A pediatrician and researcher urged her AAP colleagues at the 2024 Leadership Conference in Itasca, Ill., to promote environmental justice in their practice and beyond.
“We won’t be able to move the needle on health disparities unless we more broadly think about and recognize environmental determinants,” said Abby L. Nerlinger, M.D., M.P.H., FAAP, a member of the AAP Council on Environmental Health and Climate Change Executive Committee, a researcher who evaluates partnerships between health systems and communities, and a pediatric hospitalist at Nemours Children’s Hospital-Delaware in Wilmington, Del.
Those determinants include close proximity to hazardous waste facilities, traffic pollution, sources of lead poisoning or Superfund sites, Dr. Nerlinger said.
“Climate change disproportionately impacts children of Black and ethnically and racially diverse communities both now and in the future, if we don’t do something about it,” she said.
The AAP Board of Directors made environmental health one of the Academy’s four strategic initiatives for 2024.
“We have an action plan to help shift the dialogue to make sure that we’re preparing the world to be there for our kids in the future,” AAP President Benjamin D. Hoffman, M.D., FAAP, said during his conference address to AAP leaders. “And that work is not going to stop. There’s a lot to do. It’s slow, methodical, it’s based on policy; be patient, but help us.”
Effects on children
Children are more susceptible than adults to adverse health effects from their built environment, according to an AAP technical report.
“They (children) have multiple periods of development that have the potential for significant disruption by environmental hazards,” she said. “They have specific behaviors like hand-mouth behavior, limited diets … increased metabolic rate” that makes them more likely to be at risk.
Families who live near hazardous waste sites or increased levels of air pollution are exposed to multiple toxins which “accumulate up the food chain,” Dr. Nerlinger said, pointing to toxic fish in her hometown as an example. “Over the last 20 years, the Brandywine River has been closed to aquatic recreation and fishing due to the frequency of combined sewage overflow events.”
Disproportionate access to mitigating factors like green space also is a problem, especially for minority communities.
“Race is not the risk factor. Racism is,” Dr. Nerlinger said.
Climate change also can take a greater toll on low-income families.
“Families impacted by food insecurity might be more impacted by, say, supply chain issues due to climate change and rising food prices. Families living in substandard housing conditions might be more impacted by high heat days (or) extreme weather events,” Dr. Nerlinger said.
Taking action
Dr. Nerlinger outlined six things AAP members can do to help ensure patients have equitable access to a healthy environment:
- Think about how environmental and social determinants of health might be contributing to health disparities in your community.
- Incorporate climate change into clinical practice. The AAP policy statement Climate Change and Children’s Health: Building a Healthy Future for Every Child suggests “assessing climate risks and recommending solutions when screening for and addressing social determinants of health such as energy, food and housing security.”
- Engage with and empower communities to take action. Dr. Nerlinger pointed to the Nemours 2019 Community Health Needs Assessment in which 55% of community members placed environment and air quality among their three biggest concerns; only 15% of health care providers saw it as a priority. “If we don’t ask, we don’t know,” she said.
- Promote environmental sustainability at home and in clinical practice. Global greenhouse gas emissions from health care entities are equal to the annual emissions from 514 coal-fired power plants, according to a 2019 Health Care Without Harm report), and an Australian study that showed that hospitals account for 34% of the country’s CO2 emissions from health care. “It turns out keeping kids out of the hospital is not only good for patients … but it’s also good for the environment,” Dr. Nerlinger said.
- Educate families, communities and trainees on environmental justice, “although we realize it’s oftentimes the community who’s helping to educate us,” Dr. Nerlinger said.
- Ensure families have access to safe green space, which can have positive effects on weight, mental health and cardiovascular health.
Going further
Dr. Nerlinger acknowledged that many of these suggestions are “just Band-Aids.”
“The goal is really to think further upstream to reduce the factors that are contributing to environmental disparities and climate change in the first place,” she said.
Members who want to get more involved locally could advocate for electric school buses or more green space. They also could push for Medicaid payment for home remediation or publicly comment on Environmental Protection Agency (EPA) regulations.
“The scope really goes beyond an individual health care system or even an individual state, so this requires regional partnerships,” she said, suggesting academic organizations, environmental lawyers, the American Lung Association, the Sierra Club or regional EPA offices as possibilities.
Dr. Nerlinger said leaders would have to adopt novel approaches to overcome barriers to environmental justice.
“I am very hopeful that as pediatricians, advocates and leaders, we can come together and engage with communities to really break this cycle of environmental health disparities and help improve health, well-being and mental health for the children in our communities,” she said.
Additional coverage of the AAP Leadership Conference
