Session 2: How Can Our Health Systems Adapt to Help Children Build Resilience?
Capita and This is Planet Ed (the Aspen Institute) have co-convened the Early Years Climate Action Task Force to draft the first-ever U.S. Early Years Climate Action Plan. The plan will recommend ways the country can help young children, ages zero to 8, flourish in the face of climate change. It will be published in late 2023.
Climate change is a direct threat to our children’s health, safety, and ability to flourish. Yet experts in child development and climate have been slow to join forces to address this crisis. We are proud to bring together experts from both worlds to share, learn, and unite their efforts.
This listening session, the second of six, explored the myriad effects of climate change on children and families and considered ways the health care system can promote resilience. After presentations from four expert panelists, the session opened up for questions.
The experts:
Rupa Basu, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency
Parinda Khatri, Cherokee Health Systems
K. Ron-Li Liaw, Children’s Hospital Colorado
Malaika Ludman, Birthmark Doula Collective
Panelists are seeing the impacts of climate change on young children and families. But the special needs of children and families are not always accounted for.
Panelists described the effects of climate change already evident in their work lives: Struggling to help patients in hospitals that were paralyzed by Superstorm Sandy. Closing a pediatric clinic during a heatwave. Rising numbers of children whose asthma was triggered by wildfire smoke. “We are located in areas affected by flooding, tornados, and heatwaves,” Khatri said. “These events are occurring much more frequently and with greater intensity, often with significant consequences for our staff and our patients.”
Basu noted that different climate impacts cause different risks and effects, with varied exposures and populations at risk—but that children and pregnant women have often been the last to be studied. She gave the example of heat advisories, which do not mention pregnant women as being at high risk. More long-term epidemiological research is needed to understand the public health impacts of climate change on young children. The effects of wildfire exposure, for instance, are less studied than effects from heat.
The impacts of climate change on children and families are severe, diverse, and widespread. These effects are direct and indirect.
Panelists cited a host of direct impacts from climate change on children’s physical and mental health. Basu explained that heat affects all organs in the body. And it’s not only extreme or excessive heat that is dangerous—she and her colleagues have found that “background levels of temperature that we are already experiencing, even in a mild climate like California, are associated with adverse birth outcomes.” Those outcomes include preterm delivery, low birth weight, and stillbirth. Another issue: in pregnant women, the symptoms of dehydration (which are often connected to heat) resemble normal symptoms of pregnancy, so they are often missed. Liaw discussed the effects on children’s mental health, including acute stress disorder, post-traumatic stress disorder, depression, anxiety, sleep disturbance, nightmares, hopelessness, and suicidality.
The indirect effects on children are also severe, and they amplify those direct effects. Liaw cited stress on families and communities, disruptions in social supports, school closures, and a loss of place-based belonging. Ludman focused on families: They “might be separated from each other and their support systems, they face food insecurity, their care might be interrupted, they face barriers to accessing services and supplies. All of that creates disruption and stress and trauma.” She noted that stress affects parents’ choices on infant feeding—after a hurricane, for instance, when formula is being distributed, lactating people may view it as superior to their breast milk and switch, compromising babies’ health.
Liaw noted that climate change is a “threat amplifier,” exacerbating poverty, racism, and other injustices. Khatri also discussed how climate disasters intensify food insecurity, transportation problems, and other difficulties her clients already face, “those components that are always impacting the people we serve, that become harder to the nth degree.” Many families do not keep a lot of food in the house; they buy what they can when they get their paycheck. When her region’s small, winding roads flood, they cannot be traveled safely. Families can’t make it to the store, so they can’t replenish their food supplies. Children miss school.
Khatri shared the experience of her pediatric clinic as an example of the cascading effects of climate change. In summer 2022, the clinic was forced to close for 10 days because of extreme heat. The air conditioners could not keep up with the temperatures. Normally, about 100 children would have visited the clinic on each of those days. Many of its patrons are Spanish speakers, new Americans, or people living in public housing who had nowhere else to take their newborns. The clinic lost about $20,000 worth of in-stock medications.
The problems extend beyond individual communities or regions because phone systems and electrical grids are connected. Khatri and her colleagues worry whenever a severe storm hits Nashville—three and a half hours away—because it could knock out their network, leaving them (and nearby hospitals) without phone service.
The impacts of climate change hit vulnerable populations harder. Structural changes are needed to overcome these disparities.
Climate change does not affect all populations equally. For instance, Basu discussed disparities in heat-related adverse birth outcomes. The risk of heat-related preterm delivery is two to three times higher for Black, Hispanic, and Asian women than it is for white women. This added risk comes on top of their already-greater risk of adverse birth outcomes. Indigenous communities also face heightened risk.
Exposures vary by location. Communities near freeways or facilities that burn fossil fuels, for instance, are at greater risk from heat and air pollution. Residents may have fewer opportunities to mitigate the effects of climate change. In the case of heat, homes may not be air conditioned, or people may lack the ability to get to cooling centers, or they may not know about the centers or other ways to cool down. Many people who are at high risk do not know it, so they take no preventive measures.
Other reasons for the disparities come from the health care system itself, which often treats patients differently based on their socioeconomic status or race. Basu stressed the need for more female doulas, midwives, and ob/gyns, especially women of color. Patients have told her that “I was in the room, nobody listened to me, nobody looked like me, and I felt all alone.” Many of the health outcomes she covered would be preventable with a more inclusive and responsive health care system. Also needed: better education and advocacy and tougher standards on air pollution and other threats.
Liaw stressed the barriers to achieving that level of prevention. Addressing these inequities will require “real structural changes in the country and across the world.”
Health care systems must plan for disasters and build a resilient infrastructure.
Hospitals and clinics are already making physical changes to protect their ability to function during disasters, from individual steps like moving generators out of basements (which could flood) to whole-facility analyses. Khatri’s system has built in monitoring and tracking mechanisms, “things that we would have never thought of 10, 15 years ago.” Staff pay close attention to the weather. Her system is developing facilities and land use plans—something other health centers are also doing.
But the health care system must plan more broadly for resilience. Khatri’s system is training staff and beginning to educate patients about the impacts of climate change. Ludman’s organization, Birthmark Doulas, has launched Infant Ready, an emergency preparedness program to improve infant, maternal, and community health outcomes during and after disasters through safe feeding of infants and young children. Children’s Hospital Colorado, where Liaw practices, is seeing patient surges, which means it must dramatically increase capacity across many areas: its workforce, spaces, and communication to families and primary care providers. “That’s what we’re seeing in this new era of health care: you have to be able to flex and pivot on a dime,” she notes. “What happens in a flood, when communications systems, Internet, cooling, and other systems are down? We have to think about those considerations.”
Further, these steps toward resilience need to be coordinated. In a climate disaster, the whole region is affected. “We’re all calling the same people, we’re all ordering the same parts,” Khatri notes. “This is where having a coordinated community response is important and then investing in infrastructure across the board.”
Strong community infrastructure is also essential. We must foster children’s resilience to the effects of climate change and promote social connectedness.
Liaw urged a broad public health focus on building resilience to climate change—on interventions that strengthen the internal resources of children and families. “We have to invest as much in disaster and crisis management as we do in prevention, health equity, and disparity interventions.” This effort must reach families in multiple settings, not just health care. She described partnerships in Colorado among school districts, primary care providers, and community organizations who are teaching skills that all children and families will need to weather the climate and other crises. They are teaching basic mental health and resilience and healthy relationship skills.
Participants also discussed the need for community resilience in addition to individual and family resilience. Ludman noted the importance of social connectedness to healthy birth and postpartum outcomes. Social connections facilitate information sharing and advocacy. But they also make it easier for families to receive functional support: help with meals, housework, or caring for older children. “In our culture, we’ve lost turning to our sisters and aunties and elders for that support, and families have separated. In an intensified climate crisis, people turn to ‘Dr. Google’ for answers and feel very isolated,” she said. “But having social connectedness and access to information and support can add an extra cushion of resilience and support.”
Khatri described a “gift” of the pandemic: the partnerships that developed out of necessity during the COVID crisis. Before COVID, it might take months to plan a testing event. But during the pandemic, “when you have three days to plan a testing event with your grocery store, the gas station, and a local church, guess what: you do it.”
Those connections will play a vital role in developing the broader infrastructure to respond to climate change. For instance, many children with asthma are exposed to mold after their homes flood. For them, a visit to her clinic is not the answer. The core issue—conditions in the home—must be addressed. Khatri’s system is working with nonprofit partners on education and funding to help families make their homes more resilient to climate change.
“We can’t let these partnerships and strategies for community impact go after the pandemic,” Khatri said. “We need much more collective action so we can continue to provide the care our patients need and the community deserves.”