42 JULY-AUGUST 2025 | THE FOREIGN SERVICE JOURNAL FOCUS ON GLOBAL HEALTH DIPLOMACY “Wherever the Wind Takes Us”— Poor Air Quality and Long-Term Foreign Service One ESTH officer with access to an air quality monitor set out to discover how poor air quality at some posts might affect fellow Foreign Service officers and their family members. BY MICHELLE ZJHRA WITH CLAIRE KIDWELL AND LINDA GEISER Michelle Zjhra, PhD, is a recently retired Foreign Service officer with the State Department. She thanks her co-authors, Claire Kidwell, a Department of State Virtual Student Federal Service intern and a master’s candidate in public policy at Duke University, and Linda Geiser, PhD, the Air Resource Management national program leader for the U.S. Department of Agriculture Forest Service. I was having trouble breathing as I left the embassy in Antananarivo, Madagascar, to return home from work. This was not an uncommon occurrence—the exhaust from cars mixing with cookstove smoke during peak commuting times often left the air clogged with fumes. And it was not the first time I experienced this during an overseas posting. In more than a decade of service with the Department of State, I have worked in countries with even worse air pollution than Antananarivo, where the very air itself takes on a pallid yellow hue. But at this moment, as my lungs struggled in the evening air, I started to wonder what the effect of breathing bad air over long periods of time had on me, my fellow Foreign Service members, and our families. World Health Organization (WHO) data show that most people worldwide breathe air that “exceeds WHO guideline limits and contains high levels of pollutants, with low- and middleincome countries suffering from the highest exposures.” These pollutants are a major public health concern and include fine particulate matter, carbon monoxide, ozone, nitrogen dioxide, sulfur dioxide, lead, and a chemical soup of volatile organic compounds, metals, and partial combustion products. Both outdoor and indoor air pollution cause respiratory and other high morbidity/high mortality diseases. While we as members of the Foreign Service anticipate some
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