Susan Pachecho

You’ve been in this climate space for a long time. What first brought you to climate?

It goes back to 2006. My kids had homework to go see the documentary (ed: “An Inconvenient Truth), and I remember not being happy because it was midweek and I had clinic the following day. So we went, and at the time I was completely different about the climate crisis. I remember hearing about it on NPR here and there, not paying a lot of attention. But then I went, and it was one of those epiphany moments. I've had a few, and this was one of them.

I remember at the end of the documentary, they said, “Write to Congress, and if they don't reply, run for Congress.”

I'm not a politician, but that really shocked me. The theater goes dark, then the lights come up, and I'm still sitting there. I remember my little one, Andres, tugging at me and saying, “Mom, it's time to go.” And I remember thinking, “Susan, you take pride in the mother you are and the pediatrician you are – how can you choose to neglect this?”

Have you seen the movie “Close Encounters”? When the character has that compulsion to build the mountain – that's how I felt discovering climate change and then Climate Reality. It was a compulsion. I had to read and read and read. I discovered there was a training, and I gave myself two weeks to see if it would pass. It didn't. I applied, got accepted, and there is this history 20 years ago. It changed my life.

You applied to the training and you were one of the very first ones, right?

Second training.

What do you remember?

I remember it was the first time I met a lot of people from different backgrounds. There were teachers, social workers, mothers. For me, that was refreshing. In medicine, I'm an academic – even being an academic in the medical community, we only relate to people like us. You know, doctors' friends are doctors in general. So finding people from all walks of life, all levels of training and careers, all trying to figure out what to do for the common good – for me, that was very, very moving.

I don't know how many people went to that second training, but I remember I sat in the front. Mr. Gore was giving his slides, we had our binders, and I wanted to grasp everything. The energy of this man and the way he delivered the message was very moving. That was very, very inspiring to me. And then talking with the people there – I had my reasons, but everybody had their reasons for being there. In their own little bubbles they were trying to do something, and that was very inspiring.

What did you take from the training? How did it shape your work?

It's very interesting, because at the time it was all climate change, right? And of course, I'm a physician, so I gravitated toward the health aspect – and health was not talked about. In the early 2000s, although the intersection between climate change and health was addressed to some extent, the main focus was on the changing climate, not health. This was the case for the IPCC, the US Synthesis Assessment Products (SAP) reports, and even the WHO. Towards the end of the decade, this started to change. That's where I carved my niche.

That's what I've been doing for the last 20 years: helping people make the connection between health and climate change.

It's been striking how little health is a part of the climate conversation, even now.

You said that and I got goosebumps.

Because it starts before in utero. These kids that were exposed because their mothers were exposed to pollution, to stress, to heat. They are born and they’re going to be developing in the same soup of pollution, extreme weather events, extreme temperatures. I hate to be a pessimist, but it's the truth. It's going to affect us all. It affects the most vulnerable the most – people who cannot cope because of where they live and what resources they have. Socioeconomically limited groups, the groups that are marginalized in our communities. You and I can keep our AC running and get in our cars, but we are not the rule. We're the exception. 

What do you wish more people understood?

The scope of the health impact is enormous. Everything gets affected. Starting with pregnancy.

Climate change and air pollution give you what I call multisystemic injury. Every organ system is affected. Every organ system. 

One of the things has been very worrisome – I call it the nightmare that fuels my effort – is the work of researcher Lilian Calderon-Garciduenas in Mexico City. Years ago, she saw dogs in the city that were demented. They forgot where they lived. They forgot their owners. They would not eat. She studied the brains and sees inflammation from air pollution. So she looks at the brains of children who had grown up in Mexico City and died for other reasons – car accidents, etc. And the same changes were there. They had changes that were histologically similar to Parkinson's disease and pre-Alzheimer's disease. 

That data is sobering. Just plain sobering. There’s so many, many things and I have this urgency. I’m changing my approach because we are at a stage that I think we have the responsibility of educating people to protect themselves. 

I’m obsessed with pregnancy because maternal exposure to heat waves or increased air pollution can increase adverse pregnancy outcomes such as prematurity and stillbirths.

So if we anticipate and teach people that these are the things you need to be doing the week before. If you live in LA, you will not be able to escape pollution, right? But you can be a bit more careful the week before you deliver that baby. You stay indoors and you may prevent having a stillbirth.

So that is the approach that I’m shifting in now in that direction. Yes, we need to do mitigation. But at the same time we need to start helping people so we can prevent deaths. Because the one-in-a-thousand year events are increasing dramatically.

When you're talking with patients in your practice, what does that conversation look like?

That's a delicate part of it. I'm in an academic practicing in a large medical center, caring for children and families, many of whom have limited resources. When patients have to struggle to get money, to take a bus, to come and see, you can't talk to these people about mitigation. They have their universe full of real, pressing problems.

So what I've done, I bring the conversation to exposure to air pollution, exposure to extreme weather events, how to prepare, and heat exposure. With patients, I have to talk adaptation. I cannot do mitigation. 

When you have this conversation with your colleagues, what kind of response do you get?

I have given hundreds of talks on climate change and health ever since watching “An Inconvenient Truth” 20 years ago. Only a handful of people have stepped up into leadership roles to tackle this issue with me. However, I remain an optimist. I know that within the medical community, knowledge about how climate change affects human health – such as through extreme weather, rising heat, and air pollution – can be limited. However, simply raising awareness builds a vital foundation for human health. That awareness can turn into actionable interventions to protect the patients we care for. You cannot protect yourself from a threat you do not know exists.

You've been doing this for a long time. How do you keep getting out of bed in the morning? How do you find hope?

Do we have any other option? That's a real question. You cannot give in to despair. 

I know the science. I know how the temperatures are changing, and I know the scenarios. Even though they've told us that [the worst-case scenario] may be a stretch, that doesn't mean things will be great. We won’t get 3 or 4 degrees. It’ll be maybe 2 or 2.5 degrees. That's not trivial. 

I think about the Montreal [Protocol], and that gives me a little hope. We've done it before. I have the child who comes to my office and their mother asks me, "What are we going to do?" I'm not going to tell her there's nothing. No, we keep fighting.

What would you say to somebody who sees what's happening and says there's nothing I can do?

That's what I would say.