Climate and child health: Dr. Ari Bernstein

Climate change and children’s health problems may have some of the same solutions. (Photo: Michael Goderre/Boston Children’s Hospital)

When the pediatrician at Boston Children’s Hospital, Dr. Aaron Bernstein, who was in medical school, was told that climate change – an interest of his since the age of 7th Class – belonged in the realm of politics, not medicine. A professor told him flatly, “You’re trying to put a square pin in a round hole.”

But another professor linked it to what is now the Center for Climate, Health, and the Global Environment (C-CHANGE) at Harvard TH Chan School of Public Health. The center’s mission is to use scientific evidence on the health benefits of climate solutions to improve understanding and action.

Pediatricians care about prevention. We are not interested in waiting for children to get sick or disabled, we want them to stay healthy.

This agenda lit a fire under Bernstein. Today he is interim director of Harvard Chan C-CHANGE. He also directs Climate MD, a C-CHANGE program that encourages physicians to relate climate change to health here and now.

Talking about the connections between climate and children’s health is a natural part of being a pediatrician for Bernstein. In fact, the American Academy of Pediatrics was the first major medical organization to issue a climate change statement in 2007.

“Paediatricians care about prevention; We’re not interested in waiting for children to get sick or disabled,” he says. “We want to keep them healthy”

Cure disease, protect the planet

As an attending physician in hospital medicine, Bernstein has treated children with diseases transmitted by ticks and mosquitoes (which spread as the world warms) and trauma from natural disasters. But he also sees strong links between climate change and some of the biggest problems affecting children’s health – such as asthma, obesity and mental health problems. And he sees climate change and such health problems as part of the same solutions.

In the case of asthma, phasing out gasoline-powered vehicles would reduce air pollution, a major cause of respiratory problems in children, particularly poor children of color. An estimated 1 in 5 American children develop asthma from inhaling vehicle exhaust. At the same time, it would reduce the emission of greenhouse gases that cover and warm the earth.

Many measures against obesity are also good for the climate. Creating green spaces and urban parks encourages children to be active. It also helps absorb carbon from the atmosphere and provides shade, mitigating urban “heat islands”. Riding a bike instead of driving reduces our carbon footprint, as does eating healthier, plant-based meals. (Meat production is a major contributor to greenhouse gas emissions.)

With mental health among children, particularly adolescents, reaching crisis levels, fears about climate change may exacerbate mental health concerns. Bernstein cites a Danish study in which children who were exposed to the most green spaces were half as likely to have mental health diagnoses as children who were exposed to the least green spaces.

“These are all win-win situations,” says Bernstein. “In this decade we can make decisions that fundamentally shape the existence of our children.”

warmth and health

A warming world leads to more frequent and intense heat waves. Bernstein recently led the first large-scale study on the effects of heat waves on children’s health. Heat waves are particularly dangerous for children, who spend more time outdoors and whose smaller bodies can be more prone to dehydration. Heat waves can also worsen pollution and air quality.

Climate, deforestation and pandemics

Animals and humans increasingly come into contact as humans clear forests, hunt, and engage in the wildlife trade. As a result, animal viruses sometimes spill over to humans. COVID-19 is the latest zoonotic pandemic; others are swine flu, bird flu and HIV. In a recent article in scientific advances, Bernstein and colleagues call for more virus surveillance, better management of the wildlife trade and a drastic reduction in deforestation to prevent pandemics. The last two actions would also help conserve biodiversity, which Bernstein and his colleague Eric Chivian, MD, have shown are vital to human health, and help curb climate change.

The study looked at 3.8 million emergency room visits at 47 US children’s hospitals in late spring and summer and found that hot days increased children’s visits. Heat-related illnesses such as dehydration fueled some of the visits. But children also visited her for other problems that adults did not encounter. These included bacterial intestinal infections, ear infections, skin and soft tissue infections, blood disorders, and seizures.

Ear infections can result from children swimming in hot weather and developing “swimmer’s ear”. Unchilled picnics and food can lead to intestinal infections. Headaches and seizures can be caused by dehydration. But other conditions, like blood and immune system disorders, are more mysterious and require more research, says Bernstein.

Climate-informed medicine

Bernstein believes healthcare professionals have a role to play when it comes to helping families cope with the effects of climate change. He and his colleagues recently published a guide for paediatricians on climate-informed primary care.

“If we send children home from the hospital during a heat wave, we should consider going somewhere without air conditioning. If a child has had surgery and lives on the fifth floor without air conditioning, they are at a higher risk. Or, if they have air conditioners, can they afford to run them? Do they have access to a refrigeration center? We have to ask and make sure the child has a safe place to rest.”

Bernstein calls this approach “patient-centric climate resilience.” It also applies to hurricanes, floods and other weather events caused by climate change.

Questions to consider could be:

  • Will the family have access to food and clean drinking water?
  • In the event of a power outage, will they have access to electricity to run ventilators and other medical equipment?
  • Could their access to medication be disrupted?
  • Is your house damp and moldy due to flooding?
  • Does the child need a referral to mental health services?

“We can add questions like these to our other standard screening questions like ‘Are you wearing a seat belt?’ Add. or ‘Is there a gun in your house?’” says Bernstein. “A lot can happen in clinics. We can make a difference.”


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