An ill wind? Climate change, migration, and health

Addressing the Impact of Climate Change on Sexual and Reproductive Health Among Adolescent Girls and Young Women in Low- and Middle-Income Countries

There is an urgent need to better understand the role of climate change on sexual and reproductive health outcomes, particularly among adolescent girls and young women in low- and middle-income countries. Stakeholders at all levels should apply a rights-based, gendered approach to climate action and adaptation.

Half a Century of Research on Posttraumatic Stress Disorder: A Scientometric Analysis

We conducted a scientometric analysis to outline clinical research on posttraumatic stress disorder (PTSD). Our primary objective was to perform a broad-ranging scientometric analysis to evaluate key themes and trends over the past decades. Our secondary objective was to measure research network performance. We conducted a systematic search in the Web of Science Core Collection up to 15 August 2022 for publications on PTSD. We identified 42,170 publications published between 1945 and 2022. We used CiteSpace to retrieve the co-cited reference network (1978-2022) that presented significant modularity and mean silhouette scores, indicating highly credible clusters (Q = 0.915, S = 0.795). Four major trends of research were identified: 'war veterans and refugees', 'treatment of PTSD/neuroimaging', 'evidence syntheses', and 'somatic symptoms of PTSD'. The largest cluster of research concerned evidence synthesis for genetic predisposition and environmental exposures leading to PTSD occurrence. Research on war-related trauma has shifted from battlefield-related in-person exposure trauma to drone operator trauma and is being out published by civilian-related trauma research, such as the 'COVID-19' pandemic impact, 'postpartum', and 'grief disorder'. The focus on the most recent trends in the research revealed a burst in the 'treatment of PTSD' with the development of Mhealth, virtual reality, and psychedelic drugs. The collaboration networks reveal a central place for the USA research network, and although relatively isolated, a recent surge of publications from China was found. Compared to other psychiatric disorders, we found a lack of high-quality randomized controlled trials for pharmacological and nonpharmacological treatments. These results can inform funding agencies and future research.

Associations between climate change-related factors and sexual health: A scoping review

There is growing attention to the ways in which climate change may affect sexual health, yet key knowledge gaps remain across global contexts and climate issues. In response, we conducted a scoping review to examine the literature on associations between climate change and sexual health. We searched five databases (May 2021, September 2022). We reviewed 3,183 non-duplicate records for inclusion; n = 83 articles met inclusion criteria. Of these articles, n = 30 focused on HIV and other STIs, n = 52 focused on sexual and gender-based violence (GBV), and n = 1 focused on comprehensive sexuality education. Thematic analysis revealed that hurricanes, drought, temperature variation, flooding, and storms may influence HIV outcomes among people with HIV by constraining access to antiretroviral treatment and worsening mental health. Climate change was associated with HIV/STI testing barriers and worsened economic conditions that elevated HIV exposure (e.g. transactional sex). Findings varied regarding associations between GBV with storms and drought, yet most studies examining flooding, extreme temperatures, and bushfires reported positive associations with GBV. Future climate change research can examine understudied sexual health domains and a range of climate-related issues (e.g. heat waves, deforestation) for their relevance to sexual health. Climate-resilient sexual health approaches can integrate extreme weather events into programming.

The impact of anthropogenic climate change on pediatric viral diseases

The adverse effects of climate change on human health are unfolding in real time. Environmental fragmentation is amplifying spillover of viruses from wildlife to humans. Increasing temperatures are expanding mosquito and tick habitats, introducing vector-borne viruses into immunologically susceptible populations. More frequent flooding is spreading water-borne viral pathogens, while prolonged droughts reduce regional capacity to prevent and respond to disease outbreaks with adequate water, sanitation, and hygiene resources. Worsening air quality and altered transmission seasons due to an increasingly volatile climate may exacerbate the impacts of respiratory viruses. Furthermore, both extreme weather events and long-term climate variation are causing the destruction of health systems and large-scale migrations, reshaping health care delivery in the face of an evolving global burden of viral disease. Because of their immunological immaturity, differences in physiology (e.g., size), dependence on caregivers, and behavioral traits, children are particularly vulnerable to climate change. This investigation into the unique pediatric viral threats posed by an increasingly inhospitable world elucidates potential avenues of targeted programming and uncovers future research questions to effect equitable, actionable change. IMPACT: A review of the effects of climate change on viral threats to pediatric health, including zoonotic, vector-borne, water-borne, and respiratory viruses, as well as distal threats related to climate-induced migration and health systems. A unique focus on viruses offers a more in-depth look at the effect of climate change on vector competence, viral particle survival, co-morbidities, and host behavior. An examination of children as a particularly vulnerable population provokes programming tailored to their unique set of vulnerabilities and encourages reflection on equitable climate adaptation frameworks.

Demographics and risk of isolation due to sea level rise in the United States

Within coastal communities, sea level rise (SLR) will result in widespread intermittent flooding and long-term inundation. Inundation effects will be evident, but isolation that arises from the loss of accessibility to critical services due to inundation of transportation networks may be less obvious. We examine who is most at risk of isolation due to SLR, which can inform community adaptation plans and help ensure that existing social vulnerabilities are not exacerbated. Combining socio-demographic data with an isolation metric, we identify social and economic disparities in risk of isolation under different SLR scenarios (1-10 ft) for the coastal U.S. We show that Black and Hispanic populations face a disproportionate risk of isolation at intermediate levels of SLR (4 ft and greater). Further, census tracts with higher rates of renters and older adults consistently face higher risk of isolation. These insights point to significant inequity in the burdens associated with SLR.

Supporting the Respiratory Health of Migrants and Refugees

Migrants and refugees are at risk of developing acute and chronic respiratory diseases at their destination countries. Yet, people from these populations are also least likely to access care within the current health care system across the world. Although biological, psychological, and social factors play a role in influencing risk of respiratory diseases among these populations, the influences from cultural differences on health behaviors cannot be ignored. Cultural differences are influential in affecting an individual's level of health literacy. Health professionals can contribute to the provision of equitable care to diverse communities through addressing issues related to linguistic and cultural differences.

Household Flood Severity and Migration Extent in Central Java: Analysis of the Indonesian Family Life Survey

Central Java, Indonesia, is prone to river and coastal flooding due to climate changes and geological factors. Migration is one possible adaptation to flooding, but research is limited due to lack of longitudinal spatially granular datasets on migration and metrics to identify flood-affected households. The available literature indicates social and economic barriers may limit mobility from flood prone areas. The Indonesian Family Life Survey (IFLS) provides self-reported data on household experiences with natural disasters among 1501 Central Java households followed over two waves (2007 and 2014). We examined how the severity of flooding, defined by household-level impacts captured by the IFLS (death, injury, financial loss, or relocation of a household member), influenced the extent of household movement in Central Java using a generalized ordered logit/partial proportional odds model. Households severely impacted by floods had 75% lower odds of moving farther away compared to those that did not experience floods. The most severely impacted households may be staying within flood-affected areas in Central Java. Public health, nutrition, and economic surveys should include modules focused on household experiences, impacts, and adaptations to facilitate the study of how climate changes are impacting these outcomes.

Health and wellbeing implications of adaptation to flood risk

Adaptation strategies to ameliorate the impacts of climate change are increasing in scale and scope around the world, with interventions becoming a part of daily life for many people. Though the implications of climate impacts for health and wellbeing are well documented, to date, adaptations are largely evaluated by financial cost and their effectiveness in reducing risk. Looking across different forms of adaptation to floods, we use existing literature to develop a typology of key domains of impact arising from interventions that are likely to shape health and wellbeing. We suggest that this typology can be used to assess the health consequences of adaptation interventions more generally and argue that such forms of evaluation will better support the development of sustainable adaptation planning.

Increasing digitalization is associated with anxiety and depression: A Google Ngram analysis

The prevalence of anxiety disorders and depression are rising worldwide. Studies investigating risk factors on a societal level leading to these rises are so far limited to social-economic status, social capital, and unemployment, while most such studies rely on self-reports to investigate these factors. Therefore, our study aims to evaluate the impact of an additional factor on a societal level, namely digitalization, by using a linguistic big data approach. We extend related work by using the Google Books Ngram Viewer (Google Ngram) to retrieve and adjust word frequencies from a large corpus of books (8 million books or 6 percent of all books ever published) and to subsequently investigate word changes in terms of anxiety disorders, depression, and digitalization. Our analyses comprise and compare data from six languages, British English, German, Spanish, Russian, French, and Italian. We also retrieved word frequencies for the control construct "religion". Our results show an increase in word frequency for anxiety, depression, and digitalization over the last 50 years (r = .79 to .89, p < .001), a significant correlation between the frequency of anxiety and depression words (r = .98, p < .001), a significant correlation between the frequency of anxiety and digitalization words (r = .81, p < .001), and a significant correlation between the frequency of depression and anxiety words (r = .81, p < .001). For the control construct religion, we found no significant correlations for word frequency over the last 50 years and no significant correlation between the frequency of anxiety and depression words. Our results showed a negative correlation between the frequency of depression and religion words (r = -.25, p < .05). We also improved the method by excluding terms with double meanings detected by 73 independent native speakers. Implications for future research and professional and clinical implications of these findings are discussed.

Mini Review: The Impact of Climate Change on Gastrointestinal Health

Global warming and climate change are important worldwide issues which are a major human health threat. Climate change can affect the gastrointestinal (GI) system in many ways. Increased rainfall events and flooding may be associated with increased GI infections and hepatitis. Climate change could cause changes in gut microbiota, which may impact the pattern of GI diseases. The stress of access to essential needs such as clean water and food, the effects of forced migration, and natural disasters could increase brain-gut axis disorders. The association between air pollution and GI disorders is another challenging issue. There is a lot to do personally and professionally as gastroenterologists regarding climate change.

Climate Change and the Public Health Imperative for Supporting Migration as Adaptation

In an era of accelerating global climate change, human mobility has reached unprecedented levels. While it is acknowledged that many cases of human migration in the context of climate change are forced or involuntary, particularly where adaptation measures have failed to achieve sufficient resiliency of communities against impending slow- and sudden-onset disasters. There are also many cases where migration is, itself, a voluntary adaptive measure to secure otherwise unattainable physical safety and life-sustaining resources. It is in these cases that migration can be viewed as adaptation. Under the right policy conditions, it is possible for such adaptive migration to save countless lives. Moreover, it can achieve remarkable health and well-being gains for otherwise vulnerable communities residing on environmentally degrading lands and disproportionately suffering from the health impacts of climate change. While several activists have spoken loudly on the topic of climate migration, emphasizing the human rights imperative for supportive global policy action, the public health community has not been equally vocal nor unanimous in its stance. This paper, a product of the World Federation of Public Health Associations (WFPHA) Environmental Health Working Group, aims to rectify this gap, by analyzing adaptive climate migration through a public health lens. In doing so, it argues that creating an enabling environment for adaptive climate migration is not just a human rights imperative, but also a public health one. This argument is supported by evidence demonstrating how creating such an enabling environment can synergistically support the fulfillment of key public health services and functions, as outlined under the internationally endorsed Global Charter for the Public's Health of the WFPHA.

TURNING UP THE HEAT: A CONCEPTUAL MODEL FOR UNDERSTANDING THE MIGRATION AND HEALTH IN THE CONTEXT OF GLOBAL CLIMATE CHANGE

Background

The triangular relationship between climate change-related events, patterns of human migration and their implications for health is an important yet understudied issue. To improve understanding of this complex relationship, a comprehensive, interdisciplinary conceptual model will be useful. This paper investigates relationships between these factors and considers their impacts for affected populations globally.

Methods

A desk review of key literature was undertaken. An open-ended questionnaire consisting of 11 items was designed focusing on three themes: predicting population migration by understanding key variables, health implications, and suggestions on policy and research. After using purposive sampling we selected nine experts, reflecting diverse regional and professional backgrounds directly related to our research focus area. All responses were thematically analysed and key themes from the survey were synthesised to construct the conceptual model focusing on describing the relationship between global climate change, migration and health implications and a second model focusing on actionable suggestions for organisations working in the field, academia and policymakers.

Results

Key themes which constitute our conceptual model included: a description of migrant populations perceived to be at risk; health characteristics associated with different migratory patterns; health implications for both migrants and host populations; the responsibilities of global and local governance actors; and social and structural determinants of health. Less prominent themes were aspects related to slow-onset migratory patterns, voluntary stay, and voluntary migration. Actionable suggestions include an interdisciplinary and innovative approach to study the phenomenon for academicians, preparedness and globalized training and awareness for field organisations and migrant inclusive and climate sensitive approach for policymakers.

Conclusion

Contrary to common narratives, participants framed the impacts of climate change-related events on migration patterns and their health implications as non-linear and indirect, comprising many interrelated individual, social, cultural, demographic, geographical, structural, and political determinants. An understanding of these interactions in various contexts is essential for risk reduction and preventative measures. The way forward broadly includes inclusive and equity-based health services, improved and faster administrative systems, less restrictive (im)migration policies, globally trained staff, efficient and accessible research, and improved emergency response capabilities. The focus should be to increase preventative and adaptation measures in the face of any environmental changes and respond efficiently to different phases of migration to aim for better "health for all and promote universal well-being" (WHO) (World Health Organization 1999).

Evolution trend and hot topic measurement of climate migration research under the influence of climate change

Introduction

Global climate change, which is characterized by climate warming, has become one of the most prominent risk problems in society at present. Climate migration brings many accompanying problems to the environment, economy, politics, society, and culture. It is of great theoretical and practical significance to study the internal relationship between climate change and population migration.

Methods

The data were extracted from the Web of Science core collection database (WOS) and China Knowledge Network database (CNKI). A total of 785 documents and 157 documents in the field of climate migration from 2008 to 2021 were selected as analysis samples. Word frequency analysis, clustering analysis, sudden word detection analysis, and other methods were extensively used to build the evolution trend map of climate migration using CiteSpace visual bibliometric software.

Results

It is concluded that climate migration research has experienced three stages of development: initial exploration stage (2008-2011), development enrichment stage (2012-2017), and system deepening stage (2018).The hot topics of climate migration include: (1) different types of climate migration research; (2) Quantitative model research on climate migration; (3) Climate justice research. Different types of climate migration include 7 main types: (1) migration caused by sea level rise; (2) Resettlement caused by flood disaster; (3) Migration due to worsening drought; (4) Migration caused by extreme climate events; (5) Voluntary migration due to climate change discomfort; (6) Project resettlement caused by climate change response engineering measures; (7) Migrants whose livelihoods are broken due to climate change.

Discussion

The study points out that climate migration research is an interdisciplinary research field, which needs joint research by scholars from different academic backgrounds. In the future climate migration research, 1) strengthen the prediction ability of climate change population migration model; 2) Make use of China’s beneficial exploration in the migration fields such as engineering resettlement, ecological resettlement and poverty alleviation resettlement to formulate climate migration policies, regulations and strategic planning; 3) Establish a database cloud platform related to climate change and population migration; 4) Strengthen the exchange and cooperation between Chinese researchers in the field of climate migration and international scientific research institutions.

The dynamics of early-stage transmission of COVID-19: A novel quantification of the role of global temperature

The global outbreak of COVID-19 has emerged as one of the most devastating and challenging threats to humanity. As many frontline workers are fighting against this disease, researchers are struggling to obtain a better understanding of the pathways and challenges of this pandemic. This paper evaluates the concept that the transmission of COVID-19 is intrinsically linked to temperature. Some complex nonlinear functional forms, such as the cubic function, are introduced to the empirical models to understand the interaction between temperature and the "growth" in the number of infected cases. An accurate quantitative interaction between temperature and the confirmed COVID-19 cases is obtained as log(Y) = -0.000146(temp_H)³ + 0.007410(temp_H)² -0.063332 temp_H + 7.793842, where Y is the periodic growth in confirmed COVID-19 cases, and temp_H is the maximum daily temperature. This equation alone may be the first confirmed way to measure the quantitative interaction between temperature and human transmission of COVID-19. In addition, four important regions are identified in terms of maximum daily temperature (in Celsius) to understand the dynamics in the transmission of COVID-19 related to temperature. First, the transmission decreases within the range of -50 °C to 5.02 °C. Second, the transmission accelerates in the range of 5.02 °C to 16.92 °C. Essentially, this is the temperature range for an outbreak. Third, the transmission increases more slowly in the range of 16.92 °C to 28.82 °C. Within this range, the number of infections continues to grow, but at a slower pace. Finally, the transmission decreases in the range of 28.82 °C to 50 °C. Thus, according to this hypothesis, the threshold of 16.92 °C is the most critical, as the point at which the infection rate is the greatest. This result sheds light on the mechanism in the cyclicity of the ongoing COVID-19 pandemic worldwide. The implications of these results on policy issues are also discussed concerning a possible cyclical fluctuation pattern between the Northern and Southern Hemispheres.

The Threat of Climate Change on Tick-Borne Infections: Rising Trend of Infections and Geographic Distribution of Climate Risk Factors Associated With Ticks

Ticks transmit a wide range of pathogens. The spread of tick-borne infections is an emerging, yet often overlooked, threat in the context of climate change. The infections have rapidly increased over the past few years in South Korea despite no significant changes in socioeconomic circumstances. We investigated the impact of climate change on the surge of tick-borne infections and identified potential disease hot spots at a resolution of 5 km by 5 km. A composite index was constructed based on multiple climate and environmental indicators and compared with the observed tick-borne infections. The surge of tick-borne episodes corresponded to the rising trend of the index over time. High-risk areas identified by the index can be used to prioritize locations for disease prevention activities. Monitoring climate risk factors may provide an opportunity to predict the spread of the infections in advance.

Climate change and human health in the Eastern Mediterranean and Middle East: Literature review, research priorities and policy suggestions

Human health is linked to climatic factors in complex ways, and climate change can have profound direct and indirect impacts on the health status of any given region. Susceptibility to climate change is modulated by biological, ecological and socio-political factors such as age, gender, geographic location, socio-economic status, occupation, health status and housing conditions, among other. In the Eastern Mediterranean and Middle East (EMME), climatic factors known to affect human health include extreme heat, water shortages and air pollution. Furthermore, the epidemiology of vector-borne diseases (VBDs) and the health consequences of population displacement are also influenced by climate change in this region. To inform future policies for adaptation and mitigation measures, and based on an extensive review of the available knowledge, we recommend several research priorities for the region. These include the generation of more empirical evidence on exposure-response functions involving climate change and specific health outcomes, the development of appropriate methodologies to evaluate the physical and psychological effects of climate change on vulnerable populations, determining how climate change alters the ecological determinants of human health, improving our understanding of the effects of long-term exposure to heat stress and air pollution, and evaluating the interactions between adaptation and mitigation strategies. Because national boundaries do not limit most climate-related factors expected to impact human health, we propose that adaptation/mitigation policies must have a regional scope, and therefore require collaborative efforts among EMME nations. Policy suggestions include a decisive region-wide decarbonisation, the integration of environmentally driven morbidity and mortality data throughout the region, advancing the development and widespread use of affordable technologies for the production and management of drinking water by non-traditional means, the development of comprehensive strategies to improve the health status of displaced populations, and fostering regional networks for monitoring and controlling the spread of infectious diseases and disease vectors.

Chasing the ghosts: stories of people left behind on the frontline of climate and ecological crisis

Human-induced global climate change is associated with population migration as places become uninhabitable. Uttarakhand is one of India’s most ecologically fragile and climatically vulnerable states. There are massive disparities between the hill and the plain districts as the development initiatives remain concentrated in the plain districts. The inadequacy of the state government, coupled with environmental changes, has made the life of the hill communities challenging. Many people have migrated from the hills resulting in depopulated or ghost villages. Based on interviews with 75 people, the article attempts to shed light on changes that occur when the inhabitants of a place leave. Loss of a place and its community life can have severe implications on the well-being of the people. Respondents showed a range of emotions, including the longing for their homes before the onset of environmental changes. With more intense and frequent climatic events, it has become essential to understand such social and cultural costs of migration.

The impact of climate change on the risk factors for tuberculosis: A systematic review

BACKGROUND

Tuberculosis (TB) continues to pose a major public health risk in many countries. The current incidence of disease exceeds guidelines proposed by the World Health Organisation and United Nations. Whilst the relationship between climate change and TB has surfaced in recent literature, it remains neglected in global agendas. There is a need to acknowledge TB as a climate-sensitive disease to facilitate its eradication.

OBJECTIVE

To review epidemiological and prediction model studies that explore how climate change may affect the risk factors for TB, as outlined in the Global Tuberculosis Report 2021: HIV infection, diabetes mellitus, undernutrition, overcrowding, poverty, and indoor air pollution.

METHODS

We conducted a systematic literature search of PubMed, Embase, and Scopus databases to identify studies examining the association between climate variables and the risk factors for TB. Each study that satisfied the inclusion criteria was assessed for quality and ethics. Studies then underwent vote-counting and were categorised based on whether an association was found.

RESULTS

53 studies met inclusion criteria and were included in our review. Vote-counting revealed that two out of two studies found a positive association between the examined climate change proxy and HIV, nine out of twelve studies for diabetes, eight out of seventeen studies for undernutrition, four out of five studies for overcrowding, twelve out of fifteen studies for poverty and one out of three studies for indoor air pollution.

DISCUSSION

We found evidence supporting a positive association between climate change and each of the discussed risk factors for TB, excluding indoor air pollution. Our findings suggest that climate change is likely to affect the susceptibility of individuals to TB by increasing the prevalence of its underlying risk factors, particularly in developing countries. This is an evolving field of research that requires further attention in the scientific community.

Exploring the temporal patterns and crisis-related risk factors for population displacement in Somalia (2016-2018)

Introduction

Over the past 30 years, south-central Somalia, Puntland (north-east) and Somaliland (north-west) have experienced recurring drought- and conflict-related crises. By the end of 2018, the number of internally displaced persons (IDPs) in the region had reached 2.6 million; most were displaced to larger towns under government control, where humanitarian assistance was more accessible. Understanding the drivers of crisis-related displacement can provide insight into how responses can best manage and respond to displacement to prevent downstream morbidity and mortality. We aimed to explore the temporal patterns and crisis-related risk factors for population displacement in Somalia from 2016 to 2018, a period of severe drought.

Methods

We conducted an ecological study of secondary panel data stratified by district and month. The study population included all people in the region from 2016 to 2018. The outcome was defined as the number of new out-migrating internally displaced persons (IDPs) per district-month. Exposure variables included armed conflict, rainfall, food insecurity and food security services. Lags at one, two and three months were generated to explore possible delayed effects. All univariate and multivariate analyses were conducted using negative binomial regression models with mixed effects incorporating the district as a random effect.

Results

From 2016 to 2018, the proportion of IDPs increased from 9% to 25% in Somalia, Puntland and Somaliland. We observed strong associations between IDP out-migration rate and failed rains at a three-month lag, food insecurity at a one-month lag, and the presence of therapeutic food services with no lag. IDP out-migration rate was not associated with armed conflict intensity, and cash- and rations-based food security services.

Discussion

This study identified temporal, and socially and biologically plausible associations between key crisis-related risk factors and displacement in Somalia. The findings suggest a sequence of events spanning a few months, where failed rains and consequent food insecurity likely prompted early population out-migration to larger urban centers where humanitarian services were more accessible. The presence of therapeutics-based food security services could represent a more general correlate of crisis severity and the decision to migrate.

Bibliometric analysis of immigration and environmental degradation: evidence from past decades

The aim of this paper is to examine immigration and environmental degradation using bibliometric analysis. This paper also analyzes sources of publication, authorship, citations, distributions publications and other bibliometric indicators. The study focuses on a total of 1372 articles published from 2000 to 2020. These articles were collected through an automated process from the Scopus database and later analyzed using techniques such as bibliometric indicators analysis, VOSviewer, and Perish or Publish. The research identified 991 articles from varieties of published sources. The topic of immigrants and environmental degradation has been an emerging topic since 1981. Starting in 2000, most of the scholars actively producing an articles pertinent to this topic. Most of the articles were published in journals, and English is the primary language of research. United States is the leading country in contributing the publications. Meanwhile, the most significant fields in which the sources were produced were environmental science, agricultural and biological sciences, arts and humanities and earth and planetary sciences. However, some limitations has been found. It has been suggested for future research, to lengthen this work to other databases, as well as bibliometric analyses of immigration and environmental degradation in developed and developing countries by adding a new keyword such as energy consumption and climate change. This paper aims to assess recent trends in the expansion of academic literature on immigration and environmental degradation using the bibliometric analysis method. Network visualization and bibliometric indicators are used in this paper to present the results.

Environmental Displacement and Mental Well-Being in Banjarnegara, Indonesia

BACKGROUND

Residential moves (displacement) owing to climate- and weather-related disasters may significantly impact mental health. Despite the growing risk from climate change, health impacts of environmental-mobility remain understudied.

OBJECTIVES

We assessed the effects of displacement on the association between landslides and changes in perceived mental well-being in Banjarnegara, Indonesia. We also investigated whether sociodemographics (age, sex, level of education, household-level income, or employment in agriculture) and landslide characteristics (number and severity of landslides) were associated with differing odds of relocation after experiencing landslides.

METHODS

In this cross-sectional study, we surveyed 420 individuals who experienced landslides between 2014 and 2018 to assess perceived changes in mental well-being, comparing after landslide exposure to before landslide exposure. We used a novel six-item measure that was created in collaboration with the local community to compare perceived changes between those who were displaced by landslides and those who were not displaced, using logistic and multinomial regressions adjusted for sociodemographic characteristics. We then assessed whether the odds of displacement differed based on sociodemographic characteristics and landslide exposure characteristics, using logistic regressions.

RESULTS

Those who were displaced were more likely than those who were not displaced to report perceived increases in economic stability [odds ratio (OR)=3.06; 95% confidence interval (CI): 1.45, 6.46], optimism (OR=4.01; 95% CI: 1.87, 8.61), safety (OR=2.71; 95% CI: 1.44, 5.10), religiosity (OR=1.92; 95% CI: 1.03, 3.65), and closeness with community (OR=1.90; 95% CI: 1.10, 3.33) after landslides compared with before their first landslide during the study period. More frequent landslide exposures were associated with reduced odds of relocation, but more severe landslides were associated with increased odds of relocation.

DISCUSSION

These findings suggest that landslides affect the mental well-being not only of those who are displaced but also of those who are left behind. Further, this work supports the need for community-based participatory research to fully capture the health impacts of environmental mobility. https://doi.org/10.1289/EHP9391.

Exploring linkages between climate change and sexual health: a scoping review protocol

INTRODUCTION

The effects of climate change and associated extreme weather events (EWEs) present substantial threats to well-being. EWEs hold the potential to harm sexual health through pathways including elevated exposure to HIV and other sexually transmitted infections (STIs), disrupted healthcare access, and increased sexual and gender-based violence (SGBV). The WHO defines four components of sexual health: comprehensive sexuality education; HIV and STI prevention and care; SGBV prevention and care; and psychosexual counselling. Yet, knowledge gaps remain regarding climate change and its associations with these sexual health domains. This scoping review will therefore explore the linkages between climate change and sexual health.

METHODS AND ANALYSIS

Five electronic databases (MEDLINE, EMBASE, PsycINFO, Web of Science, CINAHL) will be searched using text words and subject headings (eg, Medical Subject Headings (MeSH), Emtree) related to sexual health and climate change from the inception of each database to May 2021. Grey literature and unpublished reports will be searched using a comprehensive search strategy, including from the WHO, World Bank eLibrary, and the Centers for Disease Control and Prevention. The scoping review will consider studies that explore: (a) climate change and EWEs including droughts, heat waves, wildfires, dust storms, hurricanes, flooding rains, coastal flooding and storm surges; alongside (b) sexual health, including: comprehensive sexual health education, sexual health counselling, and HIV/STI acquisition, prevention and/or care, and/or SGBV, including intimate partner violence, sexual assault and rape. Searches will not be limited by language, publication year or geographical location. We will consider quantitative, qualitative, mixed-methods and review articles for inclusion. We will conduct thematic analysis of findings. Data will be presented in narrative and tabular forms.

ETHICS AND DISSEMINATION

There are no formal ethics requirements as we are not collecting primary data. Results will be published in a peer-reviewed journal and shared at international conferences.

A Scoping Review to Assess Sexual and Reproductive Health Outcomes, Challenges and Recommendations in the Context of Climate Migration

Background: As growing numbers of people may be forced to migrate due to climate change and variability, it is important to consider the disparate impacts on health for vulnerable populations, including sexual and reproductive health (SRH). This scoping review aims to explore the relationship between climate migration and SRH. Methods: We searched PubMed/MEDLINE, CINAHL Plus, EMBASE, Web of Science, Scopus, Global Health and Google for peer-reviewed and gray literature published before 2nd July 2021 in English that reported on SRH in the context of climate migration. Data were extracted using a piloted extraction tool and findings are reported in a narrative synthesis. Results: We screened 1,607 documents. Ten full-text publications were included for analysis: five peer-reviewed articles and five gray literature documents. Reported SRH outcomes focused on maternal health, access to family planning and antiretroviral therapy, sexual and gender-based violence, transactional sex, and early/forced marriage. Recommendations to improve SRH in the context of climate migration called for gender-transformative health systems, education and behavior change programmes, and the involvement of local women in policy planning and programme implementation. Discussion: While the disparate impacts of climate change and migration are well-established, primary data on the scope of impact due to climate migration is limited. The SRH outcomes reported in the literature focus on a relatively narrow range of SRH domains, emphasizing women and girls, over men. Achieving holistic and equitable SRH in the context of climate migration requires engaging all genders across the range of SRH outcomes and migration contexts. This review highlights the need for further empirical evidence on the effect of climate migration on SRH, with research that is context-specific and engages communities in order to reflect the heterogeneity of outcomes and impact in the climate-migration-SRH nexus.

Proceedings from the CIH-LMU 2021 Symposium: "Global Health Perspectives: Climate Change & Migration"

Climate change shapes human migration through the interaction of environmental changes with political, social, economic, and demographic drivers of mobility. Low-and middle-income countries bear the brunt of the health impacts of climate change and migration, despite their overall low contribution to greenhouse gas emissions. The CIH^LMU Symposium 2021 aimed to explore the complex interconnections between climate change, migration and health from diverse global perspectives. A number of themes, such as the relationship between climate and trade, the role of technology, and the issue of responsibility were tackled. The speakers also highlighted the need for climate resilient health-systems, gender mainstreaming in climate strategies, collaboration between the Global North and South and urgently defining the ‘climate refugee’. It is crucial that the narrative around climate change moves from an environmental framing to encompass human health and migration within climate discussions and strategies.

Risk and Resilience: How Is the Health of Older Adults and Immigrant People Living in Canada Impacted by Climate- and Air Pollution-Related Exposures?

BACKGROUND

In the rapidly shifting Canadian climate, an ageing population, and increased migration, a greater understanding of how local climate and air pollution hazards impact older adults and immigrant populations will be necessary for mitigating and adapting to adverse health impacts.

OBJECTIVES

To explore the reported health impacts of climate change and air pollution exposures in older adults and immigrant people living in Canada, identify known factors influencing risk and resilience in these populations and gaps in the literature.

METHODS

We searched for research focused on older adults and immigrants living in Canada, published from 2010 onward, where the primary exposures were related to climate or air pollution. We extracted data on setting, exposures, health outcomes, and other relevant contextual factors.

RESULTS AND DISCUSSION

We identified 52 eligible studies, most focused in Ontario and Quebec. Older people in Canada experience health risks due to climate and air pollution exposures. The extent of the risk depends on multiple factors. We found little information about the climate- and air pollution-related health impacts experienced by immigrant communities.

CONCLUSIONS

Further research about climate- and air pollution-related exposures, health, and which factors promote or reduce resiliency in Canada's older adults and immigrant communities is necessary.

Effects of riverbank erosion on mental health of the affected people in Bangladesh

Background

In Bangladesh, riverbank erosion is a major problem that regularly displaces millions of people and affects their mental health every year.

Objectives

The primary objective is to explore the effects of riverbank erosion on mental health problems such as depression, anxiety, and stress in Bangladesh.

Methods

We conducted a household survey from August 2019 to November 2019 on randomly selected adult respondents from Rajbari District located along the Ganges River and Tangail District located along the Brahmaputra River. The respondents were divided into two groups: exposed and non-exposed to riverbank erosion. All participants were asked to complete self-reported questionnaires on the Depression, Anxiety and Stress Scale-21, and other socio-demographic, economic and riverbanks erosion-related factors. We performed Chi-squared test and multiple logistic regression analysis to explore the significant risk factors (P<0.05) of mental illness (depression, anxiety and stress).

Results

We surveyed 611 households, of whom 410 were from Rajbari and 201 were from Tangail. Among 611 respondents, 509 (83.31%) were exposed by riverbank erosion whereas 102 (16.69%) were non-exposed. The prevalence of depression, anxiety and stress (DAS) was 38.30%, 76.60%, 32.41%, respectively, and they were significantly higher among the exposed group than the non-exposed group (depression: 45.19% versus 3.92%, P<0.001; anxiety: 82.71% versus 46.08%, P<0.001; stress: 38.11% versus 3.92%, P<0.001). The respondents exposed to river erosion were respectively 8.28, 2.26 and 5.09 times more likely to develop DAS disorder compared to their non-exposed counterparts (OR_D = 8.28, 95% CI = 2.75–24.89; OR_A = 2.26, 95% CI = 1.31–3.88; OR_S = 5.09, 95% CI = 1.64–15.76). Females and those who lost their houses and displaced, were more likely to have DAS disorder compared to their respective counterparts.

Conclusions

The exposed people were more likely to experience mental health problem and demand some social safety net programs with special focus on female and those who lost houses and displaced.

The Ecology of Unsheltered Homelessness: Environmental and Social-Network Predictors of Well-Being among an Unsheltered Homeless Population

People experiencing homelessness (PEH) face extreme weather exposure and limited social support. However, few studies have empirically assessed biophysical and social drivers of health outcomes among unsheltered PEH. Social network, health, and outdoor exposure data were collected from a convenience sample of unsheltered PEH (n = 246) in Nashville, TN, from August 2018–June 2019. Using multivariate fixed-effects linear regression models, we examined associations between biophysical and social environments and self-reported general health and emotional well-being. We found that study participants reported the lowest general health scores during winter months—Nashville’s coldest season. We also found a positive association between the number of nights participants spent indoors during the previous week and general health. Participants who spent even one night indoors during the past week had 1.8-point higher general health scores than participants who spent zero nights indoors (p < 0.01). Additionally, participants who experienced a conflict with a social contact in the past 30 days had lower emotional well-being scores than participants who experienced no conflict. Finally, women had worse general health and emotional well-being than men. Ecologically framed research about health and well-being among PEH is critically needed, especially as climate change threatens to increase the danger of many homeless environments.

Assessment of environmental sustainability in renal healthcare

The health effects of climate change are becoming increasingly important; there are direct effects from heatwaves and floods, and indirect effects from the altered distribution of infectious diseases and changes in crop yield. Ironically, the healthcare system itself carries an environmental burden, contributing to environmental health impacts. Life cycle assessment is a widely accepted and well-established method that quantitatively evaluates environmental impact. Given that monetary evaluations have the potential to motivate private companies and societies to reduce greenhouse gas emissions using market mechanisms, instead of assessing the carbon footprint alone, we previously developed a life cycle impact assessment method based on an endpoint that integrates comprehensive environmental burdens into a single index-the monetary cost. Previous investigations estimated that therapy for chronic kidney disease had a significant carbon footprint in the healthcare sector. We have been aiming to investigate on the environmental impact of chronic kidney disease based on field surveys from the renal department in a hospital and several health clinics in Japan. To live sustainably, it is necessary to establish cultures, practices, and research that aims to conserve resources to provide environmentally friendly healthcare in Japan.

Family Physician Perceptions of Climate Change, Migration, Health, and Healthcare in Sub-Saharan Africa: An Exploratory Study

Although family physicians (FPs) are community-oriented primary care generalists and should be the entry point for the population’s interaction with the health system, they are underrepresented in research on the climate change, migration, and health(care) nexus (hereafter referred to as the nexus). Similarly, FPs can provide valuable insights into building capacity through integrating health-determining sectors for climate-resilient and migration-inclusive health systems, especially in Sub-Saharan Africa (SSA). Here, we explore FPs’ perceptions on the nexus in SSA and on intersectoral capacity building. Three focus groups conducted during the 2019 WONCA-Africa conference in Uganda were transcribed verbatim and analyzed using an inductive thematic approach. Participants’ perceived interactions related to (1) migration and climate change, (2) migration for better health and healthcare, (3) health impacts of climate change and the role of healthcare, and (4) health impacts of migration and the role of healthcare were studied. We coined these complex and reinforcing interactions as continuous feedback loops intertwined with socio-economic, institutional, and demographic context. Participants identified five intersectoral capacity-building opportunities on micro, meso, macro, and supra (international) levels: multi-dimensional and multi-layered governance structures; improving FP training and primary healthcare working conditions; health advocacy in primary healthcare; collaboration between the health sector and civil society; and more responsibilities for high-income countries. This exploratory study presents a unique and novel perspective on the nexus in SSA which contributes to interdisciplinary research agendas and FP policy responses on national, regional, and global levels.

The spatiotemporal distribution of historical malaria cases in Sweden: a climatic perspective

Background

Understanding of the impacts of climatic variability on human health remains poor despite a possibly increasing burden of vector-borne diseases under global warming. Numerous socioeconomic variables make such studies challenging during the modern period while studies of climate–disease relationships in historical times are constrained by a lack of long datasets. Previous studies have identified the occurrence of malaria vectors, and their dependence on climate variables, during historical times in northern Europe. Yet, malaria in Sweden in relation to climate variables is understudied and relationships have never been rigorously statistically established. This study seeks to examine the relationship between malaria and climate fluctuations, and to characterise the spatio-temporal variations at parish level during severe malaria years in Sweden 1749–1859.

Methods

Symptom-based annual malaria case/death data were obtained from nationwide parish records and military hospital records in Stockholm. Pearson (r_p) and Spearman’s rank (r_s) correlation analyses were conducted to evaluate inter-annual relationship between malaria data and long meteorological series. The climate response to larger malaria events was further explored by Superposed Epoch Analysis, and through Geographic Information Systems analysis to map spatial variations of malaria deaths.

Results

The number of malaria deaths showed the most significant positive relationship with warm-season temperature of the preceding year. The strongest correlation was found between malaria deaths and the mean temperature of the preceding June–August (r_s = 0.57, p < 0.01) during the 1756–1820 period. Only non-linear patterns can be found in response to precipitation variations. Most malaria hot-spots, during severe malaria years, concentrated in areas around big inland lakes and southern-most Sweden.

Conclusions

Unusually warm and/or dry summers appear to have contributed to malaria epidemics due to both indoor winter transmission and the evidenced long incubation and relapse time of P. vivax, but the results also highlight the difficulties in modelling climate–malaria associations. The inter-annual spatial variation of malaria hot-spots further shows that malaria outbreaks were more pronounced in the southern-most region of Sweden in the first half of the nineteenth century compared to the second half of the eighteenth century.

A Transdisciplinary Approach to Address Climate Change Adaptation for Human Health and Well-Being in Africa

The health sector response to dealing with the impacts of climate change on human health, whether mitigative or adaptive, is influenced by multiple factors and necessitates creative approaches drawing on resources across multiple sectors. This short communication presents the context in which adaptation to protect human health has been addressed to date and argues for a holistic, transdisciplinary, multisectoral and systems approach going forward. Such a novel health-climate approach requires broad thinking regarding geographies, ecologies and socio-economic policies, and demands that one prioritises services for vulnerable populations at higher risk. Actions to engage more sectors and systems in comprehensive health-climate governance are identified. Much like the World Health Organization's 'Health in All Policies' approach, one should think health governance and climate change together in a transnational framework as a matter not only of health promotion and disease prevention, but of population security. In an African context, there is a need for continued cross-border efforts, through partnerships, blending climate change adaptation and disaster risk reduction, and long-term international financing, to contribute towards meeting sustainable development imperatives.

Climate-related migration and population health: social science-oriented dynamic simulation model

BACKGROUND

Social science models find the ecological impacts of climate change (EICC) contribute to internal migration in developing countries and, less so, international migration. Projections expect massive climate-related migration in this century. Nascent research calls to study health, migration, population, and armed conflict potential together, accounting for EICC and other factors. System science offers a way: develop a dynamic simulation model (DSM). We aim to validate the feasibility and usefulness of a pilot DSM intended to serve as a proof-of-concept and a basis for identifying model extensions to make it less simplified and more realistic.

METHODS

Studies have separately examined essential parts. Our DSM integrates their results and computes composites of health problems (HP), health care (HC), non-EICC environmental health problems (EP), and environmental health services (ES) by origin site and by immigrants and natives in a destination site, and conflict risk and intensity per area. The exogenous variables include composites of EICC, sociopolitical, economic, and other factors. We simulate the model for synthetic input values and conduct sensitivity analyses.

RESULTS

The simulation results refer to generic origin and destination sites anywhere on Earth. The effects' sizes are likely inaccurate from a real-world view, as our input values are synthetic. Their signs and dynamics are plausible, internally consistent, and, like the sizes, respond logically in sensitivity analyses. Climate migration may harm public health in a host area even with perfect HC/ES qualities and full access; and no HP spillovers across groups, conflict, EICC, and EP. Deviations from these conditions may worsen everyone's health. We consider adaptation options.

CONCLUSIONS

This work shows we can start developing DSMs to understand climate migration and public health by examining each case with its own inputs. Validation of our pilot model suggests we can use it as intended. We lay a path to making it more realistic for policy analysis.

Poverty, depression, and anxiety: Causal evidence and mechanisms

Why are people who live in poverty disproportionately affected by mental illness? We review the interdisciplinary evidence of the bidirectional causal relationship between poverty and common mental illnesses-depression and anxiety-and the underlying mechanisms. Research shows that mental illness reduces employment and therefore income, and that psychological interventions generate economic gains. Similarly, negative economic shocks cause mental illness, and antipoverty programs such as cash transfers improve mental health. A crucial step toward the design of effective policies is to better understand the mechanisms underlying these causal effects.

Human Health and Ocean Pollution

Background

Pollution - unwanted waste released to air, water, and land by human activity - is the largest environmental cause of disease in the world today. It is responsible for an estimated nine million premature deaths per year, enormous economic losses, erosion of human capital, and degradation of ecosystems. Ocean pollution is an important, but insufficiently recognized and inadequately controlled component of global pollution. It poses serious threats to human health and well-being. The nature and magnitude of these impacts are only beginning to be understood.

Goals

(1) Broadly examine the known and potential impacts of ocean pollution on human health. (2) Inform policy makers, government leaders, international organizations, civil society, and the global public of these threats. (3) Propose priorities for interventions to control and prevent pollution of the seas and safeguard human health.

Methods

Topic-focused reviews that examine the effects of ocean pollution on human health, identify gaps in knowledge, project future trends, and offer evidence-based guidance for effective intervention.

Environmental Findings

Pollution of the oceans is widespread, worsening, and in most countries poorly controlled. It is a complex mixture of toxic metals, plastics, manufactured chemicals, petroleum, urban and industrial wastes, pesticides, fertilizers, pharmaceutical chemicals, agricultural runoff, and sewage. More than 80% arises from land-based sources. It reaches the oceans through rivers, runoff, atmospheric deposition and direct discharges. It is often heaviest near the coasts and most highly concentrated along the coasts of low- and middle-income countries. Plastic is a rapidly increasing and highly visible component of ocean pollution, and an estimated 10 million metric tons of plastic waste enter the seas each year. Mercury is the metal pollutant of greatest concern in the oceans; it is released from two main sources - coal combustion and small-scale gold mining. Global spread of industrialized agriculture with increasing use of chemical fertilizer leads to extension of Harmful Algal Blooms (HABs) to previously unaffected regions. Chemical pollutants are ubiquitous and contaminate seas and marine organisms from the high Arctic to the abyssal depths.

Ecosystem Findings

Ocean pollution has multiple negative impacts on marine ecosystems, and these impacts are exacerbated by global climate change. Petroleum-based pollutants reduce photosynthesis in marine microorganisms that generate oxygen. Increasing absorption of carbon dioxide into the seas causes ocean acidification, which destroys coral reefs, impairs shellfish development, dissolves calcium-containing microorganisms at the base of the marine food web, and increases the toxicity of some pollutants. Plastic pollution threatens marine mammals, fish, and seabirds and accumulates in large mid-ocean gyres. It breaks down into microplastic and nanoplastic particles containing multiple manufactured chemicals that can enter the tissues of marine organisms, including species consumed by humans. Industrial releases, runoff, and sewage increase frequency and severity of HABs, bacterial pollution, and anti-microbial resistance. Pollution and sea surface warming are triggering poleward migration of dangerous pathogens such as the Vibrio species. Industrial discharges, pharmaceutical wastes, pesticides, and sewage contribute to global declines in fish stocks.

Human Health Findings

Methylmercury and PCBs are the ocean pollutants whose human health effects are best understood. Exposures of infants in utero to these pollutants through maternal consumption of contaminated seafood can damage developing brains, reduce IQ and increase children's risks for autism, ADHD and learning disorders. Adult exposures to methylmercury increase risks for cardiovascular disease and dementia. Manufactured chemicals - phthalates, bisphenol A, flame retardants, and perfluorinated chemicals, many of them released into the seas from plastic waste - can disrupt endocrine signaling, reduce male fertility, damage the nervous system, and increase risk of cancer. HABs produce potent toxins that accumulate in fish and shellfish. When ingested, these toxins can cause severe neurological impairment and rapid death. HAB toxins can also become airborne and cause respiratory disease. Pathogenic marine bacteria cause gastrointestinal diseases and deep wound infections. With climate change and increasing pollution, risk is high that Vibrio infections, including cholera, will increase in frequency and extend to new areas. All of the health impacts of ocean pollution fall disproportionately on vulnerable populations in the Global South - environmental injustice on a planetary scale.

Conclusions

Ocean pollution is a global problem. It arises from multiple sources and crosses national boundaries. It is the consequence of reckless, shortsighted, and unsustainable exploitation of the earth's resources. It endangers marine ecosystems. It impedes the production of atmospheric oxygen. Its threats to human health are great and growing, but still incompletely understood. Its economic costs are only beginning to be counted.Ocean pollution can be prevented. Like all forms of pollution, ocean pollution can be controlled by deploying data-driven strategies based on law, policy, technology, and enforcement that target priority pollution sources. Many countries have used these tools to control air and water pollution and are now applying them to ocean pollution. Successes achieved to date demonstrate that broader control is feasible. Heavily polluted harbors have been cleaned, estuaries rejuvenated, and coral reefs restored.Prevention of ocean pollution creates many benefits. It boosts economies, increases tourism, helps restore fisheries, and improves human health and well-being. It advances the Sustainable Development Goals (SDG). These benefits will last for centuries.

Recommendations

World leaders who recognize the gravity of ocean pollution, acknowledge its growing dangers, engage civil society and the global public, and take bold, evidence-based action to stop pollution at source will be critical to preventing ocean pollution and safeguarding human health.Prevention of pollution from land-based sources is key. Eliminating coal combustion and banning all uses of mercury will reduce mercury pollution. Bans on single-use plastic and better management of plastic waste reduce plastic pollution. Bans on persistent organic pollutants (POPs) have reduced pollution by PCBs and DDT. Control of industrial discharges, treatment of sewage, and reduced applications of fertilizers have mitigated coastal pollution and are reducing frequency of HABs. National, regional and international marine pollution control programs that are adequately funded and backed by strong enforcement have been shown to be effective. Robust monitoring is essential to track progress.Further interventions that hold great promise include wide-scale transition to renewable fuels; transition to a circular economy that creates little waste and focuses on equity rather than on endless growth; embracing the principles of green chemistry; and building scientific capacity in all countries.Designation of Marine Protected Areas (MPAs) will safeguard critical ecosystems, protect vulnerable fish stocks, and enhance human health and well-being. Creation of MPAs is an important manifestation of national and international commitment to protecting the health of the seas.

Environmental impacts and risk factors of renewable energy paradigm-a review

The transition to a low carbon society is dependent on renewable energy-based electrification. Nevertheless, energy programs have resulted in growing societal polarization in several regions. Therefore, around the globe, government and legislative authorities at the local, regional, national, and international levels are highly concerned about the environmental impacts and risk factors that influence the energy paradigm. Thus, to minimize and/or limit the environmental insecurity issues, the world needs swift and effective actions to secure the climate for a better tomorrow. Moreover, there is a dire need to look for new energy alternatives, along with reducing the complete dependence on petro-based energy sources. Keeping this burning issue in mind, herein, an effort has been made to present the potential of several renewable energy sources, including wind-based renewable energy, solar-based renewable energy, hydro-based renewable energy, and biomass-based renewable energy. Following a brief introduction of energy-related problems and opportunities, a comparative overview is given to renewable vs. non-renewable energy sources. Then, several renewable energy sources, including wind, solar, hydro, and biomass, along with the worldwide energy capacity of each energy source are given with suitable examples and statistics. Finally, risk factors, concluding remarks, and future guidelines are discussed towards the end.

A Critical Analysis of the Drivers of Human Migration Patterns in the Presence of Climate Change: A New Conceptual Model

Both climate change and migration present key concerns for global health progress. Despite this, a transparent method for identifying and understanding the relationship between climate change, migration and other contextual factors remains a knowledge gap. Existing conceptual models are useful in understanding the complexities of climate migration, but provide varying degrees of applicability to quantitative studies, resulting in non-homogenous transferability of knowledge in this important area. This paper attempts to provide a critical review of climate migration literature, as well as presenting a new conceptual model for the identification of the drivers of migration in the context of climate change. It focuses on the interactions and the dynamics of drivers over time, space and society. Through systematic, pan-disciplinary and homogenous application of theory to different geographical contexts, we aim to improve understanding of the impacts of climate change on migration. A brief case study of Malawi is provided to demonstrate how this global conceptual model can be applied into local contextual scenarios. In doing so, we hope to provide insights that help in the more homogenous applications of conceptual frameworks for this area and more generally.

Health Status and Health Care Needs of Drought-Related Migrants in the Horn of Africa-A Qualitative Investigation

Somalia, Kenya and Ethiopia, situated in the Horn of Africa, are highly vulnerable to climate change, which manifests itself through increasing temperatures, erratic rains and prolonged droughts. Millions of people have to flee from droughts or floods either as cross-border refugees or as internally displaced persons (IDPs). The aim of this study was to identify knowledge status and gaps regarding public health consequences of large-scale displacement in these countries. After a scoping review, we conducted qualitative in-depth interviews during 2018 with 39 stakeholders from different disciplines and agencies in these three countries. A validation workshop was held with a selection of 13 interviewees and four project partners. Malnutrition and a lack of vaccination of displaced people are well-known challenges, while mental health problems and gender-based violence (GBV) are less visible to stakeholders. In particular, the needs of IDPs are not well understood. The treatment of mental health and GBV is insufficient, and IDPs have inadequate access to essential health services in refugee camps. Needs assessment and program evaluations with a patients’ perspective are either lacking or inadequate in most situations. The Horn of Africa is facing chronic food insecurity, poor population health and mass displacement. IDPs are an underserved group, and mental health services are lacking. A development approach is necessary that moves beyond emergency responses to the building of long-term resilience, the provision of livelihood support and protection to reduce displacement by droughts.

Impact of Extreme Weather Events on Sub-Saharan African Child and Adolescent Mental Health: A Protocol for a Systematic Review

Sub-Saharan Africa (SSA) has been identified by the Intergovernmental Panel on Climate Change (IPCC) as being the most vulnerable region to climate change impacts. A major concern is the increase in extreme weather events (EWE) such as storms, floods, droughts, heatwaves, wildfires, and landslides in SSA and their potential to affect the health and well-being of children and adolescents. The objective of this systematic review is to examine the direct and indirect impacts of EWE on the mental health of children and adolescents living in SSA, in order to inform protective adaptation strategies and promote resilience. A meta-analysis will not be possible, since the assumption is that limited studies have been published on the EWE-associated mental health impacts on children and adolescents living in SSA and that those studies that are available are heterogenous. There is acknowledgement in the global literature of the need to highlight child and adolescent mental health more prominently in climate change health strategies and policies. It is vital that adaptation strategies are informed by research on risk prevention and promotion of resilience to ensure the mental health of children and adolescents is protected.

Migration health crisis associated with climate change: A systematic review

BACKGROUND

The empirical assessment of the health outcomes associated with migration caused by climate change is still unclear. However, health outcomes in the early stages are expected to be similar to the health outcomes associated with refugees. The objective of the present study was a systematic review of the health effects of migration caused by climate change.

METHODOLOGY

A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Online databases (PubMed, Scopus, Web of Science, and Google Scholar) were used to identify papers published that evaluated the health effects of migration caused by climate change. The search, article selection, and data extraction were carried out by two researchers independently. All English-language articles on the health effects of migration caused by climate change were included in this study.

RESULTS

An analysis of the complex ways in which climate change influences populations can be facilitated using a three-class classification: compulsory displacement, resettlement planning, and migration. Subsequent to climate changes, other changes, and environmental deficiencies, compulsory displacement may occur in case of inadequacy of compatibility responses. A part of migration-related health outcomes caused by climate change is from displacement from rural to urban areas, especially in developing countries. There is significant documentation on health and livelihood inequalities between migrant groups and host populations in developed countries.

CONCLUSION

If climate change continues in its current direction, it is likely that the number of refugees and crises will increase in the coming decades. Although the domain and the extent of health hazards caused by the displacement of the population associated with climate change cannot be clearly predicted, by reducing global greenhouse gas emissions, along with social and environmental adaptation strategies, migration caused by climate change, health risks and its relevant crises can be greatly reduced.

International migration and health: it is time to go beyond conventional theoretical frameworks

The large-scale international migration in the 21st century has emerged as a major threat to the global health equity movement. Not only has the volume of migration substantially increased but also the patterns of migration have become more complex. This paper began by focusing on the drivers of international migration and how health inequalities are linked to migration. Situating migration within the broader structural contexts, the paper calls for using the unharnessed potential of the intersectionality framework to advance immigrant health research. Despite coming from poorer socioeconomic backgrounds and facing disparities in the host society, the immigrants are often paradoxically shown to be healthier than the native population, although this health advantage diminishes over time. Studies on immigrant health, however, are traditionally informed by the acculturation framework which holds the assimilation of unhealthy lifestyles primarily responsible for immigrant health deterioration, diverting the attention away from the structural factors. Although the alternative structural framework came up with the promise to explore the structural factors, it is criticised for an overwhelming focus on access to healthcare and inadequate attention to institutional and societal contexts. However, the heterogeneity of the immigrant population across multiple dimensions of vulnerability demands a novel approach that can bring to the fore both premigratory and postmigratory contextual factors and adequately capture the picture of immigrant health. The paper concludes by questioning the acculturation perspective and pushing the structural paradigm to embrace the intersectionality framework which has the potential to address a wide range of vulnerabilities that intersect to produce health inequalities among the immigrants.

Impacts of climate change on the public health of the Mediterranean Basin population - Current situation, projections, preparedness and adaptation

The Mediterranean Basin is undergoing a warming trend with longer and warmer summers, an increase in the frequency and the severity of heat waves, changes in precipitation patterns and a reduction in rainfall amounts. In this unique populated region, which is characterized by significant gaps in the socio-economic levels particularly between the North (Europe) and South (Africa), parallel with population growth and migration, increased water demand and forest fires risk - the vulnerability of the Mediterranean population to human health risks increases significantly. Indeed, climatic changes impact the health of the Mediterranean population directly through extreme heat, drought or storms, or indirectly by changes in water availability, food provision and quality, air pollution and other stressors. The main health effects are related to extreme weather events (including extreme temperatures and floods), changes in the distribution of climate-sensitive diseases and changes in environmental and social conditions. The poorer countries, particularly in North Africa and the Levant, are at highest risk. Climate change affects the vulnerable sectors of the region, including an increasingly older population, with a larger percentage of those with chronic diseases, as well as poor people, which are therefore more susceptible to the effects of extreme temperatures. For those populations, a better surveillance and control systems are especially needed. In view of the climatic projections and the vulnerability of Mediterranean countries, climate change mitigation and adaptation become ever more imperative. It is important that prevention Health Action Plans will be implemented, particularly in those countries that currently have no prevention plans. Most adaptation measures are "win-win situation" from a health perspective, including reducing air pollution or providing shading solutions. Additionally, Mediterranean countries need to enhance cross-border collaboration, as adaptation to many of the health risks requires collaboration across borders and also across the different parts of the basin.

The effects of household's climate-related displacement on delivery and postnatal care service utilization in rural Bangladesh

Exposure to extreme climate events causes population displacement and adversely affects the health of mothers and children in multiple ways. This paper investigates the effects of displacement on whether a child is delivered at a health center, as opposed to at home, and on postnatal care service utilization in Bangladesh. Using cross-sectional survey data from 599 mothers who gave birth in the three years prior to the date of interview, including 278 from households which had previously been displaced and 231 from households which had not been displaced, we use multivariate logistic regression to identify the factors associated with maternal healthcare service utilization. The results show that displaced households' mothers are only about a quarter as likely to deliver at a health center as mothers from non-displaced households. The use of health center-based delivery decreases as the numbers of past displacements increases. Higher number of previous children, lower use of antenatal care during pregnancy, lower household income, and lack of access to radio/television also significantly reduce a mother's likelihood of delivery at a health center. Displaced mothers are also substantially less likely to use postnatal care services for their neonates, especially those supplied by trained providers. Use of health facilities for delivery, use of antenatal care services, and previous number of children are other important predictors of postnatal care service utilization for neonates. In light of these findings, relocation of local health facilities with basic and emergency care provisions to areas in which the displaced have resettled, reinforcement of Family Planning services, and extension of coverage of the Maternity Allowance benefits in the displacement-prone mainland riverine areas are recommended policy responses.

The (in)visible health risks of climate change

This paper scrutinizes the assertion that knowledge gaps concerning health risks from climate change are unjust, and must be addressed, because they hinder evidence-led interventions to protect vulnerable populations. First, we construct a taxonomy of six inter-related forms of invisibility (social marginalization, forced invisibility by migrants, spatial marginalization, neglected diseases, mental health, uneven climatic monitoring and forecasting) which underlie systematic biases in current understanding of these risks in Latin America, and advocate an approach to climate-health research that draws on intersectionality theory to address these inter-relations. We propose that these invisibilities should be understood as outcomes of structural imbalances in power and resources rather than as haphazard blindspots in scientific and state knowledge. Our thesis, drawing on theories of governmentality, is that context-dependent tensions condition whether or not benefits of making vulnerable populations legible to the state outweigh costs. To be seen is to be politically counted and eligible for rights, yet evidence demonstrates the perils of visibility to disempowered people. For example, flood-relief efforts in remote Amazonia expose marginalized urban river-dwellers to the traumatic prospect of forced relocation and social and economic upheaval. Finally, drawing on research on citizenship in post-colonial settings, we conceptualize climate change as an 'open moment' of political rupture, and propose strategies of social accountability, empowerment and trans-disciplinary research which encourage the marginalized to reach out for greater power. These achievements could reduce drawbacks of state legibility and facilitate socially-just governmental action on climate change adaptation that promotes health for all.

The MJA-Lancet Countdown on health and climate change: Australian policy inaction threatens lives

Climate plays an important role in human health and it is well established that climate change can have very significant impacts in this regard. In partnership with The Lancet and the MJA, we present the inaugural Australian Countdown assessment of progress on climate change and health. This comprehensive assessment examines 41 indicators across five broad sections: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. These indicators and the methods used for each are largely consistent with those of the Lancet Countdown global assessment published in October 2017, but with an Australian focus. Significant developments include the addition of a new indicator on mental health. Overall, we find that Australia is vulnerable to the impacts of climate change on health, and that policy inaction in this regard threatens Australian lives. In a number of respects, Australia has gone backwards and now lags behind other high income countries such as Germany and the United Kingdom. Examples include the persistence of a very high carbon-intensive energy system in Australia, and its slow transition to renewables and low carbon electricity generation. However, we also find some examples of good progress, such as heatwave response planning. Given the overall poor state of progress on climate change and health in Australia, this country now has an enormous opportunity to take action and protect human health and lives. Australia has the technical knowhow and intellect to do this, and our annual updates of this assessment will track Australia's engagement with and progress on this vitally important issue.

Climate change impact on migration, travel, travel destinations and the tourism industry

Background: Climate change is not only increasing ambient temperature but also accelerating the frequency, duration and intensity of extreme weather and climate events, such as heavy precipitation and droughts, and causing sea level rise, which can lead to population displacement. Climate change-related reductions in land productivity and habitability and in food and water security can also interact with demographic, economic and social factors to increase migration. In addition to migration, climate change has also implications for travel and the risk of disease. This article discusses the impact of climate change on migration and travel with implications for public health practice. Methods: Literature review. Results: Migrants may be at increased risk of communicable and non-communicable diseases, due to factors in their country of origin and their country of destination or conditions that they experience during migration. Although migration has not been a significant driver of communicable disease outbreaks to date, public health authorities need to ensure that effective screening and vaccination programmes for priority communicable diseases are in place.Population growth coupled with socio-economic development is increasing travel and tourism, and advances in technology have increased global connectivity and reduced the time required to cover long distances. At the same time, as a result of climate change, many temperate regions, including high-income countries, are now suitable for vector-borne disease transmission. This is providing opportunities for importation of vectors and pathogens from endemic areas that can lead to cases or outbreaks of communicable diseases with which health professionals may be unfamiliar. Conclusion: Health systems need to be prepared for the potential population health consequences of migration, travel and tourism and the impact of climate change on these. Integrated surveillance, early detection of cases and other public health interventions are critical to protect population health and prevent and control communicabledisease outbreaks.

Climate Change-Induced Impacts on Smallholder Farmers in Selected Districts of Sidama, Southern Ethiopia

Different factors control the types of adaptive strategies and likelihoods of experiencing climate change-induced impacts by smallholder farmers. By using a mixed research method, this study examines the types and determinants of climate change-induced impacts on smallholder rural farmers in drought-prone low lands of Sidama, Southern Ethiopia. Randomly selected (401) households were surveyed on climate change-induced impacts. Longitudinal climatic data were also collected from the Ethiopian National Meteorological Agency to assess the trend of rainfall (RF), temperature and drought incidents. The analyses of the data revealed that RF and temperature had shown decreasing and increasing trends, respectively, during the three decades under consideration (1983–2014). These changes in RF and temperature exposed farmers to climate-related epidemics, drought, harvest loss, and hunger. The logit model results revealed that different factors control the likelihood of exposure to climate change-induced impacts. The findings revealed that literacy level, involving women in family decisions and farmers’ involvement in adaptation planning, reduces the likelihood of exposure to climate change-induced hunger. Therefore, there is a need to work on human capital of the farmers through expanding education, strengthening women’s participation in family decision-making, and by improving public participation in climate change adaptation undertakings to minimize climate change-induced impacts.

Could exotic mosquito-borne diseases emerge in Canada with climate change?

Of the 3,500 species of mosquitoes worldwide, only a small portion carry and transmit the mosquito-borne diseases (MBDs) that cause approximately half a million deaths annually worldwide. The most common exotic MBDs, such as malaria and dengue, are not currently established in Canada, in part because of our relatively harsh climate; however, this situation could evolve with climate change. Mosquitoes native to Canada may become infected with new pathogens and move into new regions within Canada. In addition, new mosquito species may move into Canada from other countries, and these exotic species may bring exotic MBDs as well. With high levels of international travel, including to locations with exotic MBDs, there will be more travel-acquired cases of MBDs. With climate change, there is the potential for exotic mosquito populations to become established in Canada. There is already a small area of Canada where exotic Aedes mosquitoes have become established although, to date, there is no evidence that these carry any exotic (or already endemic) MBDs. The increased risks of spreading MBDs, or introducing exotic MBDs, will need a careful clinical and public health response. Clinicians will need to maintain a high level of awareness of current trends, to promote mosquito bite prevention strategies, and to know the laboratory tests needed for early detection and when to report laboratory results to public health. Public health efforts will need to focus on ongoing active surveillance, public and professional awareness and mosquito control. Canadians need to be aware of the risks of acquiring exotic MBDs while travelling abroad as well as the risk that they could serve as a potential route of introduction for exotic MBDs into Canada when they return home.