Bowles et al. Public Health , 17, 6 of 20 cultural and family ties, whilst fend factors deter migration into an area such as hostile immigration policies.
Recent studies highlight that climate change may act as a glue factor in many situations, rather than as a push factor as is often popularised [26]. Climate change is a sub-category of environmental drivers which may be further categorised into three classes [10,37,39]. These are perhaps best described as primary physical effects, secondary biological and ecological effects, and tertiary anthropogenic effects [37,38].
Climate change is segregated here from other environmental factors and framed as an externality to the determinant system. This facilitates investigation of the impacts of climate change as an upstream pressure to all five classes of drivers. Each of the five categories is described in further detail below.
To demonstrate the temporal nature of the system, the model is presented on a set of axes with time on the horizontal dimension with arbitrary timepoints t0 and t1. This encourages consideration of the dynamicity of all determinants, as well as the changing nature of their interactions through time.
As such, feedback implication on both host and source environments and communities of a migration decision may be decoded. Externalities, such as future climate shocks or political interventions, such as climate mitigation, which may alter the system and resultant migration can also be presented and their impacts conjectured.
The y axis depicting scale of impact refers simultaneously to the societal and spatial level of impact thereby encouraging the disparate nature of drivers on these scales to be considered. Micro refers to small-scale, individual- or household-level factors whilst macro may be factors affecting large distances and large numbers of people. Within the next section, we take a more granular view of each of the key families of drivers, and consider how each may directly or indirectly impact migration.
This analysis is not exhaustive but attempts to provide a detailed summary of drivers over time and space, thereby encouraging a more nuanced and detailed exploration of the complexity of climate change. Climate Change All climate factors are considered to occur at the macro spatial scale Figure 1 , which correlates to the macro societal impact level as described in Table 1 above. Temporality of climate factors varies, and depends on the climate determinant as shown in Table 2.
The true speed of climate change varies geographically and so there can be no definitive definition for fast or slow onset. Furthermore, some aspects may manifest across multiple timeframes. Table 2. Key climate change characteristics that increase population vulnerability to environmentally induced migration. Public Health , 17, 7 of 20 Physical Effects It is well established that climate change is increasing the frequency and magnitude of extreme weather events and climate shocks, which can be a direct cause of forced displacement.
Nevertheless, in such natural hazard events, socially constructed vulnerabilities often govern the extent and type of migration responses which occur. Myers et al. Similarly, Gray and Bilsborrow [14] identified within an Ecuadorian household migration survey, that household vulnerability factors such as home ownership, connectedness of household to roads and schools , and poverty level, all confounded the environmental signal in the causes of observed migrations.
Less clear is the extent to which long-term or chronic climate change affects migration. Chronic changes may include changes in average temperature, average rainfall, rainfall variability or extent of periodic drought and flooding.
Such changes often impact migration via mediating biological and anthropogenic factors such as impeded agricultural outputs [13,41], adverse health outcomes [42,43], or labour productivity [44]. In such examples, the extent of climate factor as a driver of migration compared to other sociodemographic and economic factors is seen to vary greatly across studies.
To better understand such relationships, we classify these indirect impacts as biological or anthropogenic secondary or tertiary. Such biological changes may alter the vulnerability of human populations. For instance, climate change may drive changes in the distribution of disease vectors [37,45]. Anthropogenic or tertiary aspects of climate change comprise the resultant alterations to human systems. Examples may include changes in anthropogenic land use and land availability due to sea level rise.
Alterations, for example, in crop yield and fish catch, may have direct implications to socioeconomic factors, for example, due to reduced agricultural output [41], food security [1], and therefore upon urbanisation rates due to rural to urban migration [38]. Such anthropogenic pathways generally act over a longer temporal scale and can lead to the climate signal being masked by more proximal factors. As such, understanding of their impact on migration remains inconclusive [46] and less studied than direct physical impacts [39].
Furthermore, additional consideration is needed to assist the recognition of dynamic interactions between the physical, ecological and anthropogenic aspects of climate change. Other Migration Drivers There are of course a range of other drivers of migration which are important to understand as well as how they may be affected by climate change. We now present a more detailed view of some key drivers within each of the five main classes identified. These are outlined in Table 3 below.
As well as existing as intermediary drivers, each of these drivers may have direct impacts on migration decisions. For example, Henry et al. Ezra and Kiros [15] also found marital status and poverty level acted as push factors. Warner et al. Public Health , 17, 8 of 20 causes. However, each analysis is limited to a specific type of migration and set of pre-assumed key drivers.
It is not possible within this paper to examine in depth the nature and relationships of each driver, rather the authors focus on presenting a broad overview, elucidating the multilevel and multitemporal nature of migration drivers, as well the dynamicity of the drivers and their linkages. Some key examples are used to demonstrate such complexities. Table 3. Non-climatic drivers of migration. Drivers are split into five classes: social, economic, political, demographic and environmental.
Societal level refers to the societal scale at which drivers typically impact. Some drivers may exist both as micro and macro factors. Temporal scale refers to the typical timescale of change in each driver.
Whilst there is no set demarcations, slow change refers to a change typically over years or decades and change fast refers to changes which may occur immediately or over a short timeframe of months. Static implies that factor is not usually time varying. Determinants of Migration Societal Scale Temporal Scale Social Family and societal relations and expectations micro slow Migration and social networks including remittance networks micro slow Changes in marital status micro slow Education level micro slow or static Ethnicity multilevel static Economic Average household income micro multilevel Key economic activity of household micro multilevel Cost of living e.
Education and literacy rates have also commonly been identified as determinants of vulnerability [35,51—54]. Social drivers such as education and poverty may also alter other drivers. Public Health , 17, 9 of 20 of irrigation techniques to increase crop yields [54,55]. However, Joshua et al. This interaction between poverty and adaptation approach has significant implications for future vulnerability levels and on future social and political factors.
Of course, such impacts are not isolated to only impoverished communities. Developed countries with lower poverty levels can also suffer compound impacts of climate change on other social determinants [56]. However, developed countries generally have a higher capacity to mitigate or adapt to such changes resulting in different outcomes migration and other , with different distributions across communities [57].
Economic Drivers Closely linked to social factors are economic considerations such as employment opportunity and household wages [58] at the micro societal level. Macro-level factors such as average employment rates and average income of a community may also act as push or pull factors which have often been identified as the dominant drivers of migration [11,41]. These economic models may contribute to future migration behaviour due to relations between poverty and mobility [1] and the effect of inequality gradients acting as sinks for migration [59].
For instance in the Malawian example given above, Findlay [54] also comments on the additional causes of food insecurity beyond water scarcity, including soil erosion, socioeconomic factors including vulnerability to poverty, ability to financially withstand crop failures, low food utilisation and infrastructural factors such as high transport costs.
Political Drivers Political drivers are largely absent from environmental migration quantitative studies and yet present a significant category of migration drivers.
Possibly the most influential and most studied of this category is the role of political insecurity on migration. Whilst the role of political insecurity and conflict is a well-acknowledged driver of migration, the role of climate change in driving political instability remains contested [20].
Burrows and Kinney [6] present an overview of multiple pathways through which climate change may lead to or exacerbate conflict such as through increasing rural to urban migration, resource competition or dispute between migrant and host communities. Sokolowski et al. Though largely overlooked in general climate migration literature, some models do focus on political drivers of migration with relatively accurate predictions [59,62].
Sokolowski and Banks [60] modelled population displacements that occurred in Syria in using UNHCR guidelines for factors prompting departure. Indeed, the Syrian conflict can be argued to contain both political and climate determinants in the mass displacement that has resulted [63]. Other political drivers include level of governance and trust in government and the level of institutionalisation and infrastructure within a community.
Infrastructure and governmental and non-governmental organisations are critical intervention nodes and as such their connection to environmental migration form an important area of potential study. Other policies such as water, food and agricultural policy also co-interact and may result in a range of normative and adaptive migration approaches.
For example, Loevinsohn [64] studied the Malawian food crisis and identified primary causal factors to be both environmental drought and the underinvestment by the national government in agricultural stock. Crackdown on immigration policies in Western countries such as Britain, the USA and across the EU will also have significant impact upon future migration trends.
Public Health , 17, 10 of 20 impact the numbers of both internal and international migrants in the future, existing dichotomies between the evidence on migration drivers and the political response to it will undoubtedly renew pressure on migration issues [65].
Demographic Drivers Demographic factors at the micro level such as age, gender, ethnicity as well as at the macro level such as average living conditions, affluency, diaspora presence can act as push or pull factors as well as interact with other factors. The combined effect of climatic drivers and demographic drivers have resulted in many developing countries being the most vulnerable nations to climate change and has helped to drive research and narratives around climate justice [66] and climate refugees [67].
Rapid urbanisation is often a trend in such locations, leading to slum development, poor infrastructure and high vulnerability to future climate change, not to mention other shocks such as the Covid pandemic. In developed countries, different demographic challenges such as population ageing may also impact upon population mobility and health.
For example, an older population may result in a reduced willingness to move and increased mental health burden of doing so [68]. As such, appreciating the demographic factors, their dynamics and interactions is essential to understanding climate risk on future sustainable development and population changes. When modelling future environmental migration, it is therefore essential to take into account the demographic situation of the study area.
Environmental Drivers Climate change is a key driver of environmental change. Environmental degradation, such as desertification, permafrost melt and coastal erosion, undermines livelihoods and therefore acts as a push driver for migration away from these regions. In the short term, there may be positive environmental changes such as increased precipitation and improved agricultural production in many parts of the globe which may act as a migration pull factor [58].
Environmental determinants such as rainfall and vegetation cover are commonly used in quantitative studies of climate change though other ecosystem attributes and ecosystem degradation appears somewhat overlooked in migration studies, such as food availability from natural sources and pollution of water. Many environmental factors occur independently of climate change and may be influenced by other socio-political factors, often overlooked in environmental migration studies.
For example, changes in land use, urbanisation, overexploitation of natural resources, environmental pollution and geophysical natural hazards may each be key determinants of migration. Such environmental changes often have strong feedback loops—for example, rural to urban migration has significant repercussions on environmental degradation, air and water pollution, energy consumption and greenhouse gas emissions [70].
Environmental drivers have been found to be critical in many development studies. In the context of urbanisation led by adaptive migration, this hypothesis suggests that urbanisation will result in further environmental degradation, with significant implications for future development [33,72], health [73], political security [74], and internal migration [75].
Applying the Model to the Case Study of Malawi We now provide a brief example of applying the conceptual model to a case study.
We select rural Malawi as a pertinent example of a climate-vulnerable society. Already Malawi has witnessed an annual mean temperature increase of 0. Malawi is a land-locked country in southern Int. Africa J. Figure 2. A conceptual model exploring the relationship between climate change and migration in the Figure 2. A conceptual model exploring the relationship between climate change and migration in the context of Malawi.
A key advancement of this Malawi-specific model is that each variable is quantifiable using A key advancement observational datasets. Asof this itMalawi-specific such, demonstrates how modelthe is that each of application variable is quantifiable the generalised using conceptual observational datasets.
As such, it demonstrates how the application of the generalised model in Figure 1, to a local context, allows the creation of an astute, practical and measurable conceptual model in model, Figure from which1, to a local well context,policy-relevant grounded, allows the creation of anquestions research astute, practical may beand measurable formulated and model, tested.
Additionaland it holistically information aboutcaptures key variables each variable that may can be found be of relevance in supplementary for future information testing. Additional information about each variable can be found in supplementary Table S1. Based on this conceptual model, the next step in the method would be to identify appropriate information Table and study S1. The insights from suchor integrated models may models to quantify the extent of each relationship depicted by the arrows in Figure therefore make possible evidence provision which can be particularly relevant for national adaptation, 2.
The insights from suchdevelopment economic models may therefore and public make possible health plans. Complexities within the Model Complexities naturally arise when taking an upstream, systems-thinking approach to migration determinants. There are two key complexities identified. Firstly, the acknowledgement of multilevel and interactions and feedbacks between drivers.
Secondly the dynamicity of drivers and their connections over time and space. Despite these complexities, models must be transparent and provide results from which simplicity may be derived in order to be useful for decision makers and intervention planning. To aid reflection upon such interactions, Figure 3 depicts a simple representation of the interactions between individual and classes of drivers.
Each class of driver is represented by a funnel, from which a combination of both macro and micro drivers is filtered from an interconnected reservoir where drivers from different classes interact on a range of temporal, spatial and social scales.
Each class of driver is represented by a funnel, Int. Public Health , 17, 12 of 20 from which a combination of both macro and micro drivers is filtered from an interconnected reservoir where drivers from different classes interact on a range of temporal, spatial and social of drivers scales.
Theatcombination the individual of migrant drivers at level theresults in a unique individual migrantvulnerability level resultsprofile and context in a unique which vulnerability determines the migration decision made by each potential migrant. Climate change profile and context which determines the migration decision made by each potential migrant. Climate is again presented as an externality, change cross-cutting is again presented as anallexternality, other drivercross-cutting classes and acting across all other the classes driver temporalandand societal acting levels.
As inover both 1, Figure time eachanddriver spatialmay dimensions. Figure 3. A Figure 3. A simple simplerepresentation representationofofinteractions interactionsbetween betweendrivers and drivers andclasses of of classes drivers and drivers thethe and rolerole of climate change as a source of external pressure on all drivers simultaneously.
The concept of a vulnerability profile allows for the acknowledgement that each migrant has The concept of a vulnerability profile allows for the acknowledgement that each migrant has a a unique set of drivers due to the multilevel and multitemporal combination of factors he or she is unique set of drivers due to the multilevel and multitemporal combination of factors he or she is subjected to. In this way vulnerability may be conceived as a meta-driver of migration.
The concept subjected to. The concept of vulnerability describes the ability of an individual or community to withstand and recover from a of vulnerability describes the ability of an individual or community to withstand and recover from a risk such as a disaster event [20]. Other meta-drivers include resilience and adaptive capacity [78—80]. Other meta-drivers include resilience and adaptive capacity [78— Whilst vulnerability is a commonly used meta-driver in much climate migration literature, resilience is 80].
Whilst vulnerability is a commonly used meta-driver in much climate migration literature, often the currency of choice in the fields of disaster management and climate change adaptation [81]. However, these terms are broad and often overlap and are even used distinction and usefulness within scientific analysis questionable. Despite this, such meta-drivers are interchangeably, rendering their distinction and usefulness within scientific analysis questionable.
Despite this, such meta-drivers are the dialogue of choice for policy makers and must be utilised for However, care should be taken when referring to such meta-drivers and the contributing drivers as research to have political relevance. However, care should be taken when referring to such meta- explored above must be contextually relevant and carefully selected.
Modelling Opportunities and Challenges Previous conceptual models explore the linkages between climate change and migration with different assumptions and perspectives. The Foresight report identifies five key families of drivers and concludes that migration may be an adaptive strategy in the face of climate change and represents possibly the best to-date, globally accepted conceptual model for climate migration [10].
The report disputes the long-time argument that migration represents a failure to adapt in situ. This conclusion, however, fails to consider several key aspects of migration: firstly, the agency and social well-being of migrants involved at each stage of the migration process prior to movement, in transit, and at host destination.
Public Health , 17, 13 of 20 decision—even as a supposedly proactive adaptation measure. Finally, the delicate line between forced and voluntary movement, based upon a composition of drivers and the bias of the person s awarding the classification. The ongoing Lancet Commission on Climate Change and Health also presents an interesting framework where migration as a result of climate change is appropriately framed as a health challenge, and a public health opportunity [7].
This framework, however, does not give a large amount of consideration to intermediate drivers and various pathways by which climate change may drive migration or produce trapped communities. Helping to close this gap, and drawing on a range of political and economic, as well as health literature, the model presented by Sellers, Ebi and Hess considers a puzzle of immediate and longer-term drivers of social instability, with both climate shocks and migration as contributing factors and possible outcomes [82].
McMichael et al. Whilst this and other conceptual models encourage an upstream approach to environmentally induced migration, putting such thinking into practise presents further challenges. The paucity of empirical studies limits our understanding of how global climate change may threaten development and public health, particularly regarding the indirect impacts of climate change.
Lack of suitable data and quantitative metrics needed to conduct such studies remains a perennial challenge. It is essential that these challenges be overcome through future data collection and empirical modelling. Migration datasets are largely based on cross-sectional survey and census data whilst information about health and well-being, disaggregated by migration status, is largely lacking.
Furthermore, collecting and disseminating such data present significant ethical and privacy concerns. For many drivers, proxies may be used. Henderson et al. Lu et al. However, each of these datasets has its own challenges concerning spatial and temporal resolution, uncertainty and effectiveness as a proxy.
Furthermore, misalignment of datasets at the spatial, temporal and social levels creates further challenges in appropriately modelling migration determinants. Other, more squidgy drivers such as perceived political stability and social networks remain elusive to measurement and under-represented in quantitative studies. The availability and quality of data in turn create methodological challenges for empiricists.
Some studies utilise a range of statistical and epidemiological methods. However, traditional epidemiological methods each have their short-comings. Cross-sectional analyses do not allow for the temporal nature of drivers. Timeseries analyses are often impeded due to lack of sufficient data and the ability to control interactions between drivers across a range of temporal and spatial resolutions.
Gravity models can capture linear push and pull factors at the macro level, though may struggle with ecological fallacy and in modelling of the more nuanced relationship between driver and migration outcome. Recent developments in mathematical models offer useful insight.
Such models include improved agent-based modelling ABMs and multiagent systems approaches [21,52,85,86]. Study approaches must be chosen appropriately based on the assumed relevant determinants and their interactions, as choice of methods may have significant impact on the study results.
BMC Public Health Page 6 of 9 of inbound, outbound, and internal migrant flows in- related issues. Identification of datasets and data collec- cluding those of left-behind migrant families. The re- tion processes that can be adapted and mined for disag- search findings ultimately contributed to the gregated health data related to migration are also crucial formulation of an evidence-informed National Migration in advancing the evidence base.
We support the develop- Health Policy and national action plan in [24]. The ment of a sustainable global reference group that can research was led through local research institutions and share research evidence, expertise and experience, de- research process were linked to an inter-ministerial and velop methodological and ethical guidelines, undertake inter-agency process chaired by the Minister of Health.
The research net- including communicable disease surveillance, monitor- work was formed around the need to build a global ing of interventions, applied research collaboration alliance of migration and health researchers and provide across national borders and capacity building — particu- a platform to share, collaborate, develop, mentor, advo- larly interdisciplinary postgraduate training.
A key goal of the net- Consortium is a sub-regional co-operation spearheaded work is to enable researchers from developing nations by health ministries from member countries Cambodia, the opportunity to collaborate and promote research in China, Lao PDR, Myanmar, Thailand and Vietnam [25]. The network has grown to encompass In relation to labour migration, regional processes — researchers globally, across diverse disciplines, geo- such as the Colombo Process [26] - should explore the graphic areas and stages of career.
A global reference management of overseas employment and contractual group would be well placed to develop good practice labour. In addition, migrant health-related concerns guides on data collection systems, research methods and should be emphasised in the negotiation of free trade ethics; research translation and dissemination; and, pol- agreements that increase migration between states, such icy integration strategies.
Researchers need to be sensitive when designing Methods to map human mobility for public health and disseminating research findings as data on migration preparedness and response stemming from outbreaks and health may be misused, both at an individual and and other health emergencies are needed in order to population level.
Key questions related to how re- provide accurate information on population movements, searchers can exercise their duty of care as they engage for monitoring the progression of outbreaks, predicting in research, and how we can promote careful use of data future spread and allocating resources for surveillance and research to make sure it does more good than harm.
Human mobility was a crit- Activities associated with international migration some- ical factor in the spread of Ebola virus in the West Afri- times take place in a climate of victim blaming, othering, can region. Pressing concerns were identified and health is urgently needed.
Potential elements include that relate to the ways in which researchers can navigate collaboration with stakeholders involved in implement- this increasingly challenging environment, and how trust ing global initiatives — such as the SDGs — to ensure that can be established among different stakeholders — in- indicators and data collection strategies are sensitive to cluding with international migrant groups.
Ethical approaches to research, with a clear holders, particularly with migrant communities. This in- commitment to universal human rights, are therefore cludes building inclusive migration and health research paramount in a climate of increasingly restrictive immi- networks, developing communities of practice, and sup- gration regimes.
Our research also needs to in- with the collection of data with and from migrant popu- clude the experiences of service providers who engage lations. These include sampling, biases, and practical with various migrant populations, such as those within barriers such as language and culture, as well as the the health care sectors, border management, law en- challenges inherent in reaching people who are often forcement, and labour migration.
The development of highly marginalised and potentially criminalised. Particu- effective research translation and public engagement lar attention needs to be given to ethical issues: protect- strategies for sharing research findings is critical: not ing confidentiality and ensuring that participation in only to shape multi-level policy processes but also public research does not have an adverse impact on migrants, and political opinion.
The development hancing the quality and breadth of multi-level research of meaningful partnerships and respectful research prac- evidence to support the development of improved re- tice with actors involved in the migration process will sponses to migration and health. Our research needs to be underpinned relationships between migration and health. With adequate funding, capacity development, of epistemologies and methods to local realities, intricate and support for academic freedom, we can improve the dynamics, and the multiple voices and perceptions of evidence base to guide policy and programming for mi- migrants, health professionals and other individuals in- gration and health at multiple levels and in so doing volved [24].
However, the lack of dedicated research contribute to improving health for all. Sensitising the donor community to the migration and health agenda, especially those funding 1. Ibrahim Abubakar Director, Institute for Global research, is paramount.
Curriculum development and Health, University College London, United teaching support for building the next generation of Kingdom migration and health researchers is critical to success- 2. Charles Hui Associate Professor of Paediatrics and to support key, identified stewardship functions [17] at Chief of Infectious Diseases, University of Ottawa, the global, regional, national and local levels.
Key gaps in Ottawa, Ontario stewardship related to the lack of major funding mecha- 6. Michael Knipper Associate Professor, Institute of nisms for research at national, regional, and global the History of Medicine of the University of levels, and the need to invest in capacity building for Giessen, Germany emerging researchers through training programs and 7. Health of migrants: resetting the agenda.
Report of the 2nd global consultation. Colombo, Sri Lanka, February Geneva: IOM; Ursula Trummer Head, Center for Health and 2. Global Migration Trends Factsheet. Accessed 13 Sep Annu Rev Public Health. Witwatersrand 4. Kolitha Wickramage Migration Health and health. Migr Health Eur Union. Migration and health in the world: a global public health perspective. Public Health. Philippines 6. Global Health - Thematic Discussion Paper. Anthony Zwi Professor of Global Health and www. Vulnerability and Resilience - Thematic Discussion Paper.
Abbreviations Accessed 13 Sep Development - Thematic Discussion Paper. Bowen S, Zwi AB. PLoS Med. New York; Members of the research stream at the 2nd Global Consultation on Lougarre C. Using the right to health to promote universal health coverage. Migration and Health who participated and contributed to the discussions Health Hum Rights. Neha Misra Posted on: Oct 23, In consultation with members of Women in Migration Network: Center human mobility, rights and protections in all COP26 deliberations on mitigation, adaptation, loss and damage, and financing -- bringing attention to those already displaced, in vulnerable situations, and with a consistent gender lens throughout.
Be especially mindful and inclusive of those in vulnerable situations due to poverty, all forms of discrimination, residence and work in areas affected by or vulnerable to climate-related factors and events, and migration status, including the stateless.
Ensure that acros Catherine Tactaquin Posted on: Oct 20, Download pdf Kayly Ober Posted on: Oct 20, Dr Rita Issa Posted on: Oct 20, Download docx Laura Healy Posted on: Oct 20, Not a level playing field. Anonymous Posted on: Oct 01, Please share one message per indent in not more than words per key message. Florence Kim Posted on: Sep 28, Timo Schmidt Posted on: Oct 19, Looking ahead to the IMRF and the Global Stocktake of the Paris Agreement, both taking place in , how can the climate and migration nexus best be reflected in those upcoming high-level discussions?
Please be as specific as possible. Engage in multi-level consultations, mindful of limitations of access due to Covid, physical circumstances, language and technology access. Push strongly for financing to address mitigation, adaptation and loss and damage that reaches directly affected communities and involves them in shaping responses.
Bring a focus on gender and intersectional impacts of climate change, including on women migrants, and insist on gender-related research and data gathering at all entry points, including consideration of mitigation, adaptation and loss and damage. What specific recommendations beyond those reflected in the GCM do you expect the 2nd Secretary-General report to address to States and the UN system on climate and migration?
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