Global Climate Change, Population Displacement, and Public Health

population displacement and its effects through the development and maintenance of partnerships involving academics, policymakers, service providers, communities, and climate refugees themselves.
Chapter 2. Katrina and New OrleansThis chapter begins with a recounting of Hurricane Katrina and City of New Orleans, Louisiana in 2005. It examines why so many residents were forced to relocate to other communities such as Houston and Atlanta and the impact of this relocation on the migrants themselves, the City of New Orleans, and the communities that hosted them.  An estimated 1.5 million people living along the Gulf Coast were displaced as a result of the hurricane.  Many of the former residents of New Orleans experienced mental and behavioral health problems and social isolation due to separation from family and friends. Interviews with former residents of New Orleans living in Houston will be used to illustrate how the trauma experienced by Katrina was exacerbated by the more recent experience of Hurricane Harvey.  The population of New Orleans declined from 484,000 to 344,000 in the year after Katrina. Host cities such as Houston experienced a severe strain on resources as they were challenged with finding adequate housing, services, and schooling for the new residents. This resulted in tension between established residents and new arrivals. 
Chapter 3. Maria and Puerto RicoThis chapter describes the Category 5 hurricane that struck Puerto Rico and the islands of the Lesser Antilles in the Caribbean, beginning on September 6, 2017.  It examines the destruction of Puerto Rico's infrastructure and disruption of the economy and follows the migration of island residents to the United States mainland.  It is currently estimated that as many as 200,000 Puerto Ricans will leave the island (Marketplace, Sept 17, 2017, https://www.marketplace.org/2017/09/27/economy/more-residents-are-expected-flee-puerto-rico-contributing-brain-drain).  As was the case with the residents of New Orleans after Katrina, many of these displaced migrants have already or will experience increased rates of posttraumatic stress disorder and other mental and behavioral health problems. Departure of many of Puerto Rico's better-educated and younger citizens will make efforts by those left behind to rebuild and recover more difficult (USA Today, Oct 12, 2017, https://www.usatoday.com/story/news/nation/2017/10/12/puerto-rico-young-professionals-leaving-hurricane-maria/754753001/).  As with Katrina, host communities like Miami and New York will experience a severe strain on resources as they are challenged to find adequate housing, services, and schooling for the new residents, resulting in tension between established residents and new arrivals.
Chapter 4. The Tubbs Fire and Santa RosaThis chapter describes the devastating wildfires that began on October 8, 2017 and destroyed entire neighborhoods of Santa Rosa, California, resulted in 42 deaths, and inflicted severe damage in other communities like Napa, Sonoma, and Marin Counties, including the destruction of over 8,400 homes. Using newspaper accounts and interviews with displaced residents, this chapter examines the reasons why some residents have chosen to move from the area while others have chosen to stay.  These decisions are used to make the argument that climate change is a social justice issue as it is usually the poor, the elderly, and the socially disadvantaged who are most impacted by such events.  The chapter also discusses the effect of loss of property, social networks, and other resources on the mental and behavioral health of displaced residents.  Particular attention is paid to the impact of displacement on those who remain behind in affected communities. For instance, a recent news story reported that hundreds of physicians and other medical personnel have been displaced by the fires, many tied to Santa Rosa's three major hospitals (Press Democrat Oct 24, 2017, http://www.pressdemocrat.com/news/7546178-181/hundreds-of-sonoma-county-doctors?artslide=0). The departure of these healthcare providers from the region could lead to a critical shortage in delivery of health care.
Chapter 5. Fleeing Drought: Africa and the Great Migration to EuropeThis chapter examines the relationships between climate change, internal civil conflicts, and international debate over the relocation of millions of migrants from the Middle East and Africa. It describes how prolonged drought has affected the agricultural economics and ways of life of residents in countries like Syria, Sudan, Chad, Mali, and Niger and how refugees from climate change and civil strife have become intermingled on their way to seek asylum in Europe.  As with previous chapters, newspaper reviews, journal articles, and government reports are supplemented with first-hand accounts of climate refugees living in Europe to describe the effects of this mass migration on the physical and mental health of climate refugees, on their communities of origin, and on the host communities.  However, the primary focus of this chapter is on climate change as an international security issue. The increasing numbers of migrants arriving in Europe through dangerous transits in Greece, Italy, and the Mediterranean have led to debates over who should be admitted and who should be turned away, the obligations of host nations, and the social and economic consequences of having new residents.  The current legal status of displaced populations as climate refugees will be reviewed, along with efforts of host nations to accommodate to the needs of newly arrived migrants. 
Chapter 6.  Fleeing Flooding: Bangladesh and the Asia-Pacific RimAsia accounts for 7 of the world's 10 countries most vulnerable to climate change. Bangladesh alone has had 70 climate-related natural disasters in the past 10 years. Large parts of cities such as Ho Chi Minh City, Jakarta, Manila, and Bangkok are at risk for flooding and water scarcity challenges as saltwater intrusion contaminates freshwater supplies. Island nations such as the Maldives and Vanuatu are at risk of being submerged due to rising sea levels. In 2010 and 2011, 42 million people in the Asia Pacific region were displaced due to disasters caused by climate change. The number of people at risk in Asian coastal cities could rise from 300 million to 410 million by 2025. According to the UN Economic and Social Commission for Asia and the Pacific (2014), there are five 'hotspots' in the Pacific that are likely to become source areas for climate change-related migrants: (a) urban areas; (b) urban atolls; (c) non-urban atolls; (d) coastal, delta, and riverine communities; and (e) communities prone to drought. Population shifts have significant implications for the Asia-Pacific region, straining infrastructure capacities and economic resources and creating new social challenges associated with changing community demographics (IPCC, 2014). As with previous chapters, this chapter documents where relocation is happening and why, as well as the public health impacts of relocation on migrants, their communities of origin, and host communities and countries.  Efforts of some countries to negotiate the purchase of land in other countries for resettlement purposes will be described, as well as the efforts of national and international organizations to respond to this growing crisis.
Chapter 7.  Fleeing Coastal Erosion: Newtok and Isle de St. JeanThis chapter presents the experiences of two communities in the United States that are gradually being reduced in size and habitability by coastal erosion due to rising sea levels. A Yup'ik community located on the Bering Strait, Newtok is one of Alaska's most eroded coastal villages and the only one that has begun a physical move, with the raging Ninglick River steadily inching toward homes. Officials estimate Newtok, 480 miles west of Anchorage, has until the end of the decade before erosion causes severe damage. Efforts to relocate the community have led to social conflict as a dispute has arisen over the local management of relocation funding. Until the matter is resolved, millions of dollars in government funds for the relocation effort have been halted (Oregonian, 2013, (http://www.oregonlive.com/environment/index.ssf/2013/11/coastal_erosion_threatens_alas.html).  Located in Southeastern Louisiana, residents of Isle de Jean Charles received $48 million, which represents the first allocation of federal tax dollars to move an entire community struggling with the impacts of climate change. The divisions within the community the effort has exposed and the logistical and moral dilemmas it has presented point up in microcosm the massive problems the world could face in the coming decades as it confronts a new category of displaced people who have become known as climate refugees (New York Times, 2016, https://www.nytimes.com/2016/05/03/us/resettling-the-first-american-climate-refugees.html). While the chapter addresses the reasons for the relocation and the health and economic effects of relocation on community residents, it will focus primarily on the social conflicts that have arisen in response to relocation efforts. It also examines how the experiences of these two communities serve as a model for the experience of other indigenous coastal communities around the world. 
Chapter 8.  Policy Responses to Climate-related DisplacementThis chapter examines the current legal status of climate refugees attempting to cross international borders or relocate elsewhere within their own country of origin and explains why a change in status is needed.  As described in Chapter 5, climate change is an international security issue. It precipitates civil conflicts such as the ongoing civil wars in Syria and South Sudan; it leads to widespread famine and ruined economies, such as occurred in North Korea after the floods of the late 1990s, or in Chad and Mali as a result of prolonged drought.  As these examples illustrate, civil conflicts carry with them enormous potential to become international conflicts.  Likewise, the influx of refugees from predominately Muslim countries has heightened fears within non-Muslim host nations of terrorism, competition for scarce jobs and resources, and dilution and disappearance of traditional culture. These two threats to public health and international security are examined in detail in this chapter. The chapter also focuses on current policies that affect resettlement in the United States, such as recovery assistance by the Federal Emergency Management Agency (FEMA) and the provisions of the Stafford Act that limit relocation of communities impacted by climate change. 
Chapter 9.  Practice Responses to Climate-related DisplacementIn this chapter, the Three-Tier Model of climate refugee resettlement impacts is used to identify health and social services that can potentially prevent, manage, and mitigate the impacts of climate change and climate-related population displacement. It describes how Tier 1 services can address immediate socioenvironmental needs by developing sustainable communities in areas undergoing environmental changes as well as host communities of displaced climate refugees; how Tier 2 services can address the potential for social tension and conflict resulting from the differential distribution of resources and arrival of displaced individuals in host communities; and how Tier 3 services can address health issues such as PTSD, depression, anxiety, substance abuse, domestic violence, disruptive childhood behavior, and climate-related diseases experienced by displaced populations. The chapter provides suggestions for community planning for influx of climate refugees, including acquisition and distribution of resources and housing and efforts to develop host communities that are socially, economically, and environmentally sustainable based on United Nations SDG goals. It will also describe specific evidence-based programs, practices, and interventions that can be delivered to climate refugees to address physical and mental health, housing, and employment needs. 
Chapter 10: Conclusion: The Future of Climate-related Displacement?The last chapter begins with a discussion of whether current and projected levels of climate-related population displacement represent a transient crisis or the new normal.  It examines potential efforts to prevent population displacement that focus on economic, social, and environmental sustainability; efforts to manage population internal and international displacement; and efforts to mitigate the health consequences of population displacement.  It concludes with an examination of the role of partnerships involving researchers, policymakers, service providers, and communities in addressing these efforts.