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[15 December, 2010]

CLIMATE CHANGE INDUCED ENVIRONMENTAL HEALTH OF CHILDREN

by: Jill Lawler, UNICEF East Asia and Pacific Regional Office1
Background Paper for Conference on the " The Environments of the Poor”, 24-26 Nov 2010,
New Delhi2

SUMMARY

According to the Intergovernmental Panel on Climate Change (IPCC), today’s children will
experience at least a 2° C increase in temperatures in their lifetime. Recent studies suggest that
a minimum 3° C increase is more likely. Even if the best case climate projections come true,
many of the region’s children will be facing a future of declining water security, rising pressures
on food production, and increasing disasters and risks of disease, with long-term consequences
on their development.

Children have a right to live in a safe and decent environment, as codified in the UN
Convention on the Rights of the Child (CRC, 1989). Yet this is not a reality for a large number of
children. Too many live in unsafe and unsanitary conditions, characterized by over-crowded
conditions, poor land use management, and high burdens of disease. Too many are socially
excluded into communities with already high levels of poverty, material deprivation and
exposure to environmental hazards and toxic pollutants. Over three million children under the
age of five die each year globally due to environment-related diseases like diarrheal disease
and acute respiratory diseases. Many more die from exposure to environmental hazards or to
toxic pollutants.

The effects of climate change will create an even larger barrier to realizing children’s
fundamental rights. Changing rainfall patterns and rising temperatures will complicate the
provision of clean water and sanitation services when access to quality water is already an
issue. Warmer temperatures and rainfall will likely contribute to more vector breeding grounds,
and to increased disease transmission, especially in locations not previously affected. And
extreme weather events like cyclones, floods and storms will likely lead to increased loss of life
or injury, damage to infrastructure resulting in temporary or permanent displacement. Children
forced into temporary shelters are vulnerable to disasters, disease epidemics, and greater risks
of exploitation and sexual violence.

If we take as a starting point that children’s bodies are different from adults, that they
experience the world differently, then we can begin to understand how children may be
differently affected by climate change. Children are at a particular disadvantage. Their ongoing
development puts them at higher risk of contracting diseases and succumbing to related
complications because they have less acquired functional immune response. Children also

1
Jill Lawler is a consultant with UNICEF’s East Asia and Pacific Regional Office, Social Policy and Economic
Analysis Section in Bangkok. Prior to joining UNICEF, she served as a consultant to the UNDP’s Regional Centre
in Bangkok Enivonment and Sustainable Development unit.
2
For more information, see the conference website: http://www.adb.org/Documents/Events/2010/Environments-
Poor/default.asp
breathe, eat and drink more than adults, and have greater proportionate exposure to toxins and
pollutants as a result.

Available research suggests that climate-related health threats will present as both
potentially new diseases and emergence of new strains of viruses, as well as also changes in
the incidence, range, intensity and seasonality of existing health disorders (McMichael et al.
2008). Climate-sensitive diseases like diarrhea and acute respiratory illness already contribute
to over three million deaths each year of children under the age of five each year and are
predicted to worsen with climate change, with the majority of diseases likely to be borne mainly
by children in developing countries (Haines et al 2006).

Climate change will interact with these and other factors like population growth, inequities in
services, urbanization, land use changes, and environmental degradation. The children of poor
households or from families deprived of basic social services are disproportionately more
vulnerable to the impacts of extreme weather events then those that can afford medical
treatment, or to send their children to school and to provide their children with adequate protein
and nutrients for healthy development. The unforgiving truth is that by virtue of some seemingly
arbitrary circumstance such as standing in society, or location at birth, a large number of
children are unfairly deprived of the basic components for being able to prepare, withstand and
cope to climate change impacts.

Discussions about climate change, vulnerability and children cannot be separated from
broader issues of exclusion, discrimination and wide forms of material deprivation. The
interconnected nature of climate change impacts and existing social and economic deprivations
reinforce the need to take a disparity-based perspective when considering children’s
vulnerability to climate change and the factors that may influence their health and survival. This
paper seeks to illustrate patterns and trends of climate change impacts on child health through
the lens of existing child disparities, making the case for outcome-based policies and
programmes that take children’s entire health and development into account. It provides
recommendations on how research and argues that while better data and coordination is
needed, there is enough evidence of the links between children’s development and from climate
science to warrant stronger action by government, donors, development partners and civil
society.

INTRODUCTION

The IPCC Fourth Assessment Report determined that global warming is “unequivocal” and
that human activities are “very likely” the cause of warming (IPCC, 2007). Between 1970 and
2004, global anthropogenic greenhouse gas emissions – mostly from carbon dioxide from the
burning of fossil fuels -- increased by 70 per cent. Temperatures have increased an average of
0.74° C within the last century. The prevailing view in scientific literature establishes a threshold
of 2° C above pre-industrial levels in order to prevent catastrophic climate effects on
ecosystems and human lives. The best estimate for stabilization based on IPCC scenarios
would lead to 2° C - 2.4° C above pre-industrial levels by 2050. A more realistic projection
based on current emissions and likely policy impacts would be an increase of 3° C above pre-
industrial levels (Arndt et al, 2010; Richardson et al, 2009). Temperatures at this range will have
profound impacts on other climatic parameters, such as rainfall intensity and distribution, carbon
sequestration, frequency and intensity of extreme weather events, soil evaporation and evapo-
transpiration, humidity, and the ocean acidity.
 For many countries, climate change is already a reality. Sea level rise and natural disasters
like floods, droughts and cyclonic weather have contributed to immense economic and social
disruption in damaged infrastructure, injury and destroyed livelihoods, loss of life, and ultimately
displacement. Over 400 million people have been impacted by desertification in China’s arid
regions (IIED, 2007). From 1991 to 2000, damage to agricultural areas due to droughts, floods
and storms cost Thailand up to 50 billion baht (IIED, 2007). (Table 1 provides a summary of
projected impacts for the Asia Pacific region based on the IPCC AR 4).

Table 1: Impacts of Climate Change in Asia-Pacific (IPCC, 2007).

Countries Examples of possible future climate impacts identified by IPCC AR4
Cambodia, Indonesia, • Decrease in the availability of freshwater.
Laos, Malaysia,
• Sea level rise leading to salt water intrusion and coastal flooding causing
Myanmar, Philippines,
significant losses in the built environment and coastal ecosystems.
Thailand, Vietnam, East
Timor • Increases in morbidity and mortality resulting from diarrhea and disease.
• Reductions in crop yields ranging from 5 to 30% by 2050, compared with
1990 levels, with risks of hunger.
Bangladesh, India, • Increase in the intensity of heavy rainfall events, decrease in total number of
Nepal, the Maldives rainy days
• Sea level rise leading to salt water intrusion and coastal flooding causing
significant losses in the built environment and coastal ecosystems.
• Melt water from Himalayan glaciers and snowfields will increase flood risk
during the wet season and strongly reduce dry-season water supplies
• Increase incidence of extreme heat, leading to higher mortality rates
• Changes in intensity of rainfall events combined with increased risk of critical
temperatures could reduce crop yields
Cook Islands, Federated • Sea level rise causing accelerated coastal erosion, saline water intrusion and
States of Micronesia, Fiji, increased flooding from the sea causing significant effects on human settlements.
Kiribati, Marshall Islands,
• Freshwater resources seriously compromised resulting from predicted 10%
Nauru, Niue, Palau,
reduction in average rainfall by 2050.
Papua New Guinea,
Samoa, Solomon • Significant reductions in mangrove areas and coral reefs with knock on
Islands, Tokelau, Tonga, effects on commercial and artisanal fisheries.
Tuvalu, Vanuatu • Reductions in agricultural production both in coastal and inland areas.

At the same time, countries in Asia and the Pacific are confronted with a variety of
development issues in rapidly expanding populations, rising inequalities and social strife, and
widespread environmental degradation. Record growth has lifted millions out of poverty and a
growing majority of people now live in countries classified as either lower or upper middle
income. However, the gains of economic development have not been distributed equally.
Labour productivity in urban areas has increased at a faster rate than labour productivity in rural
ones. This geographic concentration of high productivity has increased inequalities between
rural and urban areas, with wealth predominantly owned by a small proportion of society, and
the poor increasingly concentrated in poor areas.

Differences in development between urban and rural areas are contributing to increased
migration from rural to urban centers where, for Mongolia and China, nearly half of the
population live (2010 estimates). Growing urban populations are placing considerable strains on
natural resources, as well as the government’s ability to provide adequate social services and
employment opportunities. Unemployment and underemployment remain chronic issues for
rural and urban areas. A number of countries still depend on agriculture (including fisheries) for
employment and economic development, which is highly vulnerable to flooding, drought,
typhoons and sea level rise. Logging and slash-and-burn agricultural practices have contributed
to deforestation and soil degradation in some areas, contributing to the risk of flooding, and
worsening air pollution. Social stability is tenuous for many countries as new and increasingly
young workers compete for fewer jobs.

And while the number of children in Figure 1: Prevalence of Stunting, Wasting and
Asia and the Pacific that die before the Underweight of Children under 5 in Asia and Pacific.
age of five has dropped by half – from
6.8 million in 1990 to 3.4 million in Viet Nam
2009 – issues relating to nutrition Vanuatu
Tuvalu
persist. Figure 1 shows prevalence of Timor-Leste
stunting, water and underweight in Thailand
Solomon Islands
Asia and Pacific. One-third of children Singapore
will not reach their full physical and Philippines
cognitive potential in ten of seventeen Papua New Guinea
Nauru
countries, and one in five children are Myanmar
underweight in almost half the Mongolia
Lao People's Democratic …
countries listed. Stunting, or low Indonesia
height for age, reflects the cumulative Democratic People's…
effects of undernutrition and infections China
Cambodia
since birth, and leads to delayed stunting (WHO)
0 10 20 30 40 50 60
motor development, impaired wasting (WHO)
cognitive function and poor school underweight (NCHS/WHO)
Source: State of the World’s Children, 2010.
performance, which are largely
irreversible. Wasting, or low weight for height, is a strong predicator of mortality among young
children under 5 and is usually the result of acute food shortage and disease.

Differences development indicators are widening between groups. Burdens of disease,

mortality, under nutrition, exploitation and proportions of children out of school are highest
amongst poorer households; poorer geographic regions; rural areas; and girls. A rich child or a
child living in an urban area is far likelier to reach age five – and be at the appropriate weight
and height -- than a poor child or a child living in a rural area. Mongolia provides an excellent
example. Of the 49,250 km of roadway in Mongolia, only 2,824 km are paved with the majority
of these located in Ulaanbaatar. The remaining roads are gravel or unpaved surfaces, making
travel difficult. It is no surprise that under-five mortality rates (U5MR) and maternal mortality
rates (MMR) are highest amongst rural areas and amongst poor households, where services
are less likely to be concentrated. For Mongolia, the majority of maternal deaths (40%) occur
amongst herder women.

Children in urban areas face different challenges. Political, socioeconomic, and

discriminatory forces coupled with spatial patterns of industrialization and development typically
segregate the poorest of the poor and the socially excluded into communities with already high
urban poverty, material deprivation and higher levels of exposure to environmental hazards and
toxic pollutants (Morello-Frosch and Jesdale 2006; Williams and Collins 2004). The urban poor
often live in informal squatter settlements located on marginalized land that typically lack
adequate sewage and drainage systems, access to health facilities, diverse asset bases, and
other resources to reduce risk (UNISDR, 2009). Poor drainage in human settlements increases
exposure to contaminated water and provides habitat for mosquitoes, leading to increased
incidence of water-borne and vector-borne diseases.

These issues are all important to children’s health and all influence children’s vulnerability to
environmental hazards and climate change. For many children, vulnerability to climate change
is more than an environmental concept; it is a multi-dimensional reality of undernourishment;
disease burden; school drop-out, child labor; access to education, health care; household
income; and access to water and sanitation. As the next sections illustrate, climate change
impacts will serve as an amplifier of existing vulnerabilities and associated health risks (WHO,
2009; The Lancet, 2009) and will vary greatly among individuals and communities, based on the
extent and magnitude of climate change as well as age, geography, income, health care
availability and quality, nutrition, occupation, genetics and environment (Lancet 2009; WHO,
2009).

CLIMATE CHANGE AND CHILDREN’S HEALTH: ASSESSING THE EVIDENCE

“We recognize that a growing number of diseases in children have been linked to environmental
exposures . . . that environmental exposures are increasing in many countries . . . that new emerging risks are
being identified, and that more and more children are being exposed to unsafe environments.” -- Bangkok
Statement, International Conference on Environmental Threats to the Health of Children, 2002

Table 2: Modalities and mechanisms by which children may be

It is well known that children more susceptible to climate change than adults.
are especially vulnerable to Modality Mechanism Increased Exposure
environmental threats, as Metabolic • Higher respiratory • Air pollution, allergens
evidenced by the above Bangkok rate • Malnutrition, thermal
Statement on Environmental • Higher metabolic rate extremes
• Greater water • Gastrointestinal
Threats to the Health of Children, demand per unit body Diseases, dehydration
and policy work by the World mass
Health Organization and other Behavioral • More time spent • Infectious diseases, air
agencies on developing child outdoors pollution, UV radiation,
environmental health indicators • Vigorous activity thermal extremes,
• Less ability to avoid allergens
(WHO, 2009). Children,
unhealthy situations • Weather extremes, UV
especially those under 5 years, radiation, thermal
• Less swimming
are sensitive to environmental capacity extremes
factors such as temperature, • Drowning
precipitation, air and water Physiology • Greater surface area: • Infectious diseases, UV
quality, owing to their developing volume radiation
• Less detoxifying • Air pollution, infectious
physical, cognitive and
capacity diseases, thermal
physiological capacities (WHO, • Less skin extremes
2009; Akachi et al, 2009). development • UV radiation
• Less immunity • Infectious diseases,
Table 2 shows potential allergens/mycotoxins
mechanisms by which children Time • Greater latency for • UV radiation,
genetic/long-term malnutrition, allergens
may be more susceptible to effect
climate change than adults (see • Greater lifetime
also Annex 2 on children’s exposure time
environmental health indicators Development • Undergoing • Malnutrition, stunting,
for major morbidity and mortality development psychosocial trauma
causes). Children’s bodies are • Morbidity and quality of
life
different from those of adults. Source: Adapted from Bunyavanich, 2003.
Their incomplete development
poses unique complications of under-nutrition, such as permanent stunting. It also puts them at
higher risk of contracting diseases and succumbing to related complications. As children, they
have lower acquired functional immune response. Children also breathe, eat and drink more
than adults, and have greater proportionate exposure to toxins and pollutants per unit body
weight as a result (COEH and Kim 2004; Landrigan and Garg 2005). Their rapidly growing
metabolisms are often not able to metabolize and discharge toxic substances as well as adults
and thus more susceptible to toxic exposure, particularly in the early stages of life. Illness and
disease not only increases a child’s vulnerability to other infectious diseases and associated
mortality, but also undermines a child’s physical and cognitive development, which in turn
affects school performance and productivity during adulthood.

Epidemiological studies on climate and disease transmission show that many diseases are
highly sensitive to climate variability (Kumaresan et al, 2010; IPCC, 2007; Gommes et al 2004).
Literature shows associations between a change in the seasonality of some allergenic species;
a change in the distribution of some diseases vectors; an association between climate and
seasonal distribution of malaria, dengue, tick-borne diseases, cholera and other diarrheal
diseases; and changes in maximum temperatures (heat waves) and extreme weather events
and increase risk of mortality and morbidity.

The extent to which climate change will impact health depends on multiple interrelated
variables. Ebi (2009) states that “human health vulnerability to climate can be defined as a
function of a) sensitivity, which includes the extent to which health, or the natural or social
systems on which health outcomes depend, are sensitive to changes in weather and climate
(the exposure–response relationship) and the characteristics of the population, such as its
demographic structure; b) the exposure to the climate-related hazard, including the character,
magnitude, and rate of climate variation; and c) the adaptation measures and actions in place to
reduce the burden of a specific adverse health outcome, the effectiveness of which may
influence the exposure–response relationship (Ebi, 2009).”

It is difficult to assess specific causal linkages to children’s health due to the lack of
available data -- few of the publications describing health impacts of climate change focus on
effects to children -- and difficulty in scope and presence of confounding variables (Balbus and
Malina, 2009; WHO, 2009; Akachi, 2009). Nonetheless, studies on environment and health
provide enough evidence to suggest that even small shifts in temperature, rainfall, humidity or in
ecosystem function as the result of climate change may increase the risk of climate-sensitive
conditions, such as diarrhea and malnutrition, and could result in increases in total disease
burden (McMichael et al. 2003; National Research Council, 2001; Patz et al. 2005). The
following explores in more detail evidence on environment and climate change, transmission
pathways and impacts to children’s health.

CLIMATE CHANGE, CHILDREN’S HEALTH AND TRANSMISSION PATHWAYS

Mortality and Physical Injuries from Extreme Weather Events

Asia and the Pacific is the most disaster prone area in the world, with 70 per cent of lives
lost to disasters located in the region. According to the ISDR Global Assessment Report (GAR)
of 2009, 75 per cent of global flood mortality risk was concentrated in only three countries:
Bangladesh, China and India, while 85 per cent of cyclone deaths were in Bangladesh and India
(GAR, 2009). Disaster statistics are not often disaggregated by age or gender, so it is difficult to
assess whether the number of child fatalities or injuries have increased over the past decade.
Women and children no doubt comprise a sizeable majority but more detailed research is
needed.

The IPCC projects an increase in the frequency and intensity of extreme weather events like
intense rainfall and droughts, heat waves, tropical storms and hurricanes as warmer
temperatures lead to higher rates of evaporation and consequently higher concentrations of
water vapor in the atmosphere.
Save the Children estimates that 175 million children per year will be affected by climate-related
disasters in the next decade (Save the Children, 2008). Extreme weather events impact
children’s health through loss of life or injury, as well as through the loss or contamination of
potable water leading to disease and poor nutrition, loss of crops resulting in food shortages and
food insecurity, and infrastructure damage resulting in temporary or permanent displacement
(Akachi et al. 2009; Bunyavanich et al. 2003; COEH and Shea 2007; Ebi and Paulson, 2007;
UNICEF, 2007; USEPA, 2009).

Studies show that women and children are The Case of Haiti
disproportionately impacted by natural disasters, with higher
mortality rates from floods and typhoons – drowning is a Haiti provides an example of how
leading cause of deaths of children over one year -- and climate change may exacerbate
higher incidence of psychological trauma due to disruption of existing development challenges. In
February 2010, a magnitude seven
family and social networks (see the section on mental stress earthquake devastated the country,
below). During the 1991 cyclone disasters in Bangladesh, killing 230,000 people, injuring
90% of the 14,000 fatalities were women (UNDP, 2010). 300,000 and leaving over one
Rates among children under ten were over six times greater million people homeless.
Essential services in the most
than men. affected areas were largely
destroyed. As of July 2010, over 1.6
Women are often restricted in their mobility given gender million people lived in temporary
norms that restrict them to remain in the household. They shelters or ‘tent cities’ with no
are also less likely to be able to read, interpret and act on electricity, running water or sewage
disposal. Crime was widespread
information concerning climate risks and adaptation especially against women and girls.
measures (UNDP, 2010). Young children are also exposed
as they typically rely on their mothers for care. Studies show In October 2010, the health ministry
that infants and young children’s chances of surviving reported the first outbreak of
cholera, an intestinal disease
beyond age five greatly reduces if their mother dies, in part caused by ingesting food or water
because they are less likely to receive adequate nutrition contaminated with the Vibrio
and healthcare (Save the Children, 21010). A study in cholerae bacteria. The outbreak had
Bangladesh showed that a child whose mother dies has only been contained in Haiti’s Artibonite
a 24% chance of surviving to the age of ten, but an 89% and Central Plateu regions, but
spread to the capital Port-au-Prince
chance of living to ten if the mother remains alive (Save the as a result of flooding along Haiti’s
Children, 2010). Overall, women and children are more than Arbonite river, the source of
14 times more likely than men to die during a disaster contamination, following Hurricane
(Peterson, 2007). Children forced into temporary shelters are Tomas.
also vulnerable to disasters, disease epidemics, and greater About 583 have died as of
risks of exploitation and sexual violence. November 2010, with over 9,000
hospitalized. Children previously
Though climate related events seem to be increasing, displaced by an earlier earthquake
natural hazards by themselves do not cause disasters. It is and living in tent cities have fallen
ill. Overflow from latrines and septic
the combination of exposure, vulnerability3 and tanks could contaminate the supply
preparedness that influence disaster results. An estimated of fresh drinking water and
55% of the total population of Asia and the Pacific is contribute to the spread of the
expected to live in urban areas by 2030 (ADB, 2008). Many bacteria. As of November 2010, one
tenth of Haiti’s population was in
of these people will reside on marginalized land that typically temporary shelters.
lack adequate sewage and drainage systems, access to
3
Vulnerability is a function of physical exposure to hazards, sensitivity to the stresses they impose, capacity to adapt to these
stresses, susceptibility, fragility and lack of resilience in socio-economic and physical infrastructures (GAR, 2009).
health facilities, and other resources to reduce risk (UNISDR, 2009). A 2008 OECD report
indicates that 900,000 people and US$39 billion in infrastructure are currently exposed to flood
risks in Bangkok. This is projected to increase to 5 million people and US$1.1 trillion by 2070
(Nicholls, 2008). Over one million people reside in coastal slum communities in Indonesia’s
capital, Jakarta, where population density is already 12,635 people per square kilometer (IIED,
2007). Flood risks increase as many natural drainage courses such as canals and ditches have
been filled to make room for roads and infrastructure, preventing rain fall and water surges from
naturally draining. Stagnant water, poor sanitation and congested spaces make these areas
particularly susceptible to disease outbreaks, injury and illness.

Displacement caused by Extreme Weather Events and Climate Change

By destroying infrastructure, homes, land and jobs, climate change impacts can force
families to migrate in search for other sources of livelihoods. UNHCR estimates that in the next
fifty years 250 million to one billion people globally will be forced to move due to climate change
(UNHCR, 2009); many of these will be children. Internal resettlement of coastal populations has
already occurred in Kiribati, Vanuatu and Tuvalu. More people are expected to relocate to cities
as land becomes unusable or for work, leading to more crowded conditions and competition for
scarce resources.

Displacement and forced or voluntary migration raises a host of issues for children including
loss of social networks and cultural identity, disruptions in health care and school attendance,
challenges in birth registration, and greater risk of exploitation and trafficking. Access to health
care and vital supplements and vaccines is often tied to birth registration (UNICEF, 2008).
Children without or with missing birth registration are more likely to be denied access to basic
services and health related programmes.

Displacement also exposes populations to disease as people move into congested areas
where existing or new pathogens exist. The association between displacement and disease has
been documented for malaria, cholera and schistosomaiasis, among others (Prothero 1994; see
text box on Haiti). A study in Timbuktu, Mali following a drought and subsequent migration
reported the crude mortality rate to be twice the national rate due to famine and a measles
outbreak (Carnell and Guyon 1990). Preventative treatment like immunizations, vaccinations,
and medical treatments that require repeated follow-up are difficult to carry out, with children
often lost in follow-up phases due to constant movements (Akachi, 2009).

Women and children account for a large proportion of displaced persons following natural
disasters and are the most susceptible to adverse health effects such as malnutrition and
outbreaks of diseases (Sapir 1993, Chew and Ramdas, 2005). Poorly nourished women and
children are at risk to vector-borne diseases as they typically lack preventative coverage, or
move into endemic areas where they lack the requisite immunity. The spread of falciparum
malaria resistant to chloroquine has been facilitated by movements of people, particularly of
refugees in South East and South Asia (Akachi, 2009; Verdrager 1986, Payne 1987).

Mental health

Children are also subject to adverse psychological suffering from natural disasters and other
outcomes of climate change. Studies following the Asian tsunami in 2005 found that 20-40% of
affected people suffered from short-lasting mild psychological distress (WHO, 2008). Another
30-50% suffered from moderate to severe psychological distress. In Indonesia there was a
reported 15-20% increase in outpatients with anxiety. Younger children and individuals with
greater exposure to and perception of threat experienced higher levels of PTSD and other
psychological disorders.

Water Security

Climate change will alter precipitation, evaporation, run‐off water and soil moisture, affecting
surface recharge and ultimately water security, with risk of disease. In Indonesia, studies
indicate a declining trend in stream flow over the past two decades for some of the largest
watersheds. In Thailand, the number of rainy days have decreased since 1959. And in
Mongolia, drought conditions have increased by 95% in the last 60 years with the worst drought
period registered between 1999-2003 which affected 50-70% of the country. A 2007 study found
852 of Mongolia’s 5,128 rivers and streams, 2,277 out of 9,306 springs and 1,181 out of 3,747
lakes and ponds have dried up over the past decade.

Changes in snow and glacier melt will also affect seasonal variation in runoff, causing
flooding and water shortages during dry summer months. Glaciers feeding the Yellow River in
China have already retreated 17% leading to a loss of 2.39 billion cubic meters of water which
would have served as a water source for the river. Data from Mongolia suggests that glacial
melt is occurring at a much faster rate than previously expected, contributing to high spring river
flows, which now begin 5-20 days earlier and last an average of 10 days longer. River flows
have become increasingly unpredictable, with too high or too low flow rates during the wet and
dry seasons. Retreating glaciers will threaten long-term water resources as glaciers contribute a
sizeable portion of freshwater resources in the region. In the short-term, the fast pace of melting
could actually increase glacial runoff and river flows.

Variations in rainfall will likely impact surface water resources and ground water recharge,
and cause flooding, soil erosion, and landslides, and impact access to quality water sources
when access to freshwater sources is already strained. Some of the most densely populated
and economically vibrant areas are also located in water scarce areas. Withdrawal for
freshwater sources is already high for many countries, with the majority of water going to
agriculture and industry, leaving a limited amount for domestic use.

China offers a telling example. Studies indicate that rainfall in China has declined an
average rate of 2.9 mm/10a since the 1950s with regional and seasonal variations. Withdrawal
for freshwater sources is already high at roughly 549.76 cu km/yr, with agriculture consuming
68%, and industry 26%, leaving only 7% for domestic use. China depends on 400 billion cubic
meters of water per year for irrigation alone (expected to reach 665 billion tonnes by 2030).
According to China’s National Assessment on Climate Change, increased agriculture production
(in part due to better weather conditions) will likely lead to water shortages of 20 billion m3 /a
between 2010-2030. China’s per capita water resources of 415 cubic meters per year is one
fourth the global average, and some of the most populous and economically vibrant areas of
China are also the most water stressed. Water scarcity has already cost China $39 billion a year
in lost crops, lower industrial production and economic output.

China is not unique. Per capita water availability in Indonesia is only 372 cubic meters per
year, with Java the most water scarce of all provinces. (Per capita allocation of 1700 cu/m/yr is
considered the benchmark for water scarcity.) Mongolia is already water stressed with only 599
cubic kilometres of water comprised of glaciers, lakes and streams. Under most IPCC
scenarios, future water resources are likely to be seriously compromised for all Pacific Islands
as coastal erosion and saltwater intrusion risk contaminating freshwater supplies. Higher water
temperatures, increased precipitation intensity, and longer periods of low flows will likely
exacerbate issues of water scarcity as freshwater
supplies come into contact with various of forms of
pollutants including sediments, nutrients, dissolved
organic carbon, pathogens, pesticides, salt and thermal
pollution.
The challenge is that many households already lack
access to quality water, and of sufficient quantities. An
estimated 406 million people in rural areas and 60 million
in urban areas still live without access to clean water in
Asia and Pacific. The proportion of households with
access to clean water is only 50% for the Pacific Islands
with almost all urban households have access to
improved water compared to about a third of rural
households. Over half (52%) of urban households in
South-East Asia have access to piped water compared to
about a third (16%) of rural households (WHO-UNICEF
JMP, 2010).
Water pollution from organic and factory waste has
rendered large quantities of Viet Nam’s water unsafe for
drinking at the time when demands for water are
increasing. According to the ADB, eleven out of the 16
river basins in Viet Nam have no domestic wastewater
treatment, and while sixty percent of hospitals have
wastewater treatment plants, only 18% are considered to
be properly operated. A large amount of wastewater from
hospitals and factories is discharged into the public
sewage system. The region as a whole is off-track, with
only 36% of households in South Asia, and just over half of those in East Asia and the Pacific
Islands using improved sanitation sources (WHO/UNICEF JMP report, 2010). Poor sanitation
systems leave ever unpredictable water sources vulnerable to fecal contamination.
Pacific Islands
The Pacific Islands are particularly
vulnerable to impacts of climate change
due to their small size, population
density, poor infrastructure, proneness
to natural disasters, exposure to global
economies, and low adaptive capacity.
Most islands have limited water supplies
and any variations in the distribution
and frequency of rainfall could lead to
drought conditions. Under most IPCC
scenarios, future water resources are
likely to be seriously compromised as
coastal erosion and saltwater intrusion
risk contaminating freshwater supplies.
Rising sea levels coupled with
reductions in rainfall will likely
compound the risk to water availability.
Coastal flooding and heavy rainfall
patterns may lead to the transmission of
water and vector borne diseases such
as malaria, dengue and
schistosomiasis. Extended periods of
drought together with loss of soil fertility
from saltwater intrusion and coastal
erosion will likely impact agriculture
production and food security for most
Pacific islands. Without adaptation, the
World Bank estimates economic
impacts for high islands (e.g. Fiji) to be
US$23–52 million per year by 2050 and
US$8–16 million a year for lower islands
(e.g. Kiribati) (IPCC, 2008)

The above shows that even without added pressure from climate change, millions of
children will still suffer from diarrhoeal diseases and intestinal worms because of unsafe water,
inadequate sanitation and poor hygiene. Changing rainfall patterns, extreme weather events
and rising temperatures will complicate the provision of clean water through contamination,
destruction of infrastructure, and unpredictable flow levels. The majority of the disease and
mortality burden and the associated social and economic costs will continue to be borne
disproportionately by the poorest and most disadvantaged households. Vulnerability in this
regard is ultimately related to policy decisions. Laying water pipes and developing treatment
plants is time and resource intensive. Improvements in water access tend to be concentrated in
municipal areas where there are greater economies of scale. For families not connected to
piped services, disruption in water flow could force families to use untreated water for cooking
and hygiene, with risk of disease, as discussed below.

Transmission of Water and Food Borne Diseases

Acute water shortages from droughts and contamination of freshwater supplies from
flooding will increase the number of people using untreated water for drinking or crop irrigation,
increasing the risk of infectious water borne diseases (e.g. diarrhea, hepatitis A, typhoid fever
and cholera). Poor water and sanitation has been associated with increased risk of infections in
children (Daniels et al., 1990; Huttly et al., 1990; Mertens et al., 1990); increased malnutrition
(Adair and Guilkey, 1997; Huttly et al., 1990; Daniels et al., 1991; Ricci and Becker, 1996); and
lower physical growth as evidenced by stunting (Merchant et al., 2003). In Viet Nam, about 44%
of children are already infected with whipworms, hookworms or roundworms, contributing to
malnutrition. Water and food-borne illnesses also contribute to higher mortality.

A range of studies have analyzed the relationship between temperature, humidity and
rainfall and the occurrence of various pathogens (WHO, 2008). Though exact causal linkages
remain unclear, climate variables may have an impact on the replication rate of certain bacterial
and protozoan pathogens that cause diarrhea (Campbell- Lendrum and Woodruff 2006; Drayna
et al., 2010; Fleury et al., 2006; Singh et al., 2001; Thomas et al., 2006; Zhang et al., 2008).

Of the studies measuring climate impact on disease, the most reliable data seems to be the
impact of temperature on diarrheal disease (broadly defined). For instance, a study in Dhaka,
Bangladesh found a correlation between temperature and non-cholera diarrhea with diarrhea
cases per week increasing by 6% per 1°C increase (Hashizume et al., 2007). A study from
Japan found that the weekly number of infectious gastroenteritis cases increased by 8% for
every 1°C increase in the average temperature (Onozuka et al., 2010). In a recent study from
two sites in China, a regression analysis found increases of 11–16% in the number of cases of
bacillary dysentery for each 1°C temperature increase (Zhang et al., 2007). And a study tracking
temperature and childhood diarrhea prevalence in Lima, Peru found that admissions for
childhood diarrhea increased by 7 per cent per 1°C increase in mean temperature (Checkley et
al., 2000). Admissions doubled to 200% of their previous level during the 1997–1998 El Niño
event when the temperatures in Lima were 5°C above normal.

Cholera also seems susceptible to temperature. Based on an analysis of monthly 18-year

cholera time series data, the study found that climate phenomena (El Niño) accounted for over
70 per cent of disease variance suggesting a strong association between ocean temperature
rise, rainfall and cholera (Rodo Et al, 2002). Excessive rainfall and warm temperatures have
been associated with increases in plankton blooms (Colwell & Patz, 1998; Lipp et al., 2002)
which provide nutrients for Vibrio cholera.

Studies analyzing the relationship between rainfall and diarrhea are more uncertain. Some
studies suggest a link between flooding and communicable diseases such as cholera and
hepatitis A (e.g., leptospirosis) (Patz and Khaliq, 2002). Others have reported no association
between rainfall and transmission of diarrheal pathogens (Zhang et al., 2007); while others have
found an association between low levels of rainfall and high incidences of diarrhea (Singh et al.
2001). However, anecdotal evidence suggests some correlation between heavy rainfall and
disease outbreaks. In September 2008, more than 200,000 people in northern Thailand were
diagnosed with waterborne diseases after 19 days of heavy flooding (IRIN, 2008). In Mumbai,
India, an eight-fold increase in leptospirosis incidence was noted after severe flooding in 2005.
And in Manila, Philippines, a large outbreak of leptospirosis was reported after tropical storms
and severe flooding in October 2009. The number of leptospirosis-related hospital admissions
increased from 140 to 1027 in 3 days, with a case–fatality rate of 8.6%.

Heavy rainfall, drought and other climate-related events increase human’s exposure to
harmful pathogens through complex transmission processes. The extent of these influences is
highly dependent on the pathogen mix, overall health of the population, and water and
sanitation infrastructure in different regions, and the availability of antibiotics and preventative
health interventions like vaccinations. Extreme weather events like flooding and storms can
disrupt public health services and infrastructure,
destroy sanitation and sewer systems, disrupt
refrigeration and cooking processes, or lead to
wide scale contamination of safe water supplies,
forcing people to access poorer quality water
supply sources, often sharing water with
livestock.
A large number of children are already
vulnerable to disease even without added
pressure from climate change in increased
exposure to pathogens, destruction of sanitation
and health facilities and others. In Asia and the
Pacific, diarrhoea caused 11 per cent of all
deaths among children under the age of five and
is ranked as the fifth leading cause of death in
the world (Black et al., 2010; WHO, 2008).
Thermal Stress
Climate change is expected to increase the
frequency and intensity of extreme heat days
and heat nights. Studies suggest this is already
occurring. Data from 70 monitoring sites
distributed across Mongolia show an 8-18 day
increase in the length of annual heat waves (or
days over 25-30°C). Trends in extreme
temperature across the South Pacific for the
period 1961 to 2003 also show increases in the
annual number of hot days and warm nights,
and decreases in the annual number of cool
days and cold nights. A 2008 study conducted
by the Department of Meteorology found that
from 1991-2000, the maximum average
temperature in Bangkok in the summer months
was significantly higher than the long-term
average.
The most widely studied effect of thermal
stress to health relates to heat stress, though
mortality rates increase at both high and low
extremes of temperature (Curriero et al. 2002).
In estimating the impact of future climate change
on heat-related mortality, Gosling et al (2008)
found an association between mortality and
increases in the mean and variability of
temperature rather than with change in the
mean temperature alone. Threshold temperatures where heat-related deaths began to occur
varied indicating the importance of other factors such as socioeconomic conditions and
availability of suitable infrastructure in heat-related mortality.
Compounded Effects of Drought and Extreme
Winters in Mongolia
The 2010 dzud is indicative of how climate change
will amplify existing vulnerabilities. Mongolia is no
stranger to severe winters or ‘dzuds’. A series of
dzud events in 2000-2001 and 2001-2002
contributed to a 40 per cent decline in agriculture
productivity, a 20 per cent decline in its contribution
to GDP; malnutrition and death.
The 2010 dzud was particularly severe as it was
preceded by other climate stresses. Warmer
temperatures, declining precipitation and poor land
use practices have reduced available pastureland
for animal grazing. A series of summer droughts
prevented herders from stockpiling sufficient hay
and fodder reserves to sustain their animals through
the winter. Higher-than-usual winter snow fall
prevented animals from accessing what pastures
remained. Snow prevented farmers from accessing
stored feed for the animals. Short periods of
unseasonable warming during winter months led to
rapid melting and freezing of ice. This formed a
hard, impenetrable ice-cover which prevented
animals from grazing, leading to famine and
livestock kill, with devastating effects on herder
families reliant on livestock for food and income.
Deaths of children under-5 years increased
substantially between January-March 2010
(UNICEF Mongolia, 2010). In the first three months
of 2009 for example, an under-five mortality rate of
23.4 per 1000 live births was recorded. For the
same period in 2010, under-five child mortality has
already reached 28.7 per 1000 live births with a
dramatic increase in the affected aimags reaching
39.7. March alone registered a 35-40% increase in
infant and under-five child mortality in dzud-affected
areas.
Causes of death were the result acute respiratory
infections, malnutrition and exposure due to poor
heating, inadequate food and water supplies and
poor sanitation and shelter. Snowfall limited
families’ ability to access food, fuel and medical
services while poor road access and infrastructure
prevented critical medical care and food supply
from reaching these families.
Deaths and illness were largely preventable with
better land use and health planning. for instance
prepositioning food, water, heath and fuel supplies
before the winter season; training of community
health workers and developing emergency
response.
 Rising temperatures are correlated with higher body temperatures while humidity hinders
the body’s natural cooling process by decreasing sweat evaporation. Both can lead to heat
illness and death from cardiovascular, cerebravascular and respiratory disease. Death and
disease seem to be concentrated amongst people over the age of 65 (Huynen et al., 2001)
though studies from Brazil (Wyndham and Fellingham 1978; Gouveia 2003) and Sydney (Lam,
2007) suggests that infants and young children are also vulnerable.

Generally, children spend more time outside playing and are susceptible to heat exhaustion
and dehydration. Children living in unstable settlements with no access to electricity and air
conditioning are particularly susceptible to heat exposure as are urban areas as heat is trapped
between tall buildings, known as the urban heat island effect. A Study by Lam (2007) showed
an association between the number of hot days and child hospital admissions, mostly for fever
from heat stress, and an increase in hospital admissions for gastroenteritis (Lam, 2007). In
California, incidence of emergency room visits of children aged 0-4 years with electrolyte
imbalances increased compared to periods without heat waves (Knowlton et al, 2009).
Dehydration has been linked to renal effects in children due to lower urine volume and higher
saturation of stone-forming salts (Fakheri and Goldfarb, 2009).

Respiratory Illnesses

Effects of childhood exposure to ozone and particulate matter have been well documented.
Ambient air pollutants such as nitrogen dioxide, ozone, and organic compounds have been
linked with respiratory problems including coughing, asthma and shortness of breath; wheezing
and chest pain; inflation of the lungs and increased susceptibility to respiratory illnesses like
pneumonia and bronchitis; decreased lung function; and permanent lung damage with
continued exposure (Silverman and Ito 2010; Bateson and Schwartz 2008; Rodriguez et al.
2007; Trasande and Thurston 2005; McConnell et al. 2002, McConnell et al. 1999). Studies
have also shown increased rates of preterm births, low birth weight, and infant mortality in
communities with high particulate levels (Akachi, 2009). Weed pollen and grass pollen have
been associated with children’s asthma exacerbations and emergency department visits and
hospitalizations (Héguy et al. 2008; Schmier and Ebi, 2009; Ziska et al. 2008; Beggs et al,
2005).

Though not a direct effect of climate change, indoor air pollution from the burning of biomass
fuels such as wood, crop waste and dung, and coal contributes to an estimated 1.6 million
deaths annually with more than half of these deaths children under age five (Akachi, 2009).
Indoor air pollution ranks fourth in risk factors for death and disease in developing countries
(WHO, 2010). Indoor air pollution has been linked to low birth weight, increased infant and
perinatal mortality, and acute respiratory tract infections in children (Suk, 2003; Smith, 2000).

Warming temperatures are expected to exacerbate the existence of ozone and other
pollutants, such as nitrogen oxides, particulate matter and sulfur oxides. For instance, Ebi
(2008) reviewed how climate change could affect future concentrations of tropospheric ozone
and particulate matter and potential effects on health. The study found that climate change
could affect air quality through changes in chemical reaction rates and changes in airflow
patterns that influence pollutant transport (Ebi, 2008). Higher levels of ozone and other
particulate matter could exacerbate cardiovascular and respiratory disease, pollen and other
allergens. Increasing CO2 levels have been shown in laboratory and field studies to increase
plant biomass and to raise the pollen production of ragweed (Beggs and Bambrick, 2005; Beggs
and Walczyk 2008).
 Considerable uncertainty remains over the degree of future climate change, future
emissions of air pollutants and their precursors, and how population vulnerability may change in
the future (Ebi, 2008). However, it seems likely that climate change will compound problems
associated with already high levels of air population, cardio-respiratory illnesses and other
related diseases. Children are especially vulnerable to air pollutants as their lungs are still
developing, and children breathe at a higher rate than adults, taking in more harmful
compounds which, because their lungs are still growing, may remain in the lungs for a greater
duration (EPA, 2010; Bateson and Schwarts, 2008). Children’s evolving immune system means
they are less able to fight infection. Data on potential impacts of climate change on respiratory
health show enough of a correlation to warrant further research.

Toxic exposures

Changes in precipitation, minimum and maximum daily temperature and evaporation rates
have been linked to changes in the density and distribution of mycotoxin-producing fungi, and
specifically aflatoxin, which typically effect grains and legume (Ono et al 1999; Stosnider et al.
2006). Long-term exposure increases the risk of cancer, impaired growth, birth defects, and
immunity suppression (Etzel, 2002). Increases in child mortality have been recorded as a result
of acute outbreaks of aflatoxin (Strosnider et al., 2006; Williams et al. 2004). Climate change
may also lead to a changing global distribution of heavy metals such as mercury and lead and
to greater exposure to chemicals and pesticides (Booth and Zeller, 2005; Noyes et al. 2009;
Boxall et al., 2009; Confalonieri et al., 2007; Carrie et al., 2010). Exposure to harmful chemicals
and other pollutants during the fetal stage or during the period of child’s life where tissues and
organs are developing can have significant long-term impacts on organ growth and functioning
(Gavidia et al., 2009).

Vector-borne diseases

Temperature, humidity, levels of precipitation, soil moisture and sea level rise can all impact
the transmission of vector-borne diseases (Epstein, 2000). The clearest association between
climate change and prevalence of infectious vector-borne diseases seems to be with malaria
and to some extent dengue fever. Studies of temperature effects on malaria have found that
increased temperatures shorten the viral incubation period in mosquitoes, shorten their breeding
cycle, increase the frequency of mosquito feeding and, with for instance dengue fever, allow a
more efficient transmission of dengue virus from mosquitoes to humans. A study in Colombia
using historical climate data and annual malaria case data from 1960 to 2006, found that a one
degree Celsius change in sea surface temperature (associated with an ENSO cycle) translated
to an approximate 20 per cent increase in malaria cases (Mantilla et al. 2009).

In modeling effects of weather and climate change on malaria transmission, Parham (2010)
identified a temperature window of around 32–33°C where endemic transmission and the rate of
malaria spread in disease-free regions increased (Parham et al., 2010). Mosquito extinction
increased at temperatures above or below this range, preventing, in this case the Plasmodium
parasite, from completing its life cycle (due to a rapid decline in vector survival probability at
higher temperatures and a rapid increase in the duration of the cycle at lower temperatures)
(Parham et al., 2010).

Malaria already claims the lives of 800,000 children per year and causes 350 million to 500
million illnesses annually (WHO, 2005). The percentage of the world’s population exposed to
malaria is expected to increase from 45 per cent to 60 per cent in the next 100 years due to
climate change (Save the Children, 2007). Pregnant
women are particularly at risk. Malaria contributes to
increased maternal anaemia and maternal death, low
birth weights and neonatal death.
Dengue fever is also sensitive to increased
temperatures, humidity and rainfall (Gubler et al., 2001).
Cooler temperatures slow the replication process for the
virus serotypes (of the genus Flavivirus) that cause
dengue fever. Hales et al. (1999) found a positive
relationship between monthly dengue incidence and
temperature and rainfall in the south Pacific where an
outbreak of dengue fever in Fiji coincided with the 1997–
1998 El Niño (Hales et al, 1999). Other vector-borne
diseases that are affected by climate variability include
Jencephalitis, Lyme disease, Yellow fever,
Leishmaniasis and Schistosomiasis. A study by Rao et
al. (2000) found that incidence of Jencephalitis in India
increased as temperature and rainfall increased (Rao et
al 2000). In Europe, rising temperatures have led to a
latitudinal shift in ticks, resulting in changes in the
incidence, distribution and transmission of tick-borne
encephalitis. Increased temperatures are expected to
expand the transmission of Schistosomiasis to non-
endemic areas in the north of China (Zhou et al., 2008).
Warmer temperatures and increased humidity and
rainfall may lead to more vector breeding grounds, larger
vector and pathogen populations, resulting in increased
disease transmission and in locations not previously
affected. However, despite these studies, there is still
debate as to the exact role that climate plays in driving
malaria and dengue epidemics (Pascual et al. 2008;
Zhou et al. 2004). Climate alone may not be an accurate
predictor of disease transmission. Transmission also
requires that the reservoir host, a competent vector and
the pathogen be present in an area at the same time and
in adequate numbers to maintain transmission (IPCC,
2007).
Undernutrition
Child nutrition is a complex issue involving a variety
of external factors such as household income, maternal
health and education, vaccinations and medical care at
birth, disease, and feeding and hygiene practices at
home (HDR, 2010). The effects of undernutrition are bi-
directional (Scrimshaw 2003, Walter 1997, Victora
1990). Diseases like diarrhea, malaria and respiratory
illness weaken children’s nutritional status. A weakened
immune system from undernourishment can leave
Effects of Climate Change on
Agriculture and Fisheries
Despite industrial development,
agriculture still comprises a large portion
of GDP for a majority of countries,
making them highly vulnerable to the
impacts of climate change, namely
changes in temperature, precipitation
and salinity of water, and distribution of
arable land.
- In China, agriculture employs 39.5% of
the population and contributes 11% of
GDP, with industry and services
contributing another 40% respectively.
- Agriculture (including fisheries)
employs 65% of the population in
Vanuatu and contributes 26% of total
GDP.
- Over 75% of people in the Solomon
Islands derive their livelihoods from
agriculture.
- Agriculture employs 43% of Thailand’s
population and contributes 12% of
GDP. Agriculture (including fisheries)
employs 42% of the population in
Indonesia and contributes 14.4% of
total GDP.
Fishermen and farmers rely on annual
floods, sediment and river-borne
nutrients to sustain fisheries and
agricultural production. Changes in
temperature and rainfall patterns, floods
and droughts will disrupt these patterns
and ultimately impact productivity.
Changes in rainfall patterns will also
affect the ability to predict planting
seasons leading to damage of first crops
and/or delay in harvesting, resulting in
hectares of farm land laying fallow.
Fish stocks and aquaculture are also at
risk as warmer water deprives fish of
oxygen, kills other nutrients which fish
rely on for food, and disrupts spawning
grounds. Changes in rainfall patterns and
increased salinization of freshwater
sources affect the Ph balance of water,
making some waters inhabitable for
sensitive ecosystems and certain
species of fish. The ultimate result could
be fewer and smaller-sized fish.
For subsistence and small-scale farmers,
this could increase the incidence of
poverty and malnutrition as lower crop
productivity and fish catch mean less
food for consumption and for trade, and
children susceptible to pneumonia, diarrheal
Figure 2: Household Vulnerability - expenditures on food
disease as well as at higher risk of infection (%)
(Mihrshahi et al., 2007; Shell-Duncan, 1995). Poorest 30% and national average
The affects of illness and disease are further
confounded by undernutrition (Friedman et Fiji Island
al. 2005, Mihrshahi et al. 2007). Disease can
inhibit food intake, nutrient absorption, cause
Lao PDR
nutrient losses and dehydration (through
diarrhea), and increase the nutrient
requirements to support organ and tissue Mongolia
growth (Stephensen, 1999). As the previous
sections described, climate change will Bottom 30% of
Thailand
amplify issues relating to undernutrition households
through increased incidence of water and National average

vector-borne disease. Vietnam

Climate change may also impact nutrition

by directly impacting agricultural yields and 0 25 50 75 100
Source: Key Indicators, 2008. ADB.
worsening growing conditions in areas
already experiencing food insecurity (see text box on agriculture and fisheries) (Parry et al.,
2005). Over 80 per cent of global agricultural land is rain-fed making crop productivity highly
vulnerable to variations in temperature and precipitation. It is projected that cereal crops and
pasture yields will likely increase with moderate warming (1-3 °C) in mid- to high-latitude regions
due to longer planting periods and more favorable growing conditions (IPCC, 2008). Yet mild
warming will likely contribute to declines in crop yields for seasonally dry and tropical regions.
For East Asia and Pacific, rice yields are expected to decline by 11.3 % and in South Asia,
wheat production is expected to decline by 50% (International Food Policy Research Institute,
2009).

Some of the region’s largest food producers are projected to experience a decline in crop
productivity as a result of climate change. Rice yields in Thailand are expected to decline
between 6 and 40% in the next 50 years with a one degree rise in temperature. The IPCC
estimates that by 2030, up to 45% of the Mekong Delta –Vietnam’s rice bowl and also home to
four million poor – would be exposed to ‘extreme salinization’ from sea level rise and saline
intrusion, leading to declines in crop productivity, with rice productivity falling by 9 percent. This
comes as global food demand is rising. China alone is expected to import 175 million tonnes of
grain by 2030; however, current global supply is only 200 million/tons (IFPRI, 2009. Future
supply is not expected to meet global demand. Climate change models indicate a potential
doubling of food prices for all the major grains by 2050. Higher food prices will threaten the
poor’s ability to afford nutritious food, this when a growing number of people are already
considered food insecure.

The poor spend a disproportionate amount of household income on food (see figure 2). On
average, the poorest 30% pay almost 50% of their household income on food compared to the
national average. An increase in the price of staple foods would be the equivalent of a decrease
in real income and would further reduce the amount of disposable income available for
purchasing crop inputs (e.g. seeds for replanting), as well as health care and education. With
few assets and little access to insurance, families may be forced to withdraw children from
school, forgo health treatment or cut food expenditure.
 Lack of access to affordable nutritious food could exacerbate prevalence of undernutrition,
and especially stunting, which are already high. Studies of climate shocks in India, Bangladesh,
Zimbabwe and Ethiopia show the transmission of weather-related shocks to nutrition deprivation
and stunting. In Ethiopia, children born during drought years were 41 per cent more likely to be
stunted than those born in non-drought years (HDR, 2007). Studies of children’s nutritional
status in India revealed both stunting and wasting (Singh et al., 2006). The implication is that
even a small risk of increased droughts could lead to large human development setbacks (HDR,
2007).
Livelihood Shocks in Mongolia

Livelihoods Mongolia is highly dependent on pastoralism for

Climate change impacts the livelihoods of
the poor through the culmination of repeated
floods, drought and other disasters. For
families just barely able to meet their basic
needs, any additional income stress from
delayed harvests or increased costs for
agricultural inputs could drive families to
adopt coping strategies that ultimately
exacerbate their underlying vulnerability (see
text box on Mongolia).
Urban and rural areas will be impacted
differently. Whereas the rural poor often build
up productive assets like livestock as a form
of self-insurance during times of shocks, the
urban poor are more limited in their asset
creation and their access to insurance. A
single shock (flood) or a combination of
repeated shocks (repeated droughts) can
send families into poverty, impacting
children’s lives, development and overall
potential as families are forced to adopt
coping strategies such as withdrawing
children from school, selling off liquid assets
that lead to further entrenchment of chronic
poverty.
economic development. The pastoral livestock sector
engages over half of the population; provides food
(meat and milk) and fiber to a majority of Mongolia’s
population; and contributes one-third of total exports.
Agriculture, including herding, employs roughly 34% of
Mongolia’s population and contributes over 21% of total
GDP of which the majority is based on livestock and
livestock productivity (e.g. wool, milk etc.).
Changes in plant phenology and biomass due to
temperature and precipitation changes may have
serious implications for Mongolia’s 45 million livestock
as pasturelands decline. Areas with unfavorable
grazing conditions are expected to increase from 40%
to 70% by 2050 and to 80% by 2080. Live-weight of
animals is expected to decrease significantly,
especially in the forest-steppe and steppe regions.
Data already show a decline in average weight of
sheep, goat and cattle by 4kg, 2 kg and 10kg
respectively from 1980-2001. Low weight impacts other
development processes such as fertility and birth,
productivity, and resilience to cope with extreme winter
weather. Animal mortality is expected to increase to
12% by 2020, to 18-20% by 2050, and to 40-60 % by
2080.
Livestock and livestock productivity is the livelihood
base for nearly half of Mongolia’s population. Animal
by-products such as dung are used as energy sources
for cooking and heating, while wool provides important
clothing during winter months. Loss of livestock means
less income, less food and less protection for these
populations.

How climate change will affect children’s nutritional status is difficult to quantify due to other
confounding socio-demographic factors such as population growth, changing diets (for meat
and dairy), competing claims to agriculture lands (e.g. shifts from food to biofuel production),
and changes in water use for irrigation and industry. Another main driver of food insecurity is the
use of low input subsistence methods, slash and burn agriculture, which lead to deforestation
and soil degradation, and yields lower than the agronomic potential, which is often not enough
to feed a family let alone provide sustainable income. This reinforces the point that health
planning and related policies will need to go hand-in-hand with broader development policies
and sustainable land use practices.

FINDINGS AND RECOMMENDATIONS

 The previous section outlined the role of climatic parameters, disease and infection
dynamics and children’s health. Available data seem to support the assertion that climate
change will amplify existing health issues. The health threat that climate change presents is not
only one of potentially new diseases and emergence of new strains of viruses, but also changes
in the incidence, range, intensity and seasonality of existing health disorders (McMichael et al.
2008).

Despite improvements in our understanding of some transmission processes, there is still

considerable uncertainty over the impacts of future climate change. Studies mainly focus on
impacts to adults, and on risks that are easier to quantify using standard epidemiological
methods (e.g. impact on heat and cold extremes). Yet, children’s bodies are different from those
of adults. Their incomplete development poses unique complications of under-nutrition, such as
permanent stunting. It also puts them at higher risk of contracting diseases and succumbing to
related complications. As children, they have lower acquired functional immune response.

Climate change will interact with these and other factors such as population growth,
inequities in services, urbanization, land use changes, and environmental degradation. The
children who already lack access to health and other critical services, or who already suffer from
high burdens of climate-sensitive diseases, will be the most vulnerable to a range of risks
related to weather and climate, from flooding to infectious diseases.

The interconnected nature of climate change impacts and existing social and economic
deprivations reinforce the need to take a disparity-based perspective when considering
children’s vulnerability to climate change and the factors that may influence their health and
survival. That a significant number of children do not have access has to do with policies and
the way resources and services are distributed. Public policies create and perpetuate disparities
by allocating resources and services to easier to reach, more politically influential and generally
better off sections of society. The case of water utilities is indicative of pro-rich policies where
the poor pay significantly more than the rich for water services. User fees, opportunity costs and
the cost of medicines create additional barriers to access. The wealthy are better able to pay
user fees, afford nutritious foods and ensure that their children receive needed immunizations
and medical care when needed. There are a number of areas where governments and partners
can engage.

Better Targeting and Scaling Up Proven Interventions

Many of the health risks and outcomes associated with climate change are already being
addressed through low cost, high impact interventions like immunization, micronutrients for
children and women (vitamin A supplementation, iron-folic acid supplementation and
fortification, multiple micronutrient supplements, therapeutic zinc, and salt iodization), de-
worming tablets, behavioural change for adequate infant and young child feeding and care
practices. These interventions are relatively cheap. A package of six vaccines assembled by the
World Health Organization costs less than $1, and deworming (which can increase school
attendance) cost just 50 cents a year (HDR, 2010). The World Bank has found that sanitation
promotion and hygiene promotion are the most cost effective of any health intervention, costing
$11 and $3 per DALY averted respectively, which is almost 100 times more cost-effective than
ORT, which costs $1062 per DALY averted and less than insecticide-treated nets ($17 per
DALY) (Ross et al., 2009). Safe disposal of excreta can reduce diarrhea by 36%. Hand washing
with soap can reduce diarrhea by 45% and Acute Respiratory Illness by 23%. (Ross et al.,
2009)
 Public education and awareness campaigns have proven effective in reducing the risk of
waterborne diarrheal diseases. A study covering 278,000 children in 45 developing countries
showed that actions of parents, such as providing fluids during episodes of diarrhea,
significantly reduced the prevalence of common diseases that kill children (HDR, 2010). These
same strategies can help reduce risks and mitigate the effects of climate change on children.
Scaling up improved water and sanitation services would reduce diarrhea while ensure access
in the case of decreasing and more variable water supplies.

Strengthening Investments for Health Systems

Additional investments will be needed to strengthen and improve health systems, water and
sanitation services and related health infrastructure to be able to meet current and emerging
challenges, especially where capacity is already weak.

Cost estimates for strengthening country capacity in the face of climate change are
substantial. The United Nations Framework Convention on Climate Change estimates that by
2030, USD$5 billion dollars per year will be needed for treating malaria, diarrhea and
malnutrition. An additional USD$11 billion per year will be needed for water supply and
infrastructure. This is on top of the USD$22 billion needed by 2015 to improve maternal,
newborn and child health (Global Strategy estimates) and the US$40 billion needed in additional
investment to enhance human resource capacity to be able to meet MDG 4 in the lowest
income countries. This is important as areas with already high levels of child mortality will likely
face greater pressure with climate change.

Health systems are already struggling to deliver quality services to the poor and most
vulnerable. Natural disasters can destroy infrastructure and disease epidemics can overwhelm
already fractured systems. Climate change will likely change the spatial distribution of vectors
and potential diseases to non-endemic areas. Disease epidemics become even more important
in the context of increased displacement and population movements. Countries will need to
increase spending in health care to scale up coverage in these areas. Eliminating user fees to
primary health care will go a long way in ensuring that children have immediate access to vital
care in times of emergencies. Advances in mobile phone technology for disease surveillance
and emergency services, diagnostic tests, transport systems (e.g. bicycle ambulances) make
the scale-up of primary services more feasible, rapid, effective, and inexpensive. Access to such
services will be important particularly in disaster prone areas.

Strengthening Surveillance and Response to Hazards and Disease

Multi-hazard warning systems and disease and nutrition surveillance will need to be
developed to identify emerging epidemics or changing disease patterns. Equipment and
supplies (e.g. de-worming tablets, iodized salt, oral rehydration fluids, etc.) will need to be
positioned in advance in areas estimated to be hardest hit by climate change. Studies have
shown that visits by community health workers in the first hours and days following birth
significantly improve newborn survival and maternal health among rural populations. However,
the capacity of health workers is critically low, especially for some of the most disaster prone
countries. The WHO estimates that of the 68 countries with the highest burden of maternal and
child deaths, 53 do not meet the critical threshold of 23 physicians, nurses and midwives per
10,000 people considered generally necessary to deliver essential health services (WHO,
2010).
 A significant number of health workers will need to be hired and trained to be able to
respond to new health emergencies and diseases not previously addressed (e.g. dengue in
higher altitudes), and help coordinate proper emergency response and disaster preparedness.
Involving communities in the design and implementation of health plans, and providing medical
first-responder training can be an effective low-cost strategy to scale-up at least a baseline of
medical care in times of emergencies. Local public health efforts have been shown to make
substantial differences in the morbidity and mortality from natural disasters (Keim, 2008) as well
as the influence of climate on vector borne diseases.

Expanding Social Protection

Other policy approaches, tools and financing arrangements and mechanisms will be needed
to accommodate new drivers of change. Progressive taxation, social safety nets and social
protection, pro-poor public spending on health, nutrition and education have been tried and
tested, with clear benefits to the poor. Improving social welfare, particularly educating and
empowering women, is a fundamental requirement for improving health. A study by Save the
Children found that cash transfers that actively target children under five as well as pregnant
and lactating mothers have the potential to tackle malnutrition brought about by climate change i.
Countries could pilot integrated social protection systems that offer a suite of community-based
options to address poverty and livelihood insecurity as a result of disasters and climate change
(e.g. micro-insurance for farmers and fishermen, targeted benefits packages based on food
prices etc.).

Child-centered Data Generation and Policy Development

Better child health data and meteorological data is needed to determine who and where the
most vulnerable are (e.g. geographical areas or ethnic groups living in areas prone to food
insecurity, flood or drought risks), their specific vulnerabilities as well as the factors that can help
build their health resilience to a range climate and other drivers of change (e.g. socioeconomic
development, rapid urbanization, environmental degradation etc. Incorporating climate
vulnerability indicators within Multiple Indicator Cluster Surveys (MICS) is one low cost
intervention that could be employed to monitor and capture sub-national variations in child
development indicators which may signal risks for greater vulnerability. Governments could
work with academic institutions, the private sector and UN agencies on creating a system that
integrates child-specific data (MICS data; Health and Nutrition Management Information System
data etc.), with climate change statistics, to improve data documentation and flag trends in
children’s health that requiring further investigation.

Research should not be an end in itself but should seek to guide our understanding of where
change is likely to occur, and support public health policies that best respond to this change.
Data outcomes should be integrated and rooted more firmly within poverty reduction and
sustainable development strategies and health planning. This means expanding focus on
climate change from purely the realm of environment and environment ministries – which are
typically the least well-funded and politically influential of the sectors -- to other key sectors,
such as health, planning and finance so that climate change activities become an integral
component of all aspects of policy-making.

Strengthening Partnerships and Coordination for Positive and Sustained Results for Children

There is need for better coordination between government ministries and sectors. Countries
should develop a joint agenda or programme of work that address the wider determinants of
poor health and mortality. The Hyogo framework for Action and Bali Action Plan support such
comprehensive approach. There should also be a mechanism to continuously update and
incorporate current and projected climate change risks into existing health policies, plans and
programmes. National health plans should link with country health information systems, disease
prevalence, budgeting and planning processes (Ross et al, 2009).

Health impact assessments, water sector assessments and other vulnerability-based

assessments will be needed to determine how and to what extent children will be affected by
climate change as well as identify strategies for managing those risks. There is a need for
quality and continuous environmental health indicator data that are disaggregated by age group
and include childrenii. The World Health Organization is pilot testing internationally comparable
children’s environmental health indicators according to context, exposures, health outcomes,
and actionsiii. Including children’s issues to the range of criteria used to develop and assess
public policy interventions can help build in sustainable methods for data collection and ensure
climate-proofing measures to ensure that programme activities meet intended outcomes in the
most effective way.

Countries will require access to international funds to be able to adapt to climate change,
predict its likely effects on health systems, and reduce the risk and impact of natural disasters or
epidemics. A number of multi-donor funding mechanisms have been created to address
mitigation and adaptation measures. Donors, national governments and multilateral institutions
should increase investment for and support to health strategies that have proven effective in
tackling malnutrition and poverty among the poorest families. Cooperation between and within
countries, and across multiple sectors of society, will be crucial for scaling up context
appropriate solutions.

Partnerships with non-state providers (civil society organizations, faith based organizations,
non-governmental organizations and the private sector) can help governments reduce the
financial and logistical burden of public service delivery, while increasing coverage of services
vital for building the adaptive capacity of communities. Examples include public-private
partnerships in waste removal and providing clean water, as well as enhancing access to
schools and health facilities, in areas that are particularly vulnerable to climate change.
Partnerships with national and local media can help advance child-friendly messaging and
outreach campaigns (e.g. disaster risk reduction, behavior and hygiene, etc.), and enhance
visibility of specific child-based health issues.

Involving and Learning from Children

Children and youth comprise a tremendous resource of skill and creativity that has yet been
tapped. Many children are already aware of climate change through access to various forms of
media and through formal and informal education. Experiences with community risk mapping
and mitigation activities show that children have a much greater capacity to participate in
disaster risk reduction than previously assumed as they are often those most familiar with their
physical surroundingsiv. They can be strong stewards and advocates for the environment,
helping their homes, schools, and communities adapt to climate change. Governments could
work with youth focus groups to understand and promote youth strategies for addressing
climate, encourage youth participation in ecological restoration and protection, and develop safe
community health, water and sanitation plans or road maps that map out climate risks.
Governments and partners can ensure that climate change action plans, community-based
health plans, education and awareness initiatives, and DRR interventions pay attention to
children’s concerns.
CONCLUSION

Evidence of current climate impacts provides ample justification for adopting a more prudent
course. It is in the context of present and future deprivations that countries must consider their
obligations to uphold children’s fundamental rights. Enhancing health equity should be a priority.
A variety of old and new interventions may need to be considered. Adopting a holistic approach
to child health, focusing on health outcomes rather than on specific diseases or interventions,
will ensure that all children benefit. The Integrated Management of Childhood Illness (IMCI)
could be one model. IMCI is an integrated approach to child health that focuses on the well-
being of the whole child and includes both preventive and curative elements that are
implemented by families and communities as well as by health facilities (Ross et al., 2009).
Countries should revisit their commitments under the Alma-Ata Declaration regarding
strengthening first-level primary care, and develop costed strategies to strengthen health
systems based on need, evidence and available resources.

The interventions listed above have been effective in reducing poverty inequity, and
improving overall human development. These should be scaled up where appropriate and new
interventions considered in light of changing risk profiles, giving priority to areas where coverage
is already below the national average; where child mortality is already high; and where
increases in the disease burden are likely to overwhelm existing capacity. Policies to provide
free primary care to strengthen existing primary healthcare systems can go a long way in
making the children of Asia and the Pacific live longer, healthier lives.

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ANNEXES

ANNEX 1: HUMAN RIGHTS AND CLIMATE CHANGE

Example of Rights Threat from Climate Change

Right to Life
International Covenant on Civil and Political
Rights (ICCCPR, Article 5); The Convention on
the Rights of the Child (CRC, Article 6);
Universal Declaration of Human Rights, Article
3 related disorders impacting on child growth and
Right to adequate food
International Covenant on Economic, Social
and Cultural Rights (ICESCR art. 11; CRC art
24 (c); The Convention on the
Rights of Persons with Disabilities (CRPD arts.
25(f), 28 para 1); Convention on the Elimination
of All Forms of Discrimination against Women
(CEDAW art. 14, para. 2 (h)); ICERD art. 5 (e);
Universal Declaration of Human Rights, art. 25.
The Right to Water
ICESCR arts. 11 and 12; CEDAW art. 14, para 2
(h); CRPD art. 28, para. 2 (a); CRC art 24, para
IPCC AR4 projects with high confidence an
increase in people suffering from death, disease
and injury from heat waves, floods, storms, fires
and droughts.
Threat of increase in hunger and malnutrition and
development; cardiorespiratory morbidity and
mortality related to ground-level ozone.
Food production projected to initially increase at
mid to high latitudes with an increase in global
average temperature in the range of 1-3° C. At
lower latitudes crop productivity is projected to
decrease, increasing the risk
of hunger and food insecurity in poorer regions of
the word.
Poor people living in developing countries are
particularly vulnerable given their disproportionate
dependency on climate-sensitive resources
for their food and livelihoods.
Loss of glaciers and reductions in snow cover are
projected to increase and to negatively affect
water availability for more than one-sixth of the
world’s population supplied by melt water from
2 (c) mountain ranges.

Weather extremes, such as drought and flooding,

will also impact on water supplies, exacerbating
existing stresses on water resources and
compounding the problem of access to safe
drinking water, a major cause of morbidity and
disease.

The Right to Health Increases in malnutrition, increased diseases and

injury due to extreme weather events; increase in
diarrhoeal, cardiorespiratory and infectious
diseases.

Spread of malaria and vector borne diseases

(Decreases capacity to adapt to climate change,

and threatens functioning of health systems
worldwide)
Right to the highest attainable standard of Threat of sea level rise, storm surges to coastal
health: settlements

ICESR arts. 7 (b), 10 and 12; CEDAW arts 12

and 14 para. 2 (b); Universal Declaration of
Human Rights, art. 25; ICERD art. 5 (e) (iv);
CRC art. 24; CPRD arts. 16, para 4, 22, para 2.
And 25; ICRMW arts. 43, para 1 (e), 45, para 1
(c) and 70.

Right to Self-Determination Rising sea levels threaten territories and livelihood

sources of low-lying states.

ICESCR, art 11; ICERD art. 5 (e) (iii); CEDAW

art. 14, para 2.; CRC art. 27, para 3; ICRMW art.
43, para 1 (d); CRPD arts. 9 para 1 (a), 28 paras
1 and 2 (d); Universal Declaration of Human
Rights, art. 25.

ANNEX 2: Children’s Environmental Health Indicators for major morbidity and mortality
causes (WHO 2009).
i
Save the Children, 2009
ii
Akachi et al., 2009
iii
WHO, 2009
iv
Mitchell et al., 2009