SOCIAL EM & POPULATION HEALTH COMMITTEE
The Climate Crisis and Forced Displacement: Health Implications and Recommendations for Emergency Medicine Physicians Salma Yusuf, MS4, Tai Donovan, MS4, and William Mundo, MD MPH
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hen asked what some of the biggest threats to public health are, climate change is not the first answer that comes to mind but it continues to affect millions around the world and is one of the greatest known risks to global health. Climate change has the capability to indirectly impact health outcomes for vulnerable populations in the U.S. and worldwide in a myriad of ways. From the risk of extreme heat events, flooding and storms, and increased risk of respiratory illness, to the spread of infectious disease, climate change not only creates new public health challenges but exacerbates those that already exist. One of the greatest consequences of global warming is migration and displacement. According to the U.N. Refugee Agency, by the end of 2020, the world’s forcibly displaced population was at a record high, with 82.4 million individuals being displaced worldwide due to persecution, conflict, violence, or human rights violations. Migration, especially when sudden and involuntary, adds a layer of complex determinants to health connected to acculturation, access to care, pre-existing health, the mode of travel, and legal status. In the United States, if migrants can overcome the multiple challenges of receiving care, the emergency department may be the first and only contact they may have with a physician. This creates a new dimension of challenges for the ED physician while putting a strain on an already limited health care system. Our goal is to examine the clinical impact and challenges that climate change influenced migration places on emergency physicians and our health care system while identifying opportunities for improvement.
Climate change not only creates new public health challenges but exacerbates those that already exist.
Strain on ED and ED Physicians
The number of immigrants increased around the globe from 150 million in 2000 to 214 million in 2010, and this number is said to be able to reach 405 million by 2050 with a dramatic increase seen in refugees, undocumented, and asylum seekers. Undocumented status is a completely unique social determinant in that it’s modifiable. Most immigrants use the emergency department as their first point of care and in lieu of a primary care physician due to lack of health insurance. Because of this, the ED is often used for lower acuity health issues. Further, the effects of displacement, income inequalities and poverty, and immigration policies contribute to barriers to health. Emergency medicine physicians’ experiences in caring for underserved populations are tangible to promote health equity for the undocumented population. Morbidities Experienced by Migrant Populations
While the majority of the migrant population is healthy upon arrival, some, especially refugees, asylum seekers, and unaccompanied minors, suffer from disproportionate morbidity. Undocumented immigrants face a unique risk for accessing tuberculosis care and rely on ED for life-threatening conditions such as hemodialysis for ESRD and cancer chemotherapy. While other health risks include heat-related disorders, exacerbation of respiratory illness due to air pollution, the prevalence of vector-borne diseases, and gastrointestinal diseases. >>
COMMON SENSE JANUARY/FEBRUARY 2023
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