OPINION: PNW Wildfires Threaten Health Equity, Especially if You're Pregnant

by Megan Burbank

As we prepare for this summer's wildfire season in King County and throughout the state, it's essential to track disproportionate impacts on People of Color, folks living in poverty, young children and older adults, and people with underlying health conditions, like asthma and cardiovascular disease. These impacts are well-documented, but a new report shows that pregnant people are also at risk when air is unhealthy to breathe, and the toll can be even greater when other factors, like poverty, converge with expecting a baby.

According to the American Lung Association's latest "State of the Air" report, which tracks air quality from 2018 to 2020, unhealthy air can make pregnant people more vulnerable to pregnancy-related health conditions. Air pollution exposure can cause inflammation and "oxidative stress," which can in turn impact fetal development and potentially trigger hypertensive disorders, like preeclampsia. Long-term exposure to unhealthy air is also linked to premature birth and low birth weight.

This isn't unexpected: Anyone who coped with last summer's horrific heat-wave-slash-wildfire Venn diagram could tell you smoke season is bad for everyone, whether you're pregnant or not. But it's notable that the ALA's report now includes a fuller picture of the impacts of air pollution on maternal health, especially as the Northwest faces potentially worse fire seasons in the years to come.

Take what happened in 2020. If that fire season seemed especially bad, that's because it was. According to the "State of the Air" report, wildfires in the western United States have increased the number of days people must live with unhealthy air quality. They've also worsened existing air pollution. Although the Northwest isn't majorly impacted by ozone pollution, which is typically caused by industry and vehicles and results in smog, counties and cities in Washington State placed, according to the ALA's metrics, among some of the worst places in the country for short-term particle pollution — that is, temporary increases in pollution versus ongoing exposure to contaminants.

Five Washington cities were listed among the top 25 in the United States for this type of short-term pollution: Yakima, Seattle, Spokane, Vancouver, and Bellingham. Okanogan County and Yakima were also cited for both short-term and year-round unhealthy air.

This concentration is part of a major shift in air quality in the West more broadly: Nine cities in the ALA's top 25 worst for short-term particle pollution were in the Pacific Northwest in the latest report, with the majority of remaining cities in California and the Southwest. The ALA attributes this geographic concentration to the development of more frequent and larger wildfires due to higher temperatures and drought conditions driven by climate change.

Wildfires are generally framed as an environmental issue, but their impact on pregnant people and marginalized communities shows they're also a matter of reproductive health, access, and equity. The ALA's report found that nationally, People of Color were 3.6 times more likely than their white peers to live in a county with failing air quality grades. Living in poverty also correlated with increased exposure to pollution, fewer resources for avoiding that exposure, and reduced access to health care. For pregnant people, particle pollution from wildfires is closely linked with premature birth, low birth weight, and stillbirth. And if a pregnant person is likely to be disproportionately impacted by air pollution for reasons other than pregnancy, those risks are elevated.

The typical advice for getting through wildfire season may not help matters. Staying indoors may not be an option for folks who work outside or don't have the space or resources to set up a sealed-off clean room. Finding ways to cope can be even more challenging when smoky skies collide with extreme heat of the kind Seattle experienced last summer, when temperatures hit 108 degrees and people resorted to lining their windows with tinfoil or, if they could afford to, seeking relief at nearby air-conditioned hotels.

But many don't have that luxury, and it shouldn't be left up to individuals to mitigate the fallout from climate change. Among the recommendations in the ALA's report is that cities and counties develop climate action plans to reduce overall emissions and establish zero-emission-vehicle infrastructure. These efforts, the report says, should also "include measures to address the impacts of climate change on residents, including health impacts."

Wildfires are a microcosm of the way climate change can negatively affect reproductive health and exacerbate existing health conditions and economic disparities. Managing the harm wildfires cause annually in our region requires addressing climate change head-on. But we also need to take an honest look at the existing inequities fire season simply amplifies, including who gets to have a healthy pregnancy and who doesn't.

Featured Image: Illustration bypancha.me/Shutterstock.com; photo editing by the Emerald team.