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Dickson CA, Ergun-Longmire B, Greydanus DE, Eke R, Giedeman B, Nickson NM, Hoang LN, Adabanya U, Payares DVP, Chahin S, McCrary J, White K, Moon JH, Haitova N, Deleon J, Apple RW. Health equity in pediatrics: Current concepts for the care of children in the 21st century (Dis Mon). Dis Mon 2024; 70:101631. [PMID: 37739834 DOI: 10.1016/j.disamonth.2023.101631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
This is an analysis of important aspects of health equity in caring for children and adolescents written by a multidisciplinary team from different medical centers. In this discussion for clinicians, we look at definitions of pediatric health equity and the enormous impact of social determinants of health in this area. Factors involved with pediatric healthcare disparities that are considered include race, ethnicity, gender, age, poverty, socioeconomic status, LGBT status, living in rural communities, housing instability, food insecurity, access to transportation, availability of healthcare professionals, the status of education, and employment as well as immigration. Additional issues involved with health equity in pediatrics that are reviewed will include the impact of the COVID-19 pandemic, behavioral health concepts, and the negative health effects of climate change. Recommendations that are presented include reflection of one's own attitudes on as well as an understanding of these topics, consideration of the role of various healthcare providers (i.e., community health workers, peer health navigators, others), the impact of behavioral health integration, and the need for well-conceived curricula as well as multi-faceted training programs in pediatric health equity at the undergraduate and postgraduate medical education levels. Furthermore, ongoing research in pediatric health equity is needed to scrutinize current concepts and stimulate the development of ideas with an ever-greater positive influence on the health of our beloved children. Clinicians caring for children can serve as champions for the optimal health of children and their families; in addition, these healthcare professionals are uniquely positioned in their daily work to understand the drivers of health inequities and to be advocates for optimal health equity in the 21st century for all children and adolescents.
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Affiliation(s)
- Cheryl A Dickson
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Berrin Ergun-Longmire
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Donald E Greydanus
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States.
| | - Ransome Eke
- Department of Community Medicine, Mercer University School of Medicine, Columbus, GA, United States
| | - Bethany Giedeman
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Nikoli M Nickson
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Linh-Nhu Hoang
- Department of Psychology, Western Michigan University, Kalamazoo, MI, United States
| | - Uzochukwu Adabanya
- Department of Community Medicine, Mercer University School of Medicine, Columbus, GA, United States
| | - Daniela V Pinto Payares
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Summer Chahin
- Department of Psychology, C.S. Mott Children's Hospital/Michigan Medicine, Ann Arbor, MI, United States
| | - Jerica McCrary
- Center for Rural Health and Health Disparities, Mercer University School of Medicine, Columbus, GA, United States
| | - Katie White
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Jin Hyung Moon
- Department of Community Medicine, Mercer University School of Medicine, Columbus, GA, United States
| | - Nizoramo Haitova
- Department of Educational Leadership, Research and Technology, Western Michigan University, Kalamazoo, MI, United States
| | - Jocelyn Deleon
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Roger W Apple
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
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Ziegler C, Muchira J. Climate Change: The Ultimate Determinant of Health. Prim Care 2023; 50:645-655. [PMID: 37866837 DOI: 10.1016/j.pop.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Climate change ubiquitously influences social determinants of health via various pathways. Disproportionately burdening communities who have contributed the least to greenhouse gas (GHG) emissions and benefitted the least from economic benefits obtained through high-emission activities that cause climate change, climate justice must be centered in any discussion of health equity. This article will explore how climate change contributes to health disparities in vulnerable populations, why this is a justice issue for primary care to address, and what we can do to promote equity, resilience, and adaption in our current economic system while mitigating GHG emissions, leveraging the health sector.
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Affiliation(s)
- Carol Ziegler
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA.
| | - James Muchira
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA. https://twitter.com/JamesMuturi5
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White BP, Breakey S, Brown MJ, Smith JR, Tarbet A, Nicholas PK, Ros AMV. Mental Health Impacts of Climate Change Among Vulnerable Populations Globally: An Integrative Review. Ann Glob Health 2023; 89:66. [PMID: 37810609 PMCID: PMC10558031 DOI: 10.5334/aogh.4105] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/25/2023] [Indexed: 10/10/2023] Open
Abstract
Background Climate change has been shown to be directly linked to multiple physiological sequelae and to impact health consequences. However, the impact of climate change on mental health globally, particularly among vulnerable populations, is less well understood. Objective To explore the mental health impacts of climate change in vulnerable populations globally. Methods We performed an integrative literature review to identify published articles that addressed the research question: What are the mental health impacts of climate change among vulnerable populations globally? The Vulnerable Populations Conceptual Model served as a theoretical model during the review process and data synthesis. Findings/Results One hundred and four articles were selected for inclusion in this review after a comprehensive review of 1828 manuscripts. Articles were diverse in scope and populations addressed. Land-vulnerable persons (either due to occupation or geographic location), Indigenous persons, children, older adults, and climate migrants were among the vulnerable populations whose mental health was most impacted by climate change. The most prevalent mental health responses to climate change included solastalgia, suicidality, depression, anxiety/eco-anxiety, PTSD, substance use, insomnia, and behavioral disturbance. Conclusions Mental health professionals including physicians, nurses, physician assistants and other healthcare providers have the opportunity to mitigate the mental health impacts of climate change among vulnerable populations through assessment, preventative education and care. An inclusive and trauma-informed response to climate-related disasters, use of validated measures of mental health, and a long-term therapeutic relationship that extends beyond the immediate consequences of climate change-related events are approaches to successful mental health care in a climate-changing world.
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Affiliation(s)
- Bradley Patrick White
- MGH Institute of Health Professions School of Nursing, 36 1st Avenue, Boston, MA 02129, US
| | - Suellen Breakey
- MGH Institute of Health Professions School of Nursing, 36 1st Avenue, Boston, MA 02129, US
| | - Margaret J. Brown
- MGH Institute of Health Professions School of Nursing, 36 1st Avenue, Boston, MA 02129, US
| | - Jenny Rand Smith
- MGH Institute of Health Professions School of Nursing, 36 1st Avenue, Boston, MA 02129, US
| | - Amanda Tarbet
- SFPE Foundation, 9711 Washingtonian Blvd, Gaithersburg, MD 20878, US
| | - Patrice K. Nicholas
- Center for Climate Change, Climate Justice, and Health, MGH Institute of Health Professions School of Nursing, 36 1@st Avenue, Boston, MA 02129, US
| | - Ana M. Viamonte Ros
- Florida International University, Herbert Wertheim School of Medicine, Miami, Florida, US
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Belzer A, Parker ER. Climate Change, Skin Health, and Dermatologic Disease: A Guide for the Dermatologist. Am J Clin Dermatol 2023:10.1007/s40257-023-00770-y. [PMID: 37336870 DOI: 10.1007/s40257-023-00770-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 06/21/2023]
Abstract
Climate change has a pervasive impact on health and is of clinical relevance to every organ system. Climate change-related factors impact the skin's capacity to maintain homeostasis, leading to a variety of cutaneous diseases. Stratospheric ozone depletion has led to increased risk of melanoma and keratinocyte carcinomas due to ultraviolet radiation exposure. Atopic dermatitis, psoriasis, pemphigus, acne vulgaris, melasma, and photoaging are all associated with rising levels of air pollution. Elevated temperatures due to global warming induce disruption of the skin microbiome, thereby impacting atopic dermatitis, acne vulgaris, and psoriasis, and high temperatures are associated with exacerbation of skin disease and increased risk of heat stroke. Extreme weather events due to climate change, including floods and wildfires, are of relevance to the dermatologist as these events are implicated in cutaneous injuries, skin infections, and acute worsening of inflammatory skin disorders. The health consequences as well as the economic and social burden of climate change fall most heavily on vulnerable and marginalized populations due to structural disparities. As dermatologists, understanding the interaction of climate change and skin health is essential to appropriately manage dermatologic disease and advocate for our patients.
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Affiliation(s)
- Annika Belzer
- Yale University School of Medicine, New Haven, CT, USA
| | - Eva Rawlings Parker
- Department of Dermatology, Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, 719 Thompson Lane, Suite 26-300, Nashville, TN, 37204, USA.
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Brown MJ, White BP, Nicholas PK. Mental Health Impacts of Climate Change: Considerations for Nurse Practitioners. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2021.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Effective Community-Based Interventions for the Prevention and Management of Heat-Related Illnesses: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168362. [PMID: 34444112 PMCID: PMC8394078 DOI: 10.3390/ijerph18168362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/21/2021] [Accepted: 08/04/2021] [Indexed: 11/20/2022]
Abstract
Background: Extreme temperatures have negative consequences on the environment, ecosystem, and human health. With recent increases in global temperatures, there has been a rise in the burden of heat-related illnesses, with a disproportionate impact on low- and middle-income countries. Effective population-level interventions are critical to a successful public health response. Objective: This scoping review aims to summarize the evidence on the effectiveness of population-level heat-related interventions and serve as a potential guide to the implementation of these interventions. Methods: Studies that evaluated the effectiveness of community-based interventions to mitigate or reduce the impact of extreme heat on heat-related mortality and morbidity were sought by searching four electronic databases. Studies published in the English language and those that had quantifiable, measurable mortality, morbidity or knowledge score outcomes were included. Results: The initial electronic search yielded 2324 articles, and 17 studies were included. Fourteen studies were based in high-income countries (HICs) (Europe, US, Canada) and discussed multiple versions of (1) heat action plans, which included but were not limited to establishing a heat monitoring system, informative campaigns, the mobilization of health care professionals, volunteers, social workers and trained caregivers in the surveillance and management of individuals with known vulnerabilities, or stand-alone (2) education and awareness campaigns. Multi-pronged heat action plans were highly effective in reducing heat-related mortality and morbidity, especially among vulnerable populations such as the elderly and those with chronic conditions. Conclusions: The heat action plans covered in these studies have shown promising results in reducing heat-related mortality and morbidity and have included instituting early warning systems, building local capacity to identify, prevent or treat and manage heat-related illnesses, and disseminating information. Nevertheless, they need to be cost-effective, easy to maintain, ideally should not rely on a mass effort from people and should be specifically structured to meet the local needs and resources of the community.
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Mitigating the Effects of Climate Change on Health and Health Care: The Role of the Emergency Nurse. J Emerg Nurs 2021; 47:621-626. [PMID: 34275528 DOI: 10.1016/j.jen.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 12/29/2022]
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Abstract
OBJECTIVE This scoping review aims to map the roles of rural and remote primary health care professionals (PHCPs) during disasters. INTRODUCTION Disasters can have catastrophic impacts on society and are broadly classified into natural events, man-made incidents, or a mixture of both. The PHCPs working in rural and remote communities face additional challenges when dealing with disasters and have significant roles during the Prevention, Preparedness, Response, and Recovery (PPRR) stages of disaster management. METHODS A Johanna Briggs Institute (JBI) scoping review methodology was utilized, and the search was conducted over seven electronic databases according to a priori protocol. RESULTS Forty-one papers were included and sixty-one roles were identified across the four stages of disaster management. The majority of disasters described within the literature were natural events and pandemics. Before a disaster occurs, PHCPs can build individual resilience through education. As recognized and respected leaders within their community, PHCPs are invaluable in assisting with disaster preparedness through being involved in organizations' planning policies and contributing to natural disaster and pandemic surveillance. Key roles during the response stage include accommodating patient surge, triage, maintaining the health of the remaining population, instituting infection control, and ensuring a team-based approach to mental health care during the disaster. In the aftermath and recovery stage, rural and remote PHCPs provide long-term follow up, assisting patients in accessing post-disaster support including delivery of mental health care. CONCLUSION Rural and remote PHCPs play significant roles within their community throughout the continuum of disaster management. As a consequence of their flexible scope of practice, PHCPs are well-placed to be involved during all stages of disaster, from building of community resilience and contributing to early alert of pandemics, to participating in the direct response when a disaster occurs and leading the way to recovery.
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Mathiarasan S, Hüls A. Impact of Environmental Injustice on Children's Health-Interaction between Air Pollution and Socioeconomic Status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020795. [PMID: 33477762 PMCID: PMC7832299 DOI: 10.3390/ijerph18020795] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 02/07/2023]
Abstract
Air pollution disproportionately affects marginalized populations of lower socioeconomic status. There is little literature on how socioeconomic status affects the risk of exposure to air pollution and associated health outcomes, particularly for children’s health. The objective of this article was to review the existing literature on air pollution and children’s health and discern how socioeconomic status affects this association. The concept of environmental injustice recognizes how underserved communities often suffer from higher air pollution concentrations in addition to other underlying risk factors for impaired health. This exposure then exerts larger effects on their health than it does in the average population, affecting the whole body, including the lungs and the brain. Children, whose organs and mind are still developing and who do not have the means of protecting themselves or creating change, are the most vulnerable to the detrimental effects of air pollution and environmental injustice. The adverse health effects of air pollution and environmental injustice can harm children well into adulthood and may even have transgenerational effects. There is an urgent need for action in order to ensure the health and safety of future generations, as social disparities are continuously increasing, due to social discrimination and climate change.
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Affiliation(s)
- Sahana Mathiarasan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| | - Anke Hüls
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
- Correspondence:
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Munro CL, Hope AA. Bedside to Worldwide. Am J Crit Care 2021; 30:4-6. [PMID: 33385194 DOI: 10.4037/ajcc2021734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Cindy L. Munro
- Cindy L. Munro is coeditor in chief of the American Journal of Critical Care. She is dean and professor, School of Nursing and Health Studies, University of Miami, Coral Gables, Florida
| | - Aluko A. Hope
- Aluko A. Hope is coeditor in chief of the American Journal of Critical Care. He is an associate professor at Albert Einstein College of Medicine and an intensivist and assistant bioethics consultant at Montefiore Medical Center, both in New York City
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Gildner TE, Levy SB. Intersecting vulnerabilities in human biology: Synergistic interactions between climate change and increasing obesity rates. Am J Hum Biol 2020; 33:e23460. [PMID: 32618027 DOI: 10.1002/ajhb.23460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Increasing obesity rates and accelerating climate change represent two global health challenges shaped by lifestyle change and human environmental modifications. Yet, few studies have considered how these issues may interact to exacerbate disease risk. METHODS In this theory article, we explore evidence that obesity-related disease and climatic changes share socio-ecological drivers and may interact to increase human morbidity and mortality risks. Additionally, we consider how obesity-climate change interactions may disproportionately affect vulnerable populations and how anthropological research can be applied to address this concern. RESULTS Interactions between heat stress and cardiometabolic disease represent an important pathway through which climate change and obesity-related morbidities may jointly impair health. For example, individuals with higher body fatness and obesity-related metabolic conditions (eg, type 2 diabetes) exhibit a reduced ability to dissipate heat. The risk of poor health resulting from these interactions is expected to be heterogeneous, with low- and middle-income countries, individuals of lower socioeconomic status, and minority populations facing a greater disease burden due to relative lack of resource access (eg, air conditioning). Moreover, older adults are at higher risk due to aging-associated changes in body composition and loss of thermoregulation capabilities. CONCLUSIONS Few policy makers appear to be considering how interventions can be designed to simultaneously address the medical burden posed by increasing obesity rates and climate change. Anthropological research is well situated to address this need in a nuanced and culturally-sensitive way; producing research that can be used to support community resilience, promote holistic well-being, and improve health outcomes.
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Affiliation(s)
- Theresa E Gildner
- Department of Anthropology, Dartmouth College, Hanover, New Hampshire, USA
| | - Stephanie B Levy
- Department of Anthropology, Hunter College, New York, New York, USA.,New York Consortium in Evolutionary Primatology, New York, New York, USA
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Fox M, Zuidema C, Bauman B, Burke T, Sheehan M. Integrating Public Health into Climate Change Policy and Planning: State of Practice Update. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183232. [PMID: 31487789 PMCID: PMC6765852 DOI: 10.3390/ijerph16183232] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 08/24/2019] [Accepted: 09/02/2019] [Indexed: 11/17/2022]
Abstract
Policy action in the coming decade will be crucial to achieving globally agreed upon goals to decarbonize the economy and build resilience to a warmer, more extreme climate. Public health has an essential role in climate planning and action: “Co-benefits” to health help underpin greenhouse gas reduction strategies, while safeguarding health—particularly of the most vulnerable—is a frontline local adaptation goal. Using the structure of the core functions and essential services (CFES), we reviewed the literature documenting the evolution of public health’s role in climate change action since the 2009 launch of the US CDC Climate and Health Program. We found that the public health response to climate change has been promising in the area of assessment (monitoring climate hazards, diagnosing health status, assessing vulnerability); mixed in the area of policy development (mobilizing partnerships, mitigation and adaptation activities); and relatively weak in assurance (communication, workforce development and evaluation). We suggest that the CFES model remains important, but is not aligned with three concepts—governance, implementation and adjustment—that have taken on increasing importance. Adding these concepts to the model can help ensure that public health fulfills its potential as a proactive partner fully integrated into climate policy planning and action in the coming decade.
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Affiliation(s)
- Mary Fox
- Department of Health Policy and Management, Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Christopher Zuidema
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Bridget Bauman
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Thomas Burke
- Department of Health Policy and Management, Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
| | - Mary Sheehan
- Department of Health Policy and Management, Risk Sciences and Public Policy Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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