Pediatricians’ voices grow louder on climate’s impact on child health, equity

When people asked Aaron S. Bernstein, M.D., M.P.H., FAAP, why he worked on climate
change as a pediatrician, he would say the reason is simple: “Our job is to keep children
healthy, and we can’t do that without tackling climate change.”

While the question doesn’t come up as often anymore, Dr. Bernstein said it’s increasingly
important to elucidate how much climate change impacts day-to-day practice. He calls
it one of the biggest health challenges we face.

“The missing piece right now is making clear that climate change has direct effects
on our ability to deliver care to children,” said Dr. Bernstein, a member of the AAP
Council on Environmental Health (COEH) Executive Committee, assistant professor of
pediatrics at Harvard Medical School, and interim director of the Center for Climate,
Health, and the Global Environment at Harvard’s T.H. Chan School of Public Health.

The message needs to be personal, actionable and urgent, Dr. Bernstein said.

His comments come as weather events — heavy rainfall, hurricanes, tornadoes, heatwaves,
drought and wildfires — are increasing in frequency and intensity.

“I think many of my colleagues around the country are seeing immediate effects of
climate-related health,” said Aparna Bole, M.D., FAAP, chair of the COEH Executive
Committee, associate professor of pediatrics at Case Western Reserve University School
of Medicine and medical director of community integration at University Hospitals
Rainbow Babies & Children’s Hospital.

Dr. Bole pointed to wildfires on the West Coast, flooding in the Southeast and heatwaves
in her area around Cleveland. Parents ask her questions like, “Why is allergy season
lasting so long?” and “Why is my son who is on the football team at risk for heatstroke
in October?”

Climate’s health effects in children include worsening asthma, allergies and other
respiratory issues; heat illness; trauma from disasters; and greater exposure to vector-borne
diseases. Poor perinatal outcomes also have been linked to air pollution.

Mounting inequities

These effects often are magnified for people with low incomes. They tend to live in
communities with higher levels of pollution, crime, food and housing insecurity, and
unemployment, and in urban areas, which are concentrated heat “islands.”

The systems that contribute to climate change are the same ones contributing to health
inequity, Dr. Bole said. The pandemic has underscored that, and all of these issues
can take a toll on mental health.

“We’ve seen how COVID has laid bare these inequities in our economic and social systems
that are responsible for creating climate change and health inequity and climate injustice,”
she said.

There are many examples of how climate issues interact with health effects, said Perry
E. Sheffield, M.D., M.P.H., FAAP, deputy director of the Region 2 Pediatric Environmental
Health Specialty Unit and associate professor in the departments of Pediatrics, and
Environmental Medicine and Public Health at Icahn School of Medicine at Mount Sinai
in New York.

“We could take the economic stresses that COVID has brought on so many families and
overlay that with a disaster like having to be displaced because of a wildfire event
or a power outage or extreme wind events like hurricanes,” she said. “Certainly, all
of those are compounding each other and (impacting) the family’s ability to access
and be able to afford the resources they need.”

Mortgage lending practices like redlining — refusing to give someone a loan because
the area is considered a poor financial risk — also have played a role in where these
families live, she said.

“Sometimes our mistake is to think that it’s something about the people as opposed to the context in which we live, which is important for pediatricians to consider when interacting
with patients,” Dr. Sheffield said.

AAP efforts

The AAP was the first national medical association to issue a policy statement on
climate’s impact on health, Global Climate Change and Children’s Health.

The Academy continues to call for legislation to reduce greenhouse gas emissions and
address how climate change affects child health and well-being. It recently signed
on to A Declaration on Climate Change and Health.

Education, advocacy

While some pediatricians may not recognize their role in climate action, younger clinicians
and medical trainees are especially motivated, Dr. Bole said.

A recent article in Academic Medicine co-authored by Drs. Sheffield, Bernstein and others advocates for integrating climate
change into residency training ( The American Medical Association supports teaching about climate change in undergraduate,
graduate and continuing medical education.

With growing awareness of climate’s connection to health, more pediatricians seem
hopeful future action will make a difference.

“I think it would be an unprecedented honor for our profession if in 20 years’ time,
we could look back and point to pediatricians around the country as those individuals
who helped lead us all into a future that we can say is one that is better for our
children and everyone because we did what we needed to do to tackle climate change,”
Dr. Bernstein said. “And we can do that. We pediatricians can do this — we have that

AAP chapter climate advocates step up

With the help of AAP chapter executive directors, the Council on Environmental Health
(COEH) Executive Committee set out to identify one climate advocate in every chapter
to focus on state-level action. There now are 110 advocates, and their ranks are growing.

The advocates meet monthly to hear speakers and share ideas. Members have participated
in local efforts, started organizations and written opinion pieces. Others are involved
in research or education.

In addition, chapters have started climate committees and submitted resolutions for
the Annual Leadership Forum.

“It’s been a great organic movement,” said Lori G. Byron M.D., M.S., FAAP, a COEH
Executive Committee member and point person for the advocates. “We’re finding that
as people become more vocal in their state, (other) people in the state are reaching
out, which is great because climate change needs to be a collaborative effort.”

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Copyright © 2021 American Academy of Pediatrics

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