Social determinants of health (SDOHs), defined as the social circumstances in which people are born, grow, live, work, and play, profoundly affect children’s health and drive health disparities.1 SDOHs are shaped by the distribution of money, power, and resources at global, national, and local levels. The list of potential SDOHs is expansive and includes food insecurity, housing instability, violence exposure, structural racism, poverty, and immigration-related stressors. Addressing SDOHs within the pediatric medical home has garnered considerable interest lately as a potential solution to both improving health across the life course and mitigating health care costs.1 However, one critical determinant is missing from the pediatric community’s definition of SDOHs: climate change.
Climate change (also called global warming) is arguably one of the greatest public health threats of our time. Climate change is caused by rising greenhouse gas emissions from human activity, resulting in higher global average temperatures and changes...
Comments
RE:
Despite the scientific consensus that humans are driving climate change and recognition that it is a social determinant of health, policy on a federal level does not reflect this understanding. Environmental regulations continue to be rolled back on a constant basis. The New York Times reports that over 60 environmental rules and regulations have been rolled back under the Trump Administration with many others currently in progress.1
A specific area of concern, given the current COVID-19 pandemic, is air quality related policy change. According to a special report from the NYU School of Law, sulfur dioxide, nitrogen oxides, and particulate matter are all projected to increase and cause detrimental health effects on susceptible populations, including children, if the Trump Administration’s Affordable Clean Energy Plan is implemented. These effects include increased premature deaths, asthma exacerbations, and missed school days.2 A 2019 study from China found that pollutants were associated with respiratory tract infections in children under 3 years old. Fine particulate matter with diameters at or below 2.5 micrometers, or PM2.5, showed an association with increased viral respiratory infections in children under 7 months old, while larger particles showed an association with increased viral infections in preschool children.3
While we cannot assume that these viral infections include COVID-19, air pollution leaves children vulnerable to respiratory infections and possibly compromise. As far as COVID-19 specifically, a nationwide cross-sectional study has found that only a slight increase in air pollution is associated with an 8% increase in deaths by COVID-19.4
By performing the research and presenting the appropriate data, advocacy efforts for the purpose of shaping policy should emphasize the importance of maintaining clean air to protect those who are vulnerable, rather than deregulating and leaving them at risk.
References
1. Popovich N, Albeck-Ripka L, Pierre-Louis K. The Trump Administration Is Reversing 100 Environmental Rules. Here’s the Full List. May 2020.
2. Climate & Health Showdown in the Courts. March 2019.
3. Zhang D, Li Y, Chen Q, et al. The relationship between air quality and respiratory pathogens among children in Suzhou City. Ital J Pediatr. 2019;45(1):123. Published 2019 Sep 23. doi:10.1186/s13052-019-0702-2
4. Wu X, Nethery R. COVID-19 PM2.5. April 2020.