Purpose of Review: Increasing wildfire size and severity across the western United States has created an environmental and social crisis that must be approached from a transdisciplinary perspective. Climate change and more than a century of fire exclusion and wildfire suppression have led to contemporary wildfires with more severe environmental impacts and human smoke exposure. Wildfires increase smoke exposure for broad swaths of the US population, though outdoor workers and socially disadvantaged groups with limited adaptive capacity can be disproportionally exposed. Exposure to wildfire smoke is associated with a range of health impacts in children and adults, including exacerbation of existing respiratory diseases such as asthma and chronic obstructive pulmonary disease, worse birth outcomes, and cardiovascular events. Seasonally dry forests in Washington, Oregon, and California can benefit from ecological restoration as a way to adapt forests to climate change and reduce smoke impacts on affected communities.Recent Findings: Each wildfire season, large smoke events, and their adverse impacts on human health receive considerable attention from both the public and policymakers. The severity of recent wildfire seasons has state and federal governments outlining budgets and prioritizing policies to combat the worsening crisis. This surging attention provides an opportunity to outline the actions needed now to advance research and practice on conservation, economic, environmental justice, and public health interests, as well as the trade-offs that must be considered.Summary: Scientists, planners, foresters and fire managers, fire safety, air quality, and public health practitioners must collaboratively work together. This article is the result of a series of transdisciplinary conversations to find common ground and subsequently provide a holistic view of how forest and fire management intersect with human health through the impacts of smoke and articulate the need for an integrated approach to both planning and practice.

Cooling centers have played a significant role in reducing the risks of adverse health impacts of extreme heat exposure. However, there have been no comparative studies investigating cooling center preparedness in terms of population coverage, location efficiency, and population coverage disparities among different subpopulation groups. Using a catchment area method with a 0.8 km walking distance, we compared three aspects of cooling center preparedness across twenty-five cities in the U.S. We first calculated the percentage of the population covered by a single cooling center for each city. Then, the extracted values were separately compared to the city’s heat indexes, latitudes, and spatial patterns of cooling centers. Finally, we investigated population coverage disparities among multiple demographics (age, race/ethnicity) and socioeconomic (insurance, poverty) subpopulation groups by comparing the percentage of population coverage between selected subpopulation groups and reference subpopulation groups. Our results showed that cooler cities, higher latitude cities, and cities with dispersed cooling centers tend to be more prepared than warmer cities, lower latitude cities, and cities with clustered cooling centers across the U.S. Moreover, older people (≥65) had 9% lower population coverage than younger people (≤64). Our results suggest that the placement of future cooling centers should consider both the location of other nearby cooling centers and the spatial distribution of subpopulations to maximize population coverage and reduce access disparities among several subpopulations.

Prescribed burning can mitigate extreme wildfire risk and reduce total smoke emissions. Yet prescribed burns’ emissions may also contribute to smoke exposures in nearby communities. Incorporating public health considerations into forest management planning efforts may help reduce prescribed burn-related exposure impacts. We present a methodological framework linking landscape ecology, air-quality modelling and health impact assessment to quantify the air-quality and health impacts of specific management strategies. We apply this framework to six forest management scenarios proposed for a landscape in the Central Sierra, California. We find that moderate amounts of prescribed burning can decrease wildfire-specific PM_2.5 exposures and reduce asthma-related health impacts in the surrounding region; however, the magnitude of that benefit levels off under scenarios with additional prescribed burning because of the added treatment-related smoke burdens. This framework can be applied to other fire-prone landscapes to incorporate public health considerations into forest management planning.

Wildfires, prescribed burns, and agricultural burns all impact ambient air quality across the Western U.S.; however, little is known about how communities across the region are differentially exposed to smoke from each of these fire types. To address this gap, we quantify smoke exposure stemming from wildfire, prescribed, and agricultural burns across Washington, Oregon, and California from 2014 to 2020 using a fire type‐specific biomass burning emissions inventory and the GEOS‐Chem chemical transport model. We examine fire type‐specific PM_2.5 concentration by race/ethnicity, socioeconomic status, and in relation to the Center for Disease Control's Social Vulnerability Index. Overall, population‐weighted PM_2.5 concentrations are greater from wildfires than from prescribed and from agricultural burns. While we found limited evidence of exposure disparities among sub‐groups across the full study area, we did observe disproportionately higher exposures to wildfire‐specific PM_2.5 exposures among Native communities in all three states and, in California, higher agricultural burn‐specific PM_2.5 exposures among lower socioeconomic groups. We also identified, for all three states, areas of significant spatial clustering of smoke exposures from all fire types and increased social vulnerability. These results provide a first look at the differential contributions of smoke from wildfires, prescribed burns, and agricultural burns to PM_2.5 exposures among demographic subgroups, which can be used to inform more tailored exposure reduction strategies across sources.