As the effects of climate change play out worldwide, pediatricians see the evidence in their offices.
There are the children with asthma who experience more frequent attacks as a result of excess heat and longer allergy seasons. And then there are kids who have missed vaccinations or other routine care because more frequent hurricanes or other natural disasters have displaced their families.
Now a new network of pediatricians nationwide is working on a grassroots effort to raise awareness of the effects of climate change on children’s health. Pediatricians participating in the all-volunteer initiative, known as American Academy of Pediatrics’ Chapter Climate Advocates Program, told STAT that the impact is clear, and will become more serious.
Just this week, in a historic ruling, a coroner in the U.K. announced that a 9-year-old girl’s death was the first in the country in which air pollution — which can be made worse by climate change — was listed as a cause. The girl, who lived close to a major circular road in London, had a series of seizures, asthma attacks, and other complications in the years leading to her death in 2013.
“AAP advocates underscore the idea that if only every parent in America knew that climate action was essential to the well-being of their child and family, we would have no political discourse, no debates about the science, no concerns about the course of action,” said Aaron Bernstein, a pediatrician at Boston Children’s Hospital and interim director of the Center for Climate, Health, and the Global Environment at the Harvard T.H. Chan School of Public Health. “The AAP deserves a lot of credit for backing them and enabling this network.”
The network — whose work extends beyond a medical setting and includes lobbying for local laws to combat a warming planet — is the brainchild of Lori Byron, a semi-retired pediatrician in Harding, Mont., who said heavy flooding in the state in 2011 was really the turning point for her advocacy on climate change’s impact on health.
At the time she was working as a general pediatrician under the Indian Health Service on the Crow Tribe reservation. “There were people that had been just barely making it just living on the edge, with minimum-wage jobs and not much money to spare,” she said.
But when the floods hit, Byron said, “it took away everything.” Even years after the floods, “we still had families that were living in FEMA trailers or living in the spare bedroom of somebody’s house or even living in their car. And it just hits you, the environmental injustice of the whole situation.”
Your home situation is one of the most important social determinants of health, Byron explained, so when that is threatened by floods or other disasters, that “is a huge factor for parents’ health and children’s health.”
After doing climate advocacy work in Washington, D.C., Byron said she realized that local groups — as constituents — seemed to have more sway with lawmakers than national groups, and wondered if local AAP chapters, who were already lobbying on behalf of children’s health issues, could be leveraged to also become involved in climate advocacy. In 2018, the AAP chapter in Montana became the first to adopt a climate change resolution in the country, and she began pushing for a broader network of climate advocates in AAP chapters across the country.
“Lori has been an incredible leader of convening and identifying these chapter advocates — climate change reform does need to happen in multiple contexts and health advocates are important for that,” said Aparna Bole, a pediatrician at Case Western Reserve University in Cleveland, Ohio and a fellow AAP chapter climate advocate.
The network now has at least 101 chapter climate advocates — with at least one for each state — across 59 AAP chapters, many of whom had long been active in climate change advocacy. Several of the chapters have adopted climate resolutions, which acknowledge and outline the impact of climate change on children’s health, and others are in the process of passing similar measures.
The chapters vary in their makeup and the work that they do. Some have academic researchers in addition to practicing physicians. And what each chapter undertakes depends on the unique environmental challenges facing their local communities.
In Virginia, for example, a recent report from a partner organization known as the Virginia Clinicians for Climate Action found that pollution from transportation causes 2,600 asthma attacks in children per year, and more than 3,300 cases of bronchitis and related symptoms in kids. Samantha Ahdoot, a pediatrician in Alexandria, Va., and one of the state’s AAP chapter climate advocates, said pushing to reform the transportation system is a top priority, while there are also critical issues along the coast.
“Virginia’s coastal communities are experiencing the highest rate of sea rise along the eastern seaboard,” she said.
Earlier this year, Virginia became the first state in the South to pass a law committing to have all of its electricity come from renewable sources by 2045, a law that the local AAP chapter lobbied for. The group also plans to lobby in the upcoming state legislative session for Virginia to adopt California’s low-emission and greenhouse gas emission standards, which at least a dozen other states have done.
“There’s no controversy that burning fossil fuels has health effects, and clearly policies that dictate the use of these fuels also have to have a health aspect,” Ahdoot said.
Over on the West Coast, Lisa Patel, a pediatric hospitalist based in Pleasanton, Calif., and a former Environmental Protection Agency scientist, said that she saw in her practice this fall the health effects of the devastating wildfires that hit the region.
“It was a quiet summer, but then in September and October, I started seeing a lot of premature labor,” she said, explaining that research has shown that air pollution and heat are risk factors for going into premature labor and also heighten the risk for stillbirth. “These are women that were a month or two early in delivering their babies.”
Patel and her AAP colleagues have also been leading an effort to make climate change-related courses available to pediatricians who are going through their licensure recertification process through the American Board of Pediatrics.
“As doctors, it is our duty to understand all of the ways in which our patients’ health might be harmed,” Patel said. “And the ABP and AAP have seen the evolution of our understanding on climate change and health in that regard.”
In Ohio, air quality and extreme rainfall or snowfall can alter water quality, according to Case Western Reserve’s Bole, especially as toxic algal blooms and the rising water temperature of Lake Erie in northern Ohio can cause sewage and stormwater overflow.
And like other places around the U.S., extreme heat continues to be a problem for allergies, asthma, and preterm births. “All of those issues are not a one-time illness,” Bole said. “This is why a lot of us say that climate solutions are health solutions.”
As part of her work with the AAP climate advocacy group, Bole testified this year in the Ohio Congress against controversial House Bill 6. Allegations swirled that an Akron-based electric utility company paid $60 million to a nonprofit run by the speaker of Ohio’s House of Representatives in exchange for more than $1 billion in bailout funds — through H.B. 6 — to help the utility company with its struggling nuclear power wing.
“It can be surprising to politicians that pediatricians want to speak up about [energy issues], and I don’t think a politician on either side of the aisle would say they don’t care about children’s health,” Bole said.
The AAP network has also provided an avenue for newcomers to get involved.
“Prior to joining this group, I didn’t see how connected climate change is to health,” said Hayley Guilkey, a pediatrician in Myrtle Beach, S.C. “It’s not something that I learned about in residency or medical school.” Since becoming an AAP advocate, Guilkey has also founded a statewide group for other health professionals interested in combating climate change.
Few of these advocates reported getting pushback from their patients’ families or others asking them to “stay in their lane,” as has happened when doctors have promoted gun control and immigration policy reform. Even if they did face backlash, these physicians say are ready with a response. “What can you say to a pediatrician who sees a child suffocate in front of their eyes?” Patel said.
These pediatricians also say it’s only natural that their specialty is leading the charge on climate change.
“We never think of kids in a vacuum,” Bole said. “Pediatricians are used to thinking about kids in context about their families, homes, and environments, and extending our purview of children beyond the 15 minutes we spend with them.”
She added: “Nobody is going to bear the brunt of the effects of climate change more than kids.”