Interview: How Two Physicians Make Climate Justice Part of Patient Care

Photograph by Markus Spiske

Neelu Tummala, MD and Irène Mathieu, MD are physicians and climate health activists, who advocate for climate solutions to protect the health of their patients and advance public health. They are members of the Virginia Clinicians for Climate Action (VCCA) steering committee, one of many healthcare provider-led climate advocacy groups that focuses on climate solutions as health solutions.

Neelu and Irène sat down to talk about what brings each of them to this work, how they stay energized, and how they process the climate crisis both professionally and personally.

Irène Mathieu, MD: We first met in front of a green screen at the University of Virginia, where you were creating videos of clinicians discussing the health impacts of air pollution.

Neelu Tummala, MD: That was such a fun day! I remember feeling so excited to meet you. I had read your poetry, and now I was getting to collaborate with you.

IM: Since then, I’ve joined you as a member of the steering committee of VCCA. How – and why – did you first get involved with climate justice work?

NT: I first got involved with climate justice work about five years ago. I remember reading studies showing how Black children are more likely to live in areas with higher levels of air pollution, which worsens asthma symptoms. And that communities of color are more likely to be exposed to higher levels of smog and more heat extremes in urban neighborhoods because they often live in areas that are near highways, have less green space and more concrete.  The decades of work environmental justice communities have been doing to fight for basic rights of clean air and a healthy environment is what has inspired me to join these efforts.  

It seems incredible now to think back to a time when I was not very familiar with all the health impacts of climate injustice. Once you learn about the environmental hazards people are faced with daily, you cannot unlearn these harrowing truths. And once you learn about them, how can you not get involved with climate justice work? 

IM: It’s one thing to intellectually understand how climate change affects the most vulnerable; it’s another thing entirely to experience on a personal level. You’re right that the truths of the climate crisis cannot be unlearned, and I’ve felt that both intellectually and viscerally. I spent the last stages of my pregnancy in the beginning of another uncharacteristically hot Virginia summer. The day before I was due, it was 97 degrees and our air conditioner cut out. I tossed and turned on the couch under our ceiling fan as my daughter pummeled my insides, fretting about how this heat exposure might affect our delicate physiology. Thankfully we were able to get the unit fixed the next day, and we suffered no untoward health effects. But I couldn’t help but ruminate on the pregnant folks who don’t have air conditioning at all, and maybe not even a ceiling fan.

NT: I have so many patients who have been through similar situations. I had a patient who had to go to a train station and walk around because her home was too hot for her grandchild to sleep in during a warm summer night. As the IPCC reports highlight, climate weather extremes are becoming more common in a warming world. 

IM: Do you remember learning about climate change in your medical training?

NT: I don’t. 

IM: I don’t either.

NT: We both trained at a time when climate change was not a part of the medical school curriculum (thankfully that is starting to change!), and so it was definitely a shock to learn about the health concerns. But once you do, you see it all around you. Ten years ago, I never would have thought about climate change as being an important topic to discuss in the clinic. But now, in the face of worsening summer heat extremes, record wildfire seasons, and more intense natural disasters, it feels like such an essential part of public health awareness. 

IM: Anything you’re seeing in your patients recently?

NT: With the warmer spring weather coming on, my patients often reflect on how their pollen allergy symptoms seem to be starting earlier in the year. Data show that this is in part due to climate change. As compared to 30 years ago, global warming and associated changes in temperature and precipitation patterns have contributed to a pollen allergy season that is about 3 weeks longer than it used to be (it is starting earlier in the year and lasting longer), and there is about 20% more pollen in the air. I recommend starting many of the nasal allergy sprays about two weeks before the pollen season to best control symptoms, but unfortunately knowing when to start can be confusing for patients when the start date changes. 

IM: The consequences of shorter winters. 

NT: As a pediatrician, you are on the front lines of climate change in your patients. What are some of the ways you approach the topic of climate change with your patients and their caretakers?

IM: A common reason for kids to come to the doctor’s office is for insect bites. Unfortunately I am seeing tick and mosquito bites for longer portions of the spring and fall, so that’s more potential exposure to Lyme’s disease, Rocky Mountain Spotted Fever, West Nile Virus, and other diseases transmitted by these insects.

NT: This past December, I noticed that there were mosquitoes around me during the unseasonably warm winter weather. I mentioned this to another pediatrician. She was telling me how surprised she was to have two patients one day with tick bites – a previous anomaly for our region.  

IM: I also help them think through family disaster preparedness. And I often point out that climate change is the reason we need to have these conversations. A lot of what we do in pediatrics is what we call “anticipatory guidance.” My job is to help parents and families anticipate what might happen, as so much of the climate crisis is about uncertainty.

NT: Of course, and one of the most concerning ways we are seeing this individual impact is through the impact on respiratory health. Children with asthma are more likely to show up in the emergency room with more intense and frequent asthma attacks when breathing in air that has higher levels of pollutants, such as smog, which is worsening with the climate crisis. And of course, we know that air pollution levels are more likely to be higher in communities of color. 

IM: It’s tough. The frustration that so many young people feel about the inaction of older generations is valid, as is the guilt and anxiety of their parents and grandparents. I often feel challenged by the fact that, unlike, say, having one’s child get routine lab tests, the effects of the climate crisis cannot be prevented on an individual basis. 

NT: This is definitely a “we are in this together” movement where we have to recognize the greater good of climate action. Raising awareness and mobilizing political will for real climate solutions is a “treatment modality” for protecting public health, which is essential to a healthier future for everyone.


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Dr. Irène P. Mathieu is an academic pediatrician, writer, educator, and public health researcher. She is the award-winning author of three poetry collections – Grand Marronage, orogeny, and the galaxy of origins. She is an assistant professor of pediatrics at the University of Virginia, where she practices outpatient pediatrics, runs community-engaged research and advocacy projects, and serves as an assistant director of the Program in Health Humanities. Her writing and advocacy work have been featured in The Washington Post, LA Times, Richmond Magazine, NPR, and more.

Dr. Neelu Tummala is a surgeon, writer, and climate advocate who has a special interest in education and advocacy concerning the health effects of climate change and environmental injustice. She is a co-director of the Climate Health Institute at George Washington University and vice-chair of Public Relations for Virginia Clinicians for Climate Action. A writer and avid lecturer, she has contributed opinion pieces to The Washington Post, Scientific American, Newsweek, CNN, USA Today, The Hill, The Baltimore Sun, World War Zero, and the Roanoke Times.