A 5-year-old with second-degree burns on their hands and thighs after playing on a playground with a metal structure in direct sunlight. A 7-year-old child presenting with altered mental status and a body temperature of 104 degrees, whose family tried to get to an air-conditioned library but couldn’t because the power cables for the bus had melted. A 17-year-old receiving follow-up, gender-affirming care who is struggling to keep their estrogen patch on because it’s been sweating off in a heat wave.
Presenters from Seattle Children’s Hospital at Pediatric Hospital Medicine 2022 offered these examples of how climate-change-driven heat—which has generated record-breaking temperatures in the Northwest and across the U.S. recently—has made everyday life a struggle for children. And they described the need for change in a country where, too often, the effects of climate change are disproportionately harsh for Black people, indigenous people, and people of color.
“Climate change is real, and it causes global morbidity and mortality, particularly for children who are much more vulnerable than adults,” said Julia Hadley, MD, a third-year resident at the hospital, who presented with Sruti Pisharody, MD, also a third-year resident.
The effects of climate change are wide-ranging, Drs. Hadley and Pisharody pointed out. Rising sea levels lead to changes in water quality that can help spread waterborne illnesses. Extreme weather events influence the ecology of vectors that can boost levels of malaria and dengue. Severe weather results in injuries and mental health problems. And all these threats have led to the forced migration of vulnerable populations.
“Climate change has even altered the nutritional content of our food, with decreased protein, iron, and zinc from crops grown in environments with higher carbon dioxide,” Dr. Pisharody said.
“No other category of hazardous weather events in the United States has caused more fatalities in the last decade than extreme heat,” Dr. Hadley said. And heat is the leading cause of morbidity in the summer, she said.
Audience members cited problems for their patients that include a lack of air conditioning, heat stroke, and canceled school activities.
Even within the same city, heat can affect people very differently depending on where they live in that city, they said. In King County in Seattle, it can be 96 degrees in one neighborhood and 76 in another. These “heat islands” are wrought by an abundance of concrete that absorbs and retains heat in ways that green areas with tree cover do not. Heat-island neighborhoods tend to have higher populations of Black, indigenous, and people of color, Dr. Hadley said.
“Which neighborhoods have more trees is not random,” she said.
Structural racism has helped sculpt a country with uneven effects of climate change along racial lines, they said.
Indigenous people were pushed off traditional and productive lands and were forced to settle in areas more vulnerable to climate change, Dr. Pisharody said. The Quileute people in La Push, Wash., have seen rising temperatures and sea levels and worsening storms, bringing flooding and destruction to their homes. In Newtok, Alaska, rising seas have thawed out the permafrost and caused erosion, forcing the Yup’ik people to abandon their village and move to higher ground.
In the 20th century, laws forbidding non-whites from owning land in certain areas—and, later, policies of refusing mortgages and insurance in predominantly Black neighborhoods—led to segregated enclaves.
Today, if you look at maps of Seattle side by side, it’s easy to see that redlining, racial distribution, canopy cover, and temperatures follow a strikingly similar pattern, Dr. Pisharody said. The same can be seen in other cities, she said.
“Although the racist policies of the 20th century have been removed from legislation, we can see that their legacy remains,” she said. This is because the redlining meant devalued land, and more investment in clustered buildings and industrial spaces, with decreased canopy cover, she said.
A 2020 study showed that 94% of neighborhoods that were historically redlined experienced higher temperatures than non-redlined neighborhoods.1
These disparities come at a high cost. In a 2008 study, researchers showed that an increase of 10 degrees is associated with increased mortality for infants less than a year old, adults over 65, and Black people. Part of this mortality risk for Black people is due to underlying illness but is also due to less access to air conditioning, she said. In 2010, the same researchers found that an 8.6% increase in pre-term delivery was associated with a 10-degree increase in weekly temperatures.2,3
There is no validated tool for screening patients for climate change vulnerabilities, but a 2021 paper put forward a guide to providing primary care that considers climate change-related conditions. Drs. Hadley and Pisharody are hoping to work with others at Seattle Children’s and community members to develop an easy-to-use screening tool that can be used in both the inpatient and outpatient settings.4
Clinicians can ask questions that include: Are there trees or areas of shade in the neighborhood? Do you have air conditioning, filters, or fans? In the past 12 months, have you had trouble paying your utility bills? Do you know how to identify heat-related illnesses? How do you store medications? These questions will help screen families who are vulnerable to extreme heat by evaluating energy insecurity, housing conditions, complex medical history, and familiarity with local climate patterns.
Doctors can also review how to use weather forecasts and indicators of air quality, identify places where families can stay cool, and spend extra time with families new to the area.
Children, they said, should be taught about climate change, since it is a source of anxiety and uncertainty for them.
“It’s important that we talk to kids directly about climate change,” Dr. Hadley said.
Changes at the institutional level are important as well, they said, given that health care contributes 10% of the greenhouse gas emissions in the United States, and that hospitals are the second most energy-intensive facilities. Institutions should take steps to reduce single-use plastics, reduce food waste, and restore native plantings in their landscaping, among other steps, Dr. Pisharody said. Hospitals should also push for policy change, she said.
“Our institutions have a lot of power, and we should use this to guide legislators to prioritize climate justice-centered legislation.”
Tom Collins is a medical writer in South Florida, who has written about everything from lethal infections to thorny ethical dilemmas, runaway tumors to tornado-chasing doctors. He gathers health news from around the globe and lives in West Palm Beach, Fla.
- Hoffman JS, et al. The effects of historical housing policies on resident exposure to intra-urban heat: A study of 108 US urban areas. Climate 2020;8(1):12.
- Basu R, Ostro BD. A multi-county analysis identifying the populations vulnerable to mortality associated with high ambient temperature in California. Am J Epidemiol. 2008;168(6):632-7.
- Basu R, et al. High ambient temperature and the risk of preterm delivery. Am J Epidemiol. 2010;172(10):1108-17.
- Philipsborn RP, et al. A pediatrician’s guide to climate change-informed primary care. Curr Probl Pediatr Adolesc Health Care. 2021;51(6):101027. doi:10.1016/j.cppeds.2021.101027.