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I'm happy to introduce the presenters of an ounce of prevention.
How predictable disasters redefine quality, health, Care Christine, Nixon and Elizabeth Goodman of a one M.
Solutions, Christine Nixon is the founder and CEO of a one M.
Solutions, and brings 25 years of expertise in the Medicare and Medicaid healthcare.
It industry, Christine, lives in Chico, California, an area that has been deeply impacted by climate change and Christine founded M.
Solutions in as an economically disadvantaged woman, owned small business focusing on the intersection of human center design with policy and data for historically under invested communities.
Elizabeth Goodman is vice President of design and strategy at A.
On M. Solutions a Elizabeth is a researcher designer, and writer, with over 20 years of professional experience, with deep experience in design for emerging technologies and health care, at M.
Solutions she focuses on bridging policy and design perspectives to find new opportunities for public health before joining A.
One M. She served as 18 Fs. Director of design, and led early stage design for Login Backup, welcome.
Okay. Good morning, everybody. We are ready to go. I'm assuming everybody can see my screen if I'm sharing right
Okay. So yeah. Today we're going to talk to you.
What's that with
Out!
I was gonna say, could you hit presentation mode? I can see your full screen
No
Perfect.
I'm not sure. Oh, perfect. Okay, good, great alright.
So yeah. Today we're gonna talk about something a little bit.
Probably less conventional than maybe some of the other topics for today.
We have a case study that we wanted to talk to you about.
About an actual event that's happened in my area and move into how these natural disasters are really starting to become more predictable, and how might we think differently about them oh, here!
We go today is an actual, really important day in our community.
At about 6 30 in the morning 4 years ago, on this very day there was a fire that started in a very small mountain community called Polga, that was the town's name. And it was way up in the mountains and within a matter of 4 h it burned down the entire town of Paradise.
Which is a much larger community. We had just the perfect convergence of factors that day.
There were 40 mile an hour winds. We had extremely low humidity because we hadn't had any rain, and not to mention that the trees and the mountains around us in the forest have been compromised from drought and bark beetle and so when the fire started everything just went up
Like kindling, and started to spread quickly. I didn't realize that there was a fire that day until I was driving to take my kids to school at 7 30 in the morning, and this was the view from my car and when I saw this plum of smoke, I thought to myself.
I had never felt an aura like this before it it carried more of more of a evil in a way than any fire I had ever been around, and we have a lot of fires in our area so needless to say the fire spread at a rate of 80 football fields per minute
And, as I mentioned earlier, within 4 h, the entire town of Paradise, which was not far from where the fire started in Polga, I should say also it's called the Campfire not because somebody was sitting around with Marshallows it actually started on Camp Creek, Road, and so you know Fire
Crews main fires accordingly. 50,000 people live in that area.
Paradise is, was a pretty large community within Butte County, for those of you who are not familiar with California View County is actually in Northern California.
I always like to say the other state, but it's larger than the State of Rhode Island and Paradise is right.
Next door to cheap little, and Chico is my hometown, and it's where I'm sitting talking to you at this very moment.
So when 50,000 people evacuated, this is what it looked like for them trying to get out.
There were only 2 roads that were leading out of Paradise, or that do lead out of Paradise, and they lead into Chico where I am, and when a fire moved that fast and that hot the fire crews don't try to stop the fire anymore.
They are a 100% focused on trying to get people out, and that's what they did in that particular day.
Unfortunately, 86 people, didn't make it out. There are still some that are unaccounted for but 86 people we're confirmed you know that they they didn't make it and it's left 30,000 people permanently, displaced even as of now only
about 90 or 10% of the population has returned to Paradise.
So 90% of the population has not seen 15,000 homes and businesses were destroyed.
There were 19,000 structures. This was not a huge community, but it was a thriving community.
In the morning of November, eighth, 2,000, and 18, and it completely destroyed.
Schools, hospital medical systems, homes, businesses and people's lives.
In the early days of the fire. Those of us who lived in the surrounding communities became either we were helpers or you needed help.
There was really nothing in between. There were so many people that needed assistance, and one of the most immediate impacts that I saw.
My family and I went and helped with the temporary shelters that they were setting up was that the there was an incredible immediate impact on seniors.
Paradise was absolutely retirement community, and many of them left with every single anything that they had on their back, and that was about the gist of it.
So when they came into the shelters we were literally just trying to help them with prescriptions and medicines, and
Within 2 months, though it became pretty obvious that these folks had nowhere else to go.
A lot of them lived completely alone. And it was not a temporary problem.
This was a problem where we needed shelter to become permanent.
People could not return to the area because of water contamination and you know Fema was in there doing all sorts of things something else that really interesting started to happen, though that you don't think about necessarily as a pertains to health but here enters the beginning of the housing shortage which, becomes a
Mapive, Social Determinant of health in my area within 2 months people who were insurance started to get insurance money, and they came into Tico to try to stay here.
And we didn't have a lot of supply to begin with, on the housing market, but they bought up everything and the housing prizes started to increased dramatically.
I want to be very clear. This is not just for folks that are on medicaid.
But this is problematic. There are seniors who were living perfect, comfortable lives on fixed incomes who now cannot afford housing in this area, and and they are largely medicare beneficiaries.
This is outside Feather River Hospital in Paradise you can't see it very well, but that particular day we lost an entire hospital, and not only just the hospital but the Medical services and the providers and so many long-term care facilities and care homes that we have a shortage, now
because these people are still in the area, but they have no services to use, so they're providers who were there before, and their pharmacies that they went to no longer existed
4 years later we are sitting here with semi different problems, but still absolutely significant problems.
I mentioned before only 10% of the population has returned, but, as you can see here the housing crisis has continued to just accelerate houses went up by 175,000 within a 4 year time period so October was the month before the fire, hit and just this last May
we're seeing an average house price of 500,000, not to mention house for the rent for apartments.
Another big trend that we see, and that I observed with my own eyes, is the impact on the homeless population.
And what's happening with our permanent shelters?
That population has now increased significantly to be over 65 years old.
And I can't stress again enough how much housing has become such an incredibly big factor in this entire area, not just in Chico, but our rural communities around Chico Chico by the way, is about a 100,000 people and 30 of those 30,000 of those are college kids because where a university
town, but everywhere around Chicago is very, very rural.
These fires are starting to create healthcare deserts, and I know you can't see this very well.
But Chico is kind of in the middle, the the red blob to the right is where the fire was, and Chico is he goes underlined with a little bit of blue.
I wanted to circle this area. And yeah. I realized that it goes off the map because Tiko now serves as the main hospital system specialist medical providers for an enormously large area.
Beyond what goes off to the right in the circle. We now have residents that are traveling not 90 miles to get anything other than a small clinic in their area, and not only that you don't think about this but the providers, have moved out of the area, their homes burned and so what happens is it
leaves the hospital system like Karen Chico: that's still considered rule that is still fighting with the insurance companies to get even average payments or rate.
They can't, they don't have the bargaining power that the larger hospital networks do.
And meanwhile demand is increasing in so many different ways.
I mean. I turn it over to Liz now, but I just really wanted to reiterate that these natural disasters don't just come, and go, I really thought that they happen.
And then people carry on, and communities come back. They do come back.
It's very different, though, and they aren't becoming anomalies.
We had another fire just last year. That was the largest fire in California's history.
So over to you is to pick it up from here
So that's exactly what I'm going to talk about is the fact that this isn't an annoying at all.
More acres are burning each year. This is an app from the EPA, and it shows historical data, and you can see that wave of red and orange sweeping all the way down from Alaska.
To Texas, next Slide
So that means more people affected all over. Let's talk about the campfire you can also read along with the notes.
While Christine could see the fire. I and the rest of the bay area breathed it in.
So wildfire has immediate problems for you. You can feel it even with your purifiers running all day and all night.
I could feel it indoors. Smoke from wildfires, though especially when human, built features, like those in Paradise, burned down, have toxins with long term effects from the construction materials smoke in general affects the immune system which causes inflammation, which leads to higher risk of
Blood cots, which can then cause stroke and heart attacks so wildfire smoke is really bad for everybody in my family.
I have 2 kids and it's especially bad for them.
I have a mother-in-law who's in her eightys. It's especially bad for people over 65 and I have a husband with cardiovascular illness, especially bad as you can imagine for people, with ciovascular problems, it's also bad for people with
Asthma and diabetes, which, as we know, are also growing all over the rates of them, are already growing all over the Us.
So the bay area my home is now a long term natural experiment in particulate inhalation, congratulations on to all of us that being said, it's not just the bay area if you do the math in that quote on the left you can see that the negative health effects from pacific
northwest wildfires will actually affect as much as a thorough of the Us.
Population given, prevailing weather patterns next slide
So this is not going to change, because the problem, as Christine pointed out, is a changing climate in the future.
More of the Us. Is likely to face more days with heavy wildfire conditions.
That's the Kbdi measure that you see in the legend.
So the darker red obviously is hotter days hotter, dryer days.
Many of those reaches in red on the map have counties that, according to the most recent census, have 25% or more of the population over 65.
Christina's pointed out. That's that's our Medicare population, and that population is extremely prone to dangers of extreme heat.
Another environmental health risk. Not everyone has air conditioning that works all the time.
If you especially if you're in substandard housing.
So there's this terrible choice of health risks that comes to people who live in these places in summer and fall, which is, do you expose yourself to air pollution from wildfires, or do you risk overheating that's the risk that my family and I faced because we don't have air
conditioning in the bay area. Here's a bit of better news that see that green type in Bold in my caption.
We didn't used to be able to get this kind of projection it's only relatively recently that the necessary factors for reliable put extreme event prediction have come together for not just government like the EPA but academia, and private industry so those are very large environmental data sets available
Compute power tested scientific models, and unfortunately enough events to test the predictions against for those of you in the southeast.
You should know that it's not just wildfires that are getting more predictable.
It's also heat waves, floods, and hurricanes, although not earthquakes, so well, I'm gonna keep talking about wildfires, and particularly the campfire.
You should please imagine how what we're saying applies to whatever environmental hazard you worry about most in your backyard next slide
So what can we do now? We're in a dairy new situation for public health, with some exceptions, as Christine pointed out, public health professionals have tended to find quality health, care after natural disasters in terms of emergency responses because those disasters were relatively
Unexpected if we're now able to model and predict these extreme environmental events, is emergency response.
Now our only option or more disasters, like the ones at the campfire, and those follow on health catastrophes just inevitable.
Next slide, no, that's the answer. We can learn from the campfire, and we will first.
Disasters are not inevitable. We can prevent an environmental event causing catastrophic damage, then by definition, it's not.
It doesn't disaster just like not all flu seasons are the 1918 pandemic, and not all wildfires destroyed hounds.
It's people, not Mother Nature, who make a disaster.
Disaster. So that's where I wanted to introduce Fema's risk model for disasters.
So fema. Introduces the risk of disaster, not in terms of individual harm and personal responsibilities, but in terms of, as you can see on the right community or social vulnerability, and community resilience so think about what Christine told us about the town of paradise paradise was a
Flourishing retirement. Community people, there lived just fine.
They had housing. They had care for those who needed it.
They were not seen, as particularly vulnerable, except to the normal illnesses of old age.
Then the campfire hit the community, the surrounding areas like those that Christine Dan rallied to help.
But the fire wiped out. Housing stock, hospital beds and long term care rooms, and you can't replace those with a goal.
Go, fund me so here's a second lesson without resilient systems, even a tightly knit community or region can still collapse, and that leads me.
To our third lesson, which is how unexpected it all was.
Climate change is taking groups who weren't seen as a usually vulnerable, and then putting them around next slide
What's interesting, though, is that this is part of health care.
This is what health care. Does it identifies and manages human risk at scale.
So, for example, my own, a personally very very relevant example for me.
Take cardiovascular care you can see in the diagram on the right that death rates from heart disease were going down, and even dramatically declining among those older than 75 since around 2010, and even before then you see a spike in 2,019 clearly people's personal health couldn't
have changed to that dramatically during the pandemic.
So what happened access to preventive clinical care was lost.
What does preventive cloud vascular care do? It takes risk assessments that are based on population, level statistics and then applies them to individuals.
So my husband, when done effectively it turns what used to be these unexpected, acute crises into predictable manageable preventative health care routines, next slide since preventative, K.
Are regularly heads off these predictable disasters that befall at risk humans.
We want to conclude by considering what preventative Ka preventive care could do for these predictable disasters that are befalling.
Now at risk us communities, Christine will close
Thanks, Liz, so you know we've said this a couple of times, and I really have learned this personally.
But these don't. These disasters just don't end.
When the smoke is gone, and they ashes are cleaned up.
We have seen that there hitting the most vulnerable populations first and they tend to hit them the hardest, and we see that throughout the country that's not just here in this area, but another thing, that I just really never expected was the the impact on our healthcare services in these areas they're
decimated, and that's to say the least, it's not okay that people are driving 90 plus miles for any type of I mean, there are no emergency services so they're driving to just have their normal.
Provider. See them, and this has become a public health crisis in my mind.
I think that we need to continue to evolve.
You know I I sit here today in this chair, not talking to you as a government contractor who's been involved in these programs are really long time.
But more as a representative of a community that was deeply impacted by a natural disaster.
Several times and when we're talking about one of them today and I have been ecstatic lately to see what's happening in some of the States with the Medicaid programs now being allowed to include social determinants of health as a part of their medical or here in California it's called medical
So we just started a program called AIM for Cal AIM.
That now, and it now encourages advocacy organizations to come in and actually provide these services.
Transportation, food and housing as a part of whole person care, and I just think it's time for Medicare to start thinking about this as well.
I I know that there's work done in some of the Apms, but I have to be honest with you.
My rural community is not thinking about an Apm. We've and my husband is is on stage at the hospital, and you we talked to the CEO, and they they are not talking about Apms.
They are literally talking about how to make sure to serve these populations that we have that are just increasing continuely so.
I personally, if I could have anything I would like to see that we consider some new providers, new Medicare provider types.
Perhaps the Abbey organizations that are on the ground helping these community.
And these people with transportation. We've started to see even with the medication assisted treatment centers, you know, with the opioid crisis.
That was a new provider type as well as even just recently the establishment of rural emergency hospitals.
I think those are all fantastic, but I think with so
With that.
And I think we're done
Christine and Elizabeth. We're looking forward to your presentation
Alright well.