Joe Waters: Welcome to this conversation on the impacts of climate change on perinatal and pediatric health. I’m Joe Waters, the co-founder, and CEO of Capita. We are delighted to welcome those of you who are watching live and those of you who will watch down the road. We have a great conversation planned today between Greg Wellenius and Megha Agarwal.
Greg is an epidemiologist and a professor at Boston University, where he leads the brand-new Center for Change and Health in the School of Public Health.
Megha is the Executive Director of the Monarch Foundation in New York City, which is doing a ton of interesting work related to early childhood and improving the outcomes for children and families as well as very interesting work on climate change.
I’m going to turn the conversation over to Megha.
Megha Agarwal: Thanks so much for having me, I’m excited to be here in conversation with you, Greg. First, I would love to just open up the field to learn a little bit more about the work that you do. I know we just got a great introduction from Joe, but is there anything else that you can share about what it is that you’re actually studying and how that relates to the conversation that we’re having today?
Greg Wellenius: Thanks Megha, great to be with you today, and thanks, Joe, for the invitation and for organizing us today. Climate change is a really big problem. We hear a lot about it on the news and for a long time this was framed as an environmental problem – we should care about climate change because it’s destroying or harming our environment. That’s true, but I think the real reason we care about climate change is that we have to live on this planet; it’s impacting our opportunity to live well and live healthy for us today, not our families and not some distant people in the far future, but our families in our communities today. A lot of my research has been focused on documenting and understanding the health impacts of climate change, and how things that are changing in a rapidly changing world are affecting our health and well-being today.
Things like extreme heat, air pollution, and hurricanes are threats to our health today; if we can better understand the connections between those events and our health, then we can learn to better prepare for them and become more resilient. That’s what my work has been focused on. We have a very large community at Boston University that works in this space. Our new Center on Climate and Health is hoping to bring together people that are working in this space and help them be even more successful and visible than they have been today.
Megha Agarwal: That’s incredible. Even what you said right at the beginning really resonates. I think climate change for a lot of people can be this massive issue that they think we may be dealing with decades or even centuries from now, but I think that’s just not the reality, particularly when you look at it with a public health lens. It’s interesting to hear about that and honestly great to hear about the types of communities that already exist to combat this. I’d love to center the conversation a little bit around what Joe kicked off with – the impacts of climate change specifically on perinatal and pediatric health and for child flourishing, obviously cognizant that children continue to grow, and then it becomes an issue for adult health. It also has impacts on adults who are actually raising the children that we’re speaking of. I’d love to get a sense from you of what are the most intense impacts that we’re seeing right now of climate change on child health – how does it actually show itself and show up?
Greg Wellenius: It’s a great point. So much of the research and attention has been on the impacts of climate-relevant events on people’s risk of dying – dying is super important, but by and large, fortunately, kids don’t die in high numbers. When we think about who’s dying, 80 percent of individuals in the U.S. that die are 65 or over. What we’re realizing now is that climate impacts people across the life course from preconception all the way to the end of life. The impacts on children and during pregnancy have received less attention and in some ways have been a little bit more challenging to study, but what we’re seeing now is a wide range of impacts.
If we take extreme heat as one particular example, we can dive into that a little bit further. If you think of the heatwave that affected the Pacific Northwest last summer – this was a major heat wave that had serious impacts on the State of Washington, the State of Oregon, and across Western Canada – we still don’t quite have the final numbers, but the attention is largely on seniors and their health, as well as to some extent outdoor workers, but we have almost no insights into the impact on children. We know that kids are not just little adults, but that they’re uniquely vulnerable and that they’re perhaps less physiologically able to adapt to heat and they’re also maybe less self-aware in terms of when they’re feeling overwhelmed or ill and when they might need, for example, to seek shelter or even need medical attention. Young children especially might just be far less aware of that. As parents ourselves, we need to be very aware of what our kids are feeling. It might be really hard to judge when they are overheating and when they are becoming dehydrated. It’s an incredible challenge both from a how-to-study perspective and also how to understand the health impacts. What a number of papers now show is that the impacts of heat are not just in the elderly or even in the middle-aged, it’s across the life span, including the very youngest kids. Increased risk of emergency room visits, an increased number of not just heat-related illnesses, but other illnesses that are exacerbated by days of high heat.
Megha Agarwal: Yeah absolutely. I mean, even if you look at prenatal experiences or experiences for babies before they even have the ability to speak, a lot of the time we’re unable to actually understand the impact of things like this, because of the fact that they can’t advocate for themselves. We end up having to become the advocate on an issue that we don’t actually really know that well.
I do want to dive into a little bit of what you were saying, that research just doesn’t exist around some of this stuff or it’s very sparse. From your perspective, what do you see as some of the roadblocks that have existed to date in terms of actually collecting data around this, and creating awareness around the need? Where are we going moving forward and where are we right now in having small successes with actually being able to prove the need for this?
Greg Wellenius: I think those are all great questions. One of the challenges in studying the impacts of heat or other climate-relevant hazards on pregnancy health and children’s health is really the lack of data. We have really good national data sets on mortality – who is dying, when, and where – we have data available from Medicare and to some extent Medicaid regarding what’s happening to the elderly, as Medicare covers elderly individuals by and large, but it’s much harder to get large data sets on pregnancies with the detail that you need to actually do the types of studies we’re talking about. In children’s health, there are very few large-scale datasets that can be used to identify patterns in children’s health. We’ve been fortunate in my group. Colleagues have been able to leverage large data sets available, for example in New York City or New York State. My group has used studies of children with health insurance or children who go to children’s hospitals across the U.S., but these are unique data resources that we have. The biggest challenge has been the availability of big data to understand these questions.
The other aspect of this is that we haven’t actually been asking the questions for that long i.e. What are the impacts of climate change on kids? Because we inherently start by thinking about the risk of dying, then who’s most vulnerable to dying, which is the elderly and then we work backwards from there as to who’s getting sick, and children by and large are very resilient. Yet, despite that, we’re seeing these health effects. To go forward, I think to get the attention, we need more research because it’s hard to get attention to a problem if you don’t really know the size of the problem or the details about the impacts. I think there are multiple groups across the country and across the world working on the impacts of these climate-related hazards on pregnancy complications, early childhood growth, early childhood healthcare needs, and then into adolescence and beyond.
Megha Agarwal: It’s fascinating. You’ve mentioned heat quite a bit in terms of it being one of the biggest factors. Our globe is warming and I think it ends up having direct impacts. What are some other ones that we’re seeing in terms of climate impacts on children and just generations and people more broadly?
Greg Wellenius: Heat is one that is relatively well understood. We can forecast heat. People intuitively know that it’s at least uncomfortable; some people realize it’s also dangerous to your health. Other hazards might include the smoke from wildfires, which are becoming more common, more severe, and more extensive. Just on the news this morning, I heard talk about fires in the southwestern U.S. during ‘fire season’ – if we can even call it a fire season anymore because they’re extending more and more year-round. Of course, the fires themselves threaten the local communities, but the smoke from those wildfires can extend hundreds of thousands of miles away and influence the health of a much larger population. There are emerging studies now on the impact of wildfire smoke on pregnancy outcomes, pregnancy risks, and childhood, particularly around asthma and other respiratory diseases. So, wildfire smoke is one that’s climate-relevant.
Another one is hurricanes. Again, we are familiar with the destruction that hurricanes cause or can potentially cause and we are also aware of the reports of how many people die during a hurricane, primarily from injury. But really, much of the burden of or the health impacts of hurricanes come in the days after a hurricane, when there’s no power and maybe there’s high heat or people don’t have access to healthcare in the same way. We’re just starting to understand what might be the health impacts of hurricanes. For instance, a recent study showed that hurricanes are associated with a higher risk of preterm birth among pregnant women. Whether that’s the stress of the hurricane coming or the stress of trying to board up your house or make other preparations, or the disruption in care that you experience in that time frame, it’s hard to tell, but there are some important effects across the life course.
Megha Agarwal: That’s really interesting, especially that last bit you mentioned about hurricanes leading to preterm births; I think there is that stress aspect to a lot of what we’re speaking about. I think a lot of climate change impacts can lead to increased levels of anxiety and increased levels of undue stress. Is there data surrounding the impact on mental health, whether that’s for adults or children, more specifically? Of course cognizant that it’s probably harder to track in children.
Greg Wellenius: That’s such a fascinating question because I think there’s a wide awareness in the research community that all these factors and threats must be influencing people’s mental health, and so we’ve kind of taken that as a given, but there’s not a ton of evidence to show that’s true. There was a recent paper by a colleague of mine, Dr. Amruta Nori-Sarma at Boston University that actually documented more emergency room visits for mental health conditions associated with days of extreme heat. That builds on a larger literature showing that people’s judgment is impaired, and there seems to be more violence on very hot days. There’s another study from colleagues at Harvard that showed that the ability of students to do basic math operations is impaired on very hot days if they don’t have air conditioning. Injuries are more common on very hot days, there are some studies showing that so clearly has an impact on mental health.
For children, I don’t believe there are any studies about mental health and pregnant women associated with these climate hazards. Again, we suspect that the health effects are there, but we really need to keep working to document those, so that we can address them appropriately.
Megha Agarwal: Absolutely. It’s interesting because we’re talking about two extremely vulnerable populations – pregnant people and then babies and children. They should be there at the top of the list, it’s what fuels our future generations. It’s tough and there needs to be an investment and funding towards collecting that data and then acting upon it.
You’ll have a lot of non-believers say, “We’ve been dealing with climate change in one capacity or another for the past 100 years even if you look at 500 years ago to where we are today, the climate has shifted and it’s adapted and we as humans and our children are resilient, we also have adapted.” What makes this moment especially important? Are there ways that we can become more resilient and that we can rely on our children, our babies, and our pregnant people to become more resilient, or is there actually a need for the intervention? Why is that so important at this moment in particular?
Greg Wellenius: I’m really glad you took the conversation in that direction. John Holdren was the head of the White House Office of Science Technology and Policy under the Obama Administration and he said at a talk one time that climate change is going to require us to do some mitigation, which means reducing future emissions, some adaptation, which means getting ready for some of the impacts that are unavoidable, and pain. The choice that we have is just how much of each we do. The more mitigation and adaptation we do, the less pain and suffering we’ll have. I like that because it shows you that we really need all of the above. We do need to reduce our future emissions to avoid the worst scenarios that have been projected into the future of climate change, but we also know that the change is here, it’s not in the future, it’s in the present and it’s affecting everybody. Although, as you mentioned, it affects some people more than others, so we need to do what we can to make our communities and our families as resilient to these changes as possible.
There’s going to be some inescapable harm that comes from this. In the same way that we still see people dying from extreme heat, we see people whose health and well-being are jeopardized by wildfires and their smoke, hurricanes, and by Lyme disease and other vector-borne diseases etcetera. The choice we have as a society is how much mitigation and adaptation we do to avoid the pain. That actually gives me hope, because there’s so much momentum right now in the world and in the country. Although politically, this is a really challenging issue, when you talk to actual people, nobody’s opposed to being healthier or protecting themselves. There’s just again this incredible momentum in communities in cities across the country. That’s where the local action is and in aggregate that local action is really making a difference.
Megha Agarwal: It’s interesting to hear you say that. From your perspective, how much of this needs to be a policy-first solution versus maybe a grassroots-first solution? Does it start at the top and then go down or is it bottom-up, or both?
Greg Wellenius: It just has to be both, because there isn’t time to shirk our responsibility and let the other side do it. I’ve seen great success at the community level with communities proactively reducing their emissions in aggregate and creating ways to do that in a way that’s not financially harmful to people because people are also struggling financially. You don’t want to say, “Okay, now let’s all pay more for our electricity for some perceived far-off benefit.” Let’s do this in a way that’s financially sustainable, but do it on a large scale at the city or town level. There are these grassroots efforts and then also the federal government, and the state government. These international agreements can be helpful to create an environment in which these actions are more attractive financially and easier to implement from a policy point of view.
Megha Agarwal: One other player that we haven’t spoken too much about is a public health issue. We’ve talked a little bit about the public, but I’m interested in the health side as well. When you look at healthcare professionals and medical institutions, what role do they play in this, and have we seen care shifting? Have we seen those institutions and individuals start to understand climate change as a medical emergency? What does that actually look like?
Greg Wellenius: Absolutely. I think there are three things to touch on in the healthcare industry. One is that the healthcare industry is a huge emitter of greenhouse gasses – carbon dioxide and other gasses that contribute to climate change. As an industry, they need to do less harm by being greener. There are lots of really good efforts on that, I think this is a recognized problem – Healthcare Without Harm is a national organization based in Boston that does a ton of great work in this area and has some proven success. So, that’s one – is less of a contributor to climate change.
A second pillar is that your healthcare provider is amongst the most trusted voices in any community. Whether you see physicians making media appearances or whether they’re talking to individual patients, when you ask people who they trust for expert opinion, healthcare professionals are among the top. They have a communication role that I see has been growing – medical societies have position statements on the importance of climate change to health. The New England Journal of Medicine, which is one of the top medical journals, has published multiple thought pieces on how this is an important health and healthcare problem.
The third one is that particularly during disasters, healthcare workers are at the front line of responding. This is where we go when we’re feeling ill from that heat wave or the wildfire smoke. They’re very much part of the solution on that front as well because they are the front-line workers and need to be ready for the increased risk and the need for information during those moments.
Megha Agarwal: It’s fascinating. I didn’t actually even know that institutions really contributed to the problem as much as the solution. That’s something to be cognizant and aware of, how much of our systems are actually the issue. They’re going to be the ones that have to move forward with solutions, but also part of it is mitigating the harm that they’re causing in the first place.
Greg Wellenius: I see a tremendous amount of momentum where there’s a number of large medical systems and hospitals leading on this issue from the inside, so not even being pressured from the outside necessarily to change, but being pressured by their own community and their own members and leadership to change.
Megha Agarwal: You had an editorial on a climate change issue of pediatric and perinatal epidemiology; I have a quote here. You wrote that “failure to urgently address the reproductive perinatal and pediatric health impacts of climate change will perpetuate and worsen reproductive injustices wherein the most marginalized populations will be deprived of their ability to procreate and safely parent their children.” That statement really stuck with me, because I think it shows that there are massive implications for the future of humanity here and for people and for their children and future generations. If there’s one message that you really wanted to get across, whether that’s to policymakers or to funders who could potentially push some of their capital toward this issue, what would that message be? What’s the most critically urgent thing that we can do to actually address these impacts?
Greg Wellenius: That’s great; thanks for raising that commentary and particularly that quote. I just want to acknowledge the co-author on that commentary – it was co-written by my colleague Amelia Wesselink, also at Boston University, who really led a lot of the work on that issue.
I think the key message is that this is not a problem of the future, this is a problem of the now. Everybody’s at risk, everybody’s affected in very real ways. Let me just dive into that a little bit. If you live in coastal Rhode Island with more than 400 miles of coastline, sea level rise and coastal storms become a very big problem. If you live in an area in the western U.S. where you’re impacted by wildfire smoke, that’s going to be the dominant problem. This can be very personal and in a very localized way. What’s important to one person or one community might be very different than what’s important to a different community, but in some way or another, we’re all affected. Our health and well-being, broadly, are going to be affected regardless of who we are or where we live.
That said, some people are much more impacted than others. The real challenge and the thought behind that quote that you read are that the burden of risk is disproportionately borne by those that are least able to cope. We already see pregnancy complications are higher amongst communities of color than they are amongst predominantly white populations. Many of the impacts of climate change and these climate hazards also differentially impact people and communities in those same ways, and so climate change is not only a risk in and of itself for our health, but it’s also making the existing health disparities and environmental disparities that we’re seeing even worse. This is really from both a health perspective and an equity perspective. To go forward, what do we need? We certainly need, I would argue, research not just to better understand the problem but to develop solutions. We’re really good at describing the problem in some ways and we’ve done less work on saying, “Okay, here’s what you do about it,” and not just, “here’s what somebody else should do about it”, but “here’s what my community can do about it, here’s what my patient can do about it, here’s what my family can do about it.” It’s a very localized, personalized solution. That would be a great start. Those solutions obviously cost money and that’s probably where governments need to step in at all levels of government – local state and federal government – to make those solutions possible and cost-effective.
Megha Agarwal: Absolutely. That’s a beautiful end point – a strong call to action. I want to thank you for your time, it was incredible to hear just a little bit more about this issue, particularly given that I think it is a space that not a lot of people naturally start to think about. It’s something that’s a second-order or third-order level of thinking when you think about climate change. It’s really just interesting and important to hear more about this.
Watch the conversation here.