Transcript: Climate change is harming children's health — and it's going to get worse

When it comes to climate change, children are most at risk

Interview conducted by Aaron Warnick, a reporter with The Nation’s Health newspaper, and Leyla McCurdy, chair of the Children’s Environmental Health Committee of the APHA Environment Section.

Listen to this interview as a recording on our podcast page.

This is The Nation's Health podcast, part of the APHA Podcast Network. I'm Aaron Warnick, your host and reporter for The Nation's Health.

In addition to producing award-winning news stories, The Nation's Health lets you hear directly from the people we're talking to — or, in this case, some of the people we work with.

In this episode, I'm joined by Leyla McCurdy. She’s a member of APHA’s Environment Section, and chair of its Children’s Environmental Health Committee.

Thanks for dropping by, Leyla.

McCurdy: Thank you, Aaron. I'm delighted to be here.

Warnick: In a moment, we'll call Dr. Aaron Bernstein, co-director of the Center for Climate, Health and the Global Environment at the Harvard T.H. Chan School of Public Health and pediatrician at Boston Children’s Hospital.

But before the call, here’s what you should know.

These experts are joining me today because of Children’s Environmental Health Day. Held on the second Thursday of October, it is a day to raise awareness and mobilize society to take action on children's environmental health issues and it involves many national and local organizations across the country. Our world’s climate is rapidly changing — and it affects all of us, but it especially affects the next generation. Child under 5 years old carry about 88% of the disease burden related to climate change.

Many in the children's environmental field — including dedicated public health professionals at Harvard’s C-CHANGE and APHA’s Center for Climate, Equity and Health — are concerned about how climate change will worsen existing environmental health threats to and health inequities among children. Solutions are needed.

The goal of the Children's Environmental Health Committee is to increase awareness and promote collaborative efforts to reduce environmental health risks to children where they live, learn and play. Recognizing that climate change is the greatest public health threat to the physical and mental well-being of children we are focusing our efforts on this issue during October, which is Children's Health Month, and on Children's Environmental Health Day on October 10th.

To talk more about children’s environmental health, Aaron Bernstein has called in.

Bernstein: Thanks, Leyla and Aaron, for having me, and I'm really happy to have the opportunity to speak with you about the relevance of climate change and fossil fuels to the health of children. And as a pediatrician it's really quite apparent how these matters are really important for our children.

McCurdy: Dr. Bernstein, thank you very much for talking to us today. How have you seen climate change impact your own patients and medical practice at Boston Children's Hospital?

Bernstein: In spring of 2018, I was practicing at Boston Children's and I was taking care of a child who I needed to order IV fluids for, which — IV fluids form the foundation of medical care around the world and the United States. And I went to order IV fluids. I received a notice that we were rationing IV fluids because of concerns about shortages.

And if you trace that notice back and where it comes from, it actually came from Hurricane Maria, which struck Puerto Rico the previous winter. So Maria, as you know, was a major issue that really set Puerto Rico back and also happened to put out commission the major supplier of small-volume IV fluid bags to the United States, the plant that was responsible for those. And that led to a national shortage of critical IV fluids.

And so we know that climate change is driving more dangerous hurricanes and that signal is certainly evident in the models by mid-century and later in the century, but there's some evidence to suggest they've already become more severe. And I think that story is really important because it shows that even when climate change extreme weather affects places that may be far away from where we live, it can have direct relevance to the care that, for this instance, I can provide in Boston to children in my own community.

McCurdy: Can you also give us some examples about the health impacts you see in children that have been impacted by climate change-related events?

Bernstein: Climate change poses health risks to children regardless of whether they are healthy or may have existing medical conditions and regardless of where they live. And it can affect infectious disease risks particularly for diseases transmitted by insects, but also, and perhaps under-recognized, infections that are transmitted through water systems. So we know that the heavy downpours that we have already seen and are likely to see more of as climate change unfolds contribute to outbreaks of waterborne diseases.

One of the most prominent examples of this was in Milwaukee in the early '90s when a water filtration plant to the north side of the city failed to adequately filter out Cryptosporidium that was washed into the water supply by heavy downpours and that led to 800,000 people that were served by that plant, about 400,000 contracted cryptosporidiosis, the largest outbreak in our nation's history. But these outbreaks are happening more often potentially because of heavier downpours.

We see risks related to allergic diseases. We know that pollen seasons have become longer, that because of elevated carbon dioxide itself, regardless of its effects on the climate, plant like ragweed are producing more pollen, so seasonal allergies are worse. People with asthma, children with asthma may have a harder time.

Higher temperatures are dangerous to child athletes, particularly youth football players. Higher temperatures also produce — contribute to more ozone production. Ozone, when it's high in the atmosphere is great for filtering out ultraviolet radiation, but when it's present at ground level where we can breathe it, it's toxic to lungs, particularly dangerous to the lungs of children with asthma, but also to healthy children who may be outside playing.

There's an important mental health dimension to climate change. We see time and again after disasters like the Camp Fire in northern California or the wildfires have occurred in Australia or in Russia that children who witness their homes go up in flames unsurprisingly are a little uncertain about the world they're living in and have higher rates of symptoms from anxiety disorders. And I could go on.

I think that the key point here is that we have a tremendous amount at stake for the health of our children when it comes to climate change.

McCurdy: Definitely. Climate change impacts all people and all children, but some kids get hit the hardest by the impact of climate change. Can you elaborate what you have observed yourself and also in the literature we see regarding some of the impacts on certain populations?

Bernstein: Sure, and thanks for that question because you're absolutely right that climate change, as with almost any environmental concern, does not affect everyone equally and these problems almost uniformly affect those who can least afford to grapple with them the hardest, and climate change is no exception.

At a global scale it's clear that the poorest kids in developing countries, particularly those living on coasts, are potentially greatest at risk. There are several hot spots though. I would say the South Pacific islands where there's already concern about the viability of being able to live there because water supplies where climate change extreme weather, particularly droughts have triggered civil unrest. We've seen that in Syria and Afghanistan.

Also in Central America it's part of the equation that has driven so many people to try and migrate northward into the United States and Canada. And so it is a great issue of equity, both in communities, developed countries, and also in the global south, I would argue, as compared to the global north.

And so the flip side of that, which is a critical point, is that addressing climate change is a huge potential opportunity for reducing health disparities. And so I think people often lose sight of that in the context of the downside, but it is very much the case that the more we can do to reduce greenhouse gas concentrations, carbon pollution in our atmosphere, the more likely we are to really reduce health disparities that could come with it.

McCurdy: What can public health professionals do regarding climate change and children's health? I know you wear both hats. You're a pediatrician, a health care provider and also you work on public health. So we would love to hear from you your thoughts about how can the public health professionals take more steps in this regard, and as well as how can health care providers and public health professional work together to increase climate change and health awareness?

Bernstein: Yes, it's a great question, and there is a tremendous amount that could be done. I think one is to really think about — as public health professionals are on the front lines of really safeguarding the health of people, both in the United States and around the world — the kinds of information and resources you need to really address the health of the people you're trying to serve. Because it's abundantly clear to me that we have tremendous resource needs, we have tremendous information needs and that the folks who are grappling with these issues of both preparedness and also how do we change our transportation systems so that they, for instance, don't put out as much air pollution that we know is bad for people, that there are real information gaps there.

And that's really a call to those of us in academia to say we really need to be doing a lot more than we are to really put on the table how both the solutions to climate change matter and how much they matter to health, and also to recognize that we need to prepare more.

Heat is a good example. Many cities around the country are really trying to figure out how to prevent heat-related illness in their populations and we need much more information about how to do that effectively.

I think it's important to add that we do need to do more, but the lack of activity in my view is not because people don't want to do more. I think in many cases it's because there are either financial limitations — the NIH provides almost no funding for research in this area. And EPA and this administration has not provided any resources.

In academia there is a real challenge in cultivating research in this area, partially because there's not an NIH-funded track to promote people, but also because there aren't many senior faculty around who've dedicated their careers to this. And so it can be hard to find mentorship and cultivate a career trajectory.

So there's many things that need to be acknowledged, and I think it's critical we do because, as you alluded to, there may be few concerns that are more relevant to the health of people around the world present today than climate change. And so to have barriers in place and resource constraints, these are things that are solvable and I think that the urgency of the issue speaks to the need to address them.

Warnick: In closing, as someone working on children’s environmental health, how do you react to recent youth-led protests and climate actions that we have seen lately?

Bernstein: I think the thing that — particularly given that this is in relation to Children's Health Month and Children's Mental Health Day — I'd like to make clear that what we saw with the climate strikes that occurred around the world in some 163 countries probably created 2,500 events. And the final count to those involved is not here, but it was probably in the millions. Our children have now called us adults in the room to accounts on climate change. They have learned about this issue as they've grown up and they have seen what is at stake and they have looked at us and said you all need to do more.

And so I think it's incumbent on all of us to listen to our children and to recognize that they perhaps more than anyone have more at stake for their health, both in the near term because of the effects of fossil fuels, the air pollution, water pollution that come from our reliance on fossil fuels that disproportionately harms our children, but also of course across their life spans in terms of climate change.

And we'd better get our act in gear here and use their inspiration, their commitment and their passion to motivate us to do everything we can to understand the issue, to understand solutions and to take the actions that we know are going to benefit health, both today and promote a healthier and more just future for everyone, and especially our children.

Warnick: And with that, we thank Dr. Aaron Bernstein for his time and expertise.

McCurdy: If you are going to be at the APHA Annual Meeting in Philadelphia, please join us for the “Protecting Children: Climate Change, Children’s Health and Equity” session on November 5th.

We also invite you to participate in Children’s Environmental Health Day activities. For more information on how you can leverage Children’s Environmental Health Day please visit www.CEHN.org/CEHday.

I remain hopeful that by raising our collective voices and joining an increasingly powerful youth movement of young leaders advocating for their own futures, we will help to bring about the actions necessary for safeguarding children’s health.

Warnick: For more reporting on climate and how it impacts public health, you can read The Nation’s Health online at thenationshealth.org.

Thank you for listening to The Nation’s Health Podcast.