Aug. 18, 2021

SOS! Summer of Smoke, lessons learned from the Northwest Territories

UCalgary research finds advance planning decreases anxiety and increases feelings of empowerment
Intense fire seasons in the north informed the recommendations of researchers to help mitigate the impacts of future fires.

In 2014, much of the Canadian Arctic including the Northwest Territories (N.W.T.) experienced an intense fire season that led to people being exposed to one of the most prolonged smoke exposures ever recorded. The N.W.T. is known to have one of the best air quality ratings in the world. During the summer of 2014 the daily mean measurement of particulate matter peaked at more than ten times the World Health Organization's 24-hour mean air quality threshold.

Celebrating a first birthday party in a Yellowknife park during a particularly smoky summer.

After a month and a half of sheltering inside as a result of wildfire smoke, Dr. Courtney Howard, MD, and her pediatrician husband gathered in a Yellowknife park with their closest friends and family to celebrate their daughter Vivi’s first birthday. As a blanket of smoke curled around the edges of the playground, a few realizations set in; wildfire advice designed for short smoky periods is hard to follow for months at a time, this summer fire and smoke season was unlike any they had seen before, and the situation surely must be taking a toll on the physical and mental health of the population.

The UCalgary researcher and emergency physician found that she was seeing many patients with asthma in the ER. She wanted to find out as much as she could about the impact the climate event was having on the mental and physical health of the members of her community and on the relationships within that community.

Howard partnered with the Yellowknives Dene, the Ka’a’ga Tu First Nation, and researchers from across Canada including Dr. James Orbinski, MD, inaugural Director of York University’s Dahdaleh Institute for Global Health Research. Together, they built a team of investigators with local and national collaborators and received funding from Health Canada. Their study results were recently published in the medical journal BMJ-Open.

Significant Health Effects

The findings provided insights that could help health-care systems and individuals better cope with fire season.

Courtney Howard

Courtney Howard collaborated on a study to provide insights to help health-care systems and individuals better cope with fire season.

“The two-and-a-half-month-long wildfire smoke exposure was associated with a doubling of emergency room visits for asthma and a 57 per cent increase in visits for pneumonia,” says Howard, first author on study. “ER visits for asthma were higher in Dene people. There was an increase in primary care visits for asthma, pneumonia and cough compared to previous summers and a 48 per cent increase in community dispensation of salbutamol, a medication given to ease breathing.”

Interview data showed people had frequent feelings of isolation, fear, stress, and anxiety. They described extended time indoors, and disruption of traditional land-based activities. In many communities, neighbours checked on Indigenous Elders, and decision-makers waved fees for clean air shelters to provide well-filtered recreation spaces to encourage physical activity.


For many people, the summer represented a sentinel event that changed their understanding of the impact climate change is likely to have on their and their children’s mental and physical health, generating feelings of ecological grief and ‘eco-anxiety’.

Preparation is empowering

People who were better informed about protecting their homes from fires and who had a well-defined evacuation plan were not only better prepared on a practical level, but also expressed feelings of empowerment and decreased anxiety.

We have entered the age of converging planetary health emergencies. To respond meaningfully, we must work to adapt to the already very real planetary health impacts of ecological change, and simultaneously work to mitigate and radically reduce greenhouse gas emissions enough to keep impending future impacts to a manageable and sustainable minimum,” says Orbinski, principal investigator on study. “We must view all of this work through an equity lens and decrease the impacts of colonialism and discrimination as we build the systems we need to keep human beings and our biosphere healthy into the future.

The Summer of Smoke

As a result, Howard and the research team formulated a set of recommendations for health-care providers and policy makers, in hopes of mitigating the impacts of future fire seasons. These include:

  • pre-stocking higher volumes of asthma medications
  • making HEPA filters available to vulnerable patients
  • ensure residents understand the Air Quality Health Index (AQHI) and how it applies to them
  • ensure evacuation or shelter-in-place plans are well-communicated to populations before wildfire activity begins and are accessible to all.

 “Almost every media interview I’ve ever done about wildfires has contained the question, ‘So Doctor, are we at a new normal?’ The answer is no. We are not at a new normal. We’re already 2.5 degrees C warmer here than we were 70 years ago, and we know warming will continue until at least mid-century. Summers are going to get smokier for at least the next 20 to 30 years. The smoke will only level out if we emergently decrease greenhouse gas emissions now,” says Howard.

Ecology North, a charitable, non-profit environmental organization based in Yellowknife that supports sound environmental decision-making, also produced a Summer of Smoke documentary film, focused on the personal impacts for several of the affected Indigenous communities.

Courtney Howard, MD, is a clinical associate professor with the Department of Family Medicine at the Cumming School of Medicine and is an Emergency Department physician in Yellowknife.

This work is the final product of a years-long Health Canada-funded collaboration between the Yellowknives Dene First Nation, the Ka’ga’a Tu First Nation, Ecology North, Yellowknife physicians, and academics from southern Canada. The team would like to thank the late Doug Ritchie, an inspirational member of the northern community, for setting this project in motion.