The World Health Organization (WHO) states that climate change is the biggest global health threat of the 21st century.1 The major source of both air pollution and the greenhouse gas emissions driving climate change is the combustion of fossil fuels (coal, petroleum [oil], and natural gas).2 The joint occurrence of air pollution, extreme heat, and other climate-related changes leads to worse air quality.2 Furthermore, environmental and epidemiologic data indicate that air pollutants and climate change interact to negatively affect children’s short-term and long-term health.3
Children are particularly susceptible to the adverse effects of air pollution and climate change due to numerous physiologic and behavioral factors.4 Children are at a higher risk of acute respiratory infections, asthma, and decreased lung function due to air pollution exposure.3 Extensive, high-quality evidence has demonstrated the association between air pollution and respiratory morbidity.2–4 In multiple large cohort studies in Europe and North America, investigators have explored early-life exposure to air pollutants such as nitrogen dioxide, particulate matter, or measures of traffic and found consistent associations with increased risk of development and exacerbations of asthma.5–7
Although all children are at risk, the greatest burden falls on those who are marginalized and economically disadvantaged.8 Given the disproportionate burden that outdoor air pollution has on the respiratory health of Black and Latinx children, improving outdoor air quality—particularly in neighborhoods that have been the “dumping ground” for various toxins—can reduce racial disparities in children.9–11 Moreover, although providers have long recognized the importance of improved air quality in reducing respiratory morbidity, we urge pediatric pulmonologists and allied health professionals to increase advocacy efforts aimed at improving air quality.8
Optimizing advocacy efforts aimed at improving air quality requires understanding the concept of environmental justice. The Environmental Protection Agency defines environmental justice as “the fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income, with respect to the development, implementation, and enforcement of environ mental laws, regulations, and policies.”12 Environmental justice will be achieved when those who have been most affected by inequitable policies and practices receive protection from environmental and health hazards, access to the decision-making process, and appropriate cleanup of communities overburdened by the placement of waste and other polluting facilities in the environment in which children live, learn, and play.12,13
Medical societies like CHEST and the American Academy of Pediatrics have a long history of advocating for policies that protect the health and welfare of children; as pediatric pulmonologists, we should join our general pediatrics colleagues to advocate for policies that promote environmental justice and help ensure that all children can grow up in a safe and healthy environment.4,13,14
Check out an issue of CHEST Advocates that explores the health impact of climate change and environmental injustices.
References
1. Pan American Health Organization. Climate change and health. PAHO/WHO. https://www.paho.org/en/topics/climate-change-and-health
2. Perera F, Nadeau K. Climate change, fossil-fuel pollution, and children’s health. N Engl J Med. 2022;386(24):2303-2314.
3. Aithal SS, Sachdeva I, Kurmi OP. Air quality and respiratory health in children. Breathe. 2023;19(2):230040.
4. Ahdoot S, Baum CR, Cataletto MB, Hogan P, Wu CB, Bernstein A; Council on Environmental Health and Climate Change; Council on Children and Disasters; Section on Pediatric Pulmonology and Sleep Medicine; Section on Minority Health, Equity, and Inclusion. Climate change and children’s health: Building a healthy future for every child. Pediatrics. 2024;153(3):e2023065504. doi:10.1542/peds.2023-065504
5. Brumberg HL, Karr CJ; Council on Environmental Health. Ambient air pollution: health hazards to children. Pediatrics. 2021;147(6):e2021051484. doi:10.1542/peds.2021-051484
6. Guarnieri M, Balmes JR. Outdoor air pollution and asthma. Lancet. 2014;383(9928):1581-1592. doi:10.1016/S0140-6736(14)60617-6
7. Thurston GD, Balmes JR, Garcia E, et al. Outdoor air pollution and new-onset airway disease. An official American thoracic society workshop report. Ann Am Thorac Soc. 2020;17(4):387-398. doi:10.1513/AnnalsATS.202001-046ST
8. Sadreameli SC, Coates A, Shearles B. Advocacy and health equity The role of the pediatric pulmonologist. Clin Chest Med. 45(2024):771-783. https://doi.org/10.1016/j.ccm.2024.02.024
9. Grineski SE, Staniswalis JG, Peng Y, et al. Children’s asthma hospitalizations and relative risk due to nitro gen dioxide (NO2): effect modification by race, ethnicity, and insurance status. Environ Res. 2010; 110(2):178–188. doi:10.1016/j.envres.2009.12.002
10. Symanski KWW E, Han I, Rammah A, et al. Assessing metal exposures among children living in environmental justice communities near metal recycling facilities in Houston. Texas. Environl Justice. 2023;16(1)1-11. doi:10.1089/env.2022.0033
11. DiCiaula A, Gentilini P, Diella G, et al. Biomonitoring of metals in children living in an urban area and close to waste incinerators. Int J Environ Res Publ Health. 2020;17(6):1919. doi:10.3390/ijerph17061919
12. US Environmental Protection Agency. Environmental justice. Published 2023.
13. American Academy of Pediatrics. Climate change, clean air, & environmental justice.
14. Durrwachter-Erno KH, Nguyen V. Informing policy on built environments to safeguard children in environmental justice communities: case study of five AAP climate advocates. J Appl Res Child. 2021;12(1):1-20.
