Coping with the health impacts of wildfire in Northwest Territories

In 2020 a team led by Yellowknife physician Dr. Courtney Howard, supported by Yellowknife-based ENGO Ecology North and researchers from the University of Waterloo, completed a project called Summer of Smoke (SOS). Through this, qualitative and quantitative reports were published outlining the effects of major wildfires in the Northwest Territories on its citizens as well as practical actions that can be taken such as improving communication between public health organizations and the public. The qualitative report, entitled ‘Lived Experience of a Record Wildfire Season in the Northwest Territories, Canada’ considers the lived experience of a variety of community members across four locations in the Northwest Territories (Yellowknife, N’Dilo, Detah, and Kakisa) after the wildfire season in the summer of 2014. While no one was directly injured by the wildfires, thick smoke was seen to have major effects on livelihood, mental health, and physical health. Following an in-depth review of themes arising from various semi-structured interviews across the four locations the report provides recommendations for change in order to strengthen community resilience in future events. These recommendations include improved coordination of community-based education, a greater degree of communication between public health agencies and the public as well as inclusive adaptation initiatives. The quantitative study entitled ‘SOS! Summer of Smoke: A retrospective cohort study examining the cardiorespiratory impacts of a severe and prolonged wildfire season in Canada’s high subarctic’ was published 2 years after the qualitative study and details increased instances of hospital visits, primary care visits, and medication dispensation related to respiratory illness following the 2014 wildfire event. This led authors to recommend a series of mitigation and adaptation measures to reduce the negative health impacts of extended periods of exposure to poor air quality deriving from wildfire events.

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Understanding and Assessing Impacts

The quantitative and qualitative SOS studies understandably take different approaches to understanding the impacts of the Northwest Territories 2014 wildfire season. The qualitative SOS report utilized a three-pronged vulnerability framework in order to understand the impacts of wildfire smoke on four Northwest Territories communities. The framework included considerations related to exposure, sensitivity, and adaptive capacity. In this instance exposure refers to specific health outcomes related to the wildfires; sensitivity considers the ability of all involved to address the severity of exposures; lastly, adaptive capacity speaks broadly to the preparedness, approach and adaptive ability of all actors to the health and livelihood effects associated with wildfire and smoke. The aforementioned framework was applied to a series of semi-structured interviews conducted by the research team along with community coordinators. These interviews had the effect of shedding light on myriad ways that the population was affected by prolonged periods of severe smoke cover. Some of these included feelings of isolation and limitations on traditional practices. Quantitative research utilized air quality data from the summers of 2012 and 2013 as a baseline to compare against those of 2014. In particular, the study focused on levels of PM2.5 – fine particulate matter known to cause respiratory issues if inhaled – over various time spans. The study also considered hospital visit information from the Stanton Territorial Hospital, rates of dispensation of respiratory medication (salbumatol) as well as the number of primary care visits in a given wildfire season. Increased need for respiratory medication as well as more frequent access to medical care for difficulty breathing was seen in during the 2014 event. The report anticipates that such record wildfire events will persist in the future, becoming less anomalistic.

Identifying Actions

While the planning phase is somewhat informal in the case of the qualitative study, actions were inspired by responses given throughout the aforementioned semi-structured interviews which were then inputted into a software program called QSR NVivo 11. As mentioned, research was conducted, and information was gathered for the qualitative report using a vulnerability framework which highlights considerations related to sensitivity, exposure and adaptive capacity. The software package organized interview information based on previously agreed upon themes. After processing the information through the software, new themes, which were generated by the software were considered through consultation with relevant stakeholders. These themes helped to systematically organize qualitative information provided throughout the interviews and to clarify main points of concerns among citizens as well as to identify service gaps. Through the analysis of themes potential actions were identified such as the introduction of more comprehensive and clear adaptive planning measures (ie: well promoted private vegetation and brush clearing initiatives), greater communication from public health agencies as to the risk associated with wildfire and smoke such as through accessible public education initiatives and smoke forecasting, as well as an acknowledgement of the importance and incorporation of place-attachment considerations in future adaptive planning. Through their study of baseline (2012-2013) and 2014 particulate matter concentrations, the quantitative SOS study found that concentrations seen in 2014 (up to 5-times higher than previous years) would have negative effects on indoor air quality. Further, interviewees in the qualitative study expressed the importance of preparation during these events in order to reduce anxiety and increase safety. For these reasons, the quantitative study recommended taking action to improve indoor air quality as well as the proactive dispensation of asthma-reliever medications to vulnerable populations.

Outcomes and Monitoring Progress

Although the actions identified by both the quantitative and qualitative SOS reports have largely not been implemented, the most significant response to the report comes in the form of a document published by the Government of the Northwest Territories entitled: Smoke Exposure from Wildfire: Guidelines for Protecting Community Health and Wellbeing. This document is in direct response to the abnormally acute wildfire season of 2014 in the Northwest Territories. The document provides practical guidance for public health agencies as well as monitoring and emergency response organizations. While the guideline acknowledges the work being done by the SOS project, it was published prior to the publication of the SOS project and so doesn’t directly address their identified actions. While this guideline provides advice and some clarity to public health and emergency response groups it falls short on identifying how this information will reach those who need it or how improvements to wildfire response systems will be funded. In terms of co-benefits, the qualitative SOS report has also reinforced the importance of community and traditional practices through their findings in addition to providing practical advice on adaptive measures. This said, widespread changes to the Northwest Territories wildfire response system may be slow to come. This may be due in part to language used in the guideline which firmly identifies severe wildfire events as a rare occurrence and so may reduce the urgency for change. Further insight from the quantitative SOS report highlights that in and out-migration of populations during major wildfire events may have an effect on the accuracy of the reported quantity of those affected, however, due to the large changes in instances of respiratory medication dispensation (48% increase in the summer of 2014) and other variables, general effects can be ascertained with a high level of certainty.

Next Steps

The most apparent next steps in the case study are to implement actions identified by both the quantitative and qualitative reports as well as to find ways to operationalize suggestions provided by the Government of the Northwest Territories. The actions identified by the qualitative report look to address the effects of wildfire and smoke prior to, during, and following wildfire events through preparation, communication and consultation. The quantitative report suggests pre-emptive inhaler prescriptions where appropriate as well as improved ventilation systems for those expected to remain indoors for extended periods during wildfire and smoke events. Information offered by the guideline (Smoke Exposure from Wildfire: Guidelines for Protecting Community) including insight into the nature of air contamination should be shared with the public in preparation of future events. Information related to operational improvements within the guideline should be shared widely with public health and emergency response agencies in the area in order to increase preparedness. However, this information must also be paired with funding in order to ensure implementation. Budget shortfalls are currently prevalent in relation to emergency response to wildfires in the Northwest Territories as they are not designed to address wildfire events of the scale described in this case study. Therefore, budgetary issues will prove to be a major barrier to next steps. Iteration will likely be necessary as more is understood about the nature of wildfire related health effects.