The issue of climate-forced migration, and its impacts on human health, is a discourse that is often underplayed when it comes to discussions about climate impacts and adaptation.  The ramifications of ignoring it, and consequently failing to put in place appropriate policy frameworks to cope with increased levels of migrants at an international level, will be huge.  The health problems associated with climate-related migration also pose a major challenge for existing healthcare systems and the international humanitarian response. 

According to International Organisation for Migration and United Nations figures, between 200 million and 1 billion people could be forced to leave their homes between 2010 and 2050 as the effects of climate change worsen, potentially inundating current response strategies.

Climate change migration is already happening across the world - right now. 

Some are migrating because of the direct impacts of natural disasters like floods, droughts and acute water shortages.  Whilst indirect impacts such as conflict and increases in food prices can also contribute to people being forced to leave their homes.

There is no doubt that forced migration due to climate change will increase the pressure on existing infrastructure and urban services, especially in sanitation, education and social sectors and also consequently increase the risk of conflict over access to scare resources, even amongst migrants.

A study released on 28 November, entitled ‘where the rain falls: climate change, food and livelihood security, and migration’ reveals a much more nuanced relationship between projected climate variability and migration, which could provide key insights into likely drivers of migration the coming years.  The study, carried out by CARE International and UN University, in 8 countries in Asia, Africa and Latin America, revealed that in nearly all instances in which rains have become too scarce for farming, people have migrated, but mostly within national borders. 

At a side event at COP18 on this issue last week, one of the authors, Dr Koko Warner, remarked that "those resilient households use migration to reduce their exposure to climatic variability… In those households, migrants are in their mid-20s, single, move temporarily and send remittances back home. Those resilient households use migration to invest in even more livelihood diversification, education, health and other activities that put them on a positive path to human development."

However, there are also much starker consequences for more vulnerable households:

1. Households may migrate in an attempt to manage risk but suffer worse outcomes.  They are found in countries with less food security and fewer options to diversify their incomes. They move within their countries seasonally to find work, often as agricultural labourers.

2. The study also described how migration could be an ‘erosive coping strategy’; as a matter of human security, when few other options exist. These households are found in areas where food is even scarcer. They often move during the unpredictable dry season to other rural areas in their regions in search of food or work.

3. Lastly, the study found "households that are trapped and cannot move, and are really at the very margins of existence," according to Warner. These households do not have the capacity to migrate.

Health policy making in the context of migration can either been seen as a human rights issue, putting the needs of the individual first, or as a security issue, in terms of its threats to public health (eg. communicable disease control) and social stability.  The latter approach relies principally on monitoring, surveillance and screening, and could be argues to be the modern-day cousin of centuries-old quarantine measures, without an individual-focused perspective.  The human-rights based approach takes into account nuances and special needs of individuals, as well as the social determinants which may have affected individuals’ health along the migratory pathway.

With respect to the UNFCCC process, the response to environmental migration is an area that is particularly underdeveloped.

The negotiating text elaborated at Tianjin in 2010 invited Parties to enhance adaptation action under the Adaptation Framework through: [‘m]easures to enhance understanding, coordination and cooperation related to national, regional and international climate change induced displacement, migration and planned relocation, where appropriate’.  The Cancun agreement in 2010 took some strides forward and laid out a roadmap for progress with reference to migration, but as yet it hasn’t been implemented, and highlights the need for better and more equitable policy at a global level.

As Jane McAdam observes: “Finally—and perhaps most significantly—there seems to be little political appetite for a new international agreement on protection. As one official in Bangladesh pessimistically observed, ‘this is a globe for a rich man’.

In “Migration and Climate Change,” a recent publication by UNESCO, Stephen Castles, Associate Director of the International Migration Institute at the University of Oxford suggests that we may need to re-think our strategy.  “The doomsday prophesies of environmentalists may have done more to stigmatize refugees and migrants and to support repressive state measures against them, than to raise environmental awareness.”

We should be doing more, much more, to raise awareness of this issue, and we must start preparing to cope effectively with the health issues associated with it.

When disaster strikes, make no mistake about it: the poor and vulnerable are by far the worst hit.  Five weeks ago, news headlines were dominated by the second costliest hurricane in recent years, Hurricane Sandy; claiming the lives of 253 from seven countries and preliminary economic losses of $65.6 billion (2012 USD). 

It was indeed a huge tragedy and without sounding like a ‘Doomsday Prepper,’ it could be a sign of things to come.  The World Bank released a report last week called ‘Turn Down the Heat’ spells out in clear terms what our world would be like 4 degrees Celsius warmer, which is what climate scientists are almost unanimously predicting what will happen by the turn of the next century without serious and urgent changes in policy.

To paint a broad picture, 4 degrees scenarios are devastating.  Coastal cities will be inundated, there will be increasing risks for food production, unprecedented heat waves in many regions, especially in the tropics, substantially exacerbated water scarcity in many regions; increased frequency of high intensity hurricanes and irreversible loss of biodiversity, including coral reef systems.

I’m interested in how this affects us, as people - in the UK, Europe and beyond.

Many of you currently experiencing the cold snap in the UK will probably think this is bunkum and a warmer world is just the ticket.  However, it is not quite so simple.  Before you go out to ready the huskies and don the ski gear for a venture outside, let me tell you why we I think in the UK should take note of the effects of climate change, on us the rest of the world.

  I believe the biggest problem that we have in the UK is that far too many of us are not climate change sceptics, but climate change ignorers.  Most of us know what’s happening; the floods, heat waves, Hurricane Sandy, but after a flash of fear, helplessness takes over and we simply tune out and turn a blind eye.

We know the science and most agree that we have come to a point where the next 100 years could see some of the biggest changes in our environment and consequently how we live our lives.  But it’s not all doom and gloom.  As Anne Karf points out in her recent Guardian column, ‘Martin Luther King never inspired millions by saying “I have a nightmare.”’ 

Can we buy billions around the world into a vision that is carries with it the suggestion that a 2100 will be uninhabitable and generally a misery for us all?  Unlikely.

I believe what is needed is a shift in the narrative, moving away from the notion that climate change is a huge wrecking ball hurtling toward us at breakneck speed, with nothing that we can do to slow or halt the imminent destruction.  This simply breeds widespread apathy and inaccessibility.  Why should I cycle to work some days instead of taking the car everyday, or ease off on the amount of red meat that I eat for the sake of the planet?

Well… one reason that could persuade me has little to do with preventing climate change: they’re healthier.

I’m a firm believer in social justice, and using our political and social capital in the UK for good internationally.  We will be affected by this, but not at all to the same extent that smaller nation states, low lying countries and nations with smaller economies will.

Yesterday I participated in an action to show support for those affected by the typhoon in the Phillipines.  It was a powerful message by youth groups from every continent who stood in solidarity with the world’s poorest people, who are most at risk from the current and projected impacts of climate change.

Unfortunately, extreme events like this disaster and Sandy seem to be becoming the ‘new normal’ – but there are many things we can do both to reduce climate change itself (mitigation) and support people to help reduce its impacts (adaptation).

Ask yourself some the questions we all need to be asking of ourselves.  What can you do to help?  What skills do you have that would be useful?  What can you do to make a difference?  And when can you start?

Shuo Zhang

I recently attended Healthy Planet's panel discussion with Professors Hugh Montgomery, Ian Roberts, Anthony Costello and David Satterthwaite during the climate talks. They have all had long and varied careers, but their interests have converged in recent years by a deep motivation to advocate for urgent action on climate change. 

What really struck me during their presentations, and the subsequent question and answer session, is how far the climate change and health movement has come since the UCL-Lancet Commission in 2008, and also the diversity of perspectives, approaches and forms of engagement on the issues.  During these past four years, arguments have been redefined, emphasis redirected, and the movement has taken on board some important new evidence.

Past motivations

First, a quick history of how the climate change and health movement has gathered momentum.

In 2007 Climate and Health Council formed as ‘a meeting of doctors, nurses and other health professionals recognising the urgent need to address climate change to protect health’.  In 2008, Anthony Costello led The Lancet commission framed Climate Change as the ‘biggest health threat in the 21st century’  and set forth an interdisciplinary research directive to clarify and quantify the potential magnitude of climate change's direct and indirect health impacts. 

Impacts such as heat waves, changes in vector disease, air pollution and broader economic and geopolitical instability.  The Campaign for Greener Healthcare, now named the Centre for Sustainable Healthcare, was set up at the same time to develop a range of projects and programmes which focused on engagement, knowledge sharing, and transformation of the health system.  In April of the same year, the NHS Sustainable Development Unit was established to ‘help the NHS fulfil its potential as a leading sustainable and low carbon healthcare service'.  They state that they do this by 'developing organisations, people, tools, policy and research which will enable the NHS to promote sustainable development and mitigate climate change'.

These strands of global health, NHS sustainability and interest in transformative healthcare came together in 2009 with an organised and coherent health message at The Wave march before COP15 in Copenhagen – that 'what’s good for the climate is good for health'.

These strands still very much underlie and motivate the work that is being done, however both the political and economic landscape have changed.  There is a new urgency - since the initial Lancet Commission in 2008, new evidence now confirms some previously uncertain climate change impacts - however with the current economic recession, it seems there is less political will and public interest in the topic.

Why do we still care?

Perspective from the panel came from both personal and professional motivations. Prof Hugh Montgomery articulated the interconnected social, geopolitical and economic impacts on vulnerable populations in the developed and developing world of the indirect impacts of climate change today. This was most keenly illustrated through the impact of global weather on grain harvests, food prices and acting as a contributing factor to the Arab Spring.

Resource insecurity further compounds the pressures of future population growth on an already struggling planet. These themes of population, gender empowerment, new technologies, carbon-co benefits, have been consolidated within a development discourse and further, within an intergenerational justice discourse. Prof Anthony Costello presented updated research on the direct health impacts of climate change in terms of disease modelling.

It’s not just about future global impacts either. Prof Ian Roberts articulated the difference between demanding action to mitigate against the impacts of carbon on health, and demanding action on the negative health effects of carbon now.  Focusing on active travel in particular, he showed the potential benefits of reducing our reliance on the car and embedding active travel in our lifestyles, cities and communities.  And not just because it's healthier or lower carbon - but also because it can be more enjoyable.  This is applicable across the board: decarbonising our lifestyles re-emphasising meaning over consumption can help us to have healthier bodies and nicer places to live. 

Prof. Satterthwaite stressed that we mustn't forget that vast populations still live on the edges. They build homes and communities in the high risk peripheries of cities as cities are where today's economic opportunities lie. These incredibly vulnerable settlements need adaptation to the impacts of climate change now, but they are often the least able to vocalise their needs and participate in local governance.

So what is needed for the future?

Some questions that I feel still need to be answered: should emphasis be on top-down action and policies or bottom-up capacity building?  Can city and community level organisations be a new centre of power?  How do we make sure that money and support gets to the people who need it most?  And how can we ultimately make the most difference?

Fundamentally we all need to change what we are doing now, and to make better plans for the future.

I feel that healthcare professionals still have a lot to offer - we have a duty of care morally for our patients, and to minimise the impact of our healthcare systems on the planet, since it in turn sustains health.  Moreover, healthcare professionals interact with all sectors of society, have a global outreach and from the already existing healthcare partnerships and projects already set up, there is a pre-existing infrastructure there to disseminate information and create change.