AAP Voices Blog

Climate Education and Advocacy Go Hand in Hand

My journey to pediatrics began with environmental health. As an enthusiastic middle school science fair student, I sampled the water quality in a neighborhood stream, tested for lead levels in the soil around my home, and tried to determine the amount of CO2 in my breath compared to my family’s car exhaust. Despite this early start, it was not until I read Bright Futures, the guide for preventive pediatric care, in continuity clinic that I started to connect more of the dots between child health and our environment. I realized that we were not talking to families about how to deal with the current and anticipated health effects of climate change. I did not have any idea about how a warming world would affect my future medical practice, but I knew this was an important question for the field and pediatric health care professionals needed to be better prepared (especially after living through the health care system failures of the COVID-19 pandemic).

The American Academy of Pediatrics (AAP) was the first health care organization to release a policy statement on the health effects of climate change in 2008. The Academy updated the policy in 2015. Both statements summarize the strong evidence showing climate change will impact the health of children, yet much uncertainty remains around the amount of warming we will experience and how these impacts will unfold across children’s lives. The EPA’s new 2023 report “Climate Change & Child Health in the United States” highlights some of the clearest data yet.

With a 2° C temperature increase, children in the U.S. can expect to see a 4% reduction in academic achievement relative to average learning gains and potentially $6.9 billion lost in future income – largely from heat exposure and lack of air conditioning in homes and schools. At 2° C, worsening air pollution is expected to produce at least 34,500 new childhood asthma diagnoses yearly, and health care professionals can expect an additional 5,800 asthma-related emergency department visits each year from worsening pollen counts. Intensified allergy seasons could result in an additional 41,000 visits for seasonal allergies, and at least 120,000 additional prescriptions of allergy medications each year.

“Despite a growing understanding of the complex effects of climate change on child health, efforts remain in their infancy to educate pediatricians and other health care professionals, precluding their ability to have conversations with families on how they can best cope and prepare for a troubling future.”

While much remains unknown regarding the changing burden of infectious disease in a warmer world, growing tick populations are expected to cause an additional 2,600 cases of Lyme disease yearly. Rising sea levels, coastal flooding, and flash floods from extreme weather events may cause 185,000 children to completely lose their homes, and one million children may suffer from temporary displacement without further adaptation measures by communities.

Despite a growing understanding of the complex effects of climate change on child health, efforts remain in their infancy to educate pediatricians and other health care professionals, precluding their ability to have conversations with families on how they can best cope and prepare for a troubling future. We must change that by providing a better environmental health education, especially in medical school and residency training programs.

Thanks to mentorship from the Region 2 Pediatric Environmental Health Specialty Unit (PEHSU), I’ve started addressing this education gap in my own health care system by introducing a residency curriculum linked to Accreditation Council for Graduate Medical Education competencies that prioritizes anticipatory guidance and local community resources for trainees to use in patient encounters. These include HealthyChildren.org materials and Prescriptions for Prevention. Early evaluation results are promising, showing improved trainee knowledge and confidence in engaging families on climate change topics. But to really “treat” the health effects of climate change, we must prevent the worst warming scenarios. To do that, we must build health professional capacity in communities and legislative advocacy efforts.

Health professionals cite many barriers to participating in advocacy, such as clinical care responsibilities, limited knowledge of advocacy opportunities, and a lack of training or experience. However, by building partnerships with local and state advocacy groups, then highlighting local opportunities within my curriculum, I’ve been able to lead other pediatric residents to advocate for climate laws on behalf of our patients. A broad, grassroots coalition working on climate advocacy has resulted in some of the strongest climate change policy decisions seen in New York State’s FY 2024 state budget. By strengthening this movement with our voices, we help ensure the health and wellbeing of our families and communities for generations to come.

Despite the challenges, it is easy enough to get involved in climate action, as more resources are created almost daily to facilitate engagement. Practice Greenhealth and My Green Doctor are great starting points for creating more sustainable health care systems and practices. For those interested in engaging more in advocacy, The Medical Society Consortium on Climate and Health serves as an excellent resource. Health care professionals can get involved in their state or regions as AAP Chapter Climate Advocates or through new groups springing up around the country, like my state’s New York Clinicians for Climate Action. As our knowledge and awareness of the dangers from climate change increase, pediatric health care professionals are joining the call for climate education and advocacy across the country. Jump in and get involved.

Thanks to Lauren Zajac, MD, MPH, FAAP, Maida Galvez, MD, MPH, FAAP, and Perry Sheffield, MD, MPH, FAAP, for reviewing this piece.