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Background

• Supporting and protecting children and young people from the impact of climate change requires ambitious and urgent action. All four UK Governments have begun to take action to mitigate and adapt against climate change.
• The Governments in England, Scotland and Wales have each published a clean air strategy outlining measures to improve air quality. Despite this, emissions from transport, agriculture, and industry continue to contribute to air pollution.
• The UK and Northern Ireland Governments have set a target to achieve net zero greenhouse gas emissions by 2050, while Wales and Scotland have their own emissions reductions targets of 2030 and 2045. Despite these targets, progress has been reported to be slow to meet them and calls have been made for the UK to adopt the more ambitious target of 2030.1

Key facts: climate change’s impact on child health in the UK

More detail is available in the RCPCH position statement, The impact of climate change on global child health.

Air pollution

Globally, more than 90% of children are exposed to ambient fine particulate matter (PM2.5) levels above the World Health Organisation’s Global Air Quality Guidelines.2

Children are more vulnerable than adults to the effects of air pollution3 because:

• they breathe faster, so they inhale more airborne toxicants in proportion to their weight, than adults exposed to the same amount of air pollution.��
• their organs are still forming. Therefore, exposure to air pollutants during pregnancy and early childhood can have harmful and irreversible effects on the development of the lungs and other organs with the potential for respiratory and other health problems as an adult.

Many studies have shown clear links between exposure to air pollution and issues with growth and development in early life, including: a link between higher exposure to traffic and poorer lung function in childhood4 ,��5 ,��6 and exposure to high levels of PM2.5, PM10 and NO2 being associated with both smaller infant head size and increased risk of intrauterine growth restriction.7 ��A 2021��meta-regression and analysis study concluded that globally 15.6% of all low birth weight and 35.7% of all preterm births could be attributable to PM2.5 exposure throughout pregnancy.8

Extreme weather

Very young children are especially vulnerable to heat-related deaths, including dehydration, as they cannot regulate their temperature and control their environment. This risk is greater if the child is already vulnerable due to homelessness, poor access to water and sanitation, or malnutrition.9

In addition to heat waves, climate change is leading to increased risk of flooding. The use of unsafe water sources, such as surface water, and the spread of faecal matter into water resources after flooding, increases the spread of water-borne diseases (eg diarrhoea) and food insecurity, resulting in higher rates of under-five mortality in flood-affected areas.10

Extreme weather events such as drought and flooding frequently force families to leave their homes every year.11 ��When families are displaced, children are exposed to higher risks of violence, physical and sexual abuse, and potential mental health consequences.12  In addition, natural disasters increase the risk of separation of children from their families while extreme weather disrupts preventive healthcare and education. ��

Food supply

Climate change will impact food security in a myriad of ways, both directly – via mechanisms such as variable rainfall, excessive temperatures, increased pest prevalence, decreased pollinators, poor livestock adaptation, ocean warming and acidification; and indirectly – via flooding, forest fires, human migration, conflict, disrupted distribution systems and increased poverty.  Crop yields are sensitive to temperature and water availability and reduction in production is anticipated, particularly in low-latitude regions, by up to 25% for maise and 15% for wheat.13

Increased food insecurity will have its greatest impact on children at critical periods of their growth and development. Underweight-malnutrition increases the risk of dying from infections, and overweight-malnutrition is a risk factor for cardiovascular disease, diabetes, and cancer. Undernourished infants are more likely to be obese adults.14

Evidence how climate change exacerbates health inequalities

Health inequalities

Children and young people experience the impacts of climate change unequally, which has the potential to widen existing child health inequalities as low income households that are already disadvantaged are most vulnerable to the effects of extreme weather events and systemic shocks15 . ����

Unequal exposure��

• The direct impacts of climate change on health are created by the changing exposures to, for example, heat and cold, increased air pollution and flooding.16
• However, exposures are not distributed evenly. Low-income households have least choice in where they live and more likely to live in less optimum environments, which creates inequalities in exposure to extreme weather events and poorer air quality. ��
• Evidence shows: ��
  • air pollution concentrations are highest in the most deprived areas17 ��
  • people living in deprived urban areas have less access to green space, which accentuates the severity of heatwaves or flood events18
  • low-income households are over-represented in areas at risk from coastal flooding.19  
• For CYP in low-income families, this means facing an increased mortality risk from extreme weather events, while air pollution can exacerbate respiratory conditions or contribute to adverse child health outcomes such as cancer, diabetes and obesity.20

Capacity to adapt��

• The impacts of climate change will not be the same for everyone due to the differing adaptive capacities of children and young people and their families, which may widen health inequalities. Low-income households may have limited economic resources which will decrease their capacity to adapt, for example, their homes to mitigate the effects of climate change.
• Climate change is leading to increased incidents and severity of heatwaves in the UK. Air-conditioning provides protection from high temperatures, however installing these in households is expensive and can therefore be inaccessible to households living in poverty.21
• At the same time, climate change is leading to more damp and cold homes as a result of increases in winter precipitation in the UK.22 ��For low-income households, their home may be too expensive to heat to an adequate temperature, which increases their exposure to cold. ��
• When a household’s adaptive capacity is lower, this can lead to an increased risk of heat-related deaths for children and young people. While living in cold and damp or mouldy homes can additionally exacerbate respiratory illnesses.

Unequal food system��

• Currently, 46% of food consumed in the UK is imported, much of which comes from countries that are vulnerable to the impacts of climate change.23
• Climate change is putting food production and supplies at risk as rising temperatures are shortening crop growth duration and extreme weather events can damage crops, which pose a threat to crop yields and reduce food availability24 .
• A shortfall in supply coupled with the current energy crisis will drive increases in food prices.25 ��This will likely have the greatest impact on lower-income households, as they are more likely to experience food insecurity as a result of higher food prices, and may have to reduce the quantity and/or quality of, or buy cheaper foods which are often less healthy.26 ��For children and young people this may lead to an increased risk of malnutrition.

Eco-distress

• The increasingly visible effects of the climate crisis have given rise to new concepts, such as eco-distress.27 ��
• Eco-distress is emerging condition seen in children and young people and refers to the overwhelming or unmanageable feelings felt when they hear about the environmental threats of climate change, which can have a negative impact on mental health28 . A recent survey found that 73% of 16-24 year olds reported the climate crisis was having a negative effect of their mental health29 . ��
• Central to this is the intergenerational inequity children and young people experience: they have little influence and depend on adults in positions of authority to address this. Only 9% of 16-24 year olds believe that young people have a great deal of influence in making decisions about climate change30 .

RCPCH policy recommendations

• The UK Government to appoint a Cabinet level Minister for Children to ensure a child health in all policies approach to decision making and policy development is adopted.����
• All four UK Governments to introduce a statutory obligation to conduct a child's rights impact assessment when developing policies affecting children and young people, and as part of this ensure that climate change policies do not further exacerbate child health inequalities.��
• A commitment from all four UK Governments to engage with children and young people in the development of climate change and health inequalities policies.  ��

Key messages for health professionals

• The climate crisis is urgent and will affect all aspects of children's lives. Health professionals can play an important role in relaying this information as they are highly regarded and respected members of the community and are listened to by the public for this reason.
• Many children feel anxious and depressed about climate change and enquiry about this could enter routine consultations where appropriate.

Role of paediatricians

• Paediatricians should consider engaging with the urgent issues of climate change and health inequalities, and support RCPCH in calling on governments to take urgent action on these issues.����
• Paediatricians should consider ways to keep up to date with relevant resources relating to climate change and child health, including signing up to the bi-monthly RCPCH Climate Change ebulletin.
• Paediatricians should consider introducing the importance of climate change and sustainability into consultations where appropriate, and be able to advise simple, positive steps that individuals, families and communities can take to mitigate the impact of climate change on their health.

Children and young people's voice

The Children and Young People's Engagement team at RCPCH conducted a variety of roadshow engagement activities across the four nations in the UK capturing the voices of 1,262 children and young people which are included in our report about how children and young people view climate change in the UK, Preserving the world for future generations. In these activities, some children and young people were given prompts directly related to climate change whereas others were asked general questions such as, ‘What keeps you happy, healthy, and well? and��'What are the barriers to achieving it?’, where themes regarding climate change and its impacts on the planet, environment, and the health of children and young people emerged.

The key themes and discussions from the voicebank data were as follows:

• Children and young people emphasised the importance of stopping climate change as it negatively impacts other social, health, and environmental issues. As seen in the example below (image 1), one group of CYP from Cornwall depicted in one drawing how the earth is green and vibrant and another photo next to shows the detrimental effects that climate change has on the planet.

• Children and young people acknowledged that climate change is a barrier to achieving basic human rights for some individuals such as it inhibits their ability to access clean water, sanitation, and food.
• Children and young people recognised the impact that extreme weather changes can have on their wellbeing as it reduces their right to play, access to outdoor and green spaces, and can negatively impact their access to necessities such as food, water, and shelter (image 2 below). In addition, children and young people highlighted that extreme weather changes can cause increased eco-distress based upon their geographical location and exposure to the negative impacts of climate change.��

• Voicebank data also highlighted that children and young people are becoming increasingly worried about climate change resulting in a higher prevalence of eco-distress. For example, one participant from Caerphilly noted that something has to be done to improve the climate in order to reduce the mental health decline that is impacting children and young people (see image 3). Furthermore, children and young people emphasised that they are worried about the planet that future generations will inherit from the current generation inequity. Several children and young people stated that “climate change means preserving the world for future generations.”��

• Children and young people frequently stated that climate change will negatively affect their health due increased pollution which will cause breathing problems and conditions such as asthma to be more prevalent (see image 4). This theme was common amongst participants from the four nations, emphasising that this is a nationwide phenomenon that requires urgent support from the UK governments.��

• Children and young people also highlighted the inequitable impacts climate change has on individuals because of illnesses, deforestation, displacement and migration, and extinction. For example, one group of children and young people discussed how climate change can take people away from each other and another group highlighted that flooding could cause displacement amongst populations. These affects will not be equally distributed and depend on an individual's geographical location as well as their socioeconomic status to be able to ensure their shelter can withstand extreme weather changes.����

Additional voicebank examples

The next three images in response to:

• Left hand – what does climate change mean to you?��
• Middle circle – how does climate change impact the health of children and young people?��
• Right hand – imagine you have a magic wand what would be your idea linked to climate change and staying healthy, happy and well?��

Tool 1 - Develop your understanding

Tool 2 - Advocate for action

Preserving the world for future generations: Children and young people's perspective

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• 2World Health Organisation. Air Pollution and Child Health [Internet]. 2018 [cited 2021 Jun 30]. Available from:
• 3Schraufnagel DE, Balmes JR, Cowl CT, Matteis S De, Jung S-H, Mortimer K, et al. Air Pollution and Noncommunicable Diseases: A Review by the Forum of International Respiratory Societies’ Environmental Committee, Part 1: The Damaging Effects of Air Pollution. Chest [Internet]. 2019 Feb 1 [cited 2021 Sep 16];155(2):409. Available from:
• 4Schultz ES, Hallberg J, Bellander T, Bergström A, Bottai M, Chiesa F, et al. Early-life exposure to traffic-related air pollution and lung function in adolescence. American journal of respiratory and critical care medicine [Internet]. 2016 Jan 15[cited 2021 Sep 8]; 193(2): p. 171-7. Available from: pubmed.ncbi.nlm.nih.gov/26397124/
• 5Gauderman WJ, Urman R, Avol E, Berhane K, McConnell R, Rappaport E, et al. Association of Improved Air Quality with Lung Development in Children. N Engl J Med [Internet]. 2015 Mar 5 [cited 2021 Sep 16];372(10):905. Available from:
• 6Rice MB, Rifas-Shiman SL, Litonjua AA, Oken E, Gillman MW, Kloog I, et al. Lifetime Exposure to Ambient Pollution and Lung Function in Children. Am J Respir Crit Care Med [Internet]. 2016 Apr 15 [cited 2021 Sep 16];193(8):881. Available from:
• 7Clemens T, Turner S, Dibben C. Maternal exposure to ambient air pollution and fetal growth in North-East Scotland: A population-based study using routine ultrasound scans. Environ Int [Internet]. 2017 [cited 2021 Sep 16];107:216. Available from:
• 8Ghosh R, Causey K, Burkart K, Wozniak S, Cohen A, Brauer M. Ambient and household PM2. 5 pollution and adverse perinatal outcomes: A meta-regression and analysis of attributable global burden for 204 countries and territories. PLoS medicine [Internet]. 2021 Sep 28 [cited 2021 October 12]; 18(9): p. e1003718.Available from:
• 9United Nations Childrens Fund. Unless we act now [Internet]. 2015 [cited 2021 Jul 5]. Available from:
• 10United Nations Childrens Fund. Unless we act now [Internet]. 2015 [cited 2021 Jul 5]. Available from:
• 11UNHCR. Strategic Framework for Climate Action [Internet]. 2020. Available from:
• 12Office of the United Nations High Commissioner for Human Rights (OHCHR). Analytical study on the relationship between climate change and the full and effective enjoyment of the rights of the child. 2017;07113(May):18. Available from:
• 13Myers SS, Smith MR, Guth S, Golden CD, Vaitla B, Mueller ND, et al. Climate Change and Global Food Systems: Potential Impacts on Food Security and Undernutrition. [Internet]. 2017 Apr 6 [cited 2021 Aug 29];38:259–77. Available from:
• 14Swinburn BA, Kraak VI, Allender S, Atkins VJ, Baker PI, Bogard JR, et al. The Lancet Commissions The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report. Lancet [Internet]. 2019 [cited 2021 Aug 28];393:791–846. Available from: dx.doi.org/10.1016/
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• 20www.rcpch.ac.uk/resources/outdoor-air-quality-uk-position-statement
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