In Alaska's arctic communities, Inuit contemplating the need to relocate have reported that the loss of sea ice would make them feel like they are lost or going crazy. Zika and other vector-borne diseases have been a concern primarily for people in the southeastern United States. Recent research on the long-range internal migration of people from the coasts to the interior suggests a broader national concern regarding "climate augmentation" of disease. These are just two examples of the many public health effects we can expect as climate change forces people to uproot themselves.
In the future, extreme climate events — including more severe fast-acting coastal storms, rising seas, and more widespread droughts — will dislocate people and affect our public health infrastructure.
Migration can result in poor health outcomes when migrants find they have to face marginalization and discrimination, poverty, exposure to disease vectors, malnutrition, and crowding. Host communities may also experience increased demand on health services as they seek to accommodate migrants.
Climate change leads to three types of migration-related effects on health: 1) primary or direct effects such as injuries and death resulting from extreme weather events; 2) secondary or indirect effects from the increased geographical range of and populations exposed to new diseases; and 3) tertiary or delayed effects from disrupted health services for individuals in need.
To combat these effects, new efforts must be taken to adequately address increasing healthcare needs. Whether it's a disruption in services caused by events such as Superstorm Sandy (when critical healthcare infrastructure could not function for weeks) or the wide range of health maladies that force Marshall Islanders to migrate to the United States for better care, the public health infrastructure will need a new climate-migration minded approach.
Physically, climate change can influence the geographic range, seasonality, and incidence of infectious diseases as they move with migrants and increase the risk to host communities. Vector-borne diseases, such as Zika, are of particular concern. They can have grave impacts, because climate change augments them, increasing the rate of vector reproduction, the frequency of vector interactions with humans, and the geographic distribution. Moreover, climate change will also affect services for those suffering from chronic health conditions such as cancer, hypertension, coronary heart disease, and diabetes. As migrants move into new communities, they will further strain public health infrastructure.
The mental health impacts of migration are also often overlooked; though, research has revealed high rates of poor mental health. For example, in Hurricane Katrina-affected areas, suicide and suicidal ideation more than doubled, one in six people met the diagnostic criteria for post-traumatic stress disorder, and 49 percent of people living in Katrina's path developed an anxiety or mood disorder such as depression. Additionally, the loss of one's home or community has inspired new terms like "solastagia," which describes the feeling of losing a place that is important to one's sense of self as well as the accompanying erosion of social networks.
To minimize any health inequities and to ensure migrants get access to services and that their health needs are met, we must first recognize the complexity of migration (especially climate-induced migration) and its impacts on public health. Furthermore, decisionmakers, public health actors, and advocates would do well to identify at-risk populations, as the poor and powerless are likely to suffer disproportionately from climate change. For example, states can improve their vulnerability mapping by using census data to identify those who are more susceptible to health effects, such as the elderly. Florida has done this with measurable impact.
Law and policy that specifically addresses the synergistic effects of climate change and gaps in public health infrastructure is lacking. The most important policy measure we can take now is to reduce adverse health outcomes related to climate migration by dramatically cutting greenhouse gases. If changes in climate are less severe, fewer people would suffer, and we would be better able to adapt.
Other interventions can address current needs. One might be continued and increased aid to developing countries to improve health. For example, uninterrupted and expanded aid to the Affiliated Pacific Islands like the Marshall Islands could head off morbidity at its source and reduce out migration.
Another example of a way to enhance preparedness is European "Migrant-Friendly Hospitals." Upon recognizing that migrants may not receive the same level of care as the average population, a group of hospitals from 12 European countries decided to improve their response to the healthcare needs of migrants and ethnic minorities with this migrant-focused health services initiative.
In the long-term, a more appropriate and modern legal system would anticipate migration flows. In her article, "Migration Emergencies," Professor Jaya Ramji-Nogales suggests that the field of immigration law itself contributes to many contemporary migration and refugee crises because it encourages risk-taking and extralegal activities that often exacerbate crises. Proactive planning that incorporates the perspectives of migrants and ensures that the state protects migrant rights is urgently needed. As Ramji-Nogales writes: "One can imagine a legal regime that anticipated migration flows and enabled safe and lawful movement for migrants of all types." Indeed, the global community could make such a regime part of its belated response to climate displacement and climate related cross-border migration.
For those who must move, Ramji-Nogales says, it is important to "enable safe and lawful journeys as part of a coherent and comprehensive approach to global migration." Regional migration governance might also succeed given that most climate migration will occur within country or region and that regional agreements can facilitate experimentation in shared planning and governance.
Healthcare providers and legal actors can also work together in more innovative ways. Legal advocates might first engage providers to determine what existing law and policy frameworks hinder or advance work at the intersection of climate and health. More assertive engagement by such actors could shape future policy and outcomes.
Finally, in addition to the desperate need for greater research, understanding, coping with, and embracing the inherent uncertainty in the interplay among climate, health, and migration will be vital. The health impacts of forced displacement, migration, and relocation are well documented now, and the risks are much easier to convey. If we improve how we communicate to decision-makers, trusted public health practitioners, and the public generally about the impacts of climate change while facilitating decision-making despite uncertainty, we can help to prevent planning paralysis.
Although the current political climate does not yet promote enhanced protections for migrants, given the urgency and potential severity of climate change impacts, we must call for swift action to support the well-being of migrants and the communities that host them.