Republished under a Creative Commons license
By Dr. Aaron Bernstein in Coverage

How to nurture resilient young minds amid the crises of COVID-19 and climate change

As a pediatrician, I have more than a decade of experience caring for children and adolescents with mental health disorders, and the combined onslaught of COVID-19 and the wildfires and hurricanes that have battered communities across the country in recent months leave me especially concerned about our children’s mental health. As parents, caregivers, and community members, we must do everything we can to build resilience in our children to the hardships that COVID has brought about and take actions that promote better mental health. We can protect the climate and our health more broadly when we do so, too.

I’m often asked if COVID harms children. The stock answer to that question is that the disease tends to spare children as the evidence shows that children who are infected tend to recover better than adults. But this is too narrow an assessment. COVID has caused enormous economic hardships for families and led to greater social isolation, with both the virus and the economic fallout taking a disproportionate toll on communities of color. Such crises constitute adverse childhood events or “ACEs.” Children who don’t have the social networks and other resources to buffer their minds from ACEs can experience toxic stress, which can damage developing brains and bodies and have lifelong health impacts. ACEs can come from pandemics as well as from the wildfires in the West that have burnt down homes, the hurricanes in Gulf states that have flooded homes and schools, or other natural disasters that climate change has made more dangerous. Regardless of the source of the ACE, we can all help children build resilience to toxic stress. Here are a few ways:

• Maintain your involvement in your child’s life. The best buffer to toxic stress in a child is an engaged and caring grown-up.
• Support responsible and healthy risk-taking. For example, encouraging your child to step out of their comfort zones and try new activities or meet new people can help build their self-confidence.
• Show your child the value of persistence as you overcome an obstacle in your life. When your child struggles with or fails at a task, talk with them about times when you have had a setback. Help your child understand that life comes with challenges and that persistence can help overcome them.

Here are additional steps we must take to better protect children’s minds and mental health.

Improve access to mental health care

We must address the uneven progress in improving mental health access. More than half of youth and adults with mental health disorders still receive no treatment. I can’t imagine what kind of outcry would ensue if half of people who had heart attacks got no care. Many strategies have been put forward to fill the treatment gap, including providing greater access to telemedicine. Abundant research shows that telehealth visits can provide effective mental health care. They have proven useful after natural disasters when patients and providers may have a hard time seeing each other in person, making it a potentially critical component of addressing the growing mental health burden that climate change may create. Telemedicine can also save time and transportation challenges, limiting emissions of air pollution and greenhouse gases.

Increase green space

Living near green space has been found to improve mental health, perhaps by its ability to reduce air pollution, or perhaps by exposure to nature directly. In one of the most striking studies to date, nearly 1 million children in Denmark were studied from birth to age 10. Those who grew up with the most exposure to green space were 55% less likely to be diagnosed with a mental health disorder than those children who were exposed to the least, after accounting for a host of other factors that affect risk of mental health diagnoses. Urban green space also cools down urban environments which may buffer risk from heat-associated adverse mental health outcomes, especially higher risk of suicide.

Build active communities

Aside from green space, urban design matters to mental health in terms of how it can promote (or impede) socialization. Suburban sprawl, greater dependence on car travel for work, and neighborhoods without walkability may all contribute to social isolation which is a major factor in mental health and health more broadly. Of course, walking, biking and using public transportation instead of cars reduces air pollution and greenhouse gases too.

We haven’t reached the end of the COVID tunnel and we haven’t seen our last wildfire or hurricane of the year, but we can act now to reduce the harmful impacts on our children’s mental health and take action that will lead to a healthier and more sustainable world for their bodies and their minds.

For more information on climate change and mental health, visit https://www.hsph.harvard.edu/c-change/subtopics/climate-change-and-mental-health/

Republished under a Creative Commons license
By Dr. Aaron Bernstein in Coverage

We can all take steps to address race and health disparities that contribute to asthma and other illnesses

I always hope that the next time I care for a child who needs a breathing machine to save their life from an asthma flare it will be my last. Cases of children with asthma this severe are fortunately rare, but across my career I’ve cared for many, and each time I do, I wonder what’s made this child’s asthma so much worse than all the other children who have the disease?

There’s something about seeing a child hooked-up to a breathing machine that has seared their faces in my memory. They were mostly boys. Often early adolescents. And almost always Brown or Black.

The faces I remember line-up with what data from across the country tells us. Black children are nearly twice as likely to have asthma and 10 times more likely to die from the disease than white children. The odds that any child dies from asthma in the United States declined sharply between 2005 and 2015, but the disparity in risk of death between Black and white children grew.

These differences speak to a larger story of health disparities in the United States. It’s a story that has been too rarely told but has never been more important. The factors that make a Black child more likely to get asthma relate to those that help explain why Black communities in the U.S. have death rates from COVID-19 that are three times higher than the national average.

In the case of asthma, health disparities start before birth. Many factors can contribute to whether a child develops asthma. Among these, being born too early stands out and evidence continues to mount that women who breathe more air pollution during pregnancy are more likely to deliver babies before they reach maturity. Not only are Black people in the United States far more likely to live in places where air pollution is worse overall, near major roadways or power plants, pregnant Black women are twice as likely as pregnant white women to live in counties with the worst air quality. Exposure to air pollution after birth also can contribute to getting asthma and making asthma worse once you have it.

Black Americans’ disproportionate exposure to air pollution has everything to do with racism in the United States. For centuries, Black Americans were systemically prevented from owning homes, particularly in neighborhoods with better-funded schools, parks and other amenities. In a cruel irony, the National Housing Act of 1934, intended to improve home ownership opportunities for Americans, resulted in codified racial discrimination. More than American cities were zoned by their “investment security” in a process that later became known as redlining.

Due to redlining in Boston, historically Black neighborhoods were much more likely to receive the lowest ratings – class D. This meant that Black people and other minorities were unable to get the mortgages that the federal government was backing. The redlining of the past can still be seen in Boston—and other cities—as areas graded as D are more likely to be near sources of pollution (like major roadways or power plants) and have residents more likely to get sick because of it. They also have fewer trees and more intense urban heat islands. More than 80 years later, and 50 years after the Fair Housing Act, researchers continue to find widespread evidence of discrimination in access to housing.

When I care for a Black child with asthma (or a host of other health problems that disproportionately impact Black children), I am often doing so as a result of centuries of racial discrimination that have created health inequalities that persist today.

In our collective present reckoning with how to fight the injustice we see in our society today—and all the harms to our health it causes—we can all commit to anti-racist actions that promote environmental justice.

To do this, we need to get engaged. Issues of environmental justice have been embedded into our policies, laws, and communities for decades, and to undo their injustices, we need to educate ourselves and speak out. A good place to start is by attending your local town meetings and hearings, where decisions are made about new developments, infrastructure, and transportation initiatives that may impact air pollution in your community. Get involved in local efforts to fight for clean air and water.

We will also need leadership from the private sector and our government. And when it comes to governments, we can vote for environmental justice. We can learn about—and vote on— candidates’ stances (and better yet, track records) on pollution. If we all take these and other steps to reduce air pollution, we could go a long way to making asthma less of a problem for our children, and especially for children of color in this country.

Republished under a Creative Commons license
By Dr. Aaron Bernstein in Coverage

The prospect of a really hot summer on top of a pandemic requires new thinking about how to keep people safe

Summer is upon us, and as we hope for the continuing decline of COVID in Massachusetts and the loosening of physical distancing restrictions, we also need to remember the health effects of the heat that the season will bring.

Last year was tied with 2016 for the hottest summer on record for the Northern Hemisphere. This winter was one of the warmest yet for the contiguous United States, and 2020 is on track to be the hottest year ever. Summer heat, made more common and severe because of climate change, isn’t just uncomfortable. In the U.S., some 12,000 each year die from heatwaves, making heat one of the most deadly natural disasters. The more we study heat, the more we realize that it saps just about everything we care about, including our economy, our minds, and our spirits.

The prospect of a really hot summer on top of a pandemic requires new thinking about how to keep people safe. Getting those at risk from heat, including older people and those with chronic medical problems, to cooling centers on hot summer days isn’t easy under normal circumstances. This summer we have to contend with the reality that those most at risk from heat are also the most at risk from COVID, and may not feel comfortable going to a public center, particularly if it means taking public transit. To innovate around these challenges, many cities have started to partner with community organizations embedded in neighborhoods around the country. These groups, from religious congregations to choirs, have personal ties with individuals who may be at high risk from COVID and heat, which can make all the difference in saving a life when a heatwave arrives. Some cities have a buddy system to encourage people to check up on each other.

For anybody at risk, and especially folks who may not use or have AC, here are some simple and important ways to stay safe:

• Drink water and not caffeine or alcohol as these can dehydrate you. You know if you are well-hydrated if your urine is light yellow or clear.
• Dress like you are at the beach. Wear loose-fitting clothes.
• Stay on the lowest floor of your home. If the basement is livable, use it.
• Take a cool shower or bath.

Even without AC, actions can be taken to keep temperatures in homes and apartments from going up:

• Cover windows with curtains, shades or whatever works to keep the sun from shining in.
• Eat food that can be eaten cold, so you don’t have to use your oven or range.
• If and when the temperature falls below 70, which in many places happens early in the morning and at night after the sun has gone down, open windows and use a fan to circulate air.

COVID and heat also pose unique risks to those on the frontlines and others who have to wear protective gear like masks, gloves, and face shields to protect themselves from the coronavirus, and especially when outside. To keep workers like emergency responders, farmers, and construction workers safe, workplace heat safety protections are important:

• Increasing cool-down and hydration breaks
• Providing shaded rest areas that allow for physical distancing
• Avoiding physical activity during the hottest times of day
• Increasing ventilation and opening windows
• Engineering physical workspaces to use PPE as a last resort—e.g., allowing for physical distancing, alternating rows in a field or installing partitions in an office.

Taking steps to prevent heat-related illness and COVID transmission this summer will help ensure that we protect communities of color and the poor, who have been hit hardest by the pandemic. We also can give a reprieve to our nation’s healthcare workforce, which in many places are just starting to recover.

And as we hopefully move steadily closer to enjoying summer, keep in mind that we can also take steps to reduce the risks from pandemics and heat moving forward. Some of the same actions we can take to reduce our risks from pandemics also reduce risks from climate change, including extreme heat. Burning less fossil fuel will reduce harmful air pollution that can lead to worse outcomes from COVID-19 and carbon pollution that drives climate change. Creating more green spaces, especially in low-income urban areas, can cool down neighborhoods, lower utility bills, and reduce air and noise pollution. We can do all this now so that next summer, and in future summers, we will be healthier, more prepared and more resilient to heat.

Republished under a Creative Commons license
By Dr. Aaron Bernstein in Coverage

Fifty years ago, the first Earth Day captured a growing awareness that the emissions billowing from factories and cars, which for so long had been a mark of prosperity and booming industry, were damaging the Earth and ourselves. Today, we can look back and see that the actions taken then dramatically cleaned up our nation’s air and water, saved millions of lives, kept people healthy and prevented millions of heart attacks, strokes, and asthma attacks, all while growing our economy. We can also see that we must do more, especially to ensure that these benefits extend to the most vulnerable people in our own country and around the world who have not benefited from these gains.

Evidence has emerged that breathing polluted air is one of the risk factors for those suffering the most from COVID-19. We know that people of color in our country, who have been dying at strikingly higher rates than others from COVID-19, and the poor are more likely to breathe polluted air. The same disparate harms of air pollution we see in our country are seen around the world. I hope that by the 100th anniversary of Earth Day we will be able to say that better air quality has benefited everyone.

While caring for children in recent weeks, I have often thought about how a virus, which first entered into a person from an animal somewhere in Asia, might be infecting a child in my care in Boston. These moments have made clear that the current pandemic, like the overwhelming majority of the emerging infections that have occurred in recent decades, has resulted from our mismanagement of our relationships with other life on Earth. Fifty years ago, the founders of Earth Day helped us all recognize that we must protect the environment to protect ourselves. No moment in our history makes this more clear than this one.

To prevent further pandemics, we need better disease surveillance and testing, among much else. We need better access to critical medical supplies and support for providers who have had to endure some of the most trying days of their careers. But most of all we need to do more to make sure that these pathogens never get into people in the first place.

Since the COVID-19 pandemic began, I have received countless questions about the connections between the environment and COVID-19. I hope these connections, outlined in my Q&A, make clear that Earth Day, and our commitment to protect and preserve the natural world, is more important now than ever.

Does climate change affect the transmission of coronavirus?

Climate change alters how we relate to other species on Earth and that matters to our health and our risk for infections.

As the planet heats up, animals big and small are headed to the poles or to cooler or higher elevations or waters to get out of the heat. That means animals are coming into contact with other animals they normally wouldn’t, and that creates an opportunity for pathogens to get into new hosts.

While we don’t have direct evidence that climate change is influencing the spread of COVID-19, we do know that many of the root causes of climate change may increase the risk of new infections. Deforestation, which occurs mostly for agricultural purposes, is a driver of habitat loss worldwide. This forces animals to migrate and potentially contact other animals or people and share germs. Large livestock farms may also serve as a source for spillover of infections from animals to people. Less demand for animal meat and more sustainable animal husbandry may decrease these risks, as well as lowering greenhouse gas emissions.

Climate change affects where animals and plants live and where diseases may occur. Historically, we have grown as a species in partnership with the plants and animals we live with. So, when we change the rules of the game by drastically changing the climate and life on Earth, we have to expect that it will affect our health.

Does air pollution increase the risk of getting coronavirus, and does it make symptoms worse?

A recent study from Harvard shows that even small increases in air pollution are associated with an increased risk of dying from coronavirus. Air pollution is strongly associated with people’s risk of getting pneumonia and other respiratory infections and with getting sicker when they do get pneumonia. A study done on SARS in 2003, a virus closely related to COVID-19, also found that people who breathed dirtier air were about twice as likely to die from the infection.

What actions can we take to prevent future outbreaks?

We can make many smart investments that could help avert another outbreak.

• Federal, state and local agencies can support public health leadership and science, providing more funding for needed research, early response to outbreaks and supplies for testing.
• We can do more to control the illegal wildlife trade, which researchers have linked to disease transmission.
• We can take climate action to prevent the next pandemic. For example, preventing deforestation — a root cause of climate change — can help stem biodiversity loss as well as slow animal migration.
• By rethinking our agricultural practices, including those that rely on raising tens of millions of animals in close quarters, we can help prevent transmissions between animals and spillover into human populations that may increase the risk of infectious disease spread.
• Reducing air pollution caused by burning fossil fuels like coal, oil and natural gas is another critical action we need to take to keep our lungs healthy, which is especially important to fight respiratory infections like coronavirus.
• When COVID-19 eases, and we are ready to restart our economy, we can make our workforce healthier and more climate-resilient by scaling-up our investments in low-carbon technologies.

We also have an opportunity now to recognize that prevention is by far the best approach to protecting health. Preparation for pandemics is also about keeping people healthy at baseline. If one-third of Americans are obese and 5-10% have diabetes, we’re going to be immensely more vulnerable. And if you look at why people in the U.S. are not healthy at baseline, the factors include our diets, pollution and climate change.

And so the great challenge for all of us on the 50th anniversary of Earth Day is to do everything we can to be better stewards of the earth for the sake of all life on Earth and especially for our own lives, the lives of children, and for generations to come.

Click here for more questions and answers on COVID-19 and climate change from Dr. Bernstein.

Republished under a Creative Commons license
By Dr. Aaron Bernstein in Coverage

As we near the start of pollen season — and as many of us find ourselves spending more time outdoors in parks or woodlands, as businesses temporarily close — tens of millions of allergic Americans are bracing for discomfort, and even for serious illness. We have medicines that can help relieve the sneezing, snuffling, and aching that allergies can cause, as well as reduce the chances of an emergency room visit for a pollen-induced asthma attack. But there may be a more significant way to deal with the growing suffering from seasonal allergies: climate action.

Fifty years ago, New England’s pollen season started, on average, a week later than it does today, and ended a week earlier. What’s changed? The climate.

The climate has changed primarily because we’ve flooded the atmosphere with carbon dioxide from fossil fuels like oil, gas, and coal. This higher concentration of carbon dioxide causes plants like ragweed to make more pollen. A ragweed plant grown today may make twice as much pollen per plant as it would have in the 19th century when carbon dioxide levels were much lower.

Burning fossil fuels — especially from cars and trucks — also releases air pollutants that can worsen children’s allergies and even trigger asthma.

Your allergies may be especially active if you live in a city, where carbon dioxide levels can be 30% higher and temperatures 3+ degrees warmer than in surrounding areas. Cities are hotter than suburbs or nearby rural areas because of the “urban heat island effect.” Cities have more dark roofs, paved roads, and lack cooler and greener surfaces in comparison to surrounding areas, which all leads to more heat absorption. The warmer temperatures and higher carbon dioxide levels mean that ragweed plants thrive in cities—they flower earlier, make more pollen and live longer than their rural counterparts.

A first line of medication defense against seasonal allergies are antihistamines, such as loratadine (Claritin), fexofenadine (Allegra), cetirizine (Zyrtec) and diphenhydramine (Benadryl). These medications can work wonders for people with allergies. At the same time, they are often paired with other medications, such as decongestants, that can affect how our bodies sweat and regulate temperature. (Diphenhydramine may do this on its own as well).

This matters because climate change is causing more severe heatwaves and taking certain medications, including those taken for allergies, may increase your risk for fainting, over-heating, or getting dehydrated, among other problems. If you take allergy medications, and especially if you take other medications regularly, make sure to pay attention to how hot it is outside as summer approaches, which for many of us is now.

Beyond taking antihistamines, we can all take important actions to make pollen season more bearable:

• Keep an eye on the pollen forecast. If it looks bad, try to stay indoors in a room that has good air filtration to take out pollen.
• If you have forced heating and cooling, replace the air filter on your furnace at least twice a year, and more if you have pets or smoke.
• If you live in a city, maximize your green space, whether inside or outside, with plants that make little or no allergenic pollen (like these). Think about a green roof. More plants can help cool things down and suck up carbon dioxide, too.
• Driving less and walking, bicycling and taking public transit more will mean less fossil fuel is burned and less carbon dioxide and other air pollutants are produced.

Allergies are never fun, but climate actions can clean our air and shorten pollen seasons, and that means we can all breathe a little easier.

Coverage is a news service of Blue Cross Blue Shield of Massachusetts

Republished under a Creative Commons license
By Dr. Aaron Bernstein in Coverage

This year, watching Australia go up in smoke hasn’t been easy. I have friends who live in Melbourne, Sydney and Canberra, who have sent me stories and pictures of a summer gone bad. Air toxified. Wildlife decimated. Power out. Minds frazzled. More than 10,000 miles away, I have struggled with how to respond.

Australia—and the world—has a new climate. We’ve added enough carbon pollution to the atmosphere to give the planet a fever and, especially in places that tend to be dry like much of Australia, leave it parched. Heating and drying make fires worse. They also put trees at risk for infections and infestations that can turn a forest into kindling.

The same forces that have fueled Australian fires are imperiling and ravaging the western U.S. The most destructive fire in California history, 2018’s Camp fire, burned more than 18,000 buildings to the ground, killing nearly 90 people. Officials are still calculating the health toll from the smoke, but thousands may have been sickened.  Many more died from the smoke than from the fire itself.

Smoke from the Camp fire traversed the continent all the way to New York City;  and we know that smoke from the Australian fires has already traveled around the world.

Guidance for protecting yourself from wildfire smoke includes staying indoors and wearing a mask. While less than ideal, because the former won’t work if you are in a fire’s path and the latter don’t fit well on children (who are particularly vulnerable to air pollution), these actions may reduce exposure.

The dangers of wildfires reach beyond the physical health threats from fire and smoke. Living through a wildfire can exact a toll on mental health, particularly on children. Post-traumatic stress, anxiety, and depression symptoms are common symptoms after extreme weather events and may persist long after communities are physically rebuilt.

We absolutely must acknowledge the reality that more people will need medical care when wildfires happen. But we face the prospect of more destructive wildfires—as well as hurricanes, floods and heatwaves—and deep challenges in keeping people (and all other life forms) safe when they occur. That underscores how important climate actions are to reduce our dependence on fossil fuels. It also means it’s high time for more doctors, nurses and other health care providers to get involved in the fight for a healthier climate.

As a part of my response to the Australian and American wildfire disasters, I’m working to educate my colleagues in health care about how much climate change affects our ability to do our jobs. With this understanding, we may be more empowered to use our voices—not to mention adapt our practices—to support measures that expand resources for climate change preparedness and mitigation.

For the first time, every teaching hospital in Boston, Harvard Medical School, the Harvard Global Health Institute and the New England Journal of Medicine, among others, will be part of a conversation about how climate change matters to clinical practice. When we gather, we will discuss what’s needed to better prepare ourselves for climate change. If you are a health care provider, please join us.

If you aren’t a health care provider, you can talk to one. Let them know that climate change matters to you. Let them know that research has shown time and again that in the United States, primary care providers are a trusted and powerful voice in climate change conversations unfolding around the country, and you would like them to join that conversation. (And here are some concrete ways they can do so.)

Working together to make climate change a health care priority, especially a child health care priority, is exactly what the doctor ordered. It’s time to depoliticize climate change and accelerate the solutions we need to ensure a healthy and sustainable future.

Coverage is a news service of Blue Cross Blue Shield of Massachusetts

Republished under a Creative Commons license
By Dr. Aaron Bernstein in Coverage

If you’ve made a New Year’s resolution, chances are you want to be more fit or save more money. Everyone knows making good on these resolutions ain’t easy. So when you hit the wall in your workout routine, or are tempted to splurge on earpods or an Instapot, consider this: You can lose weight and save money by taking actions that also combat carbon pollution. Here are some tips to transform your New Year’s resolutions into a personal climate action plan that could save you money and may make you healthier in 2020.

Shrink food waste 

First, let’s take food. As you may know, food waste in the U.S. is a staggering problem. Our food system uses vast quantities of fossil fuels for fertilizers, pesticides, farm equipment, transportation, refrigeration, and more. So when food gets wasted, so too does its embedded carbon, making it one of the largest sources of pollution on the planet. In the U.S., food is often wasted after it is sold at a market, when it rots in our refrigerators or gets thrown away by restaurants. Here’s a menu of options to eat healthier and reduce wasted food in your life:

• At home, create a weekly food plan. Make a list of the ingredients you’ll need, then shop your fridge and cupboards before you go to the store. For more ideas, check out EPA’s tips to reduce food waste at home.
• At work, ask about plans to address food wasted in your cafeteria or from catered lunches. Many resources can help organizations reduce food waste, such as on ReFED or WRI’s websites.
• If you find yourself at an all-you-can-eat buffet, swap the tray for a smaller plate. This will help nudge you towards manageable portion sizes that don’t get left uneaten at the end of the meal. Good for the planet and your health, too!

Rethink transportation

For most Americans, our leading sources of energy consumption are gas for our cars and heating fuels in our homes. To reduce your reliance on cars, there are small changes you can make that have a big impact on the world, your wallet, and your waistline:

• Switch up your commute once a week: Can you work from home, carpool, take public transit, or bike to work one day per week? Research suggests that building activity into your day by trading car commutes for public transit, walking, or biking can lead to weight loss.
• Consider using flex time: If your workday can be flexible, you could avoid the stress of traffic while also reducing your carbon emissions if you can leave home or work before or after rush hour.
• If you are buying a new car: Go for the most fuel-efficient model that makes sense for your family and don’t rule out electric vehicles, which are increasingly affordable, have longer battery ranges, and are really fun to drive. Remember that you may be eligible for major tax breaks from the federal government and in many states for the purchase of an electric vehicle.

Keep heat in and energy waste out

Food and transportation account for about 40% of the average American’s carbon footprint. The other large chunk of energy consumption (about 30%) comes from our homes, and heating in particular. Many homes lose 25% of their heat, which is literally money out the door, window, or roof. Fortunately, there are some easy ways to reduce energy waste in your home, saving you money and reducing your carbon footprint.

• Get an energy audit: Many states have excellent programs to help homeowners find where energy is wasted and give incentives to make repairs. These programs can also help offset the cost of new boilers, water heaters, air conditioning units, and much more.
• Use a programmable thermostat: You can easily lower your temperature setting in colder weather (and raise it in warmer weather) when you’re asleep or away. If you don’t have a programmable thermostat, many of the state energy programs will subsidize those too. In cold months, reducing the temperature by 7-10 degrees for 8 hours a day can save you 10% on your energy bill.
• Unplug unused appliances: You might be surprised by how much energy our electronics draw even when we are not using them. You can save money and watts by unplugging counter-top appliances, computers, and entertainment systems when not in use. Programmable powerstrips can help you schedule on/off times, and electricity usage monitors can help you measure how much each appliance uses.

Money isn’t the only thing we save when we use less energy at home. Burning less gas and coal means there’s less air pollution and better health for everyone downwind of a power plant—which is, surprisingly, most everyone in the country.

Small changes that require a little creativity or curiosity, such as taking a new route to work, designing a new recipe, or participating in a home energy program, can make big impacts. While some scoff at individual actions, labeling them as inconsequential, many small actions can—and do—inspire bigger ones. When we take actions in our own lives to reduce fossil fuel consumption, we send a signal that we can do so and still live well. We also show that we care about climate, our health, and our children’s future.

Taking action to live without fossil fuels is a step towards staying healthy and saving money. This New Year, consider how your own resolutions can become a personal climate action plan. Together, we can spark more widespread aspiration to live without fossil fuels and support bigger and bolder climate actions. If we really want carbon policies to stick in our states and country, our own actions—and New Year’s resolutions—are a must.

Coverage is a news service of Blue Cross Blue Shield of Massachusetts

Republished under a Creative Commons license
By Dr. Aaron Bernstein in Coverage

I remember the first patient I ever treated as a pediatrician. He was a young boy, maybe 5 or 6 years old, who needed IV antibiotics for a routine skin infection. Ten years later, what sticks with me most about this child and his illness is that he got better. I was in awe of how so many things went right: we made the right diagnosis; we had the right medicine on-hand to treat it; the medicine was given correctly and promptly; and, of course, the medicine cured the disease.

What I’ve learned in the past decade is that what we count on to make care go right has increasingly become harder to count on. A host of challenges have put my ability to do my job as a doctor at risk, and at the top of that list is climate change. Here’s why.

Climate change makes it harder for people to stay healthy.

Carbon pollution has made extreme heat more common and severe across the country, but few medical providers know much about heat-related illnesses. Our best science suggests that extreme heat can contribute to stillbirths, suicides, and asthma attacks, among other effects, and it is especially dangerous to people with chronic medical conditions such as diabetes, heart failure, and kidney disease, conditions that affect more than 1 in 10 Americans.

More people are living with episodic heatwaves that are unprecedented in their lifetimes (a single heatwave in July 2019, the hottest month ever on record, had nearly half of Americans endure temperatures above 95 degrees) and may not recognize these health risks. Their health care providers may not either, especially when it comes to prescribing medications like diuretics, anti-hypertensives, and selective serotonin reuptake inhibitors that may be riskier when taken in hotter temperatures. Beyond heat, climate change puts health at risk in many other ways—through spreading infections, making food less available and less nutritious, and polluting our air and water, among others.

Climate change also makes it harder for medical providers to do our jobs.

A trend in practitioner specialization and high-tech care has made healthcare better in so many ways, but it also has made us more vulnerable to unwelcome surprises. Take power outages, for example. Extreme weather events, including severe storms and heatwaves, have grown more dangerous and frequent with climate change, and these disasters have caused more power outages in the United States over the past 15 years than anything else. Hospitals and clinics use back-up generators during an outage, but caring for patients in a hospital running on back-up power—which sometimes fails—is far from routine. Care delivery may slow down or be more prone to error, especially when care is delivered by highly specialized providers who need high-tech devices.

Even low-tech care is vulnerable to extreme weather. In fall 2017, Hurricane Maria wrecked Puerto Rico as a whole as well as the factory that supplied the bulk of small-volume IV fluid bags to the continental U.S. Ensuing shortages of IV fluids and IV bags, which are foundations of healthcare, left most hospitals and clinics around the country scrambling to figure out how to ration fluids and deliver medicines. Hurricane Maria made one thing especially clear: climate change fueled extreme weather can matter to care delivery far from where disaster strikes.

We should combat carbon pollution because it protects our ability to deliver care to those who need it. But we should also take climate action because it can improve everyone’s health—especially those whose health is at risk already—right away. Getting more people safely walking, bicycling and taking public transit to and from school and work, for instance, means less carbon pollution, less traditional air pollution like ozone and particulate matter, and more physical activity, which can reduce rates of obesity, diabetes, and asthma and improve mental health (see examples here and here). Major health benefits come with generating electricity from cleaner sources like renewables (see examples here and here). Because air pollution from burning fossil fuels is well known to disproportionately harm neighborhoods with high African-American and Latino populations, decreasing fossil fuel reliance can reduce health inequities that come from these communities breathing dirtier air.

Not long after I became a pediatrician I realized that I had to work on climate change if I wanted to do the job I’d signed up for—to keep children healthy. Even if everything goes right in the hospital, no prescription I write can safeguard children from climate change. That’s why, at the Center for Climate, Health, and the Global Environment, known as Harvard Chan C-Change, at the Harvard T.H. Chan School of Public Health, we’re trying to help families, medical providers, and policymakers better understand the connection between climate and health that will lead us to a healthier future. Our work will not be complete without engagement and action from all of us, so please join us in this fight and follow this series to learn how you can take steps in your daily life to improve health through climate actions and encourage leaders to take bold action.

Coverage is a news service of Blue Cross Blue Shield of Massachusetts