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Purpose of Review In this article, we examine the intersection of human migration and climate change. Growing evidence that changing environmental and climate conditions are triggers for displacement, whether voluntary or forced, adds a powerful argument for profound anticipatory engagement. Recent Findings Climate change is expected to displace vast populations from rural to urban areas, and when life in the urban centers becomes untenable, many will continue their onward migration elsewhere (Wennersten and Robbins 2017; Rigaud et al. 2018). It is now accepted that the changing climate will be a threat multiplier, will exacerbate the need or decision to migrate, and will disproportionately affect large already vulnerable sections of humanity. Worst-case scenario models that assume business-as-usual approaches to climate change predict that nearly one-third of the global population will live in extremely hot (uninhabitable) climates, currently found in less than 1% of the earth’s surface mainly in the Sahara. Summary We find that the post–World War II regime designed to receive European migrants has failed to address population movement in the latter half of the twentieth century fueled by economic want, globalization, opening (and then closing) borders, civil strife, and war. Key stakeholders are in favor of using existing instruments to support a series of local, regional, and international arrangements to protect environmental migrants, most of whom will not cross international borders. The proposal for a dedicated UN agency and a new Convention has largely come from academia and NGOs. Migration is now recognized not only as a consequence of instability but as an adaptation strategy to the changing climate. Migration must be anticipated as a certainty, and thereby planned for and supported.

The effects of climate change are accelerating and undermining human health and well-being in many different ways. There is no doubt that the health care sector will need to adapt, and although it has begun to develop more targeted strategies to address climate-related challenges, a broad knowledge gap persists. There is a critical need to develop and cultivate new knowledge and skill sets among health professionals, including those in public health, environmental science, policy, and communication roles. This article describes specific initiatives to train future leaders to be proficient in understanding the linkages between climate change and health. We present an agenda for expanding education on climate and health through health professional schools and graduate and postgraduate curricula, as well as in professional and continuing education settings. Our agenda also identifies ways to promote sustainability in clinical practice and health care management and policy. Throughout, we cite metrics by which to measure progress and highlight potential barriers to achieving these educational objectives on a larger scale.

Lower per capita GDP and higher wind speeds were associated with greater mortality rates in small countries. Excessive fatalities occurred when powerful storms struck resource-poor nations. Predictions of increasing storm amplitude over time suggest increasing disparity between death rates unless steps are taken to modify the risk profiles of poor nations. (Disaster Med Public Health Preparedness. 2016;10:832-837).

Specialized non-physician clinicians practicing in a dedicated Emergency Department can perform resuscitation, bedside imaging and laboratory studies to aid in diagnosis of acute surgical patients and arrange transfer to an operating theater in an efficient fashion. This model has the potential to sustainably address structural and human resources problems inherent to Sub-Saharan Africa's current acute surgical care model and will benefit from further study and expansion.

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Background: Tropical cyclones are a recurrent, lethal hazard. Climate change, demographic, and development trends contribute to increasing hazards and vulnerability. This mapping review of articles on tropical cyclone mortality assesses geographic publication patterns, research gaps, and priorities for investigation to inform evidence-based risk reduction. Methods: A mapping review of published scientific articles on tropical cyclone-related mortality indexed in PubMed and EMBASE (English) and SINOMED and CNKI (Chinese), focusing on research approach, location, and storm information, was conducted. Results were compared with data on historical tropical cyclone disasters. Findings: A total of 150 articles were included, 116 in English and 34 in Chinese. Nine cyclones accounted for 61% of specific event analyses. The United States (US) reported 0.76% of fatalities but was studied in 51% of articles, 96% in English and four percent in Chinese. Asian nations reported 90.4% of fatalities but were studied in 39% of articles, 50% in English and 50% in Chinese. Within the US, New York, New Jersey, and Pennsylvania experienced 4.59% of US tropical cyclones but were studied in 24% of US articles. Of the 12 articles where data were collected beyond six months from impact, 11 focused on storms in the US. Climate change was mentioned in eight percent of article abstracts. Interpretation: Regions that have historically experienced high mortality from tropical cyclones have not been studied as extensively as some regions with lower mortality impacts. Long-term mortality and the implications of climate change have not been extensively studied nor discussed in most settings. Research in highly impacted settings should be prioritized.

Hurricanes, also referred to as tropical cyclones or typhoons, are powerful storms that originate over warm ocean waters. Throughout history, these storms have had lasting impacts on societies around the world. High winds, rain, storm surges, and floods affect lives, land, and livelihoods and have a variety of effects on human health. The direct health impacts of hurricanes include drowning due to flooding and trauma resulting from storm surges, blown debris, and structural collapse. Systems for detection, forecasting, early warning, and communications can give populations time to make preparations before hurricane landfall. Evacuation, shelter use, and other preparedness efforts have reduced mortality from hurricanes in many parts of Asia and the Americas. Engineered defenses such as sea walls, flood barriers, and raised structures provide added protection in some settings. While effective in the medium term, such approaches are costly and require dedicated resources, and therefore they have not been implemented in many at-risk sites around the world. Indirect health impacts of hurricanes arise from damage to housing, electricity, water, and transportation infrastructure, and from effects on social supports, economies, and healthcare systems. Indirect health impacts can include infectious diseases, carbon monoxide poisoning, trauma sustained during cleanup, mental health effects, exacerbations of chronic disease, and increases in all-cause mortality. Indirect and long-term health consequences are poorly understood because dedicated study of specific impacts has occurred in only a handful of settings, and, given the diverse array of societies and geographies affected by hurricanes, it is unclear how generalizable the results of these studies may be. Policy makers face three interlinked challenges in protecting human health from hurricanes. First, climate change is leading to increased hazards in many locations by altering hurricane dynamics and contributing to sea-level rise. Second, patterns of intensifying coastal settlement and development are expected to increase population exposure. Third, unequal patterns of exposure and impact on specific populations will continue to raise issues of climate and environmental injustice. Situationally appropriate strategies to protect health from future storms will vary widely, as they must both address the locally relevant manifestations of hurricane hazards and adapt to the cultural and economic context of the affected population. In some areas, inexorable ocean encroachment may lead to consideration of managed retreat from high-risk coastlines; in others, the presence of very large coastal urban populations that cannot feasibly evacuate may lead to design and use of vertical shelters for temporary protection during storms. New ideas and programs are urgently needed in many settings to address hazards associated with extreme rainfall, rising seas on floodplains and low-lying islands, landslide risk in areas undergoing rapid deforestation, and structurally unsound housing in some urban settings. Policies to reduce greenhouse gas emissions will help reduce long-term risk from hurricanes and sea-level rise. Without concrete actions to address both hurricane hazards and population vulnerabiliy, the 21st century may be marked by increasingly dangerous hurricanes affecting growing coastal populations that will be left with few viable options for seeking safety.