Climate Change, Extreme Weather Events, and Child Health: A Call to Action

Asthma is the most common chronic disease of childhood, affecting millions of people worldwide and nearly 4.7 million children in the United States.^1,2 It is inextricably linked to the climate crisis, defined as human-driven planetary warming because of increased carbon emissions from burning fossil fuels.³ The climate crisis intensifies contributing factors of asthma morbidity and mortality, including air pollution, mold, allergens, and extreme heat.⁴ Pediatric clinicians and health care systems have an urgent responsibility to advocate for evidenced-based solutions to address the climate crisis.

In this issue of Pediatrics, Utsumi et al examined how another consequence of the climate crisis, extreme flooding, influenced asthma prescription rates for children in Japan.⁵ They found that inhalers (particularly controller-type) were more commonly prescribed to children who experienced flooding.⁵ Globally, flooding is the most common type of extreme weather event (EWE) and >500 million children reside in flood zones worldwide.^6,7 Climate change increases the frequency and severity of floods, with compounding effects on child health. The study by Utsumi et al appropriately defines flood victims broadly, because flooding results in risk of injury and death, spread of infectious disease and malnutrition because of disrupted food and water supplies, and financial and property loss, etc.⁸ Exposure to such devastation also profoundly affects children’s mental health, with a well-documented rise in rates of depression, anxiety, and posttraumatic stress disorder after disasters.⁹

In the United States, there is a disproportionate negative impact on the health of marginalized communities because of longstanding injustices from environmental racism.¹⁰ Historic redlining practices resulted in these groups’ overexposure to environmental hazards such as air pollution and extreme heat, both amplified by climate change.¹¹ Concentrated poverty compounds this by limiting accessibility to adaptive measures such as adequate cooling, stable housing, and high-quality health care.¹² Societal disruption from EWEs can perpetuate this imbalance by destroying homes and livelihoods, depleting families’ ability to break cycles of poverty for future generations.¹³

Utsumi et al found increased inhaler prescription rates were most significant for older children.⁵ Although children <5 years old are disproportionately affected, climate-related health issues span childhood and adolescence.¹⁴ Pediatric clinicians must be aware of regional climate threats to provide evidence-based care that is comprehensive and up to date.¹⁵ Disaster preparedness should be incorporated into anticipatory guidance, such as recommending that families prepare emergency kits with essential medications and first aid supplies, sign up for emergency notifications to stay informed about EWEs, and understand how to access community resources such as shelters and food banks. Distributing disaster preparedness resources in frontline clinics (eg, educational materials, emergency kits, and safe cleaning supplies) is also necessary. For medically complex patients, clinicians should consider how power outages or disruptions in access to health care facilities could affect management of their medical conditions. Routine guidance around risks of extreme heat (eg, during sports physicals), how air quality influences asthma and allergy severity, behavioral health consequences of the climate crisis, and advocacy through civic engagement should also be addressed. Climate-specific education for learners at all levels of training and practice is needed to ensure that pediatricians can leverage evidenced-based strategies when discussing climate change during clinical encounters.¹⁶

It is also critical for us to think about the role of the health care system. In the United States, 60% of power outages are attributed to EWEs, and global projections estimate that 1 in 12 hospitals is at risk for shutdown without a timely phase out of fossil fuels.^17,18 Climate change increases demands on the health care system while simultaneously threatening it. Despite this vulnerability, the health care system actively contributes to the climate crisis by accounting for 8.5% of all greenhouse gas emissions in the United States.¹⁹ Health care systems must rigorously evaluate and reduce their own carbon emissions aiming to achieve carbon neutrality by 2030. National metrics, resources, and guidelines are central to achieving a systemwide transition to decarbonized, climate-resilient health care.

As climate change worsens, EWEs such as flooding will continue to exacerbate child health problems, including asthma, and threaten health care infrastructure. The climate crisis places an imperative obligation on pediatricians to elevate messaging that climate change is already underway, climate solutions are health solutions, and adaptation efforts must amplify the voices of patients, families, and communities. Effective, reciprocal partnerships with local organizations and community leaders can enhance resilience, promote health equity, and ensure that the needs of overburdened populations are prioritized. Together, pediatricians and communities can advocate for policies at local, state, and federal levels to eliminate the root cause of climate change, fossil fuels, and realize a greener and healthier future for all.

Glossary

EWE

extreme weather event