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This article examines how clean air advocates in the San Joaquin Valley amplified a collective action frame of air pollution as a public health crisis. This frame serves to mobilize communities and attribute responsibility to relevant authorities while countering the San Joaquin Valley Air District’s narrative that places blame on the public and unalterable aspects of the physical environment, characterizing the problem as largely unchangeable. Core questions are: How did advocates facilitate frame construction and sustain resonance across time and place? How did this frame compel urgent action, including representational change in the Valley Air District Governing Board through the adoption of Senate Bill 719? Findings show that advocates counter the San Joaquin Valley Air District’s frame by shifting the focus on the negative impacts to public health and quality of life, particularly in disproportionately impacted environmental justice communities. Building and leveraging a resonant frame required strategic “stretch” in capacity while cultivating collective identity and solidarity. Within the Valley Air District, the change in governing board composition has measurably impacted dialog and provided a more welcoming reception of public participation at meetings, with the doctor and scientist appointees providing critical perspectives and contributing to subtle shifts in the agency’s dominant messaging and decision making. While a public health frame has taken shape around air pollution in the San Joaquin Valley, these efforts are not complete or without ongoing strain.