It can be tempting to think that the recent wildfire disasters in communities across the West were unlucky, one-off events, but evidence is accumulating that points to a trend.

In a new study, we found a 246% increase in the number of homes and structures destroyed by wildfires in the contiguous Western U.S. between the past two decades, 1999-2009 and 2010-2020.

This trend is strongly influenced by major fires in 2017, 2018 and 2020, including destructive fires in Paradise and Santa Rosa, California, and in Colorado, Oregon and Washington. In fact, in nearly every Western state, more homes and buildings were destroyed by wildfire over the past decade than the decade before, revealing increasing vulnerability to wildfire disasters.

What explains the increasing home and structure loss?

Surprisingly, it’s not just the trend of burning more area, or simply more homes being built where fires historically burned. While those trends play a role, increasing home and structure loss is outpacing both.

As fire scientists, we have spent decades studying the causes and impacts of wildfires, in both the recent and more distant past. It’s clear that the current wildfire crisis in the Western U.S. has human fingerprints all over it. In our view, now more than ever, humanity needs to understand its role.

Wildfires are becoming more destructive

From 1999 to 2009, an average of 1.3 structures were destroyed for every 4 square miles burned (1,000 hectares, or 10 square kilometers). This average more than doubled to 3.4 during the following decade, 2010-2020.

Nearly every Western state lost more structures for every square mile burned, with the exception of New Mexico and Arizona.

Humans increasingly cause destructive wildfires

Given the damage from the wildfires you hear about on the news, you may be surprised to learn that 88% of wildfires in the West over the past two decades destroyed zero structures. This is, in part, because the majority of area burned (65%) is still due to lightning-ignited wildfires, often in remote areas.

But among wildfires that do burn homes or other structures, humans play a disproportionate role – 76% over the past two decades were started by unplanned human-related ignitions, including backyard burning, downed power lines and campfires. The area burned from human-related ignitions rose 51% between 1999-2009 and 2010-2020.

This is important because wildfires started by human activities or infrastructure have vastly different impacts and characteristics that can make them more destructive.

Unplanned human ignitions typically occur near buildings and tend to burn in grasses that dry out easily and burn quickly. And people have built more homes and buildings in areas surrounded by flammable vegetation, with the number of structures up by 40% over the past two decades across the West, with every state contributing to the trend.

Human-caused wildfires also expand the fire season beyond the summer months when lightning is most common, and they are particularly destructive during late summer and fall when they overlap with periods of high winds.

As a result, of all the wildfires that destroy structures in the West, human-caused events typically destroy over 10 times more structures for every square mile burned, compared to lighting-caused events.

The December 2021 Marshall Fire that destroyed more than 1,000 homes and buildings in the suburbs near Boulder, Colorado, fit this pattern to a T. Powerful winds sent the fire racing through neighborhoods and vegetation that was unusually dry for late December.

As human-caused climate change leaves vegetation more flammable later into each year, the consequences of accidental ignitions are magnified.

Putting out all fires isn’t the answer

This might make it easy to think that if we just put out all fires, we would be safer. Yet a focus on stopping wildfires at all costs is, in part, what got the West into its current predicament. Fire risks just accumulate for the future.

The amount of flammable vegetation has increased in many regions because of an absence of burning due to emphasizing fire suppression, preventing Indigenous fire stewardship and a fear of fire in any context, well exemplified by Smokey Bear. Putting out every fire quickly removes the positive, beneficial effects of fires in Western ecosystems, including clearing away hazardous fuels so future fires burn less intensely.

How to reduce risk of destructive wildfires

The good news is that people have the ability to affect change, now. Preventing wildfire disasters necessarily means minimizing unplanned human-related ignitions. And it requires more than Smokey Bear’s message that “only you can prevent forest fires.” Infrastructure, like downed power lines, has caused some of the deadliest wildfires in recent years.

Reducing wildfire risks across communities, states and regions requires transformative changes beyond individual actions. We need innovative approaches and perspectives for how we build, provide power and manage lands, as well as mechanisms that ensure changes work across socioeconomic levels.

Actions to reduce risk will vary, since how people live and how wildfires burn vary widely across the West.

States with large tracts of land with little development, like Idaho and Nevada, can accommodate widespread burning, largely from lighting ignition, with little structure loss.

California and Colorado, for example, require different approaches and priorities. Growing communities can carefully plan if and how they build in flammable landscapes, support wildfire management for risks and benefits, and improve firefighting efforts when wildfires do threaten communities.

Climate change remains the elephant in the room. Left unaddressed, warmer, drier conditions will exacerbate challenges of living with wildfires. And yet we can’t wait. Addressing climate change can be paired with reducing risks immediately to live more safely in an increasingly flammable West.

Philip Higuera, Professor of Fire Ecology, University of Montana; Jennifer Balch, Associate Professor of Geography and Director, Earth Lab, University of Colorado Boulder; Maxwell Cook, Ph.D. Student, Dept. of Geography, University of Colorado Boulder, and Natasha Stavros, Director of the Earth Lab Analytics Hub, University of Colorado Boulder

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Over the past year, cities across the United States have unveiled new policy plans to address homelessness amid rising concerns about health and crime – for homeless people themselves, as well as for surrounding communities. Notably, several proposals include civil commitment, also referred to as involuntary treatment, for people with severe mental illness or substance use disorders.

In November 2022, for example, New York City Mayor Eric Adams announced a plan to use mental health laws to facilitate involuntary treatment when people are unable to care for themselves, or when their actions endanger others.

Court-mandated treatment could include therapy, social workers, housing referrals, medication or other interventions, either in hospitals or on an outpatient basis. New York’s plan builds on other recent initiatives to connect more homeless and mentally ill people with shelters or supportive housing.

Political leaders in California and Portland, Oregon, have approved similar plans to use civil commitment laws.

As a health law and medical ethics professor, I believe it’s worth explaining how these laws work and the ethical issues they raise.

How civil commitment works

Civil commitment laws have been around for decades. However, they only recently appear to have regained traction as a strategy for addressing the intersection of homelessness, mental illness and substance use disorder.

States have enacted these laws based on two theories. First, under the doctrine of parens patriae, a Latin phrase that means “parent of the nation,” states have a legal and ethical obligation to step in and help vulnerable people who cannot act for themselves. Second, in public health law, the concept of police power means that states have a duty to pass and enforce laws to preserve public health and safety, which can be impacted by homelessness.

Every state has different laws outlining civil commitment. Importantly, these laws are a civil mechanism for courts to oversee a treatment plan for people with severe mental illness or substance use disorders that meet specific criteria. For example, a court could assess testimony and evidence from clinicians that a person has such a severe substance use disorder that he repeatedly loses consciousness, will not accept assistance and risks freezing to death outside. These laws do not “criminalize” or punish homelessness.

During the initial assessment process, the person receives care in a hospital, where clinicians determine their medical needs. Afterward, the court may order a treatment plan that would outline requirements for the person to accept shelter and maintain weekly appointments such as attending therapy or drug treatment. Treatment in inpatient hospitals are generally only used in cases of severe illness, and laws require using the least restrictive plan possible.

Civil commitment laws also require due process, or a fair procedure for people to participate in the process, object and have assistance from legal counsel.

Understanding chronic homelessness

What is often called “the homeless” population is actually multiple groups with different needs, including youth, families, veterans, people with short episodes of homelessness spurred by job loss or unexpected bills, and the chronically homeless.

However, the most visible population – those who are chronically homeless without shelter – suffer from high rates of untreated severe substance use disorders and mental illness, though estimates vary. The University of California’s California Policy Lab analyzed surveys of 64,000 people who were homeless across 15 different states and found that 78% of the unsheltered homeless suffered from mental illness and 75% from a substance abuse disorder. Fifty percent experienced both.

Clinicians note that mental illness and substance use disorders can contribute to homelessness, and worsen it, too.

Ethical issues

Civil commitment aims to improve the well-being of individuals and communities. But it raises difficult questions about core ethical issues such as autonomy – people’s right to make medical decisions for themselves – and beneficence, or ensuring that interventions provide more benefit than harm.

Some experts oppose using civil commitment laws and assert that states should rely on voluntary services. Voluntary treatment, some of them contend, is just as effective but preserves autonomy and the freedom to choose or decline treatment.

Critics also assert that involuntary commitment violates the principle of beneficence, because it can stigmatize homeless people with severe mental health and substance use disorders by implying that they do not belong in public. Others contend it is cruel and coercive.

Advocates for plans like New York City’s, on the other hand, assert that civil commitment laws are not only effective at connecting people with help, but fulfill a moral obligation to prevent people from suffering on city streets.

In most instances, health care workers and ethicists presume that adults can make their own medical choices in line with their values and needs. But people with severe mental illness or substance use disorder may experience impairment in their ability to deliberate, assess their needs and make decisions, which compromises their autonomy. Though involuntary treatment violates autonomy, it can also help people regain it through stabilization and recovery.

Many clinicians and outreach workers argue that glossing over the impact of untreated mental illness and substance use disorder violates the principle of beneficence, because avoiding treatment may result in more health harms.

Wider effects

Ethics debates must also grapple with how treatment affects the surrounding community, such as safety – including for other people experiencing homelessness. As one data point, the San Diego District Attorney’s Office has compiled data showing people who are homeless are far more likely to be the victims of crime. Its data found that this population commits dramatically higher rates of vandalism, arson, assault and burglary as well, although there are few nationwide studies. And while most people who are homeless, have a mental health illness or have a substance use disorder are not violent, some studies suggest people with a severe mental health illness are three to four times more likely to display violent behavior.

Some evidence suggests that civil commitment can increase follow-through with treatment plans, reduce acute hospitalization and decrease violent behavior. Proponents assert that despite the coercive nature of civil commitment, it provides benefit as a step toward restoring the health of each person, and of society.

Katherine Drabiak, Associate Professor of Health Law, Public Health Law and Medical Ethics, University of South Florida

This article is republished from The Conversation under a Creative Commons license. Read the original article.

President Joe Biden announced on Jan. 30, 2023, that he intends to end both the national emergency and the public health emergency declarations related to COVID-19 on May 11, 2023.

Biden’s announcement came on the same day that the World Health Organization said it still considers the COVID-19 pandemic to be a public health emergency of international concern, or PHEIC, a status that is reassessed every three months. The WHO’s advisory committee noted that although the pandemic is at a turning point, “COVID-19 remains a dangerous infectious disease with the capacity to cause substantial damage to health and health systems.”

The Conversation asked public health experts Marian Moser Jones and Amy Lauren Fairchild to put these statements into context and to explain their ramifications for the next stage of the pandemic.

What does ending the emergency phase of the COVID-19 pandemic mean?

Ending the federal emergency reflects both a scientific and political judgment that the acute phase of the COVID-19 pandemic crisis has ended and that special federal resources are no longer needed to prevent disease transmission across borders.

In practical terms, it means that two declarations – the federal Public Health Emergency, first declared on Jan. 31, 2020, and the COVID-19 national emergency that President Donald Trump announced on March 13, 2020 – will be allowed to expire in May 2023.

Declaring those emergencies enabled the federal government to cut through a mountain of red tape, with the goal of responding to the pandemic more efficiently. For instance, the declarations allowed funds to be made available so that federal agencies could direct personnel, equipment, supplies and services to state and local governments wherever they were needed. In addition, the declarations made resources available to launch investigations into the “cause, treatment or prevention” of COVID-19 and to enter into contracts with other organizations to meet needs stemming from the emergency.

The emergency status also allowed the federal government to make health care more widely available by suspending many requirements for accessing Medicare, Medicaid and the Children’s Health Program. And they made it possible for people to receive free COVID-19 testing, treatment and vaccines and enabled Medicaid and Medicare to more easily cover telehealth services.

What policy changes will occur once the emergency is declared over?

The end to the federal emergency could substantially reduce the number of people insured under Medicaid. Before the pandemic, states required people to prove every year that they met income and other eligibility requirements.

In March 2020, Congress enacted a continuous enrollment provision in Medicaid that prevented states from removing anyone from their rolls during the pandemic. In a December 2022 appropriations bill, Congress passed a provision that will end continuous enrollment on March 31, 2023.

The Biden administration has defended this time frame as sufficient to ensure that “patients do not lose access to care unpredictably” and that state Medicaid budgets – which have been infused with emergency funds since 2020 – “don’t face a radical cliff.” But many people with Medicaid may be unaware of these changes until they actually lose their benefits.

Some states have already indicated that they will begin disenrolling members in April 2023 or require members to apply to be considered for renewal. This could result in between 5 million and 14 million people losing coverage.

People with Medicare do not have to worry about losing their benefits, since this program is age-based, not income-based. The array of telehealth services that Medicare began covering during the pandemic will continue to be covered through December 2023. Medicare coverage for many telehealth services could also be made permanent after this year.

The end of the emergency could additionally curb access to COVID-19 drugs, tests and vaccines. Federal emergency funding for free treatment or vaccination will end when the emergency status is lifted on May 11. If such programs are to continue, the cost will fall to state and local health agencies or insurance companies.

We are concerned that the withdrawal of federal emergency funds for vaccination may further slow the already sluggish uptake of boosters. As of Jan. 25, 2023, about 20% of the population ages 5 and up and only 40.1% of those 65 and older – who are at the highest risk of death from COVID-19 – had received an updated bivalent booster dose. Once the emergency ends, measures that allowed a broad array of health providers – from pharmacist interns to retired nurses and even veterinarians – to administer vaccines will expire, which could lead to decreased access to vaccination in many parts of the U.S.

What does this mean for the status of the pandemic?

A pandemic declaration represents an assessment that human transmission of a disease, whether well known or novel, is “extraordinary,” that it constitutes a public health risk to two or more states and that controlling it requires an international response.

At some point the WHO will end its pandemic declaration. On Jan. 30, 2023, World Health Organization Director-General Tedros Adhanom Ghebreyesus described the pandemic as being “at a transition point.” But the WHO’s assessment is that the risks are still considerable. Ghebreyesus noted that COVID-19 continues to strain health care systems, exacerbate health care workforce shortages and exceed surveillance system capacities.

The U.S. remains one of the global COVID-19 hot spots. With more than 3,500 hospitalizations per week on average in January 2023, and 3,452 deaths per week as of early February 2023, the U.S. has among the highest deaths per capita in the world.

How does the Biden administration’s stance differ from the WHO’s position?

In some ways they are very similar. The WHO is looking at the pandemic from a global perspective while the Biden administration is examining it from a national perspective. The WHO’s stance reflects the assessment that the world is not sufficiently vaccinated, that health care systems remain vulnerable and that unchecked disease transmission in some parts of the world should remain a source of international concern and attention.

China’s massive outbreak after the lifting of its zero-COVID policy in early December 2022 has received a great deal of media attention. But less noted is the fact that vaccination rates across African nations average 40%, and that vaccination rates are very low in countries that are experiencing conflict, such as Syria, where only 15% of the population has received any COVID-19 vaccine.

The WHO’s continuation of the global pandemic status signals that there is more international coordination and work to be done. In contrast, the Biden administration is making a social and political judgment that it is time to wind down the federal role.

Biden’s order will not affect state-level or local-level emergency declarations. These declarations have allowed states to allocate resources to meet pandemic needs and have included provisions allowing them to respond to surges in COVID-19 cases by allowing out-of-state physicians and other health care providers to practice in person and through telehealth.

Almost all U.S. states, however, have ended their own public health emergency declarations. Eight states – California, Colorado, Delaware, Georgia, Illinois, New Mexico, Rhode Island and Texas – still have emergency declarations in effect, but all of them will expire by the end of February 2023 unless renewed.

While some states may choose to make permanent some COVID-era emergency standards, such as looser restrictions on telemedicine or out-of-state health providers, it could be a long time before either politicians or the public regain an appetite for any emergency orders directly related to COVID-19.

Amy Lauren Fairchild, Dean and Professor of Public Health, The Ohio State University and Marian Moser Jones, Associate Professor and Graduate Director of Family Science, The Ohio State University

This article is republished from The Conversation under a Creative Commons license. Read the original article.