framing and reflexivity

A reflexive research framework guided our review where we applied United Nations Declaration on the Rights of Indigenous Peoples criteria to identify Indigenous Peoples [13] and used Indigenous-informed health definitions [14, 15], recognising the global diversity of Indigenous communities.

Five of the six co-authors (J.J.T., N.R.H., P.N.L.S, C.J.A.B., M.A.J.) are non-Indigenous. As Western-trained researchers examining the health of Indigenous children globally, we acknowledge our positionality as outsiders to the lived experiences and cultural Knowledge of Indigenous communities. We recognise the limitations and potential biases accompanying Eurocentric/Western perspectives and dominant research paradigms. Guided by a decolonising praxis, we are committed to doing culturally responsive, ethically grounded research honouring Indigenous ways of knowing.

Our research is guided by meaningful engagement with and co-authorship by Aboriginal academic Mara West, a Yamatji Elder and Operations Manager of the Kulunga Aboriginal Unit at The Kids Research Institute Australia in Perth, Western Australia. Engagement with and inclusion of Dr West helped ensure that we not only acknowledged Indigenous perspectives, but also embedded them meaningfully throughout the research process. Her ongoing input informs the methodology framing and ethical considerations of our review, particularly in how we defined key concepts: Indigenous peoples, children, health and climate change (Table 1).

Table 1.

Conceptual definitions of main concepts used in this review

Concept	Definition
Indigenous Peoples	There is no single, universally accepted definition of Indigenous Peoples, due to the vast cultural diversity that exists both among and within these populations and communities globally. We followed a set of descriptive characteristics for Indigenous Peoples outlined by the United Nations Declaration on the Rights of Indigenous Peoples (2007): “Self-identification as Indigenous Peoples at the individual level and accepted by the community as their member; historical continuity with pre-colonial and/or pre-settler societies; strong link to territories and surrounding natural resources; distinct social, economic or political systems; distinct language, culture and beliefs; form non-dominant groups of society; [and a] resolve to maintain and reproduce their ancestral environments and systems as distinctive Peoples and communities [11]”. We used the term ‘Indigenous’ as a general reference for all included Indigenous populations globally. However, we acknowledge and respect that different groups might prefer specific terminology. Thus, we prioritised community-preferred and self-determined terminology.
children	The United Nations Convention on the Rights of the Child defines children as individuals under the age of 18 years [10]. We acknowledge the diversity of Indigenous conceptualisations of family and community, in which children and youth are understood as inseparable from the family and community collective rather than as a distinct subgroup. Accordingly, Indigenous children’s health and wellbeing are understood as being shaped by the cultural knowledge, practices, and relationships held and transmitted within families and communities.
health	Health is defined by the World Health Organization (1946) as “… a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity” [16]. Indigenous Peoples’ conceptions of health and wellbeing are deeply multidimensional, extending beyond physical health to include spiritual, emotional, social, and environmental dimensions [14]. Unlike Western frameworks that focus on biophysical indicators, Indigenous perspectives emphasise the interconnectedness of land, culture, community, family and spirituality. We incorporated these perspectives into our definition of health to ensure that the health measures analysed are more reflective of Indigenous worldviews and lived experiences.
climate change	According to the latest assessment report by the Intergovernmental Panel on Climate Change, climate change is defined as variation in climate properties that typically persist for decades or longer [2]. The United Nations Framework Convention on Climate Change attributes these changes in global atmospheric composition to direct and indirect human activities and natural climate variability [3].

Search strategy

On 2 March 2025, we did a systematic literature search using five databases: MEDLINE (ovidsp.ovid.com), Embase (embase.com), PubMed (pubmed.ncbi.nlm.nih.gov), Scopus (scopus.com), and CINAHL (ebscohost.com/nursing/products/cinahl-databases). We selected these five databases to ensure comprehensive coverage across biomedical, public health, environmental, social science, and Indigenous studies literature, consistent with comparable systematic reviews on Indigenous health and climate-related topics [7]. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines (Supplementary information Appendix A) (prisma-statement.org). We developed the search strategy using the population, exposure, comparator, outcome (PECO) framework (Table 2) [17]. We provide detailed search strings, term sources, and database-specific strategies in Supplementary information Appendix B.

Table 2.

Population, exposure, comparator, outcome (PECO) framework to structure search strategy around four main concepts: Indigenous populations, children, climate change, and health

population	Indigenous children or pregnant Indigenous women from any global region (concept 1,2)
exposure	climate change (concept 3)
comparator	not applicable—no specific comparison group required
outcome	health (concept 4)

Selection process

We established eligibility criteria using the PECO (population, exposure, comparator, outcome) framework (Table 2), and summarised the inclusion and exclusion criteria, along with their corresponding rationales and explanatory notes in Table 3.

Table 3.

Eligibility criteria for the search strategy used in the literature review

Criteria topic	Inclusion	Exclusion	Rationale and explanation
demographic	Indigenous children (<18 years, in line with UNCRC) [10] or pregnant Indigenous women from any global region	Indigenous individuals (≥18 years old), non-pregnant Indigenous women, or studies without a clear Indigenous child focus	Indigenous pregnant women included to reflect relational Indigenous health worldviews and perinatal relevance to child health.
climate-change exposure	studies explicitly addressing climate-change impacts on health, including those referencing environmental variables directly linked to climate change	studies unrelated to climate change	Studies eligible if they directly addressed climate change or examine environmental variables that can be linked to climate change, such as increase in global temperatures, growing occurrence and severity of extreme weather events, shifts in rainfall patterns and water availability, rising sea levels and their subsequent environmental impacts, and wider ecosystem disruptions like biodiversity loss and desertification.
health outcome	definite health outcome, including both biomedical indicators and Indigenous concepts of health	studies without a specific health outcome	Review adopts eligibility criteria for health outcomes, encompassing not only disease and pathology linked to a human body system, but also Indigenous perspectives on health. ‘Psychosocial and cultural wellbeing’ reflects the relational nature of Indigenous wellbeing globally.
study type	peer-reviewed primary research (quantitative, qualitative or mixed-method study designs), that included target demographic, either through disaggregated or aggregated results	reviews (systematic, scoping, narrative); conference abstracts; editorials; commentaries; letters; media articles; protocols; unpublished dissertations; grey literature including government reports, policy documents, and organisational publications	Qualitative studies included to reflect Indigenous research paradigms and centre Indigenous voices. ‘Mixed method’ = research combining both qualitative and quantitative components. All reviews excluded to avoid results duplication. To reflect intersecting inequities, studies were classified according to the level of data disaggregated by age, Indigeneity, and related factors. Both disaggregated and aggregated studies included due to anticipated scarcity of studies with inclusion demographic as primary population. Studies classified as disaggregated if they reported specific results for inclusion demographic, even as a subpopulation. Aggregated studies met 1 of the 3 criteria: results reported separately by age, ethnicity, or both, but not cross-stratifying to isolate inclusion demographic; age groupings not aligned with United Nations definition of children (<18 years); or inclusion demographic embedded in a broader population and only repeatedly referenced, without distinct reporting. Our rationale for including both study types was also informed by the recognised diversity of Indigenous conceptualisations of family and community, in which children are often understood as inseparable from the family and community collective rather than as a distinct subgroup. Accordingly, aggregated studies were included where they provided relevant evidence relating to Indigenous children’s climate-related health and wellbeing. We treated both study types equivalently within the convergent integrated synthesis, applying no formal differential weighting.
date of publication	no restriction; all studies published prior to 2 March 2025	studies published after 2 March 2025	No date limit was applied based on anticipated scarcity of studies, identified through preliminary searches, at the intersection of climate change and Indigenous children’s health. This approach was adopted to maximise retrieval.
study language	English	non-English	Only English-language studies included.

UNCRC = United Nations Convention on the Rights of the Child

Screening and selection

We imported all search results into Covidence (covidence.org) for duplicate removal and screening. Three co-authors (J.J.T., M.A.J., N.R.H.) independently screened titles, abstracts, and full texts according to the eligibility criteria (Table 3). Conflict resolution procedures are in Supplementary information Appendix C. We did backward-citation searching using reference lists of excluded reviews that met all eligibility criteria except for study design. We summarise the screening process in the PRISMA 2020 flow diagram (Supplementary Fig. 1) (prisma-statement.org/prisma-2020-flow-diagram).

Quality assessment

We assessed methodological quality using the 2018 mixed methods appraisal tool [18] because of its ability to appraise qualitative, quantitative, and mixed-methods studies within a single, integrated framework. Two reviewers and co-authors (J.J.T., M.A.J.) independently assessed the methodological quality of each included study. Reviewers were blinded to each other’s assessments until they completed all appraisals to minimise potential bias and enhance rating consistency. We resolved any discrepancies through discussion until we reached consensus. We evaluated inter-rater reliability using Cohen’s kappa statistic [19]. In accordance with this appraisal tools guidance, we did not calculate overall methodological quality scores; instead, we reported individual criterion ratings [18]. We excluded no studies on methodological quality; instead, appraisal findings informed the synthesis and interpretation of the review.

Synthesis

We used a convergent integrated-synthesis approach, adapted from the Joanna Briggs Institute framework for mixed-methods systematic reviews, to combine results from both qualitative and quantitative studies [20]. We analysed all included studies together, narratively summarising and qualifying quantitative findings where necessary to facilitate integration with qualitative results. We applied a matrix-based method adapted from Rocque et al. (2021) [21] to synthesise and analyse results. We created two matrices, one for disaggregated studies and another for aggregated studies (for definitions and classification criteria, see Table 3), to map the relationship between climate-change exposures and health outcomes. We predefined the exposure categories using climate-health frameworks [4, 22], and developed health-outcome categories inductively through the data collection process in which we tabulated the important information. Through this mapping process, we identified recurring categories of health outcomes that formed the basis for a structured, theme-based narrative synthesis. We then explored each theme in greater depth to examine patterns, differences, and contextual factors that influence how climate change affects the health of Indigenous children globally. A meta-analysis was not feasible due to heterogeneity and scarcity of studies.

Results

Selected studies

Database searches retrieved 2020 studies, and after screening and selection processes, we selected 53 studies for inclusion in the review (Fig. 1).

Fig. 1.

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 flow diagram. Illustrates the identification, screening, and inclusion process, including database results, duplicate removal, eligibility exclusions, and the identification of additional studies via backward citation searching

General study characteristics

Supplementary information Appendix D summarises the main findings and study characteristics collected from each included study. The included studies comprised 16 qualitative, 23 quantitative non-randomised, six quantitative descriptive and eight mixed-methods studies. Of the total number of studies, 27 reported disaggregated results, and 26 presented aggregated results (see Table 3 for classification criteria). The publication rate has increased over time, with approximately 50% of included studies published in the past 5 years (Fig. 2). However, this appears consistent with broader publication trends in climate change-related research fields [23].

Fig. 2.

Number of studies included in this review by year of publication from 01.01.1996 to 02.03.2025 (solid maroon line; left y axis). Also shown for comparison (dashed blue line; right y axis) are the annual number of studies in climate-change adaptation science from Nalau, et al. (2021) [23]

Figure 3 illustrates the geographical distribution of Indigenous children represented in the included studies, mapped to the country of their respective Indigenous group locations. The studies meeting our inclusion criteria are concentrated in high-income countries, with Canada, the United States, and Australia accounting for over half of all studies. Within these countries, multiple studies report findings for Indigenous children from the same communities, meaning that Indigenous children from fewer distinct Indigenous communities are represented than the total number of included studies.

Fig. 3.

Geographical distribution of Indigenous populations represented in the included studies. The terminology we used reflects that used in the included studies; however, we acknowledge that some terms might be outdated and that some Indigenous groups prefer alternative identifiers. Where specified, we provide the names of the communities within these groups in Supplementary information Appendix D. Countries colour-coded by frequency of representation: Canada (n = 14), United States (n = 10), Australia (n = 7), Uganda (n = 6), Peru (n = 3), Russia (n = 3), Bolivia (n = 2), and Greenland, India, Kenya, Malaysia, New Zealand, Norway, the Philippines, and Solomon Islands (n = 1 each). Mapping reflects the geographic location of the Indigenous groups where data collection occurred, rather than the country of origin of publication

Quality assessment

The methodological quality of included studies varied by study design. Most qualitative studies applied appropriate methods for data collection and analysis (15/16 = 93.8%), with limitations largely confined to a single study. Quantitative non-randomised studies generally demonstrated appropriate representativeness of participants and adequate measurement of exposures and outcomes. However, almost one-third of studies did not adequately address incomplete outcome data (7/23 = 30.4%), and we identified inadequate consideration or control of confounding in over one-third (9/23 = 39.1%). Quantitative descriptive studies largely met the criteria, although non-response bias was not consistently addressed. All mixed-methods studies clearly justified the use of a mixed-methods design and generally integrated qualitative and quantitative components effectively. However, five of the eight studies (5/8 = 62.5%) did not adequately address divergences between qualitative and quantitative findings, and four of the eight studies (4/8 = 50%) did not clearly demonstrate that both methodological components met the quality criteria expected for their respective study designs. Across all study types, several criteria received a Can’t tell rating, reflecting insufficient reporting rather than methodological weaknesses per se. We provide complete criterion-level quality appraisal ratings and detailed justifications in Supplementary information Appendix E.

Inter-rater reliability was substantial: Cohen’s kappa was 0.6397 between the two independent reviewers and co-authors (J.J.T., M.A.J.). We resolved all initial disagreements (32/265 = 12.1%) through discussion to achieve consensus. We provide a detailed summary of reviewer disagreements, their resolution, and the Cohen’s κ calculations used to assess inter-rater agreement in Supplementary information Appendix F.

Climate-change exposures and child health outcomes by disaggregation status

We mapped studies using a matrix-based method to identify combinations of climate-change exposures and health outcomes (Table 4), through which five health-outcome themes emerged inductively: malnutrition, psychosocial and cultural wellbeing, infectious diseases, mortality and morbidity, and perinatal health. We examined these themes in relation to six predefined climate-change exposure categories; definitions for all health themes and exposure categories are in Supplementary information Appendix G. Across both exposure and outcome categories, the mapping identified that many studies addressed multiple climate-change exposures and/or health outcomes, demonstrating the interconnected ways in which climate change affects Indigenous children’s health. For example, psychosocial and cultural wellbeing were linked to all but one climate-change exposure and directly or indirectly associated with all other health outcomes. This health outcome is related to malnutrition and perinatal health through traditional food systems and maternal mental health. At the same time, we identified cultural Knowledge and practices as protective factors against mortality, morbidity, and infectious diseases.

Table 4.

Matrix mapping of climate-change exposures and health outcomes. (a) Disaggregated studies. (b) Aggregated studies. Each matrix cell lists the included studies by first author and year. Number in round brackets within each cell indicates the total number of studies mapped to that exposure-outcome combination. Totals for each row and column also shown in round brackets

(a) Disaggregated studies
health outcome categories	climate-change exposure categories
	heat stress (14)	changing seasonal and oceanic patterns (2)	hydroclimatic variability (17)	air pollution and degradation (2)	acute climate-related disasters (2)	other climate-related environmental risks (5)
malnutrition (10)	Godoy, et al. (2008) [24]; Berrang-Ford, et al. (2012) [25] (2)	Hart, et al. (2014) [26] (1)	Godoy, et al. (2008) [24]; Rosinger, et al. (2023) [27]; Sahani, et al. (2022) [28]; Valdivia-Gago, et al. (2023) [29]; Shirisha (2019) [30]; Berrang-Ford, et al. (2012) [25] (6)	nil	nil	Batal, et al. (2021) [31] (1)
psychosocial and cultural wellbeing (6)	nil	nil	Sahani, et al. (2022) [28], Shirisha (2019) [30] (2)	nil	Sahani, et al. (2022) [28]; Shirisha (2019) [30] (2)	Vylka Ravna (2019) [32]; Bruyere et al. (2016) [33] (2)
infectious disease (11)	Ost, et al. (2022) [34]; Berrang-Ford, et al. (2012) [25]; Xu, et al. (2014a) [35]; Xu, et al. (2014b) [36]; Green, et al. (2015) [37] (5)	Saavedra-Samillán, et al. (2024) [38] (1)	Torres-Slimming, et al. (2023) [39]; Harper, et al. (2011) [40]; Rosinger, et al. (2023) [27]; Saavedra-Samillán, et al. (2024) [38]; Berrang-Ford, et al. (2012) [25] (5)	nil	nil	nil
mortality and morbidity (3)	Lai, et al. (2024) [41]; Whitehead, et al. (1996) [42]; Green, et al. (2015) [37] (3)	nil	nil	nil	nil	nil
perinatal health (12)	Doyle (2023) [43]; Ha, et al. (2024) [44]; MacVicar, et al. (2017b) [45]; MacVicar, et al. (2017a) [46] (4)	nil	MacVicar, et al. (2017b) [45]; Bryson, et al. (2024) [47]; Bryson, et al. (2021) [48]; MacVicar, et al. (2017a) [46] (4)	Ha, et al. (2024) [44]; Heelan-Fancher, et al. (2024) [49] (2)	nil	Bank-Nielsen, et al. (2019) [50]; Vylka Ravna (2019) [32] (2)

(b) Aggregated studies
health outcome categories	climate-change exposure categories
	heat stress (17)	changing seasonal and oceanic patterns (13)	hydroclimatic variability (4)	air pollution and degradation (1)	acute climate-related disasters (4)	other climate-related environmental risks (7)
malnutrition (10)	Bogdanova, et al. (2021) [51]; Flint, et al. (2011) [52]; Petrasek MacDonald, et al. (2013) [53] (3)	Panikkar, et al. (2020) [54]; Organ, et al. (2014) [55]; Vogliano, et al. (2021) [56] (3)	Panikkar, et al. (2020) [54] (1)	nil	Edwards, et al. (2021) [57] (1)	Organ, et al. (2014) [55]; Harper, et al. (2015) [58] (2)
psychosocial and cultural wellbeing (21)	Kowalczewski, et al. (2018) [59]; Petrasek MacDonald, et al. (2013) [53]; Cunsolo Willox, et al. (2013a) [60]; Cunsolo Willox, et al. (2013b) [61] (4)	Panikkar, et al. (2020) [54]; Cunsolo Willox, et al. (2013a) [60]; Petrasek MacDonald, et al. (2015) [62]; Harper, et al. (2015) [58]; Cunsolo Willox, et al. (2012) [63]; Davydov, et al. (2011) [64]; Organ, et al. (2014) [55]; Stenekes, et al. (2020) [65]; Cunsolo Willox, et al. (2013b) [61] (9)	Panikkar, et al. (2020) [54]; Cunsolo Willox, et al. (2012) [63]; Ziegler, et al. (2024) [66] (3)	nil	Edwards, et al. (2021) [57] (1)	Organ, et al. (2014) [55]; Galway, et al. (2022) [67]; Stenekes, et al. (2020) [65]; Vogliano, et al. (2021) [56] (4)
infectious disease (1)	nil	nil	nil	nil	nil	Harper, et al. (2015) [58] (1)
mortality and morbidity (13)	Gillespie, et al. (2025) [68]; Ndovu, et al. (2025) [69]; Fleischer, et al. (2014) [70]; Sharpe, et al. (2022) [71]; Knowlton, et al. (2009) [72]; Vaidyanathan, et al. (2020) [73], Bogdanova, et al. (2021) [51]; Flint, et al. (2011) [52]; Panikkar, et al. (2020) [54] (9)	Vogliano, et al. (2021) [56] (1)	nil	Howard, et al. (2021) [74] (1)	Sharpe, et al. (2022) [71], Standen, et al. (2022) [75] (2)	nil
perinatal health (1)	Strand, et al. (2012) [76] (1)	nil	nil	nil	nil	nil

Differences in study design were evident between disaggregated and aggregated studies. Most disaggregated studies were quantitative in design (19/27 = 70.4%), with fewer qualitative (6/27 = 22.2%) and mixed-methods studies (2/27 = 7.4%). In contrast, aggregated studies were more evenly distributed across study designs, comprising 10 qualitative (10/26 = 38.5%), 10 quantitative (10/26 = 38.5%), and 6 mixed-methods studies (6/26 = 23.1%).

We synthesised and visualised the matrix results in Fig. 4. In disaggregated studies, hydroclimatic variability (n = 17) was the most reported climate-change exposure affecting Indigenous child health, and perinatal health (n = 12) was the most frequently reported outcome, primarily associated with heat stress and hydroclimatic variability. Malnutrition linked to hydroclimatic variability was the most studied combination (n = 6). In aggregated studies, psychosocial and cultural wellbeing was the most frequently examined outcome (n = 21). The most common exposure-outcome combinations included mortality and morbidity related to heat stress (n = 9) and psychosocial and cultural wellbeing related to changing seasonal and oceanic patterns (n = 9).

Fig. 4.

Mapping (a) disaggregated and (b) aggregated studies across climate exposure-health outcome combinations. Health outcomes shown on x axis, and climate-change exposures represented by coloured bars. Colour coding and y-axis numbering consistent across panels to facilitate comparison. Numbers of studies addressing each combination of health outcome and climate-change exposure (y axis). Many studies addressed multiple exposure-outcome combinations and were mapped to multiple matrix cells (total frequency > total number of included studies)

Health-outcome themes

The five interconnected health-outcome themes structured a narrative synthesis that summarised the diverse pathways linking climate-change exposures to health outcomes among Indigenous children across varied environmental and cultural contexts. We prioritised community-specific examples and self-determined terminology to recognise and respect the diversity of Indigenous experiences represented in the studies we reviewed.

Across diverse Indigenous contexts, 11 studies showed that climate-related environmental changes disrupt food security, resulting in malnutrition among Indigenous children [25, 27, 29–31, 51–55, 58]. In Arctic and sub-Arctic regions, shifts in precipitation and snowfall linked to rising temperatures increase food insecurity among Indigenous children from Inuit, First Nations, Nenets, and Alaska Native communities by reducing the availability of traditional food sources [31, 51, 52, 54, 55]. These climatic shifts alter seasonal and oceanic patterns, leading to ecosystem disruption, delayed sea ice formation, reduced harvest yields, water scarcity, and changes in wildlife behaviour and migration cues, which restrict hunting opportunities and agricultural productivity [31, 51–55, 58].

Seven studies identified undernutrition—measured by stunting, wasting, low body mass index, or dietary recall—as a main climate-related health outcome among Indigenous children, particularly in tropical and subtropical countries [25–30, 57]. Among Batwa (Uganda), Tsimane (Bolivia), Shawi (Peru), Temiar (Malaysia), and Baiga (India) communities, increased rainfall and flooding exacerbate food insecurity by deepening existing structural and geographic inequalities [25, 27–30, 57]. For example, Tsimane children in remote areas of Bolivia face higher undernutrition risk following flooding events due to limited access to organised food aid [27]. Dietary shifts from traditional foods contribute to increased micronutrient deficiencies due to greater reliance on low-nutrient, processed foods [31, 51, 52, 54, 56]. Cultural adaptations and community support were discussed as potential buffers against climate-related nutrition impacts for children [24, 27], reinforcing the need for greater recognition of Indigenous sovereignty in adaptation planning [31].

Cultural and psychosocial wellbeing was the most frequently reported health outcome, identified in over one-third of the 53 included studies (n = 19, 35.8%) [28, 30, 32, 33, 53–67]. Across diverse contexts, poor emotional wellbeing among Indigenous children, including stress, anxiety, depression, trauma, and substance abuse, was directly linked to diminished cultural wellbeing, resulting from disconnection from land, cultural identity, language, traditional knowledge, and land-based practices [28, 30, 32, 33, 53–67].

Within this theme, most studies (n = 14, 73.7%) centred on Indigenous populations in the Arctic and sub-Arctic, mainly Inuit and First Nations in Canada, and Sámi and Nenets in Northern Europe and Russia [32, 53–55, 58–67]. The main drivers of compromised wellbeing include rising temperatures and altered seasonal cycles driving permafrost thaw, unstable ice, reduced snowfall, ecosystem disruption, and shifts in wildlife migration. These changes undermine land access, traditional hunting practices, intergenerational Knowledge transfer, safe travel, access to cultural sites and ceremonies, and the availability of traditional foods and resources [32, 53–55, 58–67].

Other studies examined Indigenous populations in Kenya [33], the Solomon Islands [56], India [30], Philippines [57], and Malaysia [28]. Shared wellbeing impacts are evident despite varied climate-change exposures, such as intense rainfall, acute climate-related disasters, sea-level rise, and ecosystem disruption. These include Indigenous children’s limited Traditional Knowledges [33], decreased access to traditional foods [28, 30, 56], and increased mental health challenges associated with floods, monsoons, and typhoons [28, 57].

Although 14 studies within this theme did not disaggregate findings for Indigenous children, their experiences were often reflected through caregivers, Elders, and community members expressing deep concern for younger generations [53–60, 62–67]. Six studies explicitly included Indigenous youth, an age group that encompasses children, who reported ecological grief and psychosocial distress linked to rapid climate change and weakened cultural continuity [32, 53, 59, 63, 64, 66]. For example, Inuit youth described reduced opportunities for land-based learning and Knowledge transfer as increasing feelings of isolation, distress, hopelessness, low self-worth and grief [32, 53, 59, 63, 64, 66]. Studies also emphasised the importance of involving Indigenous children and youth in community-led climate adaptation and resilience efforts.

Across seven studies, climate-related exposures, particularly shifts in temperature and precipitation, were consistently linked to increased vulnerability to vector- and water-borne infectious diseases among Indigenous children in Uganda, Peru, Bolivia, and Canada [25, 27, 34, 38–40, 58]. Rising temperatures and stagnant water from changing rainfall patterns heighten malaria incidence among Batwa children in Uganda, and Awajún and Wampis children in Peru [25, 38, 40]. The risk of malaria among Indigenous children in Peru is exacerbated by limited healthcare access and poverty [38]. In Canada, infectious gastrointestinal illnesses, including those from Giardia, were observed in Nunatsiavut Inuit children after heavy rainfall and snowmelt, which caused bacterial contamination of drinking water [40, 58]. Similarly, acute climate-related disasters, such as flooding, were associated with a heightened risk of diarrhoea in Tsimane and Shawi children in Bolivia and Peru, respectively, due to compromised sanitation and water supplies [27, 39]. Two studies emphasised the need for more research on how cultural knowledge and Indigenous practices could reduce the incidence of malaria and infectious gastrointestinal illnesses [38, 40].

In Australia, Aboriginal children are disproportionately vulnerable to respiratory infections associated with temperature variability [35–37]. In the Northern Territory, this demographic has increased hospital admissions for acute respiratory diseases following hot nights [37]. In Brisbane, heatwaves, cold spells, and day-to-day temperature fluctuations were associated with higher emergency department visits for pneumonia among Aboriginal children, with disproportionate impacts likely exacerbated by housing and socio-economic disparities [35, 36].

Fifteen included studies linked mortality and morbidity among Indigenous children to climate-change exposures, including heat stress, acute climate-related disasters, air pollution, and changes in seasonal and oceanic patterns. Among the 12 studies examining heat stress, only three (n = 3, 25%) disaggregated findings specifically for Indigenous children, limiting the precision with which child-specific impacts can be assessed [37, 41, 42]. In those studies, exposure to high ambient temperatures and heat stress was associated with increased heat-related fatalities and hospital admissions for non-communicable diseases among Māori and Pacific Islander children in New Zealand, and Aboriginal children from communities in Adelaide, Australia [37, 41, 42]. In contrast, the remaining nine studies (n = 9, 75%) reported findings for broader Indigenous populations despite frequent references to Indigenous children in the discussion and data [51, 52, 54, 68–73]. Increased rates of emergency department use, hospitalisations, injuries, and deaths associated with rising ambient temperatures were indicated among Native American and Alaska Native populations in the United States [68–70, 72, 73]. Additionally, warming temperatures in Arctic and subarctic regions correlated with a rise in non-communicable diseases, including obesity, diabetes, and cardiovascular conditions, stemming from declining nutrition due to a shift from nutrient-rich traditional diets [51, 52, 54]. Some communities, including the Nenet and Alaska Natives, expressed concern for their children’s nutritional health [51, 52, 54]. The remaining four studies linked mortality and morbidity to climate-change exposures other than heat stress, including acute climate-related disasters, such as wildfires and extreme weather that increase respiratory illness and mortality [71, 74, 75], and changes in seasonal and oceanic patterns that increase the risk of nutrition-related non-communicable diseases [56].

Ten included studies highlighted the interconnectedness of maternal and child health, with climate-change exposures affecting pregnant Indigenous women contributing to adverse perinatal outcomes [32, 43–50, 76]. In the United States, higher ambient temperatures during late gestation, along with degraded air quality from wildfire smoke and pollution, were linked to increased preterm birth and low birth weight in Native American and Alaska Native communities [44, 49]. Aboriginal communities in Australia’s Northern Territory and Brisbane experienced similar perinatal outcomes due to extreme heat [43, 76]. In Uganda, rising temperatures and variable rainfall led to prolonged dry seasons, resulting in undernutrition, physical overexertion, dehydration, and emotional distress during pregnancy for Batwa women [45–48]. These factors contributed to adverse perinatal outcomes, including miscarriage, stillbirth, and low birth weight [45–48]. Climate-related disruptions in Russia affected Nenet maternal and newborn health by limiting access to healthcare and traditional birthing environments [32]. In Greenland, climate-driven transport of environmental pollutants contaminates food sources, raising concentrations of heavy metals in the blood of pregnant Inuit women and contributing to reduced fetal growth and preterm birth [50].

Discussion

Our systematic review provides the first synthesis of global research on the health impacts of climate change among Indigenous children. The findings consolidate past studies indicating Indigenous children globally experience a range of adverse climate-related health outcomes. Most studies examined multiple interconnected exposures and outcomes. Psychosocial and cultural wellbeing emerged as a cross-cutting theme, associated with all but one exposure, and linked to all other outcomes through both directional and reciprocal relationships. Importantly, Indigenous children’s climate-health experiences were diverse across the populations represented. Exposure-outcome combinations interacted with and amplified diverse pre-existing determinants of health and were moderated by cultural protective factors.

Our findings align with Indigenous health conceptualisations, recognising wellbeing as inseparably connected to land, culture, family, community, spirituality, and broader social, environmental, political, and historical determinants [6]. Although Western health models have only recently begun to acknowledge these connections [5], Indigenous Peoples have long embodied these principles [77]. Indigenous Knowledge systems and traditional practices have historically supported adaptive responses to environmental change and remain central to community resilience [77]. This reaffirms the centrality of Indigenous Knowledge systems in understanding and responding to climate-related health impacts on Indigenous children. In line with Dr Rhys Jones’ (Ngāti Kahungunu; Māori Iwi [tribe] from the east coast of North Island, Aotearoa/New Zealand) recommendations, effective responses must be multidimensional, addressing structural determinants while centring Indigenous Knowledge systems and traditional practices that are fundamental to community resilience [78]. This role is recognised in Article 7.5 of the Paris Agreement under the United Nations Framework Convention on Climate Change, which calls for the integration of Indigenous Knowledges into climate change action [79].

Several studies underscored Indigenous children’s unique capacities to contribute to climate action through intergenerational Knowledge transfer and cultural continuity [53–55, 60, 63]. Research participants described how engaging younger generations in community-led climate action strengthens protective factors underpinning psychosocial and cultural wellbeing, including cultural identity and self-determination [53–55, 60, 63]. As highlighted in the matrix-mapping findings, psychosocial and cultural wellbeing are closely linked to other health outcomes, such that their improvement can enhance overall health.

Building on these findings, we developed an evidence-informed model (Fig. 5) to illustrate how centring the engagement of Indigenous younger generations, including children, in Indigenous-led climate action improves health and wellbeing. This strength-based, relational model aligns with the Paris Agreement’s (Article 7.5) calls for integrating Indigenous Knowledges into climate adaptation [79], and the United Nations Permanent Forum on Indigenous Issues’ recommendation to involve Indigenous children in climate action to address their health [11]. Thus, our findings provide an evidence base for culturally responsive, child-centred climate action, underscoring the importance of meaningful engagement with Indigenous Peoples and the inclusion of their Knowledge systems.

Fig. 5.

Evidence-informed model centring the role of younger generations in climate–health responses. The relational and strength-based model synthesises main findings to illustrate an amplifying positive feedback loop through which engaging Indigenous children in climate responses generates four interconnected outcomes, each reinforcing the next. This cyclical process strengthens over time, contributing to increasingly culturally relevant and effective responses led by and for Indigenous communities. (i) Inclusion of Indigenous Knowledge systems: Engagement promotes intergenerational Knowledge transfer, cultural continuity, and the preservation of storytelling and oral traditions. It strengthens land-based Knowledge, care for land, Indigenous health perspectives, and Knowledge sovereignty, grounded in relationality, interconnection, and reciprocal exchange. (ii) Process-based health and wellbeing benefits: Engagement enhances psychosocial and cultural wellbeing through belonging, identity, self-determination, and agency. It deepens connections to Country, culture, spirituality, language, family, and community, and fosters emotional security and relational empowerment. (iii) Improved strategic and practical responses: Engagement enables co-design and community ownership through strength-based, culturally relevant, and context-specific approaches. It supports adaptive, child-centred planning, Indigenous-led solutions, relational accountability, local priority setting, and ethical approaches. (iv) Implementation-driven health and wellbeing benefits: Engagement contributes to sustained improvements by strengthening intergenerational resilience, climate-health literacy, and community leadership. It builds capacity for future action, supports health equity across life stages, and promotes environmental and cultural stewardship

Indigenous children remain underrepresented in climate-health research, with only 53 studies meeting our review’s eligibility criteria. This sparse evidence base, marked by uneven geographical representation and variable methodological depth, restricts its ability to inform strategic and practical responses that effectively address the distinct climate-related health needs of Indigenous children. In the following section, we discuss these gaps and offer recommendations to strengthen the evidence base, thereby guiding future strategic and practical responses.

The available evidence is concentrated in high-income countries such as Canada, the United States, and Australia, with Indigenous children in Central America, the Caribbean, and most of Africa excluded from the evidence base (Fig. 3). However, this geographical concentration does not necessarily reflect broader representation of Indigenous children within these high-income countries, because multiple publications reported findings from Indigenous children belonging to the same communities. Consequently, the range of climate change exposures and associated health outcomes we identified in this review is disproportionately informed by and reflects evidence from a few Indigenous child populations. These omissions reflect structural inequalities in global climate-health knowledge production, leaving those most affected underrepresented [80]. This lack of global research equity restricts understanding of climate-change impacts on Indigenous children’s health across diverse contexts, risks inappropriate generalisations, undermines climate justice, and limits culturally responsive strategy development. Future research must address these regional and community-level disparities in climate-health research to improve understanding of the diverse climate-health experiences of Indigenous children globally.

Of the included studies, 26 did not disaggregate findings specifically for Indigenous children, limiting understanding of Indigenous children’s climate-related health vulnerabilities and resilience factors. Although these studies embedded Indigenous perspectives, children’s experiences were often subsumed within broader community narratives. Strengthening the evidence base requires disaggregation by Indigenous identity and age, aligned with the United Nations definition of children (<18 years) [10], while ensuring that Indigenous children’s voices are represented in ways that recognise their inseparable relationships with families, communities, and cultural systems. Future research must also be culturally grounded and responsive, with methods that respect Indigenous Knowledge systems, uphold Indigenous data sovereignty, and ensure community leadership.

The strengths of this review include Indigenous consultation, consideration of researcher positionality, recognition of Indigenous diversity, and inclusion of Indigenous perspectives on health. We adopted these approaches to support cultural relevance and respect throughout the research process. Despite a comprehensive search strategy, our conclusions were limited by restricted access to some full-text articles and exclusion of non-English studies. Methodological appraisal indicated that the included studies were generally robust across study designs. However, the predominance of observational research, together with recurring limitations relating to residual confounding and incomplete reporting, reduces confidence in attributing observed health outcomes solely to climate change [81]. Although we included community-specific references where possible, the evidence base reflects general trends and does not fully capture the diversity of Indigenous children’s lived experiences. Taken together, these methodological and evidence-base limitations indicate that the review findings should be interpreted as evidence of broad associations rather than definitive causal effects. Application of this evidence base therefore requires reference to community-specific findings (Supplementary information Appendix D).

Conclusion

Overall, our review offers a strengths-based, child-centred contribution that aligns with and aims to support Indigenous Peoples’ long-standing and ongoing global advocacy to decolonise and Indigenise climate-health research and action. Our review has addressed a global research gap at the intersection of climate change, Indigenous Peoples, health, and child-specific vulnerability. By consolidating evidence of climate-related health impacts among Indigenous children, it identifies commonly studied exposure-outcome combinations, highlights extensive research gaps, and provides recommendations for future research. The findings underscore the importance of meaningful engagement with Indigenous children and inclusion of their communities’ Knowledge systems in climate-change responses. This establishes an evidence base to inform culturally appropriate, child-centred responses to the climate-related health challenges affecting Indigenous communities. For climate health responses to effectively acknowledge and respond to Indigenous Peoples’ sovereignty, Knowledges, and lived experiences, there is an urgent need for systemic change in how climate-health research includes Indigenous children. Achieving equitable, culturally grounded, and child-centred climate-health action requires genuine leadership by, and partnership with, Indigenous communities that centre their Knowledge systems and strengthen the cultural processes that amplify their children’s agency and improve their children’s health outcomes.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Author contributions

JJT: Conceptualisation, Methodology, Investigation, Formal analysis, Data curation, Visualisation, Writing – original draft, Writing – review & editing, Project administration. NRH: Investigation, Data curation, Writing – review & editing. MW: Conceptualisation, Writing – review & editing, Validation. PNLS: Supervision, Writing – review & editing, Validation. CJAB: Visualisation, Writing – review & editing, Software, Validation. MAJ: Supervision, Conceptualisation, Methodology, Investigation, Data curation, Writing – review & editing, Project administration.

Funding

Not applicable.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.