Sep. 2023 Science Corner | In their own words-What the California health sector can tell us about wildfire smoke impacts and opportunities for cross-sector collaboration

Report Authors: Teresa Feo, Kim Seipp, Signe Stroming, Kirsten Hodgson, Clare Loughlin, and Phil Saksa

Science Corner by: Kirsten Hodgson and Signe Stroming

“Where there’s smoke, there’s fire,” the old saying goes. Yet, smoke can and does travel long distances from fire. From the “orange day” in San Francisco, to smoke choking Seattle, and this year’s haze enveloping New York and Washington DC, we are increasingly seeing how smoke can directly impact people far away from wildfires themselves.

This is just one dimension of why health impacts from wildfire smoke (a product of smoke emissions, dispersion, and exposure, as depicted below) are estimated to be in the billions of dollars, making smoke-related health impacts potentially the single largest cost of wildfires.

Much of our work at Blue Forest is focused on understanding, communicating, and quantifying the multiple benefits of healthy forests, and then facilitating collaboration between land managers and the groups that benefit from management or restoration work. While the bulk of our work thus far has focused on fire risk reduction and water benefits of resilient forests, it’s increasingly clear that we need to consider the potential human health benefits as well. If forest management can deliver benefits to human health through improved smoke outcomes, that means the health sector has a stake in improved forest health and reduced fire risk in forests both near and far from the populations they serve. Before engaging health sector groups in forest management projects, we wanted to hear their perspectives on wildfire smoke and forest management.

As part of our recently published peer-reviewed study, The Human Health Benefits of Improved Forest Management, co-produced with The California Council on Science & Technology (CCST), our team at Blue Forest had the opportunity to interview 60 people representing organizations across California’s health sector. We asked them to share how they are impacted by wildfires and wildfire smoke and we explored what cross-sector collaboration could look like between the health and forest management sectors. In this piece, we share quotes from four interviewees who work in California’s health sector, and we reflect on how these insights relate to Blue Forest’s ongoing and future work and priorities.

1. On health and health sector impacts of smoke

“What we’ve seen is an increase in frequency and duration [of wildfires]. So you have an entire population of folks just consumed by the thickest smoke you could possibly imagine, for months on end, and it settles in these valleys and just stays there. And so you have people with pre-existing conditions, that have asthma or COPD, and that gets exacerbated, which does strain our operations. And as you can imagine, too, the smoke infiltrates into our buildings. So you’re attempting to provide care in an environment that is potentially unsafe to people that are already sick.”

– Health System Interviewee [Q2, id096]

It’s undeniable that wildfire smoke impacts human health. The acute impacts and differences in relative vulnerability to wildfire smoke-related health impacts are well understood and documented in the literature. Yet, we are just now learning about the ways in which smoke also impacts the healthcare industry, public health departments, and even health insurance companies.

In our interviews, we heard about how challenging it is to provide care to patients when hospital staff are experiencing smoke impacts themselves and when facility air filtration can’t keep up with the smoke. Many interviewees representing health systems told us about current efforts to upgrade air filtration systems in their facilities and even additional staff training for managing respiratory health issues in light of smoke impacts.

Our report describes a wide array of smoke-related impacts described by people working in public health, health systems, and health insurance, making it an important source of information for government and leadership to provide additional resource inputs and guidance to these health sector groups to prepare their organizations and communities for smoke events. Capturing the types of impacts experienced by the health sector is also an important input for researchers and interested parties who aim to track and quantify the costs of these wildfire smoke impacts.

2. On (not) tracking the costs of wildfire smoke

“When you’re kind of dealing with the tyranny of the urgent in a small hospital during a wildfire event, then you’re just not necessarily calculating, doing anything more than you have to do.”

– Health System Interviewee [QA12, id423]

Given the breadth and detail of smoke impacts described by interviewees, we were surprised by how rarely these smoke impacts or costs were being monitored by the organizations that are directly impacted. This could be for several reasons, including that tracking impacts from a complex, multifaceted event like wildfire smoke is complicated; that doing so requires resources, capacity, and expertise; and that the groups who are most impacted by wildfire smoke are also the most busy during wildfires and smoke events, prioritizing the well-being of their patients, staff, and communities.

Because these impacts are not being tracked, we do not know what their true costs to human health and to health system organizations are. The estimates that do exist are likely conservative but show that wildfire smoke impacts may be the largest impacts of wildfires. These impacts are costly for individuals, communities, and health system organizations; and conversely, reduced fire risk due to forest management activities could represent a massive cost reduction and benefit to these same groups. To fully understand the potential health benefits of decreased wildfire smoke to these groups, we must quantify the value of the current impacts of wildfire smoke.

Understanding the smoke-related impacts that health sector organizations are commonly experiencing can help to motivate groups to explore these costs, which will likely be a collaborative effort requiring data, resources, expertise, and interest from various participating groups.

3. On information needed to facilitate cross-sector engagement

“We haven’t as a society… done a great job of quantifying health impacts based on smoke events, or other sorts of environmental issues. So, I think the key for the healthcare system writ large is really connecting those dots. I think it’s evident to people that these things happen, but not tangible.”

 – Health Insurance Interviewee [QA19, id845]

In the literature review portion of our study, we found that there is growing evidence to support the idea that forest management – even including the use of beneficial fire, which itself emits smoke – can benefit human health via reduced overall smoke exposure. If forest management leads to net improvement in smoke outcomes, and therefore decreased health impacts, there is an opportunity for the health sector to engage with forest management in a way that benefits both forest health and human health.

The goal of collaborative engagement is not for those in the health sector to make technical decisions around forest management activities, but instead an opportunity to support, promote, and provide perspectives that can lead to improved outcomes for all. Potential avenues for this  engagement include advocating for accelerated work, sharing information about forest management and wildfire smoke preparedness with the public, and even cost-sharing of restoration projects to help avoid the otherwise high costs of unmitigated wildfire smoke.

Most of the groups we spoke with acknowledged this connection and expressed enthusiasm for the possibility of expanded collaboration between the sectors, but they identified key information needs that could help to support this collaboration. Key among these identified information gaps was a need for information demonstrating that wildfire smoke is currently having a detrimental impact on health sector organizations, through impacts to their operations and their populations of service, and that engagement with forest management will pay dividends in reduced health impacts and reduced costs to these organizations. Quantifying the costs of wildfire smoke events is one part of this, but many people will need to work together to start to fill these knowledge gaps and build a foundation for greater collaboration.

4. On structures and roles in wildfire smoke response

“People start looking at each other in government. They’re like, ‘what do you do about this?’… It sort of became clear to me that maybe public health is kind of the gravitational center of that [wildfire smoke] response, even though, a priori, we hadn’t been really tasked with that explicitly, nor had we been given tools to do that.”

 – Public Health Interviewee [Q16, id877]

Quotes like this one capture another point-of-view expressed by our interviewees: as impacts from wildfire smoke become more widespread, there is a need to establish clear roles, responsibilities, and avenues for collaboration. And, it’s increasingly clear that the health sector must be part of that conversation, because in reality, they already are.

In our report, we recommend that additional evidence-based best practices for wildfire and wildfire smoke response should be prepared for the health sector (Recommendation #18) and that California and the federal government should encourage and enable health sector participation in forest management advisory bodies to strengthen links between public health and forest management planning and practice (Recommendation #34).

Closing thoughts

Blue Forest and CCST’s recent report lays the foundation for future work increasing the connections between human health and forest health. This work will include new research, data, and tool development as well as practical models and examples of greater engagement and collaboration.

Our report shows that the impacts of wildfire smoke to human health and the health sector are varied and growing. But, because these impacts have not yet been quantified, we still don’t know the true costs of wildfire smoke to health. In the literature review portion of the report, we found  evidence suggesting that improving forest health can benefit human health as well, yet we also learned that this is a new and growing area of research. It’s telling that most studies we found on the potential human health benefits of forest management were published in the last two years.

Strengthening our understanding of both the costs of wildfire smoke to human health and the health sector and the potential health benefits of improving forest management are critical inputs for Blue Forest as we continue in our goal to innovatively engage new partners and beneficiaries to promote more resilient forests and healthier communities.