Sixteen places in Washington have been identified as communities overburdened by poor air quality. A review of data from 2016 to 2020 found that residents of these communities had an average lifespan of 78 years, compared with 80.4 among people across the rest of Washington.
Most of these communities are affected by car exhaust or industrial fumes, but in the rural towns of Wenatchee and East Wenatchee, wildfire smoke is the key contributor to poor air quality due to the presence of fine particulate matter (PM2.5), which the U.S. Environmental Protection Agency defines as “inhalable particles, with diameters that are generally 2.5 micrometers and smaller.”
The state passed two landmark environmental laws in 2021: the Climate Commitment Act and the Healthy Environment for All Act. The laws include environmental justice provisions calling for the state to identify the disproportionately impacted communities and to fund ways to help improve their air quality.
Bindu Nayak, MD, an endocrinologist with Confluence Health, noticed the impact the smoke was having on the community—particularly Hispanic children with asthma who had become frequent visitors to Confluence Health emergency departments.
“After living in Wenatchee for 15 years, I've seen the effect the wildfire smoke has had,” Dr. Nayak said. “It just seemed like it was largely unnoticed by the state—probably because it is such a small area and a small population.”
Dr. Nayak, the co-medical director of health equity at Confluence Health, has worked to make sure state officials take notice, and supplied the Department of Ecology with the data that showed wildfire smoke was having an inequitable effect on the health of the community.
Confluence Health, which serves an area of more than 12,000 square miles in North Central Washington State, is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
“The data that I shared was hugely impactful in Wenatchee and East Wenatchee getting this designation which will allow our communities to have access to $10 million to help with addressing the health effects of wildfire smoke with more sensors for the area and more resources,” Dr. Nayak said.
To make its decision on which communities qualified as disproportionately impacted, Dr. Nayak added that officials also looked at other factors such as health, social and environmental inequities beyond just air pollution.
The state is in the process of determining how to allocate the funds which will be distributed in the form of monetary grants, according to the Department of Ecology.
Climate change is a health issue
There were 1,880 wildfires across Washington in 2023, the second-biggest total in state history, Gov. Jay Inslee wrote in a column on the state website. Citing a measurement the state uses to track airborne fine particulate matter from wildfire, he noted that the East Yakima U.S. Census tract registered a 4,986 “smoke score.” This was topped by the East Wenatchee tract, which had a score of 6,174. The statewide average was 2,289.
“People forget—this is a health issue,” the governor said. “People often think climate action is just about the polar bears.”
Globally, about 44 million people are exposed to unhealthy air quality due to wildfires, according to a recent JAMA Insights essay.
The state issued a previous report in the aftermath of a 34-day period of wildfires in Central Washington during fall 2012, which noted that air monitors in Wenatchee recorded the state’s highest levels of particulate matter.
Hospitals in the surrounding five counties saw a 28% rise in the average number of ED visits a day for cardiovascular disease and 18% more ED visits for respiratory disease while the fires were burning and a during a 19-day period after, compared with the average number of daily visits in the two weeks before the fires.
The report also noted that 86% of the visits studied occurred at the Wenatchee Valley Medical Center, which merged with Central Washington Hospital in 2013 to create Confluence Health.
“The overall increase in respiratory visits for all age groups combined was primarily due to the increases among children,” according to the report, which did not stratify patients by race or ethnicity.
In 2022, the AMA declared climate change a public health crisis that threatens the health and well-being of everyone. Climate change contributes to injuries and premature deaths related to extreme weather events as well as health-related deaths due to continued warming. To address this, the AMA adopted policy in support of the goal to “reduce U.S. greenhouse gas emissions aimed at a 50% reduction in emissions by 2030 and carbon neutrality by 2050.”
Addressing health inequities
While working on a community wildfire “vulnerability index,” University of Washington researchers learned that during 2014 wildfires in East and Central Washington, the state’s evacuation alerts were not given in Spanish and that the area’s only Spanish-language radio station didn’t receive any emergency notifications.
Located roughly midway between Seattle and Spokane, Wenatchee has a population of less than 35,000 and is about one-third Hispanic, according to Deloitte’s Data USA database.
“Our Health Equity Council had created a health equity dashboard in 2021 on which we were publishing certain health metrics stratified by ethnicity,” Dr. Nayak said. “We looked at all children with asthma in our region, and there's a higher percentage of them who are non-Hispanic versus Hispanic. But there’s a disproportionate percentage who have emergency department visits for respiratory problems with asthma who are Hispanic.”
Specifically, Dr. Nayak and colleagues found that 50.5% of their pediatric asthma patients are white children, compared with 37.6% who are Hispanic, but Hispanic children with asthma visited the emergency department 1.7 times as often as the others.
“There were disproportionately higher rates of emergency department visits for Hispanic children with asthma in my community, which doubled during a bad wildfire season affecting our region,” she said.
To address this, Confluence Health launched the Pediatric Asthma Equity Action Project to help patients with asthma and restrictive airway disease maximize their health. The efforts include providing the parents of every child with these lung conditions with educational materials in electronic and print formats, in English and Spanish. The materials include a wildfire-season asthma action plan, teaching them how to keep their children as safe as possible.
Confluence Health also provided these materials to other health care and community organizations.
“This is all new—it's really never been done before,” Dr. Nayak said. “It really is somewhat new public knowledge compared with when we had the bad wildfire smoke in 2012, there really wasn't much information available publicly then about the health effects of wildfire smoke.”
Typically, the Pacific Northwest wildfire season occurs in August and September, but Dr. Nayak said this summer, the fires started in July.
“It’s already smoky and there are several fires going,” she said. “The good news is that the community has become more prepared for wildfire smoke with fire management, and they're doing an amazing job locally.”
Because public health departments in sparsely populated areas often lack resources, Dr. Nayak said rural health systems can have a bigger role to play in population health and health equity efforts than their urban counterparts.
“The use of a health equity dashboard to stratify health metrics by race, ethnicity and other demographic categories can be very helpful for improving the health of one's own region or community because no one else may be doing that,” she said. “Physicians and medical centers can have a huge impact on the health of their communities by doing this health equity work.”
