Climate change, migration and public health.
Εducation as a tool to fill the gap between science and lay public perceptions.
Constantina Skanavis, Professor of Environmental Education and Communication
Department of Environment
University of the Aegean
Mytilene, Greece
Maria Sakellari, Senior Researcher
Research Centre of Environmental Education and Communication
University of the Aegean
Mytilene, Greece
Abstract—Despite the scientific discussion for synergies for action between the fields of climate change adaptation, human security and public health, the lay public presents a limited awareness of the association between climate change and human health risks. The paper suggests that public education strategies must be reoriented to draw attention to climate change’s human health consequences, in order to challenge popular misconceptions about environmental migration and health related issues and encourage individuals to take actions to reduce their own contributions to climate change and protect themselves from its impacts.
Keywords-climate change; environmental migration; health; public education
I. Introduction
Climate change has the potential to significantly influence the health of people around the world. The initial specific driving forces are temperature, hydrologic extremes and sea level rise. These in turn may lead directly to adverse impacts on public health effects in a range of aspects: extremes in heat, exacerbated air pollution, changes in vector-borne and water-borne diseases, water and food resources, and ultimately environmental refugees [1]. Until recently, research had only linked climate change to human injuries, deaths and illnesses, but new studies have emerged that address other potential stressors that may also impact public health, such as increased vulnerability to poverty and refugee migrations [2,3]. Together with a need for greater understanding of epidemiologic studies of the health impacts of climate change, there is also a need for better understanding of the social processes that shape vulnerability to the impacts and the means by which individuals and institutions can manage the impacts [4]. As migration will be an increasingly important aspect of human activity due to environmental factors and climate change, improving the health of migrants and reducing adverse health outcomes related to migration can be expected to be a growing concern globally. This argument is supported by the fact that international regulations directed at disease mitigation and control have not kept pace with the growing challenges associated with the volume, speed, diversity, and disparity of modern patterns of human movement [5] and population of low socio-economic status, those who are most vulnerable to climate change impacts due to their limited capacity to adapt and reduce risk, tend not to respond equally well to health promotion campaigns compared to the general population [6].
Educators in environmental education have promoted environmental sustainability and health as central to the curriculum, and creating a sustainable and healthy environment [7, 8,9, 10]. The significance of environmental education and health has been recognized by the United Nations, which has designated 2005–2014 as the Decade of Education for Sustainable Development. However, climate change appears to lack salience as a health issue and people are not are aware of the growing human health risks associated with climate change. In order to explore this gap between theory and practise, this paper will explore the environmental migration issue and its impacts to public health and will examine the implications of public education strategies.
II.the environmental migration issue
Climate change is likely to become the most significant cause of population displacement within the next years [11,12, 13, 14]. Although developed countries have been almost entirely responsible for greenhouse gas emission, most likely to suffer is any poor country lacking the economic capacity and infrastructure to cope with the worst consequences of climate change[13, 15]. Due to irreversible climate change, by the end of the century there will be millions of ‘boat people’ from developing countries looking for safer ground [15].
Africa is frequently cited as an example of a place where environmental scarcity resulting from degradation of natural resources has given rise to violent conflicts forcing millions to flee [16, 17, 18, 19, 20,21]. Although Africa remains the prime locus of environmental refugees, there are sizeable numbers in other regions and countries, like China, Vietnam, Egypt, Mexico, Haiti and India[11,22, 23]. In Alaska, temperatures across the state have increased by between 2 and 3.5 degrees Celsius since 1974, arctic sea ice is decreasing in extent and thickness, wildfires are increasing in size and extent, and permafrost is thawing, creating a humanitarian crisis as four Alaskan indigenous communities must relocate immediately and dozens of others are at risk; meanwhile, government agencies are struggling to meet the enormous new needs of these communities [24]. Tuvalu, in southwest Pacific Ocean, is one of the places on earth that is most vulnerable to the affects of global warming. The threat of sea level rise may bring complete disaster to Tuvaluan population residing on nine extremely low-lying coral atolls. In 2001, New Zealand agreed to formally admit 75 Tuvaluans a year as environmental refugees due to impacts of climate change and the threat of sea level rise.
In 1985, in a United Nations Environmental Programme document, El-Hinnawi first defined environmental refugees. El-Hinnawi’s definition does not distinguish between people displaced beyond the borders of their own state and those displaced within state borders [13]. Also, El-Hinnawi did not provide generic criteria distinguishing environmental refugees from other types of migrants, nor did he specify differences between types of environmental refugees, so many people can be classified under the umbrella of ‘environmental refugee’ that critics question the usefulness of the concept [25]. El-Hinnawi defined environmental refugees as:..those people who have been forced to leave their traditional habitat, temporarily or permanently, because of a marked environmental disruption (natural and/or triggered by people) that jeopardized their existence and/or seriously affected the quality of their life. By ‘environmental disruption’ in this definition is meant any physical, chemical, and/or biological changes in the ecosystem (or resource base) that render it, temporarily or permanently, unsuitable to support human life[26].
Ten years later Myers and Kent offered an alternative use of the term: Environmental refugees are persons who can no longer gain a secure livelihood in their traditional homelands because of environmental factors of unusual scope, notably drought, desertification, deforestation, soil erosion, water shortages and climate change, also natural disasters such as cyclones, storm surges and floods. In face of these environmental threats, people feel they have no alternative but to seek sustenance elsewhere, whether within their own countries or beyond and whether on a semi-permanent or permanent basis [27].
In addition international organizations, like International Organization for Migration (IOM) proposed new and broader definition of human mobility due to environmental factors: Environmental migrants are 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 habitual homes, or choose to do so, either temporarily or permanently, and who move either within their country or abroad [28].
Despite all efforts, still there is no consensus regarding of who the environmentally displaced persons are. Environmental migration, climate change-induced migration, ecological or environmental refugees, climate change migrants, environmentally displaced persons and environmentally-induced forced migrants are terms that are found scattered throughout the literature, due to the lack of a generally accepted and precise definition of migration caused by environmental factors. Furthermore, those particular terminological questions reflect the difficulty of isolating environmental factors from other drivers of migration [29, 30]. Additional problems closely associated with the environmental factors displacing people are population pressures and poverty, malnutrition, landlessness, over-rapid urbanization, unemployment, pandemic diseases and government shortcomings, together with ethnic strife and conventional conflicts and exogenous problems such as foreign debt [11,12]. In particular, it is sometimes difficult to differentiate between refugees that are driven by environmental factors and those that are impelled by economic problems [11]. Peoplewho migrate because they are poor are frequentlydriven by root factors of environmental degradation that causes poverty. The ultimate cause of migration by environmentally-displaced peoples often lies in social, political and economic conditions [19]. While migration derivesfrom environmental problems, it is equally a crisis of social, political and economic sorts [12]. In war-torn societies, insecurity is a primary cause of environmental change and consequently of population displacement [20] while ‘other environmental refugees’ are rural populations, mainly in Africa, who are displaced by the creation of national parks and protected areas [31]. Deterioration refugees migrate as a result of gradual, anthropogenic changes in their environments that were not intended to produce migrants and may be separated into sub-groups by the source of the degradation in terms of pollution and depletion [25]. Whatever the cause, people are forced by environmental circumstances to move from the danger ‘at home’ and to look for a safer place where they can meet their basic needs [13].
Furthermore, a range of climatic events and conditions known from past experience to have stimulated distress migration are expected to increase in terms of frequency and severity in many reasons regions as a result of climate change [32, 33]. Evidence supports the argument that climate-change related disasters like hurricanes, torrential rains, floods and droughts, do not provoke long-term and long-distance population displacements, because the majority of the displaced people return as soon as possible in the disaster area to reconstruct their home and live hoods [34, 35, 36, 37, 38] or because, living mainly in poor countries, people are very poor and vulnerable and therefore, unable to move [39, 40, 41]. However, in the literature exist significant cases studies of forced massive and long-term migration due to natural disasters from climatic events such as in Ethiopia [21], in Brazil [42] and in Bangladesh [43].
In spite of the increased attention, interest, and sense of urgency in understanding and responding to climate change [44], and although there is a growing recognition of the connections between disaster risk reduction, climate change adaptation and human security, with less developed countries and the poorest people in all countries to be those most at risk due to their limited capacity to adapt and reduce risk [45, 46, 47, 48, 49, 50, 51], the broader social causes and consequences of climate change are seldom addressed [44, 22,52, 53].
Literature lacks attention to micro-level impacts of risks associated with climate change such as household assets, livelihoods, and well-being [53], and to macro-level impacts such as the limits of host countries' capacity to take in outsiders, as in the wake of perceived threats to social relationship and national identity, refugees can become an excuse for political disorder [11,12]. On the other hand, research on vulnerability and adaptation to climate change from the social sciences has not been applied widely in terms of health [54]. Consideration is required of future climate and socioeconomic changes and how they will influence the health risks [55].
Moreover, addressing climate change requires a rethinking of consumption patterns, energy choices, and lifestyles. As past experience shows that population movement is a response to pressure, researchers suggest that there in need to accommodate migration as a climate-change adaptation measure rather than as problem [41, 56, 57, 58]. The role migration may play in helping home communities adapt requires a new global governance [58, 59], a change in policy makers’ perceptions of migration and a better understanding of the role of institutions in supporting and accommodating mobility [41]. In this framework, environmental migration will result from a complex decision-making process in which the long-term effects of changes to the environment are considered in the context of livelihoods, means of subsistence, and overall quality of life.This presents an important opportunity for public health, as many actions to combat climate change also could bring substantial health co-benefıts [60].
In order to introduce migration as a successful post-disaster response securing full recovery of the affected populationa range of migration stressors must addressed, including serious health problems both directly, from the various stresses of the migration process, and indirectly, from the possible civil strife that could result from chaotic movement of people and finally from poor access to health care [61].
III.environmental migration and public health
Generally the flow of populations between locations with widely different health determinants and outcomes creates situations in which locally defined public health threats and risks assume international or global relevance [62].
In terms of public health, migration has implications for recognition of threats, as well as for surveillance and response capacity [63]. Migration influences the background burden of chronic or latent diseases, both infectious and non-infectious, and patterns of pre-existing immunity, the use and uptake of disease prevention and health promotion interventions, and health-care service utilization in general [64, 65]
Migrants originating from areas of poverty, those who are forcibly displaced by conflict or environmental calamity, those with limited educational and linguistic skills, and those who are dependent on their communities for protection, such as people with pre-existing health conditions, unaccompanied minors, the elderly, the young, and single-parent families, are those at greater risk of adverse health outcomes [66]. At the same time, new arrivals who are subjected to legal, economic, and social exclusion can be very vulnerable to contracting disease resulting from poor living environments and exploitative working conditions, including lack of access to health care and preventive services [62].
Although interest in how migration impacts health, especially in the area of mental health and psychological well-being is evolving in the literature, studies are scarce with selection factors, type of migration, so that the impact of environmental migration on public health can be appropriately estimated.
According to MacPherson and Gushulak (2009) the association of human population mobility with global climate change and public health can be viewed through two lenses [67]:
(a)Total population number, spatial density of human beings on the planet and the distribution and epidemiology of infections as a consequence of the movement of goods, conveyances, and people. Globalization of trade and movement of goods and people are accelerating. Movements of people, materials, or vehicles have been responsible for short- and long-distance transfer of several disease vectors [68]. Increased urbanization will raise the density of human populations, along with global population growth; both will increase the total numbers of people at risk [69], while the intensity of contacts between humans is increasing in the emerging megacities with inadequate water supply, sanitation, and public health infrastructures [70].
(b)Climate change, changing physical environment and the potential for extreme weather events to provoke or generate adaptive population movements and emerging and re-emerging infectious diseases.As already noted, four key climate change-related phenomena are particularly associated with migration: natural disasters; rising sea levels; drought and desertification; and competition for natural resources, leading to conflict and mass displacement. As a result, the most socially vulnerable, usually the poor, are most affected, and most likely to migrate. At the same time, displacement and migration is often associated with the disruption of social networks and access to health services, leading to an overall decline in human health. In this context, health challenges can involve the spread of communicable diseases and an increase in the prevalence of psychosocial problems due to stress associated with migration. Disruption in medical care, loss of relatives and friends, ad hoc living arrangements, separation from home and community, financial ruin, and many other factors contribute to the difficulty in resuming “normal life” and to stress and mental health concerns. Women, young people, and people with low socioeconomic status are thought to be at comparatively high risk of anxiety and mood disorders after disasters [71]. This is often worse for women, who are more likely to experience gender based violence in the wake of forced migration. Women and girls are at higher risk of sexual violence, sexual exploitation and abuse, trafficking, and domestic violence in disasters [72] and may avoid using shelters as a result of fear [72, 73].Overcrowding, lack of privacy and the collapse of regular routines and livelihood patterns can contribute to anger, frustration and violence, with children and women most vulnerable [74].
Evidence from known climate-related migration events shows that migration responses are highly variable within and acrosspopulations [75]. Not all households exposed to a given climate event adapt through migration, and not all those who might migrate do so [76]. Migrants may act on the perception of an impending environmental risk rather than waiting for the actual occurrence of the environmental risk itself [77]. In this framework, the role of existing health status as an additional element of vulnerability poses as adistinct challenge for researchers. The importance of considering both the potential dual risk effect of hazards for human health, which is the compounding interaction between increased risk of falling ill and decreased access to health-supporting services, demandsfurther research attention [78].
IV.As warnings about climate change, migration and associated health risks are approaching, what are the implications for public education?
Risk perception influences behavior [79, 80,81, 82]. Perception of risk defines people decision to migrate rather the risk itself [77]. The psychology of risk perception suggests that in many cases people’s reactions won’t match the realities of the danger, and as a result, some of their choices and behaviors might not maximize their safety. Furthermore, riskperception has been identified as playing a critical role in individual willingness to take action to address climate change [82, 83] and personal perception of risk is the strongest motivator of health behaviour change based on the health promotion literature [84].