As extreme weather continues to worsen and the danger of wildfires increases, researchers are finding the impacts go far beyond damage to physical structures. A new paper published by Fedcap’s Community Impact Policy Institute looks at the dangers for schools and daycare facilities, many of which are not equipped to filter the fine particulate matter in wildfire smoke. Using childcare facilities as a case study, this paper examines how programs in Arizona, Oregon, and Massachusetts directed limited resources toward building improvements and what those efforts reveal about the support needed to achieve meaningful progress, particularly for low-income communities. Spotlight spoke with two of the paper’s authors, Julie Abrams and Angie Im of Healthcare Ready. The transcript has been lightly edited for length and clarity.
Why don’t we start with a general introduction to Healthcare Ready and your new relationship with Fedcap?
Julie Abrams: Healthcare Ready is a nonprofit focused on keeping people connected to healthcare before, during, and after disasters. We bring together government, healthcare providers and the private sector to protect access to medications, supplies, and care. We were founded in the wake of Hurricane Katrina to make sure that the private sector and the public sector were not only talking to each other but talking the same language. Healthcare Ready came in to translate what was being asked and requested so that we can connect all of those dots for everyone.
I lead the overall organization with a focus on overall preparedness, response and resilience work. And then Angie leads all of our research and policy work. There's a lot going on and we're a very small team. There's only five of us, including myself and Angie. So, we're very, very nimble and able to pivot quickly and focus on what's happening in the world of disasters.
And you’re new to Fedcap?
Yes, we are. We officially became part of Fedcap earlier this year, and it's a great opportunity. What it does at the end of the day is connect our operational experience with a much, much broader network that's also focused on health, education, and workforce development, as well as policy. And it's a great opportunity to turn what we're learning during emergencies into stronger systems before the next crisis hits. It also really, really strengthens our overall research and policy arm through the work with the Community Impact Policy Institute.
Angie, would you like to talk a bit about the current paper you’ve been working on and which has just been published?
Angie Im: So, obviously we've had an unprecedented summer when it comes to heat and wildfires. I say unprecedented, but this is a pattern that we're seeing each year now. And so, one of the things that we wanted to explore was the connection between wildfires, wildfire smoke that's produced, and the intersection with children, particularly young children in schools and daycare centers. In this paper for CPI, we focus on indoor air quality.
And just in general terms, how does wildfire smoke impact an indoor environment for kids?
Abrams: The extreme heat coupled with prolonged dry conditions create and allow wildfires to spread more rapidly and more readily. But the smoke problem goes beyond the actual fire itself. It can travel hundreds or thousands of miles from where it originated and enter these buildings through windows, doors, and ventilation systems. And so just simply moving indoors isn't enough if the inside air quality isn't actually cleaner than it is outside. And that's what makes the filtration and the building readiness, the building infrastructure readiness, and having clear smoke response plans an essential part of the overall preparedness in general, but specifically for childcare centers, daycare centers and schools.
We know that young children are especially vulnerable to wildfire smoke because their lungs are still developing and they breathe more air relative to their body weight than adults do. Smoke contains these very, very small particles that can penetrate deep into the lungs. And any kind of exposure, especially prolonged exposure, can cause coughing, wheezing, irritation within the eyes, asthma flare-ups, and even more serious breathing problems that can require urgent medical care. Children with asthma and other chronic conditions need particularly close attention, but for any child, breathing in these particles can have immediate and prolonged effects
Angie, anything you’d like to add to that?
Im: Sure. Speaking of immediate and prolonged health effects, one of the reasons why we're also focusing on young children is that there are implications for cognitive impairment in children when they face poor air quality. Poor indoor air quality specifically is associated with impacts on learning and memory, and there's also a connection with school absenteeism—obviously you think about the impact on working families when children miss school or if the school temporarily closes.
And are pediatricians already beginning to see evidence of this?
Im: There's a lot more data coming out more recently, as you can imagine. And that includes data showing a connection in increased medication interventions for young children who are near wildfires, such as more inhaler use. Following the San Diego wildfires a few years ago, there was a study connecting increased emergency department visits for children who have asthma, as well as adults who have asthma.
So, more to the heart of your paper, obviously most schools and daycares were not built with the threat of increasing wildfires in mind. What do facilities need to have in this era? And are there some examples that you can point to of states that are sort of developing best practices that you want to highlight?
Im: So, we think about it in terms of three layers of protection. First are engineering controls, the physical practices that we use to control indoor air quality. The second is administrative control, which are the steps that building operators take to determine how facilities respond when an event happens. And personal protections are the final layer when those building level measures are insufficient. As Julie mentioned earlier, more ventilation is not the solution. During a smoke event, you need increased filtered air, so that requires building controls. And facilities need to know how to respond specifically when an event is about to occur.
So, Angie, are there places that are doing this the right way, who are getting ahead of the curve that can serve as examples for other localities, states, and/or municipalities?
Im: There are no comprehensive solutions out there that address every single thing. But there are a few programs that have made advances, and I want to highlight two in particular. In Arizona, their program really demonstrates what temporary pandemic funding accomplished. What happened is the pandemic highlighted this focus on indoor air quality in schools and there was also simultaneous investment in childcare facilities—it provided around $60 million to almost 500 different childcare providers in creating thousands of new childcare spaces.
What's really interesting about Arizona's program in particular is that it showed what a large, targeted investment can accomplish. The state paired funding with unusually extensive technical assistance, including bilingual materials, office hours, facility guidance, contractor information, and project management support. And this really highlighted one of the barriers to improvements overall for both schools and childcare centers, which is there's just not enough funding. The issue in Arizona is that it’s time-limited; a lot of that funding came from temporary pandemic support, so those investments are primarily ending this year.
My other example, Massachusetts, demonstrates how to sustain that investment. Its current capital plan includes nearly $57 million targeted largely towards facilities serving lower-income children. One highlight from the Massachusetts program is that first of all, it treats childcare buildings as essential public infrastructure as the Arizona program did, but it specifically also funds HVAC systems, windows, classroom renovations. The Arizona program did as well, but it wasn't a particular focus of that program.
The Massachusetts program is being sustained by being incorporated as part of the state's capital plan. What's great about both programs is that they both targeted facilities that serve lower-income children, which is a big problem overall. Poor indoor air quality or a bigger infrastructure gap, let's say, is primarily associated in areas that have lower-income families or among communities that face multiple environmental hazards, poor indoor air quality being one of them.
And Angie, if you could wave your magic wand and create legislation or best practices for states that are interested in making changes in this area, what are the key policy levers that you would suggest that they look at?
Im: States can establish clear indoor air standards, require HVAC inspections and response plans, and make air quality information publicly available. And there is a blueprint that exists called the Model Clean Indoor Air Act. States can adopt the full framework or begin with individual provisions that address each of these areas that I just mentioned.
Is that a framework that has been offered as legislation or it's just a framework of policy suggestions?
Im: It can be adopted in part or in whole. It’s written so that it can be reframed or revised for legislation.
And is there any legislation at the federal level that's addressing these issues or proposed legislation?
Im: In 2024, there were increased air standards that were put in place to provide guidance for buildings and manufacturers. In 2025, those environmental regulations were rolled back. So, the simple answer is no.
And I guess this issue would play a role in training people who are working in childcare facilities on a variety of levels, including to have a greater understanding of how HVAC systems work, what you need to do if there is an increased threat, and also to be able to recognize the symptoms of potential impact on the kids that you're serving.
Im: That's a great point. At Healthcare Ready, one of the things that we always think about in any kind of disaster is really who is going to be the most impacted? And I think that what you point out is one practice that all practitioners and teachers should be aware of is that when something happens, which of the kids are most susceptible.