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For elders with dementia, youth with anxiety, or evacuees coping with displacement, smoke is not just a public health irritant. It's an accelerant for mental health issues.

You can't put an N95 on your brain. You can't tell your nervous system to calm down when the air outside looks like dusk at noon. For older adults, people with asthma, families on fixed incomes, or those living in crowded apartments or trailers, wildfire season in Manitoba is more than just a nuisance. It's a trigger. Of breathlessness. Of panic. Of helplessness.

And every year, the advice is the same: "Stay indoors. Use a HEPA filter. Seal your windows."

That line gets repeated like a national mantra. But in many communities -- from high-rises in Winnipeg to temporary shelters in Thompson -- it's just not possible. Not everyone has the luxury of a sealed home, the money for an air purifier, or a place to escape the smoke.

Clean air has quietly become a privilege, not a given.

Many families simply can't afford HEPA filters. Many elders live in homes that are drafty, overcrowded, or far from any nearby care. And frontline workers especially those in care homes, shelters, or community clinics, are often expected to just keep going, even when air quality dips into the "high risk" zone.

And while the Air Quality Health Index (AQHI) was designed to keep us informed, for many it feels more like a daily dread barometer than a useful tool.

"Monitor air quality," they say. Then what?

Because even when the AQHI flashes red, most people can't just stop working, seal their homes, or check into a clean-air haven. There's no "then" after the alert: just exposure. And hope that the inhaler still has one more puff.

We tend to think of wildfire smoke as a threat to our lungs. But what if its quietest, most lasting damage is happening in the brain? Studies are now linking wildfire smoke exposure to brain inflammation, especially in parts of the brain responsible for memory, learning, and emotional regulation. It's been connected to worsened anxiety, cognitive fog, depression, and even increased dementia risk.

And it hits harder for those who are already vulnerable: people living with pre-existing mental health conditions, chronic illness or trauma. In other words, the same people who are least able to protect themselves from the smoke in the first place.

We're repeatedly told to "stay inside" and "use purifiers," but for many, turning your living room into an air sanctuary just isn't realistic. The guidance feels less like public health and more like a privilege checklist: a kind of wellness insurance for those who can afford it.

So maybe it's time we ask a different question: If wildfire smoke is now a recurring hazard rather than a once-a-decade crisis, should clean air, especially during fire season, become a healthcare entitlement? A part of public and workplace insurance, much like coverage for asthma inhalers or mental health counselling?

What would it look like to treat clean air the way we treat medication? Covered. Prescribed. Integrated into our systems of care. Imagine subsidized HEPA filters for low-income households, clean-air rooms in workplaces and clinics, and mental health services that explicitly recognize brain inflammation as part of wildfire trauma. It might sound bold, but when the air itself feels unsafe, where do we draw the line between personal responsibility and collective care?

That's not radical. That's rational.

Because we're no longer dealing with isolated wildfires. We're living in a new climate reality. One where smoke season may last longer than summer itself.

And in this new reality, our public health responses can't afford to lag behind the science or ignore the inequities.

When the air itself becomes dangerous, what does it say about us if only some people are able to breathe safely?

We can't keep treating clean air like a luxury good. Not when we know what's at stake. Not when we know whose health is quietly being eroded. And not when the solution isn't just individual but collective. Because clean air shouldn't be something we earn. It should be something we all have.

" Marwa Suraj is a naturalized Canadian, a proud Manitoban, and a physician by training. She is Black, Muslim, and a woman: identities that shape her passion for equity, innovation and social accountability