For Moms’ Call the Doctor series, we peek behind the medical privacy curtain and get to know the people we entrust our health with, including their motivation, research, career goals, and daily work.
If you’ve never been to San Diego, you might not know that its notoriously pleasant climate isn’t uniform; it varies by neighborhood. “Some get access to wonderful air. Others have to deal with big rigs commuting between the U.S. and Mexico, or the port that brings in ships and all their pollution, and because we’re in a coastal desert, we also get fires. They used to be a seasonal thing, but have become year-round now,” explains Dr. Sabrina Perrino, pediatrician and co-founder of San Diego Pediatricians for Clean Air, a volunteer coalition.
Tell Congress: The Climate Clock Is Ticking. Act Now for Our Kids’ Future.
Extreme heat disrupts a mild climate
Extreme heat also varies neighborhood by neighborhood. “Some have stereotypical weather, but we have communities where there are no trees,” says Dr. Perrino. These are the locations suffering the most now that San Diego, like many places across the country, is experiencing increasing stretches of above 90 degree days. Dr. Perrino grew up in San Diego and has witnessed the shift firsthand. “We used to have a much shorter duration of the hot part of the year. There are communities now in the 100s for months. The nicer neighborhoods have more tolerant climates,” she notes.
San Diego isn’t built for this extreme heat. Air conditioning was never a building staple. “Now there’s more talk about where people are supposed to go for cooler air when it’s hot. Families with babies used to use libraries and malls to try to find air conditioning, but because of budgetary reasons, some places are closed. There is literally nowhere to go.”
San Diego schools are similarly unprepared for extreme heat. “All our schools are designed with bungalows. We don’t have a building where all the classes are,” Dr. Perrino says, noting this configuration is also a problem when wildfire smoke makes it dangerous to walk or play outside. She says, diplomatically, that there’s “room to make progress” with the local schools on heat exposure plans.
Maybe a path to progress will come out of the fourth annual Heat and Human Health Summit at the University of San Diego, cohosted by San Diego Pediatricians for Clean Air later this month. Colleagues will gather and share recent research and more to an audience mostly full of professionals working in advocacy and health, though the event is open to the community.
Day-to-day work
Dr. Perrino works on the summit and other advocacy projects in the margins of her days spent seeing patients in the southern part of San Diego, about a 10-minute drive to Mexico. While she sees impacts of air pollution and environment daily—increased asthma rates in kids living close to local highways, for example—her families don’t often ask her climate-related questions. “Some do, but the ones at highest risk for dealing with these things, their lives are so busy. They’re living paycheck to paycheck and have their priorities.”
So Dr. Perrino makes a point to let families know about the connections between environment and health, to offer practical advice, but also always to tell them their kids’ illnesses are not their fault. “Sometimes I’ll reference other, wealthier neighborhoods near the beach to let them know they’re experiencing something that is a consequence of the neighborhood and larger decisions that are being made. And once they hear that, you can see things click. It helps to take that burden when they realize this is related to larger system things.”
She only gets to offer practical, thoughtful advice when kids have reason to be in her clinic. When she sees overheated youth athletes who don’t know how to recognize the signs of heat illness—or what to do and when—she can help educate them. And when kids with asthma flares related to Santa Ana winds combined with hot, dry weather show up, she can start a conversation about air quality. Her patients’ families don’t necessarily check the Air Quality Index before planning their days, even if they look outside or notice the air smells like a barbecue. “Everybody still needs to be out going to work, picking up kids, and doing stuff. I don’t think people have shifted how they approach their day based off air quality. Most people don’t live life like that,” she says. Once they’re in her examining room, she’s able to talk about checking air quality and taking a preventative approach. “Today it’s actually really poor so you may have to change your plans,” she’ll share.
Enlisting pediatricians for advocacy
But these are one-off appointments. San Diego Pediatricians for Clean Air was founded about 10 years ago to help more broadly. “As doctors we do one-to-one visits, and over the years, we see patterns. When you start to see patterns, then it’s like, what can we do to try to help solve these problems at a larger scale and be a little more efficient?” she says, adding, “There are still some people who trust the medical expertise of doctors, and we can use our voice to speak up for families that need this kind of advocacy.”
The volunteers, all doctors, work on everything from representing patients’ voices in spaces where they’re not being heard to family education to legislation. Gathering volunteer colleagues has been a “nice collective experience,” and Dr. Perrino says everyone in the coalition uses their distinct skill set to bring awareness to air pollution, extreme heat, and more. They’re learning about the issues in real time, not through training, she notes. A recent win for the group was having one of their pediatrician volunteers get on a local air pollution control board. “We try to insert ourselves where we can to remind everybody making decisions that people need to breathe clean air.”
As health professionals, they’re also working to recognize how fast the climate and its health impacts are changing. This is critical. “The advice we give one year may shift the next. We are starting to have flexibility and elasticity to understand that the people we are taking care of are going to deal with more, different from last year, and that the urgency to inform them is greater.”
Tell Congress: The Climate Clock Is Ticking. Act Now for Our Kids’ Future.