Migration is a social justice issue and so is climate change!
By Leonie Mac Fehr
The preconference on “Health System Responses to Migration: From crisis mode to diversity-sensitive inclusive systems” was organized by Heidelberg University Hospital, Section for Health Equity Studies & Migration and Bielefeld University, Dep. for Population Medicine & HSR, and the EUPHA Migrant health section. Bernadette Kumar, the president of the EUPHA Migrant and ethnic health section held the first keynote and illustrated the way forward: developing refugee and migrant sensitive health systems start with the leadership and governance building block, i. e. that refugees and migrants need to be included in the system not only as patients but also as facilitators, providers, and decision-makers.
During the conference I talked to Mathura Kugan, a young professional from the Lancet Migration European Regional Hub and we agreed that there needs to be more representation of refugees and migrants, not just in leadership, but also in research. As this year’s EUPHAnxt fellow for Migrant and ethnic minority health, I was very happy to see that young professionals had the opportunity to have the last word on every session and enriched the preconference with their perspectives and some critical questions.
For my interview, I wanted to learn more about how climate change and migration are linked and had the chance to talk to Patricia Nayna Schwerdtle. Trish’s PhD focuses on the nexus between climate change, migration, and health and she has served as the Vice President of Médecins Sans Frontières, Australia, and currently advises the MSF International Board on climate change issues.
Leonie Mac Fehr: What are your takeaways from the panel discussions so far? And what would you like to lay your focus on in future discussions surrounding migration?
Patricia Nayna Schwerdtle: The first session was about data, and I have to admit that's not my filed of expertise because I'm a qualitative researcher and a synthesis researcher, that's my toolkit. I'm looking at big databases and AI and all of that is a little bit out and it's difficult to understand what data is available and where the gaps are. But in these kinds of conferences, you always seem to be made aware of the fact that we don't have good data on migrants and refugees and their health, and that's an area where we can improve. Also from a climate change perspective, it's going to be very difficult to demonstrate and anticipate how people are going to move in the future unless we know how they're moving today at 1.1 degrees. So that was probably my key takeaway there.
And the second one was that we do tend to focus on migrants. There wasn't very much on host communities and sending communities. And I think we have to think more about the entire migration ecosystem and not just the people that are on the move at that time. We think about it in very simple terms, in terms of origin and destination, whereas migration is a really complex phenomenon and it looks really different in different populations in different parts of the world. If we just get a cross-section of it, we're not seeing the whole picture.
And in terms of where I want to focus in the future, I'm probably going to do my post-doc on the connection between climate change, migration and health in Burkina Faso, if I get funding because I'm interested in the nexus in lower and middle income countries, because most climate related migration happens in lower and middle income countries where people's livelihoods depend on the natural environment, it happens everywhere. But I think that's where the risks are the highest. And for that research I want to do those two things. So firstly, look at the entire ecosystem of the whole phenomenon of climate related migration and health, including the sending communities who sometimes do not benefit, or they benefit differently from the migration, or they're put at increased risk due to the migration and also host populations and also look at that phenomenon longitudinally. So not at one point in time.
Leonie Mac Fehr But it can be difficult to find funding for longitudinal projects sometimes…
Patricia Nayna Schwerdtle Yeah, and also sampling is really tricky too, because if you have to follow people, you have problems with attrition, you have problems with incentivizing people to follow up and then that systematically changes the sample. Often when we find a gap, there's a reason why there's a gap, because that particular area is difficult to get funding for or it's just not very feasible or too challenging, too risky. I think a lot of research has to think about risk mitigation, like how are you actually going to get to your findings? And we take steps and sometimes we compromise the quality of the research by reducing the risk of that that we won't have meaningful findings. So yeah, it's kind of like a systematic bias in research that we don't talk about very often.
Leonie Mac Fehr And you've mentioned the ongoing COP 27 already. We've talked about lower and middle income countries. Where do you see the responsibilities, especially from research coming from the global north and from governments, if we also consider colonial continuities, in this whole climate change scheme?
Patricia Nayna Schwerdtle Yeah, that's a good question and it's a complex one because we've got this situation where climate change, climate change and health, and climate change and migration is a social justice issue because it's primarily affecting the people least responsible for the problem. So, there is critique about high income countries intervening in low and middle income countries. At the same time, you've got a lack of funding capacity and technical expertise in a lot of these countries and there are big gaps in evidence in those countries. There is practically and functionally a reason why we have to have those North-South partnerships. At the same time, I've seen some really effective South-South partnerships. There's a great need for collaboration to address these evidence gaps, but it has to be participatory. The questions have to be co-developed with the people that are most affected by the problem, because that's where the unique insights will come from. And I really think people have the solutions for their own problems if you look closely enough and pay attention.
Leonie Mac Fehr You started your talk with a statement that we have had 30 years of research, the evidence is there, we have the tools - so what is missing? What would be the next step you would think is the most important to pursue?
Patricia Nayna Schwerdtle I was talking about the need for translation of evidence into practice, which is a historical problem in medicine and public health. And I referred to it as a 17 year odyssey. There is a paper on that, that it does show that it takes 17 years from innovation to mainstreaming what we need to do about that. I think we need to invest more in implementation research. Pure knowledge generation research is important, but there should be a responsibility for researchers to work at the interface of research and policy and research and practice to make sure that their findings are actually making their way into the real world and where it happened. We're at a point in time where we do really do have to accelerate that process because we have a narrow window of mitigation that's closing. And if we don't mitigate enough in time, we'll see a situation of climate tipping points and runaway climate change, where mitigation will no longer be effective in reducing global heating. And that at that point in time, we'll look back at now and will say, I wish we did this and I wish we did that. We can already say that that's going to be the case and it's going to be in our lifetimes. It's really important to to accelerate solutions and to focus on that part of translating what we know into practice.
Leonie Mac Fehr: To follow up on this: Who do you think has the responsibility to do that? Which fields should those changemakers come from?
Patricia Nayna Schwerdtle I think pretty much at this stage they have to come from everywhere. I think we have to stop pointing the finger in terms of responsibility as well. We need leadership everywhere because otherwise we're not going to see the scale of change that we need to see in time. We need to transform our economies and our societies at a scale of the industrial revolution in the next ten years. And that's a massive, massive challenge. So, if everybody doesn't commit and act, then and if we continue to point the finger and in terms of responsibility and also responsibility for action, then we're shooting ourselves in our own foot because we're not going to see the change that we need to see in the period of time that we need to see it.
Leonie Mac Fehr Thank you very much for the interview!
Written by Leonie Mac Fehr, MSc Global Health from Maastricht University, medical student at Hannover Medical School with a special interest in racism in medicine, minorities health, planetary health, and global health workforce; and EUPHAnxt fellow at the 15th European Public Health Conference, held 9-12 November 2022 in Berlin, Germany.