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An estimated 850 million children — or 1 in 3 children worldwide — live in areas “where at least four climate and environmental shocks, such as severe drought, flooding, air pollution, and water scarcity, overlap,” according to the authors of a scientific review published June 16 in the New England Journal of Medicine (NEJM).
The researchers reviewed 78 recent scientific reports and studies showing how and why young children, babies and developing fetuses are most at risk from the effects of climate change and air pollution.
The authors wrote:
“The fetus, infant, and child are especially vulnerable to exposure to air pollution and climate change, which are already taking a major toll on the physical and mental health of children.
“Protection of children’s health requires that health professionals understand the multiple harms to children from climate change and air pollution and use available strategies to reduce these harms.”
Socially and economically disadvantaged children bear the greatest burden of climate change and air pollution, said two researchers.
Frederica Perera, Ph.D., professor of environmental health sciences and director of the Columbia Center for Children’s Environmental Health, and Kari Nadeau, M.D., Ph.D., professor and director of the Sean N. Parker Center for Allergy and Asthma Research at Stanford University, conducted the review and wrote the report.
Fetuses, infants, children are most vulnerable to ‘synergistic effect of heat and air pollution
Children, babies and fetuses are uniquely vulnerable to the environmental impacts of climate change and related air pollution for several biological and behavioral reasons.
While in utero, a fetus is highly susceptible to developmental disruption due to toxic chemicals that may come into the mother’s body when she breathes polluted air.
Stress to the mother’s body from exposure to extensive heat can also negatively affect an infant’s development, said Perera and Nadeau.
They wrote:
“In addition, the biologic defense mechanisms for detoxifying chemicals, repairing DNA damage, and providing immune protection are immature in the infant and child, thus heightening their vulnerability to psychosocial stress and physical toxicants.”
Children and infants need to take in more food and water than adults to support their growing bodies, so disruptions to clean food and water supply impact them more than adults.
They also breathe more air relative to their body mass than do adults, increasing their exposure to air pollutants. And their narrower airways are more vulnerable to constriction by air pollution and allergens.
Children are more vulnerable to severe heat because of their bodies’ compromised thermoregulatory function, meaning they sweat less and have higher core body temperatures than adults when exposed to extreme heat.
Additionally, Perera and Nadeau explained, children are very vulnerable to the effects of displacement due to climate-intensified extreme events, such as wildfires on the west coast of the U.S. and major flooding from hurricanes such as Hurricane Katrina.
“They [children] are prone to physical injury and psychological traumas as a result of being forced to leave their homes,” they wrote.
Moreover, an estimated 7.4 million children in the U.S. were exposed to lung-damaging wildfire smoke each year between 2008 and 2012, and that number has only increased, wrote Perera and Nadeau.
They noted an NEJM special report published in November 2020 revealed a link between exposure to wildfire smoke in utero and decreased birth weight and preterm birth, as well as asthma exacerbations, wheeze, pneumonia and bronchitis in childhood.
Children who suffer the early onset of an illness such as asthma face a lifetime in which symptoms may persist and worsen, Perera and Nadeau pointed out.
“There is evidence of a synergistic effect of heat and air pollution on the incidence of hospitalization related to childhood asthma,” they wrote.
Moreover, the proliferation of mold caused by climate change in the form of heavy rains and flooding, such as during Hurricanes Katrina and Rita in 2005, can trigger an asthma attack whether or not the child has an allergy to mold.
Finally, in certain areas, climate change is also associated with increased risks of several vector-borne diseases – such as malaria, dengue, the Zika virus, and Lyme disease – because of changes in the transmission season and geographical spread of the disease.
‘Substantial inequities according to income and race’
The greatest burden of these risks falls on those who live in socially and economically disadvantaged communities, according to the researchers.
Perera and Nadeau stated:
“Disparities are most obvious between higher- and lower-income countries but are also evident within the United States, where children in low-income communities and in certain racial and ethnic groups, such as Black and Hispanic children, have disproportionate exposure to air pollution and to the effects of climate change.
“Contributing factors include the siting of polluting sources in or near disadvantaged neighborhoods and a lack of adequate nutrition, health care, education, and social support.
“Risks from heat waves are greater in low-income communities of color, where discriminatory policies such as redlining have created urban heat islands (characterized by heat-trapping asphalt, few trees, dense concentration of buildings, traffic, industry, and highways) and where resources to protect children from heat are fewer.”
Nadeau told Stanford News:
“Children of color are up to 10 times more likely to be exposed to toxins, pollution, and climate change than other children. In the U.S., rates of childhood asthma are twice as high among Black children as white children likely because of higher concentrations of particulate air pollution in Black communities.
“These and other environmental impacts, combined with poverty-related stress, injustice, and lack of access to health care, add up over a lifetime. They lead to worsened health effects and shortened lifespans.”
Two kinds of solutions are needed, according to Perera and Nadeau.
People need to take action to protect children from climate hazards — Perera and Nadeau labeled these “adaptation” solutions — while simultaneously working on “mitigation” solutions by addressing the root causes of climate change and air pollution.
To enact mitigation solutions, federal, state and local policies need to shift away from relying on fossil fuels and renewable energy sources, they stressed.
As an adaptive solution, public officials need to be sure children and families facing drought or famine have access to clean water and food.
Among their recommendations were shady areas for children to play and live, disaster-response training and evacuation planning for families and children, and mosquito nets to protect children in areas where malaria and dengue are present.
They also emphasized that pediatricians should take into account the socioeconomic status of the children they serve by making sure the behavioral changes they recommend to their patients are empowering and actionable, rather than inducing feelings of powerlessness, fear or guilt.
Fossil fuels are ‘major source’ driving climate change
The researchers identified the combustion of fossil fuels (coal, petroleum and natural gas) as “the major source of both air pollution and the greenhouse-gas emissions driving climate change.”
Their review of scientific literature and studies showed:
- Emissions of two key greenhouse gases, methane and carbon dioxide, have risen sharply during the past 70 years, causing the earth’s surface temperatures to rise by approximately 1.1 degrees C (2 degrees F) since preindustrial times.
- Carbon dioxide emissions reached 35 billion metric tons in 2020. Five billion metric tons were emitted in 1950, according to Earth System Science Data published in December 2019.
- Methane concentrations in the atmosphere measured more than 1,900 parts per billion last year, according to data released in January by the U.S. National Oceanic and Atmospheric Administration, Nature reported.
- The rising temperatures across the globe are damaging health and causing death – and those most vulnerable to these risks are the young.
‘We could have been more ahead of this than we have been’
A decade ago, air pollution generated by fossil fuel use and related rising temperatures were not generally discussed as an issue of pediatric health.
That has changed, the authors said.
“Almost nobody was considering climate change a health problem at the time [when I became a pediatrician 15 years ago],” Aaron Bernstein, the interim director of the Center for Climate, Health, and the Global Environment at Harvard T.H. Chan School of Public Health, told CNN.
“I feel like a total idiot for not seeing it earlier, because we could have been more ahead of this than we have been,” Bernstein added.
Now the American Board of Pediatrics has a maintenance of certification module on climate, health and equity. According to Perera and Nadeau, it is the first board to offer such content.
Additionally, the Climate Impact Lab — an international team of economists, climate scientists, data engineers and risk analysts — is working to build the world’s most comprehensive body of research that quantifies climate change impacts area-by-area and community-by-community around the world.
On its website, the lab features a “lives saved calculator” that uses a model of historical death records and localized temperature projections to generate an estimate for the number of lives saved if emissions are eliminated.
The analysis looks only at lives at risk from extreme heat, so the true climate toll could be higher due to other growing threats such as flooding and strong storms.
“Each additional ton of carbon has these global impacts — there is a tangible difference in terms of death rates,” Hannah Hess, associate director at the research group Rhodium, which is part of the Climate Impact Lab consortium, told the Guardian June 16.
