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

April 22, 2021

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 power.”

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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