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Suggested Citation:"5 The Trials of Recovery." 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:"5 The Trials of Recovery." 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:"5 The Trials of Recovery." 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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Page 49
Suggested Citation:"5 The Trials of Recovery." 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 50
Suggested Citation:"5 The Trials of Recovery." 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 51
Suggested Citation:"5 The Trials of Recovery." 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 52
Suggested Citation:"5 The Trials of Recovery." 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 53
Suggested Citation:"5 The Trials of Recovery." 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 54
Suggested Citation:"5 The Trials of Recovery." 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 55
Suggested Citation:"5 The Trials of Recovery." 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 56
Suggested Citation:"5 The Trials of Recovery." 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 57
Suggested Citation:"5 The Trials of Recovery." 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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Page 58

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.

5 The Trials of Recovery Key Points Highlighted by the Speakers • Greater coordination of emergency management and human services programs can optimize the delivery of social services. (Mason) • Long-term recovery represents the majority of the costs of wildland fires, and states and local communities bear much of this burden. (Schmidt) • Universities have distinct responsibilities in responding when disasters hit the communities in which they are located. (Kurtz). The organization of the workshop’s second day reversed the usual sequence of preparedness, response, and recovery in discussing disasters. One reason is that communities are often still recovering when the next disaster hits. Also, multiple disasters can hit at the same time in close succession, as in the case of drought, wildfires, and mudslides in California. The workshop therefore began by discussing recovery from disasters, then discussed enhancing operational responses (see Chapter 6) and preparing for disasters (see Chapter 7). Recovery is often multisectoral, resource intensive, all-consuming, and borne by the local communities for years afterwards, observed 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, who moderated the session on recovery. By the time communities have begun to recover, the camera crews have gone home and researchers are back at their home institutions. As a result, the research literature contains little information on the health aspects of recovery from disasters generally and wildfires in particular, despite the typically long duration of recovery and its impact on health and well-being. PREPUBLICATION COPY: UNCORRECTED PROOFS 5-1

5-2 IMPLICATIONS OF THE CALIFORNIA WILDFIRES FOR HEALTH, COMMUNITIES, AND PREPAREDNESS CONNECTING EMERGENCY MANAGEMENT WITH HUMAN SERVICES The Administration for Children and Families (ACF) within the Department of Health and Human Services (HHS) serves communities and families that are at crisis or live in crisis every day. It funds the Temporary Assistance for Needy Families program, Head Start, and a variety of other programs. When there is a natural disaster, the Office of Human Services Emergency Preparedness and Response within the ACF serves families by working to connect emergency management to the provision of human services, explained Byron Mason, the office’s deputy director. Mason also was deployed in Sacramento for the California wildfires before taking his current position, “so I have firsthand experience” with wildfires, he said. Mason’s office partners with the Federal Emergency Management Agency (FEMA) when there is a Major Disaster Declaration under the Stafford Act. One of the resources that it deploys is the immediate disaster case management program. The intent of the program is to connect disaster survivors to resources, whether faith-based, nongovernmental, state, local, or federal. This helps individuals who in many cases have never engaged with the social services system and are suddenly faced with having to navigate multiple agencies and organizations providing various types of support. In the case of the Camp Fire, for example, Mason’s office had interacted with more than 6,000 survivors by the time of the workshop, connecting them with resources like food, housing, clothing, and transportation. The office helps people understand how to apply for both individual assistance and the Small Business Administration’s disaster loans. For the most acutely affected families, it creates disaster recovery plans so that they can identify milestones and where they want to be within a certain timeframe. Wildfire recovery is different compared to when ACF or FEMA helps states and communities recover from hurricanes, explained Mason. In those types of disasters, his office tends to focus on the counties or parishes where landfall occurred or where the storm surge or wind destroyed structures or infrastructure. But in Butte County and particularly in Paradise, the initial focus was the particular damage that occurred. “How do we clear and remove and dispose of this debris? How do we get the power back online? What do we do about these houses that have been destroyed?” At the same time, individuals who were displaced from Paradise were living in Chico, Oroville, or other parts of Butte County. Social service providers in those areas were not directly impacted by infrastructure damage, but they were faced with welcoming and receiving an influx of people that they did not have the budgets, staffs, or planning to accommodate. ACF, in addition to running its disaster case-management program, had been looking at strategies and encouraging its providers and grantees to recognize that recovery from wildfires is a long-term effort. “This is their new normal 6 months, 12 months, 18 months after the disaster. They have a new population that they now have to support in addition to the population that was already there. What are the challenges that they may be facing? That requires a lot of coordination.” In California, the Health and Social Services Recovery Support Function had been activated since roughly January 2019 with partners coordinating across agencies, “recognizing that all our social services programs, in many cases, touch the same families.” These programs were typically created by different pieces of legislation, which results in different statutory authorities for eligibility. As a result, the agencies had been coordinating across programs and across departments, “recognizing, again, that it is one family that needs our support.” PREPUBLICATION COPY: UNCORRECTED PROOFS

THE TRIALS OF RECOVERY 5-3 The benefit of the Immediate Disaster Case Management program is that people do not have to tell their stories to multiple agencies to finally get to the right place. Case managers help them navigate. “They are the buffer between that survivor and their family and all of these agencies and resources. They are connecting the pieces together and thinking strategically. That is a huge value—not monetarily, but reducing the trauma to survivors.” This program also enables the affected county and state to focus on the recovery knowing that the program will connect people to FEMA’s transitional sheltering assistance program, to the direct housing program, and to other programs brought in by the United States Department of Housing and Urban Development (HUD), the United States Department of Agriculture (USDA), and other parts of HHS. The next step is to ensure that the county and state can continue their work once ACF transitions out and begins to focus again on its steady-state programs for children, families, and the community. Funding is a complication. Said Mason: “It is incumbent upon us, within ACF and across HHS, to figure out how to fit our programs into the disaster, as opposed to fitting the disaster into our programs.” His office negotiates that work with emergency managers, the community, and its program managers. In response to a question from Barbara Hannah, executive director for Caring Choices, about the need to respond to domestic violence because of the stresses produced by a disaster, Mason said that he shared her concerns. His office was created after Hurricane Katrina but “never, unfortunately, truly fit or stepped into the space of prioritizing human services.” Human services are much more difficult to tackle than a damaged road or bridge, he said. Infrastructure projects have a beginning and an end, but applying emergency management to human services is much more challenging. For example, Emergency Support Function 6 in the National Response Framework is about sheltering, mass care, and human services, but operationally it focuses solely on sheltering and mass care. In Mason’s 4 months in his position, he and his colleagues have been having conversations with their counterparts at FEMA, Save the Children, Child Care Aware, the National Association of Voluntary Organizations Active in Disaster, and other organizations to build relationships and to “step into that space . . . and highlight the human services part of that emergency support function.” He also noted that this office implements the Immediate Disaster Case Management program, whereas FEMA and the Substance Abuse and Mental Health Services Administration implement the Crisis Counseling Assistance and Training program. Greater coordination of these programs in the future will better address the mental health needs of people who have been displaced and traumatized, he said. “All our social services programs, in many cases, touch the same families.” Byron Mason RECOVERY AND ADAPTATION IN NORTH-CENTRAL WASHINGTON STATE The centerpiece of the National Cohesive Wildland Fire Management Strategy is “To safely and effectively extinguish fire when needed; use fire where allowable; manage our natural resources; and as a nation, to live with wildland fire” (Department of the Interior and Department of Agriculture, 2014, p. 1). Recovery in this context can be challenging, said Annie Schmidt, strategic advisor for the Fire Adapted Communities Learning Network, but it also provides opportunities to address substantial and long-lived community needs. PREPUBLICATION COPY: UNCORRECTED PROOFS

5-4 IMPLICATIONS OF THE CALIFORNIA WILDFIRES FOR HEALTH, COMMUNITIES, AND PREPAREDNESS North-central Washington State, which is the area in which Schmidt works, has an extensive fire history. In 2014, Washington State experienced its most substantial wildland fire season, with 425,000 acres burned. In particular, the fires heavily impacted the town of Pateros, which has about 600 residents and lost 111 structures in the town and surrounding areas. The next year was worse, with more than a million acres burned in Washington State and much of the state covered with smoke. These and other fires have “given us lots of opportunities to recover,” said Schmidt. “It also gives us lots of opportunities to prepare for wildland fire and lots of opportunities to, as the vision of the National Cohesive Wildland Fire Management Strategy suggests, live with fire.” In 2018, Headwaters Economics published a paper that sought to calculate the full community costs of wildland fires (see Figure 5-1). Based on an analysis of case studies, it concluded that suppression costs represent only about 9 percent of the cost of wildland fires. Long-term recovery represents about 65 percent of the costs, and states and local communities bear much of this burden. “The local folks have to stand up when [outside] assistance stands down.” The incident management teams leave. A Burned Area Emergency Response team, commonly called a BEAR team, might come in and talk with community members about post- fire flood hazards. A federal disaster declaration might trigger additional assistance. But in a town like Pateros, everything is affected, from the tax base to the water system to community service organizations. Individuals and organizations have to stand up after a fire to provide services and meet needs often without the resources that they need to do those jobs effectively, said Schmidt. “They do them not because it is a line item in their budget but because there is nothing else to be done.” Schmidt previously worked for the Chumstick Wildfire Stewardship Coalition in north- central Washington State, where she led the development of an After the Fire Toolkit.1 It identified many of the risks to communities after a fire and what communities could do to ameliorate those risks, and the coalition sought to disseminate it as widely as possible. When the fires occurred in 2014, the first call Schmidt made was to the Okanogan Conservation District to tell them about the toolkit. Her next call was to the Community Foundation of North Central Washington to thank them for their service as a hub for recovery donations. Donations funded a series of unmet needs roundtables for several years after the fire. Funds were distributed to fill gaps in federal programs, such as replacing hearing aids that were lost in the fire. The After the Fire Toolkit and unmet needs roundtables are two examples of communities working actively to reduce the impact of wildland fire at the local level. Linkages among the Okanogan Conservation District, other Okanogan County recovery organizations, and the Chumstick Coalition formed the basis of the Washington State Fire Adapted Communities Learning Network. Instead of the traditional linear picture of a short-term response followed by a long-term recovery, the learning network has developed a more cyclical approach in which response, recovery, and preparedness are ongoing and reinforcing. As an example of how this new approach changes perspectives, Schmidt described something she has often heard from survivors of wildfires: that an emphasis on preparedness makes them feel as if they are being blamed for their loss. A different and better way to think about it is that communities are in multiple phases of the cycle at the same time. Some people are recovering. Some are preparing. “We have to come up with ways to talk to our communities that meet the entire community where they are, not just one sector,” said Schmidt. 1 The toolkit is available at https://afterthefirewa.org/community-assistance/after-fire-toolkit. PREPUBLICATION COPY: UNCORRECTED PROOFS

THE TRIALS OF RECOVERY 5-5 She drew several take-home messages from her experiences. The first is that organizations working in communities that are experiencing recovery should do no harm. For example, discussing how to harden your home in the context of recovery “warrants some thought,” she said. It is important work, but the topic must be handled with care. The second involves the need to meet each person where they are. People have different needs in recovering from a disaster. Voluntary organizations must be flexible in meeting those needs. The third lesson is that cross-sector leadership provides opportunities, as does honoring communities as knowledge holders and empowering their recovery rather than treating it. Finally, she mentioned the need “to take care of our own.” When someone is drowning, you should reach for or throw something to that person, not jump in and drown, too. “Reach or throw; don’t go.” FIGURE 5-1 Long-term damage accounts for two-thirds of the costs of wildfire impacts. SOURCES: Headwaters Economics, 2018. Presented by Annie Schmidt. PREPUBLICATION COPY: UNCORRECTED PROOFS

5-6 IMPLICATIONS OF THE CALIFORNIA WILDFIRES FOR HEALTH, COMMUNITIES, AND PREPAREDNESS “The local folks have to stand up when [outside] assistance stands down.” Annie Schmidt ACCESSING THE RESOURCES OF A LOCAL UNIVERSITY Megan Kurtz, a lecturer in the Recreation, Hospitality, and Parks Management Department at California State University, Chico, has also served as the university’s campus– community liaison for the Camp Fire. Being a community liaison “has given me a unique perspective of how a university should be looking at responding when a disaster hits the community that hosts an institution,” she said. “What does this mean, as academics, that we have this capability, a network that is behind us, as well as being community members?” Chico State, which is just outside the border of the Camp Fire, was closed for 2 weeks after the fire and then for the Thanksgiving holiday. More than 300 faculty and staff at Chico State lost their homes, as did even more faculty and staff at the local community college, Butte College, and students from both institutions. Very quickly, the organization Wildcats Rise was working to make sure that faculty, staff, and students had the support they needed to find housing, supplies, and other immediate needs. In addition, the president of the university and the university’s Office of Civic Engagement created the liaison position in which Kurtz has been able to meet and work with long-term recovery groups. A unique partnership has formed with different community leadership groups. The university formed a formal partnership with the leadership of Paradise and with Urban Design Associates, which is the architect/design company that is involved in rebuilding Paradise. Any academic institution that reaches out to Paradise looking to do research is told that Chico State is the host institution. In the first five months after the fire, Kurtz talked with more than 75 universities from around the globe. “That is a lot of people doing a lot of very smart stuff that is very helpful,” she observed. “It is also a lot of people doing a lot of stuff that is maybe not as helpful in the moment to the survivors of our community.” Drawing from Packenham (2017), Chico State created ethical guidelines around disaster research: • Prior to consent, prospective participants should be asked, to the extent feasible, about unmet needs and provided assistance, including referrals and resources to reduce risk and maximize benefit. • Post-fire research and teaching should be encouraged for members of vulnerable groups that are underrepresented in the disaster research literature, such as women, racial/ethnic minorities, and elderly and disabled populations. • Participant burden associated with multiple duplicative studies in the field should be minimized through coordination and communication of efforts. • All research should have a plan for the timely dissemination of actionable research results back to key stakeholders. As an example of how these guidelines are applied, Kurtz described a situation in which people are asked to participate in surveys and later have regrets about how they responded. As campus–community liaison, she tries to meet with researchers, or even with documentary film crews, to give them a brief introduction to the issues and the resources available to them. She emphasizes the equity issues that were intensified by the fire, including the situations of PREPUBLICATION COPY: UNCORRECTED PROOFS

THE TRIALS OF RECOVERY 5-7 vulnerable groups that might not have the resources to recover at the same rate as other groups. Even people whose insurance companies placed them in nicer hotels than others can have an advantage. Kurtz tries to make sure that people are aware of such issues before going in to talk with impacted residents. She also tries to make sure that they know about similar work that is going on to avoid the duplication of studies. Chico State has also been using the Camp Fire as a teaching opportunity. Many of its professors and lecturers have incorporated the Camp Fire into their curricula and disciplines. For example, many aspects of the fire have connections to the Recreation, Hospitality, and Parks Management Department, which prepares future community leaders, Boys and Girls Club directors, executive directors, and other professionals. Academic freedom is important in this research. Different lenses across the spectrum that ranges from social sciences to the medical sciences can provide a broad array of perspectives on the issues raised by the fire. So, too, is returning results to the people involved in research. People have put heart, time, and their own vulnerability on the line by participating in research, and they deserve to receive some benefits from that research, said Kurtz. “It comes down to being a good neighbor,” she said. “These are simple things.” But they also can lead to hard issues. “How do we talk about some of the hard things, like the historical racism that existed on the Ridge? How do we talk about people who were uninsured and knew they were uninsured?” People might have been lauded for staying behind to fight the fire, but part of their motivation was that they did not have business insurance. How can people discuss such issues while still being good neighbors? Chico got 20,000 new inhabitants almost overnight, bringing its total population to about 112,000 people. Not only have two communities come together but so have all the subsets of those communities. That mixing has affected people’s activities, habits, and interactions with others. When someone overhears a conversation that is misinformed, how can that person provide truth and facts? When a new urban campground pops up where someone used to run or ride a bike, how should that person respond? How should members of the community react to disaster tourists who come to see the devastation? How can people who were traumatized by the fire avoid being reminded of it? Some parts of the community have become unofficial counselors. “Our beauty industry—they are now story holders, because you are sitting in a chair for anywhere from 20 minutes to maybe 3 hours and sharing your story,” said Kurtz. How can beauty industry professionals cope with the trauma that they encounter every day? For other people, too, reminders of the trauma occur every day, including questions about paperwork, debris removal, rebuilding, research, documentary film crews, and family and friends moving away. The recovery is making good progress, said Kurtz, “but we need to talk more about where people want to be in recovery, healing, and resiliency.” People naturally want things to return to the way they were—only better. Universities have a large and important role in this recovery, she observed. She listed five ways in which universities can help provide context for recovery, healing, and resiliency: • Teaching and showing ways to communicate about what is going to happen • Building capacity and understanding as professionals • Making research findings approachable for the general public • Engaging undergraduate students in the community • Using the university system protocol for the response PREPUBLICATION COPY: UNCORRECTED PROOFS

5-8 IMPLICATIONS OF THE CALIFORNIA WILDFIRES FOR HEALTH, COMMUNITIES, AND PREPAREDNESS • Promoting community and university leadership that values transparency How do we better use our buildings? How can we, in the aftermath of a disaster, talk to each other across disciplines to see what we are doing in our classrooms? How can we use our knowledge base and alumni networks to respond to the community? Kurtz asked. Universities have to be responsive to the neighborhoods and towns in which they exist, Kurtz concluded. People in those neighborhoods and towns, even if they are not associated with the universities, see them as places that have the resources and expertise to reach out and help. She also pointed out that the California State University system has 23 campuses in locations ranging from San Diego to Humboldt. These campuses are also connected to community colleges, K–12 schools, and the University of California system. Communities in California can take advantage of all these interconnected institutions, which serve as a valuable resource in recovering from disasters occurring anywhere in the state. “We need to talk more about where people want to be in recovery, healing, and resiliency.” Megan Kurtz DISCUSSION The Need for Trauma-Informed Services At the beginning of the question-and-answer period, Eisenman asked about opportunities to bring trauma-informed principles, which have become common in the social services, into long-term recovery programing, policy planning, and community engagement. Kurtz responded that Chico State engaged with an expert on trauma for an entire day early in the recovery process, “and hopefully we will be able to do something again.” The focus of that conversation was students, but other people would have benefited from the conversation as well. Schmidt pointed to the importance of education on wildfire community preparedness for disaster case managers and originated from the local level, but this education has not been institutionalized in policy. Still, the issue has come up often among practitioners, generally at the instigation of survivors who have said “this is not the language you need to be using.” Mason spoke in this context about “compassion fatigue.” Though not established in policy, the federal agencies involved in responding to hurricanes have recognized the need to address compassion fatigue among the members of volunteer organizations and among responders, “who in many cases do not think that they need to take care of their own mental health.” Agencies have expanded their mental and behavioral health support to teachers, child care providers, bus drivers, and lunchroom workers who interact with children. “It is not a policy, but it has become a best practice for us,” he said. One question is when to have a conversation about that issue, whether early on, when people are still running on adrenaline, or later, when fatigue is beginning to set in. Partnerships Among Organizations and Communities In response to a question about whether Chico State has worked with the community to identify needs for the researchers who want to study those communities, Kurtz responded that the university has long had a relationship with the community, because many of its students live PREPUBLICATION COPY: UNCORRECTED PROOFS

THE TRIALS OF RECOVERY 5-9 in the community. Since the fire, her partnership with the leaders of Paradise has enabled her to direct people in mutually beneficial ways. “Knowing where the town is, attending their meetings, going to their recovery processes, being on the long-term recovery board, establishing friendships and partnerships with all the agencies that exist inside the long-term recovery group, has kept me and others on the pulse of where the town is,” Kurtz explained. Paradise is about a 12-mile drive from Chico State. That drive gives her a chance to establish a relationship with people when she is taking them to the town and to address some of their misconceptions. “Being able to be offended for my neighbors is something that I can do and something the university can do.” Schmidt pointed out how valuable the service Chico State provides can be. “In some places in the rural west that are impacted by fire, they don’t have a university in their backyard. Not only are researchers coming to look at recovery, they are coming to look at preparedness, they are coming to look at response.” The need to know is “wonderful,” she said, “but it also can be a drain on communities.” On this same issue, Winston Wong, medical director of community health and director of disparities improvement and quality initiatives for Kaiser Permanente and a member of the Roundtable on the Promotion of Health Equity, noted that wildfires have effects both on the communities where they occur and on other communities, including downwind communities, but they are very different types of effects. Also, different communities experience different kinds of trauma, whether related to natural disasters or other factors, which leads to the question of how the isolation among communities dealing with trauma can be broken down. Schmidt pointed out that communities need to be broadly resilient. “Whether it be a Cascadia Subduction event, a tsunami, an earthquake, a geologic hazard, a volcano, or a wildland fire, east or west of the Cascade Mountains, this need for interwoven connections between us, innovative partnerships, and broad-based resilience is very common.” Schmidt also observed that recovery is a multiscale problem. The Washington State Fire Adapted Communities Learning Network is disseminating best practices and knowledge about recovery among its members to make sure that those pieces are not lost at the community level. This networking has multiple benefits, she said. It accelerates the innovation and adoption of best practices. It reduces the isolation that many rural communities feel. It creates cross-disciplinary approaches. This cooperation can also extend across borders. When fire broke out in Gatlinburg, Tennessee, communities in Washington State put together a list of local community organizations that were impacted and active in recovery, and it was transmitted through the governor’s office to the governor of Tennessee. “It is really important that connectivity and networking happens . . . at the state level, at the federal level, and through organizations.” David Shew, a consultant at Wildfire Defense Works, pointed to the value of and need for cooperation among communities that are facing the task of rebuilding and communities that have already been through that process. Addressing the Social Determinants of Health In response to a question from Octavio Martinez, executive director of the Hogg Foundation for Mental Health and associate vice president in the Division of Diversity and Community Engagement, The University of Texas at Austin, and a member of the Roundtable for Health Equity, about the opportunities that natural disasters create to address previously existing social determinants of health, Mason pointed out that, particularly with the Immediate Disaster Case Management program, the individuals who are marginalized prior to the disaster PREPUBLICATION COPY: UNCORRECTED PROOFS

5-10 IMPLICATIONS OF THE CALIFORNIA WILDFIRES FOR HEALTH, COMMUNITIES, AND PREPAREDNESS tend to be the individuals most supported after the disaster. Also, it can be difficult for officials from Washington, DC to come into communities as outsiders, so they build relationships with faith-based groups, with community action agencies, and with other organizations to give them a voice. “Cultural competency, the social determinants of health, and social vulnerability are primary drivers for our leadership.” A shortcoming, he added, is that these conversations tend to occur each time there is a disaster rather than on an ongoing basis. “It is not as structural as it needs to be.” Schmidt responded to this question by noting that Washington State has gotten better at institutionalizing policies that advance equitable outcomes in the response framework. In 2014 and 2015, evacuating the camps of migrant farmworkers had poor outcomes, both in terms of the short timeframe available to emergency managers and the lack of systems or policies. The state legislature then passed a bill requiring language access notification for emergency evacuation for “significant population segments,” which was defined as 5 percent of the population or 1,000 people, whichever is less. However, no new funding came with the new policy, leaving local communities to incorporate the provision in emergency planning, so the legislation “does not guarantee effectiveness in implementation.” Schmidt also observed that rural communities can receive less assistance than more populated areas because of the formulas used to allocate assistance. Kurtz called attention to housing issues. Though the City of Chico put a 10 percent cap on rental increases, the market has still been disrupted. People have returned to houses they were renting, creating housing insecurity for students and other renters. Especially with students who are already facing disparities, housing insecurity adds to their academic challenges, Kurtz observed. Eisenman added to this answer by noting that the Robert Wood Johnson Foundation has recently funded programs in several cities to broaden the concept of community resilience to incorporate community stressors other than natural disasters. In Sacramento, for example, an organization is applying the community resilience framework to the chronic stressor of violence, and a community on the Gulf Coast is applying the concept to unmet mental health needs while also preparing for future hurricanes. Recognizing Links to the Land Eisenman pointed out that the land brings solace to many individuals in communities at risk of wildfires. “People live in the wildlands for a purpose, many purposes, of course, but one of them is to be among the wildlands.” He asked about opportunities for using this attachment to the land to motivate recovery programs. Kurtz pointed to what forest therapy can do for people who have experienced disasters, especially wildfires, “to learn not to be afraid of the places that you want and love to live, to understand how being in the trees helps you.” Academic institutions can help by taking a cross- disciplinary approach that looks at mental health, public health, and recreation together as parts of recovery. Chico State, for example, has an ecological reserve that it can use for this purpose, including some land burned by the Camp Fire. The director of the reserve was able to secure a grant to bring children to the reserve and teach them about fire and about the benefits of the land. Schmidt pointed out that north-central Washington had many large fires before the fires of 2014 and 2015. A photographer named John Marshall, with federal funding, established a series of photo points to track post-fire landscape recovery. Those photo points provide an opportunity to show residents in similar ecosystems that the landscape will recover. PREPUBLICATION COPY: UNCORRECTED PROOFS

THE TRIALS OF RECOVERY 5-11 At the same time, she said, the presence of fire in ecosystems cannot be marginalized. “Just as we look at the landscape recovering, we have to look at the return of fire to that landscape and what that means for those communities, for the ecosystems that thrive with fire. It is a tricky balance between those two things, but fire has to be part of the conversation.” PREPUBLICATION COPY: UNCORRECTED PROOFS

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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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