In Moms’ Call the Doctor series, we peek behind the medical privacy curtain and get to know the people we entrust with our health, including their motivation, research, career goals, and daily work.
There isn’t one specific thing that motivated Dr. Amanda Millstein, a primary care pediatrician practicing in Oakland, to focus on how climate change impacts children’s health. Instead, it was a variety of experiences, including living through wildfire events in Northern California, that pushed her to co-found Climate Health Now and to help launch the Climate Change and Child Health Committee of her local American Academy of Pediatrics (AAP) chapter. Once, after her parents had to evacuate their home in Napa when she was pregnant with her second child, she remembers feeling “very vulnerable” and even wondering, “What sort of world am I bringing these kids into?”
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Working within the plume
An undeniable catalyst for Dr. Millstein was a job practicing pediatrics in Richmond, California, a “refinery community” deeply impacted by the Chevron facility that has been operating there since 1901, as well as other fossil fuel production facilities in the surrounding area. Within a month of starting work there in 2019, during a normal day of clinic, everyone’s phones all of a sudden started dinging. “There had been an explosion at one of the refineries. We looked outside and could see black smoke and were told to shelter in place,” she recalls.
The next day, Dr. Millstein saw multiple families that had scheduled same-day visits. “They just wanted their kids, most of whom have a history of asthma, checked out. And for most of these families, this was not a surprise,” she says. For her as a relative outsider, this was a big wake-up call. “This seemed like, can you believe what we’re going through? This is crazy! This is abnormal!” But for community members used to living “within the plume,” it just wasn’t—she was much more shocked than anybody else.
Dr. Millstein describes Richmond as a historically redlined community, noting that people who live downwind of the refinery tend to be majority non-white and poor. “These are communities that don’t have means to move elsewhere. It’s not like anyone is saying I want to live in the shadow of this large polluting industry,” she says. Children attend schools within the plume too. “I’ve talked to teachers in Richmond who literally clean toxic crap off of their windows as part of their daily cleaning the classroom.”
Dr. Millstein did what she could, working with local parents on harm reduction. “There are exposures we can’t necessarily avoid. As a medical community we can hopefully help families understand what to do when the air quality index is 200 versus 100. How can we help parents understand in the context of your child’s specific medical condition? Is this a newborn baby? Is this a child with asthma?”
Taking action no matter what
Sometimes these conversations about harm reduction felt too small. “I’ve had all this training. I’ve spent so much time getting myself to this position of being able to practice pediatrics. And I had an incredibly profound sense of inadequacy and that I wasn’t doing the right things. I literally had experiences of being in an exam room in my clinic, treating a child with albuterol, the medication we use to treat asthma, and looking out at smoke,” she says. Concerned that what she was doing was “not even a drop in the bucket compared to what needs to happen,” Dr. Millstein decided to get active.
First, she had noticed her local AAP chapter was doing good advocacy but wasn’t specifically addressing climate change, so she and other local pediatricians founded a climate-focused committee. “We’ve made good inroads elevating the issue within the chapter. When we come together for board meetings, people are now talking more about climate change, and when the State Government Affairs Committee meets, there’s more emphasis on what climate legislation we should be looking at,” she says.
Concurrently, Dr. Millstein launched Climate Health Now, a statewide organization with a mission to activate, mobilize, and educate the California health community around climate advocacy. She co-founded this with her own primary care doctor, after they bonded over climate anxiety and being mothers to young children at a visit. “I really thought I was the only one feeling this way,” says Dr. Millstein. The organization takes a “big tent” approach, striving to get members, including nurses, doctors, medical assistants, doulas, and public health experts, to write letters to the editor and to testify locally in support of or in opposition to legislation that pertains to climate and, ultimately, children’s health.
Lately, Dr. Millstein has a new focus as chair of the green team at her hospital: reducing the environmental impacts of practicing medicine. “The healthcare sector in the U.S. is 8 to 10% of our greenhouse gas emissions. It’s waste, it’s energy use, it’s transportation.” She wants to change the culture of how physicians and nurses approach sustainability—even things as mundane but impactful as reducing the amount of plastic gloves used per encounter.
Answering parents’ climate questions
Despite all these volunteer projects, the majority of Dr. Millstein’s work remains seeing patients. “There is something so special and sacred about the pediatrician-family relationship,” she says. Living in Northern California, the climate crisis is now part of well visits and more. She regularly fields parent questions about wildfire smoke exposure, masking, and air filtration. Families who rent frequently don’t know the quality of their air filtration at home, or if they even have any. She’s also educating families on how to make decisions about outdoor play and attending school based on checking the air quality index (AQI).
“It’s been tricky to navigate, to say the least, questions about air filtration at school and whether it’s safer for their kid to stay home or go to school. A lot of our school infrastructure is very poor, very old. It’s an impossible question, because then it’s also getting at learning,” she says.
While Dr. Millstein is now well-versed in these complicated conversations, not all doctors are. And yet they are on the frontlines of where the climate crisis and children’s health intersect—with very little education to lean on. Environmental health is not a focus at most medical schools.
Still, Dr. Millstein says they’re up for the challenge. “Pediatricians are inherently advocates for the future. Pediatrics has a very rich history of advocacy. It’s integrated into our training. It’s hard to be a pediatrician without thinking about the future because that’s so much of what we do day-to-day.”
And pediatricians can also draw on personal experiences to deepen their climate-related work and enhance their learning curve. “As a mom, I deeply understand that when you’re concerned about your child, there’s nothing more primal than that,” says Dr. Millstein. “That’s what untapped this in me. I was concerned about my own kids ultimately in a way that I didn’t know how to act on—and I still don’t always.”
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