Experts urge nations to include children’s health in climate adaptation plans

Experts warn that climate change impacts on children’s health and nutrition are a global blind spot. They are calling for improved age-disaggregated nutrition data so that governments can better identify who are most at risk from heat, flooding, food insecurity, and disease.

As nations set 2025 adaptation plans and prepare funding cycles, a Weill Cornell Medicine investigator and members of a technical advisory group to the WHO and UN Children’s Fund outline a set of concrete and achievable indicators to ensure children’s health is accounted for in climate change goals.

Their commentary in The Lancet Planetary Health points out that a previous list of 5,339 indicators lacked a child health focus. 

Nutrition Insight speaks to lead author Dr. Ilan Cerna-Turoff, epidemiologist and emergency medicine physician at Weill Cornell Medicine, US, who proposes 17 indicators, such as mortality, stunting, malnutrition, and anemia, which countries can measure. 

He presses world leaders on how countries plan on tracking climate progress without concrete metrics: “Children ultimately will inherit the world that we create today, and we can’t afford to leave the youngest members of our society behind.”

What are we still missing in measuring how climate change affects children’s health and nutrition?
Cerna-Turoff: One of the biggest challenges is that we do not consistently collect age-stratified data, and when stratified, it is not disaggregated into all meaningful age categories of children. Children under one year of age have different health needs than children under five, as do children under 18. This is a problem that affects data broadly, beyond climate change. Data originates from multiple systems that are not always structured for or sensitive to child health issues. When we seek to create globally comparable or even nationally representative numbers, we often run into a fundamental issue that the data do not exist. This is overlaid upon the standard biases and hurdles in accurately measuring the nutritional status of children.

Dr. Ilan Cerna-Turoff, epidemiologist and emergency medicine physician at Weill Cornell Medicine (Image credit: Travis Curry).On the exposure side, we similarly run into challenges. The global community still lacks consensus on how to measure climate change. We do not have a consistent feature of climate change or timescale that can be readily applied to health and nutrition in all cases.

Climatological changes and weather events often require complicated exposure assessment and models to estimate. Individuals need area-specific expertise to conduct these analyses. Given the historical silos between health and climate science, the skills needed are often concentrated in other areas of science. Likewise, climate scientists do not understand nutrition and health. We need to work on identifying consistent measures of the most health-sensitive elements of climate change and build interdisciplinary climate and health units to reduce structural and disciplinary barriers.

Which child nutrition or health issues are most likely to be ignored?
Cerna-Turoff: Encouragingly, we found that global agencies and governments advocated for standardized measurement of stunting and malnutrition in children under five and anemia in pregnant women, which has obvious health impacts on the nutrition of infants, in the period leading up to COP30. These are high-quality, Tier 1 indicators that also link to the UN Sustainable Development Goal (SDG) Target 2.2 of ending all forms of malnutrition by 2030.

An area that received less attention is dietary diversity for children aged six to 23.9 months. Healthy diets are fundamental to healthy development and underpin multiple other development indicators, including SDG 3.4 for ending premature mortality. Unhealthy diets exacerbate non-communicable diseases and other aspects of ill health that affect all aspects of life. The ability to eat a varied and healthy diet is also often tied to economics, with impoverished families and communities less likely to be able to access the breadth of food that children need. Healthy diets require a systemic approach to poverty and changing access and agricultural practices. 

When an indicator is upstream of more immediate health metrics, it often gets deprioritized, as it does not easily pertain to the daily ways data are already being collected in health and other systems. These are the kinds of indicators that should be prioritized, with named focal points who have the allocated budget and clear responsibility for data collection and dissemination to stakeholders, because they have the greatest potential of improving population health for nutrition, have knock-on effects in other areas of health and development, and often are the most cost-effective.

How could better child-focused data change the way governments make nutrition policies?
Cerna-Turoff: Data makes visible the invisible. It is the bedrock of making evidence-based decisions. By collecting better data on child nutrition, we can make informed decisions about how to spend limited resources. Identifying areas of nutrition that seem to be influenced by climate drivers can be quantified in economic costs of inaction and cost savings by early intervention. 

Researchers call for child-focused health and nutrition indicators to be integrated into national climate adaptation plans.I find that these kinds of arguments are appealing to policymakers and make data more concrete. Regardless, however, a starting point is to collect age-specific data in a regular and standardized way across populations to understand patterns of child nutrition and health.

Why has children’s health been left out of climate plans, even though they are more at risk?
Cerna-Turoff: We still lack data to know the ways and instances when children are disproportionately affected by climate change. We have glaring gaps in our knowledge base because of the fundamental issue of data being collected in ways that do not allow for age stratification. Much more information has been collected on older adults and climate drivers compared to young people. The increase in data collection will help support children’s health in the future.

Health is also generally underrepresented in the climate agenda. We only had our first dedicated Health Day, and the official climate and health plan was launched in 2023 during COP28 — the official conference for signatories to the Paris Agreement. The climate agenda largely developed due to pressure from other sectors, and so, health is only beginning to be fully integrated. We have seen most countries generally acknowledge that children are a priority group, but the majority do not have concrete plans for how to address health concerns for this age group. 

How might indicators reveal more children are at risk than previously thought — and what would that mean for nutrition programs?
Cerna-Turoff: We will likely see differences by gender, sub-age groups, and income status, as with almost every other health issue. It would mean that nutrition programs should at minimum be structured in ways that are gender, age, and economically sensitive. Evidence helps to push nutrition programs and other social services to be accountable. It is both a carrot and stick; programs have a beacon for a gold standard that they should work toward, and they are forced to change practices that are not ideal to abide by the latest evidence.

A likely gap will be for children displaced by climate change within countries and children on the move across national borders. All of these groups of children often fall through the gaps of traditional data collection and are harder to reach with nutrition programs. We will need to learn from what worked with these populations in conflict and other fragile settings to most effectively deliver programs and collect data. We will also need to think critically about structures that could be applicable across multiple settings to scale up standard delivery and capture of information.