Sustainable environments for Australian children's and young people's health and wellbeing: our young's welfare is threatened

As highlighted by the recent World Health Organization–UNICEF–Lancet Commission on children wellbeing, our children face an uncertain future.1 As stated in the Commission's report, “Climate change, ecological degradation, migrating populations, conflict, pervasive inequalities, and predatory commercial practices threaten the health and future of children in every country”.1 The welfare of Australia's children, young people and future generations is certainly under threat (Box).

Ensuring all children and young people have the right to clean, healthy and sustainable environments has recently been adopted within the United Nations Rights of the Child (General comment no. 26).2 “Environments and sustainable futures” is also one of the seven domains considered in the MJA supplement on the Future Healthy Countdown 2030, which aims to track key indicators of children's and young people's wellbeing and outline policy areas where change could make a real difference by 2030.

Australia is doing badly on climate and sustainability issues

Two recent reports highlighted just how badly Australia is doing and how lowly it ranks on climate and sustainability issues.1,3 The premise here is that although high income countries may rank well on conventional statistics that favour survival and flourishing, they are doing so at the expense of compromising a sustainable future for their children. However, total country data hide significant inequalities across diverse groups and locations within the country (see below). The WHO–UNICEF–Lancet Commission created a sustainability rank based on carbon emissions exceeding 2030 targets.1 Using this method, Australia ranked 174 out of 180 countries, with excess emission of 524%. Only Qatar, Trinidad and Tobago, Kuwait, the United Arab Emirates, Bahrain and Saudi Arabia, which are all oil and gas producing nations, ranked lower.1

• How do environmental factors affect children's wellbeing?
• How are many of the world's richest countries faring in terms of providing a healthy environment in which children can live, develop and thrive?
• What actions can these countries take to improve the environments in which children live?

There are also three cross‐cutting themes that will guide how to respond to this report. These illustrate interlinkages, suggesting the need for whole‐of‐government and whole‐of‐society responses; demonstrate the considerable inequalities in these environments and, therefore, the variability in children's responses (thus the causes of poverty in our nations need to be seriously addressed); and identify how powerless children are with respect to influencing policies (with good examples of how to engage young people in the solutions to improving these environments).

The report was a damning indictment for most wealthy countries but particularly so for Australia. Unhealthy living conditions can irreversibly harm children's mental and physical wellbeing, their cognitive development and, hence, their prospects for a happy and healthy life. A life that enables their full participation as citizens. High density traffic, air pollution and limited urban green spaces mean that many children find it hard to avoid such dangers. Children are most vulnerable to these environments as they have a longer lifetime of exposure and are more immature in their ability to mitigate the effects.3,4,5

The UNICEF report card is quite different from its predecessors in two main ways: it focuses on environments that are either positive or negative for childhoods, rather than on measuring and ranking outcomes; and it used high quality data that in many cases did not depend on the nations to provide it. This independently collected information is comparable across time and between geographic locations. The data are used to rank countries across expanding sets of environments: those close to the child such as air, noise and light pollution, water quality, heat and cold, toxicants and pesticides. The next level of environments are community spaces — the area of green spaces and play facilities, housing quality, public transport, walkability and traffic. The overarching global influences include emissions, waste and recycling, management of the natural environment, climate change and natural disasters, renewable energy and housing, transport, and food policies.

If the rest of the world behaved like Australia, we would need five planets Earth to ensure survival for us and our children

Australia performs very badly in the broader category of the world at large, both historically and currently. Australia had very low rankings on areas that should guide our climate and environmental policies.1,3 We produced 21.7 kg of electronic waste per person per year, ranking 38 out of 43. Our consumption‐based carbon dioxide (CO₂) emissions since the Kyoto protocol was adopted in 1997 were 14.8 tonnes per person per year, ranking 39 out of 43 (with the United States and Canada). Australia, the US and Canada emitted more metric tonnes of CO₂ per capita than any other Organisation for Economic Co‐operation and Development (OECD) country. Yet you still hear arguments that we are so small that our emissions contribute very little. If the rest of the world behaved like Australia, we would need five planets Earth to ensure survival for us and our children. Thus, as global citizens we perform very badly indeed. Despite recent changes in government rhetoric, there are still large sections of politics and industry wedded to coal‐fired electricity generation. In addition, gas developments are still being approved, even on sacred Indigenous lands.

In the overall league table, 43 OECD countries are ranked in these three environmental domains. Australia ranks at 30 with Canada (28), Latvia (29) Israel (34) and the US (37). Spain is ranked 1 and clearly performs better than most in all three environmental domains. But no country does well overall and there is obviously substantial room for improvement in all countries. The report highlights how these analyses link to both the UN Convention on the Rights of the Child and the Sustainable Development Goals. So why do we rank so low? Australia ranks well on current air pollution from particulate matter 2.5 (exposure in parts per million), not so well in water‐related morbidity of children aged less than 15 years (maybe influenced by our poor regional and remote water quality),6,7,8,9 too many of our children have high levels of lead compared with children from other OECD countries and more of our children are exposed to pesticide and other chemical pollution. Although Australia rated well on air pollution at the population level, the report did not measure the main pollutant from vehicle emissions (nitrogen dioxide), which we know is poor in certain parts of the country (eg, Melbourne's Inner West).10 Similarly, although water sustainability rated well, access to fresh drinkable water is poor in many rural and remote communities, especially those housing Indigenous children.6,7,8,9

Even though there were no analyses by subpopulation, the data clearly showed that people who are poorer and marginalised (eg, Aboriginal and Torres Strait Islander people) are more likely to have less capacity to cope with the stresses and environmental conditions outlined in this report. Much data collected in Australia relevant to child wellbeing are not categorised by subpopulations,8,11 making meaningful examinations of disadvantage impossible.

There are a number of climate and sustainability issues that are highly relevant to our children. Australia is experiencing unprecedented and extreme floods, fires, major heatwaves, and drought. These events lead to major changes in land use, population displacement, and disruption to children's schooling. The impacts of such events on mental health are being recognised, but perhaps less evident is an increase in child anxiety.12 A global survey of 10 000 children and young people conducted in mid‐2021 reported that 82% of Australian children were at least moderately worried about climate change, with 32% reporting their anxiety negatively affected their functioning.12 Similar data were reported in the UNICEF report, with just over 40% of Australian young people stating they would be hesitant about having children due to climate change and a staggering 60% reporting beliefs that their government was betraying them and their future due to inadequate climate policies.3

Our children are subjected to predatory marketing

One of the sustainability issues highlighted by the WHO–UNICEF–Lancet Commission report affecting children's future was predatory marketing.1 Children are specifically targeted by marketing of unhealthy and unsafe products, especially related to cigarettes and electronic cigarettes, junk food (high in calories, fat, sugar and salt), gambling, and sexualisation of children. Much attention has been paid to junk food and to sexualisation of children, and although these remain problems for Australian children, more attention needs to be paid to electronic cigarettes and gambling. Despite officially not available to Australian children, electronic cigarettes are becoming a growing problem, increasing exposure to toxic chemicals and nicotine, even in those claiming not to include nicotine.13,14 A major problem facing Australia's children is the enormous penetration of the gambling industry into their lives. It is not possible to watch sport without being bombarded by gambling advertising. Children readily recognise logos of gambling companies and are gaining the impression that gambling is harmless — after all if you lose you get your money back.15,16 What is perhaps more disturbing are the political donations from the gambling industry that are currently attracting media attention, which is reminiscent of the past behaviour of the tobacco industry.17,18 We encourage UNICEF to include measures of predatory marketing practices in their next report card.

There are glimmers of hope on the horizon, with a public backlash against gambling advertising during televised sport. Very recently, a public push has emerged for the government to implement a comprehensive ban on sports gambling advertising following the release of the report from the Parliamentary Inquiry on Online Gambling and its Impacts on Those Experiencing Harm.19 Support is increasing among players of some sporting teams for their clubs to reduce reliance on gambling revenue.

So, how can we improve the future of Australia's children and young people? Several groups, including an offshoot from the WHO–UNICEF–Lancet Commission known as CAP‐2030 (Children in All Policies 2030; https://cap‐2030.org/), have suggested viewing all government policy through a child's lens. This would see the responsible Minister explain to Cabinet how the new policy being promoted would affect children if adopted. This would advance several important goals; for example, the impacts on children would be actively considered, the natural government silos would be opened, and governments would be forced to think beyond the next election when framing policy. In addition, publicising the UNICEF Innocenti report widely and making Australia's ranking an instrument by which politicians can be held accountable would improve our children's future.

Turning things around in the environment and sustainability domain is crucial to all living beings, as the goal of keeping global warming within 2°C is slipping further and further out of sight. Key indicators that can help us track our progress in this domain and ensure we can make a difference in this area for children, young people and future generations by 2030 include consumption‐based CO₂ emissions, metric tonnes per capita; and the ratio of a country's ecological footprint to its biocapacity. In addition, we call for indicators of predatory marketing practices, such as electronic cigarettes, gambling and junk food.

Our children are our future, but their future is under threat. A concerted effort is required to change this situation and putting children at the centre of all policy decisions would be a good start.