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Our Most Vulnerable, Our Future, Our Patients

In this article, we will explore how pediatricians need to confront and act on the evidence surrounding climate change and its disproportionate effect on vulnerable populations, such as the pediatric patients served around Salt Lake City.


Dane Hegdahl, MD

Fellow, University of South Dakota Sanford School of Medicine 2021


Sanders B (1), Cook G (1), Lenz A (1), Nagarajan M (1), Hegdahl D (1)

(1) University of Utah


I walk by the window to overlook the Salt Lake Valley on my third week of caring for patients in the children’s hospital. I see a toxic haze lingering over the city. “Inversion” used to be a new, novel weather condition that I hadn’t experienced prior to starting my pediatrics residency. However, now, deep in the midst of an unprecedented respiratory season, my mind is flooded by the surge of patients I can expect to be admitted for continuous breathing treatments, breathing tubes, and children crying beneath CPAP masks.


Our changing climate has significant and real consequences for the health of children. In fact, 88% of the existing global burden of disease attributable to climate change happens in children five years or younger, even in the United States.1 The data supporting environmental triggers of chronic diseases, especially respiratory conditions, in the pediatric population is robust. We know that exposure to pollutants and poor air quality can worsen the health of our communities, especially the more susceptible population of children and infants.2 This vulnerability stems from metabolic and social influences of the pediatric population, including physiologic differences compared to adults; periods of rapid development; exposures at increased density per unit of body weight; differences in daily behaviors, including diet and outdoor time; and life expectancy, with additional years for these exposures to contribute to future illness.2


This year in Salt Lake City we have been dealing first-hand with the impacts of climate change. There is growing concern over the impact of the shrinking Great Salt Lake on air quality, with the possibility of dust clouds containing toxic metals blowing towards the city.3 In February of this year, a bad inversion event kept air quality in city at harmful levels for a week. This spring, local infrastructure is struggling to manage the accelerated snow-melt runoff, causing flooding and other public hazards.


In addition, longstanding inequitable policies and practices through the Home Owner’s Loan Corporation and Federal Housing Authority share a deep-seated history of redlining, land zoning, and moderating population density, alongside systematic denial of mortgages based on race and ethnicity, which have created health disparities that are being further exacerbated by our changing climate.4 While well documented in more urban centers, West Salt Lake City is an extension of these historic consequences, yielding a poorer, more densely populated, and more industrial living environment with increased proximity to the Great Salt Lake, which has become a major ecologic concern.5 It is not enough to simply address climate change; we must also consider how systemic racism contributes to how climate change will disproportionately affect our most vulnerable populations.


Healthcare providers can help respond and treat children who present with conditions such as asthma exacerbations secondary to environmental exposure, but why are we allowing it to get to that point? Why are we placing a Band-Aid on the situation instead of focusing on the underlying causes and triggers that bring patients into our care? Primary prevention of morbidity and mortality are an obligation of all practicing providers, but particularly of those caring for children because of their especially vulnerable patient population.


We must also advocate for policy changes at local, state, and national levels to minimize the impact of environmental pollutants and climate change on our patients and communities. We are encouraged by some progress made by our policymakers during this year’s legislative session, including Senate Bill 118, which incentivized water-efficient landscaping and increased funding for air quality research efforts.6,7 By addressing the ecologic insults that are continuing to fuel climate change at an ever-increasing rate, we will be able to stunt the impacts of climate change that have demonstrated an effect on us all, but particularly those most vulnerable. In our eyes, the most vulnerable are children, especially those who have been disproportionately disadvantaged by systemic social constructs. However, we still have many strides to make to ensure a healthier environment for Utah’s future.


Climate change is the single greatest threat to humanity today. Our most vulnerable, our future, our patients, have the most at stake. What we do now is critical to their future. A measure of the quality of a society is how they take care of their children – how will we choose to measure up?



References:

  1. Zhang Y, Bi P, Hiller JE. Climate change and disability-adjusted life years. J Environ Health. 2007;70(3):32-36.

  2. Sheffield PE, Landrigan PJ. Global climate change and children's health: threats and strategies for prevention. Environ Health Perspect. 2011;119(3):291-298. doi:10.1289/ehp.1002233

  3. Scott A, Siegler K, Cirino M, Metzger L, Spitzer G. What we lose if the Great Salt Lake Dries up. NPR. March 21, 2023. Accessed May 17, 2023. https://www.npr.org/2023/03/20/1164829382/what-we-lose-if-the-great-salt-lake-dries-up.

  4. Bryant-Stephens TC, Strane D, Robinson EK, Bhambhani S, Kenyon CC. Housing and asthma disparities. J Allergy Clin Immunol. 2021;148(5):1121-1129. doi:10.1016/j.jaci.2021.09.023

  5. Miller S, Alixel Cabrera | Salt Lake Tribune. Salt Lake valley west-siders bear the brunt of bad air. tell us more about it. KUER. December 16, 2022. Accessed May 17, 2023. https://www.kuer.org/health-science-environment/2022-12-12/salt-lake-valley-west-siders-bear-the-brunt-of-bad-air-tell-us-more-about-it.

  6. SB 118 Water Efficient Landscaping Incentives. SB0118. Accessed May 17, 2023. https://le.utah.gov/~2023/bills/static/SB0118.html.

  7. Utah Division of Water Resources. Accessed May 17, 2023. https://water.utah.gov/legislation/.



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