Pediatric Critical Care and the Climate Emergency: Our Responsibilities and a Call for Change

Abstract

Critical care is perhaps one of the most "climate-intensive" divisions of health care. As greenhouse gas emissions continue to rise, the unprecedented threat of climate change has belatedly prompted an increased awareness of critical care's environmental impact. Within our role as pediatric critical care providers, we have a dual responsibility not only to care for children at their most vulnerable, but also to advocate on their behalf. There are clear, demonstrable effects of our worsening climate on the health of children, with the resultant increased burden of pediatric critical illness and disruption to health care systems. From increasing wildfires and their effect on lung health, to the spread of vector-borne diseases such as dengue, and the increased migration of children due to a changing climate, the effects of a changing climate are here, and we are beginning to see the changing epidemiology of pediatric critical illness. Ensuring that the effects of ongoing changes are minimized, including its future effects on child health, requires a multifaceted approach. As part of this review, we will use the Lancet Countdown on Climate Change indicators to explore the impact of pediatric critical care on climate change and the inevitable influence climate change will have on the future practice of pediatric critical care globally.

Climate Change and Child Health Inequality: A Review of Reviews

“…Of the included reviews, four were systematic reviews (Table 2) [21][22][23][24], three were technical and commissioned reports (Table 3) [13,25,26] and 16 were narrative reviews, or opinion pieces with substantive literature reviews (Table 4) [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] All reviews and reports were published in international peer-reviewed journals with the exception of the Assembly of First Nations Report which was included as the challenges faced by indigenous children and their families are under-represented in the literature. Sixteen reviews The primary theme of interest in the scoping review was the association of climate change and child health inequalities reported in three specific dimensions; within country differences by social groups, between country differences (LMICs vs. HICs), and living in specific geographical locations.…”

“…Of the included reviews, four were systematic reviews (Table 2) [21][22][23][24], three were technical and commissioned reports (Table 3) [13,25,26] and 16 were narrative reviews, or opinion pieces with substantive literature reviews (Table 4) [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. All reviews and reports were published in international peer-reviewed journals with the exception of the Assembly of First Nations Report which was included as the challenges faced by indigenous children and their families are under-represented in the literature.…”

“…All reviews and reports were published in international peer-reviewed journals with the exception of the Assembly of First Nations Report which was included as the challenges faced by indigenous children and their families are under-represented in the literature. Sixteen reviews had a global focus incorporating LMICs and HICs [13,[23][24][25][27][28][29][30][31][32]34,35,37,39,40,42], four reviews had a specific country focus (US [21], Canada [26,33], Cambodia [41]) and three reviews focused on grouped nations of a specific world region (LMICs [22,24], Sub-Saharan Africa, North America). Reviews were published from 2007 to 2020 and all were published in English.…”

“…Between country inequalities, comparing LMICs with HICs, were reported in 16 reviews [13,[23][24][25]27,31,32,[34][35][36][38][39][40]. All reported descriptive evidence and three reported quantitative evidence [13,23,25].…”

Bedside to Worldwide

“…Climate change is a striking example of a global threat that is anticipated to affect human health in multiple ways, and there are clear implications for critical illness. [3][4][5][6][7] Cardiac, pulmonary, and renal conditions can be worsened by heat stress, and the dangers are worse for older adults, children, and socioeconomically disadvantaged people. Climate change is expected to exacerbate both natural disasters and infectious diseases, with subsequent associated health problems.…”