Ethical considerations regarding the effects of climate change and planetary health on children

Abstract

Climate change represents one of the most significant health challenges and global inequities of our generation. As a ‘wicked’ problem, climate change imposes an involuntary exposure on vulnerable individuals and societies that is regressive in its nature, with those least responsible for destroying planetary health at greatest risk of suffering the direct and indirect health consequences of unabated warming of the planet. The current and future generations of children are the most vulnerable population to suffer the effects of climate change. By 2030, there will be 131 000 additional child deaths each year if climate mitigation strategies are not enacted, driven by the synergy of an increasing burden of infectious diseases, food insecurity and political instability. Over half a billion of the world's children live in areas vulnerable to extreme weather events, and there is a pressing risk that our current lack of action to mitigate and adapt to climate change will result in today's children, and future generations, being the first to have poorer physical and mental health than previous generations – creating a significant intergenerational ethical dilemma. Child health‐care professionals need to advocate for policies to address climate change that consider the complex health, planetary and ethical considerations necessary to solve the most significant risk to our children's health today. Without immediate action, the health of the current and future generations of children is perilous.

Thinking Honestly About Climate Change: Intergenerational Ethics and the Limits of Rationality

“…Stanley et al contend that permitting First Nations communities' decision-making power to improve outcomes and effectively partner with governmental and other resources was critical in the success of the Aboriginal and TSI response to COVID-19. 1 Based on the achievements of Australian First Nations communities, one may reasonably infer that granting similar trust and control of resources and leadership to AI/AN populations may serve to improve health outcomes in the context of COVID-19 and beyond. All providers who serve AI/AN children must also seek opportunities to partner with local tribes to better understand the priorities, needs and historical experiences of the population, ensure adequate training in culturally sensitive care, thoroughly evaluate the social determinants of health, and leverage cultural assets and resilience to preserve Indigenous identity while improving overall health.…”

“…Professor Ian Kerridge 1,2 Professor Paul Komesaroff 1 Despite challenges similar to those facing Indigenous populations world-wide, the authors conclude that the remarkably low morbidity and mortality in these communities due to COVID-19 can be attributed to rapid implementation of best practices and Indigenous leadership alongside transparent communication and collaboration with governmental partners. 1,2 Unfortunately, American Indian/Alaska Native (AI/AN) communities in the United States have suffered disproportionately from COVID-19. According to the Centers for Disease Control, AI/AN people were three to five times more likely to be diagnosed with COVID-19, with twice the mortality rate of non-Hispanic white people.…”

“…3 This demonstrates the impact of suboptimal health-care delivery due to decades of severe social inequities and limited access to resources. 1 Although there is no uniform Indigenous experience, some factors that consistently predispose AI/AN people to health inequity include living in food deserts, crowded, multi-generational households, unemployment, lack of access to technology, distance from health centres and distrust of health-care systems and governments due to historical traumas. 3 While data describing COVID-19 in paediatric patients in AI/AN communities are currently limited, extrapolation of the literature allows us to conclude that the burden of the disease may also disproportionately affect the AI/AN children relative to their non-Hispanic white counterparts.…”

“…Treatment of PRS aims to slow disease progression and provide symptomatic relief. 1,2,5 Immunosuppressive therapies, such as systemic corticosteroids, methotrexate, antimalarials or mycophenolate mofetil, have been used with variable success. 3,5 When clinically stable, cosmetic procedures like autologous fat-grafting can be attempted.…”

“…1,3 However, clinical improvement with immunosuppressive therapy during the active phase of the disease strongly suggests an underlying immunologic-mediated process. 1,3 Neurological symptoms (seizures, headache and facial pain) affect 15-20% of patients and brain involvement can be better evaluated with magnetic resonance imaging. 1…”