Global Climate Change and Children’s Health: AAP Recommendations

The “Climate Change and Children’s Health: Building a Healthy Future for Every Child” policy statement, published in 2024, notes the following:

“The warming of our planet matters to the health, well-being, and future of every child. Climate conditions stable since the founding of modern pediatrics in the mid nineteenth century have shifted, and old certainties are falling away. Climate change causes profound shifts in temperature, precipitation, and ecosystems. These effects on earth systems compromise air and water quality, increase food insecurity, change the incidence of infectious diseases, intensify allergy seasons, and result in more devastating wildfires and hurricanes and more dangerous and frequent heat waves.” 

Climate change poses threats to human health, safety, and security, and children are uniquely vulnerable to these threats. Given this knowledge, failure to take prompt, substantive action would be an act of injustice to all children. Pediatricians have a uniquely valuable role to play in the societal response to climate change. The policy statement offers the following recommendations:

Recommendations to Pediatricians and the Health Sector

Pediatricians have a long history of advocating for policies that protect the health and welfare of children. Informed by an understanding of the threat that climate change poses to their patients, pediatricians serve as a voice for children in the societal response to this global challenge. The following are recommendations to help achieve this goal.

1. Incorporate climate change counseling into clinical practice. Assess climate risks and recommend climate solutions when screening for and addressing social determinants of health such as energy, food, and housing security. Educate families on regional climate and health risks and protective strategies. Use existing anticipatory guidance as a framework for discussing climate change solutions. For example, encourage active modes of transport or promote consumption of plant-based proteins to reduce carbon emissions and promote health. Encourage family choices that reduce fuel consumption and promote mobility, such as utilization of public and active transportation, and fuel-efficient vehicles.
2. Incorporate climate, health, and equity curricula into medical school, residency, continuing education, and board examinations to prepare pediatricians to adequately provide health care for children.
3. Reduce carbon emissions from the health sector through operating facilities on carbon-free energy sources; improve energy, water, and other resource efficiency in health care buildings and health care product manufacture; transition to zero-emission vehicles and promote active and public transportation for patients and employees to hospitals and clinics; minimize medical waste, including pharmaceutical waste; serve sustainably grown food and eliminate food waste; use telehealth when appropriate; include climate resilience in facility design and disaster preparedness efforts; and invest in climate and health innovation. On the basis of accepted clinical performance measures, incentivize decarbonization through incorporating the carbon intensity of services into value-based health care metrics. US health sector GHG emissions exceed those of any other nation in both absolute and per-capita terms, and are projected to increase significantly without climate action within and outside the health sector.
4. Serve as a role model in your personal and professional community for practices that promote sustainability. For example, embrace active transportation, reduce home energy use, transition to clean electricity sources, reduce air travel, and adopt a more plant-based diet. Actions to reduce personal carbon footprint can increase the efficacy of messaging and advocacy efforts.
5. Advocate for equitable climate solution policies at the local, state, national, and international level. Pediatricians are ideal advocates with whom to partner and uplift youth and community voices working to advance zero-carbon energy policy and climate justice. Educate elected officials and health insurance entities on the risks that climate change poses to child health and the benefits of local solutions, including improved air quality, safe streets, tree canopy and green space, and access to affordable fresh fruits and vegetables. Engage with the community by speaking at public hearings, providing expert testimony, and writing letters to the editor. Maximize impact by working with other health care professionals in an organization focused on climate and health.
6. Bring the child health voice to coalitions working to address climate change. Pediatricians are well positioned to collaborate with health departments, universities, and research facilities to enhance surveillance, analysis, and reporting of climate-sensitive health effects and vulnerable communities. Develop local, regional, and national preparedness measures that protect the best interests of children from current and future harm. Prioritize engagement with members of communities at highest risk as a result of historical underinvestment and racist policies.

Recommendations to Government

Consistent with scientific assessments of the United States’ responsibility to meet our obligation under the Paris Agreement, policies should be put in place that reduce GHG emissions to net-zero by 2050. Policies also must be enacted that promote climate resilience, especially for children. Stakeholders can act to:

1. Promote energy efficiency and renewable energy production at the federal, state, and local levels. Preserve essential public health protections in the Clean Air Act. Establish an effective and equitable carbon pricing regimen that reflects the health costs of fossil fuel reliance and ensures a positive impact on communities affected by environmental injustice and energy sector dependence. End federal subsidies and tax incentives for production and consumption of carbon-intensive fuels.
2. Establish laws or regulations that transition on road vehicles, the leading source of GHG emissions in the United States, to zero carbon emission at a rate consistent with attaining our obligations under the Paris Agreement. Expand public transportation, increase construction of safe bikeways and walkways, and support urban planning designs that reduce dependence on automobile transit.
3. Promote more plant-based diets with reduced red meat and sugar consumption in line with current dietary guidelines and associated with reductions in both GHG- and diet-related disease risks in children. Improve food security through incentivizing crop and soil resilience, regenerative agriculture, and reduced GHG contributions from livestock.
4. Increase urban green space, safe routes for walking and biking, and access to mass transit where appropriate. Invest in strategies that reduce heat islands in communities that experience higher temperatures. Prioritize support for communities that have experienced historical underinvestment.
5. Positively incentivize the health care sector through payment reforms, grants, value-based initiatives, or other mechanisms to improve energy efficiency, reduce waste, and increase reliance on clean energy. Support resilience of hospitals and health systems to climate shocks.
6. Expand and develop pediatric research and climate change related public health adaptation, mitigation, and resilience measures to protect children, with a focus on vulnerable communities and environmental justice. Deploy early-warning systems for extreme weather events that include health care professionals and that reflect the specific needs of children. Improve surveillance of climate-associated infectious diseases, including new and emerging pathogens.
7. Promote enhanced, localized community resilience with active engagement and support of impacted communities. Promote environmental justice through investments in communities that have historically been overburdened by pollution. Direct public housing and school infrastructure funding to incorporate green building design.
8. Advance global actions to decarbonize through setting sound domestic climate policies and supporting international efforts to reduce greenhouse gas emissions among all nations.