OPINION:
Nurses have held the hand of a child struggling to breathe. Nurses have watched a grandmother’s oxygen levels drop during an air quality alert. Nurses have seen healthy adults admitted with sudden respiratory or cardiac events on days when the air outside looked clean but wasn’t. After more than two decades as a nurse, I know what air pollution does to the body. What I’m less sure of is why we keep treating it like it doesn’t exist.
We’ve been here before. For decades, Americans shared enclosed spaces with cigarette smoke while the science quietly, then loudly, made the case: secondhand smoke kills. It took years of medical evidence, public education, and political will to change America’s smoking culture. But eventually we did. Not because smokers were villains, but because the people around them had a right to breathe, and science told us that secondhand smoke exposure is deadly.
Today, we have another secondhand pollution problem threatening clean air. Call it secondhand smog. And it comes from cars, trucks, and buses, large semis and other freight trucks.
Transportation is the single largest source of air pollution in the United States. Every day, millions of vehicles exhale a toxic mixture of nitrogen oxides, particulate matter, climate pollution and volatile organic compounds into the air that everyone, drivers and non-drivers alike, breathe. The people most exposed aren’t always behind the wheel. They’re the kids at the bus stop, or worse, on the bus. The elderly woman on her front porch two blocks from the freeway. The construction worker eating lunch at a job site near a congested road. They didn’t choose to inhale it. They don’t have a choice.
Clinically, the consequences are not abstract. Tailpipe pollution is directly linked to asthma attacks, chronic obstructive pulmonary disease, cardiovascular disease, stroke, and lung cancer. Fine particulate matter, the kind produced by gas and diesel-powered engines and power plants, is small enough to cross from the lungs directly into the bloodstream. It inflames arterial walls. It stresses the heart. Research shows that as clean car adoption increases in a community, local air pollution levels measurably drop. The reverse is also true: more combustion vehicles, more pollution, more patients.
Low-income communities and communities of color bear a disproportionate burden of this exposure, often living closer to high-traffic corridors and industrial routes. These are not communities with the political capital to demand cleaner air or the financial resources to relocate. As nurses, we can treat the symptoms, but we cannot treat the ZIP code or the source.
This is why the ongoing rollback of clean vehicle standards is so alarming from a public health standpoint. Stronger fuel economy and tailpipe pollution standards don’t just benefit the environment. They reduce the concentration of pollutants in the air outside schools, hospitals, and homes. They are, in a very literal sense, a public health intervention, one that costs nothing for the people breathing the air and saves billions in downstream medical costs.
Cleaner cars take this further. A car that produces zero tailpipe pollution, for instance, is a car that does not contribute to secondhand smog. Widespread EV adoption doesn’t just help the person in the driver’s seat save money on gas and maintenance; it helps the child on the sidewalk breathe. That’s not a partisan argument. That’s physiology.
When the science on secondhand smoke became undeniable, we didn’t simply ask smokers to be more considerate. We changed the rules to protect people. We decided collectively that the freedom to smoke did not extend to forcing others to bear the consequences. The same logic applies here.
The freedom to drive is an American value. The freedom to drive is about lower fuel costs, cleaner air, and energy independence. It doesn’t require four years of construction detours or thousands of dollars in tolls.
I am not asking people to give up their cars. I am asking policymakers to take seriously what medical science has established for years: tailpipe pollution is a public health crisis hiding in plain sight, distributed across every commute and every breath. Cleaner cars and trucks, stronger standards and a real commitment to electrification are not luxuries or political preferences. They are the prescription for a health problem.
We eventually recognized secondhand smoke for what it was. We changed course. We can do it again with second-hand smog if we take the threat seriously.
• Katie Huffling, DNP, RN, CNM, FAAN, is a certified nurse-midwife and is the Executive Director of the Alliance of Nurses for Healthy Environments.
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