As a pediatrician and a mother, I am particularly concerned about the impacts of climate change on maternal and child health. Pregnant women are especially at risk from heat because they have a higher body temperature to start with, and are “cooling for two”, which makes them more susceptible to dehydration, heat exhaustion, and heat stroke. Heat exposure during pregnancy puts babies at risk for congenital heart defects and low birth weight. It also increases the risk of premature birth, the leading cause of illness and death in newborns. One in ten births in the United States is pre-term (one in seven for Black babies), at an estimated societal cost of $26.2 billion. I have cared for many babies born too soon who needed breathing tubes, feeding tubes, or emergency surgery to live, and who are at risk of lifelong health problems including chronic respiratory problems, developmental delay, and cerebral palsy. It is heartbreaking, especially since many of these situations, and their financial and emotional impact on families, are preventable.
The latest report from the UN Intergovernmental Panel on Climate Change (IPCC), which synthesizes over 14,000 scientific studies, makes clear that human-driven global warming is happening faster than anticipated. The medical community is increasingly speaking out on the grave risk that climate change poses to human health. Across the country this year, Americans endured, and in some cases died in, unprecedented heat waves, hurricanes, flooding, and wildfires. While extreme weather has always happened, climate change “loads the dice,” making higher intensity events more frequent. A recent analysis in the journal Science shows that the generation born this year will experience up to seven times the heatwaves, three times as many droughts, floods and crop failures, and twice the wildfires as their grandparents.
While climate change affects everyone, the impacts are inequitably distributed. People of color and low-income people are more likely to be exposed to extreme heat, due partly to a history of “redlining"—racist lending policies that deprived majority Black neighborhoods of investments in cooling shade trees, green spaces, and quality housing. Previously redlined neighborhoods can be more than 12° F hotter than non-redlined neighborhoods. This has real impacts on health and well-being: every one degree Fahrenheit increase in heat wave intensity has been associated with 2.5 times higher risk of death, and hot classrooms have been linked to lower academic achievement for children.
At the same time, the fossil fuel-based energy and transportation sectors driving climate change produce deadly air pollution. Prenatal exposure to air pollution was linked to nearly 6 million premature births worldwide in 2019, as well as low birthweight babies and childhood asthma. As with extreme heat, people of color at all income levels are disproportionately exposed to air pollution, and disproportionately suffer the disease burden associated with breathing polluted air. Black children, for example, have more than twice the prevalence of asthma as white children, and eight times the death rate from asthma.
A more hopeful, healthy future is possible. Decades of American innovation have yielded economically and technically feasible climate solutions that will also have immediate health benefits due to a reduction in air pollution. A recent report from Princeton researchers suggests that by switching to cleaner energy, the United States could prevent more than 400,000 deaths and avoid over $3.5 trillion in health costs by 2050.
When it comes to improving neonatal outcomes, the controlled experiment has already been done. Between 2001 and 2011, eight coal and oil power plants in California closed down, providing a perfect opportunity to study the near-term health impacts of fossil fuels. In just the first year after a closure, pregnant women who lived near a power plant were 20 percent less likely to have a premature baby than before the closure—and the benefit was even stronger for African-American and Asian women—and fertility rates went up. Women living near coal plants that remained in operation did not see the same health improvements.
We still have a chance to choose a future in which climate change is limited to 1.5°C (2.7°F) above pre-industrial temperatures—a threshold that scientists and world leaders say will limit catastrophic damage. This month, Congress is debating the Build Back Better Act, to invest in historic measures to protect mothers, babies, and future generations from climate change, while world leaders convene at COP26 to set national climate goals. Ambitious national carbon emissions targets, matched with bold investments in clean energy, electric transportation, green space, sustainable food systems, and climate-resilient utilities infrastructure, including targeted investments in communities of color, are urgently needed to save lives, save money, and help close the health equity gap.