The Multidimensional Condition of Systemic Cooling Poverty Affecting Children's Health Worldwide

Climate change is a global reality.1 Over the past 50 years, ecosystems have undergone more rapid and intense changes than at any other time in human history.2 The latest 2023 report from the United Nations Intergovernmental Panel on Climate Change3 highlights the alarming magnitude and speed of this phenomenon, driven primarily by persistent greenhouse gas emissions. Carbon dioxide concentrations have been steadily rising for over a century, increasing from 280 ppm in the preindustrial era to over 400 ppm today, marking the highest levels in the last 800 000 years.4 Recent years, aside from a few exceptions, have been the hottest ever recorded since environmental temperature monitoring began.5 According to the annual World Meteorological Organization state of the global climate report, 2023 was the warmest year on record, with the global average near-surface temperature 1.45 °C above the preindustrial baseline, with a margin of uncertainty of just ±0.12 °C.5 The decade from 2014-2023 also ranks as the hottest on record.5 This indicates that every component of worldwide socioeconomic systems, including households, must adapt to the escalating impacts of climate change and related phenomena. The effects of global warming typically have a disproportionate impact on the most vulnerable and economically disadvantaged populations, such as the elderly and children.6,7 Recent studies have emphasized that without sustainable and affordable adaptive cooling solutions, countries with high levels of income inequality will face emerging forms of thermal inequality.8 These disparities will affect critical services, including safe sanitation, housing, education, health care, nutrition, and energy access.8,9 In addition, communities in low-income neighborhoods often have less access to cooling resources, leaving them more exposed to rising surface air temperatures and related consequences, such as the urban heat-island effect.8,10,11 Furthermore, increasing humidity levels, coupled with higher surface air temperatures, contribute to thermal stress, increasing heat-related mortality rates and straining public health systems and prevention programs.8,12,13 In this context, a systemic socioeconomic condition known as “cooling poverty” is emerging.8 This condition occurs when public and private structures, families, and individuals are exposed to the harmful effects of increasing heat stress due to inadequate infrastructure.8 It is a multidimensional and global issue with negative impacts on the most vulnerable and socially disadvantaged groups,8 particularly children. This commentary, prepared by members of the European Pediatric Association, Union of National European Pediatric societies and Associations Working Group on Social Pediatrics, explores the nature and multidimensional aspects of systemic cooling poverty and its implications for children's health. The article emphasizes that only through a holistic and multidimensional approach, encompassing technological, social, political, and cultural solutions,14 can the effects of extreme heat be mitigated and the health of children and other vulnerable communities15 safeguarded. We aim to raise awareness among pediatricians about this emerging form of social inequality and highlight the importance of prioritizing children's health in efforts to address current climate emergencies and in the urban planning of future residential areas