Steven J. Goldstein, MD, FAAP
(Dr. Steven J. Goldstein, MD, FAAP is a pediatrician in Brooklyn and Queens. He is the immediate past president of the NYS AAP Chapter and serves as co-chair of its Pediatric Council and Committee on Environmental Health)
Committed pediatricians address the problems and consequences of gun violence, hunger, homelessness, immigration status, healthcare coverage, and anti-vaccine sentiment daily, and there is progress, albeit slow, on many fronts. But there is an over-riding issue with little progress being made that will affect all of us, and children disproportionately, and is inescapable on the daily news. I am referring to Climate Change.
As large portions of California burned, and now as Australia sees unprecedented destruction, there are daily reports that the early predictions of the effects of climate change were underestimates, and the response of our country (and others as well) to both these issues seems feeble at best. And lest pediatricians think that in their locales the effects of climate change are going to be a long time coming, witness the respiratory issues in states adjacent to the wildfires, the rising sea levels in Miami and other coastal locales necessitating raising the streets, and the almost daily reports of extreme weather events both here and abroad-including flooding, tornadoes, high winds, and drought. This global change will result in island nations that, if trends continue, will no longer exist or lose vast amounts of land due to rising seas. And the slow northward march of tropical diseases previously unknown in North America will change how we practice medicine. The devastation of pines in northern habitats killed by a blight that now overwinters successfully due to rising temperatures affects whole ecosystems. These seemingly distant examples of climate change will cumulatively affect all of us and our patients, no matter where we live or practice.
If these occurrences weren’t worrisome enough, we are also faced with a rollback of protections for clean air, water and food by an administration that fosters business interests over public health ones. And this denial of science is not limited to our country. This past week the Australian Prime Minister denied the role of climate change in the wildfires and pledged to support the coal industry (Washington Post). In the US, the administration discounts daily the role of science in public policy, and those at the head of the EPA and other governmental organizations charged with protecting the public interest, including once sacrosanct National Parks, now protect the fossil fuel industry ( NY Times). Chipping away at the protections designed to protect future generations put in place by previous administrations and slowly replacing advocates for children and the future with advocates for fossil fuels is the new normal. Two examples: Dr. Ruth Etzel, a pediatrician and epidemiologist well-known to many of us was removed from her position as head of the EPA’s Office of Child Protection in 2018 and efforts to undermine protections against asbestos exposure were detailed by Dr. Phil Landrigan in August in the New England Journal of Medicine .
The psychological effects of climate change issues on children and families is profound, and only adds to the burden of already existing stressors. Some populations, like the Inuit and Pacific Islanders, are already dealing with these issues on a daily basis as rising seas and melting ice threaten their way of life, their physical and mental health and their futures. These issues and how to help our patients build resilience are addressed in a report from the American Psychological Association and ecoAmerica (Access the report here). The report details recommendations we can use to help individuals, communities and leaders to foster resilience, action, and mental health.
Undoubtedly there are children and families under our care that are worried and stressed by this issue-experiencing what has come to be known as Climate Grief. I am proposing that we discuss these global issues at office visits and see this as an opportunity to educate and enlist families in adjusting their lifestyles, building resilience, and advocating for the future not only of themselves, but also the planet.
I believe that pediatricians should make it a priority to learn more about environmental health, climate change, and ecology. Joining the AAP Council on Environmental Health and working with the Chapters on their new initiative to raise consciousness about climate change will add our voices to the national conversation and help us chart the future for ourselves and future generations.