When smoke from Canadian wildfires was descending upon parts of the Midwest and Eastern United States in early June, children and parents gathered in the courtyard of Burns Park Elementary in Ann Arbor, Mich., for a picnic celebrating the last week of school.
Shannon Hautamaki was loath to cancel end-of-school activities for her 5-year-old son, Ian. But Ian has severe asthma and had been to the emergency room five times over the last two years, and she anticipated a flare-up from the smoke. So after he attended the picnic, she did not let Ian leave the house; she supplemented his regular medications with nebulizer treatments and ran air purifiers full blast until the skies cleared.
As physicians who specialize in respiratory health and children, our first thought last week as wildfire smoke again engulfed parts of the United States was of little ones Ian’s age and younger because their developing lungs are particularly vulnerable to smoke inhalation. And we worried most about the millions of children in this country with asthma who may not have access to the prescription medications they need or to a clean indoor space to breathe. This new recurring threat of terrible air quality from wildfire smoke is one big reason we believe that for a child born today, climate change may be the single greatest determinant of health over the course of their lives.
There are, of course, other pressing public health problems affecting children, including gun violence, opioid addiction and obesity. But the health effects of fossil fuel pollution and climate change are inescapable and cumulative, jeopardizing our children’s development while increasing health inequities. The latest example of what they are up against is the large and profuse wildfires, fueled by extreme heat and drought that are growing worse as the planet warms, spewing huge columns of soot, tiny particles and other toxic material into the air.
Smoke from wildfires carries health risks far beyond your typical campfire. One study estimated wildfire smoke to be 10 times as harmful to children’s respiratory health as the regular pollution we breathe from everyday sources such as exhaust from vehicles. In recent weeks, when smoke smothered New York City, emergency room visits for asthma soared; Black and Latino children, who tend to be exposed to more baseline pollution were disproportionately affected.
And the younger the child, the greater the risk of hospitalization following smoke exposure. Our lungs, which don’t reach full maturity until our early 20s, undergo rapid growth in the first few years of life. Children also breathe faster than adults relative to their size and tend to spend more time outside, thus taking in more polluted air.
Those of us practicing medicine in California have experienced days where black plumes of wildfire smoke were so overwhelming, our neonatal intensive care unit reeked of it. Premature infants with lungs the size of walnuts breathed in these toxic fumes as the hospital-grade air filtration system failed to keep up.
The risks may begin before birth and affect organs far from the lungs. Smoke exposure has been linked to higher rates of prematurity and low birth weight. Signs of air pollution have even shown up in the brain and liver of fetuses; after the 2019-2020 Australian wildfires, doctors observed blackened placentas.
Like the ghastly smoke particles that seep into our homes through a window crack or around a door jamb, the effects of fossil fuel pollution and climate change are unavoidable, putting nearly every child at risk. The effects go beyond wildfire smoke and often compound one another, placing children’s physical and mental health in jeopardy for years to come. The basics of survival — clean air, potable water, nutritious food, safe shelter — are all under threat from climate change.
Last week alone, some of the same places that experienced choking smoke were later placed under heat advisories. Among those at highest risk? Children, who already can have difficulty self-regulating their body temperature.
In the short term, we can better protect children from climate change-fueled threats like wildfire smoke through simple public health interventions. Better data on air quality would inform parents of the dangers in real time. More sensitive air quality monitors like the ones the City of Ann Arbor has installed are a good start, but they might not be available to less affluent communities nor do they report on the air inside buildings where children gather. That’s why indoor air quality monitoring in schools is so important too.
We also have to make sure that health warnings make it to people with limited internet access; for that, community alert systems could help. Schools and summer camps also need clear guidance on what to do when air pollution thresholds are crossed.
Schools will need more federal and state dollars to install, upgrade and maintain heating and cooling systems to ensure clean indoor air as well. California is leading the way on this front by considering legislation to help modernize school buildings with a strong emphasis on climate resilience.
All these emergency preparedness measures should help more kids and adults limit their smoke exposure. But crisis management only goes so far, and we must also focus on prevention. That means ending the burning of fossil fuels that are dangerously heating our planet.
Laws like the Inflation Reduction Act are supporting the transition away from fossil fuels and toward renewable energy. There is no time to lose. We must keep the pressure on policymakers, reminding them of the connections between fossil fuels and poor health. Several rules, including one to regulate carbon pollution from power plants from the Environmental Protection Agency, can help rein in the very emissions driving worsening wildfires and heat waves. All the while, we must remind ourselves that a better, healthier future for our children is possible.
While children are adaptable, they are still especially vulnerable to climate change. Let’s turn things around for them.
Alexander Rabin is a clinical assistant professor of pulmonary and critical-care medicine at the University of Michigan. Lisa Patel is a clinical associate professor of pediatrics at Stanford Children’s Health and executive director of the Medical Society Consortium on Climate and Health.
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