The Haze Has Lifted, but the Threat Remains: Climate Impacts on Public Health and the Case for Emergency Preparedness

In June of this year, millions across the Midwest and East Coast of the United States awoke to darkened skies, watery eyes, and scratchy throats resulting from smoke from raging Canadian wildfires. This time it was not Mumbai, Jakarta, or Bangkok, but New York that topped the global list of cities with the worst air quality, with the air quality index reaching 484 out of a scale of 500 on June 7.  

A few weeks later, a new wave of smoke billowed into the Midwest, with worsening air quality stretching across Chicago, Detroit, and Milwaukee, and pollution seen as far off as Europe.  And just this week, 18 states had air quality warnings related to the ongoing fires.

These incidents will only grow more frequent. But during both occurrences, as residents fretted about eerily orange skies and how to keep themselves and their families safe, public officials remained worryingly silent about this new health risk. 

Increase in Weather-Related Emergencies 

For those studying the impacts of climate change on both the environment and public health, these events are a grim reminder that weather-related emergencies are becoming more widespread, frequent, and severe. If we look at the increasing number of federal public health emergency declarations over the last five years, with the exception of those related to COVID-19, virtually all were weather-related. Across the country, there has been a record-breaking number of hurricanes, winter storms, wildfires, flooding, and tropical storms that had profound impacts on human health and well-being.   

While these weather-related emergencies can seem disparate, event attribution science shows that the frequency and the intensity of these events are increasingly linked to climate change. But unlike our relatively robust plans to prevent or respond to infectious disease emergencies, policymakers underestimate the health aspects of climate-driven emergencies.  

Ultimately, everyone will be affected by the public health impacts of climate change. High temperatures and wildfire smoke will heighten cardiac and respiratory risks. The frequency and severity of allergies are likely to increase due to the impact on pollen, which has a longer growing season as the temperature rises. Climate change also expands the range of mosquito-borne illnesses that thrive under hotter, wetter and more humid weather conditions. And the likelihood of food-borne illness increases as well, because warmer, wetter weather increases presence of disease-causing pathogens. Finally, persistent weather-related emergencies cause profound social, economic and political stresses that will negatively impact mental health.   

Although no one is safe from the impact of climate change, it will have an outsized impact on people in disadvantaged communities. People living in poverty have fewer protective resources, such as air conditioning, air purifiers, and the ability to relocate during dangerous periods. They are more likely to have jobs that are outdoors or in other environments that put them at risk. In addition, certain populations are more vulnerable due to their age (specifically children and older adults), underlying health status, sexual orientation or gender identity, and the impact of systemic discrimination. This heightened risk calls for specialized planning efforts on the part of the federal, state, and local officials in conjunction with organizations serving and representatives of those sub-populations. The Centers for Disease Control and Prevention (CDC) and the American Public Health Association have developed a helpful resource to help guide such work to ensure that equity and inclusion are central components of climate change programs and operations. 

State Actions to Reduce Health Impact 

In some ways, it should be easier to reduce the dangers associated with climate change than those associated with infectious disease. While we can’t always determine the origin of a novel virus outbreak, we know that climate pollution that causes many of these weather-related emergencies. And there are both long- and short-term actions which can be effective.  

While there is a role for virtually everyone in reducing climate change and its impact of health, state policymakers have a critical part to play. For one thing, states will feel the impact in specific ways and will need tailored approaches. A state’s agricultural sector may likely suffer as weather – an essential, but erratic, input into crops – becomes even more unpredictable and extreme. Their energy infrastructure may be put the test as excessive heat boosts demand for air-conditioning. Their firemen and other first responders may be stretched to their limits responding to dangerous wildfires and flooding. And their Medicaid costs will soar as residents develop weather-related illnesses and injuries, such as respiratory afflictions and strokes and heart attacks related to record temperatures.   

So, what can state policymakers do? Prevention is by far the best approach when it comes to climate pollution. For example, states can consider adopting measures to reduce greenhouse gas emissions to mitigate climate change. Carbon reduction policies, such as carbon pricing, can be effective at slowing the pace and severity of climate disruption. And technology adoption incentives, especially for heat pumps, can accelerate and expand access to energy-efficient heating and cooling. These actions – once implemented – can result in noticeable improvements in air quality and thus immediate co-benefits for public health. For states where wildfires may occur, prevention measures may also include controlled fires to reduce undergrowth that can fuel uncontrolled fires.    

Still, it will be important to identify ways to prepare for, manage, and reduce the harms to public health when they do occur. Additional attention to indoor air quality is one such approach.  States can act to require improvements in air quality in schools and workplaces; the Environmental Protection Agency offers states ways to keep indoor spaces safe during an emergency like the recent Canadian fires.  

State public health agencies can ensure that they have incorporated weather-related (including wildfire-related) prevention, readiness, and response components into their planning.  This may include:  

• Conducting air sampling to determine the level of risk 
• Providing guidance on the use of HEPA portable air cleaners or box fan filter kits  
• Informing the public of the risks of poor air quality related to the wildfires, as well as the steps they can take to protect themselves and their families when the risks are elevated  
• Working closely with the health care sector to monitor how many patients are presenting with wildfire-related symptoms   

Medicaid officials can ensure that their enrollees and clinical providers receive useful health information about the health risks of wildfires – especially for those who are vulnerable due to asthma or other health conditions – so they are prepared to take appropriate precautions.   

States can also support proactive research into changing disease vectors and risk areas. And they can bring those from other sectors – such as businesses, schools, and universities – to the table with health, energy, and emergency response officials to coordinate with each other.    

While many states have strengthened their climate-related preparedness efforts, a report from Trust for America’s Health indicated that many had room for improvement. Fortunately, helpful resources exist. States can look to the CDC’s 5-step BRACE framework to plan and implement effective approaches. In addition, the National Environmental Health Association has recently produced a useful guidebook that is specifically focused on wildfires to assist state and local health officials in their consideration of necessary steps. And ICF and other climate-oriented organizations are actively working to inform policymakers and their stakeholders about objective, science-based, data-driven options to mitigate climate change and its impacts, including on public health. 

Policymakers in the states, as well as those at the federal and local levels, shouldn’t wait until the next time the skies turn an unnatural orange before acting. There is an opportunity to act quickly and prioritize taking evidence-based steps to reduce the health risks associated with climate change. Thanks to this summer’s stark reminder of how we share one atmosphere, for better and for worse, now is the time to prepare to prevent the worst and work to make things better.