Dr. John Balmes is Professor Emeritus at UCSF in Medicine and at the UC Berkeley School of Public Health in Environmental Health Sciences. He’s a physician in Pulmonology and Occupational Medicine, and also an Environmental Epidemiologist. He has a moderate and pragmatic approach to ameliorating health effects from air pollution. Some of his key insights include the following:
If we mitigate climate change, we will immediately address the health effects of air pollution.
Most people – even healthcare providers – do not appreciate the degree to which air pollution affects not only lung disease, but also cardiovascular disease and metabolic dysfunction, which can result in obesity and diabetes.
Policy changes based on science make real and significant differences in the lives of everyday people.
There are simple, do-able changes we can all make to both mitigate and adapt to climate change and associated air pollution.
While there are some economic difficulties with the energy transition, particularly in developing nations, economists have developed feasible pathways, starting with not subsidizing fossil fuels.
The irrational denial of science is potentially the greatest threat to the healthy functioning of our society.
I hope you enjoy the conversation nearly as much as I did.
This interview has been lightly edited for length and clarity.
Figure 1: Dr. John Balmes
JMK: Hello! So nice to meet you. That is a beautiful vista behind you [the Golden Gate Bridge on a sunny day]. I was just thinking of the other pictures we’ve seen of the Golden Gate Bridge against orange skies. This is a lot nicer. I’m west of Chicago at Benedictine University.
Figure 2: The Golden Gate Bridge during the Wildfires
JRB: I’m from Chicago. I was born there. I lived a year in Rogers Park then grew up in Skokie. I finished high school in New Jersey, college on the East Coast, but then I came back to Illinois for a while for medical school at University of Illinois in Chicago (UIC), then transferred to Mount Sinai in New York because I had a girlfriend. I did my residency there and then did my pulmonary critical care fellowship at Yale, before moving to California for a different woman – who is now my wife.
JMK: Well, good – it’s a happy ending then. My parents are in Sacramento. We are Midwesterners, some of whom ended up out in California. I really appreciate you taking the time to talk with me – I was trying to remember if it was Bruce Lanphear or Mark Miller who referred me to you.
JRB: I know both of them, but Mark was the one who told me about you. I know Bruce and met him a few times and respect him, but it’s really Mark I have a longtime association with.
JMK: It’s been a delight getting to know all you California folks in that group. I’m on the CHPAC with Marya Zlatnik, who is at UCSF right now. I interviewed her last week.
JRB: Yes – Mark connected us as well through the Pediatric Environmental Health Specialty Unit (PEHSU).
JMK: I have a list of questions, but I really just want to get your stories. Mark is keen on me blogging everyone’s stories, and he wants me to write a history of the profession at some point. I said, I would love to, but let me get this book done first, and then maybe after that. But I’ve been so delighted to meet everyone.
The first question is about your background. How it was that you got interested in health effects of environmental exposures? And I know that you are a pulmonologist, and I looked at the California Air Resources Board (CARB), on which you serve as a Board member. Was there anything in your childhood or early training that got you interested?
JRB: How far do you want to go back? I went to high school in New Jersey. My father worked for Illinois Bell, but he then got transferred to ATT. So we lived in New Jersey for my high school years, and we lived down the street from a hospital. I decided to volunteer. You’ve probably heard of candy stripers.
JMK: I was one.
JRB: Boys – we were the junior corps, and so that got me interested in medicine.
I always liked science. In college, I was a crazy pseudo-hippie student radical. I didn’t really apply myself but did well enough to get into medical school. I decided on medicine because with the cultural revolution and impending political revolution I was hoping for during the Civil Rights era and Vietnam, I wanted to be able to apply science to help people. In medical school, I wanted to go into family medicine, but it wasn’t considered to be a real specialty in New York at Mt. Sinai – it was considered anathema, so I decided on internal medicine. In medical school, I really enjoyed the pulmonary medicine docs I worked with. I decided to do a subspecialty training in pulmonary, and I was also interested in occupational exposures. I don’t know if you’ve heard of Irving Selikoff – he was a famous pulmonary physician who got into occupational hazards and put asbestos on the map. I got to work with him at Mt. Sinai. I wanted to combine pulmonary and occupational exposures, though I wasn’t thinking environmental that much then. I went to Yale for my pulmonary fellowship in part because I was able to do both occupational and pulmonary training. The occupational training was not formal, in that they didn’t have a residency set up, but I got plenty of experience. And that’s when I started to get into environmental exposures.
I moved to California with my then girlfriend, now wife; she wanted to get her PhD at UCLA in History, so I took a job at USC, where I could combine pulmonary medicine and occupational exposures. I did some environmental exposures, but mostly occupational. But then I was dissatisfied at USC. So when my wife got far enough along in her PhD that she didn’t have to take classes, I took a position at UCSF, where I am still Professor Emeritus, and which is one of the best pulmonary critical care programs in the world.
I also got a joint appointment in Occupational and Environmental Medicine. I started doing some controlled human exposure studies in air pollution. I had a chamber where we exposed adults, usually young adults, to pollutants. We didn’t make them sick, but we tried to get some biological signal change in lung function, evidence of airway inflammation. I enjoyed that. That really got me into air pollution health effects research.
But then I got a little frustrated because you can only study acute, short-term effects with controlled human exposure studies. I wanted to study chronic exposures, so I collaborated with folks at UC Berkeley. I live a mile from the Berkeley campus, so I started collaborating. They were doing population studies – epidemiology – and many of the collaborations involved kids. And I then realized the advantage of studying children in terms of health effects of air pollution – they didn’t smoke, didn’t work, were healthy except for asthma. So I’ve done many epidemiologic studies on kids even though I am an adult pulmonologist and don’t take care of kids clinically. I’ve done more air pollution and health effects research in children around the world than with adults.
I also got involved in household air pollution from domestic cooking and heating with solid fuels in Guatemala, Malawi, Nepal, and Rwanda. Household air pollution with solid fuels like wood is not a problem in the U.S. – except perhaps among Native Americans, who often cook with solid fuel – wood. I’ve been involved in Northern California, where there are several reservations of Native Americans who still cook and heat their homes with solid fuels.
I have a long-term study in Fresno, CA following cohorts of children over two decades with regard to the health effects of air pollution. Initially, it was asthma, but we have now expanded it to other outcomes, including metabolic outcomes. Unfortunately, the population we study is largely Latinx, and so they are often poor, and the kids tend to be overweight.
We’ve shown that air pollution is a contributor to their metabolic dysfunction, meaning they have an increased risk of diabetes, obesity, and high blood pressure. So we have published several studies in that regard.
In Rwanda, in another big study I have been involved in, we are conducting a randomized controlled trial of clean-cooking LPG stoves and clean solar lighting in children and adults. And we are looking at both lung function and blood pressure.
JMK: That’s wonderful – so you are intervening and giving them the clean cooking equipment…
JRB: Yes. My household air pollution research has all been intervention related.
JMK: I really love that – because regardless, you’re probably improving outcomes for the experimental group.
JRB: Not always. In Malawi, we didn’t improve outcomes because they cook outside – it’s called the warm heart of Africa – so the cleaner-burning biomass stoves weren’t clean enough, so we didn’t see a difference. And it was 10,000 children – it was powered to see if it was an effective intervention. Also, the stoves broke down. It’s called stacking when you use traditional kinds of cooking as well as the stoves. In Guatemala, the intervention was a chimney stove, and that did improve outcomes. We had reduced childhood pneumonia in the intervention arm. And at the end of the study period, we gave the clean stoves to the control arm. And we did follow those kids and show improvements. The longer that you had the cleaner-burning cookstoves, the better your outcomes, both for lung function and for growth, as we followed them over time.
One thing – we definitely don’t parachute in and then leave a community without resources. So I’m very proud of the work we did in Guatemala, where we did, in fact, improve the lives of whole villages that we worked in. I don’t know if you know much about the history in Guatemala, but there has been basically a kind of genocide towards the Mayan population. We were in Mayan villages, and they totally mistrusted the government, including the healthcare ministry. But by the end of our eight-year study time, we had convinced them to work with the local clinics. It helped that there was a change of government that was more respectful of the Mayan population. The same thing was true in Malawi – we made a difference, though a little less dramatically than in Guatemala because there was not a distrust of the healthcare system.
The study in Malawi was of kids and pneumonia, but then we did a side project on the adults that showed that blood pressure was improved if you got the stove compared to those who use the traditional open fires cooking on three-stone fires.
JMK: Wow! I mean, so much of this research that you did probably led to some of the realization that all of our gas cook stoves are not so good for us because of poor indoor air quality.
JRB: Did Mark tell you? One study is finished where we were studying stove range hoods in Richmond, CA, which has a low-income neighborhood with kids with asthma. In that study, we reduced exposures with a range-hood intervention. We either showed that people had range hoods that worked, or we gave them a new one so the range reduced exposures. We didn’t have significant results because with the pandemic, we couldn’t go into homes and so only recruited 25% of the population that we hoped to get to. But that study led to us getting a big grant from the California Energy Commission. It’s a cooking and ventilation study to try to improve childhood asthma. We’re recruiting about 240 households – each one with a kid with asthma. And we are actually changing out gas cooking for electric cooking with induction stoves, which are the best. I don’t know if you still cook with gas….
JMK: I do! I’ve been thinking my kids are grown now, but still, I should probably switch. I have an old, old stove.
JRB: A regular electric stove is better than gas in terms of environment and health. I like to cook, and I needed a new stove and went to get a fancy gas stove but then decided to walk the walk and got an induction stove. I love it. There are a lot of advantages to it. Aside from climate and health, they are safer in terms of burns because it’s only hot underneath the pan. You do have to get new pans if you have pans that are not magnetizable. That was good for me because I got a whole new set of stainless-steel pans. And I could still use my cast iron skillets, which I love.
JMK: I have cast iron and stainless steel anyway. I could switch – I just have an old wide stove that would be $9000 to replace, or something crazy.
JRB: It heats very evenly – there’s not a ring of fire. You just have to get used to it. They heat up fast. I’m proselytizing here, but you know that there is not only more particulate matter; there is nitrogen dioxide (NO2), which is really of more concern in terms of gas cooking impacting health. If nobody has asthma or other respiratory diseases in your house, and your kids are gone, it’s probably not a big health deal for you, but it may be climate-wise.
JMK: I switched to solar and geothermal, and so those are two big ones, and it wouldn't be that hard to get off gas completely at this point. I should.
It was interesting what you said about Richmond. I talked to Amanda Millstein and blogged that interview not long ago.
JRB: Actually, Amanda was helping us recruit subjects for that study. That’s wonderful – Mark must have connected you with Amanda, too.
JMK: That was actually through Lisa Patel at Stanford, and she was a delight as well.
JRB: I don’t know Lisa as well – I know of her.
JMK: I have been trying to talk to some people who are more keen on climate change and others who are more pure environmental health exposure scientists.
JRB: I do both.
JMK: Yes. Obviously, if we fix climate change, we'll also clean up the air just immediately. This is something I share with my students all the time – that air pollution is the low-hanging fruit. We could fix this within 10 years if we really went for it.
JRB: So the California Energy Commission gave us 4 million dollars for this grant to buy stoves for people, which is why it is so expensive. They don’t normally do health studies. But because they would like to see reduced gas appliances for climate purposes, they are hoping that a randomized, controlled trial, which is of course the highest level of health-effect evidence, will show improvement in kids with asthma. If so, that will spur a greater effort to get rid of gas stoves. I live here in Berkeley, which banned new gas stoves. The ban was overturned by a federal judge. But new homes were not supposed to have them, and also new restaurants – but the restauranteurs were most opposed. There are other cities that have done that, and so far as I know, that federal decision only applies to Berkeley so far.
JMK: I was just talking with Susan Buchanan, the Region 5 PEHSU Director.
JRB: I know her – she’s at UIC. We were co-investigators on a study I ended up bailing out of because we couldn’t recruit enough people, trying to improve asthma through improved housing. Instead of cooking electrification, it was improved housing, and we just had trouble recruiting folks in San Francisco, so I bailed from that study.
JMK: She is now on the City Council of Oak Park, and she’s done a lot of really great things, including trying to get that same ordinance through banning new gas stoves. They are encountering a lot of obstacles, I think, but she was optimistic.
JRB: I should tell my nephew who still lives at home in Oak Park. He’s a big Climate Action person who volunteers with the Sierra Club and 350.org. I think he told me about that effort on the ordinance side. I should connect him with Susan – he’s in his thirties and a real go-getter. So he could help.
JMK: That's terrific. I wanted to go back to something you said about the metabolic activity that was identified in the traffic studies.
JRB: Maybe check my website or Google me. But we’ve been studying traffic-related air pollutants in Fresno. The study is not big enough to show an increased risk of diabetes, but we know that a marker for glucose dysregulation, Hemoglobin A1C (HbA1c), has been shown to be associated with some pollutants – also systolic blood pressures and some markers of body weight.
JMK: I just think it's so interesting because I've been following the story for at least 10 or 15 years about endocrine disruption. I'm doing a two-week Woods Hole MBL seminar on endocrine-disrupting chemicals (EDCs) in May. I don't think that the endocrine-disrupting effects of air pollution are commonly known. People understand that maybe cardiovascular disease (CVD) and of course anything to do with lungs are associated with air pollution. But this is a class of outcomes that even healthcare practitioners are not aware of, I think.
JRB: Well, healthcare practitioners generally don't think much about air pollution unless there's wildfire smoke. But there is a fair amount of literature on air pollution and diabetes in both adults and kids. There’s a greater risk for adults of diabetes, as well as bad outcomes associated with the disease. There is also evidence that it can predispose people to getting diabetes, and we’ve contributed to that literature.
There are some very good studies in Southern California where they have shown an association between air pollution and frank diabetes. Instead of just HbA1c, they also did a glucose tolerance test, as well as insulin resistance. They had people come into the hospital and do this testing, but they had a big enough cohort that they could show statistical significance. So yes – there are multiple studies, but the association is not well known.
I think a lot of practitioners scoff and say, oh, diabetes is due to bad diet and poor exercise, which definitely are risk factors. But there are other factors, and endocrine disruption is not well appreciated by most practitioners. It’s not entirely clear that air pollutants work the same way as some of the more infamous EDCs, but they might. The hand-waving explanation I and others use for mechanism is that air pollution affects the lungs first, and then you get oxidative stress and inflammation in the lungs, and that spills over to systemic circulation, which can affect extrapulmonary tissues – adipose tissue and possibly the pancreas. In any event, the association is there – even though we can’t say we have the mechanism totally worked out.
JMK: It’s so complex, isn’t it? We have fiddled with things we should not have fiddled with.
JRB: Yes. Over the course of industrialization, we have exposed people to a lot of bad things –air pollution but also myriad chemicals that are harmful. A greener more sustainable world involves clean transportation, clean power, energy efficiency, non-toxic chemicals.
JMK: Yes. And I'm so glad you're bringing your expertise to the CARB and making that connection for people between air pollution and climate change. Because, you know, gosh, we should be able to fix this one.
JRB: I was being funded by the CARB in some of my studies – and then I was on the Research Screening Committee for the CARB board, helping to decide what studies should be funded after I was no longer accepting money from them. After the previous physician member, who was a friend of mine, passed away suddenly from a heart attack, they needed a new physician member, and so they reached out to me. Governor Schwarzenegger is a Republican but good on the environment, in part because of his relative, brother-in-law Bobbie Kennedy Junior. Before he went off the rails, he was a National Resources Defense Council (NRDC) senior lawyer and wrote Schwarzenegger’s environmental platform and advised him.
So they wanted someone who knew air pollution health effects, and had done at least some climate-related health work, and so they appointed me. I got confirmed by the Senate without a single Republican vote even though a Republican Governor nominated me because I was seen correctly as someone on the left. I wrote in my statement that I was an advocate for Environmental Justice (EJ) but also said I didn’t want to wreck the economy, so I would be pragmatic. They decided that on the environment, Schwarzenegger was a Democrat, which is pretty much true [laughs].
JMK: It’s just a shame that we can’t all agree that climate change occurs and talk about different ways to solve the problem. It’s not healthy for democracy to have only one approach to the problem.
JRB: So I should also say that the oil and gas extraction folks went after the law called the Global Warming Solutions Act of 2006 (AB 32), which empowers regulations to mitigate climate change, which means clean cars, clean transportation, and cap and trade. Without question, California has the strongest regulatory regime in the country and probably the world, which we get vilified for. But our economy is cooking, so the Green Economy hasn’t hurt California. It has hurt certain dirty sectors of the economy. So the oil and gas extraction folks, the Koch brothers, funded a referendum to put the kibosh on AB32 in 2010. It totally lost. It was a 60 to 40% vote against the referendum. That showed democracy in action. Californians – even many Republicans in California – appreciate that climate change is real. I mean, we have drought, wildfires, flooding, heatwaves. So people get it here.
I get a big kick out of my New York friends who weren’t concerned about wildfires until last June. And suddenly, one very good PhD, NYU environmental epidemiologist, George Thurston – was always saying that it was coal and diesel particulates that are really harmful – and that biomass is not so bad. But after June, he published a paper showing that there was increased asthma healthcare utilization during the wildfire episode. He said, that’s respiratory, but he was not so sure about cardiovascular. But suddenly, wildfire is something that the East Coast and Midwest are now more aware of, right?
Figure 3: New York during the Canadian Wildfires of 2023
JMK: It’s interesting. My hometown is downstate – Canton, west of Peoria. It’s a small town and pretty red. But I heard people talking about the wildfire smoke. It really did get people’s attention. Even though they weren’t saying the words “climate change,” they weren’t denying it at the moment either.
Californians are in an unfortunate position. When I was talking to Lisa Patel and Amanda Millstein, they were both saying that they have young children. They both wonder about not being able to entirely protect their children from experiencing these kinds of long-term risks from wildfire exposures.
JRB: I’ve done a lot of wildfire research as well. It fits with the household air pollution work, actually; it’s all biomass. With household air pollution, we can study chronic exposures because people cook every day, but with wildfires, we get these high exposures that don’t usually last that long. So we don’t know the effects of recurrent exposures of kids to wildfire smoke, but we are concerned. Amanda and Lisa are totally right to be concerned about it, and I am as well. I give talks about that.
But the only group that we can really study with chronic exposure are wildland firefighters, which I have tried to do, but I have not been able to study them longitudinally. I co-authored a health impact assessment based on measured exposures to PM2.5 of firefighters while fighting fires. Exposures are pretty high, and then you can extrapolate over a career. Though many are seasonal, some firefighters are career. And then, you are talking about a lot of PM2.5 over time, so there is a theoretically increased risk of lung cancer and CVD. But again, that was a health impact assessment based on modeling, not actual data. But there is an effort to start collecting that data. A friend of mine, a former doctoral student who works at NIOSH was actually trying to do such a study, but they started in 2019, and then they had to stop because of the pandemic.
JMK: Sure. I have a couple of students from California who reported that some of their classmates just passed out when the wildfire smoke was really bad. That’s terrible, and I also think it’s interesting. I don’t know where you think the research is going on this, but of course, particulate matter (PM) is not necessarily all the same, right? What is the composition of that particular matter – vehicular traffic vs. wildfires? Does it matter for health effects? Do you have a take on that?
JRB: Yes. My friend George Thurston instinctively thinks the CV risk is less for biomass compared to coal-fired power plant or vehicular emissions, especially diesel, and there is some evidence to support this. But several studies from Scripps on childhood asthma and childhood respiratory illness suggest that wildfire smoke is more toxic with regard to acute respiratory outcomes. So George and I have agreed to disagree. He now agrees that respiratory toxicity is there for wildfire smoke, but he’s not so sure about CV.
But there are actually a number of studies that are showing a CV risk with wildfire smoke. The first author of one was a UCSF medical student who took a year off to do research – Zach Wettstein. He worked with both the California Department of Public Health (CDPH) and the USEPA, and they studied the 2015 wildfire season, which wasn’t even a bad one by today’s standards. They showed that wildfire smoke exposure increased the risk of respiratory healthcare utilization – ER visits and hospitalizations – as you would expect, but also CV effects, both heart and stroke. USEPA investigators have continued to study CV healthcare utilization with wildfire smoke. I’m convinced there is an effect; whether it’s as toxic as diesel particulates or coal-fired power plants is a different story, but there is definitely a risk.
JMK: Well, and I saw on your website that you linked to that study of Lahaina, and as you know, as buildings burn more often, those are so toxic.
JRB: I was just approached by a colleague in New York who has done household air pollution work in Ghana – we met in Africa: Alison Lee. She is collaborating with someone who has connections in Maui –and they are trying to follow a cohort from the Maui fires with regard to chronic respiratory symptoms. There are not many pulmonary specialists in Hawaii, so they are trying to arrange telehealth with folks here at UCSF.
I’m not going to be involved in that telehealth because I’m retired, and I’m giving up my clinical practice as of June thirtieth. But I can connect them with others here.
JMK: It must be interesting to retire after such a high-powered career!
JRB: Well, you know I am still going to do research. My wife says I do too much.
JMK: I was talking with Brenda Eskenazi, and she said she’s still just as busy as ever.
JRB: I met Brenda at Yale, but she was also at Mount Sinai at the same time as me. We just didn’t know each other.
JMK: Yes – she is wonderful. Okay. You have seen so much change over the progress of your career. What findings have influenced you most in how do you see your work in the world, and from your own work, is there one thing that you are proudest of?
JRB: I think that my work has been instrumental in supporting stricter standards – the US EPA’s national ambient air standards. Especially with regard to ozone, my group was one of the first to show that ozone caused airway inflammation and decreased lung function. Ozone was actually burning the lungs chemically. And that helped get stricter ozone standards.
I also was involved in supporting a stricter standard for sulfur dioxide (SO2). We showed that a low dose of SO2 caused asthmatics to have bronchoconstriction, or airway narrowing, and decreasing lung function. With regard to wildfires, I was part of a combined UCSF and CDPH group that conducted the first study of lung function changes in wildland firefighters across the fire season. These are super healthy people – you have to go to boot camp to qualify. So we measured their lung function at the start of the fire season, which was in May – when they would mobilize – and then at the end – in October. It’s now a longer season. We found that lung function decreases over time. That’s a study I am very proud of.
And then, being able to take my work and apply it to policy work with CARB – I’m proud of that. And it’s been very instructive to see how policy is made. We often say on the board that if we have the advocates who want stricter regulations and the regulated community that want less – if both are upset with us, we’re probably doing the right thing [We both laugh]. You have to balance what’s absolutely the best for health and the climate with regard to what’s realistic.
Mostly, we’re accused of being unrealistic. But CARB is very much evidence based. We promulgate policies that we feel we have the evidence to support.
I am also proud of being part of the Clean Air Scientific Advisory Committee (CASAC). That’s a statutory part of the Clean Air Act that requires an independent panel of experts to give advice to the administrator of the EPA about what is protective of public health. During the Trump administration, they were defunding lots of EPA activities and trying to hold the line against stricter standards, even if there was evidence that there would be a public health rationale for them. We got appointed towards the end of the Obama administration and then were kicked off by the Trump administration – but the Union of Concerned Scientists (UCS) kept us going, and we did the review we would have done if we had been the statutory committee. That review is available online and was published in the New England Journal of Medicine (NEJM) – a commentary about that. The leader of that work is now a deputy administrator at the USEPA, appointed by the Biden Administration. So I feel like there has been an arc of progress made in regards to the Clean Air Act, and on climate change policy too. But I worry big-time that if we get a Trump administration again that we will lose the arc of progress.
JMK: Yes. I feel the same way, of course – and maybe even democracy.
JRB: He says he is going to be a dictator on Day One. He’ll probably declare martial law.
JMK: And he will have learned from his mistakes the first time he tried to execute a coup. Yes, it’s very scary.
JRB: He won’t have any military folks that believe in the Constitution.
JMK: It’s just awful. So it’s tough for people like you who know what's going on with air pollution, and other kinds of pollution, and children's health. You said you're an adult pulmonologist, so I don't know how much you have talked to parents of kids or kids themselves. But I think that conversation can be very difficult because you want to educate people about wildfire smoke, about vehicular traffic smoke emissions. But you also can end up creating some anxiety or fear or guilt. So I just wondered if you had a perspective on how to treat this topic.
JRB: That’s a good question, and I try to do that. I don’t talk to parents in a clinical setting, but I have to give media discussions all the time. Every time there is a wildfire smoke episode, I get asked about it, and so I try to reassure people that if their child doesn’t have asthma or some other respiratory illness that they are probably going to be okay with the wildfire smoke – because it’s really people with pre-existing heart and lung disease who are most at risk, except for the very old and the really young.
So I try to balance concern for folks with pre-existing heart and lung disease with reassurance for people who don’t have those conditions. And I always talk about what they can do to reduce exposure and what is the best way to handle it: to stay indoors as much as possible, to have portable HEPA filtration devices, if you can, to put a MERV 13 filter on your central ventilation. Even if you don’t have the means to buy a portable HEPA filtration device, which aren’t that expensive anymore – less than $200, but to some people that is a lot of money – there are DIY systems that actually work: a Corsi-Rosenthal box. Or you could get a box fan and put a MERV 13 filter on it and put that in your window to pull out the air that contains wildfire smoke. If you have to go outside, use N95 masks, and for wildfire smoke, you don’t even need the ones without an exhalation valve, though those are fine too if you are not worried about COVID. You’re only filtering air going in, and what you exhale is fine.
But the big issue that is the hardest is schools – whether schools should stay open – that is very tricky. We’re trying to do some stuff about this in California because a lot of times, schools are clean air spaces. So we are trying to get schools to put MERV 13 filters in their central ventilation systems, or if they can’t do that, to have a HEPA filtration device in every classroom. And there is money for that in the state budget, or there was – who knows – now we have a deficit. The other thing schools and people can do is get PurpleAir monitors, and they can even assess how bad the air is if the kids are in school. They could not let them out for recess because the air quality is poor. And driving a car from home to school is not that bad because cars usually have the windows rolled up and can recirculate the air. School buses can also be outfitted with filtration to protect kids. Initially after the big wildfire smoke episodes, schools were being closed down. Now there is an effort to keep them open but cleaner.
JMK: Yes. On the Children’s Health Protection Advisory Committee (CHPAC), when we just last year wrote a letter on climate change, we argued for schools as resilience centers for children so that they have at least one safe place to go that is equipped with excellent filtration.
So the next question is, if you were suddenly granted complete power to change the US policy on environmental chemicals and climate change, and you didn't have to fight the bad actors, what would that look like?
JRB: I will leave off the chemicals for this and just stick with climate change and air pollution – for those, the sources are the same. We really have to electrify transportation. There’s no reason that people can’t drive electric vehicles. In terms of long-haul trucks, it’s a little trickier – but it looks like hydrogen is a way to go. And then that hydrogen has to be produced cleanly, which also could be done. We need clean power. I would get rid of all coal-fired power plants – gone – obviously, you have to do that in a way that people continue to have power, but it can be done. The fact is that we aren’t doing this except in California and maybe a few other states. I know Illinois is trying.
JMK: We have goals.
JRB: We have goals too, and I think we have policies that will help us get there. We need clean transportation and clean power generation. We should get rid of gas appliances in a phased way. I don’t want people to be without heat or water.
If we stopped burning gas and oil – then we would not need refineries or oil and gas extraction – both of which are very dirty and contaminating for air and water as well. And then also there would be less feedstock for the toxic chemicals we produce.
JMK: Yes. The hard thing is that the fossil-fuel industries instead see plastics and toxic chemicals as their new avenue, and I wish people would see that is not a good idea.
So the big question I looked at in my previous book and that I am addressing in this one as well, is this: if we know that we are poisoning our children, and we know we're destroying the only climate on which life depends, and we know there are solutions ready at hand just like those ones you described, how is it that we are not implementing those solutions? Or basically, how is it that as a species we could be so stupid?
JRB: Oh boy! There are a couple of things I would say. One is that there is a lot of money and power tied up in the fossil-fuel industries. Because actually, there is oil and gas extraction and refining. And there are coal mining and coal-fired power plants all around the world. The Chinese are doing great on solar power but also building new coal-fired power plants – so is India. You can’t entirely blame these countries, especially India – they have an economy that is doing well and now have the resources to bring people out of poverty. They are working on solar and wind power, but they are still building coal-fired power plants. You know, money, money makes the world go round. There are economic interests. That’s number one. Those are the reasons that are at least rational to a certain level.
It’s the irrational denying of the science of climate change that bothers me the most, more than the economic causes. The economic interests can be dealt with if you can figure out policies that are feasible economically. There are a number of economists who have written how we can achieve our climate change mitigation goals if we get serious about it – there is an economic pathway. For one thing, we should stop subsidizing oil and gas extraction.
There are some Republicans who agree that climate change is a problem and that we should do something about it. They would use market-based solutions rather than top-down command and control solution. And I actually have no problem with working out a compromise with those folks because market-based solutions may be the best way to get people in industry to be supportive. Not everybody in industry – even in coal, oil, and gas extraction – is anti-science. They know what the evidence shows. But what to do with these people, which is now 40% of the US population, that supports Trump no matter what? They are the same people denying science. It scares the heck out of me.
JMK: Yes, same here – because it is so irrational. And you know, if we're wise about this, maybe we can tackle these daunting problems. But we have to get our act together.
JRB: And I think a lot of other countries aren’t so bad, but it seems like the Trump MAGA wave here is spreading to some European countries. The Europeans have been the rational ones up until now.
JMK: Yes – I agree with you.
The last question is do you have any questions for me about the project, or about my experiences?
JRB: Well, you could tell me a little bit more about the project. I like the people that you've been interviewing.
JMK: Yes! I want to combine the stories of children like my daughter, who have suffered the consequences of the way we are doing things, and healthcare practitioners and the researchers who are looking out for these kids. I think most people are not aware how systematically we are degrading our children's health. Also, it is inspiring that so many people who are intelligent and hard working are dedicated to trying to make things better. I am looking at storytelling as a way of putting flesh on the bones of the statistics and the science that we already know. What is the effect of what we are doing? How are people trying to remedy these terrible unjust tragedies?
JRB: If you would like to talk to another policy person who is also on the CARB and who has a PhD in Health Education, Tanya Pacheco-Werner would be good. She’s the San Joaquin Valley Air Pollution Control District representative – she’s great.
Her work as a policy person is informed by exactly what you were just talking about with your own daughter. She has two kids – one’s probably three or four, and then she’s got a one-year-old.
JMK: The good thing about having children that at least it does make you want to change the world for them.
Well, thank you so much for the recommendation. I really appreciate your time today and getting to know you a little bit.
JRB: Okay, no problem. Good luck with your project.
