Breathe Easy in Retirement

As I write this, ominous, silent claxons are sounding for yet another local "air quality" alert this summer. That means lung-stinging ozone and dangerous levels of particulate matter — combined with heat and wildfire smoke from Canada — make it unsafe for folks with cardiac and respiratory issues to spend time outside.

I love being outdoors, but this caution is more pronounced as wildfire smoke from Quebec blanketed the skies of the Eastern U.S. The crimson sunsets are breathtaking, although the air quality is dangerous. Where can I move to get away from this ill wind when I retire?

When retirees start shopping for an ideal retirement locale, their lists include the usual staples: sunshine, cultural amenities and access to health care. While these factors are important, few consider local air quality.

Yet climate change and the addition of millions more vehicles can degrade air quality, shortening lives and aggravating existing respiratory and coronary conditions. Although much progress has been made in improving the air we breathe since the passage of the Clean Air Act in 1970, air quality in some metropolitan areas has declined to such an extent that it regularly imperils public health.

According to the American Lung Association's latest "State of the Air" report, "nearly 36% of Americans — almost 120 million people — still live in places with failing grades for unhealthy levels of ozone or particle pollution." While this is nearly 18 million fewer people breathing unhealthy air compared to last year's report, it still sounds a siren for those who shouldn't be exposed to specific pollutants.

We used to take clean air for granted throughout most of North America. But in an era of global warming and pollution from multiple sources and wildfires, air  has become a prime health concern, especially for older adults and people with respiratory and heart conditions.

What should concern people living in or moving to a place with consistently dirty air? Ozone, public health officials warn, is one of the greatest threats to those with chronic obstructive pulmonary disease (COPD), which makes it harder to breathe and can lead to death.

Pulmonologist Dr. Meredith McCormack, an associate professor of medicine at Johns Hopkins University, says particles that are two-and-one-half microns or less in width (known as "PM 2.5") can "go beyond the lungs and enter the bloodstream," which poses a risk for heart attacks and strokes.

McCormack notes that both ozone and fine particulates are linked to "strong evidence that they are harmful to health" for those suffering from a wide range of ailments, from asthma to diabetes.

The worst metropolitan areas for air pollution typically have abundant highways, industry and low winds. The regions with the most polluted air are Los Angeles, San Diego and the San Joaquin Valley in California as well as Phoenix, Denver and Houston.

All told, California cities occupy more than half of the slots on the "worst-25 cities" list for ozone, according to the Lung Association. Bakersfield, California, was among the three worst areas for ozone and year-round and short-term particle pollution.

Do you want to relocate to locales with the cleanest air? You'll have to log some miles. The cleanest cities were in Hawaii; Cheyenne, Wyoming; and Wilmington, North Carolina, on the year-round particle pollution scale. Albany, New York; Asheville, North Carolina; and Bangor, Maine, scored the best on ozone.

When considering moves to more out-of-the-way places, of course, don't forget other key factors such as health care access, transportation and amenities.

According to ALA spokesperson Katherine Pruitt, the best way to use the association's ratings is to "check grades by county and city and look at the trend line and changes over time." Some metro areas have improved while others have gotten worse. When considering relocation, also consider factors you may not see in air ratings or on a map.

"Transportation is a major source of air pollution in metro areas," Pruitt adds, "including truck depots." Areas with heavy industry and big polluters like refineries will also impact local air quality.

Generally speaking, climate scientists predict that cities in hot, humid or torrid climates will experience the worst air conditions as the planet continues to warm. Drought, wildfires and extreme heat and humidity are powerful contributing factors. Internationally, cities in South Asia are suffering the most, especially from increased ozone levels, reports a recent "State of Global Air" study.

"The health burden of ozone-attributable COPD is rising in countries with aging populations," according to the State of Global Air Initiative. "The growth and aging of populations accounts for much of the increase in COPD-related deaths in countries across Asia." Yet poor air quality impacts nearly every population suffering from a wide range of conditions from asthma to emphysema.

If your doctor tells you that clean air is a priority for your health, you have plenty of desirable retirement locales to choose from on the Lung Association's "Cleanest Cities" report card. Keep in mind that these ratings change every year and few, if any, places are immune from the effects of climate change and dirty air. Some local conditions may improve while others decline.

In some places, data may be incomplete. For example, I tried to find particulate pollution ratings on my home county and the ALA said it wasn't reported. Not all locales have monitoring stations.