Editor’s Note: Dr. Julie Evans (she/her) is a resident physician in pediatrics at the University of Virginia. She is interested in general pediatrics and global health. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
When I think of climate change, I jump to glaciers melting, animals going extinct, smog, deforestation, and hotter temperatures every summer.
Until I started my career in medicine, it never occurred to me how much climate change can affect medical conditions. This disconnect is exactly what Drs. Henry Annan, Iwona Baran, and Sasha Litwin from The Hospital for Sick Children in Toronto tackle in their paper titled “Five I’s of Climate Change and Child Health: A Framework for Pediatric Planetary Health Education,” being early released in Pediatrics this month (10.1542/peds.2024-066064).
The article opens up with a harrowing story of Ella, a 9-year-old who died of an asthma exacerbation. Ella lived in an area with significant air pollution. After her death, a coroner concluded that air pollution contributed significantly, and she was the first child in the world to have air pollution listed as a cause of death.
Because there are more and more cases in which changes in the natural environment can affect health, the Five I’s of Climate Change and Child Health were created as a framework to help pediatricians understand how climate change can affect our patients’ health and make medical decisions.
The Five I’s include:
- In utero effects: Climate effect exposure during pregnancy can affect the fetus and newborn. For example, mothers exposed to air pollution are more likely to have infants that are born preterm and with low birth weight.
- Inhalation risks: Airborne materials, such as pollutants (smog), which have increased in our atmosphere due to climate change, are inhaled and can damage lung tissue. Because children’s lungs are still developing and this damage occurs early in life, it increases risk for chronic lung disease.
- Infectious disease: Climate-sensitive diseases are those in which transmission is affected by climate. For example, because of increasing temperatures, the tick that carries the bacteria that causes Lyme disease is now able to live in a greater geographic area.
- Injury: Physical and mental health problems due to effects of climate change. Most adolescents, when surveyed, state that they experience moderate to severe anxiety related to climate change.
- Insecurity: Direct and indirect effects of climate change on social determinants of health. An example is increasing temperatures decreasing crop yields, which leads to increasing childhood malnutrition.
There are more specific examples of climate change effects on health in this article.
The Five I’s can and should be utilized in multiple aspects of medical education, and as a framework for advocacy.
Climate change and children’s health interact more than many of us likely think about. I could not have stated it better than the authors: “For pediatricians, our obligation is even more clear as climate change threatens the very ethos of our work—to ensure that children are provided with the best chance of living healthy lives well into adulthood.”
