IN HER 20 YEARS of practicing medicine in Boston, Dr. Robyn Riseberg has seen symptoms of illnesses like asthma and seasonal allergies worsening, and she’s observed personally how the flu and RSV seasons seem to be getting longer. 

As a pediatrician and founder of Boston Community Pediatrics, Riseberg has seen patients through countless cold New England winters and hot summers, the Covid-19 pandemic, and various strains of common illnesses. 

“We’ve definitely seen an increase in respiratory infections,” Riseberg said. “The different flu strains have changed over the course of the last 20 years as well. And so we’ve had some seasons which have been much worse than others.” 

Experts say climate change exacerbates these trends. Extreme temperatures pose a health risk on both ends of the spectrum as increasingly hot days can contribute to heat stroke and worsening seasonal allergies, while the bitter cold can aggravate respiratory health issues and cause hypothermia. They also affect water and air quality, the latter of which can be negatively impacted by high temperature, airborne allergens and carbon emissions. 

As climate change intensifies, different communities will see different effects. “The impacts are highly localized,” says Greg Wellenius, director of Boston University’s Center for Health and Climate. 

Heat is the leading weather-related cause of death in the United States, and Boston, along with much of New England, had not been built to withstand it.  

Since 1982, the Earth has been warming three times as fast per decade as it did between 1850 and the early 80s, according to the National Oceanic and Atmospheric Administration. Massachusetts has seen temperatures increase by almost 3.5 degrees Fahrenheit. Even with efforts to reduce emissions, Boston will see the average number of days over 90 degrees rise from 10 days to 46 per year by the 2070s, city planners expect. 

Buildings and infrastructure were designed with the traditional New England climate in mind – very cold winters and moderate summers, but both are becoming more extreme. Most of Boston’s buildings were built before 1950 and the popularization of central air and heating, according to a 2019 report from the city. 

“We build our buildings in a way that they tend to trap heat because that was a good way to reduce the energy needed in order to survive the winter,” Wellenius said. “But now those same design features keep our houses probably too warm in the summer.” 

In Massachusetts, there have been about 700 emergency department visits for heat stress on average per year since 2000, according to state tracking data. While heat advisory warnings ask people to stay indoors, usually in an air-conditioned space, not having that option at home can create unsafe situations, especially for children and seniors, who are the most vulnerable to extreme heat.  

Riseberg said doctors “really worry” about kids because “they need to be able to regulate their temperatures.”  

“Children are at sort of a higher risk of climate related health concerns because they’re not like small adults, they’re different,” she said.  

In 2022, Boston released a heat resilience plan to serve as a roadmap for how the city would address climate change and extreme heat as part of the Climate Ready Boston plan, which was first created in 2016. 

The “Heat Resilience Solutions for Boston” plan lays out a number of ways the city will try to tackle extreme heat, including by providing full-shade canopies to reduce surface level temperatures, improving public transportation for cooler commutes, enhancing the city’s green space and drinking fountain network, and planting more trees.  

Chris Osgood, director of Boston’s Office of Climate Resilience, said that in addition to the plans outlined in Climate Ready Boston, the city has “expanded their toolkit” to address heat emergencies by having more shade structures at community centers and libraries.  

“Last year, we installed a series of misting tents, misting coolers, and misting towers, ways that residents in the city can sort of cool off,” he said. The city’s heat website “posts all the cooling centers, places open to members of the public who may need a place to be able to keep cool during the hottest parts of the day.” 

Another way to address the heat and keep cities cooler is by planting more trees. Massachusetts’s Executive Office of Energy and Environmental Affairs has identified the loss of the urban tree cover as a climate concern for the Boston Harbor area. The city has planted more than 4,000 trees over the past few years and is partnering with local organizations to provide grants to property owners to expand the tree canopy in their yards. 

“We are particularly focused on those areas of our city that are urban heat islands,” Osgood said. “The mayor has significantly expanded our work around tree and canopy cover.” 

As winter is getting shorter and summer is getting hotter, springtime is bringing worsening respiratory issues and air quality. A 2023 study published in eBioMedicine, a division of The Lancet, showed a connection between global warming, longer growing seasons, and more potent pollen. 

“That’s driven by changes in the average wintertime temperature and essentially, the number of months during which vegetation, primarily trees and grasses, are able to grow enough to generate the pollen,” Wellenius said.  

Because of this, symptoms of seasonal and respiratory allergies, such as itchy eyes, asthma, and nasal congestion are getting worse, leading to more allergy-induced asthma attacks that result in hospitalizations.  

Riseberg said she has started seeing patients earlier in the season about their seasonal allergies compared to the beginning of her career.  

“It seems like the majority of them are getting worse,” she said. “All of the symptoms that we are used to seeing just seem to be a little bit more pronounced.”  

Riseberg said the causes of asthma attacks can be “multifactorial” and are not only due to air quality. Poor housing conditions, mold exposure, air pollution, and even mice droppings can be contributing factors in asthma attacks.  

In addition to fostering an increased pollen count, rising temperatures make it easier for air pollutants like ozone, which increase the risk of respiratory and cardiovascular conditions, to become trapped in the lower atmosphere. 

“We’ve made dramatic improvements as a country in reducing the levels of most air pollutants,” Wellenius said. “Recent gains are threatened because our average temperature increase creates conditions that are more favorable to pollutants.”  

Air quality can vary between Boston neighborhoods. East Boston, for example, where Logan International Airport is and where 1-90 and I-93 intersect is a particular concern. 

“[They] breathe in the tailpipe emissions from airplanes every single day,” said Hessann Farqooi, executive director of the Boston Climate Action Network, a grassroots climate justice movement.  

The Climate Ready Boston plan considers East Boston as a focus neighborhood for dealing with rising temperatures and excess heat, but it does not state how it will address air quality issues in the neighborhood.  

“Climate change affects everyone, but not everyone is starting in the same place,” Farqooi said.  “The people who are hit first and worst by the effects of climate change are very often the people who have the least social, political, and economic power.” 

 Maya Mitchell is a student in the Boston University Statehouse Reporting program.