The morning I drive through Bella Coola Valley, the mountains have disappeared. Smoke from the Twist Creek wildfire—still burning over 22,000 hectares to the east—has settled into the valley like a woolen blanket. Only the nearest trees remain visible, their outlines ghostly against the sepia backdrop.
“It’s been like this for almost three weeks now,” says Ellen Champlain, a family physician at the Bella Coola General Hospital, as we sit in her modest office. The air purifier beside her desk hums continuously. “I’ve seen a 40% increase in respiratory complaints since June. People with no history of asthma are coming in wheezing. Elders who’ve never left their homes during previous summers are asking about evacuation options.”
What’s happening in this remote British Columbia community isn’t isolated. As Canada faces increasingly intense and frequent wildfire seasons, millions of Canadians are breathing smoke-filled air for days or weeks at a time. While the immediate evacuation orders and property destruction make headlines, the less visible health impacts of wildfire smoke are creating what researchers now call a slow-moving public health crisis.
Health Canada estimates that air pollution contributes to 15,300 premature deaths annually in Canada, with wildfire smoke becoming an increasingly significant contributor. During intense fire seasons, like 2023’s record-breaking summer when over 15 million hectares burned, nearly every province experienced hazardous air quality for extended periods.
“We’re talking about a complex mixture of particulate matter, carbon monoxide, nitrogen oxides, and volatile organic compounds,” explains Dr. Sarah Henderson, scientific director of environmental health at the British Columbia Centre for Disease Control. “But the biggest concern is PM2.5—particles small enough to penetrate deep into the lungs and enter the bloodstream.”
These microscopic particles—2.5 micrometers or smaller, about 30 times thinner than a human hair—bypass the body’s usual filtration systems. Short-term exposure triggers inflammation throughout the respiratory system, while longer exposures have been linked to more serious conditions.
“We’re only beginning to understand the full spectrum of health effects,” Henderson tells me. A study published in Environmental Health Perspectives last year found that emergency room visits in Western Canada increased by 4-10% during smoke events—not just for respiratory issues but for cardiovascular problems and even some mental health conditions.
The morning after our conversation, I meet Lloyd Williams, a 68-year-old member of the Nuxalk Nation, at the community garden where he volunteers. He gestures toward the smoke-obscured mountains where he once hunted and gathered traditional medicines.
“My people have lived with fire for thousands of years,” Williams says, his voice gravelly from what he describes as “summer smoke throat.” “But not like this. The elders say they’ve never seen fires this big or this frequent.”
Williams shows me the portable air quality monitor the band council purchased for the community center. It currently reads 157—well into the “unhealthy” range on the Air Quality Health Index. “We’ve hit over 300 some days,” he notes. “That’s when we tell everyone to stay inside, but houses here aren’t built for that. Many don’t have air conditioning or proper filtration.”
This situation highlights one of the most troubling aspects of wildfire smoke exposure: its unequal impact. Research from the University of British Columbia found that the most severe health impacts fall disproportionately on Indigenous communities, low-income neighborhoods, and rural areas—places often with fewer resources to mitigate exposure.
Dr. Courtney Howard, an emergency physician in Yellowknife and past president of the Canadian Association of Physicians for the Environment, has been documenting these disparities. “We’re seeing a pattern where the most vulnerable populations—including those with pre-existing conditions, pregnant women, children, and the elderly—face the greatest risks,” she explains over a video call.
Howard pulls up a map showing air quality readings across Canada during the 2023 fire season. “Look at these sustained readings in northern communities,” she says. “Many remote areas faced some of the worst air quality in the world for weeks, with limited access to healthcare or evacuation options.”
The health consequences extend beyond the immediately obvious. Researchers at McGill University recently published findings suggesting exposure to wildfire smoke during pregnancy is associated with higher rates of preterm birth and low birth weight. Meanwhile, emerging evidence from Simon Fraser University indicates potential links between smoke exposure and accelerated cognitive decline in older adults.
Back in Bella Coola, I visit the local school where principal Margaret Neilson shows me the modifications they’ve made for what she calls “the new normal.” The gym has been converted into a clean air shelter with hospital-grade filtration. Recesses are now held indoors when air quality deteriorates beyond certain thresholds.
“The hardest part is explaining to children why they can’t play outside for days or sometimes weeks,” Neilson says. “We’re raising a generation that might see outdoor summer activities as occasional privileges rather than everyday expectations.”
This adaptation is happening across Canada, though unevenly. Major cities like Vancouver, Toronto, and Montreal have established clean air shelters in community centers and libraries. The federal government has expanded the Air Quality Health Index monitoring network and improved public alert systems. But comprehensive policy responses remain fragmented.
Environment and Climate Change Canada reports that wildfire seasons are projected to lengthen by at least 30 days across most of Canada by mid-century, with fire intensity increasing by 25-75% depending on the region. The smoke from these fires doesn’t respect provincial or national boundaries—last summer, Canadian wildfire smoke triggered air quality alerts as far away as Europe.
“We need to approach this as both a climate adaptation and public health challenge,” says Dr. Howard. “That means better early warning systems, improved access to filtration technologies for vulnerable communities, and clinical guidelines for healthcare providers treating smoke-related conditions.”
As I prepare to leave Bella Coola, I notice Ellen Champlain checking the provincial wildfire service app on her phone. “Two new fires started overnight,” she sighs. “This is becoming our new seasonal illness—we prepare for it like flu season, except it keeps getting longer and more severe.”
The road out of the valley climbs above the smoke line. Looking back, I can see the community below, partially obscured by the haze that has become an unwelcome summer companion across much of Canada. The true scope of this slow-moving health crisis remains partially obscured as well—visible in emergency room data and air quality readings, but still developing in the bodies and communities breathing this altered air.
