The future of children’s health
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This is Stanford Engineering's The Future of Everything, and I'm your host, Russ Altman. I thought it would be good to revisit the original intent of this show. In 2017, when we started, we wanted to create a forum to dive into and discuss the motivations and the research that my colleagues do across the campus in science, technology, engineering, medicine, and other topics.

Stanford University and all universities, for the most part, have a long history of doing important work that impacts the world. And it's a joy to share with you how this work is motivated by humans who are working hard to create a better future for everybody.

In that spirit, I hope you will walk away from every episode with a deeper understanding of the work that's in progress here and that you'll share it with your friends, family, neighbors, co-workers as well. Any child that is coming in to the hospital and has to stay for wheezing or asthma, I am talking to that family about wildfires, about how to read an air quality index, about the importance of investing in an air purifier.

I work with a lot of families that are collecting, need WIC or SNAP. So they're having to decide between food on the table or clean air. And so I talk to them about a DIY air filter that you can use. It's basically a box fan and a HEPA filter that you can tape or nail. And you can get a 50 to 60% reduction in indoor air pollution from using a device like that. ♪

This is Stanford Engineering's The Future of Everything, and I'm your host, Russ Altman. If you're enjoying the show or if it's helped you in any way, you know that's my favorite, any way, pretty low bar, please consider sharing it with friends, relatives, and colleagues. Personal recommendations are one of the best ways to spread news about the show. Today, Lisa Patel will tell us that the pollution in the air, the pollution in the water, and other environmental issues can put our children's health in jeopardy.

She's a pediatrician, and she's going to tell us what she's seeing in the clinic because of wildfires and decreasing air pollution in many areas. It's the future of children's health. Before we get started, a reminder that if you're enjoying the show, please tell friends, neighbors, family, and colleagues. It's a great way to spread news of the show.

So we all think about our health and we think about our exposures to toxins. We are very careful when we're around paints and solvents. But you know what? What about the air? We know that there's been assaults on the air from wildfire, especially in California and other places where wildfires because of climate change

have just gone up exponentially in frequency. There used to be a season, and now it seems to be year-round. And those fires release not just smoke, but toxins and many things that are bad, not only for all of our health, but especially for the health of our small children and their young lungs.

In addition, we know about plastics in the water. Those plastics are now being associated increasingly with disease. And we're all wondering, what can we do to protect our health? Well, Lisa Patel is a professor of pediatrics at Stanford University and an expert on the environmental exposures and especially how they impact children's health.

She'll tell us about all of this. She'll tell us about pneumonia, asthma from the air. She'll tell us about advanced cardiac disease from microplastics. And she'll provide us with some things that we can do to try to help the situation. Lisa, what led you to focus your work on the environment and its impacts on childhood health?

It's a long path, but I'll say what really made me switch. I was previously working as a physician. I was a new mom, a new attending. And two things happened in succession. First, we withdrew from the Paris Climate Agreement in 2017. And that started to spark youth protests all over the world. And as a pediatrician and a mom, I was thinking to myself,

We failed if kids don't get to be kids and have to be out on the streets fighting for the livable future that we haven't been able to guarantee them. And then the second thing that happened was what began as a series of terrible wildfires. And the wildfires we know are getting worse because of climate change. It was 2018. My second child had been born. And data was starting to come out about how much worse wildfire smoke was for kids and for all of us.

And we were just trapped inside for days with my children. And I was thinking, this is not okay. This is not the world that I want my kids to grow up in. And so after that, I just started doing everything I could to learn everything I could, meet other people in the space and really built my career from there. Fantastic. And I know in preparing for our chat, there are many dimensions to how the environment is influencing children health. But the one that I know that you talk about and as very a lot is

is the issue of the air and air pollution from traditional sources, but also, as you said, the wildfires. So what are the dimensions of that problem? And how does it really play out for a practicing pediatrician who's seeing kids? As you know, in California, we just have seasonal wildfires now, it seems. And so this is almost like a chronic exposure. So what are you seeing as a physician and as an expert on these influences? Dr.

I think it's so important for people to understand that fossil fuels certainly played an important role in terms of all the benefits that we have right now. But they're an old, right? Like they're fossil for a reason and we don't have to rely upon them anymore. While we did derive some benefit from them, they come with huge costs to our health. So there are more deaths, premature deaths worldwide from the burning of fossil fuels. So that is oil, coal and natural gas.

than there are from tobacco worldwide. One in five premature deaths are driven by the burning of fossil fuels.

And so it's important for people to understand that. It's important for people to understand that the Clean Air Act actually helped. It's one of the greatest public health victories we've ever had because it cleaned up our air. It made sure that when we were burning coal and gas, that we were trying to do so in the cleanest way possible. When was that passed approximately? It was the 1970s. Okay. And we are now seeing under this administration sort of a tearing apart of this act that has done so much to clean up our air. Right.

But, you know, you alluded to the fact that so we have much cleaner air than we had 30 or 40 years ago. But now we're starting to reverse those gains. And it's because of wildfires. It's because when we burn fossil fuels, it pollutes us. It pollutes the air in two ways. One, it releases something called PM 2.5. And we can talk a little bit more about that. That results in immediate health harms. But two, it releases greenhouse gases that is making climate change worse.

With that, we are seeing worsening wildfires and the wildfires have become so overwhelming. We are erasing the gains in places like California in terms of having cleaner air. So my children are breathing poorer air quality than I got to enjoy in my lifetime.

You know, I grew up in New York in Brooklyn and I remember on the 18th floor of a building and I remember as a kid looking out and being fascinated by the layers of basically air pollution that you could see. It was all stratified and the question was how much of the Empire State Building could you see before it vanished in this kind of

Brown muck. Okay. So when they, so do the kids, are they accumulating this so that they're going to get diseases when they're older? Or are you already seeing manifestations of stress on their, I guess, lungs, even as kids?

So there's a researcher who works in Mexico, and she has taken the brains of children who died by traffic accidents and took the brains of children and did autopsies of children that lived in really polluted cities and compared them to the brains of children that died by accident in unpolluted areas. She could see early markers of Alzheimer's disease because of that air pollution in the children that were born in the more polluted cities.

We understand that like any environmental exposure, these things accumulate over time. So particulate matter pollution, when we burn coal, oil, and gas, produces these tiny particles, both PM2.5 and ultra-fine particles, enter our body, our vasculature, and essentially set off inflammation.

That results in we have very good data that it results in premature mortality. You know, the more you're exposed over your lifetime, the greater that risk is also risks for cancer, heart disease, diabetes, dementia, premature birth, low birth weight infants. It really affects the entire spectrum of our lives. And the more you're exposed, the higher the risk.

are you seeing asthma in kids and are the rates of pneumonia going up? So these would be things that are affecting the kids right now. It's not a long-term risk. It's a, a present health risk. Well,

Well, and it's both, right? So I have worked and continue to work in areas where there are certain populations and we know communities of color, communities experiencing poverty, experience more of that pollution. So this PM2.5 and ultrafine pollution, it crosses the placenta. We have found evidence of that pollution in a developing fetus's brain, lungs, and liver.

And so children, and especially children in poorer areas, are born pre-polluted. These are risk factors for developing asthma in the first place. And then they're born, and they live in a polluted environment. Now, children's lungs and their bronchioles, they're just smaller. And so a bit of inflammation is a big deal to a small child, particularly children under the age of five.

So children that are exposed to this pollution are at higher risk for developing asthma. And certainly these are the kids that I see again and again in the emergency room with asthma exacerbations. So what do you tell the parents? So, you know, we all think about this idyllic childhood outdoors, like it's always good for the kids to be outside playing, running around, etc.

It sounds like that equation might be a little bit different now. And I'm almost afraid to ask what the advice is about how to, because you're also trading off cardiovascular health. I mean, you do want them running, you want them playing, you want them climbing, all those things. So how do you frame it when you're talking to the parents about the best way to kind of balance off the risks of the air with the need to be outside playing around?

I frame it in terms of the times when I know that the risk is highest. So during wild and so you had said, you know, alluded to wildfire season. Those of us that work in the space will now say there used to be a season. It used to be from like July to November, but that's now gone. It's more or less yearly and year round. And to your point, it is now a chronic exposure.

That being said, you know, there are specific times when we are seeing when there is wildfire activity. Any child that is coming in to the hospital and has to stay for wheezing or asthma, I am talking to that family about wildfires, about how to read an air quality index, about the importance of investing in an air purifier. I work with a lot of families that are collecting or need WIC or SNAP.

So they're having to decide between food on the table or clean air. And so I talked to them about a DIY air filter that you can use. It's basically a box fan and a HEPA filter that you can tape or nail. And you can get a 50 to 60% reduction in indoor air pollution from using a device like that.

Well, I just want to pause on that because that sounds really fascinating. So can people Google DIY air filter? That's right. And the EPA currently has a website that tells you how to do that.

Okay. Very good. So there are these things. Now, tell me about the – for the more normal filtration systems, the one that you buy that sit there. So it sounds like those really work because I know people are a little bit like, is this just a marketing thing or is it something for the ultra-rich who don't want to have a single bad thing go into their lung? But it sounds like this is the real deal. Yeah.

Yes, it is. And the other thing I'll say about it, we, my colleague Marshall Burke at Stanford has done a lot of work on indoor air quality. And some of the research that he's done shows that sometimes the indoor air quality is worse than what's outside because your building envelope is not great. And so that

that pollution gets inside, stays trapped inside. And so for all of those reasons, it's important, especially living in a place that is prone to wildfires and wildfire smoke, to ensure good indoor air quality. We spend 90% of our time indoors. This is great because now that you mention it, we do have one of these filter things and it tells us like whatever the particles that it's sensing. And every time I cook something,

especially if it's like a stir fry, it goes up to like 80 or 90. You hear it, it gets loud and it's like, okay, I'm cooking and therefore I'm polluting my living room. Well, you bring up another great point, which is that when the pollution is bad outside, we need to make sure that we're not burning and right, we're burning fossil gas, natural gas inside that releases those same pollutants.

And so I tell families, you know, we have long been working on getting our gas stove out. In the interim, we've invested in one of those portable induction cooktops. Yes, we did too. That's so funny. I wanted to give it a try to see if my favorite pans worked and if it was fun to cook on. And it is, right? Yep. Yes. And no pollution, which is great because 13% of pediatric asthma cases in this country are attributable to gas stoves.

Wow. So let's say that one more time because that's a little bit shocking. 13% of pediatric asthma cases in this country are attributable to gas stoves. So this conversion to induction and electric on the stoves was...

would make a big dent in childhood asthma. Yes, and when I tell other pediatric providers this, right, there's so many drivers of asthma that are so hard to wrap your head around or to make any difference on. I'm like, here's a concrete one where we could make a real difference.

Brilliant. Now, I know that you look at other aspects of the environment, and so I want to touch upon those as well. One of the things that – so we've talked about air. Of course, we want to talk about water. What do you see as the big issues for childhood health in terms of the water supply or water exposure? Or are we pretty good there? I don't want to make an issue if it's not a big issue for you. Yeah.

Unfortunately, it is. And there are a range of issues as it relates to children's health. So we'll start with the fact that the Trump administration has cut programs on lead. We did see greater investments in schools, for example, changing out the piping where sometimes lead is present. And so children were having access to water that was contaminated with lead. Is that the main issue? Is the piping systems from the olden days being made out of lead? No.

And this area, I will say, is not as water is not my highest area of expertise. It's a place where I know something about, but I know far more about air pollution. But I'll tell you the places where we worry about lead ingestion for kids. It is in houses that are older where there hasn't been abatement for lead. And again, we know that communities of color tend to be more susceptible.

to those higher levels of lead exposure. Obviously, there was the case in Flint, Michigan, where there was a dumping of industrial waste, and we saw really high lead levels in kids. As we know, lead is a neurotoxicant, and especially in young children, when their brains are rapidly developing in those first two years, it is extraordinarily, there's no such thing as a safe level of lead.

So, yes, a lot of it is from our water supply systems. A lot of it is from lead that was in paint years ago that we haven't entirely abated. And then what about microplastics? Is that something that I know we hear about it. I don't know the degree to which we've quantified the risks, either long or short term. It's just like a big worry. Or is it more than that? Yeah, let's talk about all the depressing things today. Yeah.

Well, we're going to end with positives. It's my job to end with positives. So microplastics. I will say quite honestly, a few years ago, I was like, oh, what's the big deal? You know, I'm just going to keep, we have a bunch of plastic stuff. I'm going to keep putting in the dishwasher. And then every new piece of evidence that comes out has really changed my mind and my thinking on this. So a few concerns about microplastics. First,

We are finding it everywhere, not only everywhere in the environment. We are finding it everywhere in our bodies. So there was a study that showed it's in an infant's first poo. It is in our atherosclerotic plaques. And so there was a paper out of New England Journal of Medicine that showed a higher risk for myocardial infarction because if there are microplastics there, it's in our gum. Holy God, did you know you were chewing a big wad of plastic?

I did not know. I mean, in retrospect, that's what it feels like, especially at the end. Oh, my gosh. So it is everywhere. This whole idea that we can recycle plastics was a myth that was pushed onto us by the fossil fuel industry because guess where plastics come from? They come from petrochemicals.

And so for the fossil fuel industry, plastics are their 2.0. Once we transition off the burning of fossil fuels, they hope that we continue relying upon plastics so they can continue making money.

So single-use plastics are catastrophic, certainly for the environment. And every new piece of data that we learn about our health should concern us more and more. So we've made a commitment in our family, getting rid of all the plastic in your life is tough. But we try to get rid of one by one, one item per month to try to move us away from plastics altogether. This is The Future of Everything with Russ Altman. We'll have more with Lisa Patel next.

Welcome back to the future of everything. This is Russ Altman and I'm speaking with Lisa Patel, a professor of pediatrics from Stanford University. In the last segment, Lisa told us about her worries about the air and the data showing real consequences for the health of children breathing in especially wildfire and other polluted air.

In this segment, we're going to talk about what can society do to try to protect the health of children and what can we do in a more local level, even in our homes, to protect our own health and to protect the health of the people that we care about. I wanted to go to solutions. What can society do? What can we do? What can the world do to try to better protect the health of children? So I'm sure you think about this. How do you think about the things that have to happen?

I think the number one thing, and we were making really good headway on this, and we were seeing that coal plants are starting to be shut down. Coal is highly polluting both to the surrounding community and downwind of the folks that live close to coal plants with

Really billions of dollars in health costs that people have to pay as a result of being exposed to that really terrible pollution. Gas plants as well, same thing. It is not clean. It is also highly polluting from the time that you get that natural gas out of the ground, fracking to the point of burning, also very highly polluting.

And so we were making very good headway in terms of transitioning off of those old, dirty fuels towards a cleaner future. Things that rely on things like geothermal and solar and wind. These are technologies that we know result in immediate health benefits because they reduce air pollution for the surrounding community.

And they also build really good resilience. So what we've seen is for health care centers, for example, with worsening black and brownouts, they can keep the lights on using clean energy to be able to continue offering care. Or homes that have solar, when the grid goes out, they can keep power so all the food or their medications don't spoil, for example. Right.

The trouble is we're starting to see sort of a return to some of these older types of fuels. And that's a big mistake because we know that things like solar are getting cheaper by the day. And so we really want to rely upon energy that is cheap, that is easily accessible to us, and that is better for our health. Who wants to pay more in medical bills, right, from how damaging these fossil fuels are to our health?

And the move backwards, it's mostly a money thing? Like they're currently cheaper? Is that the general idea? No, actually. Market forces are making solar cheaper. It's the policy priorities of this administration, unfortunately. So what other solutions can we look for? So maybe there's things to do there in terms of rethinking the incentive structure for the so-called emerging cleaner air, cleaner energy, and maybe...

thinking about sunsetting these other ones. Other things we should be thinking about? Yeah, we need to be investing more in public and active forms of transportation. So we know that things like active transportation, being able to walk or bike places is better for your health because you're up and moving around more. And also, right? Except you do have to breathe that air. But yeah, we're working on the air too. Bye.

But if there are more people on their bikes and walking, less cars on the road, then there's less air pollution that we're breathing. It is a little bit of a chicken and an egg problem, but this is how we get there, is that we build the infrastructure in cities for car-free streets, car-free neighborhoods, which we're starting to see more and more of, both in the U.S. and in other countries. Right.

The congestion plan pricing in New York that has gotten a lot of headlines. Early data shows fewer pedestrian accidents, better air quality and and more people that are utilizing public transportation. And that's good because it drives more money into public transportation to make those better systems for everyone. Yeah.

Do we have data on whether the electric cars, are they going to be a good thing? I mean, I know there are people who are fans of it as a green energy because of the electricity. Is there any data yet on the environmental impact or is it too early? Yeah.

And I'll have to go back through the archives of my mind, but I'm fairly certain there was a paper that came out that looked at the impact of increasing electric vehicles in Southern California and seeing decreased asthma rates because of the improvement in air quality from more electric vehicles on the road.

So, yes, there's a definite benefit. There was electric school buses. There was an interesting study there that looked at the districts that had switched to electric school buses. They saw improved school attendance. Those diesel buses, they're like air pollution death traps, the amount of pollution that comes out of them. And it makes children sick and kids miss school because of it.

I remember that smell. I remember the smell of my school bus very clearly and it was not good. Yeah. Yeah. It's like, why should we rely upon these old dirty things when we have newer, cleaner forms of technology?

So I know that you've also thought a lot about the food we eat, because, of course, as a pediatrician, I'm sure you care deeply about the food that's going into the mouths of your patients. And where are we there? And I know you've you've written about plant plant forward diets and, you know, eat your vegetables. Is it is it is it more than that?

Yeah. And I will say I grew up in Texas. I understand the importance of a good barbecue. And I understand that food is – Cheeseburgers. Yeah. I could never really say no to cheeseburgers for the rest of my life. Food is personal. Food is cultural. And I think it's tough for – I think one of the issues with vegetarian plant-forward that people often feel is like somebody is going to take away my meat.

And that's not the point here, really. It's more that there are opportunities for us to eat better. And so what I'd encourage listeners to think about is, no, you don't have to like completely eliminate meat from your diet. But if you want your kids to enjoy the things that are your own cultural tradition, if we don't decrease our meat consumption, those things are going to be taken away from us because we won't be able to have those food sources moving into the future.

So it's about responsible stewardship to say you don't have to eliminate it altogether. But we know from a planetary point of view, you know, things like cattle, highly polluting. It is bad for the environment. And we also know from increasing data, it's really bad for our health as well. So enjoy it. Enjoy it in moderation and consider how you can decrease your meat consumption because it's better for your personal health and it's better for planetary health.

And how does that work on kids? How does that work on kids? I mean, I'm sure you now have a lot of experience where the parents on board, but they need Johnny or Jill or little Lisa to get with the program.

My experience with my grandchildren who've been exposed to tons of vegetables is they like them. They actually reach for cucumbers when I would have reached for a Twinkie. Well, you know, interestingly, it's the opposite is what we see in our pediatric practice. It's usually the children who come to us because...

look, the process of making meat, if we really think about it, it is somewhat cruel and inhumane. And when children learn about, oh, that's where my meat comes from. What we often see is that it's children who are saying, I don't think I want to eat this. Um, and then the parents being very distressed because they think that their kids are not getting the appropriate nutrients that they need. Um, so a lot of the work I've done, um, I grew up in a, in a culturally vegetarian household, um,

where we eat a lot of plant forward proteins like legumes and nuts, chickpeas and beans, tofu. There are some really great options in terms of plant forward. And then there are all these meat alternatives as well, which my husband tells me tastes pretty good, pretty comparable, and doesn't come with the same health impacts and is also better for the planet.

So I would say for the more often it's that parents are distressed. Kids want to make the change. And we now have the resources to help families make those decisions and how to how to ensure that kids are getting the nutrients they need. And I really like your message that it's not like you have to say no to meet parents.

But maybe a little bit of shift towards more. And we also, and you know, I'm a general internist and we know that the fiber from plants is great for your bowel health. And we know that there's this unexplained increase in colon cancer. And a lot of us are worried that it's about the types of diets that we've all been eating. And so I,

It sounds like a really nice piece of advice, which is you don't have to say no to your barbecue or your cheeseburger, but just do a little shift so it's not quite as much and then see how it goes and you might actually like it. So I wanted to- Oh, sorry. There's one more piece here for my colleague, Tamiko Katsumoto. She's a rheumatologist at Stanford and she works a lot on plant-forward diets and provides us counseling to her rheumatology patients because it decreases systemic inflammation. Right.

So there's just so many benefits to having a more plant-forward diet. So I would say try it out and you are likely to feel better, both about your personal health and planetary health. Yeah, I have done that myself in the last three years because I'm getting older and it's been great.

I wanted to in the last couple of minutes, I just want to ask you for like a list of things. We've talked about a lot of things that somebody could count as depressing, you know, bad air, bad water. You're eating wrong. Like, why would you ever tune into this podcast again? I totally get that. So let's end on a positive. What are steps that people can take that are doable and that can kind of just move the needle a little bit more towards towards health?

So there are so many things that you can do in the realm of climate action. I would say first connect to what you're passionate about. Is it that you enjoy being outdoors? And so there's a lot of like trash pickup restoration work that you can be involved in to ensure that these areas are...

clean and beautiful and healthy so that these ecosystems can continue thriving into the future? Are you passionate about active transportation? And so you can work within your cities to create more of those corridors to encourage more active transportation. Are you passionate about education? Are there ways that you can build in as a teacher more lessons about climate change and stewardship?

There's just so much that we can do. But I would say, especially in this environment, go as local as you can. For so many reasons, I see sort of a – it's become increasingly hard to dialogue around issues of science and of health.

And so, but the easiest way for us to do that is to do that in community with the people around us. So look around at your community. There are so many solutions that we can deliver on right here. And so that you can see the benefit, your community can benefit. And if each of us takes that local action, then we can solve this problem globally. Yeah.

It's really great. And then earlier you were saying that the air filters are for real. So if you're having wildfires in your neighborhood, think about that and think about your cooking. Do water filters make sense or water filters for the plastic problem or are they not making? Yeah. You know, the one thing I was like, are you going to ask me about PFAS? Are we going to talk about that? Yeah.

It's like the line of devils of environmental health. And PFAS has been left out of this. Folks might have heard about PFAS. It's a forever chemical. And it is also in our water supply. It is in our bodies. And it also has really concerning health implications. Some of the newer water. So, yes, we have a rule from the EPA in place where municipalities need to be testing for PFAS and get it out of our water systems.

The current administration is looking to do away with that. And so I would say if you have the means to use an additional water filter, make sure that it can take PFAS out. I would encourage using it. Thanks to Lisa Patel. That was the future of children's health. Thank you for listening. Don't forget that we have an archive of a zillion past episodes where we talk about a wide range of issues and how they're leading to our future.

Please remember to hit follow in the app that you're listening to to make sure that you never miss an episode and are fully clued in on the future of everything. You can connect with me on many social media platforms at RB Altman or at Russ B. Altman at LinkedIn, Threads, Blue Sky and Mastodon. You can follow the School of Engineering at Stanford at Stanford School of Engineering or at Stanford ENG.