​Using Tools We Have to Ensure a Healthy Environment for Children

Aparna Bole, MD, FAAP

April 15, 2020

Editor’s note:
This is one of a series of “AAP Voices” posts to highlight the effect of climate change on children’s health.

Last summer, one of my patients, a 10-year-old boy I’ll call James, came to see me for a sports physical before starting a summer sports camp through a local community recreation center. James is obese, and also has asthma and allergies. We had been talking for a while about working on his nutrition and encouraging physical activity. I was proud of him for signing up for summer sports, but I had to add a note of caution: his parents would need to pay attention to the air quality index, and consider keeping him inside on ozone action days because of his asthma.

Warmer temperatures, which are a definite trend in the setting of climate change, result in higher surface ozone concentrations in the air. The chemicals that react to form surface ozone come from burning fossil fuels in cars and power plants. While ozone is a good thing in the upper atmosphere, surface ozone is a health hazard. Among other things, it can exacerbate asthma in kids like James.

In addition, like many other kids with asthma and allergies, James’s asthma can be triggered by exposure to aeroallergens like ragweed pollen. In northern latitudes like ours in Northeast Ohio, climate change is contributing to longer and more intense allergy seasons. Winters are trending shorter and milder, and higher atmospheric carbon dioxide concentrations are associated with higher pollen counts. This sets up a double whammy for kids like James: higher surface ozone concentrations and longer, more intense allergy seasons are together a recipe for more asthma problems.

James and his parents looked worried when I asked them to pay attention to the air quality index each morning of summer camp. Asthma exacerbations are scary for kids and parents, and James’s parents know they can be dangerous, too. James, a dedicated Cleveland Cavaliers fan, was especially worried he might have to miss a day of outdoor basketball. We talked for a long time about using his rescue inhaler with exercise, and reviewed his asthma action plan.

What an injustice to James and to all children it is when they’re restricted from doing what kids should be doing - playing outside - because we’ve failed to ensure they have clean air to breathe. Reflecting on patients like James and others in my practice in Cleveland, it’s clear that climate change is already affecting children’s health in my community. It’s also clear that these health effects disproportionately impact kids from populations that are already vulnerable, historically marginalized, or discriminated against. In other words, climate change can exacerbate health disparities.

At the same time, climate solutions can help to prevent some of the thorniest chronic conditions pediatricians and our patients grapple with every day – such as asthma, obesity, and mental health issues like depression and anxiety, and can help to increase health equity. Transitioning to clean and renewable energy has immediate benefits in better air quality that helps kids with chronic lung conditions like asthma, but also supports healthy birth outcomes and brain development.

Vibrant, inclusive community design practices that support active transportation, safe places for kids to walk and play, and public green spaces have immediate health benefits as well – including improving air quality, mitigating extreme heat, encouraging physical activity, nurturing strong social connections, and supporting mental health. Eating a more plant-based diet can have significant health and planetary benefits, and can be a practical strategy for families working to eat healthier on a budget.

“It can feel like the scope and scale of the problem renders solutions too abstract or out of reach. But the truth is, we have the tools right now to act on climate and safeguard a healthy environment for kids today and in the future.”

We know that kids bear the brunt of climate change’s health impacts, including worsened air quality; increased frequency and severity of events like heat waves, wildfires, extreme precipitation and storms; changing patterns of infectious disease; and threats to food and water security. And we know we are in a critical moment for bold action: according to the United Nations Intergovernmental Panel on Climate Change, we have about a decade to limit human-caused greenhouse gas emissions to keep global warming under 1.5 degrees Celsius above the preindustrial era. This threshold represents the point beyond which health and ecological consequences will grow dramatically.

It can feel like the scope and scale of the problem renders solutions too abstract or out of reach. But the truth is, we have the tools right now to act on climate and safeguard a healthy environment for kids today and in the future. Here in Ohio and across the country, we are seeing that increasing energy efficiency and transitioning to clean and renewable energy are working: here and now, they make sense from an economic and public health perspective. We have the technology today to accelerate our transition to a clean energy economy – and the interventions that mitigate climate change and enhance our resilience to the impacts of climate change have immediate child health benefits.

Climate solutions are child health solutions. Pediatricians have an important role to play in climate action: we can make climate smart personal choices and practice management decisions, and serve as trusted educators and advocates. Inspiring youth leaders across the country and around the world are making their voices heard, as they call for urgent climate action and environmental justice. Through collective action and strong policy advocacy, together we can ensure a healthy climate that allows all children to grow, learn, and thrive.

*The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.

About the Author

Aparna Bole, MD, FAAP

Aparna Bole, MD, FAAP, is Medical Director of Community Integration at UH Rainbow Babies & Children’s Hospital and an Associate Professor of Pediatrics at Case Western Reserve University School of Medicine in Cleveland, OH. She is particularly interested in the intersection between environmental sustainability and pediatric public health. She serves as chair of the American Academy of Pediatrics Council on Environmental Health, on the board of Healthcare Without Harm (as co-chair) and is a founding advisory council member of the Ohio Clinicians for Climate Action.