July 6, 2021

by drplasticpicker

Two big things happened this weekend. I final submitted for our author group Durrwachter-Erno Et Al our paper titled “Informing Policy on Built Environments to Safeguard Children in Environmental Justice Communities: Case Study of Five American Academy of Pediatrics Climate Advocates” to the Journal of Applied Research on Children. This was the final edits after the copy-editor read through. It seemed like a simple process fixing the citations and doing the rewording, but it took all weekend and probably a combined 10 hours of actual work. Commas are important, and citations have to be formatted a certain way. It was a labour of love for all six of us. The round-table discussion from Children At Risk will be made available today as well, where they interviewed our author group along with two other climate and health related papers. During this process, I half fell in love with the copy editor (with my husband’s knowledge) as I felt his last read that he really understood what we were trying to impart. My hubsand was an editor of several highschool and college publications and an English major, and he understood.

The other big event of the weekend is that I reached 500 bags of plastic pollution. 500 bags. My goal is 1000 bags to write my book, or at least make that my title. But 500 bags is a big deal for me. That 500th bag was on the stretch of beach from Crystal Pier not quite to Tourmaline beach that I love.

But this blog is not about dwelling on completed projects. Those were two big completed projects (one of our premed interns and I also completed an abstract on the organizational structure of San Diego Pediatricians for Clean Air for the upcoming AAP Conference in Philadelphia), that I know will move the climate work forward. This blog has always been about Dr.Plastic Picker me trying to save the earth, and doing it my off-beat litter-picking, middle-management, half burned-out doctor way. In that I found myself and bought a farm and had fun along the way, was a side-show – comic relief. There is still an existential threat and I do not have delusional disorder. I see the world with stark clear eyes every morning, and we all need to become carbon sinks by living regenerative lives – in reality and figuratively.

But I wanted to share some of the beautiful phrases we wrote in our paper. Each sentence of that paper is special to all of us. We were all equal contributors and it was an absolute honor to be the coordinating author. I spent many many hours on this project and many meetings with this group, and each meeting was done with joy and love.

“Climate change is a public health crisis, and more importantly to pediatricians – it is a pediatric public health crisis.  Over 88% of the diseases caused by climate change affect children under five years of age. Children are uniquely vulnerable when it comes to the health risks imposed upon humans by the changing climate. Children are still developing, including their vital organs, and have a greater surface-to-body ratio of their skin and lung epithelium to total body surface area.  These two factors make them uniquely at risk to air pollution and heat.” – Intro

“In 2020, Drs. Lori Byron and Aparna Bole from the AAP with permission from AAP National were able to quickly assemble a national coalition of climate advocates from each AAP chapter.  They formed a network of pediatricians working on climate change and health policy initiatives.  Within Facebook groups and among professional networks of former residency friends and in clinic hallways and inpatient wards, the word spread that as a specialty, we needed to coordinate and to act on climate change.  You Pediatrician, whoever and wherever you were, were needed and were needed now. The National AAP Climate Advocate program is composed of academic pediatricians, researchers, community pediatricians, pediatric specialists – indeed, any permutation of what a pediatrician can become is represented.  This awakening of clinicians to our role in climate change and health is not unique to the AAP as many groups of like-minded clinicians formed across the country to bring physician voices to what is the largest group project that will happen in many lifetimes.  Indeed, the Medical Consortium on Climate and Health is an early example, now representing 32 primary care and medical specialty societies brought together 5 years ago to inform the public and policymakers about the health harms of climate change and the health benefits of equitable climate solutions.

We are part of this national group of AAP Climate Advocates, representing diverse regions from California, Colorado, North Carolina, and Puerto Rico.  Our wide geographic range poses not only shared environmental challenges like air and water quality but also unique regional challenges from wildfires to hurricanes.  The virtual “planetary code call” went out overhead that our collective children and planet were at risk and we were among the thousands of pediatricians who showed up.

In this article, we will briefly review the literature on the dangers that children face in the air they breathe, the lack of natural green spaces, and the increasingly hostile built environments, especially to children in EJ communities.  Changes to the built environment can mitigate some of the effects of climate change.  Despite National AAP Policy Statements that are among an outpouring of policy statements from medical groups, the current response in our country is neither coordinated nor child-centric. Unequal city planning leaves EJ neighborhoods with rising temperatures due to high levels of pollution, fewer trees for shade, and older buildings that are more difficult to cool.  Even with improving national leadership in infrastructure change, there is more work to be done. Time is of the essence for global climate emissions and for addressing climate change as a pediatric public health crisis.          

What can we do as individual pediatricians from diverse regions with our shared training experience and our shared identity as child advocates? By virtue of our shared experiences, we see hope. We will review opportunities in our local areas to change the built environment that will work toward reducing carbon emissions and increase overall pediatric health.  We will use examples of how present knowledge on active transport, green canopies, and air pollution can be applied to improve health and address climate effects. Pediatricians need to be advocates and be at the table where these decisions are made.  Below are four case examples of how each of us, as part of community-based physician climate advocacy groups, is taking action.” Intro

I’ll post the entire paper link later when it becomes available later today. But I really wanted to thank the readership on this blog. You helped with this paper as well. You were there with me and with our author group as we wrote it. If I had not begun blogging two years ago and written over 600 blogpost filled with errors and incomplete sentences, I would not have the courage to have led this author group. I found my voice on this blog, and it enabled me to lead the author group and allow their voices to be loud and clear. The subheadings of our paper are meant to bring in the idea of different forces of nature (ala avatar) and impart the expansiveness of the effort from the AAP.

CALIFORNIA AND POLITICS: Industrial Waterfront, Active Transport, and Health Advocates

COLORADO AND AIR: Air Toxins and Wildfire

NORTH CAROLINA AND TREES: Tree Canopy/Green District in Charlotte

PUERTO RICO AND OCEANS: Storms and Resilience

In the conclusion, we lovingly wrote these words

“Climate change is a public health crisis, and more importantly to pediatricians, it is a pediatric public health crisis. At a time when the world is continually distracted, as a health-care community we need to stay focused.  We accept the overwhelming reality of climate change and acknowledge the virtual planetary code call, but just like one begins with airway, breathing, and circulation, there are evidence-based concrete actions we can take. 

As trusted professionals, pediatricians have a special role and responsibility in increasing climate awareness, advocating for climate action policy, and protecting the health of our patients and communities.

As pediatricians, we work to ensure environmental justice.  We have shared above our experiences as individual AAP Climate Advocates in diverse regions, how we understood the current science on climate change and health, and how we worked within our communities to enact change.  Through our shared experiences, and collaborative membership in the National AAP Climate Advocate program, we have realized that we can inform policy by doing what pediatricians do best. 

We worked together. 

We emphasized our identity as child-advocates and climate-advocates. 

We worked locally.

And the copy-editor I half fell in love with, suggested to italicize those phrases – subtitles. He understood. He read our words carefully.

And in the last paragraph we wrote,

“How do we inform policy on built environments to safeguard children in EJ communities?  By realizing the interconnectedness of the climate crisis and communities, we work to inform policy by working on it all.  We work on air pollution, water quality, carbon emissions, and child resilience.  We have concentrated on local actions, but we collaborate nationally.  We work by growing the numbers of pediatricians and community members who advocate for climate health and pediatric health by actively recruiting.  We work with hope and stay positive.  But most importantly we show up and act, realizing that a single climate victory can have cascading effects.  We are just five pediatricians sharing our experiences and what we have accomplished.  We advocate in the legislature, forge community partnerships, educate, and volunteer. There are thousands of us out there already working or ready to be activated in this international task of protecting planetary and pediatric health.”

Thank you Dr. Plastic Picker readers. Thank you from the bottom of my heart. But Dr. Plastic Picker binge watched Dawson’s Creek (I had somehow missed this in the 1990s because I was premed!), and now have rested for a day. I’m off to the next climate projects!!! I am going to work within San Diego Pediatricians for Clean Air, and we are going to apply for a grant from the local Air Pollution Control Board to do a similar project like Air Keppers. Yes we are. And I am going to start formatting my book. I want to write it this year and maybe do the book tour next summer? I’ve found a copy-editor!!! Yes, it’s the same person who edited our science article and I want to meet him eventually with Mr. Plastic Picker of course.

Oh, and I have to plan out our road trip! We probably do need to end it in Boston as I have a cousin by marriage who is a mathematician and Radcliffe Fellow who is pivoting her career as well to work on climate change. This saving the earth thing? It’s definitely a family affair.