Too hot to handle: Are we doing enough to protect children from extreme heat?

The UN Secretary General, Antonio Guterres, has issued an urgent call to action to address the impacts of extreme heat and protect the most vulnerable.

Around the world — and here in South Africa — temperatures are rising, and activities such as the burning of fossil fuels are driving a rapid rise in the intensity, frequency and duration of heatwaves. Deadly heat puts everyone at risk, but it is the most vulnerable — including children — who are hardest hit. Yet many parents, healthcare workers and local government officials are ill prepared and oblivious of the potential danger.

Heat is often described as a silent killer. People are often unaware of the risks until they are in serious trouble. While heat cramps cause mild discomfort, rising body temperature can lead to heat exhaustion, and to life-threatening heat stroke.

While the human body can adapt to higher temperatures — by sweating to cool itself down — this becomes a whole lot harder at higher temperatures and in humid conditions. And when the heat index — a measure of both temperature and humidity that captures their combined effect on the human body — climbs above 40°C, it poses a serious risk to human health.

Infants and young children are particularly vulnerable, as they heat up more quickly than adults and can easily become dehydrated or go into shock. They are also dependent on adults to regulate their temperature and fluid intake. Yet their specific needs and vulnerabilities are rarely addressed in government policies and heat action plans.

While those living in green belts of the suburbs have access to air conditioning and shade to protect them from extreme heat, those living in informal housing are at greater risk, as temperatures can be up to 10 degrees higher than outside, with the highest indoor temperatures exceeding 50°C. This threatens the health of children left indoors, as well as those attending the many early childhood development centres housed in poorly insulated shacks or shipping containers. An estimated 1.6 million South African children (8%) live in informal housing, a third of whom are under the age of six.

Significant threat

While long-term climate plans acknowledge heat as a significant threat in South Africa, this isn’t reflected in many city preparedness or emergency response plans. The CSIR’s 2019 Green Book highlights the cities most at risk, including Upington, Kimberley, Mahikeng, Bloemfontein, Musina and Mbombela. This is based on a projected rise in very hot days (above 35°C), combined with increases in heatwave days (unusually high temperatures for three or more consecutive days).

Heat and humidity alerts should be central to our early warning systems, together with clear public health guidance for families, schools, communities, health facilities and disaster management teams on how to prepare for — and respond to — extreme heatwaves. These should include specific guidelines for pregnant women, mothers, infants and children. Access to air-conditioned spaces and drinking water to prevent dehydration during heatwaves, as well as climate-proofed housing, early childhood development centres, schools and health facilities are urgently required.

While there is much to learn from other countries, we also need to ensure that global guidance is tailored for the South African context, and that it doesn’t deepen inequalities or further contribute to global warming. So, it is vital to choose cooling strategies that are affordable, safe and sustainable.

How to keep cool during extreme heat

Figure adapted from: Lancet Series on Heat and Health and South African Heat Health Action Guidelines.

Hot drinks such as tea and coffee raise our internal temperature, while sugary drinks increase the risk of dehydration and heat-related illnesses.

The Child Health Priorities Association (CHPA) of South Africa aims to address critical challenges affecting the health and wellbeing of South Africa’s children — including climate change: “As paediatricians and members of the child health community, we already bear witness to the impact of climate change on children’s physical and mental health. We are also uniquely positioned to work together with children and young people to raise awareness and take action to mitigate the impact of climate change on child and adolescent health and wellbeing.”

The association has therefore issued a call to action inviting other stakeholders in health, education, local government, children and communities to join them in ensuring that children and young people are protected and prioritised in our collective efforts to mitigate the impacts of climate change.

A call to action on climate change and child health

1. Push for Rapid Emissions Cuts: Advocate for urgent action to reduce carbon emissions and limit global warming.
2. Champion Climate Justice: Call for a fair shift to renewable energy and sustainable food systems, with those most responsible for climate change funding solutions.
3. Protect the Vulnerable: Ensure children and marginalised communities are shielded from climate impacts, and that adaptation efforts uphold human rights.
4. Put Children at the Centre: Demand that climate policies and plans explicitly address children’s unique needs.
5. Climate-Proof Children’s Spaces: Support upgrades to homes, schools and early childhood development centres to withstand extreme weather.
6. Green the Health System: Promote sustainable practices in healthcare to reduce its environmental footprint.
7. Educate the Health Community: Empower health professionals with knowledge about climate change and its effects on child health.
8. Empower Children and Families: Promote climate education in schools and communities to help families protect children’s wellbeing.
9. Strengthen Local Health Services: Build resilient, community-based healthcare systems that can handle climate-related shocks.
10. Prepare Clinically: Develop guidelines to help healthcare workers respond to heatwaves and other climate-related health issues.
11. Partner for Preparedness: Work with local governments and disaster teams to ensure child-focused emergency planning.
12. Support Research and Innovation: Collaborate with communities and children to build evidence, track climate impacts, and drive solutions.

Strong leadership and political will are essential to reduce global emissions, protect health from rising heat, and safeguard our children and future generations — and this includes taking proactive steps to protect children from extreme heat this summer. DM

James Irlam is a Senior Lecturer in the Primary Health Care Directorate, University of Cape Town, where his work focuses on environmental health and evidence-based healthcare. Lori Lake is a Communication and Education Specialist at the Children’s Institute, UCT, where her work focuses on children’s rights and advocacy for child health.