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date: 26 April 2018

Environmental Change, Migration, and Population Health

Summary and Keywords

Global environmental change amplifies and creates pressures that shape human migration. In the 21st century, there has been increasing focus on the complexities of migration and environmental change, including forecasts of the potential scale and pace of so-called environmental migration, identification of geographic sites of vulnerability, policy implications, and the intersections of environmental change with other drivers of human migration. Migration is increasingly viewed as an adaptive response to climatic and environmental change, particularly in terms of livelihood vulnerability and risk diversification. Yet the adaptive potential of migration will be defined in part by health outcomes for migrating populations. There has been limited examination, however, of the health consequences of migration related to environmental change.

Migration related to environmental change includes diverse types of mobility, including internal migration to urban areas, cross-border migration, forced displacement following environmental disaster, and planned relocation—migration into sites of environmental vulnerability; much-debated links between environmental change, conflict, and migration; immobile or “trapped” populations; and displacement due to climate change mitigation and decarbonization action. Although health benefits of migration may accrue, such as increased access to health services or migration away from sites of physical risk, migration—particularly irregular (undocumented) migration and forced displacement—can amplify vulnerabilities and present risks to health and well-being. For diverse migratory pathways, there is the need to anticipate, respond to, and ameliorate population health burdens among migrants.

Keywords: environmental migration, global environmental change, climate change, climate adaptation, forced displacement, planned relocation, population health, human mobility


Throughout history, environmental and climatic changes have influenced patterns of human mobility (McLeman, 2014). The movement of early humans was accompanied and shaped by climatic changes that led to glaciation in the northern hemisphere and increased rainfall in parts of Africa, including in the Sahel and Sahara (Behringer, 2010). Migration and mobility were means by which people adapted to challenging climatic change. In the context of anthropogenic global environmental change, understanding the causes and consequences of environmental migration is critical. Environmental changes—including changes to land use, climate, and other earth system processes—now shape human mobility as they amplify and create pressures that contribute to the displacement and migration of individuals, families and communities (ADB, 2012; Adger et al., 2015; Foresight, 2011; McMichael, Barnett, & McMichael, 2012; Tacoli, 2009).

Both slow-onset environmental changes (e.g., sea-level rise, rainfall variability, drought, land degradation) and sudden-onset changes (e.g., flooding, cyclones, wildfires) contribute to human mobility (Birk & Rasmussen, 2014; Findley, 1994; Warner & Afifi, 2014). Environmental migration dynamics are diverse and include “planned” migration where people and households aim to diversify livelihood opportunities to minimize risk in the face of environmental threats, through to “forced” displacement in response to the impacts of rapid-onset environmental disaster (Hunter, Luna & Norton, 2015). Nonetheless, the line between forced displacement and voluntary migration is difficult to define, particularly when people move in response to slower-onset risk; for many environmental migrants, aspects of choice and coercion intersect (Hugo, 2010).

Research in the 1980s and 1990s brought public attention to so-called environmental migrants and climate refugees (terms that have no legal basis in international refugee law and is misleading as it implies single causality in migration decisions) (El-Hinnawi, 1985; IOM/RPG, 1992; Myers, 2002). In the early 21st century, there has been increasing focus on the complexities of migration and environmental change including the UK Foresight project on Migration and Global Environmental Change (Foresight, 2011), international comparative research projects (Afifi & Jäger, 2010; Warner & Afifi, 2014), and engagement and assessment of climate-related migration in the IPCC’s fifth assessment report (IPCC, 2014). Within research, policy development and conferences in the area of environmental migration, the impacts of climate change increasingly overshadow other types of environmental change that shape migration dynamics.

Despite widely cited estimates that climate change will contribute to the forced displacement of hundreds of millions of people by the mid-21st century, there are no reliable forecasts of the likely numbers of environment and climate-related migrants. The International Organization for Migration (IOM) defines environmental migrants as:

persons or groups of persons who, for compelling reasons of sudden or progressive changes in the environment that adversely affect their lives or living conditions, are obliged to leave their homes or choose to do so, either temporarily or permanently, and who move either within their country or abroad.

(2014a, p. 6)

Certain places are vulnerable to environmental and climatic changes, where migration as an adaptive response is more likely. These include communities that depend on agricultural and natural resources, low-lying coastal areas, small island states, and other sites with limited adaptation possibilities (McLeman & Hunter, 2010). Importantly, however, both sudden and progressive environmental changes influence migration in intersection with other large-scale economic, social, demographic, and political drivers of migration. Wisner, Blaikie, Cannon, and Davis (2004), for example, argue that in developing countries, the adverse impacts of structural adjustment programs, neoliberal reform, and foreign debt increase vulnerability to environmental hazards. Displacement following environmental disaster must therefore be understood as a consequence of both environmental threat and the broader determinants of vulnerability and resilience. And migration is shaped by proximate household and individual characteristics including age, gender, social networks, risk perceptions, and educational background. Therefore, it will rarely be possible to identify communities and people for whom environmental and climatic factors are the sole driver of migration (Foresight, 2011; Kothari, 2013; Warner & Afifi, 2014; Piguet, Pécoud & De Guchteneire, 2011).

Environmental Change, Migration, and Population HealthClick to view larger

Figure 1. Drivers of Migration and the Influence of Environmental Change (Foresight, 2011, p. 12).

Predictions of the numbers of people likely to migrate in response to environmental change have attracted widespread criticism because of the difficulty of disaggregating environmental migration from other forms of migration, the lack of distinction between at-risk populations and those likely to migrate, and failure to account for the potential influence of other adaptation strategies (Foresight, 2011). While expressing low confidence in specific quantitative projections due to the complex, multicausal nature of migration, the Intergovernmental Panel on Climate Change (IPCC) Fifth Assessment Report emphasized the seriousness of population displacement due to climate change impacts (Field et al., 2014, p. 20). Researchers and policymakers are giving increasing attention to environmental migration—particularly climate change-related migration—its legal and governance implications, the risks associated with environmental migration, and the role of migration as a component of adaptive action.

The relationship between human migration and environmental change has increasing visibility and relevance in the international policy sphere. In 2010 the Cancun Adaptation Framework became the first Conference of Parties (COP) text to formally recognize climate-induced mobility. Parties to the Convention were invited to undertake “measures to enhance understanding, coordination and cooperation with regard to climate change induced displacement, migration and planned relocation, where appropriate, at national, regional and international levels” (UNFCCC, 2011). In the final text of the Paris Climate Change Agreement, migration and displacement were mentioned both in the preamble, and under the text on Loss and Damage (paragraph 50), with a request to establish “a task force . . . to develop recommendations for integrated approaches to avert, minimize and address displacement related to the adverse impacts of climate change” (UNFCCC, 2015). The Nansen initiative, and subsequent Agenda for the Protection of Cross-Border Displaced Persons in the Context of Disasters and Climate Change (endorsed by 109 countries), address the protection and assistance needs of people who are displaced within and across borders by environmental disaster and climate change risks, and explore potential measures that states may adopt (Nansen Initiative, 2015). Some national climate policies refer to migration, relocation, and displacement. Yet the health of environmental migrants is not addressed in these and other policy documents.

Migration associated with environmental and climatic change presents both opportunities and threats for the health and well-being of migrants and host and source communities (Bowles, Reuveny, & Butler, 2014; Carballo, Smith, & Pettersson, 2008; McMichael, 2014; McMichael et al., 2012). There is growing recognition that environmental and climate-related migration may represent a more significant threat to human health in coming decades than other more direct climate-health relationships such as heat stress or the changing ecology of infectious diseases (Frumkin, Hess, Luber, Malilay, & McGeehin, 2008; McMichael, 2013). But there has been little examination of the health consequences of migration related to environmental change.

This article discusses environmental change, migration, and population health. Population health aims to protect and promote health and well-being, to prevent disease and disability, to address conditions that lead to poor health, and foster collective resilience of people and communities. It focuses on people, not diseases, and seeks to reduce health inequities. Population health frameworks and action are increasingly calling for a global environmental focus, and assert that we must conserve and protect our planet and safeguard the physical and human environments within which we coexist and on which we depend (Horton et al., 2014, p. 847).

With this population health perspective at its foundation, this article examines the complex nexus of environmental change and migration, and focuses on the health of migrant populations. Migration associated with environmental change will influence the health of receiving and sending populations; the article, however, focuses primarily on migrants themselves. It examines “environmental migration” in response (at least in part) to global environmental changes, including: internal migration to urban areas, cross-border migration, forced displacement following environmental disaster, and planned relocation in response to slow-onset environmental threats. The article also considers health outcomes associated with more complex intersections between environment change and migration, including: migration into sites of environmental vulnerability; much-debated links between environmental change, conflict, and migration; immobile or “trapped” populations that are not willing or able to migrate; and displacement due to climate change mitigation and decarbonization actions, such as hydroelectric dams. The sections below critically consider each of these different migratory contexts, and draw on analogous scenarios or, where available, empirical evidence to review population health risks and opportunities (see Table 1 for examples of migration pathways and potential health risks).

Table 1. The Migration-Environment Nexus and Associated Health Determinants and Potential Health Outcomes

Migration Type

Examples of Health Risks

“Environmental Migration”

Internal migration to urban poor areas

Infectious disease risk (e.g., tuberculosis, diarrhoeal disease) due to crowded living conditions and exposure to pathogens, poor nutrition, air pollution and respiratory illness, risk of non-communicable diseases.

Cross-border migration

Increased risk of infectious disease in migrant and host populations, occupational health risks (particularly among irregular/undocumented migrants), psychosocial health risks, inadequate access to health services.

Forced displacement following environmental disaster

Water-borne diseases (diarrhoea, hepatitis), air-borne disease (respiratory infection, measles), vector-borne diseases (malaria), poor mental health, sexual and gender-based violence, low vaccination coverage, limited access to health services, sociocultural disruption and associated psychosocial health impacts.

Planned relocation due to slow-onset environmental threats

Altered nutrition, psycho-social health impacts of loss of place attachment (speculative, no research has examined health impacts of planned relocation related to environmental change).

Migration to sites of environmental vulnerability

Injuries and mortality related to extreme weather events and heat waves; infectious disease risks; respiratory illness; under-nutrition.

Environmental change, conflict and migration (noting causal pathways are highly contested).

Conflict-associated health threats (e.g., elevated mortality rates among combatant/civilian populations, increased infant and maternal mortality, physical and psychological effects, disability, gender-based violence, malnutrition, infectious disease).

Immobile or “trapped” populations

Morbidity/mortality due to extreme weather (storms, floods, temperature extremes), poor psycho-social and mental health, infectious disease risk, ageing populations, poor water and sanitation, food insecurity. Remittances support health infrastructure in source communities. Psychosocial benefits of remaining in site of “belonging.”

Displacement due to climate change mitigation and decarbonization actions

Psychosocial impacts, substance misuse, infectious disease risk, food insecurity (speculative, limited research has assessed health impacts of development forced displacement and resettlement).

Environmental Migration and Health

Environmental Migration

Migration can be an adaptive response that reduces vulnerability to the adverse impacts of environmental change. The health impacts for migrating populations will depend on the nature, location, and context of the migration process, policy and legal contexts, health services and conditions in sites of settlement, and resources and capacity of migrants. Increased economic and educational opportunities, improved nutrition, and access to health services in destination sites can produce health benefits. There are examples where environment-related migration protects and supports the health of migrating and source populations. For example, research conducted in Mali (Findley, 1994) and Ethiopia (Ezra & Kiros, 2000, 2001; Meze-Hausken, 2000) found that many drought and famine-affected households send family members away to feeding camps and urban areas in order to reduce demand on scarce household food. And a study of climate-induced migration in a coastal fishing community in Bangladesh (Islam et al., 2014) found that fishery-dependent households that migrated to the mainland reported less exposure to environmental risk (e.g., flood, sea-level rise, and land erosion), improved livelihoods and incomes, and better access to health services and infrastructure as compared with those households that remained.

These studies indicate that migration can be a viable strategy to adapt and respond to environmental and climatic changes, and can result in positive health outcomes. However, some researchers warn against positioning migration as an indicator of successful adaptation to environmental change, and suggest that discourses of resilience and adaptation place a disproportionate responsibility onto vulnerable or marginalized people and communities (Reid, 2013). It is important to also consider the potential risks, including health risks, associated with environmental migration. The conditions surrounding migration processes can increase health vulnerabilities for some, particularly those migrating within and between low-income countries and forcibly displaced populations (Davies, Borland, Blake, & West, 2011).

Internal Migration to Urban Areas

It is likely that climate-related migration will follow existing migration pathways. With the exception of border regions and low-lying small island states, most migrants and displaced people will remain within their own country or region, and many will move to urban areas (Findlay, 2011). Yet the extent to which climate change contributes to urban migration is context dependent. A recent study of urban migration in Africa found that in cities where there is manufacturing for export outside their regions, drier conditions increased urban migration as cities offered urban labor and income as an escape from declining agriculture; however, in market towns that provided local services to agricultural hinterlands, reduced farm incomes from drying conditions lessened demand for urban services and urban labor, hence urban migration rates did not increase (Henderson, Storeygard, & Deichmann, 2017). Similarly, earlier research in Mali indicated that rural-urban migration decreased during drought periods and increased outside of drought years, suggesting that certain resources were required in order to enable migration as an adaptation strategy (Findley, 1994).

Other research has found that environmental pressures—such as rainfall shortages, drought, and disaster—have contributed to rural-urban migration in sub-Saharan African countries, Mexico, and Bangladesh (see Wolsko & Marino, 2016). Increases in rural-urban migration are expected in the Pacific Islands as a result of climate change-related pressures (Campbell & Warrick, 2014). Where urban migration occurs, while offering diverse socioeconomic and political opportunities and costs, it will have consequences for the health and well-being of migrants.

Migration to urban-poor areas in particular is associated with risks to health, due to overcrowding, inadequate water, and sanitation facilities, poor working conditions and underemployment, income instability, and increased pressure on infrastructure and services. In Bangladesh, for example, rural-urban migration is contributing significantly to rapid and unplanned urbanization in cities such as Dhaka. Approximately 15 million people live in Dhaka, one of the most densely populated cities in the world. Rural-urban migration is estimated to account for about two-thirds of the total urban population growth of around 3–4% per year. Economic, social, demographic, and environmental factors intersect to create conditions for migration; natural disasters and slow onset environmental deterioration contribute significantly to rural-urban migration. Most rural-urban migrants are poor and live in slums in flood-prone zones such as low-lying areas along riverbanks; these dwellings often have inadequate water and sanitation and are not resistant to extreme climatic events (e.g., floods, cyclones, rapid erosion). Health indicators for people living in Dhaka’s overcrowded slums are poor, including high rates of waterborne diseases, high child mortality rate of 95 per 1,000 live births (compared with 53 per 1,000 live births in urban non-poor areas of Dhaka), and lack of access to health services (Adams et al., 2015; Walter, 2015).

It is expected that migration to urban-poor areas will also be amplified in low-lying Pacific islands—including Kiribati, the Marshall Islands, and Tuvalu—as they increasingly experience adverse impacts of climate change, particularly sea-level rise. These three countries are experiencing the “triple burden” of non-communicable diseases, communicable diseases and climate change. They have among the highest prevalence rates of tuberculosis (TB) and diabetes mellitus in the world. Migration into crowded urban-poor areas will increase TB transmission risk, primarily by increasing people’s exposure to infectious individuals. Migrants to urban-poor areas with diabetes mellitus will be particularly vulnerable to TB infection and mortality, as they have compromised immune function (McIver, Viney, Harley, Hanna, & Kienene, 2015). This convergence of climate change impacts, environmentally related urban migration, and existing population health threats may increase the risk of TB transmission for these island nations (McIver et al., 2015).

Cross-border Migration

Although most environmental migration will be within countries, many countries—such as European and North African states—are concerned that environmental and climatic change will increase cross-border migration. In 2008 a report prepared for the European Council warned that Europe must expect substantially increased migration triggered by environmental pressures, particularly from Africa (European Commission and the Secretary-General/High Representative, 2008). The likelihood and scale of cross-border migration associated with environmental change remains uncertain (see Obokata, Veronis, McLeman, 2014). Irregular (i.e., undocumented) international migration may be more likely than regular migration. This poses obstacles to understanding environment-related international migration. Hurricane Mitch in 1998 is the only recent example of environmental change (i.e., disaster) that contributed to large-scale cross-border migration, particularly Hondurans and Nicaraguans who migrated to the southern states of the United States (IOM, 2014a). Immediately after the hurricane, migration from Honduras tripled and increased by 40% from Nicaragua. And apprehension at the U.S. border of illegal migrants from Central American countries other than Mexico increased by more than 60% in the months immediately following the disaster (McLeman & Hunter, 2010).

Where people migrate across borders, the health consequences will be complex and diverse. People move between places with distinct health risks and profiles, have differing access to health services in different sites, and can be exposed to health risks or carry pathogens to new sites (McMichael et al., 2012; Zimmerman et al., 2011). Cross-border movement of people has led to new reservoirs of infectious diseases, such as malaria, dengue and hepatitis A and B. For example, many parts of western Europe have observed increased incidence of reported cases of TB in recent years, in part reflecting immigration from low-income countries. And the resurgence of drug-resistant malaria in border regions of Asia has been linked to cross-border migration (Carballo & Mboup, 2005; Hugo, 2013).

Migrants (particularly irregular migrants) tend to hold lower-skilled jobs that entail health risks such as occupational accidents and unprotected exposure to chemical products (Carballo & Mboup, 2005). Policies that limit migrant access to health services in countries of resettlement contribute to the poor health of migrant populations. Evidence indicates that international migration, particularly irregular migration (i.e., migration that occurs without authorization or documents required under the regulation of sending, transit, and receiving countries), can also present threats to psychosocial health, due to loss of social networks, job insecurity and poor working conditions, and anxiety associated with resettlement in a new context and culture (Carballo & Mboup, 2005). Further, cross-border migration increasingly occurs in geopolitical contexts in which migrants experience restrictions in receiving societies, and migration is viewed as a national security issue. This has implications for migrant health, particularly via experiences of social and economic exclusion. The European response to the crisis in Syria (an ensuing out-migration|) is a recent high-profile example. The reluctance of many states to ratify the Convention on the Rights of Migrants indicates widespread reluctance to address migration and to take account of the ethical and population health concerns (Carballo & Mboup, 2005).

Environmental Disaster and Forced Displacement

Environmental “push” factors for migration are perhaps most evident in the wake of environmental disasters. Climate change is increasing exposure to extreme weather events (such as floods and storm surges), contributing to population displacement. Since 2008 an average of 26.4 million people per year have been displaced from their homes by environmental disasters. There is substantial fluctuation in the number people displaced from year to year, but there is an increasing trend over previous decades. In 2014, 19.3 million people were displaced by natural disasters, 17.5 million of whom were displaced by weather-related hazards, primarily typhoons and floods (rather than geophysical hazards, such as earthquakes and volcanic eruptions) (IDMC, 2015). In 2005 Hurricane Katrina led to the evacuation of 1.5 million Gulf Coast residents, and somewhere between 100,000 to 300,000 residents of the New Orleans area were permanently displaced (Smith, 2007). By 2010 the population of the New Orleans region had declined by one quarter (using 2005 as the baseline), with as many as 250,000 having relocated to Texas alone (Foresight, 2011). In 2009 Cyclone Aila hit the southwest coastal region of Bangladesh, displacing tens of thousands of people with up to 125,000 subsequently migrating to cities and neighboring countries due to loss of homes and livelihoods. Notably, developing countries are affected the most by natural disasters. Approximately 175 million people from developing countries have been displaced since 2008, accounting for 95 per cent of the global total (IDMC, 2015).

Extreme weather events can lead to adverse health outcomes, particularly when they occur in developing countries and result in large-scale population displacement (Kondo et al., 2002). The health of displaced populations is determined by the availability and accessibility of safe water and sanitation, nutritional status, living conditions, exposure to infectious diseases, levels of immunity to vaccine-preventable diseases, and access to health-care services (Keim, 2008; Watson, Gayer, & Connolly, 2007). Common infectious diseases in post-disaster contexts—particularly floods—include diarrhoeal diseases, measles, meningitis, acute respiratory infection, vector-borne diseases (e.g., malaria, dengue) and tuberculosis (IFRC, 2007; Cairncross & Alvarinho, 2006; Kondo et al., 2002; Toole, 2005; Watson et al., 2007).

Extensive research identifies profound psychological consequences of natural disasters—including post-traumatic stress and generalized anxiety and depression—both due to immediate disaster and secondary processes including forced relocation (see Doherty & Clayton, 2011). Relatively little is known about protracted population displacement following environmental disaster (IDMC, 2015). Prolonged health impacts of natural disaster for displaced populations may include the disruption of disease surveillance and health programs (e.g., immunization), food insecurity and food scarcity, and the interruption of treatment regimens (Kouadio et al., 2012).

Planned Relocation

Climate change will also lead to the planned relocation of communities where they experience increasingly severe and frequent extreme weather events, livelihoods are undermined (e.g., by increasing drought frequency), or where land becomes unsuitable or uninhabitable (e.g., due to sea-level rise). Planned relocation usually takes place within national borders; however, some states, such as small low-lying islands that are highly vulnerable to sea-level rise, are seeking planned relocation solutions for their citizens abroad.

Planned relocation should be considered a last resort, when other adaptive strategies have failed (Adger, Arnell, & Tompkins, 2005; Tacoli, 2009). Yet climate-related relocation is already occurring in some places, including the Mekong River delta of Vietnam, along the Limpopo River of Mozambique, and low-lying coastal villages in Fiji (De Sherbinin et al., 2011).

Low-lying islands and communities are regarded as among the most vulnerable to climate change impacts—particularly sea-level rise—and have become prominent examples in discussions of planned relocation. The Vunidogoloa Village Climate Change Relocation Project in Fiji, for example, entailed relocation of a village of 26 houses that was suffering from substantial coastal erosion, flooding, and exposure to extreme weather events. The new site is on higher ground, nearly two kilometers inland but still within customary land boundaries. Villagers moved in 2014. The provision of basic infrastructure (running water, toilets with septic tanks, solar panels for household energy use) and livelihood generation activities (aquaculture, pineapple and banana farming, and installation of a copra drier) aimed to improve living conditions (McMichael, 2017; Tronquet, 2017). Plausibly, these conditions will support the health and well-being of the community, but no evaluative research with a health focus has been conducted to date. Longer-term outcomes—including mental, psychosocial, and physical health outcomes—of planned relocation can only be determined by follow-up studies in the years following relocation, including with subsequent generations.

Migrants Relocating to Sites of Climatic/Environmental Vulnerability

Migration is already occurring in most parts of the world as a result of diverse drivers: there are currently an estimated 232 million international migrants, 740 million people who migrate or are displaced within their own country, and an unknown number of migrants in “irregular” situations (IOM, 2014b). Contemporary migration dynamics are influenced by socioeconomic inequalities, disparate labor demands and skills shortages, political crises, demographic change, transport, and shifting capital and opportunities. Existing migration occurs in the context of global environmental change. Although there are many benefits of city living, migrants in urban-poor areas may face health risks associated with environmental change. People will migrate into areas of environmental threat—particularly low-lying megacities—as much as away from them (Foresight, 2011; De Sherbinin et al., 2012).

Migrants face health threats where they move to sites exposed to environmental risks such as floods, droughts, and extreme weather events. The potential direct health effects of climate change include injuries and mortality related to extreme weather events and heatwaves; infectious diseases related to changes in vector biology, water, and food contamination; altered air and water quality; and under-nutrition related to changes in food production (Frumkin et al., 2008). At the 2014 World Health Organization (WHO) conference on health and climate, the International Organization for Migration (IOM) called for recognition of migrants and mobile populations who are vulnerable to the adverse health effects of climate change and are often excluded from national health or social welfare systems (IOM, 2014a). The health of migrant populations living in large cities in low-income countries is of particular concern, as cities grow in size, while also increasingly affected by global environmental change.

Migrants in urban-poor areas are vulnerable to environmental threats as they tend to live in high-density informal settlements in areas prone to environmental risk, with low levels of health, water, and other services. They may have limited human, social, or financial capital (Foresight, 2011). For example, in Dakar, Senegal, 40% of migrants arriving in the past decade moved to flood-risk zones, and people from dryland areas in north-eastern Brazil have migrated to the slums of Rio de Janeiro, which are susceptible to landslides and floods (Foresight, 2011). Migrant workers—particularly manual laborers—will also face elevated health risks, as capacity of the human body to thermo-regulate may be exceeded on a regular basis in some parts of the world (Kjellstrom, Holmer, & Lemke, 2009). In 2015, a heat wave in Pakistan resulted in over 1,000 excess deaths in Karachi; this included outdoor migrant workers at elevated risk of heat-related mortality, with the “urban heat island effect” amplifying risk (Azhar et al., 2014; Dearden, 2015). Migrant workers in low- and middle-income tropical countries are at highest risk of excessive heat exposure, where climate change impacts during this century will increase (Kjellstrom et al., 2009).

Conflict and Forced Displacement

It has been frequently stated that collective violence and conflict associated with climate change impacts (e.g., resource scarcity) will pose serious threats to population health (see Patz & Levy, 2015, p. 221). However, the associations between environmental change, migration, and conflict are much debated. Homer-Dixon has argued that environmental change could lead to acute armed conflicts (Homer-Dixon, 1991, 1994). Violent conflict could in turn, under certain circumstances, produce environmental refugees with destabilizing impacts both nationally and internationally.

Academic and policy accounts of the potential associations between environmental and climatic change and conflict are usually organized around three key themes: scarcity, state failure, and under-development. Long-term and environmental shock-induced scarcity of resources (e.g., water insecurity, declines in agricultural productivity) are envisaged as leading to civil and interstate conflict; weak and failing states are held to have limited capacity to mitigate emerging tensions and conflict; and poverty and under-development are seen to increase vulnerability to resource scarcities (Selby & Hoffman, 2014). Darfur (Sudan) is regularly referred to as the site of the world’s first climate change-induced war, characterized as a perfect storm of water scarcity (despite no average decline in the Nile flow through Sudan since the 1960s), failing or weak states, and under-development (see Selby & Hoffman, 2014).

First, there is some evidence to support the notion that the impacts of environmental change will increase conflict, thereby potentially leading to forced migration. Yet while micro-level studies that focus on the causes of specific conflicts often point to plausible environmental risks, analysis of the patterns across multiple conflicts are equivocal about the role of environmental risk or resource scarcity in triggering or perpetuating conflict (Adger et al., 2015; Schleussner et al., 2016). Indeed, resource conflicts have largely arisen from “abundance” rather than scarcity, including the so-called resource curse of diamonds, oil, and other nonrenewable resources that have been linked to conflicts in sub-Saharan Africa (Koubi et al., 2014). Further, environmental change can also contribute to impoverishment; while this raises the exposure and vulnerability of individuals to conflict, people may in fact have reduced ability to move in a planned way in the context of humanitarian emergencies (Foresight, 2011).

Second, it is proposed that increased migration associated with climate change impacts will exacerbate or lead to conflict and social tensions in destination sites (Foresight, 2011; Salehyan & Gleditsch, 2006). For example, destination sites may face challenges associated with economic integration of migrants, social cohesion and increased tension, particularly if large numbers of people arrive in specific locations with an absence of political leadership. And yet most migration flows do not lead to civil conflict; since the 1950s, the majority of countries that have received large numbers of refugees have not engaged in armed conflict (Selby & Hoffman, 2014).

Given these uncertainties and persistent debates, it is difficult to forecast the health impacts that may emerge where environmental change, conflict, and migration intersect. It is well-established that war and collective violence typically lead to elevated mortality rates among combatant and civilian populations, increased infant and maternal mortality, long-lasting physical and psychological effects, chronic disability, gender-based violence, threat of malnutrition and infectious disease, and the damage to and destruction of medical care and other services (Levy & Sidel, 2008). What is less certain is the extent to which climate change will increase vulnerability to conflict (including associated adverse health consequences), or the extent to which climate change will cause or contribute to war and collective violence.

Resettlement Due to Mitigation and Adaptation Action

Climate change mitigation and adaptation action will contribute to population displacement and resettlement. The policy impetus created by climate change is likely to increase the number of large projects globally including large dams for hydro-power and water storage, biofuel plantations, and water reallocation projects in response to regional drying trends (e.g., China’s South-North water transfer scheme). The effectiveness of such large-scale projects is debated; and social disruptions can be substantial particularly when they require resettlement of populations (De Sherbinin et al., 2011). Hydroelectric dam development, for example, has led to development-forced displacement and resettlement (DFDR) of millions of people globally (De Sherbinin et al., 2011; World Commission on Dams, 2000).

The widely cited Impoverishment Risks and Reconstruction model (Cernea, 2000) identifies risks associated with development-forced resettlement: loss of land, employment, shelter, and access to common resources; economic marginalization; elevated morbidity and mortality; food insecurity; and negative cultural and psychological impacts. There are a few cases in which well-planned, financed, and implemented relocation has ensured positive outcomes for resettled populations, including improved access to electricity, living conditions, and services (Karimi & Taifur, 2013; Weerasinghe, 2014). But the impacts of DFDR for resettled populations have on the whole been negative, and any benefits are often offset by other costs (De Sherbinin et al., 2011). Few empirical studies, however, have assessed the health impacts of DFDR. For example, an analysis of the displacement and resettlement of poor and marginalized indigenous groups in Malaysia—following construction of large dams to meet domestic demand for water and energy—found that poor living conditions in resettlement villages and increasing engagement in cash-based economies contributed to elevated alcoholism and anxiety (Aiken & Leigh, 2015).

Immobile or Trapped Populations

Finally, in the face of environmental change, migration will not be possible for many (Adams, 2016; Black et al., 2012; Warner & Afifi, 2014). Migration is expensive and requires resources and capital, yet populations that experience environmental hazard or long-term environmental change may see a reduction in the very capital required in order to move. In a multicountry study of migration and water availability, for example, Warner and Afifi (2014, p. 12) identified immobile households that did not possess the necessary assets and capital and were unable to access migration options. Penning-Rowsell, Sultana, and Thompson (2013) found that women in Bangladesh are less likely to leave environmentally risky areas when male family members migrate to urban areas seeking employment. Also in Bangladesh, Gray and Mueller (2012) found that poor and food-insecure households that experienced environmental change and associated resource constraints (e.g., crop failure due to rainfall deficits) were less likely to migrate, while higher-income households were more likely to use migration as an adaptive response.

These findings challenge the widely accepted position that environmental change will contribute to increased migration among the poor and vulnerable. The greatest risks may be borne by people who do not have the social and economic capital required to migrate and who are unable to move away from sites of increasing environmental vulnerability (Foresight, 2011). There will also be those who experience adverse impacts of environmental and climatic change but choose not to migrate because of their enduring attachment to place more so than issues of resource barriers or low mobility potential (Adams, 2016). What will be the health consequences for those who lack the capacity or will to migrate in response to worsening environmental conditions?

In an analysis of three case studies in West Africa, Scheffran, Marmer, and Sow (2012) found that international migrants send their new financial resources to support construction of wells, irrigation systems, and renewable energy grids in their home communities, thereby providing health-promoting infrastructure for non-migrant populations in origin communities. Conversely, de Bruijn and van Dijk (2003) conducted research with Fulbe pastoralists in Mali, and identified increasing vulnerabilities in the origin communities as migrants were too poor to send remittances. Szabo et al. (2016) raised concerns about the health of “immobile” aging populations as environmental changes (e.g., floods and salinity intrusion in the Ganges-Brahmaputra, Mekong and Amazon delta regions) contribute to out-migration of younger people and produce shifting demographic profiles. And studies have highlighted climate change-related psycho-social and population health threats experienced by resident indigenous populations in the Arctic.

Indigenous populations in the Arctic are highly vulnerable to climate change, including climate-related erosion and flooding. Although relocation and migration is proposed as an adaptive solution, there is currently no indication of increased out-migration from the most at-risk communities (e.g., Kivalina, Newtok, Shaktoolik, and Shishmaref) because of social resistance, the challenges of relocation, limited government action, and high costs and lack of funding (Hamilton et al., 2016; Marino, 2012). In the meantime, communities remain in situ, and climate-change related population health threats include morbidity and mortality due to increasing extreme events (storms, floods, temperature extremes), increased incidence of injury and mortality associated with unpredictable ice and storm conditions, adverse mental health outcomes associated with loss of traditional lifestyle, increased incidence of obesity and chronic disease where changes in subsistence species distribution provoke a shift from traditional diet to Western diets, changes in patterns of infectious diseases, damage to sanitation infrastructure by melting permafrost or flooding, and decreased access to quality water sources (Parkinson & Evengard, 2009). These studies indicate that immobile and trapped populations may face significant health threats where migration is not possible, not facilitated, and/or not acceptable.


Globally—and particularly in low-income and climate-vulnerable contexts—the impacts of environmental and climatic change will contribute to human migration, displacement, and planned relocation. Climate change increasingly represents the primary concern and overshadows other environmental changes that shape migration dynamics. So-called climate refugees have become the human face of climate change, yet not all environmental migration is forced: the majority of movement will be within national borders. And—alongside environmental change—a myriad of social, political, and economic reasons influence migration decisions.

Migration, displacement, and relocation are increasingly viewed as representing an adaptive response to climatic change, particularly in terms of livelihood vulnerability and risk diversification, rather than a failure of local adaptation (Foresight, 2011; Hunter et al., 2015; Tacoli, 2009). But as discussed, the associations between climate change and migration extend beyond “environmental migration”; other potential intersections include migration into sites of environmental vulnerability; much debated possibility of displacement due to climate-related conflict; immobile or “trapped” populations that are not willing or able to migrate; and displacement due to climate change mitigation and decarbonization action, including hydroelectric dams.

Migration associated with environmental change should not be positioned as either wholly negative or positive; migration can create and amplify vulnerabilities and can also support resilience and adaptation (IOM, 2014a). The adaptive potential of migration will be defined in part by the health and well-being outcomes for migrating populations. In some contexts, migration will support health as it enables—for example—access to health services and improved nutrition. But environmental disasters such as Hurricane Katrina in New Orleans have highlighted the vulnerability of displaced and poor populations, and on a global scale, migrants and displaced people in low-income countries will face greater health risks than those in high-income countries (Frumkin et al., 2008).

Public health action on environmental and climatic change must seek to eliminate health disparities (Frumkin et al., 2008). There is the need to anticipate, respond to, and ameliorate population health burdens among migrants, particularly irregular migrants and forcibly displaced people. Due to the diversity of migration, displacement and planned relocation scenarios, nuanced policy and programmatic responses are required (McAdam, 2010). Potential strategies to address migrant health risks encompass a wide spectrum, commensurate with complex and diverse threats to migrant health posed by environmental changes. Local policies and actions to adapt to risks to health will vary considerably between different regions and in relation to prevailing socioeconomic conditions and available resources. Importantly, climate change and other large-scale environmental changes are unlikely to cause new migration dynamics. Therefore, it is important to further strengthen services, systems, policies and practices that address the health of migrants and displaced populations, including: migrant workers, populations displaced by disaster, and those living in urban-poor areas.

At the country level, the human migration implications of climate change need to be systematically addressed, including through the national adaptation plans (NAPs) being developed as part of the UNFCCC process (IOM, 2014a). Proactive governance of migration can facilitate positive outcomes including good population health among migrants. And yet migration will often represent a last resort option. It is one form of adaptation within a broader set of potential adaptive responses to global environmental change. The impacts of climate change on future population movements can be ameliorated through proactively building adaptive capacity in vulnerable populations and regions (McLeman & Hunter, 2010).

Without significant mitigation efforts, the world will face social and environmental impacts associated with 4°C or more mean global warming (Betts et al., 2011). Although adaptive strategies reduce the adverse impacts of environmental and climatic change, the critical challenge lies in reducing greenhouse gas emissions. Ultimately, climate change mitigation represents the essential primary prevention pathway via which to protect the health of humans.

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