Air Quality Has Long Been Overlooked, But It’s a Major Environmental Justice and Public Health Issue

From COVID to wildfires to vehicle smog, the air we breathe is dangerous, and we need a major public health campaign to educate people and provide masks—along with structural changes to address root causes.

I went for a walk earlier today and came across a bumper sticker on a car that had an outline drawing of a tree. The caption read: “Everything is connected.” I can’t help but think about how true that is as smoke from wildfires originating in western Canada has spread to over a dozen states in the southeast, northeast, and midwest regions of the U.S., even reaching as far west as north Texas. The smoke has caused very high levels of pollution in New York City, which the New York Times noted has produced “apocalyptic skies, hazardous air and stinging eyes.” In affected places, schools have been closed and outdoor sporting events postponed. Countless workers such as delivery people, dog walkers, and mobile vendors have had to brave the conditions despite risks to their health. The polluted air can cause headaches, stinging eyes, or coughing, among other symptoms, and can cause chronic conditions like asthma or other lung diseases to flare up.

The sickly haze seen in various photos is reminiscent of the wildfire-induced blood orange skies of California in 2020. The Guardian reported that 50 million people are now under an air quality alert. The story described conditions in New York City:

The whole city is immersed in a dystopian-looking smog: urban streets in sepia, emptier than usual, bathed in an eerie quiet. More were seen wearing face masks than usual these days, reminiscent of earlier days of the Covid-19 pandemic – and the feeling of potential doom the virus had induced.

Speaking of masks, last year I wrote that I thought masks ought to be a given in our lives due to COVID and air pollution (harmful particulate matter). It’s already the case in some Asian countries that masks are treated as useful everyday health measures, not just emergency devices to be deployed during pandemics. And I think it would have been helpful if everyone impacted by this pollution already had appropriate masks at the ready and available free of charge throughout our cities. An N95 or KN95 is recommended for protection against wildfire smoke. 

Masks are helpful for car commuters and cyclists, who are both exposed to harmful vehicular pollution. They are also great for preventing infection with other nasty respiratory viruses during cold and flu season. I’m a general pediatrician by training, and in my first year of practice, I got sick something like 8 times—fever, respiratory illnesses, laryngitis, and so on. After that, I decided to wear masks in all my patient encounters. This reduced my rate of illness to twice per year, which was wonderful. I really dislike getting colds and other respiratory illnesses. Fortunately we have a simple, low-cost technology for keeping us safe. 

According to the World Health Organization, most people on the planet are exposed to harmful levels of air pollution that increase the risk of heart disease, cancer, stroke, and death. The WHO noted, upon announcing its updated Air Quality Guidelines in 2021, the following:

Every year, exposure to air pollution is estimated to cause 7 million premature deaths and result in the loss of millions more healthy years of life. In children, this could include reduced lung growth and function, respiratory infections and aggravated asthma. In adults, ischaemic heart disease and stroke are the most common causes of premature death attributable to outdoor air pollution, and evidence is also emerging of other effects such as diabetes and neurodegenerative conditions. This puts the burden of disease attributable to air pollution on a par with other major global health risks such as unhealthy diet and tobacco smoking.

This is also an issue of environmental justice. People of color in the U.S. tend to be disproportionately exposed to hazardous air due to living in more polluted places (which is not an accident but a direct result of, in part, racist housing policy such as redlining), and according to the United Nations Environment Programme, “air pollution hurts the poorest [the] most” in countries throughout the world. 

Part of the air pollution problem is due to motor vehicle use; this is why it would be a great idea for us to develop clean rapid transit and more walking-friendly cities. Another problem, of course: the wildfires, which are being driven by climate change. This is yet one more reason we need to get serious about addressing the climate crisis as the emergency that it is. It can’t be said often enough: addressing the climate crisis requires rapidly and dramatically reducing the use of fossil fuels—not simply the use of “clean energy.”

The larger point here is also to think about how we can be a society that takes care of the collective—whether during a pandemic or recurrent air pollution days—through education and resource allocation. In other words, we need to do the opposite of what we’re doing to deal with major public health issues. On COVID, the Biden administration decided to end the pandemic public health emergency last month, making it seem like the pandemic is over when it isn’t. People are still dying of COVID, new variants are developing, and Long COVID is impacting millions. COVID spreads via aerosols, so indoor air quality remains a huge concern, and, tellingly, the CDC released guidelines on air ventilation just after the government ended the public health emergency. (Running a HEPA air purifier is good during times of wildfire smoke, too.)

A society that had, instead, continued to treat the pandemic as a public health emergency—providing free testing, vaccination, therapeutics, masks, and HEPA air purifiers for everyone, as well as enacting the obvious, Medicare for All—would also be more likely to take air quality and climate change seriously. 

We need a major effort to educate the public about all kinds of health issues—from air quality and pollution to fitness and nutrition, comprehensive sexuality education, and more. This includes pandemic public health education, something the U.S. has been very weak on (even a simple measure like masking was bungled not only by government officials but the media as well, which stoked doubt about whether masks work—indeed, they do). If people were more educated about air quality levels even under normal (non wildfire) conditions, maybe they would think twice before doing what the people in this photo are doing—outdoor yoga during a dangerous air pollution event. And again, we need free resources, such as masks and air purifiers, readily available to all, and to ramp up access when an emergency strikes.

While our government may be doing everything in its power to normalize things like COVID, endorsing at times a “you do you” approach, we have to do better. We can’t normalize hazardous-air days as just a part of life. 

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