November 26, 2024 • 26 mins
In this episode, we address pediatric care in the context of a changing climate, featuring insights from Dr. Lisa Patel, Clinical Associate Professor of Pediatrics at Stanford University. Our conversation will explore the unique vulnerabilities that children face due to climate change, including the concern about emerging diseases and diagnoses. Dr. Patel will review critical policy changes she advocates for to safeguard children's health in our evolving climate. Lastly, we will discuss what gives Dr. Patel hope for the future of children's health in the face of climate change.
CME Information: https://stanford.cloud-cme.com/medcastepisode93
Claim CE: https://stanford.cloud-cme.com/Form.aspx?FormID=3123
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
(upbeat music)
- [Dr. Ruth Adewuya]Welcome to Stanford Medcast,
the podcast from Stanford CME
that brings you the latest insights
from the world's leadingphysicians and scientists.
If you're joining us for the first time,
be sure to subscribe on Apple Podcast,
Amazon Music, Spotify, or YouTube
(00:21):
to stay updated with our newest episodes.
I am your host, Dr. Ruth Adewuya.
Joining me today is Dr. Lisa Patel.
Dr. Lisa Patel is aClinical Associate Professor
in Pediatrics at Stanford University
where she practices asa pediatric hospitalist.
She also serves as the Executive Director
for the Medical SocietyConsortium on Climate Health,
(00:44):
focusing on the critical intersection
between children's healthand environmental issues.
Drawing on her extensiveexperience in government,
community organizations, and nonprofits,
Dr. Patel has passionately advocated
for prioritizing children's health
in national policy discussions.
She earned her undergraduatedegree in biological sciences
(01:04):
from Stanford University,
a master's in environmental sciences
from the Yale School of Environment,
and a medical degree fromJohns Hopkins University
before completing her residencyin pediatrics at UCSF.
Through her leadership andadvocacy, Dr. Patel is dedicated
to ensuring that the healthcare community
recognize and responds tothe growing health challenges
(01:25):
posed by climate change.
Dr. Patel, thank you so much
for chatting with me today on the podcast.
- [Dr. Lisa Patel] Thankyou so much for having me.
- [Dr. Ruth Adewuya] I alwayslike to start the podcast
by learning a little bitmore about our guests
and what brings them towhere they are right now.
Can you share a littlebit about your journey
and what inspired youto connect pediatrics
(01:45):
with climate health advocacy?
- [Dr. Lisa Patel] Alonger journey than a lot
of health professionalsthat are doing this work,
I was actually anundergraduate at Stanford.
I was a biology major,
but I really studiedecology and evolution,
because I was in love with Carl Sagan
and all that he taught me
about what an incredible world we live in
and what a unique one.
(02:07):
And so I focused on ecology evolution.
I became an environmental scientist
and I was actually workingon tropical deforestation.
I was doing some work in Guatemala.
I arrived in this village
where I was supposed to do research,
and as soon as I got there,
here I was ready to talkabout tropical conservation,
but the first problemthey were dealing with
was that there was a child thatwas having repeated seizures
(02:30):
and the whole village when I arrived
was there around that child.
And through that summer,I just began to recognize
that the way into a lot of the issues
that the communities that I wanted to help
was really about health.
That was a startingplace for a conversation,
and there was a richnessaround health as the grounding,
not just in terms of theservice I could offer,
(02:51):
but the frame that I feltwas really important.
I went on to work for the EPA
to try to combine these two concepts
of environment and health,and there I got to work
for the Environmental Protection Agency
on clean air and clean waterprojects in South Asia,
and again, it all juststarted to come together
in a way that I couldn't fully articulate.
I became a pediatrician
(03:11):
because children are the most vulnerable
to these environmental threats.
You go into that tunnel of training,
you come out the otherside and you look around
and you're like, allright, it's 10 years later,
and I had become a mom, a new attending,
and in my mind I thought I would have time
to get back into figuring outhow this all went together,
but then we withdrew from theParis Climate Accords in 2017.
(03:33):
In 2018, the InternationalPanel on Climate Change
said that we have 12 years to act
before there was irreversible damage.
I had become a mom at thatpoint, and I remember thinking,
"There's no time left.
This is what I need to makemy life at this point."
- [Dr. Ruth Adewuya] I lovethe uniqueness of your story
because oftentimes you hear of clinicians
who develop a passion for climate health
(03:56):
after clinical training,
and it sounds like yours was the reverse,
and you have this foundation
from your environmentalsciences background
that just has pulled the thread through,
and it's incredible howyou've been able to combine
both of those passions.
When we talk about climate change,
it's often discussed inthis really broad terms
(04:18):
around environmental impacts,
but what unique vulnerabilitiesdo children face
when we're talking aboutthe changing climate?
- [Dr. Lisa Patel] We should start by,
obviously, childrenhave unique physiology.
Their lungs are very rapidly developing
in the first five years.
Their brains are rapidlydeveloping in the beginning too
(04:39):
as are their immune systems,and so what this means
is that these types ofenvironmental threats
place them at unique vulnerability
because of that rapid period of growth
and these very vital organsystems in our bodies.
At the same time,
children are exposed tomore of these threats
for a variety of reasons.
They tend to spend more time outdoors.
They are closer to the ground
(05:01):
and more hand to mouth behavior,
where they might be puttingthings into their mouth
that are potentially more toxic.
They breathe faster, so pound to pound,
if there's a lot ofair pollution outdoors,
they are breathing inmore of that pollution
for their weight thanwe would, for example.
And then finally, there'sthe vulnerability of children
reliant upon us for their safety.
(05:21):
For example, infants or childrenthat are left in hot cars,
I've treated infants
that were in unairconditioned apartments,
and they don't have the ability
to just kick a blanket off ifthey're too hot, for example.
Or children that arecaught in hot classrooms,
if it's too hot or uncomfortable for them,
they can't exactly tell the teacher,
"I need to go outside,
it's too warm or too hotfor me to be able to learn
(05:41):
or be comfortable."
So for all of these reasons,children are more vulnerable
to the impacts of these typesof environmental threats.
- [Dr. Ruth Adewuya] Greatexamples that you've highlighted
about how they are trulythe most vulnerable.
From the clinical perspective,
what's the data showing aroundthe impact of climate change
(06:03):
as it relates to diseases and diagnoses
that we're seeing in children these days?
- [Dr. Lisa Patel] We'll start with heat.
You would think that ourcommon wisdom is that,
oh, on hotter days therewould be more air pollution,
more kids would come inwith respiratory illness.
Actually, the literatureon that is a bit confounded
and it's not consistenton respiratory issues,
but what the literaturedoes show a signal for
(06:25):
is more children areshowing up with dehydration,
heat illness, more ear infections,
which is very interesting,more stomach bugs,
and more what's categorizedas nervous system disease,
so things like headaches as well.
In the psychiatric literature,
there is some evidence thatduring periods of extreme heat,
(06:45):
more adolescents, teenagers
showing up with variouspsychiatric complaints,
including suicidality.
Again, there's a lot more workfor us to do in the space,
and there's many morestudies we need to do.
As you would expect, wildfire smoke,
we estimate to be about 10 times as toxic
as the regular fossil fuelpollution that we breathe,
so we do see more children coming in
(07:07):
with respiratory complaints,
wheezing, asthma, bronchitis,pneumonia as well.
I'll just point out one other population
that is important to me as a pediatrician
because I'm a pediatric hospitalist
and I get called to deliveries,
if they are preterm orlow birth weight infants,
there is good literature that shows a risk
(07:28):
for increased preterm birth,increased low birth weight,
and emerging evidencefor stillbirth as well
with exposure to wildfire smoke.
- [Dr. Ruth Adewuya] We'rerecording this episode
at a time where we've justhad two hurricanes in Florida
causing mass devastation.
I'm just curious to get your thoughts
(07:48):
about those kinds ofclimate related events
that seem to be happening,
I don't have the data for this,
but they do seem to behappening more frequently.
The severity seems tobe a little different.
- [Dr. Lisa Patel] We don'thave evidence that show
we will see increased number of storms,
but there is very good evidence
that the severity of storms is worsening
(08:10):
due to climate change.
That is why we are witnessing
what we call rapidintensification of these storms
and these storms that are enormous.
Milton went from a two to a five
because the hurricaneexperienced record warm waters
in the Gulf Coast from global heating
from the burning of fossil fuels
that is essentiallygiving the Earth a fever.
(08:31):
We have good evidence forrapid intensification.
The air will hold onto more moisture
and dump a lot morerain in these scenarios,
and that's why we're seeing flooding
and huge amounts ofprecipitation in places.
And the other thing, we'reseeing sea level rise
because ice is melting.
When these storms come in,there's more water in the bowl.
You see these storm surges
(08:53):
that we haven't seen in the past either,
so those we actuallyhave good evidence for.
- [Dr. Ruth Adewuya] I canimagine that the severity
of these things mean thatit's also a longer time
for these communities to recover,
which sometimes means a longer time
for access to healthcare andall of the different things,
which could mean a worsening of symptoms
(09:14):
for children and for families.
Just another example of how these things
are all interconnected.
You are the Executive Director
of the Medical SocietyConsortium on Climate and Health.
What policy changes doyou believe are critical
for protecting children's health
in the face of climate change?
- [Dr. Lisa Patel] A social and structural
determinants of healthframe is so important.
(09:37):
Climate change, we have to look upstream.
For example, I've treateda number of children
who have come in, babies thathave come in with dehydration.
I treated an outdoor worker
that was working in 108 degree heat
and ended up with rhabdomyolysisand a tripled creatinine.
And just like any of our other issues,
we can deal with itone-on-one in our patient,
(09:59):
in our clinic and hospital encounters,
or we have to look upstream
to why these things are happening
if we're really trying to protect health.
If we look upstream, it isour dependence on fossil fuels
that has been facilitatedby a fossil fuel industry
that has kept us dependent,and the actions they have taken
(10:19):
mimic what tobacco companies have done,
what the sugar industry has done.
There is a playbook thatthese industries have utilized
to distort science, to deceive the public,
and to ensure that policies are in place
that keep their profitsgoing over our health.
So a lot of our work at the Consortium
is to really point people's attention
(10:42):
towards those upstream factors
of not only our dependence on fossil fuel,
but also what the fossilfuel industry is doing,
specifically in communities of color
and communities experiencing poverty
because where those sites offossil fuel extraction are,
it is not accidental.
It tends to happen moreoften in communities of color
(11:02):
and communities experiencing poverty.
And so I'll give you anexample, liquefied natural gas,
there were a lot of projectsbeing proposed for it
along the Gulf Coast
in communities that arealready being ravaged
by climate change, in communitiesthat are already poor,
and disproportionatelyminoritized communities.
And the Biden administration
(11:23):
attempted to put apause on those projects.
The other thing we're starting to name
is the commercial determinants of health.
We tried to do work around farm policy,
so the farm bill comes upfor a vote every five years,
and the farm bill
is basically an entirepiece of legislation
that is hugely influenced by agribusiness,
(11:45):
huge industrial farms,
huge industrial practicesthat degrade the land,
result in lots of pesticide use,
abuse of animals at the expenseof creating systems of food
that are sustainable, thatare local, that are healthier
both for our bodies and for the planet.
And so this model replicatesitself over and over again
(12:07):
in different ways thatare profoundly important
to the practice of medicine.
- [Dr. Ruth Adewuya] A lotof what you talked about
very much resonates withsomeone who's in your role.
You're leading this Consortium,
you've made it your life'swork, but a lot of clinicians
may not have that samefoundational knowledge,
that background.
What can they do to play a role in this?
(12:29):
- [Dr. Lisa Patel] I haveconfigured my entire life
around climate change for a few reasons,
and not only do I see it
as the greatest threatto my children's health
and all children born today, actually,
so do a number of othermajor medical associations,
including the World Health Organization,
multiple major medical journals as well
have called climate change
the greatest threat to publichealth in the 21st century.
(12:50):
What I tell folks is that climate change
is a health threat multiplier
and climate change affects everything,
every one of us does insome way, shape, or form.
No, you don't need todrop your whole career
and do all climate change,
however, we will not solve this crisis
unless everybody attaches aclimate lens to what they do.
You can reach out to me andI'll help you brainstorm,
(13:11):
and I can promise youthere is a climate lens
to the work you do,whether you're a researcher
and there are ways todecrease the amount of waste
that you're generating in your lab.
I know there's aSustainable Labs Initiative
that a few folks that Iwork with are working in,
for example.
If you work on gun violence,
we have more guns in thiscountry than we have people.
We have good evidence toshow that on hotter days
(13:33):
there are more episodes of violence,
and in a country that has this many guns
should concern all of us.
If you're working on food insecurity,
we understand that climate change
is going to change theavailability of crops,
so we're already seeingit this year actually
because of change in precipitationpatterns and drought.
If you work on housing insecurity,
there were some horrificstories that came out of Phoenix
(13:56):
of populations that were unhoused there
and the thermal burns,
the chronic medical conditionsthat got exacerbated
because they didn'thave a safe place to be.
So climate change interacts
with all of the varioussocial determinants.
It interacts with lots ofdifferent clinical manifestations,
whether we're talking aboutdiabetes, stroke, heart disease,
(14:18):
the burning of fossil fuels,the fossil fuel pollution,
has been listed as a topthree cause of dementia,
top three cause of dementia.
Up until now, I feelthat environmental issues
have been placed to the side,
when it is actually quite foundational
to pretty much every aspect of our health.
I would put the chargeon the listener to say,
(14:39):
what are you missingin your work right now?
How can you strengthen your work
and do a better job in whatyou do in protecting the planet
and protecting and forwardingthe health of your patients
by integrating an environmentalor climate change lens?
- [Dr. Ruth Adewuya] Ireally like that idea
of a climate change lens
and looking at everything andall of our work through that.
(15:00):
I'd like to dig a little deeper into that
and ask you to expound forus what that would look like,
a community pediatricianwho is running their clinic
and is super busy?
- [Dr. Lisa Patel] I wanna liftup the work of my colleague,
Dr. Becca Phillips who works at an FQHC,
and she actually put together this guide.
It's about how to takea social determinants
(15:22):
of health screen andintegrate a climate lens
into your questions.
So when you're talking about food,
for example, switchingout meat once a week
to a plant-based option
because it's both betterfor your personal health
and it's better for planetary health.
When you're talkingabout physical activity,
you're biking or walking or running
and talking about at the same time
that if we use our cars less,
(15:44):
that's actually great interms of air pollution
and decreasing our carbon footprint.
Talking to your family
about if they're experiencingany housing insecurity
or inability to pay their energy bills,
making sure they're connectedto services like LIHEAP
that help weatherize their homes
both so that they'resafer from air pollution
if it's outdoors,
and to decrease their energybills and their use of energy.
(16:06):
So there are ways to notadd on another question,
but infuse the questionswe're already asking
with a climate lens,
so that we're not justadding more and more on top.
The other thing we'retrying to do in pediatrics
and we'd love to see happenin other specialties,
we have been trying,we will continue to try
to integrate a nuggetof climate counseling
(16:27):
into each of those visits,
because there's no patientthat's coming to us
that's saying, "I wanna talkto you about climate change."
Again, this gets back
to climate change should beinfused in everything we do
in the ways that it makes sense.
And so what we're trying todo is put in little nuggets
into each one of those visits
to build the capacityand the understanding
(16:47):
of both the provider and the caretakers
that we're counselingon how climate change
is interfacing withtheir children's health.
That's how I think that needs to be done
as we're thinking about thesekinds of well child visits.
In an acute setting, Iwork as a hospitalist.
Every one of my patients that's coming in
with wheezing or with an asthma attack,
(17:08):
I talk to all of them
about how to read an air quality index.
I live in Northern California.
Wildfires are now more or less a yearly
and a year round occurrence,
and so in my mind, tonot talk to your patients
that have respiratoryconditions about wildfire
feels to me, for where we are right now,
like a a huge negligence in duty.
Like we need to be talking tothem about air quality index,
(17:31):
about ensuring that they haveaccess to clean air indoors,
checking in with themabout an air purifier,
giving 'em counseling on howto make their own air purifier.
If they don't have thefinancial means to do,
there's a website on the EPAthat helps you do one for $20.
It's a DIY.
And then talking to them aboutif they have to be outside,
making sure they'rewearing a KN95 or an N95,
(17:52):
depending on how bad that air quality is.
I think these things are really important
because we need to build their capacity
to understand that the world is changing
and poses a greater threat,
especially for these types ofchronic medical conditions.
- [Dr. Ruth Adewuya] Thankyou so much for this.
I think breaking it down intosome really specific ways
that clinicians can incorporate it,
(18:15):
as opposed to it beingadditive to their workload
is really important.
This framework requires them knowing
about all of these thingsthat you rattled off,
oh, ask about housingsecurity, and purifier here,
and all of that.
I would love for you to maybecall out some of the resources
that are available.
Is there one place as a startingpoint that they can go to?
(18:36):
- [Dr. Lisa Patel] We're working on it.
There are a ton of resources.
The CDC has some newresources that are wonderful.
They have something calledthe CHILL'D mnemonic
for providers to use to becounseling their patients
about extreme heat, for example.
Harvard C-CHANGE hasworked with Americares
to create a whole toolkit.
Now, this is geared towards
federally qualifiedhealth center patients,
(18:56):
and these are peer reviewed
to talk to your patients thathave chronic kidney disease
or your patients that havediabetes about how to take care
during periods of extremeheat and wildfires.
There are a ton of resources as well
through the Global Consortium
on Climate and HealthEducation out of Columbia.
They have created
the Climate HealthResources Education Hub.
(19:17):
These peer-reviewed slidesacross different organ systems
that lecturers can use tojust slot into their lectures,
so that even if this is not something
that you yourself feel expert in,
here are the slides,here's the literature,
and read up on it, because,as you've pointed out,
and certainly was the case for me,
we did not get any of this education
(19:37):
in our medical training.
This is changing in medicalschool, thanks to the efforts
of Medical Students fora Sustainable Future
and the Planetary Health Report Card,
there are more and more medical schools
that are starting to integratethis training into it.
But while we do that, there'sa lot of gaps to build,
a lot of capacity to build in the gaps.
We at the Consortium are workingwith seven medical boards
(20:01):
who want to introducethis information because,
to your point,
where are most cliniciansgoing for their information?
And usually, they're goingto places like UpToDate
or they're going totheir medical societies,
and so we're really trying towork with medical societies
and with the boards
to make this morestandardized information,
so clinicians understandthis as part of their charge,
(20:23):
that this is not extra credit.
This should really be mission central.
Medicine is a slow to move profession.
- [Dr. Ruth Adewuya] It's slow,but it's fast in some ways.
You've been involved inthis space for many years,
and so I can imaginethat you've seen changes,
but what changes have you observed
in the healthcare community'sresponse to climate change?
(20:44):
- [Dr. Lisa Patel] I felt really heartened
by the groundswell ofhealth professionals.
Every day I get emails fromfolks around the country
and not just health professionals.
I was talking to somebodywho manufactures wool,
who wants to integratehealth considerations
into fabric, for example, right?
So lots of different folksthat are really interested
in thinking about whatwe have long neglected
(21:06):
and how much work we need todo to catch up in this space.
So that has felt great.
- [Dr. Ruth Adewuya] Howcan healthcare systems
better prepare to respondto environmental impacts
in pediatric health?
- [Dr. Lisa Patel] Whatwe have not kept pace with
is despite this ground swell,
we are not seeing leadership keep pace
with creating opportunitiesfor health professionals
(21:27):
to actually have the chargewithin their institutions.
So the number of healthcare institutions
that have a clinician ina role for sustainability
within their healthcareinstitutions is minuscule.
There are very few ofthose around the country
compared to the number ofhealthcare institutions.
Despite how many health professionals
are working on sustainability,
there are not nearly enough societies
(21:49):
that are offering this type of content
through their societies.
There are plenty of doctors
who are trying to deliver this content
at their annualconferences or conventions,
but that's not enough, really.
The medical societies themselves
need to be generating thatinformation on their own.
And so where I see a bigopportunity for leadership
(22:10):
is to be more thoughtful
about how they themselves as institutions
are taking this work on
and creating leadership opportunities
for the doctors and nurses
that are very interested in this work.
- [Dr. Ruth Adewuya] It soundslike there is this movement
that needs to be supported by leadership
in order for it to really be sustainable
(22:31):
and implemented in institutions.
To all those professionals
who are working on this on their own
without the support of leadership
and listening to this podcast,what's your message to them?
- [Dr. Lisa Patel] One of the things
I'm really passionate about,
because it took me some timeto find my space and place,
(22:51):
and now that I'm the leaderof this large organization,
my mission for what my organization does
is to help people find a home,help people find a community.
With the Medical Society Consortium,
we bring together 60 medical societies.
We have 30 state cliniciangroups within our network.
There are many homes foryou as an individual,
and we are building more and more people
(23:12):
for you to be able to work with.
Whether your passion is researchor education or advocacy,
community resilience,
there are so manyopportunities to get involved.
It just takes sending thatemail and connecting with people
and finding the rightfolks for you to work with,
I would say.
And then there are a numberof other great organizations
that work in the space.
Healthcare Without Harm
(23:33):
is focused on healthcare sustainability.
The Global Consortium onClimate Health Education
is always looking formore faculty to help them.
And by the way,
you don't have to beexpert to start this work.
You are already expert bytaking care of patients.
And so just give yourself that grace
that we are all learning together,
and all it takes is the intent to learn
(23:54):
and we will learn together as a community.
And then Physicians forSocial Responsibility
is deeply advocacy focused,
and they have chapters allover the country as well.
- [Dr. Ruth Adewuya] We've talked a lot
about some of the challenges,some of the concerns,
some of the fears that wehave around climate change.
I wanna wrap up our conversationon a more hopeful note
(24:15):
and ask you what gives you hope
for the future of children's health
in the context of climate change?
- [Dr. Lisa Patel] Whatgives me a lot of hope,
she is one of my icons inthe space, Dr. Lori Byron.
She's up in Montana, andshe has basically raised up
an entire group of pediatricians
through the AmericanAcademy of Pediatrics,
identified a pediatrician inevery single state in the US
(24:38):
and brought us all together
for us to lesson share andhave a sense of community,
'cause everyone is facingsome of the same challenges,
but some that are quite different,
especially and unfortunatelyon political context
because like many issuesof medicine and science,
climate change has beenneedlessly politicized.
So folks like Lori andevery person in that network
(24:59):
that Lori has brought togethergive me a lot of hope.
The students that reach outto me give me a lot of hope,
but also fill me with a sense of charge
because the questionsthat I get from students
all the time is, how do Ihave a career like yours?
And I don't have a great answer for them
because frankly someof this was blind luck
and it shouldn't be.
We should have more dedicated career paths
(25:22):
for more people to do this work
because people are reallypassionate about it,
and this is the charge
of people like me andleaders in healthcare
to create those career paths
for just the legions ofstudents and trainees
that really wanna make thisa part of their career.
So that gives me a lot of hope
is that lots of peopleunderstand this connection,
lots of people understand
(25:42):
that we don't have a minute to waste,
and it's our charge to help connect people
and help create those opportunities
to really move us forward.
- [Dr. Ruth Adewuya] What an excellent way
to end our conversation, and so thankful
for the work that you andothers are doing in this space
to protect us, protect our children.
(soft music)Thank you so much
for chatting with me today.
(26:02):
- [Dr. Lisa Patel] Thank youfor having me, I appreciate it.
- [Dr. Ruth Adewuya] Thisepisode was brought to you
by Stanford CME.
To claim CME forlistening to this episode,
click on the Claim CME link below
or visit medcast.stanford.edu.
Check back for new episodes
by subscribing to Stanford Medcast
wherever you listen to podcasts.
(26:22):
(soft music)
(upbeat music)
- [Dr. Ruth Adewuya]Welcome to Stanford Medcast,
the podcast from Stanford CME
that brings you the latest insights
from the world's leadingphysicians and scientists.
If you're joining us for the first time,
be sure to subscribe on Apple Podcast,
Amazon Music, Spotify, or YouTube
(00:21):
to stay updated with our newest episodes.
I am your host, Dr. Ruth Adewuya.
Joining me today is Dr. Lisa Patel.
Dr. Lisa Patel is aClinical Associate Professor
in Pediatrics at Stanford University
where she practices asa pediatric hospitalist.
She also serves as the Executive Director
for the Medical SocietyConsortium on Climate Health,
(00:44):
focusing on the critical intersection
between children's healthand environmental issues.
Drawing on her extensiveexperience in government,
community organizations, and nonprofits,
Dr. Patel has passionately advocated
for prioritizing children's health
in national policy discussions.
She earned her undergraduatedegree in biological sciences
(01:04):
from Stanford University,
a master's in environmental sciences
from the Yale School of Environment,
and a medical degree fromJohns Hopkins University
before completing her residencyin pediatrics at UCSF.
Through her leadership andadvocacy, Dr. Patel is dedicated
to ensuring that the healthcare community
recognize and responds tothe growing health challenges
(01:25):
posed by climate change.
Dr. Patel, thank you so much
for chatting with me today on the podcast.
- [Dr. Lisa Patel] Thankyou so much for having me.
- [Dr. Ruth Adewuya] I alwayslike to start the podcast
by learning a little bitmore about our guests
and what brings them towhere they are right now.
Can you share a littlebit about your journey
and what inspired youto connect pediatrics
(01:45):
with climate health advocacy?
- [Dr. Lisa Patel] Alonger journey than a lot
of health professionalsthat are doing this work,
I was actually anundergraduate at Stanford.
I was a biology major,
but I really studiedecology and evolution,
because I was in love with Carl Sagan
and all that he taught me
about what an incredible world we live in
and what a unique one.
(02:07):
And so I focused on ecology evolution.
I became an environmental scientist
and I was actually workingon tropical deforestation.
I was doing some work in Guatemala.
I arrived in this village
where I was supposed to do research,
and as soon as I got there,
here I was ready to talkabout tropical conservation,
but the first problemthey were dealing with
was that there was a child thatwas having repeated seizures
(02:30):
and the whole village when I arrived
was there around that child.
And through that summer,I just began to recognize
that the way into a lot of the issues
that the communities that I wanted to help
was really about health.
That was a startingplace for a conversation,
and there was a richnessaround health as the grounding,
not just in terms of theservice I could offer,
(02:51):
but the frame that I feltwas really important.
I went on to work for the EPA
to try to combine these two concepts
of environment and health,and there I got to work
for the Environmental Protection Agency
on clean air and clean waterprojects in South Asia,
and again, it all juststarted to come together
in a way that I couldn't fully articulate.
I became a pediatrician
(03:11):
because children are the most vulnerable
to these environmental threats.
You go into that tunnel of training,
you come out the otherside and you look around
and you're like, allright, it's 10 years later,
and I had become a mom, a new attending,
and in my mind I thought I would have time
to get back into figuring outhow this all went together,
but then we withdrew from theParis Climate Accords in 2017.
(03:33):
In 2018, the InternationalPanel on Climate Change
said that we have 12 years to act
before there was irreversible damage.
I had become a mom at thatpoint, and I remember thinking,
"There's no time left.
This is what I need to makemy life at this point."
- [Dr. Ruth Adewuya] I lovethe uniqueness of your story
because oftentimes you hear of clinicians
who develop a passion for climate health
(03:56):
after clinical training,
and it sounds like yours was the reverse,
and you have this foundation
from your environmentalsciences background
that just has pulled the thread through,
and it's incredible howyou've been able to combine
both of those passions.
When we talk about climate change,
it's often discussed inthis really broad terms
(04:18):
around environmental impacts,
but what unique vulnerabilitiesdo children face
when we're talking aboutthe changing climate?
- [Dr. Lisa Patel] We should start by,
obviously, childrenhave unique physiology.
Their lungs are very rapidly developing
in the first five years.
Their brains are rapidlydeveloping in the beginning too
(04:39):
as are their immune systems,and so what this means
is that these types ofenvironmental threats
place them at unique vulnerability
because of that rapid period of growth
and these very vital organsystems in our bodies.
At the same time,
children are exposed tomore of these threats
for a variety of reasons.
They tend to spend more time outdoors.
They are closer to the ground
(05:01):
and more hand to mouth behavior,
where they might be puttingthings into their mouth
that are potentially more toxic.
They breathe faster, so pound to pound,
if there's a lot ofair pollution outdoors,
they are breathing inmore of that pollution
for their weight thanwe would, for example.
And then finally, there'sthe vulnerability of children
reliant upon us for their safety.
(05:21):
For example, infants or childrenthat are left in hot cars,
I've treated infants
that were in unairconditioned apartments,
and they don't have the ability
to just kick a blanket off ifthey're too hot, for example.
Or children that arecaught in hot classrooms,
if it's too hot or uncomfortable for them,
they can't exactly tell the teacher,
"I need to go outside,
it's too warm or too hotfor me to be able to learn
(05:41):
or be comfortable."
So for all of these reasons,children are more vulnerable
to the impacts of these typesof environmental threats.
- [Dr. Ruth Adewuya] Greatexamples that you've highlighted
about how they are trulythe most vulnerable.
From the clinical perspective,
what's the data showing aroundthe impact of climate change
(06:03):
as it relates to diseases and diagnoses
that we're seeing in children these days?
- [Dr. Lisa Patel] We'll start with heat.
You would think that ourcommon wisdom is that,
oh, on hotter days therewould be more air pollution,
more kids would come inwith respiratory illness.
Actually, the literatureon that is a bit confounded
and it's not consistenton respiratory issues,
but what the literaturedoes show a signal for
(06:25):
is more children areshowing up with dehydration,
heat illness, more ear infections,
which is very interesting,more stomach bugs,
and more what's categorizedas nervous system disease,
so things like headaches as well.
In the psychiatric literature,
there is some evidence thatduring periods of extreme heat,
(06:45):
more adolescents, teenagers
showing up with variouspsychiatric complaints,
including suicidality.
Again, there's a lot more workfor us to do in the space,
and there's many morestudies we need to do.
As you would expect, wildfire smoke,
we estimate to be about 10 times as toxic
as the regular fossil fuelpollution that we breathe,
so we do see more children coming in
(07:07):
with respiratory complaints,
wheezing, asthma, bronchitis,pneumonia as well.
I'll just point out one other population
that is important to me as a pediatrician
because I'm a pediatric hospitalist
and I get called to deliveries,
if they are preterm orlow birth weight infants,
there is good literature that shows a risk
(07:28):
for increased preterm birth,increased low birth weight,
and emerging evidencefor stillbirth as well
with exposure to wildfire smoke.
- [Dr. Ruth Adewuya] We'rerecording this episode
at a time where we've justhad two hurricanes in Florida
causing mass devastation.
I'm just curious to get your thoughts
(07:48):
about those kinds ofclimate related events
that seem to be happening,
I don't have the data for this,
but they do seem to behappening more frequently.
The severity seems tobe a little different.
- [Dr. Lisa Patel] We don'thave evidence that show
we will see increased number of storms,
but there is very good evidence
that the severity of storms is worsening
(08:10):
due to climate change.
That is why we are witnessing
what we call rapidintensification of these storms
and these storms that are enormous.
Milton went from a two to a five
because the hurricaneexperienced record warm waters
in the Gulf Coast from global heating
from the burning of fossil fuels
that is essentiallygiving the Earth a fever.
(08:31):
We have good evidence forrapid intensification.
The air will hold onto more moisture
and dump a lot morerain in these scenarios,
and that's why we're seeing flooding
and huge amounts ofprecipitation in places.
And the other thing, we'reseeing sea level rise
because ice is melting.
When these storms come in,there's more water in the bowl.
You see these storm surges
(08:53):
that we haven't seen in the past either,
so those we actuallyhave good evidence for.
- [Dr. Ruth Adewuya] I canimagine that the severity
of these things mean thatit's also a longer time
for these communities to recover,
which sometimes means a longer time
for access to healthcare andall of the different things,
which could mean a worsening of symptoms
(09:14):
for children and for families.
Just another example of how these things
are all interconnected.
You are the Executive Director
of the Medical SocietyConsortium on Climate and Health.
What policy changes doyou believe are critical
for protecting children's health
in the face of climate change?
- [Dr. Lisa Patel] A social and structural
determinants of healthframe is so important.
(09:37):
Climate change, we have to look upstream.
For example, I've treateda number of children
who have come in, babies thathave come in with dehydration.
I treated an outdoor worker
that was working in 108 degree heat
and ended up with rhabdomyolysisand a tripled creatinine.
And just like any of our other issues,
we can deal with itone-on-one in our patient,
(09:59):
in our clinic and hospital encounters,
or we have to look upstream
to why these things are happening
if we're really trying to protect health.
If we look upstream, it isour dependence on fossil fuels
that has been facilitatedby a fossil fuel industry
that has kept us dependent,and the actions they have taken
(10:19):
mimic what tobacco companies have done,
what the sugar industry has done.
There is a playbook thatthese industries have utilized
to distort science, to deceive the public,
and to ensure that policies are in place
that keep their profitsgoing over our health.
So a lot of our work at the Consortium
is to really point people's attention
(10:42):
towards those upstream factors
of not only our dependence on fossil fuel,
but also what the fossilfuel industry is doing,
specifically in communities of color
and communities experiencing poverty
because where those sites offossil fuel extraction are,
it is not accidental.
It tends to happen moreoften in communities of color
(11:02):
and communities experiencing poverty.
And so I'll give you anexample, liquefied natural gas,
there were a lot of projectsbeing proposed for it
along the Gulf Coast
in communities that arealready being ravaged
by climate change, in communitiesthat are already poor,
and disproportionatelyminoritized communities.
And the Biden administration
(11:23):
attempted to put apause on those projects.
The other thing we're starting to name
is the commercial determinants of health.
We tried to do work around farm policy,
so the farm bill comes upfor a vote every five years,
and the farm bill
is basically an entirepiece of legislation
that is hugely influenced by agribusiness,
(11:45):
huge industrial farms,
huge industrial practicesthat degrade the land,
result in lots of pesticide use,
abuse of animals at the expenseof creating systems of food
that are sustainable, thatare local, that are healthier
both for our bodies and for the planet.
And so this model replicatesitself over and over again
(12:07):
in different ways thatare profoundly important
to the practice of medicine.
- [Dr. Ruth Adewuya] A lotof what you talked about
very much resonates withsomeone who's in your role.
You're leading this Consortium,
you've made it your life'swork, but a lot of clinicians
may not have that samefoundational knowledge,
that background.
What can they do to play a role in this?
(12:29):
- [Dr. Lisa Patel] I haveconfigured my entire life
around climate change for a few reasons,
and not only do I see it
as the greatest threatto my children's health
and all children born today, actually,
so do a number of othermajor medical associations,
including the World Health Organization,
multiple major medical journals as well
have called climate change
the greatest threat to publichealth in the 21st century.
(12:50):
What I tell folks is that climate change
is a health threat multiplier
and climate change affects everything,
every one of us does insome way, shape, or form.
No, you don't need todrop your whole career
and do all climate change,
however, we will not solve this crisis
unless everybody attaches aclimate lens to what they do.
You can reach out to me andI'll help you brainstorm,
(13:11):
and I can promise youthere is a climate lens
to the work you do,whether you're a researcher
and there are ways todecrease the amount of waste
that you're generating in your lab.
I know there's aSustainable Labs Initiative
that a few folks that Iwork with are working in,
for example.
If you work on gun violence,
we have more guns in thiscountry than we have people.
We have good evidence toshow that on hotter days
(13:33):
there are more episodes of violence,
and in a country that has this many guns
should concern all of us.
If you're working on food insecurity,
we understand that climate change
is going to change theavailability of crops,
so we're already seeingit this year actually
because of change in precipitationpatterns and drought.
If you work on housing insecurity,
there were some horrificstories that came out of Phoenix
(13:56):
of populations that were unhoused there
and the thermal burns,
the chronic medical conditionsthat got exacerbated
because they didn'thave a safe place to be.
So climate change interacts
with all of the varioussocial determinants.
It interacts with lots ofdifferent clinical manifestations,
whether we're talking aboutdiabetes, stroke, heart disease,
(14:18):
the burning of fossil fuels,the fossil fuel pollution,
has been listed as a topthree cause of dementia,
top three cause of dementia.
Up until now, I feelthat environmental issues
have been placed to the side,
when it is actually quite foundational
to pretty much every aspect of our health.
I would put the chargeon the listener to say,
(14:39):
what are you missingin your work right now?
How can you strengthen your work
and do a better job in whatyou do in protecting the planet
and protecting and forwardingthe health of your patients
by integrating an environmentalor climate change lens?
- [Dr. Ruth Adewuya] Ireally like that idea
of a climate change lens
and looking at everything andall of our work through that.
(15:00):
I'd like to dig a little deeper into that
and ask you to expound forus what that would look like,
a community pediatricianwho is running their clinic
and is super busy?
- [Dr. Lisa Patel] I wanna liftup the work of my colleague,
Dr. Becca Phillips who works at an FQHC,
and she actually put together this guide.
It's about how to takea social determinants
(15:22):
of health screen andintegrate a climate lens
into your questions.
So when you're talking about food,
for example, switchingout meat once a week
to a plant-based option
because it's both betterfor your personal health
and it's better for planetary health.
When you're talkingabout physical activity,
you're biking or walking or running
and talking about at the same time
that if we use our cars less,
(15:44):
that's actually great interms of air pollution
and decreasing our carbon footprint.
Talking to your family
about if they're experiencingany housing insecurity
or inability to pay their energy bills,
making sure they're connectedto services like LIHEAP
that help weatherize their homes
both so that they'resafer from air pollution
if it's outdoors,
and to decrease their energybills and their use of energy.
(16:06):
So there are ways to notadd on another question,
but infuse the questionswe're already asking
with a climate lens,
so that we're not justadding more and more on top.
The other thing we'retrying to do in pediatrics
and we'd love to see happenin other specialties,
we have been trying,we will continue to try
to integrate a nuggetof climate counseling
(16:27):
into each of those visits,
because there's no patientthat's coming to us
that's saying, "I wanna talkto you about climate change."
Again, this gets back
to climate change should beinfused in everything we do
in the ways that it makes sense.
And so what we're trying todo is put in little nuggets
into each one of those visits
to build the capacityand the understanding
(16:47):
of both the provider and the caretakers
that we're counselingon how climate change
is interfacing withtheir children's health.
That's how I think that needs to be done
as we're thinking about thesekinds of well child visits.
In an acute setting, Iwork as a hospitalist.
Every one of my patients that's coming in
with wheezing or with an asthma attack,
(17:08):
I talk to all of them
about how to read an air quality index.
I live in Northern California.
Wildfires are now more or less a yearly
and a year round occurrence,
and so in my mind, tonot talk to your patients
that have respiratoryconditions about wildfire
feels to me, for where we are right now,
like a a huge negligence in duty.
Like we need to be talking tothem about air quality index,
(17:31):
about ensuring that they haveaccess to clean air indoors,
checking in with themabout an air purifier,
giving 'em counseling on howto make their own air purifier.
If they don't have thefinancial means to do,
there's a website on the EPAthat helps you do one for $20.
It's a DIY.
And then talking to them aboutif they have to be outside,
making sure they'rewearing a KN95 or an N95,
(17:52):
depending on how bad that air quality is.
I think these things are really important
because we need to build their capacity
to understand that the world is changing
and poses a greater threat,
especially for these types ofchronic medical conditions.
- [Dr. Ruth Adewuya] Thankyou so much for this.
I think breaking it down intosome really specific ways
that clinicians can incorporate it,
(18:15):
as opposed to it beingadditive to their workload
is really important.
This framework requires them knowing
about all of these thingsthat you rattled off,
oh, ask about housingsecurity, and purifier here,
and all of that.
I would love for you to maybecall out some of the resources
that are available.
Is there one place as a startingpoint that they can go to?
(18:36):
- [Dr. Lisa Patel] We're working on it.
There are a ton of resources.
The CDC has some newresources that are wonderful.
They have something calledthe CHILL'D mnemonic
for providers to use to becounseling their patients
about extreme heat, for example.
Harvard C-CHANGE hasworked with Americares
to create a whole toolkit.
Now, this is geared towards
federally qualifiedhealth center patients,
(18:56):
and these are peer reviewed
to talk to your patients thathave chronic kidney disease
or your patients that havediabetes about how to take care
during periods of extremeheat and wildfires.
There are a ton of resources as well
through the Global Consortium
on Climate and HealthEducation out of Columbia.
They have created
the Climate HealthResources Education Hub.
(19:17):
These peer-reviewed slidesacross different organ systems
that lecturers can use tojust slot into their lectures,
so that even if this is not something
that you yourself feel expert in,
here are the slides,here's the literature,
and read up on it, because,as you've pointed out,
and certainly was the case for me,
we did not get any of this education
(19:37):
in our medical training.
This is changing in medicalschool, thanks to the efforts
of Medical Students fora Sustainable Future
and the Planetary Health Report Card,
there are more and more medical schools
that are starting to integratethis training into it.
But while we do that, there'sa lot of gaps to build,
a lot of capacity to build in the gaps.
We at the Consortium are workingwith seven medical boards
(20:01):
who want to introducethis information because,
to your point,
where are most cliniciansgoing for their information?
And usually, they're goingto places like UpToDate
or they're going totheir medical societies,
and so we're really trying towork with medical societies
and with the boards
to make this morestandardized information,
so clinicians understandthis as part of their charge,
(20:23):
that this is not extra credit.
This should really be mission central.
Medicine is a slow to move profession.
- [Dr. Ruth Adewuya] It's slow,but it's fast in some ways.
You've been involved inthis space for many years,
and so I can imaginethat you've seen changes,
but what changes have you observed
in the healthcare community'sresponse to climate change?
(20:44):
- [Dr. Lisa Patel] I felt really heartened
by the groundswell ofhealth professionals.
Every day I get emails fromfolks around the country
and not just health professionals.
I was talking to somebodywho manufactures wool,
who wants to integratehealth considerations
into fabric, for example, right?
So lots of different folksthat are really interested
in thinking about whatwe have long neglected
(21:06):
and how much work we need todo to catch up in this space.
So that has felt great.
- [Dr. Ruth Adewuya] Howcan healthcare systems
better prepare to respondto environmental impacts
in pediatric health?
- [Dr. Lisa Patel] Whatwe have not kept pace with
is despite this ground swell,
we are not seeing leadership keep pace
with creating opportunitiesfor health professionals
(21:27):
to actually have the chargewithin their institutions.
So the number of healthcare institutions
that have a clinician ina role for sustainability
within their healthcareinstitutions is minuscule.
There are very few ofthose around the country
compared to the number ofhealthcare institutions.
Despite how many health professionals
are working on sustainability,
there are not nearly enough societies
(21:49):
that are offering this type of content
through their societies.
There are plenty of doctors
who are trying to deliver this content
at their annualconferences or conventions,
but that's not enough, really.
The medical societies themselves
need to be generating thatinformation on their own.
And so where I see a bigopportunity for leadership
(22:10):
is to be more thoughtful
about how they themselves as institutions
are taking this work on
and creating leadership opportunities
for the doctors and nurses
that are very interested in this work.
- [Dr. Ruth Adewuya] It soundslike there is this movement
that needs to be supported by leadership
in order for it to really be sustainable
(22:31):
and implemented in institutions.
To all those professionals
who are working on this on their own
without the support of leadership
and listening to this podcast,what's your message to them?
- [Dr. Lisa Patel] One of the things
I'm really passionate about,
because it took me some timeto find my space and place,
(22:51):
and now that I'm the leaderof this large organization,
my mission for what my organization does
is to help people find a home,help people find a community.
With the Medical Society Consortium,
we bring together 60 medical societies.
We have 30 state cliniciangroups within our network.
There are many homes foryou as an individual,
and we are building more and more people
(23:12):
for you to be able to work with.
Whether your passion is researchor education or advocacy,
community resilience,
there are so manyopportunities to get involved.
It just takes sending thatemail and connecting with people
and finding the rightfolks for you to work with,
I would say.
And then there are a numberof other great organizations
that work in the space.
Healthcare Without Harm
(23:33):
is focused on healthcare sustainability.
The Global Consortium onClimate Health Education
is always looking formore faculty to help them.
And by the way,
you don't have to beexpert to start this work.
You are already expert bytaking care of patients.
And so just give yourself that grace
that we are all learning together,
and all it takes is the intent to learn
(23:54):
and we will learn together as a community.
And then Physicians forSocial Responsibility
is deeply advocacy focused,
and they have chapters allover the country as well.
- [Dr. Ruth Adewuya] We've talked a lot
about some of the challenges,some of the concerns,
some of the fears that wehave around climate change.
I wanna wrap up our conversationon a more hopeful note
(24:15):
and ask you what gives you hope
for the future of children's health
in the context of climate change?
- [Dr. Lisa Patel] Whatgives me a lot of hope,
she is one of my icons inthe space, Dr. Lori Byron.
She's up in Montana, andshe has basically raised up
an entire group of pediatricians
through the AmericanAcademy of Pediatrics,
identified a pediatrician inevery single state in the US
(24:38):
and brought us all together
for us to lesson share andhave a sense of community,
'cause everyone is facingsome of the same challenges,
but some that are quite different,
especially and unfortunatelyon political context
because like many issuesof medicine and science,
climate change has beenneedlessly politicized.
So folks like Lori andevery person in that network
(24:59):
that Lori has brought togethergive me a lot of hope.
The students that reach outto me give me a lot of hope,
but also fill me with a sense of charge
because the questionsthat I get from students
all the time is, how do Ihave a career like yours?
And I don't have a great answer for them
because frankly someof this was blind luck
and it shouldn't be.
We should have more dedicated career paths
(25:22):
for more people to do this work
because people are reallypassionate about it,
and this is the charge
of people like me andleaders in healthcare
to create those career paths
for just the legions ofstudents and trainees
that really wanna make thisa part of their career.
So that gives me a lot of hope
is that lots of peopleunderstand this connection,
lots of people understand
(25:42):
that we don't have a minute to waste,
and it's our charge to help connect people
and help create those opportunities
to really move us forward.
- [Dr. Ruth Adewuya] What an excellent way
to end our conversation, and so thankful
for the work that you andothers are doing in this space
to protect us, protect our children.
(soft music)Thank you so much
for chatting with me today.
(26:02):
- [Dr. Lisa Patel] Thank youfor having me, I appreciate it.
- [Dr. Ruth Adewuya] Thisepisode was brought to you
by Stanford CME.
To claim CME forlistening to this episode,
click on the Claim CME link below
or visit medcast.stanford.edu.
Check back for new episodes
by subscribing to Stanford Medcast
wherever you listen to podcasts.
(26:22):
(soft music)
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
CrimeLess: Hillbilly Heist
It’s 1996 in rural North Carolina, and an oddball crew makes history when they pull off America’s third largest cash heist. But it’s all downhill from there. Join host Johnny Knoxville as he unspools a wild and woolly tale about a group of regular ‘ol folks who risked it all for a chance at a better life. CrimeLess: Hillbilly Heist answers the question: what would you do with 17.3 million dollars? The answer includes diamond rings, mansions, velvet Elvis paintings, plus a run for the border, murder-for-hire-plots, and FBI busts.