Dr. Lisa Patel is a pediatric hospitalist at Stanford University with a passion for environmental and climate health. Her projects include co-leading efforts to make California schools green and climate resilient and participating in the Medical Society Consortium on Climate and Health. She came to realize how important environment is to health while working in India, where she saw whole gymnasium full of children suffering from the effects of air pollution. She has worked as an advocate with the American Academy of Pediatrics (AAP); educated healthcare practitioners in many venues, including the National Environmental Education Foundation (NEEF); helped to incorporate climate change into Stanford University School of Medicine’s curriculum; promoted climate readiness in healthcare systems; and mentored student activists on the Stanford campus. She is also the mother of two young children and says that, despite the grim predictions we are seeing come out of the IPCC, having children has made her realize that “despair is not an option.”
This interview has been edited for length and clarity.
JMK: Hey, Lisa! So nice to meet you online.
LP: Nice to meet you, too, Jean-Marie.
JMK: I really appreciate you taking the time to talk to me. And I have a list of questions, but it's very roughly structured, so anything you wish to tell me, please feel free to do so. I was reading in your bio that after undergrad, you worked in Egypt, Brazil, and India, where you first realized the connection between environment and childhood health. And that's why you went to med school. I wondered if you had any specific story from your early training or childhood—or that time that you spent abroad—that compelled you to make that choice.
LP: Sometimes people feel like a big light bulb goes off. For me, it was just these flickers that got bigger and bigger. The first was when I was working in Bombay. I worked for the EPA, and we facilitated a lot of scientific exchanges between scientists and practitioners in the U.S. and those in India who were seeking to do the same thing. And so I was there in Bombay for a New York-Bombay knowledge exchange on childhood asthma, because both cities were working on it. They took me to visit their ward for children who had asthma, and the number of children who were suffering from asthma exacerbations was so many they didn't fit into the hospital. I walked into a gymnasium with beds of children having trouble breathing, where they were getting treatments, and the air quality there was really foul. And I just remember thinking, how wrong is this? At the time, in 2006, there wasn't that much literature about what air pollution was doing to children's health. But I remember thinking, breathing this air can't be good for these kids. This is really wrong, and there has to be a way to clean this air up.
And then I would say the second light bulb went off when the youth protest started, and climate change had been becoming a worse and worse problem. At this point, I had finished my training. I'd become a mother. I thought we would have some time, and then the climate change crisis arrived in California. Our wildfire season in 2018 was terrible. Once again, this issue of air pollution came up again, but this time it felt personal. And so I started trying to ask what I could do about it. I started reaching out to other researchers at first, and then when the youth movement started, that was the light bulb that really got me going because I found other people who were worried about the same thing. And we started working together. So my real climate advocacy didn't really start until 2019.
JMK: That makes perfect sense. I think I told you that I lost a child to environmental chemicals.
LP: … and I'm so sorry to hear that.
JMK: Thank you. Yes, we have every reason to believe that her leukemia was caused by the chemicals she was exposed to through mosquito spraying. Though I had declined med school, I turned back in the direction of Public Health because it became personal for me. The science is solid, and no one was talking about it.
LP: Right? And it's just one of those things that is so in our face, and yet we don't talk about it, and we haven't done anything about it.
JMK: I teach Global Environmental Health, and that's a central question. And it really is the question of the book. How could we be doing this? Did you get to know some of those youth activists?
LP: So it was a little bit different for me. What happened was because of the youth movement. Suddenly, there was a lot of movement on campus, in particular at Stanford, and so where it started for me were a lot of really concerned medical students and undergraduates at Stanford, and I just started working with them. They had all of the energy; they had all the ideas. But they needed a faculty member to get them into the rooms, and so I said, of course I'll join you! Of course I'll help you! And that's how it started for me.
JMK: It’s wonderful to have students. I’ve read some of your research. You've done so much. And I wondered if there was some piece of work that you are proudest of? Or is there some other research that you read that was really pivotal for you?
LP: I think the piece that I'm the proudest of is “Air Pollution as a Social and Structural Determinant of Health” because again, it's not something that people usually think about. And I wanted to really make this argument. I'd said it a number of times, but then I decided that I wanted to be able to frame that argument in a way I could point to in a lecture, and I was lucky that we have a group of really passionate pediatricians that meets regularly. I pitched the idea, and then a group of us came together to write the paper. There have just been so many formative papers for me as well. But I'll say one of the most formative ones has been the writing of Dr. Camara Jones, which isn't necessarily in the space of climate change. But it is in the space of structural racism. And the way she wrote about it just opened my eyes to a completely different way of seeing the world. And then I started applying that lens to climate change. Again, the environmental justice movement is very old. It's much older even than the climate movement. Bob Bullard's work started in in the 1970s or 1980s. It was reading Camera Jones's work and then thinking about the climate crisis together that made me think, “how did I not see this?”
JMK: Yes, I think that some people call that being woke, and I know that others dismiss that term. But it is a feeling like revelation.
LP: Yes!
JMK: My next question is one you've already talked about a little bit. We're both mothers. It's really tough to raise kids in a world where these things are going on, and especially for parents like me, who have lost a child. My MPH internship involved sharing information with pediatricians, OB/Gyns, and family practice physicians, and some said that they didn't want to scare parents. I know the research shows that a lot of physicians are not prepared for that conversation. So what do you say to parents about the implications of your work?
LP: It’s interesting because I do this. I'm a pediatric hospitalist, and so I would say, one of the worst situations is when I get called in to talk to a mother in premature labor. I need to tell her what to expect. It's scary. Often, women who are coming to the hospital in premature labor weren't expecting that their baby was going to be delivered early, and so they're terrified. And then one of the questions that I always get from them is, is this my fault? And so it's become a standard part of my practice to tell them that we're here in California, and we're experiencing heat waves and wildfires, and we know that these are two risk factors for premature birth. What I tell them is that the reasons for premature birth are very complex. No, there's absolutely nothing that you did that was wrong. But then there are also a number of other risk factors that were out of your control. And that is part of my standard counseling. I don't know what that means for them emotionally, but I do hope it helps take off some of the burden they might feel themselves but then help create some sense of what we're seeing and why. The other piece of counseling is that I talk to all of my families that come in with asthma exacerbations about wildfire smoke—because at this point, it would be clinically negligent not to. And so what I say to them is that if your child has asthma, whether it's wildfire season or not, you should have an air purifier. I talk to them about how to read an air quality index, and I tell them that this is very important because climate change is going to make air pollution worse. I've never had a family member tell me they didn’t want the advice. They say they didn't know the links, and they're usually appreciative to know another way to keep their kids safe. I had a father come in during a heat wave. There wasn't air pollution, but heat also drives bad air pollution. And he said, “I don't understand—he doesn't have a cold. There’s not wildfire smoke outside. I don't understand why my child had an asthma exacerbation today,” and I said, well, because on hot days there is more ozone, and he responded, “Oh, I didn't know that.” So I told him, you need to be watching out for hot days because we're going to see more of it with climate change. So what I would say is that parents want to protect their kids, and climate change is increasingly going to be a hazard. And so it is our professional obligation to empower parents with the tools to understand how they can keep their kids safe. I would want that information as a parent, and I think other parents would want that too.
JMK: I could not agree with you more. I think it’s patronizing to withhold information from parents. Who wouldn’t do everything they can?
LP: One more thing about that. I actually learned this really interesting piece of data from my colleague, Elizabeth Pinsky, who is an adolescent psychiatrist. We're seeing more and more eco-anxiety in youth. And what she's found is that the eco-anxiety is worse in those children who think that their parents, caregivers, or government aren't doing anything to address the crisis.
JMK: Gosh, I've got to look that one up. That's amazing.
LP: I can't remember if Elizabeth wrote the paper herself, or if she cited it. But the reason why youth are so distressed is their sense that they're being left this world that was screwed up, but not by them. And so part of ameliorating that, part of our responsibility, is to show that we feel that responsibility and we're doing something for it.
JMK: Absolutely. You said this has changed since you had kids, and I wondered if you would share how you feel about having children who are vulnerable in a dangerous world.
LP: There have been times when I've had to step out of the room when people present data, particularly on young children. My son is five. We've had wildfires more or less every year, for about the last five or six years, and three of the worst ones during his short five-year life. There was this presentation on long-term brain damage for young children and wildfire smoke, and I had to step out of the room, because it was just too much. Even if I keep him inside where we have an air purifier running, we can't escape all the smoke. He's going to be exposed to some of it, and especially during such a vulnerable time in his life. So there are times when I think to myself, what if my kid gets that cancer diagnosis at this age? And then I would know it's because he grew up here during a vulnerable time. And I don't borrow trouble, right? But it has certainly contributed to my sense of eco-anxiety—what are my children going to face? At the same time, I have a lot of young people come up to me and say, after they hear me give a presentation, “so I shouldn't have kids, right?” And I say, look, that's an individual decision for you. But I will tell you that since I had my kids, despair is not an option.
JMK: Exactly!
LP: I feel so hopeful—and stupidly so. But I have to. I brought these children into this world. And so I will fight with my last breath for them and for this world, and I don't have a choice about that. And so, even on the hardest days, just being able to hug them and have them—they just bring me such joy and such meaning. They ground me in a purpose that makes this work really meaningful.
JMK: I could not agree more. That’s something I talk about in my first book, quoting Barbara Kingsolver. She says, “When the scope of the problem seems insuperable, isn't it time to call this one, give it up, and get on with life as we know it. I do know the answer to that one: that's called child abuse."
LP: Yes! That’s a great way to put it.
JMK: And I tell my students the same thing as you do. I tell them yes—I see why you are questioning whether you should bring children into this damaged world. But children are the best thing in life. I'm glad to hear that story.
So yes, you and I both know how wrong the policy is, how long it's been neglected, especially on climate change. If only the powers that be had done something in the year 2000 or before! But now, going forward, if you could single-handedly change U.S. policy around climate change or around environmental chemicals, what would you do, and what would that look like?
LP: Well, we would start by not subsidizing oil companies so much. And that would reflect the true cost to actually produce that oil. We would try to get fossil fuel money out of our politics. And really, we need industry dollars out of how policy is formed and out of how politicians make their decisions—because big oil is doing what big tobacco has done, what big sugar does, what the corn industry does. All of these companies have basically produced a country of poor health. While the Inflation Reduction Actwas our first big piece of important legislation on climate and health, it came in 2022, when we've known that this is an evolving crisis since 1960. Lyndon B. Johnson was the first president to be briefed on this, and so it took us 60 years to pass a piece of significant federal legislation, and even that was watered down because we have false solutions in there, things like biomass and carbon capture and storage, and that would be the second piece—that we wouldn't prop up these false solutions that are there to make industry happy. And what they actually do is extend the life of this industry that is itself a fossil. And we continue polluting. Another piece of data I saw is that 85% of the proposed carbon capture and storage projects are going to be happening in EJ communities, the very communities that are being polluted by these oil refineries and oil rigs. And so it's the same narrative, different technology, of burdening certain communities with pollution to run our society because we don't want to make the transition to renewables. We should do away with the false solutions. We should do away with oil subsidies, and we should put a lot more of our investments and incentives into a transition to a renewable economy.
JMK: This is a controversial topic. But do you consider nuclear on the list of renewable green technologies or no?
LP: That's a really hard one, and we talked a lot at the consortium about what we would say about it. I mean, I'm not an energy policy expert. I should say that upfront. What I understand from some energy policy experts whom I respect is that we cannot fully get off of fossil fuels without nuclear being some part of the mix, so we shouldn't do away with the nuclear that we have. But nor should we build new nuclear plants; it should really be looked at as a bridge towards going completely renewable, ultimately without nuclear.
JMK: I've come to that same position. That was my class today, actually! [We both laugh.] We watched and discussed a Michael Shellenberger and Jim Hansen video that is pretty compelling on including nuclear in the mix.
LP: Right? I don't feel good about that, because of the health harms of nuclear, but in all of this, there is never going to be a perfect solution. And so we have to come up with compromises.
JMK: At Stanford, you have Mark Jacobson of Jacobson and Delucchi, right? Do you know him?
LP: You know, I reached out to him this spring to say, “Hey, can we just meet up and talk?” He's like, yes! And then I just haven't had a chance to set up a time. I do want to meet him eventually.
JMK: Yes—what a star! They are wonderful.
So you've already said something about this central question with which I'm occupied in both my book projects. In your view, how is it that we are poisoning our children and destroying our planet? Basically, how can we be this stupid? And then, how do we turn that around?
LP: Yes, big oil. Right? They basically took a page from the playbook of big tobacco. And we see this play out again and again and again: these industries that have huge, massive profits that want to protect their profits at the expense of our health. This plays out over and over and over again. Big oil knew as far back as the late 1950s. Ben Franta’s research documents just how far back they were talking about this in their conferences. I’m sure you know the research that showed that Exxon scientists predicted with really great accuracy what the level of rise is going to be. And so they've known for a long time, but rather than use that information to change what they were doing, or educate the public or decision makers, they buried that information. They started disinformation campaigns. They made us all think it was our fault, and that if we put the plastic bottle into the recycling can, we could solve the climate crisis. So they really took our attention away from what the root cause was. They made it so that we didn't understand that this was going to be affecting our health, and then they paid off politicians to support them in their campaign to carry on with fossil fuel projects. I mean, Joe Manchin is a perfect example of that, right? So that's why we are where we are right now: greedy, fossil-fuel company CEOs.
JMK: Devra Davis in The Secret History of the War on Cancer shows how even the American Cancer Society included tobacco and chemical industry people on their board, and how they helped shape the narrative.
LP: I didn’t even know this until recently: until 2021, the words “fossil fuels” weren't even in the IPCC report because of fossil fuel interests.
JMK: I heard that too—and it was just that, especially in the United States, it couldn't have been ratified. And yes, that's terrible. And what a shame that we're the pariah nation who for four years withdrew from the Paris agreement.
LP: Yes.
JMK: You said you're hopeful. I don't know if I mentioned that at the end of my last book, one criticism I got from a reader is that it was a little too optimistic; I tried to do an inverse of Rachel Carson’s Fable for Tomorrow and show another, better scenario. I think if we cannot imagine how things could be better, we won't do better. The Lancet has that wonderful video about the two pathways, for example. So what is your take on this question: what you think the status of children's health will be in 2050 or so?
LP: I agree with you again. It might be a little blind and stupid, but I have to be hopeful, given my eco-anxiety. My expertise is on wildfires, and so I was given an opportunity to write a report on how schools could prepare for climate change. And I used that opportunity. It really is a coalition-building exercise because I realized that I can write this thing. But who's going to read it? Who's going to care? But also I don't know enough about this topic to write it on my own. And so I just started reaching out to people, googling anyone I could find in the state who was working on climate change and sustainability in schools. And I was really lucky because at that same time, I found three really important partners who have been thinking about the same problem from different angles, but with the same ultimate aim. And so we built this very big, collaborative working group. There were no criteria—just, do you care about the issue? And do you want to help? And so we came up with this report on climate-resilient schools, and what the report does up front is it talks about our vision. It then lays out what the problems are. But what we united around was—we dreamt what a climate resilience school should look like. This is coming off the heels of the pandemic, which revealed how broken our public education system is, and how unjust that is to children from every angle you can imagine, because a child’s school is not just the place where a child learns. Having access to a good education determines a lifetime of a child's health.
Schools are the place where children spend the second most time after their homes. And so, what the report seeks to do is ask—how do we turn our schools into places of climate resilience and hope? And so we started talking about how the buildings themselves, by installing solar, visually show the students the solutions for the future, but they also improve their resilience during black- and brown-outs so they can keep the lights on. Installing HVAC systems: I mean my God, how many more years do we need to go before we set indoor air quality standards? Because we don't have them, right? We need clean, cool air inside so we don't have to call school off because it's too hot. Green school yards: the amount of evidence for how good greenery is for kids’ physical and mental health is just overwhelming. And we need to do away with all this black asphalt and move back to green lush areas where kids can play, where they can connect. There's evidence that they fight less when they're playing in green spaces. Things like this are long overdue. And again, it’s just a more inspirational space to be in, right? And then the food that they eat. My God, don't get me started about the food! We have an opportunity to get children excited about eating healthy from the beginning. We've created a food economy that is so screwed up and incentivizes the wrong things. But we have an opportunity to reimagine this food system that is local, regenerative, healthy, plant-forward. In this report, we talk about all these elements and use schools as the basis for a vision for a better world for kids.
JMK: That is so awesome! Do you know that we on the CHPAC came out with a letter on climate change and protecting children, and we had quite a good section on schools—a lot like what you're just describing. And I just hope we can make it so.
LP: Yes. In California, we actually got a piece of legislation introduced on healthy schools. It made it through all the committees, six committees, with not a single no vote! It got through the Senate and the House with only one no vote out of 144, and then got to Governor Newsom's desk, and he vetoed it. And in the State of California, if the Governor vetoes something, you can't override the veto. He said he vetoed it because we were asking for 10 million dollars in a deficit year. But the second, larger problem was that this plan would have asked for schools to make an upfront capital investment, and many of the schools are deep in the red. And so, from a fiscal responsibility point of view, the governor decided that schools wouldn't have been in a position to make the recommendations that they were asking for. And I'm like, well, that means we need to raise more money for schools, Governor Newsom! [She laughs.]
JMK: I don't see how people do not get that healthy environments contribute to healthy kids.
LP: I know. That's okay. Our coalition is re-energized because now we're pissed, right? So we're not done yet.
JMK: That's something! Is that the Medical Society Consortium on Climate and Health that is on the screen with you?
LP: That's my organization I lead. My work on schools came before I joined the consortium. But that was a side project.
JMK: You have a lot of passion projects! So next question: is there anybody you think I should talk to?
LP: I have a whole network of pediatricians I could connect you with. I mentioned Elizabeth Pinsky. She focuses on youth, mental health, and is a specialist on eco-anxiety. My colleague Amanda Millstein is here in California. She does primary care close to Richmond, which is where the Chevron refinery is, and so she has a ton of stories from the families that she's worked with because the Chevron refinery is just usually polluting and flares all the time.
Bethany Carlos is a pediatrician in Washington, DC. She also works for a Federally Qualified Health Center (FQHC)—National Children’s Hospital, and so she likely has some patient stories, and maybe she has a family that she's worked with. But Washington, DC., frankly, hasn't been as affected.
JMK: That's wonderful. Thank you. That idea of including a focus on environmental mental health—I might need to add a chapter on that. It’s only in the last five, or maybe ten years that people have been realizing what a huge impact it's having on everyone’s mental health.
LP: Yes. It was a discussion for us in our working group on climate resilience in schools—we went back and forth about whether to include mental health, and ultimately decided: We're not talking about children in 2023 without talking about mental health. You know, the American Academy of Pediatrics has declared a mental health crisis. And if you haven't read book Britt Wray’s Generation Dread, I'd highly encourage it. There has to be something on mental health as we talk about youth and climate change.
JMK: You've told me so many amazing things in this short time. Now, I want to just open it up to you. Do you have any questions for me about my project or my experiences?
LP: Yes. After the experience with the child whom you lost, what was your path in terms of advocacy and in processing that?
JMK: As I said, I had had a science background, and then it was April senior year deciding between med school and grad school in literature. And I love teaching literature. But when Katherine was diagnosed, I immediately went to the scientific literature to see what might have caused her cancer. And I was really shocked that the answers were so solid—the link between environmental exposures and cancer so definite—and even while she was still alive, I started becoming an activist to try to get my town to stop spraying for mosquitoes with chlorpyrifos, which is what we chiefly attribute her cancer to. And you know, she even went with me as we spread word around town. And we did get a successful referendum and stopped mosquito spraying. Then, after she died, I wanted to protect my other children, and I got my town to stop using pesticides on lawns as well. I was doing more local activism, and early on, I was hoping to write a book, and then I realized I needed credentials. So I got a Master's in Public Health centered on Children's Environmental Health, and then it really took off after I got the MPH. Now that I'm on the Federal Advisory Committee, it's such an opportunity. It is really hard to live day-to-day with the kind of grief I have. But to know people who are committing their lives to the problem—like you—you're committing your life to helping children. For me that is heartening. People look for heroes in all the wrong places. I feel like you and people like you are my heroes.
LP: Gosh—I have the same thing! I was telling my husband last night—and I tell others—that activism is the antidote to despair, and I was telling him, my antidote to despair is one of my co-hospitalists. She was an intern when I was a senior, and now we've been co-hospitalists together. I watched her grow up, and she had taken on teaching our residents about advocacy generally and had heard me give my climate change lecture a couple of times. And then she reached out because she's gotten a couple of speaking opportunities. And she said, “I'm reading everything I can on climate change. And I'm going to just start making this the thing that I do.” And I was tearing up—I have so much anxiety—and said, you are the antidote to my anxiety. [We both laugh.]
JMK: That is so true, and in this area of environmental health, you encounter the best people imaginable. Also, pediatric oncologists—a really great set of people: Katherine’s doctors are on my list of people to talk to.
LP: By the way, do you have Leticia Nogueira on your list?
JMK: I don't think so.
LP: She's amazing. She's at the American Cancer Society.
JMK: Thank you so much. I really appreciate that, and I hope that I can convey to others that this is hopeful, that the people you see on the news are not the only people in the world. There are a lot of very smart, talented, dedicated people working very hard to try to make the world a better place. And if we can get past polarization, then we can unite people around this cause. It's just like you described—uniting with people in your field to tackle this problem—because we can't keep saying, why doesn't someone do something about this?
LP: Yes—it’s up to us! Otherwise, the fossil fuel companies win.
JMK: That’s right. Any other questions that you have?
LP: No.
JMK: Well, I am so grateful to you for your time, and thank you for being so inspiring. I’ve gotten a little teary-eyed here, too, just thinking about all you do.
LP: Well it was so nice to meet you, and thank you for everything you are doing.
JMK: Thank you. Have a wonderful day!
