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Suggested Citation:"3 Populations Impacted by Wildfires." National Academies of Sciences, Engineering, and Medicine. 2019. Implications of the California Wildfires for Health, Communities, and Preparedness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25622.
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Suggested Citation:"3 Populations Impacted by Wildfires." National Academies of Sciences, Engineering, and Medicine. 2019. Implications of the California Wildfires for Health, Communities, and Preparedness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25622.
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Suggested Citation:"3 Populations Impacted by Wildfires." National Academies of Sciences, Engineering, and Medicine. 2019. Implications of the California Wildfires for Health, Communities, and Preparedness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25622.
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Suggested Citation:"3 Populations Impacted by Wildfires." National Academies of Sciences, Engineering, and Medicine. 2019. Implications of the California Wildfires for Health, Communities, and Preparedness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25622.
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Suggested Citation:"3 Populations Impacted by Wildfires." National Academies of Sciences, Engineering, and Medicine. 2019. Implications of the California Wildfires for Health, Communities, and Preparedness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25622.
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Suggested Citation:"3 Populations Impacted by Wildfires." National Academies of Sciences, Engineering, and Medicine. 2019. Implications of the California Wildfires for Health, Communities, and Preparedness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25622.
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Suggested Citation:"3 Populations Impacted by Wildfires." National Academies of Sciences, Engineering, and Medicine. 2019. Implications of the California Wildfires for Health, Communities, and Preparedness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25622.
×
Page 21
Suggested Citation:"3 Populations Impacted by Wildfires." National Academies of Sciences, Engineering, and Medicine. 2019. Implications of the California Wildfires for Health, Communities, and Preparedness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25622.
×
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Suggested Citation:"3 Populations Impacted by Wildfires." National Academies of Sciences, Engineering, and Medicine. 2019. Implications of the California Wildfires for Health, Communities, and Preparedness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25622.
×
Page 23
Suggested Citation:"3 Populations Impacted by Wildfires." National Academies of Sciences, Engineering, and Medicine. 2019. Implications of the California Wildfires for Health, Communities, and Preparedness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25622.
×
Page 24
Suggested Citation:"3 Populations Impacted by Wildfires." National Academies of Sciences, Engineering, and Medicine. 2019. Implications of the California Wildfires for Health, Communities, and Preparedness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25622.
×
Page 25
Suggested Citation:"3 Populations Impacted by Wildfires." National Academies of Sciences, Engineering, and Medicine. 2019. Implications of the California Wildfires for Health, Communities, and Preparedness: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25622.
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Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

3 Populations Impacted by Wildfires Key Issues Highlighted by the Speakers • Deploying an equity lens in disaster planning can expose vulnerabilities in communities that need to be addressed to build preparedness. (Chavez) • Indigenous communities have understandings and perspectives that incorporate the use of fire in landscapes to make them more resilient to climate change. (Hankins) • Existing inequities are a long-term disaster for vulnerable communities that then can be compounded by the impacts of natural disasters. (Flores-Haro) • The effects of wildfires and other disasters on nearby communities are immediate, drastic, and long lasting. (Miller) Many communities and populations are especially vulnerable to wildfires and other disasters, including low-income communities, migrant populations, indigenous populations, communities of older adults, and communities of color. Speakers on a panel that looked at populations impacted by wildfires examined the features of these communities that put them at a disadvantage in preparing for and responding to wildfires and at steps that could be taken to reduce these vulnerabilities. MEETING THE NEEDS OF VULNERABLE POPULATIONS The fires that occurred in Sonoma County north of San Francisco in October 2017 were the largest in the county’s history. More than 5,300 homes and 126 businesses were lost, along with 24 lives, most of whom were vulnerable seniors. More than 100,000 residents were evacuated or displaced during the fires, and local damage was estimated at between $7 billion and $13 billion. PREPUBLICATION COPY: UNCORRECTED PROOFS 3-1

3-2 IMPLICATIONS OF THE CALIFORNIA WILDFIRES FOR HEALTH, COMMUNITIES, AND PREPAREDNESS Disasters unveil the inequalities that exist in all communities, said Oscar Chavez, assistant director for the Sonoma County Human Services Department. “While the fire did not discriminate,” said Chavez, “the recovery process certainly did, depending on where you were situated and the kind of resources that you had.” Sonoma County has a large immigrant population, and about 30 percent of the county’s population is Latinx. The county also has an estimated 20,000 undocumented residents, which created vulnerabilities in its response to the fire. In California, the Human Services Departments are responsible for the care and shelter of people during evacuation, deploying staff to shelters to help set them up, to do assessments, and to make sure people get the services that they need. Chavez’s department was therefore involved both in the immediate response to the fire and in efforts to mitigate long-term impacts to vulnerable populations. This response demonstrated both the strengths and weaknesses of the public sector’s preparedness for disasters. For example, said Chavez, “oftentimes, the government does not do a very good job of having embedded structures of communication, nor do we have the kind of language accessibility that you think we would have.” During a disaster, information has to get out in the most efficient way and in a way that is understood and trusted in the community. “We had to figure out a lot of those structures,” said Chavez. Other dynamics affected the community. Many members of the immigrant community are eligible to be served by the CalFresh Program and to receive other services, but many decided not to pursue those services for fear that it might impact their immigration status. “We had to do a lot of communication in terms of going out to the community, bringing in trusted partners who had a trusted reputation with the community to communicate that they were eligible for services and that we were not going to share their important data with anybody.” Immigrant communities were also concerned about immigration raids. Many members of the immigrant population did not seek help. Instead, they set up camp at the coast where they did not have access to resources or support, which was “very problematic,” according to Chavez. “We quickly had to figure out how to send people to the camps at the coast to let the people know that they were in fact eligible for services and that our shelters were safe for them to come in and receive care and support.” In addition, resources were dispatched to the camps to support vulnerable people who were displaced. To access resources through the Federal Emergency Management Agency (FEMA), people need to provide social security numbers, and even many philanthropic partners initially required documentation that many people had difficulty providing. The result was the creation of a special fund called UndocuFund that was specifically dedicated to serving the undocumented community. At the time of the workshop, this fund had supported more than 2,000 families with rental assistance, supplies, clothing, furniture, and other resources to help them get back on their feet. “That was a huge gap that was revealed within our own disaster: We do not have the safety net to serve all residents impacted by the fire. We can only help certain residents,” Chavez explained. Sonoma County and Santa Rosa tend to have high rents, which often lead to multiple families living in one apartment. If someone was not the primary lease holder of an apartment that burned down, it could be very difficult to prove that he or she lived in that residence. As a result, some families were not able to prove that they were affected by the fires and could not access some of the services they needed, said Chavez. Furthermore, the fires quickly increased the prices of housing and rents, which further displaced people already affected by the fire. He stated that “a lot of them have had to move to PREPUBLICATION COPY: UNCORRECTED PROOFS

POPULATIONS IMPACTED BY WILDFIRES 3-3 other communities.” At the same time, the number of people who are homeless in Sonoma County has gone up, and an estimated 26,000 people are experiencing housing vulnerability, meaning that they are one paycheck away from having to move. “That is a huge problem,” Chavez added. The loss of businesses caused a loss of employment. Sonoma County has many jobs in tourism, hospitality, and retail. “These are not family-supporting wage jobs,” observed Chavez. “A lot of these families are living paycheck to paycheck. If one of the family members loses a job, they are in crisis.” Many people are still feeling the impact of the fires. They do not know whether they can move back into their communities or afford to stay in Sonoma County. Many renters were underinsured or did not have insurance, and many people experienced severe trauma as a result of the fires. The fires exposed vulnerabilities in the community, which has caused people to rethink what the county ought to do moving forward. Chavez asked, “Can the county help create a community that not only provides greater opportunities for vulnerable populations but mitigates the long-term impacts of trauma?” Doing so requires examining the existing structures in the community. “We have to call into question the kind of embedded bias that is baked into our systems and results in disproportionally negative outcomes for low-income and vulnerable populations. We have to reimagine a new kind of community that brings together diverse stakeholders to be able to tackle these complex and serious issues,” he explained. After the fire, Sonoma County hosted a statewide conference called the California Economic Summit that focused on resiliency and the long-term impacts of disasters on vulnerable populations. One conclusion of the summit was that “we had to deploy an equity lens . . . throughout everything that we did: how we invested our dollars, how we deployed services in our community, how we worked across sectors,” Chavez said. For example, the summit revealed the need to build 30,000 units of housing in Sonoma County to meet the needs of people in the community. “This is an example of the kind of positive responses that can come out of a disaster in bringing people together and reimagining new ways of building communities.” “While the fire did not discriminate, the recovery process certainty did, depending on where you were situated and the kind of resources that you had.” Oscar Chavez A NATIVE AMERICAN PERSPECTIVE ON WILDFIRES From the perspective of indigenous communities, fires are part of a sacred way of understanding the world, observed Don Hankins, professor of geography and planning at California State University, Chico. Most indigenous communities have “first fire stories,” which describe a time before humans existed when fires engulfed the world and consumed everything. From those times, people established a relationship with fire; it was used as a tool to steward indigenous territories and minimize the extent of wildfires In a 1973 study, anthropologist Henry Lewis documented many reasons why California Indians set fire to the landscape (Lewis, 1973). They set fire to create travel corridors, for conservation purposes, to grow medicinal plants, to manage game and fisheries, and “on and on,” said Hankins. He showed a slide of a feather belt currently held in the collection of the National Museum of the American Indian. It was woven early in the 20th century in Chico and it included feathers from acorn woodpeckers, snow geese, and mallards. “To me, that represents a landscape PREPUBLICATION COPY: UNCORRECTED PROOFS

3-4 IMPLICATIONS OF THE CALIFORNIA WILDFIRES FOR HEALTH, COMMUNITIES, AND PREPAREDNESS that is very well taken care of. If you can find all those resources today, you are doing great. Chances are you are not going to find them [because of degraded landscape conditions]. But if you manage your landscape right with fire, you are going to have all those things,” he said. As another example, Hankins mentioned a recent study of the impacts of fires in the Klamath River region in northwestern California. Traditional knowledge says that setting fires at the right time of year will cool water temperatures because of the smoke to keep fish runs alive (David et al., 2018). “Our knowledge base is time tested,” said Hankins. He quoted a Miwok elder who once said, “If people stop burning . . . wildfires would become rampant.” Such knowledge is a tool that indigenous communities used to manage their relationship with fire. Colonial settlement changed the way that people interacted with the landscape. It limited the continuance of cultural practices, reduced the transfer of traditional knowledge, and led to unhealthy landscapes and people. People were no longer “walking the landscape, checking out things, learning and observing when fire should happen.” Before the time of the Gold Rush, indigenous people in California used fire to manage the landscape (Taylor et al., 2016). After that, fires were suppressed by the growing Euro- American population. Before settlement, between 4 million and 12 million acres in the state burned annually (Stephens et al., 2007), compared with about 1.8 million acres burned in 2018. The dry season is increasing in length, and so too are wildfire sizes (Westerling et al., 2006). However, understanding seasonal shifts and applying fire within a landscape in the appropriate timeframes can be done to control and minimize the extent of wildfires, said Hankins. Controlled fires were also more or less frequent depending on climate fluctuations (Swetnam et al., 2009). “We, as indigenous people, have been here dealing with this since time immemorial, and we have been able to adapt through climate change to bring fire to this landscape to make it resilient.” Today, wildfires are having calamitous impacts on many communities, including Native communities, Hankins observed. Fires are destroying structures, damaging or destroying sacred sites, contaminating large areas, causing the loss of plants and wildlife, limiting access to important sites, degrading fisheries, and otherwise harming people and their communities. Some of these harms may be less visible, such as the loss of heritage trees where Native people go to collect acorns or the release of knowledge restricted to Native communities. Hankins emphasized the idea of “solastalgia,” the psychological impact of environmental change, which can be even more pronounced in tribal communities because of the intergenerational trauma of being separated from the landscape and its traditional stewardship functions. Hankins also pointed to the need for involving cultural resource monitors in disasters. For example, after the Camp Fire, members of the Mechoopda Tribe of Chico Rancheria were monitoring the removal of topsoil to look for cultural artefacts. In addition, disasters can interfere with cultural activities that are important to tribes. Hankins briefly described the work of Harold Weaver, a forester with the Bureau of Indian Affairs in the 1940s, who was able to facilitate the burning of about 65,000 acres per year by tribal people in the Coleville Reservation and the Ft. Apache Tribe. At Ft. Apache these controlled burns are still going on and have curtailed the effects of large wildfires. “There is a lot to be said in working together,” he noted. Bringing back Native culture is an important part of the response. “For tribal people, we look to bring fire back and to instill our rights to restore and take care of our landscape,” said Hankins. Indigenous cultural burning practices are distinguished from other forms of fire management in the context of traditional law, objectives, outcomes, and the right to burn PREPUBLICATION COPY: UNCORRECTED PROOFS

POPULATIONS IMPACTED BY WILDFIRES 3-5 (Eriksen and Hankins, 2014). Planning for resiliency and working together require understanding cultural values and differences, identifying cultural approaches to responses, and seeking opportunities for awareness within incident response structures, he said. Policy changes can help realize this vision. Hankins recommended integrating tribal guidance for resiliency planning and implementation, empowering tribes to assert traditional cultural practices through land-based livelihoods, and directing carbon offset funds to support tribal land-care program (Bedsworth et al., 2018). Native people need to be able “to get out there and do the type of fire that we know we need to be doing.” California’s AB 32 fund for carbon offsets that are being used out of state and out of the country “needs to be spent locally so we can help protect our forests.” “We, as indigenous people, have been here dealing with this since time immemorial, and we have been able to adapt through climate change to bring fire to this landscape to make it resilient.” Don Hankins GETTING SERVICES TO VULNERABLE POPULATIONS The Mixteco/Indigena Community Organizing Project (MICOP) is a community-based organization (CBO), not a disaster relief organization, explained Genevieve Flores-Haro, the organization’s associate director. “But when the Thomas Fire hit in 2017, that is what we became,” she explained. The Thomas Fire, which affected parts of Ventura and Santa Barbara counties northwest of Los Angeles, was at the time the largest wildfire in California history, though it was eclipsed in 2018 by the Mendocino Fire. Ventura and Santa Barbara Counties are a heavily fire-prone and drought-impacted area. Situated between mountains and ocean, agriculture and tourism are major industries, and the counties have a stark economic divide between affluent households and a large population of farmworkers, domestic workers, landscapers, and other workers (see Table 3-1). “You can see the split in both counties in terms of who has access to economic power and who does not, in terms of the narrative of wildfires—whose story gets told and whose story does not get told.” Language access was a major issue during the fire. As Flores-Haro said: The night of the fire, I was in my car. The hillsides were orange. We were pitch black, because the power went out in all of Ventura County and half of Santa Barbara County. Being the head of my organization, wanting to push out information that I had, everything I found was in English. I was in my car because my phone was at 18 percent because you do not really plan for wildfires. There I was translating whatever I could get my hands on. The county took 10 days to translate the information people needed into Spanish, and that still left out migrants who spoke indigenous languages from southern Mexico, such as Mixteco or Zapoteco. These languages are completely different than Spanish, and it fell to MICOP to get information out in these and other languages. Many of the people MICOP serves were working in the field and “no one was talking to them,” said Flores-Haro. The air quality was poor, yet many people had just bandanas or a medical mask to cover their faces, not the N95 masks that are recommended to prevent inhaling smoke. Because of drinking-water contamination, city municipalities were putting out boil-water PREPUBLICATION COPY: UNCORRECTED PROOFS

3-6 IMPLICATIONS OF THE CALIFORNIA WILDFIRES FOR HEALTH, COMMUNITIES, AND PREPAREDNESS advisories, but that information also was not getting to vulnerable communities. MICOP and its partner organizations sought to fill these gaps by delivering water to communities and providing workers with N95 masks, though even that was not straightforward: When Flores-Haro went to Home Depot to buy N95 masks, she was told that they were being saved for the “regular customers.” “As community-based organizations, we understand the inequities that exist in our communities, but it takes a natural disaster happening to expose that,” said Flores-Haro. Though only about 13 farmworker families lost houses, many people could not afford to evacuate and were left behind in evacuation zones. They stayed behind and kept working, often in extremely smoky conditions. “Post-fire we saw a lot of farmworkers coming to us saying, ‘I developed pneumonia. I developed asthma.’ There was an extreme case of a man that we were working with, an indigenous farmworker, who went back to Mexico because he was so disabled with his respiratory disease that he could not go back to work.” Many low-wage workers did not have access to unemployment or other safety net programs. Schools were closed for weeks, which meant that children did not get free breakfasts or lunches. Domestic workers and service workers lost their jobs at homes and businesses that were destroyed. Landslides and closed roads made it extremely difficult for some people to get to their jobs. “To go to Santa Paula, you can take the airplane into Santa Barbara Airport or you can take the ferry, but the ferry was $30. Again, folks are left without viable modes of transportation,” Flores-Haro explained. MICOP served about 1,300 families and expended nearly $2 million following the fires. Much of the funding came from the United Way, the Red Cross, and other organizations that had relief funds available but did not have the language access and trust that MICOP did. Along with partner organizations, MICOP also founded an UndocuFund modeled on the Sonoma County UndocuFund, which supported a coordinator and six outreach workers who also acted as interpreters. “It fills a much-needed gap in the recovery process, and it addresses the issue of safety and security for our vulnerable populations.” Government policies can limit cooperation among agencies, Flores-Haro pointed out. For example, MICOP could not work with the Voluntary Organizations Active in Disasters (VOAD), because to do so it would have to sign an agreement to do data management that was being monitored by the Department of Homeland Security. “It was a hard sell for us to tell our community members, ‘Give us your information. We promise nothing is going to happen to it,’” she explained. Long-term impacts continue to affect vulnerable communities in the two counties. The loss of housing stock pushed people out of apartments and raised rents. The Woolsey Hill Fire, which occurred in the same area the following year, caused further hardships. Flores-Haro cited several lessons learned from her experiences. One is to think beyond property values to such issues as environmental justice. Another is that existing inequities are a long-term disaster. She cited the need to share information among organizations in the aftermath of a disaster, but data also need to be protected so as not to be misused. She also said that community-based organizations cannot continue to be the main responders to disasters, “because it is not sustainable.” She concluded by listing several policy changes that could improve preparedness, response, and recovery: • AB 1877: Language access for emergency information (which has passed the PREPUBLICATION COPY: UNCORRECTED PROOFS

POPULATIONS IMPACTED BY WILDFIRES 3-7 California state legislature) • SB 160: Equity and inclusion in disaster and climate resilience planning (which has passed the California Assembly and Senate) • Outdoor worker wildfire smoke safety standards, including the distribution of effective masks • State disaster relief funds for all regardless of immigration status • Emergency funding for community-based organizations • Health4All1 • Infrastructure for transportation • Data sharing and data protection among emergency response organizations “As community-based organizations, we understand the inequities that exist in our communities, but it takes a natural disaster happening to expose that.” Genevieve Flores-Haro TABLE 3-1 Demographics of Santa Barbara and Ventura Counties Population Latino White Non-English Immigrant Noncitizen Santa Barbara County 442,996 45% 45% 40% 23% 15% Ventura County 847,834 42% 46% 39% 23% 12% Oxnard 206,732 74% 14% 68% 36% 22% Ventura (city) 110,153 35% 56% 27% 15% 8% Santa Barbara (city) 91,443 37% 56% 35% 23% 15% SOURCE: Presented by Genevieve Flores-Haro. THE EFFECTS ON SURROUNDING COMMUNITIES Andy Miller, the public health officer of Butte County, talked about the effects of the Camp Fire on surrounding communities. Paradise, with a population of about 27,000, was the town that got the most attention in the media, but other communities were also burned, including Magalia, with a population of about 11,000, and the much smaller town of Concow. Chico, with a population of about 93,000, was just on the edges of the fire. The most immediate impact of the fire on surrounding communities was that their law enforcement, fire personnel, and ambulances were pulled out of the communities and sent to the disaster. As a public health officer, Miller is a coordinator of ambulance strike teams, and about an hour and a half after the fire started he got a call asking for 6 ambulance strike teams, or 30 ambulances, to go to Paradise to evacuate Adventist Feather River hospital and a number of skilled nursing facilities in the area. 1 Health4All, created by The California Endowment, is a campaign highlighting the need to include undocumented immigrants in the California health care system. For more information, see www.health4allca.org (accessed October 17, 2019). PREPUBLICATION COPY: UNCORRECTED PROOFS

3-8 IMPLICATIONS OF THE CALIFORNIA WILDFIRES FOR HEALTH, COMMUNITIES, AND PREPAREDNESS In such circumstances, he noted, “traffic will be worse than you have ever imagined.” Even outside an evacuation zone, places that should take 10 minutes can take hours to reach. Almost immediately, the areas surrounding the fire had many thousands of people to shelter. Twelve shelters were established in churches and other facilities to house homeless people. About 50,000 people were evacuated, and “almost all of them came to Chico,” said Miller. Thousands were in shelters, while tens of thousands stayed with friends and thousands of others stayed in parking lots. All the patients from Adventist Feather River hospital went to a larger medical center in Chico, which was immediately filled beyond capacity. That hospital tried to help refilling medications, but pharmacies in the area were quickly overwhelmed. Many people who were evacuated could not take their medications with them, and many did not know what their medications were. Oxygen quickly became a problem, since people’s concentrators were left at home and battery power ran out. “I would suggest that the biggest urgent problem you have in shelters is oxygen,” Miller said. Food services, gas stations, banks, and other organizations were all affected by the tens of thousands of people moving through the community. An impact that was largely overlooked before the fire is that many people will not evacuate without their animals or they will evacuate and leave their animals behind. Very quickly, the areas around the fire were sheltering 10,000 animals—4,000 in actual shelters and 6,000 being sheltered in place. At the peak of this effort, about 600 volunteers per day were needed to care for animals, which were consuming about 20 tons of animal food. This part of the response was managed by an animal control division, consisting of ten people in the public health department. With regard to smoke, the Chico area had PM2.5 readings of 400 or above for many days, with readings between Chico and Paradise as high as 1,800 and above 1,000 for 4 consecutive days. “That is bad,” said Miller. Immediately after the fire, traffic increased by about 25 percent in the Chico area and by 77 percent in some major corridors. “That continues to this day,” Miller noted, adding that “seven months later, those traffic volumes are still up dramatically.” Hotels in the area filled up with evacuees while tourists stayed away. Besides evacuees, as many as 10,000 workers were helping with the fire and needed places to stay. Sewage volumes increased by a million gallons a day immediately after the fire. “That is 15 years of projected growth, and it happened overnight.” The fire burned for many days and threatened other locales. Oroville, for example, was under an evacuation warning for 4 days. Since then the disaster has progressed to the next chapter, which is debris and mudflows. The overall population of Chico increased by 19,000 to 20,000 people, which is about 15 years’ worth of growth. Even at the time of the workshop, about 20,000 extra people were in a town of 93,000. In 1 year, property values went up 14 percent, and they were expected to go up another 10 percent in the following year, which is 12 times the rate of increase in California as a whole. The county lost about 24 percent of its skilled nursing facility beds, and it lost an acute- care hospital with 18 percent of its acute-care beds. The infant delivery rate for the larger hospital in Chico went up by 44 percent, and emergency room visits went up by 40 percent, which created a need for increased staffing. One-fifth of the medical care staff in Chico lives in Paradise and Magalia, which further increased staffing issues. PREPUBLICATION COPY: UNCORRECTED PROOFS

POPULATIONS IMPACTED BY WILDFIRES 3-9 In the four months from the fire until the following March, traffic accidents went up 23 percent compared with the year earlier, traffic citations 66 percent, and robberies 28 percent. Violent crime statistics were stable, and property crimes decreased. Fourteen schools were lost that served 4,500 students. A high school was established in warehouses at the Chico Airport. Elementary schools were spread throughout other communities. The elementary school in the nearby town of Durham more than doubled in size. Housing will not get better anytime soon, which has implications for many other economic sectors that cannot house workers. Many physicians and other health care workers have left the area because of a lack of housing and other factors. A law in California stipulates that disaster losses need to be shared across the entire county, which means that every jurisdiction in the county has taken a hit for the loss of the tax base. Furthermore, surrounding communities do not quality for FEMA reimbursement. Downstream surface water was contaminated with heavy metals and asbestos. An estimated 600,000 trees have been, or will need to be removed. Many thousands of trucks are needed to move downed trees and debris, which increases traffic. Finally, Miller said that “I do not have the time to talk about community trauma. This is the first presentation that I have given on this subject. That is done purposefully because it is activating and it is emotional. This is not even the most emotional part. I appreciate being able to talk on this subject rather than the evacuation itself.” Perhaps the only silver lining of the disaster is that it presents an opportunity to envision how a community should look in the future. The utility company has said that all utility lines will be underground in Paradise in the future. Paradise was actually “a very practiced and fire-smart community” before the community, and discussions are now under way to make it more resilient through such measures as fire breaks, additional evacuation routes, changes in the water infrastructure, and so on. “All those things are available to us if we take advantage of them,” Miller concluded. “The impacts on Chico represented 15 years of projected growth, and it happened overnight.” Andy Miller DISCUSSION Governmental Restrictions on Housing Costs David Eisenman, professor in residence at the David Geffen School of Medicine and the Fielding School of Public Health at the University of California, Los Angeles, began the question-and-answer period by asking whether governments could restrict increases in housing costs after a disaster. Flores-Haro responded that such a restriction did apply in the area in which she worked— a year-long policy prohibited homeowners who were renting their houses to increase rents. “But it was only for the year following the disaster. After that, it is fair game.” More generally, she said, disasters tend to exacerbate issues that existed before the disaster. Housing was already an issue for the people her organization serves, many of whom might make $12,000 or $15,000 per year. “I would like to see something more in place in terms of policy.” PREPUBLICATION COPY: UNCORRECTED PROOFS

3-10 IMPLICATIONS OF THE CALIFORNIA WILDFIRES FOR HEALTH, COMMUNITIES, AND PREPAREDNESS Hankins pointed to the issue of increases and nonrenewals in insurance premiums. His insurance premium was just renewed at three-and-a-half times the rate he had been paying before the Camp Fire. An alternative might be for some communities to create their own insurance funds, he pointed out. “If there is one natural disaster that we could actually do something about, it is fire. We can set fires and do it at the right time to mitigate this and make it safe. We cannot do that for tornadoes. We cannot do that for hurricanes.” Miller observed that even if laws are in place, they need to be enforced. Also, in some rural or conservative areas in California, such laws might not be widely supported. Protecting Vulnerable Populations Winston Wong, medical director of community health and director of disparities improvement and quality initiatives for Kaiser Permanente and moderator of the panel, asked specifically about how both governments and community-based organizations can protect vulnerable populations. Chavez responded by saying that the fire provided an opportunity to rethink how those two sectors can work better together. “The fact is that, in government, we tend to be very siloed. [The fire] provided an opportunity to work across silos and across sectors to understand the needs of the community. For example, we now have a public information officer at the county who is bilingual. We now have contracts in place that can be quickly deployed to help serve vulnerable populations. All of our staff have received training on shelter management. We are now focusing on doing trauma 101, or mental health 101, but working across all of our community,” Wong explained. Chavez said he now sees an opportunity to work not just within government but with the businesses, philanthropies, community-based organizations, and individuals who are dealing with these issues every day to build resiliency. Flores-Haro agreed that “relationship building is key.” MICOP had an advantage in that it had already established relationships with the county supervisors, county public health officers, and other public officials. Also, the county had a bilingual public information officer who was deployed in the Woolsey Hill Fire, so that an earlier language gap was filled. Such relationships make a big difference, she said. She knew she had a direct line to someone and could say, “This is what is going on on the ground. Let’s work together and figure out what we need.” Still, more collaboration would be useful, she added, citing cultural competency, disaster relief planning, and long-term recovery as areas where her organization could be a valuable resource. Hankins mentioned the trust responsibilities that government agencies have to tribes, though many times “agencies do not quite understand what that means.” Because of their self- determination, tribes have the ability to set forth ways of doing things on their ancestral land. “It is not just reservation boundaries or rancherias in California. It is the ancestral territories where that applies.” Having conversations with the tribes is important for government agencies, because each tribe is going to have a different perspective on the issues it is facing. For example, when a fire started on one of the mountains in Sutter Buttes, which is an area significant to every tribe in the Sacramento Valley, Hankins was able to contact incident command personnel and warn them about bulldozing culturally important sites. “The quicker we can have those kinds of conversations and be on the same page earlier is really important.” Miller pointed out that tragedies can bring communities together and demonstrate the complementary skills of different organizations. “You quickly find out how much you need everybody in your community, your faith-based organizations, your nonprofits, government at all levels even up to the federal level.” For example, he leaned heavily on UC Davis, faith-based PREPUBLICATION COPY: UNCORRECTED PROOFS

POPULATIONS IMPACTED BY WILDFIRES 3-11 organizations, and tribal organizations to bring in volunteer physicians and nurses. “We could not have done it without everybody.” Avoiding Polluted Air In response to a question specifically about the advice given to residents to go to clean-air shelters, Miller said that his agency’s first advice was to stay indoors, which “is a reasonable thing to do, [since] in most cases, indoors is better than outdoors.” But at the time this was “about tenth on the list of priorities.” In retrospect, he thinks the advice given was good, but for future events he is working with schools and universities to create safe air spaces where the air is filtered to at least MERV 13 and above. “If the school closes because of air quality, as most people in the room know, those kids are out doing God knows what. They are either at home where we have uncertain air quality, or they are outside where we are pretty sure we do not want them to be.” The messaging also needs to be clear about masks, Miller continued. Masks do not mean it is safe to be outside, but for those who cannot avoid being outside they are recommended. His agency also pointed out that masks may not be beneficial for people with certain conditions. Despite the advice given, Richard Jackson, professor emeritus at the Fielding School of Public Health at the University of California, Los Angeles, and a member of the planning committee, pointed out that many first responders, such as those involved in the terrorist attacks of 2001, do not wear masks. “Telling people to do things does not work sometimes when you are dealing with such a mass psychological trauma,” he said. More needs to be learned about how to communicate messages that encourage first responders to protect themselves, he observed. PREPUBLICATION COPY: UNCORRECTED PROOFS

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Implications of the California Wildfires for Health, Communities, and Preparedness: Proceedings of a Workshop Get This Book
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California and other wildfire-prone western states have experienced a substantial increase in the number and intensity of wildfires in recent years. Wildlands and climate experts expect these trends to continue and quite likely to worsen in coming years. Wildfires and other disasters can be particularly devastating for vulnerable communities. Members of these communities tend to experience worse health outcomes from disasters, have fewer resources for responding and rebuilding, and receive less assistance from state, local, and federal agencies. Because burning wood releases particulate matter and other toxicants, the health effects of wildfires extend well beyond burns. In addition, deposition of toxicants in soil and water can result in chronic as well as acute exposures.

On June 4-5, 2019, four different entities within the National Academies of Sciences, Engineering, and Medicine held a workshop titled Implications of the California Wildfires for Health, Communities, and Preparedness at the Betty Irene Moore School of Nursing at the University of California, Davis. The workshop explored the population health, environmental health, emergency preparedness, and health equity consequences of increasingly strong and numerous wildfires, particularly in California. This publication is a summary of the presentations and discussion of the workshop.

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