Climate Change Is Making People Sick. Can Migration Help?

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CHAPTERS

01:19 Health Vulnerability among Climate Migrants

05:13 Groups at Highest Risk

08:36 When Migration Protects Health

11:51 How Climate Change Directly Harms Health

17:02 Strain on Health-Care Systems

22:18 Countering the "Migrants as Health Risk" Narrative

25:48 Mental Health and Climate Displacement

27:48 What to Do?

TRANSCRIPT

[00:00:03.800] 

Is climate change and migration a health issue? It might be. Lack of fresh water, extreme wildfires, and other impacts of climate change can work to make people sick, encourage the spread of diseases, and cause serious injuries. And so some people forced out of their homes by natural disasters might be more vulnerable to health challenges than those who are able to migrate voluntarily. This is Changing Climate, Changing Migration, coming to you from the Migration Policy Institute. This is a podcast on which we explore the complicated intersections of climate change and migration. I am Julian Hattem, your host and the editor of MPI's online magazine, the Migration Information Source. Our topic for today is what climate change and migration mean for people's health and for their healthcare systems. My guest is Ilse Ruyssen, who directs a research network on climate change, migration, and health called the CliMigHealth, and is also an economist at Ghent University and at the UN University of Comparative Regional Integration Studies, both of which are in Belgium. Ilsa, thank you so much for coming on today. I'm really looking forward to speaking with you.

[00:01:16.140] 

Really happy to be here. Thank you for inviting me.

[00:01:19.830] 

So let's start with the basics. Is it the case that people moving in response to natural disasters and slower onset repercussions of climate change tend to be more vulnerable to various health issues than other people? And if so, why might that be?

[00:01:34.580] 

Yes, they often do. But the reason is not simply that they move. Migration can protect health on the one hand, but the process of moving can also create new risks, especially when it happens under pressure and without enough support. Someone who leaves because of drought, flooding, or a cyclone may already have gone through a difficult period before moving. Their income may have fallen, food may have become less secure, or regular care may already have been interrupted. So their health may already be under pressure before the move begins. And the move can then reduce some risks while creating others. For example, someone may leave a flood-prone rural area, move to a city, that may reduce their exposure to flooding, which is clearly important. But if they spend time in temporary or overcrowded housing, or they end up in informal settlements with limited access to services, new risks may appear. And a chronic illness, for instance, may become harder to manage if medication is interrupted. Stress and anxiety may also increase if a person becomes separated from their support networks, or if they don't know whether they can find work, whether they can stay in that place or access care when they need it.

[00:02:59.370] 

So that's why in a review of the literature we've been conducting on the health needs among people moving in the context of climate change, we've been using the lens of the social determinants of health. In simple terms, This means the wider conditions that shape whether people can stay healthy, things like income, housing, work, legal status, social support, quality of local services. And that perspective helps explain why migration can be protective in one situation and harmful in another. You could say if people move safely with resources and support, migration can reduce health risks. It can take people away from danger, closer to work, closer to health services. But if they arrive somewhere without stable housing, secure work, or easy access to a clinic, the health problems can continue or take a different form. So I wouldn't say climate migrants are vulnerable by definition. I would say that climate-related mobility often happens in already difficult circumstances. Yeah, and health then depends very much on how safe the movement is, on whether people can access care, income, housing, and social support afterwards.

[00:04:18.500] 

That's interesting. And I wanna talk and probe this idea of the kind of paradox or the ambivalent kind of outcomes that, you know, migration in the context of climate change can be either beneficial or detrimental to one's health depending on the process of migration, where they go, how they go. I guess, but starting with the people for whom migration can be particularly problematic, I guess, are there individual populations who, you talk about the social determinants of health, who are perhaps socially determined to have lower health outcomes? I mean, you mentioned earlier, people with chronic illnesses who might have, whose illnesses might be exacerbated and exaggerated by migration, who might have problems accessing medications and things like that. I mean, who else could we throw in this bucket? I assume perhaps like the elderly might be especially prone to health complications after movement.

[00:05:13.810] 

Yeah, the evidence points quite clearly to some groups facing higher risks than others. The elderly for sure, but also children, women in particular, poorer households, and indeed people with existing health needs. But also those who depend largely on farming, fishing, or livestock for their income because they see the impacts of climate change on their livelihoods almost immediately. And that can affect their health needs and health conditions. For children, for instance, the concern is that climate-related mobility can affect their health and development at the same time. Think of a family moving after a flood or a drought or crop failure. Children may not eat as well as before. Routine care like vaccination can be interrupted. They may be spending time out of school or live for a while in crowded conditions where infections may spread more easily. So the effects aren't only immediate. They can also shape wellbeing and development over a longer period. And then, yeah, indeed for older people, the issue is often chronic illness, but also dependence on regular care. If someone needs medication for diabetes or hypertension, displacement or a damaged health system can quickly become dangerous. Same is also true when older people depend on family members or neighbors for daily support and those networks get disrupted.

[00:06:50.070] 

But yeah, they aren't the only groups at risk. It's not only a matter of age. We also see gender differences. Women on the move face specific extra pressures around reproductive health, but also safety, caregiving. Poorer households are particularly vulnerable because they often have less room to absorb a shock. If they have to move, they may have fewer options where to go. How long to stay or how quickly they can reconnect with services. And that makes, yeah, health risks harder to manage after movement. So yeah, there definitely are groups that face higher health risks. I think the important point is that these are not just abstract categories. They do point to very specific support needs, right? Including continuity of care for children, for the elderly, accessible evaluation, evacuation shelters, maternal health services, child health services, and also support for households that have fewer resources to begin with or are particularly vulnerable to the implications of climate change for their livelihoods.

[00:08:03.140] 

So let's, let's talk about the flip side then. I mean, given those challenges, you suggest that in some situations, migration mobility can be a relief for individuals who are undergoing, you know, climate stresses, right? If you're, you know, if you're your home community is flooded, it seems natural that getting someplace else might have better health outcomes. I mean, I guess, under what conditions is that the case? Under what conditions is mobility, migration, evacuation beneficial for individuals' health outcomes?

[00:08:36.560] 

Yeah, it's, it can, migration can absolutely be a relief. It's an important adaptation strategy to climate change. It's something people have been turning to, I think, as long as humanity Mobility exists, it's a way to adjust to changes in the environment. And of course, if people are living in a place where flooding is becoming more frequent or where drought is undermining livelihoods, moving can reduce pressure, open new opportunities, new possibilities. It can bring people closer to work, to family networks, schools, and also healthcare services. Yeah, it's not automatically protective. A lot depends on the conditions in which people move, which I already mentioned, but also importantly on where people are actually able to move to. Sometimes a relatively short move can already make a major difference. If a household moves to a slightly higher ground, a slightly higher uphill, for example, that may reduce exposure to flooding or sea level rise. While allowing people to remain close to land, work, family, and the community, their common surroundings. But in other situations, the environmental problem is spread over a much larger area. Think of drought, for instance, which may affect whole regions. So moving a short distance may not be enough to escape these conditions, undermining people's health and livelihoods.

[00:10:12.260] 

And It's a given that many people cannot move very far. Migration is costly. It requires information, networks, physical capacity. So also a certain health condition is needed. And that means people may end up in destinations that bring their own risks. Many climate-related moves are internal and lead toward urban areas, which can on the one hand, indeed create opportunities, but it can also mean people end up living in informal settlements with poor housing, overcrowding, insecure work, also heat exposure, as sometimes environmental conditions are worse even in the destination than before. Sanitation is often poor and access to services, including health services, is often limited. So In those cases, migration may reduce one kind of pressure but creates another. So yeah, we should definitely think about migration as a potentially adaptive strategy, but it's not a guaranteed solution. Yeah, whether it protects health depends not only on why people move or how they move, but also on where they are able to go to and what are the conditions they find there. If they Yeah, can move with dignity, access decent housing, have access to continued care, and they can build a livelihood there, then it's more likely to be health protective.

[00:11:46.350] 

If not, it may only shift people from one set of risks into another.

[00:11:51.730] 

Let's, I wanna talk about some of the health challenges caused by climate issues on their own. I mean, 'cause you know, we mentioned, Often on this podcast, we think about climate change-related issues, whether it's fast-onset disasters or slower-onset sea level rise and drought, as affecting people's livelihoods, you know, their work basically, or to some degree their physical safety. You know, if there's a hurricane or wildfire coming, that's physically unsafe to be in. But what are the— I guess, what are the more subtle health-related challenges that climate change can cause on its own, which is to say on the on one hand, what sort of challenges or health sort of challenges are people migrating away from? But also, we talk a lot on this podcast about the involu— or the immobile people who do not move, whether by choice or involuntarily. What, uh, health-related challenges are they exposed to if they remain in places that are increasingly under— increasingly climate vulnerable, increasingly under climate threat?

[00:12:58.170] 

Yeah, that is a good question. I'm happy to hear you bring up indeed the immobile for whom all of this is also very relevant. Of course, as some have the opportunity to escape, others won't, and some will do because of direct effects of climate change. Others, for others, the indirect effects through health impacts and implications for access to healthcare might indeed also be reasons to actually leave. So climate change can affect health in several ways, and the pathways often also reinforce each other. The most direct pathway is probably exposure to extreme weather. Then we can think of heat waves leading to dehydration, heat exhaustion, higher mortality, especially among older people and again, people with chronic conditions. Think of floods and storms causing injuries, deaths, trauma, wildfires worsening also respiratory problems through smoke, air pollution. And a second pathway would be through infectious disease. With warmer temperatures, changing rainfall patterns, we see differences in disease vectors where they survive. Think of mosquitoes, for instance, which can affect then diseases like malaria or dengue. Flooding can contaminate drinking water, which increases the risk of waterborne diseases like cholera, diarrheal disease. And then a third pathway is through food and indeed livelihoods.

[00:14:44.190] 

We can think of all sorts of hazards, droughts, floods, but also changing seasons damaging crops. Reducing livelihood productivity, affecting fisheries. This can lead to food insecurity and poor nutrition, loss of income and stress. And this pathway is particularly important in low-income settings because many households would depend directly on agriculture here, on fishing or livestock, and they often have fewer savings or insurance mechanisms to fall back on. And then there's also the healthcare system itself. Climate events do not only make people ill, they can also make it hard to treat people. Floods, storms, they can damage clinics, block roads, interrupt electricity or water supply, interrupt the delivery of medicines. So health needs can increase at exactly the moment when health services are harder to reach. And that's why Yeah, we shouldn't look at climate change as an isolated health risk. It's more like an amplifier. It worsens existing vulnerabilities and puts pressure on the systems that people rely on to stay healthy.

[00:16:03.200] 

And, but also, that's a great point. And I want to follow up on that too, in that large-scale migration mobility can also put pressure on existing social services. True, right? Like, you know, so if including health services. So if a large number of people are displaced from point A to point B, and especially if those people have a lot of health needs, it seems natural that they could overwhelm or kind of really strain the capacity of the hospitals and health clinics and other services in that point B, in their destination communities. You mentioned some of this earlier on, kind of the challenges on health services that come as a result of mobility. And the extent to which that determines whether mobility and migration is beneficial or not in terms of someone's health. I mean, can you talk more about that on the pressures on health services, both at origin and receiving communities and how those strain under the context of climate change and increased migration mobility?

[00:17:02.620] 

Yeah, this large-scale movement indeed can put a strain on healthcare systems. The issue isn't that migrants are a burden, but the issue is that health systems are often not designed or funded to respond well to such mobility, especially when it happens suddenly or when services were already stretched beforehand. And this is the case in many areas in Global South countries. So then if people arrive in big numbers after an environmental shock, indeed, health needs can rise very quickly. People may need emergency care, but also maternity— maternal care, medication for chronic conditions, mental health support, or simply access to clean water and sanitation. And at the same time, as I said, indeed, the climate event could also have affected the health system itself. Roads may be damaged, clinics flooded, medicine may not arrive, and healthcare workers themselves may also be dealing with the crisis as everybody else is doing. So yeah, it's creating a sort of double pressure. On the one hand, more people need care while the system may have less capacity to provide it. And what we saw in an early— one of the earlier studies we conducted within this Climate Health Network, is that we were interviewing their family physicians and healthcare workers across the whole of Sub-Saharan Africa, asking them about connections between climate change, migration, and health.

[00:18:48.600] 

And what they were putting forward all the time was that, yes, indeed, they see an impact from migration patterns shifting on healthcare, health needs and healthcare services. But they weren't pointing so much at migration as the root problem of overstretched healthcare systems as such. They were pointing to under-resourced systems, fragile infrastructure, shortages— oops, that's a difficult one— shortages in staff, poor coordination, And yeah, that's where climate-related movement makes these weaknesses more visible and more urgent. So yes, mobility can definitely put a strain on healthcare systems, but the policy response shouldn't be to restrict people's movement or portray them as the problem, right? The response should be to build health systems that are climate resilient and that are migrant inclusive. This means that these systems should be able to keep functioning during shocks, and they should be able to serve people based on need, including people who are displaced, newly arrived, or moving between places.

[00:20:08.330] 

That's a great point. And I really appreciate that because I do want to acknowledge that there is a narrative and some very ugly tropes associated with this conversation, right? There is a long history fear and anxiety around immigration or migration, incoming migration in general, both in terms that it could overwhelm and stress and, to use your word, be a burden to existing health and other facilities of the services. But also, especially in the context of healthcare, that there's this narrative suggests that newcomers could lead to public health crises. We saw this a lot, for instance, during the COVID-19 pandemic, where one of the major arguments to your point in favor of immigration restrictions was that it was necessary for, for public health reasons, right, to prevent the spread of the virus. And to be clear, like, some of this is real, right? Like, quarantine is a long-established public health protocol in certain situations that can be beneficial and lead to better public health outcomes. But in other conditions, if misused, or if, if adopted under, under the wrong conditions, it can also lead to kind of ugly and dangerous and quite harmful biases. How do you balance that?

[00:21:23.040] 

And how do you kind of make the case about the public health, the health and the healthcare needs of individuals in climate change environment, but also without kind of inadvertently suggesting that migrants themselves are either, you know, dangerous vectors of diseases or placing an undue burden on healthcare facilities?

[00:21:45.550] 

Mm-hmm.

[00:21:46.550] 

That's a big question. Yeah, anything. It is.

[00:21:49.030] 

Yeah, yeah, yeah. And I must say, as a migration economist, I do work a lot on broader questions also with respect to implications of migration for society, host societies, origin societies. So it's a phenomenon you see in the public debate, but also, yeah, in academic debates around migration. Where, yeah, there's this tendency to point the finger at migrants for whatever problems are occurring in society. They're often, yeah, made into scapegoats for problems that have much deeper causes: poverty, underinvestment, weak infrastructure, political failure, or a lack of planning. So when we talk about health and migration too, we have to be careful not to repeat that pattern. And that's also where you see a bit the shift away from the alarmist narrative about floods of climate migrants are reaching traditional destination countries towards more the appreciation of seeing migration as a potential adaptation strategy. And I think there, for me, the starting point is to treat migration as a normal part of human life. People have always moved in response to changing environments and in the context of climate change, mobility can be one way of adapting. So people who move shouldn't automatically be framed as a threat or a burden or as people doing something illegitimate.

[00:23:27.860] 

Often they're just trying to protect their lives, their livelihoods, families. But at the same time, indeed, public health risks are real and we should be able to talk about them openly. But yeah, we need to be precise about where those risks come from. Health risks increase when people are put in conditions where it becomes hard to prevent illness or get care early. For example, when shelters are overcrowded, clean water is unreliable, or sanitation is poor. Um, in these situations, this is what you'll have. So the That's very different from saying that migrants themselves are the risk. The risk is not the migrant. The risk is the situation people are placed in. So instead of saying migrants— migration spreads disease, we should say poor living conditions, interrupted services, delayed access to care can increase health risks. This is more accurate. It avoids attaching the risk to people's identity. And it also points us towards solutions: decent housing, clean water, sanitation, vaccination, accessible care, health systems that people can trust. So in any case, we need to move towards a solution-oriented narrative. And I think that can definitely start with just acknowledging what migration really is. And what it can also do to people's lives and their livelihoods.

[00:25:03.410] 

That's a great point. I very much appreciate that. We've basically primarily been talking about physical health so far in this conversation, but I think I would be— we would be remiss if we did not also mention very briefly the kind of mental health challenges that can happen both as a result of the experience of migration, especially distressed migration and living under or experiencing climate-related stressors. Both of which can cause mental health challenges. Can you speak to that very briefly? I guess what kind of mental health issues can emerge in these situations? And are, you know, is there a degree to which both migration, panicked migration, distressed migration, and the experience of undergoing climate change can be problematic for mental health?

[00:25:48.680] 

Yeah, mental health is one of the clearest themes in the evidence on climate mobility and health. Some mental health problems are linked to the shock itself. After a flood or a cyclone, people may experience anxiety, depression, sleep problems, grief, and also post-traumatic stress. But the mental health burden often continues long after the immediate events. Yeah, people may lose a home, their land, their income. The place where their family has lived for generations, that's not only a material loss, it's also a loss of identity, a loss of belonging, of control. And if they then move somewhere where they feel unwelcome, where they can't find work easily or don't know how to access services, the stress continues and can get worse. In the literature review we were conducting, We've been identifying mental health outcomes among the most frequently reported ones, especially there we see anxiety, depression, and post-traumatic stress popping up in existing studies. But I would also mention less clinical forms of distress, homesickness, for instance, uncertainty people experience, grief, fear about the future, and also the feeling of losing control over one's life is something often reported. So mental health should definitely not be treated as a secondary issue.

[00:27:26.400] 

It's a central theme to the climate migration and health nexus. Yeah, because climate change can affect not only where people live, but also their sense of safety, dignity, and belonging.

[00:27:40.150] 

We are almost out of time, but I want to kind of offer you one last question. Which is what is to be done? How should policymakers address some of these issues more generally about climate change and health, both physical and mental health? You've gestured at that in a couple of different ways about solutions-oriented narratives and trying to be proactive. But I guess, yeah, I mean, what do we do about all of this? If you were in charge of the world, how would you make this situation better?

[00:28:08.770] 

Yeah, that's— I could take another 20 minutes to answer this question and more. But a few key points, and I think they have— some of them have come up in the podcast already. I would start from the idea that people need real options. Most people facing the consequences of climate change, they don't want to move far away. So most people would just prefer to stay where they are, close to family, land, their community and livelihood if they can do so safely and with dignity. So the first policy priority is mitigation, right? The less warming we have, the fewer people will be pushed into situations where staying becomes unsafe or unhealthy. And then alongside mitigation, we need serious investment in adaptation where people already live. Water systems, food security, heat planning, early warning systems, all sorts of potential strategies that could help having people stay in better conditions. So, and this is important from a health perspective as well. But we also have to be honest that adaptation won't be enough everywhere. There are places where sea level rise, repeated flooding, erosion, or extreme heat may make it very difficult to sustain decent living conditions. And in those situations, people shouldn't be trapped.

[00:29:40.250] 

They need safe, legal, supported pathways to move. And that's indeed where we haven't really talked about the mobility, but this is where it indeed becomes important. There's some people may want to or need to leave but can't. They may lack the resources, the documents, the networks, even the health to be able to move. We see this, for instance, clearly in the Pacific context. Where there are pathways such as New Zealand-specific access category resident visa, but these are limited to just a few that pass the ballot. And so they can help some people, but they do not meet the full need for mobility from places facing severe climate risks. And that matters from a health perspective because being stuck in a place can also be harmful. I've done another recent research review of the literature that actually points this out with some colleagues. There are huge negative wellbeing effects related to involuntary mobility. And a lot of that has actually been researched in the context of climate change. So policy needs to work on both sides. It should support people who want to stay through adaptation and strong local services, but also support those who need or want to move through safe migration pathways, planned relocation where appropriate, and then also, yeah, guaranteeing access to housing, work, and healthcare after arrival.

[00:31:15.200] 

And then, yeah, a final point, I already mentioned it, health systems need to be also adapted. They need to become more climate resilient and more migrant inclusive. So they have to be able to keep functioning during shocks, but also serve people who are displaced, new, undocumented, poor, or unfamiliar with the system. Um, and here there's an important role to play for local clinics, family physicians, community health workers who are very close to, uh, people on the ground. And they may be the first to see who is being missed. And I think a final element is policy should avoid treating any case, climate mobility, as an emergency issue only. Some movement will be sudden, but much of it will also unfold over time. So that means we need planning, not just the crisis response. We need inclusive health systems, not only temporary aid and Yeah, we need to support people whether they stay, move, or in returning back home if possible.

[00:32:26.960] 

We'll have to leave things there. Uh, but Ilse, thank you so much for coming on the podcast today and sharing your thoughts. This was a really good conversation. Thanks. Thanks for your time.

[00:32:34.660] 

Thank you.

[00:32:35.720] 

Ilse Ruyssen is an associate professor at the Department of Economics of Ghent University. She's also a professorial fellow at the UN University Institute on Comparative Regional Integration Studies. Also known as UNU-CRIS, both of which are in Belgium. And she's the director of the ClimMigHealth Research Network, which aims to better understand interactions between climate change, migration, and health. She is also the co-editor of the new book, The Climate Migration and Health Nexus: Opportunities for Interregional Cooperation, which is available now and open access. Thank you for tuning in to this episode of Changing Climate, Changing Migration. Make sure to subscribe to the podcast on your app of choice so that you are alerted to new episodes the moment they come out. We are committed to exploring the connection between climate change and migration on all corners of the globe, and I hope you will continue to join us. If you want to take a stroll through our archives, you can find prior episodes on our website at migrationpolicy.org/podcasts. Also, follow MPI on social media to keep tabs on our wide array of work. This episode was produced by Daniella Espacio. Additional oversight was provided by Michelle Mittelstadt, and assistance came from Lisa Dixon.

[00:33:57.330] 

Our theme music is "Touch" by Patrick Patrikios. My name is Julian Hattem. Thanks for listening.