After the fire: A qualitative study of the role of long term recovery organizations in addressing rural community social determinants of health

Abstract

Background: Wildfire activity in the United States has increased in intensity and duration over the past several decades, disrupting housing, employment, and other social determinants of health in impacted communities. As the cumulative burden of wildfire damage is projected to increase in the coming decades, understanding what constitutes an effective community recovery process is of critical importance. Through qualitative interviews with leaders of long term recovery organizations (LTROs), a key component of wildfire recovery, we explored barriers and facilitators to LTROs’ ability to meet post-wildfire needs related to social determinants of health in rural communities. Methods: We conducted brief surveys and semi-structured interviews with 18 current and former leaders from six LTROs from February to May 2022. Participants held leadership positions on LTROs serving rural communities in Washington, Oregon, and California impacted by wildfire disasters that occurred between 2015-2020. The Robert Wood Johnson Foundation’s (RWJF) Culture of Health Action Framework guided the creation of the semi-structured interview guide and a priori codebook, to examine LTROs’ ability to address social determinants of health from a health equity perspective. Additional codes were added through an inductive approach, and emerging themes were identified. Results: Findings from this study indicate that LTROs face many barriers in meeting post-wildfire community needs related to social determinants of health, including the policies that govern access to key recovery resources and information, the slow arrival of those key resources, the COVID-19 pandemic’s impacts such as rising home prices and shortages of mental health resources, the intertwined nature of community economic health and the restoration of the built environment, and the challenge of forming a functional LTRO structure. However, participants also identified factors that facilitated the ability of LTROs to meet community health needs, such as flexible LTRO governance structure and policies, funding to hire at least one employee, the ability of county, state, and federal government officials to adapt policies and procedures, and close collaboration with other organizations present in the community. Conclusions: Policies and other factors at the societal level, community-level recovery barriers, and organizational characteristics of LTROs themselves influence LTROs’ ability to address the social determinants of health in the aftermath of a wildfire disaster. The findings of this study suggest the need for policy improvements to promote more equitable access to key recovery resources, that economic recovery of individuals and the community should be seen as a core LTRO function, and that recovery planning should be incorporated into community disaster preparedness activities. Future research should focus on the role of LTROs in other contexts and in response to other disasters.