Climate Change: The Impact On Children’s Health

 

Back Camera

We have reached a point where there is global scientific consensus that climate change is real.  While some will debate the degree of human contribution as a cause, there is no doubt that climate change is already having a major impact on our health.

Linda Marsa, author of the compelling book, “Fevered: Why a Hotter Planet Will Hurt Our Health,” skillfully connects the dots between the warming of our planet and the effects on our health.  She warns, “Protecting ourselves from this oncoming medical meltdown is the most critical issue affecting our very survival in the coming century.”  As Deirdre Imus and I have previously written, children are most vulnerable to environmental health ills and victims of what we call “environmental injustice.”  In fact, the American Academy of Pediatrics (AAP) and the Environmental Protection Agency have both published statements documenting the major impact global climate change has specifically on children’s health.

Why are children particularly at risk?  Per the AAP, “Human health is affected by the condition of the physical environment. Because of their physical, physiologic, and cognitive immaturity, children are often most vulnerable to adverse health effects from environmental hazards. As the climate changes, environmental hazards will change and often increase, and children are likely to suffer disproportionately from these changes.”

How does climate change directly affect children’s health?  The AAP and EPA papers, along with a landmark resource co-written by Drs. Perry E. Sheffield and Philip J. Landrigan, supply ample answers.

1. Declining air quality, leading to poor respiratory health.   Air pollution has been linked to a wide range of conditions including asthma, autism, and cancer.

2. Natural disasters, leading to illness and injury as a direct result of weather events (e.g., hurricanes, fires) and secondarily due to loss of homes, food scarcity and stress.

3. Water and food-borne illnesses, primarily leading to dehydration associated with infectious gastritis and diarrhea.  Direct heat stress as well contributes to dehydration.

4. Vector-borne diseases caused by population increases of rodents and insects.  The geographical distribution of Lyme disease and malaria is already changing due to worldwide climate disruption.

5. Increased toxin exposure, as the distribution of chemicals like pesticides changes due to variations in temperature, humidity and water contamination.

6. Impact on pregnant women, leading to short- and long-term health problems for infants and children.  All of the above cited concerns have added second- and third-hand impact on children based on exposure via pregnancy.  Epigenetic theories support a “double-hit” hypothesis in which a child’s predisposition to illness is altered at the same direct exposures are increasing.  The emerging concept of the exposome – essentially, an individual’s lifetime environmental exposures – must be widened to include the periconceptual and prenatal exposures as well.

What can we do to limit the impact of climate change on children’s health?  Sheffield and Landrigan urge, “Prevention efforts directed against the health effects of climate change should acknowledge the inherent vulnerabilities of children and seek to reduce both their exposures and susceptibility.”

The EPA provides two specific suggestions:

1. Know Your Carbon Footprint: “Your carbon footprint is a measure of the greenhouse gases that you produce through activities that involve burning fossil fuels. Using less energy and reducing waste will reduce your carbon footprint.”

2. Reduce Your Carbon Footprint: “We produce greenhouse gases as a result of using energy to drive, to light and heat our homes, and through other activities that support our quality of life like growing food, taking showers, and throwing away garbage. After estimating your personal or household carbon footprint, you can take actions to reduce emissions at home, work, school, and in your community.”

Additionally, you can help global efforts by raising awareness in your community about the impact of climate change on children’s health and the steps we can take to limit it.

 

(originally written for the Deirdre Imus Environmental Health Center)

We are the Earth, and the Earth is Us

nature

“There is a road in the hearts of all of us, hidden and seldom traveled,
which leads to an unknown, secret place.
The old people came literally to love the soil,
and they sat or reclined on the ground with a feeling of
being close to a mothering power.
Their teepees were built upon the earth
and their altars were made of earth.
The soul was soothing, strengthening, cleansing and healing.
That is why the old Indian still sits upon the earth instead of
propping himself up and away from its life giving forces.
For him, to sit or lie upon the ground is to be able to think more deeply
and to feel more keenly. He can see more clearly into the mysteries of
life and come closer in kinship to other lives about him.”
– Chief Luther Standing Bear

The first “official” Earth Day in the U.S. was held on April 22, 1970. The event was one of the signposts of a new environmentalist movement, and we now mark it every April as a reminder to take good care of our Earth. Yes, we should remember this each and every day, but it’s good to have a special time to be mindful of this mission.

The idea of celebrating the Earth is ancient. Native Americans have always considered the care of nature a basic element of their worldview. “We are the Earth and the Earth is us,” they say. We are not separate from nature, from the land and water, from the birds and beasts. How we live our lives impacts our planet and thus affects our lives.

This circular concept is so important to my health philosophy that the first object you will see entering The Whole Child Center is a framed Native American medicine wheel, a mirror of the cyclic nature of life and our relationship to the Earth.

Our interconnectedness to nature is something I teach children in schools when I give Earth Day presentations. I demonstrate for kids the healing power of nature, describing how the Native Americans’ first medicines were the plants that grew around them. Their lives literally depended on cultivating the flowers and trees with which they co-inhabited the Earth. I bring an assortment of herbs like chamomile, lavender, and peppermint, and we talk about how people have relied on these magical cures for as long as we can remember. The kids love to smell and touch the herbs and many, for the first time, viscerally realize how important nature is to our well-being. They are so happy to discover this truth that they laugh out loud while exploring the herbs and spices! My hope is that this experience motivates them to take better care of the Earth.

Is it possible that something as simple as happiness could be the motivating factor to stimulate sustained ecological behavioral change? Professor Paul Bloom at Yale believes so, as he discusses in one of my favorite essays about how to best engage people in environmental stewardship. Are the rising rates of environmentally-linked illnesses like asthma and autism not direct enough for us? Are the scientific predictions of the wide-ranging health impacts of climate change too removed? Bloom offers a compelling and deceptively simple argument for perhaps the most immediate reason why we should want to preserve our habitat: Being in nature makes us happy.

“Put aside for the moment practical considerations like the need for clean air and water, and ignore as well spiritual worries about the sanctity of Mother Earth or religious claims that we are the stewards of creation. Look at it from the coldblooded standpoint of the enhancement of the happiness of our everyday lives. Real natural habitats provide significant sources of pleasure for modern humans. We intuitively grasp this, and this knowledge underlies the anxiety that we feel about nature’s loss. It might be that one day we will be able to replace the experience of nature with “Star Trek” holodecks and robotic animals. But until then, this basic fact about human pleasure is an excellent argument for keeping the real thing.”
– Professor Paul Bloom

Whatever your motivation, please take a moment today to appreciate the Earth, have a conversation with your children about the wonders of nature, and take the KIWI pledge:

“We pledge to keep the earth clean and protect this planet for future generations. It is our job to promote an eco-friendly lifestyle and maintain a natural, sustainable standard. This is a responsibility we feel will empower humanity and improve our quality of life. We also believe that the protection of the environment is of the utmost importance, and, therefore, will remain in the forefront of our minds.”

A Pediatrician Recommends the Nature Prescription

It’s late afternoon in the late spring, school’s been out for an hour or so.  I can’t really say for sure ‘cause I’ve totally lost track of time.  I’m knee deep in the muddy creek, eyes scanning for crayfish.  There it is!  Caught one, put in the bucket. We’re also “building a dam,” as we liked to say.  Gathering the perfect shape and size sticks and stones to hold back the mighty river!  Success was when the water slowed at our a-beaver-would-be-proud construction and diverted around the edges.  We never could stop that flow completely despite elaborate architectural debates and plans.  My buddies and I are doing what we do after school pretty much every day, all afternoon until the sun started to work its way down, and we knew it was time to head up the hill for dinner. I’m only a few hundred yards from home but I might as well be anywhere.

When I first read “Last Child in the Woods,” this memory came flooding back in full color and sound.  This was my childhood, as I’ve heard from so many people my age and older.

As I reminisced, I also grew increasingly worried for my children and their generation, because I’m seeing every day the price they are paying for living in a world that doesn’t recognize the true value of nature and free play.

I am a father, but I’m also a pediatrician with a busy primary care practice.  And I am witnessing the slow and steady destruction of our children’s emotional and physical wellbeing.

Kids are being diagnosed with anxiety, depression, ADHD, irritable bowel syndrome and migraine headaches at all time high rates.  Whatever labels we want to use, the message is clear – our children are suffering from stress.

While I’ve written previously about our medical systems’ ineffective and (at times) dangerous “one ill-one pill” approach, my point here is about prevention.

Getting kids back into nature is a key part of the solution to keeping kids healthy and truly creating wellness. A mounting number of research studies highlight the positive impact of free outdoor play on children’s emotional and physical health.

I like that and it makes us feel good. It also helps to fund projects when people demand proof. But do we really need randomized controlled trials (RCTs) to prove that spending time in nature is good for us and for our children?

In medical school, doctors are taught that RCTs are the gold standard to prove the worth of medical interventions. But what if the intervention is not a drug dosed exactly the same for every person for the same condition? What if the “treatment” — or better yet, the “prevention” — is something so multifaceted as nature? The more complex our challenges, the more complex the solutions.

This whole person philosophy, embedded in holistic health practice, is critical to solving the chronic health woes of our time, both in research and in practice.

And it is why doctors alone will never solve any of our current major health issues. If we continue to ignore common sense and place our children in increasingly stressful environments without teaching them the crucial coping skills and providing them with the opportunities for safe, unstructured free time in natural settings, we will continue to watch painfully as they deteriorate in mind and body.

We must be willing, as a health care profession, to leave our silos and work together with those colleagues in education, government, and environmental planning who value nature as a key to optimal health. It will only be through this commitment and investment that we will save our children and our future.

Overlooked: Type 1 Diabetes and the Environment

"Diabetes and obesity
are two of the most common and most costly health problems today.  12% of U.S. adults have diabetes, and if
current trends continue, more than 50% will have diabetes or pre-diabetes by
2020.  Annual U.S. spending on diabetes
is $194 billion (2010) and could reach $500 billion by 2020."

Source: The Collaborative on Health and the Environment Working Group
on Diabetes-Obesity Spectrum

As troubling as these statistics are, the number of children
diagnosed with diabetes continues to increase at a staggering rate and will add
exponentially to the toll on public health and health care expenditures.  The explosion in pediatric type 2 (formerly
known as “adult onset”) diabetes diagnoses has drawn much needed attention to
the impact of environmental factors (e.g., nutrition, exercise, poverty,
chemicals) on insulin resistance and metabolic syndrome.  Often overlooked, though, are the equally
devastating effects of these factors on the rise in type 1 (autoimmune)
diabetes, still the most prevalent form of diabetes in children.   Before
examining new research investigating the links between the environment and
autoimmune diabetes, let’s look at current epidemiology and how distinctions
between “type 1” and “type 2” diabetes are less clear-cut than previously
believed.

Epidemiology of Pediatric Diabetes

From the CDC: The SEARCH for
Diabetes in Youth is a multicenter study funded by CDC and NIH to examine
diabetes (type 1 and type 2) among children and adolescents in the United
States. SEARCH findings for the communities studied include the following:

  • During
    2002–2005, 15,600 youth were newly diagnosed with type 1 diabetes annually, and
    3,600 youth were newly diagnosed with type 2 diabetes annually.
  • Among
    youth aged <10 years, the rate of new cases was 19.7 per 100,000 each year
    for type 1 diabetes and 0.4 per 100,000 for type 2 diabetes. Among youth aged
    10 years or older, the rate of new cases was 18.6 per 100,000 each year for
    type 1 diabetes and 8.5 per 100,000 for type 2 diabetes.
  • Non-Hispanic
    white youth had the highest rate of new cases of type 1 diabetes (24.8 per
    100,000 per year among those younger than 10 years and 22.6 per 100,000 per
    year among those aged 10–19 years).
  • Type 2
    diabetes was extremely rare among youth aged <10 years. While still
    infrequent, rates were greater among youth aged 10–19 years than in younger
    children, with higher rates among U.S. minority populations than in
    non-Hispanic whites.
  • Among
    non-Hispanic white youth aged 10–19 years, the rate of new cases was higher for
    type 1 than for type 2 diabetes. For Asian/Pacific Islander and American Indian
    youth aged 10–19 years, the opposite was true—the rate of new cases was greater
    for type 2 than for type 1 diabetes. Among non-Hispanic black and Hispanic
    youth aged 10–19 years, the rates of new cases of type 1 and type 2 diabetes
    were similar.

To summarize, the most recent data in the U.S. demonstrates
that new cases of pediatric type 1 diabetes are still much more common than of type
2, but in certain populations, new cases of type 2 are more prevalent.  Certainly social determinants are notable
contributing to major health disparities, but for youth <20 years old as a
whole, we are still seeing many more new cases of type 1 diabetes versus type
2.

Even so, differentiating between types 1 and 2 is not so
straightforward.  The Collaborative
on Health and the Environment
(CHE) points out, “There is overlap among the various types of diabetes, and scientists
are beginning to look at diabetes as a spectrum of disease, with type 1
(autoimmune) on one end, and type 2 (metabolic) on the other. Indeed,
researchers have found that 15-35% of type 2 patients diagnosed before age 45
test positive for antibodies to GAD, one of the markers of type 1 diabetes.
Many children with diabetes, meanwhile, show signs of autoimmunity as well as
insulin resistance. It may be that a large number of people with diabetes have
both autoimmune and metabolic processes contributing to their disease.”

This change in thinking about
types of diabetes is supported by data from the CDC’s SEARCH study.  In an article published in 2011,
authors reviewed data on classification of diabetes type by autoimmunity and
insulin sensitivity (IS)/resistance (IR); a large overlap was noted. 

Most subjects fell into either the autoimmune plus IS (54.5%) or
nonautoimmune plus IR categories (15.9%) and had characteristics that align
with traditional descriptions of type 1 or type 2 diabetes. The group
classified as autoimmune plus IR (19.5%) had similar prevalence and titers of
diabetes autoantibodies and similar distribution of HLA risk genotypes to those
in the autoimmune plus IS group, suggesting that it includes individuals with
type 1 diabetes who are obese. The group classified as nonautoimmune plus IS
(10.1%) likely includes individuals with undetected autoimmunity but may also
include those with monogenic diabetes and thus requires further testing.

So it’s no longer simply type 1 OR
type 2 – many diabetics in fact have evidence of autoimmunity AND insulin
resistance.  In fact, many of the same
environmental factors suspected to influence epigenetic expression of insulin
resistance and metabolic syndrome (including obesity) also are likely to
contribute the rising numbers of patients with autoimmune conditions like
diabetes.   

Environmental Factors

After several years of intense
focus on the environment and type 2 diabetes, researchers are now intently
looking at rising rates of type 1 diabetes and the role of potential
environmental factors.  Two recently
published studies from Australia are of great interest.  “Cyclical Variation in the Incidence of Childhood Type 1 Diabetes in
Western Australia (1985-2010)”
reports
that “the incidence of type 1 diabetes in children aged 0–14 years increased by
an average of 2.3% a year between 1985 and 2010, and a significant 5-year
cyclical pattern in the incidence rate trend was observed” and concludes, “The
cyclical pattern in incidence observed in Western Australia supports the role
of environmental factors in childhood type 1 diabetes. These factors may either
be environmental risk or protective factors that modify the likelihood of developing
type 1 diabetes de novo or of progressing to clinical type 1 diabetes in those
with established autoimmune prediabetes.” 
This last sentence highlights the fact that environmental factors may
push those at risk, already with immune dysregulation, past some tipping point
to develop what we clinically diagnose as diabetes.  I’ve written previously about the “iceberg” model of
disease progression for other conditions, specifically for autism and atopic
disorders (e.g., asthma, allergies). 
This functional medicine model works well to explain root cause factors
likely responsible for the increases in prevalence noted over the past 20 years
for many chronic childhood health conditions. 

One of the implicated factors,
vitamin D deficiency, is the subject of a second important diabetes paper to
emerge recently from Australia.  “Serum vitamin D levels are lower in Australian children and
adolescents with type 1 diabetes than in children without diabetes”
found
that “children with T1DM have lower 25OHD than controls, even in an environment
of abundant sunlight.  Whether low
vitamin D is a risk factor or consequence of T1DM is unknown.”  25OHD is the most commonly evaluated lab
marker for vitamin D status, and low levels have also been associated
with a need for more insulin in children with existing type 1 diabetes.  One notable publication reviewed the impact
of maternal vitamin D
status and the risk of type 1 diabetes
developing later in offspring.   The Norwegian authors discovered that “the
odds of type 1 diabetes was more than twofold higher for the offspring of women
with the lowest levels of 25-OH D compared with the offspring of those with levels
above the upper quartile” and commented, “Given future replication in
independent cohorts, our findings provide support for the initiation of a
randomized intervention trial to prevent type 1 diabetes in children by
enhancing maternal 25-OH D status during pregnancy.”  A nutritional trial of vitamin D to prevent
diabetes?  That is exactly the type of
preventive approach that could change the lives of millions of children – for relatively
low cost with potentially huge health care cost savings down the line. 

What other environmental factors
are under investigation?  CHE hosts a wealth
of resources
on their Diabetes/Obesity Working Group site, and Working
Group Coordinator Sarah Howard has created another website with specific
information about type 1 diabetes and environmental contaminants including persistent
organic pollutants, air pollutants, bisphenol A and phthalates, flame
retardants, trichloroethylene, heavy metals, pesticides and radiation.  Also under the microscope, as in many other
autoimmune disorders, is the role of gut microbiota in the development of type
1 diabetes.  According to Dr. Vaarala
from the National Public Health Institute in Helsinki, Finland, “The gut immune
system has a key role in controlling insulin-specific immunity induced by
dietary insulin. Indeed, indications for aberrant function of the gut immune
system have been reported in type 1 diabetes, such as intestinal immune activation
and increased intestinal permeability. Research on the gut immune system in
human type 1 diabetes is needed to reveal the role of oral immunity in this
disease.”  Research is needed to evaluate
whether specific pre- and probiotic strains could modify these gut immune
interactions to prevent diabetes in susceptible children.  Finnish studies have
shown that administering probiotics to pregnant and breastfeeding mothers can
lower the rate of atopy in offspring – perhaps the same will be true for
diabetes.

(Originally written for the Deirdre Imus Environmental Health Center, September 2012)

Healthy Environments Across Generations

My friend Elena, a very wise soul, not long ago told me of her dream for the future.  She spoke of an intergenerational living community in New York City committed to the health and happiness of all its members. Not just within families but across all cultural, racial, socioeconomic, age, and gender lines, elders and youngsters would share their collective wisdom. A grandmother, recently retired, would work in the community food garden with a 10 –year-old looking for a homework break. Of course there are numerous obstacles to achieving this utopia, but the idealist in me saw the promise in Elena’s concept. Might this be the way to save our communities from the health and environmental challenges we face? If so, how could we make it happen?

(Continue reading…)

Autism and the Environment: Hand-in-Hand

In April each year, we mark two very special happenings: Autism Awareness Month and Earth Day. Both of these events date back to the 1970’s but little connection has been made between them until recently.

(Click HERE to continue reading…)

New “The Whole Child” Post on the Kiwilog: January 2011

Ring in the New

New Year’s is in part about resolutions: wishes for the year to come. On everyone’s list is usually something about eating healthier, exercising more, and being less stressed. These are often cited as personal goals, but more importantly, they are core integrative principles that we can use to chart a course towards a healthier future for our children. In this month’s post, I wanted to profile three real-life examples of model programs that are helping families live healthier lives… (click link above to see more)

“Children First”: Join Us!

Save the date for "Children First: Promoting Ecological Health for the Whole Child," a groundbreaking symposium to be held on Friday, October 1, 2010 at the University of California, San Francisco.

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Wake up, America

Two organizations this week released materials calling for us to wake up and take action. We need to start putting children first.

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Going Green May Save Your Life

Three related news items this week add to mounting evidence that going green should be one of your top 2010 resolutions.  It may actually save your life.

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