RESUMEN
Background: : While climate change and migration are separately recognised as public health challenges, the combination of the two - climate change-induced migration which is predicted to increase through this century - requires further research to ensure population health needs are met. As such, this paper aims to identify initial gaps and opportunities in the nexus of climate change, migration and health research. Methods: : We conducted a questionnaire based study of academics and practitioners working in the fields of climate change, migration and health. Open-ended responses were thematically analysed. Results: : Responses from 72 practitioners collected in October 2021 were categorised into a thematic framework encompassing i) gaps and opportunities: across health care and outcomes, impact pathways between climate change and migration, most at risk groups (specific actors) and regions, and longitudinal perspectives on migrant journeys; alongside ii) methodological challenges; iii) ethical challenges, and iv) advancing research with better funding and collaboration. Broadly, findings suggested that research must clarify the interlinkages and drivers between climate change, migration, health (systems), and intersecting factors including the broader determinants of health. Study of the dynamics of migration needs to extend beyond the current focus of rural-urban migration and international migration into high income countries, to include internal displacement and immobile/ trapped populations. Research could better include considerations of vulnerable groups currently underrepresented, people with specific health needs, and focus more on most at-risk regions. Research methodology could be strengthened through better data and definitions, clear ethical guidelines, and increased funding and collaboration. Conclusion: : This study describes gaps, challenges and needs within research on the nexus of climate change, migration and health, in acknowledgement of the complexity of studying across multiple intersecting factors. Working with complexity can be supported by using the framework and findings to support researchers grappling with these intersecting themes.
RESUMEN
Although family physicians (FPs) are community-oriented primary care generalists and should be the entry point for the population's interaction with the health system, they are underrepresented in research on the climate change, migration, and health(care) nexus (hereafter referred to as the nexus). Similarly, FPs can provide valuable insights into building capacity through integrating health-determining sectors for climate-resilient and migration-inclusive health systems, especially in Sub-Saharan Africa (SSA). Here, we explore FPs' perceptions on the nexus in SSA and on intersectoral capacity building. Three focus groups conducted during the 2019 WONCA-Africa conference in Uganda were transcribed verbatim and analyzed using an inductive thematic approach. Participants' perceived interactions related to (1) migration and climate change, (2) migration for better health and healthcare, (3) health impacts of climate change and the role of healthcare, and (4) health impacts of migration and the role of healthcare were studied. We coined these complex and reinforcing interactions as continuous feedback loops intertwined with socio-economic, institutional, and demographic context. Participants identified five intersectoral capacity-building opportunities on micro, meso, macro, and supra (international) levels: multi-dimensional and multi-layered governance structures; improving FP training and primary healthcare working conditions; health advocacy in primary healthcare; collaboration between the health sector and civil society; and more responsibilities for high-income countries. This exploratory study presents a unique and novel perspective on the nexus in SSA which contributes to interdisciplinary research agendas and FP policy responses on national, regional, and global levels.
