Comment

Platforming youth voices in planetary health leadership and

advocacy: an untapped reservoir for changemaking
Although there was an effort to include diverse voices at
the 2021 UN Climate Change Conference (COP26), many
youths’ pleas for ambitious climate action were not met
in the updated commitments, highlighting the reality
that time at the podium does not necessarily influence
the key policy and finance decisions that shape our
climate-dependent future.
Many of today’s youth are already experiencing the
worst impacts of our destabilising climate. Over half
of the world’s youth population live in countries that
are deemed extremely high risk for climate disasters,1
and the mental health of countless more young people
has been impacted by climate instability.2 Given the
considerable stake and tenacity that young people have
in addressing climate change, it is essential to platform
their voices in high-level decision making.
Youth activists, such as Greta Thunberg, have mobilised
An example of an effective model is YOUNGO: the
children and youth constituency of the UN Framework
Convention on Climate Change. This constituency
forms a global network of youth activists ensuring that
youth perspectives are included in decision making. In
addition, the 2021 UN International Youth Day event on
Aug 12, 2021, provided a platform for youth to engage
in the theme of transforming food systems ahead of the
food systems summit on Sept 23, 2021.5
Youth collaboration with health institutions is
essential. The Rhode Island Department of Health’s
Youth Advisory Council and the California Endowment
are organisations that encourage youth to advise
For more on Vinisha
on multiple issues. Youth involvement within these Umashankar at COP26 see
organisations has allowed for the creation of policy and https://indianexpress.com/
article/india/we-will-lead-if-you-
programmes that target the intersectionality of the dont-indian-schoolgirl-to-world-
climate crisis and public health. leaders-at-cop26-7605863/

and demanded accelerated climate action from their

leaders. Other young people have passionately taken to
policy, technology, the arts, and advocacy as their tools
for action. Vinisha Umashankar, the 15-year-old Indian
su th
pe s, a shi uth

Id
g
ou iat rtn ng s,

le. en wi
rin

en in h nd e
e y nit pa sti on

In for
ng ive er yo
op nd ps

tif ig xp

cre pl
ag h i al xi uti

student and entrepreneur who invented a solar-powered Ed

y t to ng su ss es

y a h- er

n
ng ut din g e tit

as ane uc
ilit ity lo on ro tiv

io
nd lev tis

e a ta
o e yo itu ltin ins

at a
ab bil nd c ac ec

cc ry
co el d e o

ironing cart to replace the charcoal-powered versions

nt isi l a by on rsp

es he
gr

m ec f s

tio
ou v fu ns ti pe

sib a
pe is ub am
te

n
cc ing ng io ta h

ilit lth
In

ns ion jec bi
l a id ni sat sen ut

that are commonplace in India, addressed world leaders

at m t tio

y t an
na rov ea ni re yo

ef a m n

os dc
tio , p m ga ep rse

or kin att of

ch vi
at COP26, saying, “we [the youth] will lead if you don’t”.
tu ks ing or h r ve

ed g er yo

oo c e
sti or p d ut di

uc by ex ut

l-b ng
in etw velo s, an yo ate

i
at co pe h.

as ag
However, despite being capable changemakers,
io m rts
n de nt ase gr

ed em
na p
led s, me cre Inte

r
l b lem wit

e so nt.
ar e h t

youths face structural and institutional barriers to ur

rie nt he

ce
e
rs ing e
h- te rn in

s
to t ne
ut oca ve d

participating in the decision making processes that shape

yo adv go an

yo he rgy
ut au a
h e th nd

climate action. Reflecting on the successes of existing

ng ori
ag ty
em

youth engagement approaches,3 we propose a four-

en

Framework for
t

pronged strategy—consisting of integration, education, championing youth

planetary health leaders
ts. e
pe

en tiv

climate health storytelling, and investment—by which

En tiv
Us onn

rsp

m va
su es
e c ec

ge no
ec
c

re of
lim tio

ga in

governments, organisations, and the planetary health

th yo

en for
at , e

at u
eh m

th ng

th s
ea rce

movement can champion youth leaders and foster

e l pe
ea pa
n

y h ou
ive o
lth th

ar es
d c ple
s

et ry r
to an

intergenerational climate health leadership (figure).

lim ar
ry d

lan ta
y,
te to c

at do

d p ne
llin fu ris

e h cu

se o

First, the strategic and meaningful integration of

cu -m
g a rth is.

e
ea m
lth en

fo on
cro er

h- n
ex ed
ss col

youth voices must become a pillar of planetary health.

ut nd
pe a
all lec

yo y a
rie d
do tiv

t
Cl i

or tar
nc am
m ea

The mechanisms to achieve integration include:

ma

es p

led ne
ain ct

an lifi

h- o
te

s a ion

t
ut e m

en
d ed
he

s a on

(1) consulting existing youth advocates, (2) developing

tm
yo ilis

hs s
a lt

to th

ve
ob

to
ol e

In
M

ry
.
fo clim

longitudinal relationships with youth-led networks, tel

rh a

lin
um te

g
(3) providing visibility to youth engagement initiatives,
an

and (4) ensuring accountability for engaging young

people.4 Figure: Recommendations and strategies to foster youth engagement across all domains of planetary health

www.thelancet.com/planetary-health Vol 6 February 2022 e78

 Comment
For more on the Nurses Climate
Challenge initiative see https://
nursesclimatechallenge.org/
For more on the Climate Stories
Collaborative see https://
climatestories.appstate.edu/
e79
A comprehensive review of health studies found
that, of 420 studies collecting data from youth (aged
18–24 years), just 21 incorporated youth in the research
process.5 There are too few opportunities for youth
engagement in health research. Furthermore, journals
should publish pieces championing the efficacy of
youth participation in planetary health research and
health research pieces to which youth have directly
contributed.6
Second, integrating youth voices into the folds of
planetary health cannot happen without an established
foundation of knowledge on the subject. Numerous
organisations provide educational resources for
individuals to seek out. For instance, the Community
Check-Up is a US environmental health organisation that
builds youth climate health literacy. However, education
must also extend into classrooms; in nations with free
secondary education, the curriculum often fails to address
environmental health and teach the communication
skills required to effectively advocate. Across the world,
achieving adequate access to learning, especially for the
62 million girls without educational access, is imperative.
Furthermore, ensuring a minimum of 12–13 years of
quality education for girls advances three crucial goals to
improve planetary health: reproductive health, climate
leadership empowerment, and workforce preparedness
for roles that can further green practices.7
Institutions, and particularly those in academia
and the policy sector, often fail to address the steep
education barrier between school and higher education
that delegitimises youth opinions and prevents them
from engaging with sustainability decisions at a more
influential level. For example, becoming a physician can
take 11–16 years of training, and, with our opportunity
to tackle climate change narrowing every day, youth
cannot wait to climb the ladder of higher education. This
education barrier partly explains why environmentally
concerned institutions often adopt a silo mentality,
in which an aversion to information sharing leads to
reduced efficacy and morale; this manifests in isolated
and tokenistic youth-centred programmes that are
insufficient to allow young people to have a meaningful
say in key decisions. Combining expertise from clinical
specialists and planetary health experts with youth’s
ingenuity and passion is a promising solution.
Third, in addition to integrating young people into all
tiers of planetary health decision making, organisations
and institutions should showcase and articulate the
lived climate experiences of young people. Youth have
a unique vantage point to share their experiences
of being brought up in a climate-altered world, and
this storytelling can tap into core human values, such
as health, garnering empathy and understanding.8
Prime case studies include the Nurses Climate
Challenge initiative, which mobilises nurses to educate
50 000 health professionals on the health impacts of
climate change, and the Climate Stories Collaborative,
a university-led initiative showcasing the stories of
those affected by, and those taking action against,
climate change.
Finally, sustainable implementation of education,
integration, and climate health storytelling on the scale
necessary requires multiple forms of investment—a key
barrier to many initiatives that are youth-led and youth-
focused. Monetary investments that enable youth to
travel when needed and receive compensation for their
work must become more accessible. Investment should
also extend to non-monetary resources, like social
media outreach to underserved youth communities and
mentorship dedicated to youth advocacy.
We must reframe our view of youth. Young people
are more than victims of the climate crisis; they are
individuals capable of positive change, who must
be protected, consulted, and allowed to become full
partners in the climate conversation.9 This essential
reframing could garner the meaningful and measurable
participation of youth in planetary health discussions.
However, leaders must readdress the barriers limiting
youth advocacy from reaching its full potential. The
exclusion of young people from decision making delays
progress worldwide in fighting the climate crisis. We
call on global health leaders and institutions to make
greater investments into the potential of the youth
generation.10 With this framework in mind, we can
substantially improve our chances of securing a healthy
and sustainable future.
We declare no competing interests.
Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open
Access article under the CC BY-NC-ND 4.0 license.
*Rohan Arora, Ellery T Spikes, Cleo F Waxman-Lee,
Roma Arora
arorar@ufl.edu
The Community Check-Up, Chantilly, VA 20152, USA (RohA, ETS, CFW-L, RomA);
College of Medicine, University of Florida, Gainseville FL, USA (RohA)
www.thelancet.com/planetary-health Vol 6 February 2022

1 UNICEF. The climate crisis is a child rights crisis: introducing the children’s
climate risk index. 2021. http://data.unicef.org/resources/childrens-
climate-risk-index-report/ (accessed Dec 8, 2021).
2 Marks E, Hickman C, Pihkala P, et al. Young peoples voices on climate
anxiety, government betrayal and moral injury: a global phenomenon.
SSRN 2021; published online Sept 7. http://dx.doi.org/10.2139/
ssrn.3918955 (preprint).
3 UN. Youth2030: progress report 2021. 2021. http://www.unyouth2030.
com/progressreport (accessed Dec 8, 2021).
4 Zeinali Z, Bulc B, Lal A, et al. A roadmap for intergenerational leadership in
planetary health. Lancet Planet Health 2020; 4: e306–08.
5 Sellars E, Pavarini G, Michelson D, Creswell C, Fazel M. Young people’s
advisory groups in health research: scoping review and mapping of
practices. Arch Dis Child 2021; 106: 698–704.
www.thelancet.com/planetary-health Vol 6 February 2022
Comment
6 Spajic L, Behrens G, Gralak S, Moseley G, Linholm D. Beyond tokenism:
meaningful youth engagement in planetary health. Lancet Planet Health
2019; 3: e373–75.
7 Project Drawdown. Health and education. 2020. http://drawdown.org/
solutions/health-and-education (accessed Dec 8, 2021).
8 Health Care Without Harm. Visual storytelling guide for health care
professionals taking climate action. 2021. https://noharm-uscanada.org/
documents/visual-storytelling-guide-health-care-professionals-taking-
climate-action (accessed Dec 8, 2021).
9 Hart RA. Innocenti essays no 4. Children’s participation from tokenism to
citizenship. 1992. https://www.unicef-irc.org/publications/100-childrens-
participation-from-tokenism-to-citizenship.html (accessed Dec 8, 2021).
10 Bulc B, Al-Wahdani B, Bustreo F, et al. Urgency for transformation: youth
engagement in global health. Lancet Glob Health 2019; 7: e839–40.
e80