Climate Change,Climate Justice,and Children's Mental Health: A Generation at Risk?

Introduction

Environmental justice (EJ) research has informed our understanding of the multifaceted relationship between diverse, and frequently intersecting, environmental harms and social inequalities. According to the World Health Organization, climate change is the greatest threat to global health in the twenty-first century. ¹ Anthropogenic climate change threatens to undermine the past 50 years of progress in public health. ² Climate change poses the greatest threat to those who are the least responsible; those who are already vulnerable to deep-rooted challenges such as poverty and often living in areas with poor air quality or greater susceptibility to flooding or other weather hazards. Climate change is a threat multiplier for children's physical and mental health. It exacerbates existing disparities in children's health that are a direct product of poverty and structural racism. Children from low-income communities and communities of color often have greater risk of exposures to environmental hazards and the impacts of climate change and these impacts have the potential to have a profoundly adverse impact on child mental health.

Climate Change and Climate Justice

The distribution of risk related to climate change resembles that of broader health and illness risk patterns in conditions affected by social determinants, linking climate change vulnerabilities to health vulnerabilities through their susceptibility to social disadvantages. In the discussion of climate and health, the concept of climate justice is closely aligned with the concept of EJ. Climate change, similar to other environmental hazards and exposures, disproportionately affects people of color, those in lower income groups, those with lower socioeconomic capital, those with less political power and influence, and children. ³

The vulnerability of any group is a function of its sensitivity to climate change-related health risks, its exposure to those risks, and its capacity for responding to or coping with climate variability and change. Many factors can impact the ability to prepare for, respond to, and cope with the impacts of climate change on health. Among these factors are living in low-income communities with limited access to health care, having limited availability of information or resources in a person's native language, living in a region particularly vulnerable to impacts of climate change, for example, coastal regions or below sea level, and insufficient resources to relocate or rebuild after a disaster. ^{4 , 5}

Vulnerable groups, or populations of concern, include those with low income, some communities of color, immigrant groups (including those with limited English proficiency), indigenous people, pregnant women, older adults, vulnerable occupational groups, persons with disabilities, and persons with pre-existing or chronic medical conditions and children. ⁶

Climate change undermines the social and environmental determinants that underpin good health, exacerbating economic, demographic, and social inequalities. ⁷

Psychological and Mental Health Impacts of a Changing Climate on Children

Children are particularly vulnerable to adverse health impacts associated with environmental exposures due to factors related to their immature physiology and metabolism, their unique exposure pathways, their biological sensitivities, and limits to their adaptive capacity. They have a proportionately higher intake of air, food, and water relative to their body weight compared with adults. Children also interact with their environment in ways that may increase their exposure to environmental contaminants, for example, hand-to-mouth behavior and more time spent outside. ⁸

The interaction between climate change and other factors such as developmental stage, living conditions, diet, economic status, and living situation can increase a child's vulnerability to climate-related health threats. Therefore, although children are a uniquely vulnerable group, not all children will be equally affected by climate change. The most adversely impacted children will be those who live in areas that are most vulnerable to the impacts of climate change and those with less resilient infrastructure, and fewer services and supports. ⁹ Children living in poverty are also less likely to be able to respond to or escape from extreme weather events. ¹⁰ Children in the developing world, where 85% of children live, and those living in poverty in the “developed” world will suffer the greatest impacts. ¹¹

The significant and varied impacts of climate change on adults' physical and mental health are now well recognized. ¹² Although much less attention has been given to the psychological and mental health impacts of climate change on children research is emerging to inform our understanding and provide opportunities to plan for risks, adapt to changes, and protect mental health in children.

Indirect Effects

The indirect effects of climate change upon a child's well-being after an extreme weather event or the slow degradation of homelands may add to the longevity of the adverse mental health outcomes, often prevailing for extensive lengths of time and requiring years of mental health support. ³⁰ After an extreme weather event, children may continue to be affected by depression, anxiety, sleep disorders, substance abuse, aggression, and suicidal tendencies. The trauma that children experience from climate change and climate change-related disasters may impair the ability to regulate emotions and result in behavioral issues, inability to adjust, cognitive and language deficits, and diminished academic performance. ³¹ All of these may persist into adulthood. In cases of extreme heat, mood and behavioral disorders may be escalated in children, especially exacerbating pre-existing mental health conditions, and the onset of suicidality may occur. ³² Climatic events increase the prevalence of violence, including child abuse and domestic abuse, further jeopardizing the mental health mantle of children. ³³

In high-income developed nations, children are attuned to the detrimental impacts of climate change and harbor intense feelings of strife regarding their future. Such children have expressed grave concerns about the threats of climate change to their future and demonstrate fear, anxiety, anger, and despair when discussing the environment and its unstable future. ^{34 , 35} Although this grief transcends socioeconomic situations, the sense of loss is particularly piqued in indigenous and subsistence communities. The gradual environmental degradation is particularly damaging to the well-being of children in communities with deep cultural or working ties to the land. A “sense of place,” the concept that one's identity, both cultural and personal, is intertwined with the land and as the impacts of climate change alter this landscape and destabilize livelihoods and food security, this notion erodes. ³⁶ The loss of identity and generational knowledge attributed to the deprivation of traditional lands through climate change is echoed through the distress of its people, which has been documented in Australian Aboriginals, Ghanaian farming communities, and tribal communities along the Arctic Circle, where the negative effects of climate change are intensified. ^{37 , 38}

Migration and Refugees

Through an unplanned migration or displacement, children may face additional stressors of social isolation and marginalization due to the disruption of social and/or familial ties. ³⁹ In addition, children may face temporary or permanent separation from guardians, loss of homesteads and culturally significant places, and abrupt interruptions in education, which may contribute to further adverse and long-term mental health outcomes. ⁴⁰ Social ties are a major protective element in population health as they shield communities from social and financial stressors while supplying infrastructure for emotional support. ⁴¹ Migration and displacement due to climate change introduce a slew of challenges for children, including “fragmented social networks and separation from family, loss of familiar social contexts, poor social connections, diminished sense of belonging, economic deprivation, inadequate housing, little educational and job security, and in some cases mandatory detention.” ⁴²

Forced migration contributes to escalations of “psychiatric morbidity” through factors of increased violence, which affect vulnerable groups such as children disproportionally. ⁴³ Resource scarcity fueled by climate change, followed by mass displacement, is a factor of social strife, as currently seen in southern Sudan and Syria, although causation is still unclear. ^{44 , 45} Climate change is expected to increase population migration and displacement well beyond typical levels. ⁴⁶ During the first half of 2019, extreme weather events, many of which were attributed to climate change, resulted in the displacement of 7 million people, a record that exceeded all previous mid-year figures. ⁴⁷ The severity and prevalence of migration and displacement driven by climate change are expected to increase.

Conclusions

Health equity and mental wellness, particularly in the context of a swiftly changing climate, will require society to move away from the traditional approaches that use the more narrowly focused medical model, which is intent on treating and curing disease and less on wellness and prevention. A public health systems-based framework for action is needed to respond to mental health issues arising from climate change. Implementing such a framework will assist in recognizing and confronting the complex and often-times difficult-to-achieve social determinants of health and these influences on mental health.

A systems-based public health framework that enlists a community-based participatory approach for action can provide a comprehensive platform for identifying critical components that will improve mental health, and for developing effective strategies for change. A participatory systems-based approach would encourage dialogue and problem-solving for community-specific issues among those most affected by the broader health and social justice issues, with those who create policy. ⁵⁵