Climate Change Growing Up in a Warming World: Heightened Temperatures Pose Significant Risk to Child Health
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May 23, 2023
Harleen Marwah, MD MS | Perry World House
Harleen Marwah is a Pediatric Resident at Children's Hospital of Philadelphia. This piece was written for Perry World House’s 2023 Global Shifts Colloquium, “Living with Extreme Heat: Our Shared Future.”
Heat and Child Health
According to new research from UNICEF, 559 million children are currently exposed to high heatwave frequency, while 624 million children are exposed to high heatwave duration, heatwave severity, or extreme temperatures. The UNICEF report projects that every child will be exposed to high heatwave frequency by 2050, regardless of mitigation efforts. It is increasingly important for communities to evaluate the distinct ways heat poses risks to children.
Children are uniquely vulnerable to heightened temperatures and the increasing frequency, duration, and severity of heatwaves globally. Physiologically, their bodies have less reserve for cooling and thermoregulation. They are more vulnerable to dehydration. Heat can increase allergens or air pollution, which places children at increased risk for respiratory diseases like asthma, given their higher respiratory rate. High risk exposures, like frequent heatwaves, can increase the risk of developing chronic health conditions like cardiovascular diseases. From young infants to high school athletes, extreme heat places children at increased risk of heat-related illnesses, including life-threatening instances of heat stroke. Additionally, children rely on others to dress them, feed them, and keep them safe. When heat threatens access to nutrition, water, and livelihood, children are left vulnerable.
In the United States, the Centers for Disease Control and Prevention (CDC) gathers data on Emergency Department visits for heat stress, heat stress hospitalizations, and heat-related mortality. By capturing an estimated number of people impacted by heat cramps, heat syncope, heat exhaustion, and heat stroke, this data begins to demonstrate how increasing temperatures are harming people’s health. These resources present opportunities to better understand the multitude of ways in which extreme heat can harm people.
Stratifying this dataset by age would unlock insights specific to the pediatric population and help focus research efforts on the impact of heat in specific age ranges (e.g., infancy, early childhood, adolescents). Expanding on the definitions of heat-related illness, to capture children impacted by other heat-related co-morbidities, would allow for more refined monitoring and a deeper understanding of the impacts of heat on child health. Exploring clinical outcomes in settings beyond the emergency department, including primary care or urgent care, would allow for an expanded picture of the scope of the problem (recognizing that under-resourced communities often present to the emergency department first).
Having information like this allows researchers, clinicians, and public health leaders to better understand how children are being impacted by heat and how to protect them moving forward.
Clinicians must be prepared to counsel and care for patients in the wake of a warming planet. While progress has been made in the intersection of medical education and climate change, a 2020 survey revealed only 15 percent of medical schools globally had climate and health incorporated into their curricula. With heatwave seasons extending into atypical times of the year, clinicians should be equipped with knowledge about evolving patterns in order to more effectively counsel patients, to maintain appropriate differential diagnoses, and to appropriately advocate for the communities they serve.
Public Health Outcomes
In addition to data regarding presentations to clinical settings, it is also important to gather data on where the high-risk zones are. In Philadelphia, the “Philadelphia Heat Vulnerability Index” was developed by the city’s Department of Health and Office of Sustainability. This interactive map allows users to search an address and estimate neighborhood vulnerability to increased heat. The map is consistent with known disparities secondary to the racist policy of red-lining, with some neighborhoods in Philadelphia having temperatures 22 degrees higher than others. The map also allows users to identify the closest health centers to them.
The health of children is deeply intertwined with societal infrastructures and community resources. More data is needed to track how heat can indirectly impact health, through metrics like food insecurity, migration, disruptions in education, and infrastructure.
For example, extreme heat can create dangerous conditions for kids attending school. For instance, in Philadelphia in 2022, schools had to close during a severe heatwave due to lack of air conditioning. It is unclear how widespread cancelled school days or “heat days” have become. Missed school days put children at risk of falling behind academically and can have impacts on both physical and mental health. Many school buildings need upgrades, including cooling systems. A Government Accountability Office survey from 2020 showed that 41 percent of school districts reported school buildings that required heating and cooling upgrades. More comprehensive monitoring and data in this area would allow for more focused resource allocation and investment in infrastructure.
Turning “Monitoring” into Momentum
Ultimately, building better tools for monitoring creates opportunities for building more climate-resilient communities. For example, a deeper understanding of the temperatures at which heat-related illness frequency increases within specific communities allows public health officials to improve extreme heat alarm systems. Neighborhood heat monitoring could empower public health departments with information to deploy resources, invest in needed infrastructure, and support those at highest risk. The data opens doors for thoughtful and community-driven resiliency investments and planning, from cooling centers to canopy coverage to cool pavement technologies. It also presents an opportunity to provide more equitable interventions. The CDC explains that interventions to address exposures and equity “should consider how populations experience disproportionate, multiple, and complex risks to their health.” With more detailed and specific monitoring, communities can focus their efforts on data-driven and effective ways of protecting their communities, building a more climate resilient future for future generations.