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However, one important element of environmental health often gets missed: kids’ relationship with the natural world. This is why early childhood outdoor-based environmental education must play a larger role in the national environmental conversation, and environmental education programs must be significantly expanded and strengthened throughout the U.S.
One of the most important responsibilities that adults have is to connect our children to the natural world. As a lifelong environmentalist and outdoors person, I see few more essential tasks than helping young students acquire a sense of wonder that can infuse their entire life and to feel a connection to nature so strong that they will become the next generation of conservation-minded citizens. This serves both the students — giving them access to the physical, emotional and professional benefits of time outdoors — and society, which needs environmental advocates now more than ever.
Environmental values
Environmental progress starts with peoples’ values, that is, what people consider important, what they want to protect. Some adults have an ecological awakening later in life — maybe they read a story of drying wells or heard gossip about the “forever chemicals” in their municipal water supply. Some of us develop environmental values in college, after peers go vegetarian or our professors introduce us to concepts like environmental injustice. But kids can develop these values much earlier, starting at home and in the classroom.
The idea of showing kids the value of protecting nature before they ever start high school isn’t political indoctrination or aimed at creating the next generation of Greenpeace activists. It’s about building a personal connection with the natural world — and it starts with going outside.
Feel first, teach second
A nature-inspired picture drawn by the author's daughter.
Credit: Aaron Gilbreath.
No matter the curriculum or setting, part of my teaching as an unofficial educator comes from scientist Rachel Carson’s book “The Sense of Wonder.” “A child’s world is fresh and new and beautiful, full of wonder and excitement,” Carson writes. “It is our misfortune that for most of us that clear-eyed vision, that true instinct for what is beautiful and awe-inspiring, is dimmed and even lost before we reach adulthood.”
"One of the most important responsibilities that adults have is to connect our children to the natural world."
How do we help children develop this sense of wonder? Through parents, mentors and educators in programs like the World Salmon Council and Ecology in Classrooms and Outdoors in Oregon, Sierra Nevada Journeys in California and the National Wildlife Federation’s EcoSchools U.S. program, to name a few. Richard Louv’s Children and Nature Network might be the most formalized, vocal advocates trying to green children’s lives. Carson knew it takes just one person to build this bond. “If a child is to keep their inborn sense of wonder,” she wrote, “they need the companionship of at least one adult who can share it, rediscovering with them the joy, excitement, and mystery of the world we live in.”
As the world becomes more urbanized, fewer children have the chance to regularly interact with wildlife and the non-built environment.
Credit: Aaron Gilbreath
Carson’s approach: Take them outdoors. Discover together. Let them see what excites you. Get excited and share those feelings. Focus on the emotional experience first — the wow factor — not what information you have, she writes. Feel first, teach second. Don’t worry if you don’t have nature facts. “Adopt the child’s position,” Carson advises. Instead of being their teacher, she suggests we discover new things and feel awe with them. A single residential block can seem like a universe to a young mind and you can provide this transformative experience in your front yard as easily as you can in a wild stream in a federal wilderness area. Just look up at the clouds. Search bushes for insects. Point to the moon and the birds and literally stop and smell whatever flowers you walk past. “The sharing,” Carson writes, “is based on having fun together rather than on teaching.”
Ever since my daughter was born, I’ve spent a great deal of time showing her the outdoors, from our Portland, Oregon, backyard to the Northwest forests to the Sonoran Desert where I grew up. This summer she held wild spotted toads and giant desert millipedes in Arizona. Last month she held tree frogs while standing in knee-deep water on the banks of the Deschutes River. At age six, she has come to love wildlife so much she kissed a banana slug she found at Hoyt Arboretum and asked how old you have to be to work at the zoo. Green is her favorite color. She rattles off animal facts everywhere she goes and she always makes sure to rescue insects that get trapped in pools or indoors. She is curious, empathetic and always asking questions. Most of all, she is comfortable outdoors.
Not to toot my own horn, but in a qualitative way, her multifaceted worldview is the clear, direct result of my homegrown nature education that combines hands-on experiences, shared excitement and scientific information. It’s all about Carson’s approach: cultivating wonder and curiosity and complementing it with teaching. I believe this perspective will benefit her for her entire life. I only wish her public school had the resources to offer her similar outdoor education as part of the curriculum.
Combatting nature deficit disorder
Nature-inspired art from the author's daughter.
Credit: Aaron Gilbreath
Another reason outdoor-based education is so important is because it fundamentally involves the act of going outdoors. As the world becomes more urbanized, fewer children have the chance to regularly interact with wildlife and the non-built environment. Too many under-resourced American kids never get that chance. The forces driving a wedge between children and the natural world multiply every generation: screens, phones, social media, urbanization, anxiety, concerns about public safety, exhausted working parents. The average American spends 93% of their time indoors.
In 2008, more people lived in cities than outside of them for the first time in history, officially making Homo sapiens an urban species. And the trend is accelerating. “By 2050,” Science reported, “66% of the world’s population is projected to live in cities.” That doesn’t mean city life is good for us. According to sociobiologist E.O. Wilson, human beings’ nervous systems evolved in nature, so we are more used to — and more comfortable in — non-human environments than we are in urban environments. Outdoor education is the crucial bridge that connects us back to our recent evolutionary past.
The physical and emotional effects of what author Richard Louv calls “nature-deficit disorder” are numerous, but the flipside is that time outdoors provides quantifiable benefits.
An increasing body of research shows how time outdoors rejuvenates us, reduces stress, improves creativity, enhances our immune systems and improves our moods.
It’s hard to speak about the value of something as ethereal as wonder, because you can’t provide a value proposition if you don’t have data to support it. Wonder — how do you measure it? But anyone who has improved their own emotional and physical health by spending more time outdoors can recognize the value of providing that experience to America’s increasingly sedentary, domestic youth. If the thought-leaders and activists who work so hard to strengthen our country’s environmental policy want to continue doing the work that benefits the greatest good, we must discuss the role of early childhood environmental education.
"Ever since my daughter was born, I’ve spent a great deal of time showing her the outdoors, from our Portland, Oregon, backyard to the Northwest forests to the Sonoran Desert where I grew up. I believe this perspective will benefit her for her entire life."
Credit: Aaron Gilbreath
“I want the planet to be a safe place for my kids and my grandkids and the next generation,” Boninger, who specializes in physical medicine and rehabilitation, told Environmental Health News(EHN).
He researched what jobs he might qualify for, but the answer was right in front of him: The healthcare industry takes a significant toll on the climate and human health.
The sector accounts for an estimated 4.4% of total global greenhouse gas emissions and up to 9.8% of U.S. greenhouse gas emissions. Health damages from the U.S. healthcare sector’s pollution – including greenhouse gasses, carcinogenic emissions and other toxic air pollutants – from 2003-2013 are estimated to have cost Americans more than 400,000 years of full health, defined as years lived free of disease or disability.
After learning about the industry’s sustainability challenges, Boninger investigated how these issues were addressed at the University of Pittsburgh Medical Center (UPMC), where he’d worked since 1994, first as a physician and researcher with expertise in spinal cord injuries, then in a series of leadership roles. UPMC has more than 40 hospitals and 800 doctors' offices and outpatient centers. Most are in Pennsylvania, with some in Maryland and New York and a handful of facilities abroad.
“I looked at what UPMC had published and their outward-facing work on sustainability,” he said. “It was not impressive.”
He asked for a new job as a leader in sustainability at UPMC.
Around the same time, unbeknownst to Boninger, a small group of physicians calling themselves “Clinicians for Climate Action” were strategizing about sustainability at UPMC. Boninger said the health system’s president received his job request around the same time she got a letter from Clinicians for Climate Action with specific requests aimed at making UPMC’s operations more sustainable.
“I joined Clinicians for Climate Action immediately, but it actually worked out well that we approached this issue separately,” Boninger said. “It became a series of events that prompted UPMC to take action.”
Boninger and Clinicians for Climate Action aren’t alone — Doctors, nurses, and hospital staff across the country are leading the charge to making hospitals more sustainable. At the national CleanMed conference, held in Pittsburgh in May, health care workers who had successfully initiated new sustainability programs or policies at their organizations shared sustainability projects they’d successfully initiated at their institutions, including things like collecting and donating unused medical supplies, implementing zero waste goals, and replacing single-use products like medical masks and surgical tools with reusable versions.
Strategies for sustainability at hospitals
Dr. Michael Boninger
Credit: UPMC
Boninger was appointed as UPMC’s chief medical sustainability officer in September 2022, and went straight to work on the requests in Clinicians for Climate Action’s letter.
Their requests included signing the White House Climate Pledge, developing a climate plan by 2023 that would chart a course to carbon neutrality, committing to 100% renewable electricity at UPMC facilities by 2030, creating a climate and health center to support climate and environmental justice efforts both internally and in surrounding communities, integrating environmental quality metrics into educational, research, and operational goals, and divesting from fossil fuels.
The group didn’t make the letter public—they opted to work internally before adding public pressure. Because most of their initial requests involved planning and setting goals that could ultimately save UPMC money and bolster the institution’s public image, there weren’t a lot of barriers to their initial round of requests. Today, UPMC has either accomplished or set in motion plans related to most of these goals, with the exception of divestment, which has temporarily taken a backseat to other initiatives.
As a result of their efforts, UPMC has opened a new center for sustainability, which is creating sustainability teams at 40 UPMC hospitals with working groups focused on various priorities like food service and transportation. The center is also partnering with national regional nonprofits like Practice Greenhealth and Sustainable Pittsburgh. Education is also an important part of their work — the University of Pittsburgh School of Medicine now incorporates climate medicine as part of its population health course and offers a climate medicine elective course to med students.
The strategies they employed to get these plans in motion—working internally, demonstrating potential for cost savings, and acknowledging that institutional change takes time and requesting commitments to long-term sustainability goals—have worked at other institutions, too. Particularly when it comes to cost savings.
At Allegheny Health Network, a Pittsburgh-area subsidiary of Highmark Health with more than 300 clinical offices in the region, sustainability initiatives have focused largely on energy efficiency, recycling and waste reduction.
Allegheny Health Network was able to save $60,000 a year on energy costs simply by upgrading the lights in most of their facilities to LED bulbs — a change they say will ultimately save 465 tons of climate-warming emissions.
Dan Lesinsky, Allegheny Health Network’s energy manager, told EHN, “It’s easy to get support from every side when you’re able to demonstrate both greenhouse gas savings and savings on the bottom line.”
Meanwhile, some local environmental health advocacy groups have criticized both UPMC and Allegheny Health Network for inaction on some of the region's most pressing issues. The Breathe Project, a Pittsburgh-based collaborative of more than 50 regional and national environmental advocacy groups, recently invited executives from both health systems to attend a community town hall meeting about the region's ongoing problems with poor air quality, which is largely driven by industrial pollution, but neither responded.
The group called the health systems' lack of engagement about air quality "unacceptable," and devoted time during the town hall meeting to a discussion about the role the health systems should play in addressing the health impacts of air pollution in the region.
Big goals, small sustainability projects
Clinicians for Climate Action's one-year anniversary celebration.
Credit: UPMC
Not all healthcare sustainability initiatives require huge institutional changes. Some have a narrower focus and require more on-the-ground work.
For example, a nurse at UPMC’s Magee-Womens Hospital who is a member of Clinicians for Climate Action is leading a project aimed at replacing disposable baby bottles with a reusable bottle system for each infant in the Neonatal Intensive Care Unit (NICU). The project will result in cost savings, but will also require educating others about the safety of reusable products, developing a new system for labeling and sanitization of reusable bottles, and training others on how to use it.
“We’re all doing what we can in our own ways, but we’re all part of the same team, committed to working in the same direction,” Dr. Isabela-Cajiao Angelelli, one of the cofounders of Clinicians for Climate Action and a clinical director at UPMC Children’s Hospital of Pittsburgh, told EHN.
While Boninger is now at the helm of UPMC’s sustainability efforts and has brought on two more full-time employees , Clinicians for Climate Action has grown to more than 500 members and remains heavily involved.
Dr. Angelelli has helped develop and drive UPMC’s sustainability goals, but she’s also leading her own smaller projects. For example, she’s working on a project aimed at eliminating UPMC’s use of desflurane, an anesthetic gas that’s 2,500 times more potent than carbon dioxide when it comes to global warming potential and stays in the atmosphere for decades. The drug can be substituted with other anesthetic gasses that are less harmful to the environment but that work equally well. England’s National Health Service has committed to stop using desflurane by early 2024, but its use is still widespread throughout the US.
“Most clinicians have no idea about this,” Angelelli said, “so the first step is education, sharing this information with our anesthesiology department and leadership, and making sure everyone is part of the conversation so we’re confident this decision won’t negatively impact patients.”
Other members of Clinicians for Climate Action are heading up projects at their facilities through initiatives like reducing plastic garbage bag use, reducing waste in operating rooms, and reducing medical mask waste.
“We realized early on that we need to be part of the work, not just make an ask of the system,” Angelelli said. “This was also something we all felt really passionate about, so we said, ‘Lets do it together.’”
Editor's note: An earlier version of this article incorrectly stated that neither UPMC nor Allegheny Health Network qualified for Health Care Without Harm's Practice Greenhealth program awards. The UPMC Magee Women's Hospital won three Practice Greenhealth awards this year.
That’s why Catalyst Miami, a community-based nonprofit, made extreme heat a top priority. But when Catalyst organizers took their concerns to the local government, they received a Catch-22-like response: officials didn’t have data on extreme heat, so they couldn’t address the problem.
Catalyst Miami set out to collect the missing data. Partnering with local universities, volunteers placed heat and humidity sensors throughout the community, at bus stops and other places where people were suffering in the heat.
Their findings were stunning: temperatures were often 30 degrees Fahrenheit higher than those announced by the Weather Channel. Official measures of temperature are taken in a breezy spot at the airport —where no one is waiting for a bus.
It’s a problematic approach to climate change and health. Too often, analysis and problem solving takes place removed from real people’s lives, while problems at the ground level are misunderstood or ignored.
Catalyst Miami, and many other community-based nonprofits, are working to change that.
A community-led approach to extreme heat
One of Catalyst Miami's Overtown Community Champions working with Urban Health Partnerships on a heat study.
Credit: Catalyst Miami
Across the U.S., community groups are taking on the climate crisis from the ground up. Several are part of the Kresge Foundation’s Climate Change, Health and Equity initiative, a joint effort of Kresge’s health and environment grantmaking teams.
The initiative grew from the mismatch between those experiencing the worst effects of climate change and those devising solutions. “Due to generations of racist policies and practices, low-income communities and communities of color are most at risk from the health impacts of climate change,” Shamar Bibbins, a senior program officer in Kresge’s environment program, said. “But they are often excluded from the policymaking table. That’s a problem because it’s members of the community who are closest to the problem and they have the experience and expertise to co-create effective and equitable solutions.”
The first step is to ask community members what they are experiencing. Catalyst Miami surveyed local residents and medical professionals about their top climate-related concerns. “We already knew it was going to be heat,” said Catalyst Miami CEO Zelalem Adefris, “but the surveys confirmed what we’d been hearing for years.”
In Austin, Texas, a group called Go Austin/Vamos Austin (GAVA) listened to community concerns and changed its mission in response. Originally founded to tackle the upstream causes of childhood obesity, GAVA’s organizers pivoted after two devastating floods inundatedSoutheast Austin neighborhoods, where they’re based. Realizing that climate change guarantees similar floods in the future, “we had no business continuing to work in these neighborhoods if we weren’t going to take on these issues,” said Carmen Llanes, GAVA’s executive director. The group now has support from the Kresge Foundation’s initiative to address health and climate issues defined by the community – including flooding.
Once community priorities are identified, residents can help documenting the problem. Many groups are partnering with universities to conduct citizen science efforts – like Catalyst Miami’s heat sensor project – in which residents collect data to “groundtruth” other information sources. For example, GAVA worked with the University of Texas to compare NOAA’s climate data to residents’ lived experience. In New York City, WE ACT for Environmental Justice, another Kresge Foundation grantee, launched the Harlem Heat Project in 2016, partnering with researchers, media and residents to measure heat inside apartment buildings. More recently, WE ACT members surveyed the city’s cooling centers to understand how well these places are serving residents.
Climate injustice
A Catalyst Miami Climate Town Hall event in January.
Credit: Alexander Ruiz
As these citizen science efforts show, the view from the bus stop is different from that of policymakers in air-conditioned offices. It’s not just that environmental conditions are different on the ground; it’s also about the conditions in people’s lives. “The people who are most vulnerable to climate impacts are often coping with chronic illness, housing insecurity, financial insecurity, job insecurity — on top of systemic and institutional and interpersonal racism,” said Sonal Jessel, WE ACT’s director of policy. “People are dealing with bundles of hardships.”
Those hardships intersect and compound sometimes in deadly ways. “On really hot days, people don’t turn on their air conditioners because then their bills get too high and they can’t pay them,” said Jessel. “So, people die in their homes. Or they end up having to be hospitalized for heat stroke.” A recent study confirmed that New Yorkers found dead in their homes from heat either didn’t have air conditioning on or lacked air conditioning altogether.
Moreover, the legacy of redlining and other racist policies has left Black and brown neighborhoods more vulnerable to climate impacts. Crowded with polluting industries and deprived of parks and green spaces, these neighborhoods are hotter and more flood-prone than their wealthier, whiter counterparts.
Those intersecting hardships call for solutions that address the real conditions of residents’ lives. “You can’t assume everyone has air conditioning or can afford to turn it on,” said Adefris of Catalyst Miami. “You can’t assume everyone works in an office.” That’s why grantees involve residents at every stage of problem solving — from identifying priorities to devising solutions.
It’s an approach that differs markedly from typical planning processes, said Ucha Abbah, climate resilience project manager at GAVA. Usually, planners will announce a project and solicit public comments, “but they only want to hear from the community about one specific thing,” Abbah said. “An equitable process involves the community at every step, from inception to implementation.”
Climate solutions that work for everyone
This more-equitable approach is getting results. In Miami, data from the heat sensor project helped spur the appointment of the nation’s first chief heat officer, who is charged with developing and deploying a comprehensive action plan for extreme heat. Catalyst Miami successfully advocated for opening the committee’s meetings to the public: “There were around 50 participants in every single meeting,” said Adefris, “and people talked about the issues and the solutions they would recommend. Our community is full of solutions.”
Now being implemented, Miami’s extreme heat plan includes measures to keep people cool in their homes – by retrofitting public housing with efficient air conditioning units, for example – as well as protections for outdoor workers and efforts to expand the tree canopy.
In New York City, WE ACT helped win a program that distributes free air conditioning units to low-income households throughout the city. And WE ACT is fighting for the state’s energy assistance program to subsidize utility costs for air conditioning in the summer, as well as for heating during the winter.
In Austin, GAVA won funding for infrastructure improvements to reduce flooding in long-ignored, flood-prone neighborhoods in South Austin. The group also advocates for equitable investments in the city’s tree canopy and green spaces. And GAVA’s climate navigator program trains residents to anticipate, prepare for, and respond to flooding and other climate shocks and stressors.
Deeply rooted in their communities, these grassroots groups bring important and overlooked perspectives to climate challenges and solutions. And their approach — taking on the climate crisis from the ground up — has multiple, far-reaching benefits.
Consider, for example, those Miami residents exposed to dangerous heat while waiting for the bus. Solutions to their predicament include more-frequent bus service as well as investments in shade trees and structures. The benefits – better transit; a greener, cooler city; lower healthcare costs – accrue to everyone.
While solutions made by and for the most privileged leave too many people at risk, “the solutions that work best for the most vulnerable people in our community are the solutions that are going to work for everyone,” said Adefris.