Climate Change and Environmental Justice

Open Posted By: ahmad8858 Date: 29/04/2021 High School Research Paper Writing

When a disaster occurs, media outlets often focus on the images of the initial impact of the destruction and the grief-stricken faces of survivors. After the rubble begins to be cleared away, however, media outlets typically lose interest and fail to report on the recovery process for the survivors. However, long after the media fades, individuals continue to need help and assistance, whether due to displacement or loss of livelihood.

For this Assignment, think about the influence of climate change and effects of natural disasters. Reflect on the disparate impact on diverse communities and the role of social workers in preventing or intervening with impacted communities.

The Assignment (2–3 pages):

  • Describe the role of climate change on natural disasters.
  • Explain the concept of environmental justice as it relates to disasters caused by climate changes.
  • Explain the role of social workers to mitigate and ameliorate the effects of climate change.

Support your Assignment with specific references to all resources used in its preparation. You are required to provide a reference list and to appropriately cite, in APA style, all references used within your Assignment.

Category: Accounting & Finance Subjects: Corporate Finance Deadline: 12 Hours Budget: $150 - $300 Pages: 3-6 Pages (Medium Assignment)

Attachment 1

of Social Work & Social Welfare

Strengthening the Social Response to the Human Impacts of Environmental Change

American Academy of Social Work and Social Welfare aaswsw.org

Strengthening the Social Response to the Human Impacts

of Environmental Change Susan P. Kemp

University of Washington

Lawrence A. Palinkas University of Southern California

With the assistance of the following:

Marleen Wong University of Southern California

Kristen Wagner University of Missouri–St. Louis

Lisa Reyes Mason University of Tennessee, Knoxville

Iris Chi University of Southern California

Paula Nurius University of Washington

Jerry Floersch Rutgers University

Andreas Rechkemmer University of Denver

Grand Challenges for Social Work Initiative

Working Paper No. 5

January 2015

Grand Challenge: Create Social Responses to a Changing Environment

Grand Challenges for Social Work Initiative

Working Paper

Grand Challenges for Social Work Initiative

The Grand Challenges for Social Work are designed to focus a world of thought and action on the most compelling

and critical social issues of our day. Each grand challenge is a broad but discrete concept where social work

expertise and leadership can be brought to bear on bold new ideas, scientific exploration and surprising innovations.

We invite you to review the following challenges with the goal of providing greater clarity, utility and meaning to

this roadmap for lifting up the lives of individuals, families and communities struggling with the most fundamental

requirements for social justice and human existence.

The Grand Challenges for Social Work include the following:

 Ensure healthy development of all youth

 Close the health gap

 Stop family violence

 Eradicate social isolation

 End homelessness

 Promote smart decarceration

 Reduce extreme economic inequality

 Build financial capability for all

 Harness technology for social good

 Create social responses to a changing environment

 Achieve equal opportunity and justice

 Advance long and productive lives

Executive Committee


John Brekke Rowena Fong

University of Southern California University of Texas at Austin

Claudia Coulton

Case Western Reserve University

Diana DiNitto

University of Texas at Austin

Marilyn Flynn

University of Southern California

J. David Hawkins

University of Washington

James Lubben

Boston College

Ronald W. Manderscheid

National Association of County

Behavioral Health & Developmental

Disability Directors

Yolanda C. Padilla

University of Texas at Austin

Michael Sherraden

Washington University in St. Louis

Eddie Uehara

University of Washington

Karina Walters

University of Washington

James Herbert Williams

University of Denver

Richard Barth (ex officio)

American Academy of Social Work and

Social Welfare and University of


Sarah Christa Butts (staff)

American Academy of Social Work and

Social Welfare and University of


Grand Challenges for Social Work Initiative

Working Paper

Strengthening the Social Response to the

Human Impacts of Environmental Change

Susan P. Kemp and Lawrence A. Palinkas

The United States and other contemporary societies face unprecedented environmental

challenges as a result of climate change and escalating urbanization, ranging from acute

hazards (e.g., natural disasters) to chronic, slow-onset stressors (e.g., prolonged drought,

rising urban pollution levels, intransigent urban spatial inequities). These challenges

threaten human health and well-being; destabilize assets, coping capacities, and response

infrastructures; and substantially increase the number of socially, economically, and

psychologically vulnerable individuals and communities. They disproportionately affect

populations of lower economic privilege or social status, disrupting employment and

income, escalating food insecurity, and degrading the ecologically vulnerable,

inadequately resourced locations where poor and marginalized groups often live.

Environmental inequities are also social inequities, with significant social justice

implications. Social work is positioned to play a key role in developing and implementing

innovative strategies to anticipate, mitigate, and respond to the social and human

dimensions of environmental challenges. Core areas for social work leadership include

(1) local, national, and international disaster preparedness and response; (2) assistance to

dislocated populations; (3) collaborative capacity building to mobilize and strengthen

place-based, community-level resilience, assets, and action; and (4) advocacy to elevate

public and policy attention to the social and human dimensions of environmental change.

Key words: Global climate change, urbanization, environmental justice, natural disasters,

ecological refugees, population displacement, adaptation, mitigation, resilience, human


Unprecedented environmental changes resulting from climate change and urbanization are

among the most pressing challenges facing contemporary societies, including the United States.

Environmental threats confronting U.S. communities span a continuum from acute hazards such

as natural disasters, to chronic, slow-onset stressors such as prolonged drought, rising urban

pollution levels, and intransigent urban spatial inequities. Given the close coupling of social and

ecological systems (Keck & Sakdapolrak, 2013), these challenges have profound social

implications that threaten human health and well-being; destabilize assets, coping capacities, and

response infrastructures; and, in all likelihood, substantially increase the number of socially,

economically, and psychologically vulnerable individuals and communities. In addition to

increased exposure to more severe natural disasters such as Hurricane Sandy, many U.S.

communities will be affected by population displacement and dispersal associated with longer


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term environmental changes. Escalating urbanization and related degradation of natural

resources complicate these challenges and add additional concerns for America’s cities,

including rising social and economic inequality, increasing density, and infrastructure and

services inadequately equipped to handle novel, multidimensional socio-environmental

challenges. While global environmental changes affect all U.S. residents, they have

disproportionate impacts on those of less economic privilege or social status. Such impacts

include climate-related disruptions in employment and income, escalating food insecurity, and

further degradation of the ecologically vulnerable, inadequately resourced locations where poor

and marginalized groups often live. Environmental inequities are also social inequities, with

significant social justice implications.

There is growing recognition of the need for greater attention to the health and psychosocial

impacts of climate change and related environmental challenges. Still, much remains to be done

to develop and implement practical, effective, evidence-based, equitable, and durable strategies

for anticipating, mitigating, and responding to the human dimensions of global environmental

threats. As stated in the National Association of Social Workers’ (NASW) Code of Ethics (2013,

preamble, paragraph one), “fundamental to social work is attention to the environmental forces

that create, contribute to, and address problems in living.” The person-in-environment

perspective has consistently been a central feature of social work theory and practice (Kemp,

Whittaker, & Tracy, 2007, Saleebey, 2004). “Since the profession’s earliest formal beginning,

social workers have understood that where people live profoundly influences how they live, with

important implications for equity and social justice” (Kemp, 2011, p. 1200). Furthermore, the

current engagement of social workers in refugee resettlement, disaster response, environmental

justice, and community development efforts positions the profession for research and

intervention leadership in these domains. Recognition of the physical environment’s critical role

in social and economic sustainability and human well-being is rapidly growing among social

workers (International Federation of Social Workers, 2012). Robust attention to the

environmental dimensions of social work’s person-in-environment mandate will be central to the

profession’s efforts to attract new, diverse, and innovative groups to join in seeking social justice

for all, particularly those made vulnerable by environmental change. Nonetheless, the complexity

and urgency of the challenge demand more assertive, forward-thinking, comprehensive, and

innovative responses than social work has demonstrated to this point.

Thus, strengthening the social response to the human impacts of global environmental change is

a grand challenge for social work. This position paper details the scope of the problem,

introduces a plan for addressing the problem, identifies activities and outcomes that can be

achieved in a decade, highlights an interdisciplinary approach to these achievements, and

emphasizes the importance of transformative solutions, within and beyond the field.


The degradation of the physical environment is one of the most significant problems facing the

world today. Human impacts on the environment include increased atmospheric carbon dioxide,

air and water pollution, soil contamination and destabilization, and technological disasters such

as oil spills and chemical contamination of drinking water. Drawing on published results of


Grand Challenges for Social Work Initiative

Working Paper

leading modeling groups around the world, the fifth report of the Intergovernmental Panel on

Climate Change (Intergovernmental Panel on Climate Change [IPCC]) forecasts an increase in

world average temperature by 2100 within the range of 1.5 to 5.8 o C (2013). Sea levels during

this period are projected to increase in the range of 0.26 to 0.98m, thereby inundating low-lying

areas and developing nations such as Tuvalu, Fiji, the Solomon Islands, the Marshall Islands, the

Maldives, and some of the Lesser Antilles (IPCC, 2013). Extreme precipitation events over most

of the mid-latitude land masses and wet tropical regions will very likely become increasingly

intense and frequent by the end of this century as global mean surface temperature increases

(IPCC, 2013). For instance, Bangladesh has had 70 climate-related natural disasters in the past

10 years. Conversely, mean precipitation will likely decrease in many mid-latitude and

subtropical dry regions, leading to drought conditions, increased risk of wildfires, and rising

water insecurity (Pawar, 2013). A significant decline in ocean pH levels during this period may

lead to a dramatic reduction in marine life as a food source (IPCC, 2013).

Environmental change in the United States

The United States is by no means immune from these challenges. In the Southeast, for

instance, average annual temperatures are projected to increase by 4 to 9 °F by 2080

according to the U.S. Global Change Research Program [USGCRP] (Karl, Melillo, &

Peterson, 2009). Storm surge and sea-level rise will likely affect coastal communities and

ecosystems. However, precipitation in Florida will likely decrease, leading to prolonged

drought conditions. Projected changes in surface water runoff to the coast and groundwater

recharge will likely allow saltwater to intrude and mix with shallow aquifers in some coastal

areas of the Southeast, particularly in Florida and Louisiana (Karl, Melillo, & Peterson,

2009). Decreased water availability will challenge future growth and the quality of life of

residents in the region. Higher temperatures and more frequent heat waves will likely

increase heat stress, respiratory illnesses, and heat-related deaths (Karl, Melillo, & Peterson,

2009). Though the number of cold-related deaths is projected to decrease, net climate-

related mortality will likely increase. Declining soil moisture, water scarcity, and increasing

temperatures will likely stress agricultural crops. Sustained temperatures between 90 and

100 °F can significantly affect cattle. Severe droughts, such as the water shortage that

affected Texas in 2011, may lead to the premature slaughtering of cattle (Karl, Melillo, &

Peterson, 2009). In the Southwest, the report notes that warming has already contributed to

decreases in spring snowpack and Colorado River flows, which are an important source of

water for the region. Future warming is projected to produce more severe droughts in the

region, with further reductions in water supplies (Karl, Melillo, & Peterson, 2009). Future

water scarcity will be compounded by the region's rapid population growth, which is the

highest in the nation (Karl, Melillo, & Peterson, 2009). Warming temperatures will likely

make it more difficult for the Southwest’s rapidly growing cities to meet air quality

standards (Karl, Melillo, & Peterson, 2009). For example, over 90% of California’s

population lives in areas that violate state air quality standards for ground-level ozone or

small particles, with air pollutants causing an estimated 8,800 deaths and over $1 billion in

health-care costs every year (USGCRP, 2009). Warmer temperatures are expected to

increase the frequency, intensity, and duration of conditions that are conducive to air


Grand Challenges for Social Work Initiative

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pollution formation, further exacerbating air quality issues in the Southwest. These

conditions threaten the health and well-being of people who suffer from respiratory ailments

such as asthma and chronic obstructive pulmonary disease (Karl, Melillo, & Peterson ,

2009; United States Environmental Protection Agency, 2014).


Escalating urbanization compounds environmental risks. The majority of the U.S. population is

already urban dwelling; by 2050, 90% of Americans will live in cities (United Nations

Environment Programme, 2014). As key sites of innovation and major loci of environmental risk

(especially for the urban poor), cities are pivotal hubs in global sustainability. One third of the

world’s urban population, for example, lives in informal settlements located in environmentally

marginal locations that lack basic services. Socioenvironmental pressures from shifting urban

demographics include rising social and economic inequality, increasing density, and increased

demand on infrastructure and services. Furthermore, urbanization frequently has devastating

environmental impacts on natural ecologies, from air and water pollution and heat stress to

significant loss of key ecological buffers such as coastal marshes (Tang, Engel, Pijanowski, &

Lim, 2005; Uttawa, Bhuvandasa, & Aggarwal, 2012). Major coastal cities such as New York,

Miami, Boston, and New Orleans are particularly vulnerable to climate change events (Pelling &

Blackburn, 2014). Cities such as Detroit, which have suffered significant economic and

environmental challenges related to deindustrialization and disinvestment, face different but

equally profound vulnerabilities in the face of further environmental turbulence, such as

deteriorating infrastructure and severely reduced social and safety services.

Rural impacts

The growth of cities is mirrored, in turn, by the “hollowing out” of rural communities, which are

challenged by urban migration and by threats to rural livelihoods from acute weather events and

longer-term climatic changes (Tschakert, Tutu, & Alcaro, 2013). Climate changes such as long-

term drought and arctic warming and manmade disasters like oil spills disproportionately affect

the livelihoods and landscapes of rural residents. Such changes undermine well-being, disrupt

social networks, and deepen often unacknowledged disparities between rural and urban

populations, including differentials in access to formal resources and supports. Rural indigenous

communities, already persistently marginalized, are particularly vulnerable to negative health

and mental health outcomes as a result of changes in their environments and ways of life

(Cochran et al., 2013; Osofsky, Palinkas, & Galloway, 2010; Palinkas, 2009).


Population displacement

One of the most pronounced impacts of global climate change is the massive displacement of

populations. Environmental or ecological refugees are people forced to migrate because of

sudden or long-term changes to their local environment that compromise their well-being or

livelihood, such as increased droughts, desertification, sea-level rise, and the disruption of


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seasonal weather patterns such as monsoons (Myers, 1993). The Environmental Justice

Foundation (EJF) claimed in 2009 that 500 million to 600 million people—nearly 10% of the

world’s population—are at risk of displacement from climate change. Around 26 million have

already migrated elsewhere, a figure that the EJF predicts could grow to 150 million by 2050.

Many countries in the Global South (e.g., Bangladesh, Kenya, Papua New Guinea, Somalia,

Yemen, Ethiopia, Chad, Rwanda) could see large movements of people because of climate

change (EJF, 2009). The United States will not only see increasing numbers of transnational

climate refugees, but will increasingly be faced with internal displacement as people move from

arid, hot, and fire-prone areas to those with more equable climates. Domestically and globally,

already vulnerable and marginalized groups are most likely to be involuntarily displaced

(Warner, Ehrhart, de Sherbinin, Adamo, & Onn, 2009). Whether internal or transnational, these

population shifts will have significant implications for U.S. cities and regions, from strains on

infrastructure capacities and economic resources to social challenges associated with changing

community demographics (IPCC, 2014).

Natural disasters

Increased exposure to more severe natural disasters, both acute and chronic, is another major

impact. By 2015, on average more than 375 million people per year are likely to be affected by

climate-related disasters—over 50% more than have been affected in an average year during the

last decade (Schuemer-Cross & Taylor, 2009). Such events disrupt physical, social, and

communication infrastructures; diminish coping resources and social supports; drain or deplete

household assets; and pose temporary and long-term threats to physical and mental health and

safety (Caruana, 2010; Moser & Satterthwaite, 2010; Wells, Springgate, Lizaola, Jones, &

Plough, 2013). They exacerbate existing physical and mental health problems and create new

problems that interfere with help-seeking and evacuation (Neria, Nandi, & Galea, 2008; North &

Pffefferbaum, 2013). The World Bank’s Building Resilience report (2013) finds that economic

losses from natural disasters have risen from $50 billion each year in the 1980s to just under

$200 billion each year in the last decade. Total reported losses from disasters are estimated at

$3.8 trillion in this period with 74% caused by extreme weather (Munich RE, 2013).

Psychosocial impacts

In the United States, the psychosocial impacts of natural disasters have been well documented.

Boscarino et al. (2013) found that 14.5% of Superstorm Sandy survivors screened positive for

posttraumatic stress disorder (PTSD), 6% met criteria for depression six months postdisaster,

20% sought some type of professional counseling, and 30% experienced one or more of the

above. Perhaps the most thoroughly documented instance of postdisaster mental health impacts

was Hurricane Katrina. Galea et al. (2007) found that 17% of residents in New Orleans reported

signs of serious mental illness in the month after the disaster. Other impacts include significant

increases in the number of admissions for acute myocardial infarction during the six years after

Katrina (Peters et al., 2014), and interpersonal violence (Schumacher et al., 2010). Symptoms of

posttraumatic stress have declined over time but remained high 43–54 months later, especially

among those who had poor mental health and low socioeconomic status before the hurricane

(Paxson, Fussell, Rhoades, & Waters, 2012).


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The Katrina experience also illustrates the devastating impact of exposure to natural disasters

and forced relocation on community stability, cohesion, and resilience. An estimated 1.5 million

people left their homes along the Gulf Coast (Aljazeera America, 2013). Many who left did not

return, including a disproportionate number of African Americans, resulting in a population

decline in New Orleans from 484,000 to 344,000 (Robertson, 2011). Texas was the leading

location of displaced residents, followed by Louisiana and other locations in the South (Sastry &

Gregory, 2014). Those who relocated permanently were at increased risk for PTSD and other

mental health problems (Fussell & Lowe, 2014; Hansel, Osofsky, Osofsky, & Friedrich, 2013;

LaJoie, Sprang, & McKinney, 2010; Tucker, Pfefferbaum, Jeon-Slaughter, Khan, & Garton,


Disproportionately affected populations

Climate change and other forms of environmental degradation have an impact on all humans, but

these challenges disproportionately affect populations of lower economic privilege or social

status (Mearns & Norton, 2010; Preston et al., 2014; World Bank, 2013). These groups include

minorities, women, children, older adults, rural and urban poor, and individuals with a history of

mental or behavioral health problems, as well as low-income and geographically vulnerable

individual communities and entire nations. Disproportionate impacts include climate-related

disruptions in employment and income; escalating food insecurity; and the effect of extreme

weather events on the marginal, ecologically vulnerable, inadequately resourced locations where

the poor often live (Leichenko & Silva, 2014). As demonstrated by Hurricane Katrina in New

Orleans in 2005 and Typhoon Hiyan in the Philippines in 2013, the poorest and most

marginalized populations are especially vulnerable to natural disasters. Therefore, climate

change and environmental challenges “have social justice implications that demand

consideration” (Doherty & Clayton, 2011, p. 265). Both NASW (2012) and the International

Federation of Social Workers (2012) recognize that current and expected environmental

inequities that violate social justice principles in two key respects: (1) by unfairly targeting

vulnerable segments of the population, and (2) by increasing the numbers of vulnerable

individuals, communities, and nations.


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Social work interventions

Social workers can exercise a leading role in addressing the human impacts of environmental

change in four major areas: (1) disaster preparedness and response; (2) population dislocation;

(3) community-level organizing and development aimed at strengthening local and regional

capacity to respond to global environmental change, particularly in urban settings; and (4)

mitigation (i.e., targeted policy), advocacy, and practice engagement in addressing the

underlying causes of environmental change. Social work’s efforts must comprehensively cover

the interventions essential to addressing contemporary environmental threats: mitigation,

adaptation, and treatment. Mitigation refers to actions to limit the rate or magnitude of

environmental changes. Adaptation refers to “actions taken in advance of [environmental]

impacts or reactions in response to perceived or real…risks” (Ebi & Semenza, 2008); adaptive

capacity building, in other words, is aimed at both existing challenges and those as yet unknown

or unanticipated. Treatment refers to alleviating the health and mental health impacts of

environmental events on individuals and groups. In public health terms, mitigation, adaptation,

and treatment roughly align with primary, secondary, and tertiary prevention.

Disaster preparedness and response

Social workers have traditionally been engaged in both the development and implementation of

disaster preparedness plans and also the delivery of social and psychological services to disaster

victims. To effectively address the increasing numbers of severe disasters, however, social

workers will need to be even more actively engaged in disaster preparedness and response.

Drawing from the concept of corrosive communities and its relationship to theories of resource

conservation, cognitive activation, and risk and resilience, Palinkas (2012; 2014) proposed a

conceptual model that identifies three tiers of impacts of both natural and technological disasters:

Tier 1: Biopsychosocial impacts

Biopsychosocial impacts are direct consequences of the contamination of the physical

environment, including engagement in cleanup activities, short- and long-term economic and

cultural impacts, health effects related to contact with environmental hazards, and litigation

related to compensation for damages.

Tier 2: Interpersonal impacts

Interpersonal impacts are both direct consequences of the biopsychosocial impacts and mediators

of the relationship between the biopsychosocial and intrapersonal impacts, including a reduction

in levels of social support, increase in levels of social conflict, and an increase in collective

uncertainty about the future and long-term consequences of the disaster event.


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Tier 3: Intrapersonal or behavioral health impacts

Intrapersonal or behavioral health impacts are consequences of both the biopsychosocial and the

interpersonal impacts, including increases in the incidence of psychiatric disorders, drug and

alcohol abuse and dependence, stress-related physical and mental health symptoms, domestic

violence, and child behavioral problems.

Programs and practices designed to build behavioral resilience in individuals and communities

may serve to prevent or reduce the incidence and magnitude of biopsychosocial impacts in the

aftermath of a disaster. Over the past decade, community-based disaster management and

participatory disaster planning have emerged as broad strategies for building such resilience

(Pelling, 2007). Social work has the capacity to integrate these broad approaches with more

specific interventions tailored for application to disaster planning and prevention.

For example, existing interventions may serve as models for the development of interventions

that build resilience in families and communities before a disaster strikes. Two such

interventions are the Strengthening Families Program (SFP) and Coping with Work and Family

Stress. The Strengthening Families Program is a family skills training program designed to

increase resilience and reduce risk factors for behavioral, emotional, academic, and social

problems in children aged 3–16 years (Kumpfer, Molgaard, & Spoth, 1996). Coping with Work

and Family Stress is a workplace preventive intervention designed to teach employees aged18

years and older how to deal with stressors at work and at home (Snow, Swan, & Wilton, 2002).

The Communities That Care Program (CTC) likewise fosters an approach with potential for

adaptation to prevent behavioral health problems in children and adults postdisaster (Hawkins &

Catalano, 2002; Hawkins, Catalano, & Arthur, 2002). A community-based prevention program,

CTC mobilizes and empowers communities to adopt an evidence-based framework for the

implementation of evidence-based practices (EBPs) to prevent adolescent substance use and

other behavioral health problems. The program is designed to increase communication,

collaboration, commitment, and ownership among community members and service providers.

Social workers provide communities with technical assistance in coalition …

Attachment 2

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Climate Change, Human Rights, and Social Justice

Barry S. Levy, MD, MPH, Jonathan A. Patz, MD, MPH

Sherborn, MA; and Madison, WI

Both autho

No external

From the D




The environmental and health consequences of climate change, which disproportionately affect

low-income countries and poor people in high-income countries, profoundly affect human rights and

social justice. Environmental consequences include increased temperature, excess precipitation in some

areas and droughts in others, extreme weather events, and increased sea level. These consequences

adversely affect agricultural production, access to safe water, and worker productivity, and, by inun-

dating land or making land uninhabitable and uncultivatable, will force many people to become envi-

ronmental refugees. Adverse health effects caused by climate change include heat-related disorders,

vector-borne diseases, foodborne and waterborne diseases, respiratory and allergic disorders, malnu-

trition, collective violence, and mental health problems.

These environmental and health consequences threaten civil and political rights and economic, social,

and cultural rights, including rights to life, access to safe food and water, health, security, shelter, and

culture. On a national or local level, those people who are most vulnerable to the adverse environmental

and health consequences of climate change include poor people, members of minority groups, women,

children, older people, people with chronic diseases and disabilities, those residing in areas with a high

prevalence of climate-related diseases, and workers exposed to extreme heat or increased weather

variability. On a global level, there is much inequity, with low-income countries, which produce the least

greenhouse gases (GHGs), being more adversely affected by climate change than high-income countries,

which produce substantially higher amounts of GHGs yet are less immediately affected. In addition, low-

income countries have far less capability to adapt to climate change than high-income countries.

Adaptation and mitigation measures to address climate change needed to protect human society must

also be planned to protect human rights, promote social justice, and avoid creating new problems or

exacerbating existing problems for vulnerable populations.

K E Y W O R D S climate change, human rights,

inequalities, low-income countries, public health

© 2015 The Authors. Published by Elsevier Inc. on behalf of Icahn School of Medicine at Mount Sinai. This is

an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

“Climate change is a global problem with grave implications: environmental, social, economic, political and for the distribution of goods. It represents one of the principal challenges facing humanity in our day. Its worst

rs wrote this manuscript.

funding was used in developing this paper. Dr. Levy and Dr. Patz d

epartment of Public Health and Community Medicine, Tufts Univer

Madison, Madison, WI, Global Health Institute, the Nelson Institut

nce to B.S.L. ([email protected]).

impact will probably be felt by developing countries in coming decades.”

Pope Francis

Laudato Si June 2015

o not have any conflicts of interest.

sity School of Medicine, Sherborn, MA (BSL); and the University of

e, and the Department of Population Health Sciences (JAP). Address

A n n a l s o f G l o b a l H e a l t h , V O L . 8 1 , N O . 3 , 2 0 1 5 Levy and Patz M a y eJ u n e 2 0 1 5 : 3 1 0 – 3 2 2

Human Rights and Social Justice



Climate changedthe global climate crisisdmay be the defining moral issue of the 21st century.1,2 The environmental and health consequences of climate change, which disproportionately affect low-income countries and poor people in high-income countries, have profound effects on human rights and social jus- tice.3-11 These consequences threaten rights embod- ied in the Universal Declaration of Human Rights, such as the right to security and the right to a stand- ard of living adequate for health and well-being, including food, clothing, housing, medical care, and necessary social services.12 They threaten civil and political rights, such as “the inherent right to life” and rights related to culture, religion, and lan- guage, as embodied in the International Covenant on Civil and Political Rights.

13 They threaten eco-

nomic, social, and cultural rights, as embodied in the International Covenant on Economic, Social, and Cultural rights, including the following14:

d The right of self-determination. d The rights to freely determine one’s political status and freely pursue one’s economic, social, and cultural development.

d The right “to the enjoyment of the highest attainable standard of physical and mental health”.

d The right to education.

And they threaten the rights of women, as embodied in the Convention on the Elimination of all Forms of Discrimination against Women, especially women living in rural areas of developing countries, who are particularly vulnerable to the consequences of climate change.15 National govern- ments have a duty to ensure that all of these human rights are promoted and protected.

The United Nations Framework Convention on Climate Change (UNFCCC) is an international mechanism for facilitating international cooperation in stabilizing atmospheric concentrations of GHGs. It states: “Parties should, in all climate change- related actions, fully respect human rights.”16 The UNFCCC has concluded that human-rights considerations should guide the development, implementation, and monitoring of policies, institu- tions, and mechanisms related to climate that have been established under the UNFCCC.

Adverse environmental effects caused by climate change include increases in the following17:

d Temperature, as well as increased frequency and/or duration of heat waves.

d Heavy precipitation events. d Intensity and/or duration of droughts. d Intense tropical cyclone activity. d Sea level.

Other environmental phenomena related to climate change include the shrinking of land-based glaciers, increases in chemical pollutants and aeroallergens in ambient air, and changes in ecosystems that reduce biodiversity.17 The Intergovernmental Panel on Cli- mate Change has performed comprehensive assess- ments of (a) changes that have occurred and the human contribution to these changes and (b) the probability of further changes17 (Tables 1 and 2).

Adverse health consequences caused by climate change include heat-related disorders, vector-borne diseases, waterborne and foodborne diseases, respi- ratory and allergic disorders, malnutrition, violence, and mental health problems.18,19


There are large inequalities among countries in both the amounts of greenhouse gas (GHG) emissions and the magnitude and severity of adverse health consequences experienced as a result of climate change. Developing countries will experience the greatest impact of climate change.20-25 In general, those countries that contribute the least to GHG emissions currently experience, and will likely continue to experience, the most adverse health consequences as a result of climate change (Fig. 1).26 For example, in 2004, per-capita GHG emissions in the United States, Canada, and Australia approached 6 metric tons (mt), and those in Japan and Western European countries ranged from 2 to 5 mt. In contrast, annual per-capita GHG emissions in developing countries overall approximate 0.6 mt, and more than 50 developing countries have annual per-capita GHG emissions less than 0.2 mt. Economic Impact on Poor Countries. As global temperature increases, rich countries’ economies continue to prosper, but the economic growth of poor countries is seriously impaireddmore than previously estimated.27 The consequences for eco- nomic growth in poor countries will be substantial if we continue on a “business-as-usual” path of increasing carbon dioxide concentrations and rapid climate change, with poor countries’ mean annual growth rate decreasing from 3.2% to 2.6%.27 Poor countries are likely to suffer a greater adverse effect than rich countries from climate change because

Table 1. Assessment That Various Changes Have Occurred and Assessment of a Human Contribution to Observed Changes

Phenomenon and Direction of Trend

Assessment that Changes Occurred

(Typically Since 1950 unless Otherwise Indicated)

Assessment of a Human

Contribution to Observed Changes

Warmer and/or fewer cold days and

nights over most land areas

Very likely Very likely

Warmer and/or more frequent hot

days and nights over most land areas

Very likely Very likely

Warm spells/heat waves: Frequency

and/or duration increases over most

land areas

Medium confidence on a global scale

Likely in large parts of Europe, Asia, and Australia


Heavy precipitation events: Increase in

frequency, intensity, and/or amount of

heavy precipitation

Likely more land areas with increases than decreases Medium confidence

Increases in intensity and/or duration

of drought

Low confidence on a global scale

Likely in some regions

Low confidence

Increases in intense tropical cyclone


Low confidence in long-term (centennial) changes

Virtually certain in North Atlantic since 1970

Low confidence

Increased incidence and/or magnitude

of extreme high sea level

Likely, since 1970 Likely

From IPCC, 2013: Summary for Policymakers. In: Stocker TF, Qin D, Plattner GK, et al., eds. Climate Change 2013: The Physical Science Basis. Contribution of Working Group I to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge, UK: Cambridge University Press; 2013:7.

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(a) they are more often exposed to very high tem- peratures; (b) their economies heavily rely on agri- culture, natural resource extraction, and other sectors exposed to extreme weather variability; and (c) air conditioning, insurance, and other risk-management approaches are less available in poor countries than in rich countries.


Risk Factors. Various socioeconomic, demographic, health-related, geographic, and other risk factors,

Table 2. Assessment of the Likelihood of Further Changes in the E

Phenomenon and Direction of Trend

Likelihood o

Early 21st C

Warmer and/or fewer cold days and

nights over most land areas


Warmer and/or more frequent hot days

and nights over most land areas


Warm spells/heat waves: Frequency and/or

duration increases over most land areas

Not formall

Heavy precipitation events: Increase in frequency,

intensity, and/or amount of heavy precipitation

Likely over

Increases in intensity and/or duration of drought Low confide

Increases in intense tropical cyclone activity Low confide

Increased incidence and/or magnitude of extreme

high sea level


From IPCC, 2013: Summary for Policymakers. In: Stocker TF, Qin D, Plattner GK, et al Group I to the Fifth Assessment Report of the Intergovernmental Panel on Climat

such as poverty, minority status, female gender, young age or old age, and various diseases and dis- abilities, make populations or subgroups within populations more vulnerable to the adverse health effects of climate change. Adverse health effects caused by climate change will likely be heavily con- centrated in low-income populations at low latitudes, places where important climate-sensitive health outcomes (eg, malnutrition, diarrhea, and malaria)

arly and Late 21st Century

f Further Changes in the Early and Late 21st Century

entury Late 21st Century

Virtually certain

Virtually certain

y assessed Very likely

many land areas Very likely over most of the mid-latitude

land masses and over wet tropical regions

nce Likely (medium confidence) on a regional

to global scale

nce More likely than not in the Western

North Pacific and North Atlantic

Very likely

., eds. Climate Change 2013: The Physical Science Basis. Contribution of Working e Change. Cambridge, UK: Cambridge University Press; 2013:7.

Figure 1. Data-driven cartogram maps demonstrating (A) relative proportions of cumulative carbon dioxide emissions, by country, and (B) magnitude and severity of the consequences of climate change for malaria, malnutrition, diarrhea, and drownings, by country. (From Patz JA, Gibbs HK, Foley JA, et al. Climate change and global health: quantifying a growing ethical crisis. EcoHealth. 2007; doi.10.1007/s10393-007-0141-1.)

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are highly prevalent and where vulnerability to these outcomes is greatest.28 Other geographic risk factors include residing in areas with (a) epidemic disease associated with climate patterns, such as cholera linked to the El Niño Southern Oscillation; (b) decreased access to water or food as a result of drought or other consequences of climate change; and (c) increased risk of vector-borne or waterborne disease.


The adverse human-rights consequences of climate change are likely to have the greatest impact on

populations already suffering from human rights violations, such as residents of low-income countries and residents of low-income communities in high-income countries, as well as minority groups, unemployed people, individuals with chronic dis- eases and disabilities, and people living in unsafe or marginal environments. Women. There are many ways in which climate change disproportionately affects women.29-31 In low-income countries, women generally assume primary responsibility for gathering water, food, and fuel for their households. Climate changeeinduced droughts make this work much more difficult because water becomes less accessible, agricultural

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production decreases, and wood used for fuel needs to be obtained from increasingly distant places. As women face greater challenges in gathering water, they may develop increased risks of injury and rape.30

Women have higher rates of death than men from extreme weather events, such as hurricanes and other storms. Pregnant women are especially susceptible to vector-borne disease, such as malaria, and waterborne disease. Because of longstanding bias and discrimination, in many countries women have fewer resources to deal with damage and loss from extreme weather events. Children. Climate change adversely affects children in many ways.32,33 According to the World Health Organization (WHO), 88% of the burden of disease that can be attributed to climate change affects children younger than 5 years of age. Shortages of water and food lead to increased occurrence of childhood malnutrition and make it less likely that children will receive adequate education. In addition, children are more vulnerable than adults to extreme weather events and other disasters because they have less physical strength and during the disasters they may be separated from their parents. Like women, children are especially susceptible to vector-borne disease, such as malaria, and waterborne disease.

Because climate-sensitive health outcomes, such as malnutrition, diarrhea, and malaria, primarily affect children, the aggregate disease burden as a result of climate change appears to be borne mainly by children living in developing countries.


Climate change will likely increase the occurrence of all of the following28:

d Diarrhea in regions comprised mainly of developing countries by 8% to 9% by 2030.

d Malnutrition in a subregion of the WHO South-East Asian Region that includes India, Bangladesh, and 5 smaller countries by 17% by 2030.

d Mortality as a result of coastal floods in a subregion of the WHO European Region that includes Albania, Bulgaria, Poland, Romania, Turkey, and 11 other countries by 630% by 2030.

d Mortality as a result of inland floods in a subregion of the WHO Region of the Americas that includes the United States, Canada, and Cuba by 800% by 2030.

d Falciparum malaria, especially in African regions where it is highly endemic.

Indigenous People. Indigenous people are especially vulnerable to the adverse consequences of climate change, in part because their lives are closely tied to the natural environment. Environ- mental consequences of climate change can affect the physical well-being of indigenous people, such as their ability to obtain adequate food, water, and shelter, but also their spiritual well-being, in part because land is often an integral part of their culture and spiritual identity.

Geographic factors can also influence vulnerability of indigenous people to the adverse effects of climate change. For example, the Inuit and other Arctic peoples are experiencing major consequences of climate change because of the unusual warming in the Arctic region.34 Settlements on low-lying deltas or floodplains are at risk from sea level rise and flooding. Mountain settlements, such as those in the Andes and Himalayas that are dependent on snow pack for freshwater, are also at high risk. Workers. Workers in many occupations are also at increased risk. They include the following35:

d Outdoor workers performing jobs in extreme heat. d Other workers exposed to extremes of temperature or precipitation.

d Workers exposed to air pollutants, infectious agents, wildfires, extreme weather events, and/or psycho- logical stress.

d Workers in specific industries: utilities, transportation, emergency response, health care, environmental remediation, construction, demolition, landscaping, agriculture, forestry, wildlife management, heavy manufacturing, and warehouse work.


Heat Waves. Heat waves, which have increased in frequency in recent years, cause a variety of heat- related disorders and exacerbations of car- diovascular diseases, respiratory disorders, and other chronic conditions. (In addition, increased heat has adverse consequences on work productivity and activities of daily life.) Studies of heat waves and their adverse health consequences have identified vulnerable populations at especially high risk of morbidity and mortality, including older people, people living alone, urban populations, and those living in homes without air conditioning.36 A study in Europe demonstrated geographic differences in mortality as a result of heat waves.37

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Extreme Weather Events. Climate change has increased and is likely to produce more extreme weather events, such as cyclones or hurricanes, and has increased precipitation and flooding in some areas. In addition, climate change in other areas is increasing the number, intensity, and duration of droughts. Poor and marginalized people who live in flood plains and drought-prone areas are espe- cially vulnerable to extreme weather events and their adverse consequences on health and human rights. Compared with other populations, they generally lack access to protective and preventive services and lack the socioeconomic resilience to withstand the adverse consequences of these events.

The risk of being affected by weather-related nat- ural disasters is approximately 80 times greater in developing countries than it is in developed coun- tries.

38 The disproportionate adverse impact of

extreme weather events on the poor was demonstra- ted by Hurricane Katrina in 2005.39 Warmer water temperature in the Gulf of Mexico, resulting from climate change, increased the power of Katrina as it passed over the Gulf on its path to New Orleans and adjacent areas. However, although this hurricane affected all of New Orleans, the most vulnerable pop- ulations, including the poor, those with little or no political power, and people of color, suffered the most.40,41 Whereas helicopters removed affected people from the roofs of private hospitals, the pleas for assistance from charity hospitals were often ignored. Residents of rich neighborhoods were able to leave New Orleans in their own vehicles, whereas poor people, often from low-lying areas, were often trapped in or near their homes, and, if they survived, had to seek short-term shelter, such as at the over- crowded Superdome, and long-term shelter, often outside of New Orleans because low-income housing there became much more limited.42,43

Sea Level Rise. Average sea level throughout the world has increased about 20 cm (8 inches) during the past 100 years, a far greater amount than in the previous 2000 years.

44 Increased sea level will

worsen coastal erosion, exacerbate storm surges, inundate low-lying areas, and cause salinization of coastal aquifers. Sea level rise also threatens to inun- date low-lying coastal nations, such as Bangladesh, and small, low-lying island nations in the Pacific Ocean, such as Tuvalu and Kiribati. Sea level rise and other consequences of climate change (such as drought) are likely to make millions of people envi- ronmental refugees.45 There are many other reports and studies concerning the ways in which climate change will create forced migration.1,46-49

Air Pollution. Climate change is likely to increase chemical air pollutants, such as ozone.

50-55 Resul-

tant respiratory disorders, which are already most prevalent among low-income and minority pop- ulations,56 are likely to increase, with the impact being greatest in these populations.57-61

Because carbon dioxide stimulates plant growth, including growth of allergenic species, climate change will likely increase the allergenicity and distribution of pollen and other aeroallergens, resulting in increased prevalence and severity of allergic respiratory disorders.62-66

Food Insecurity and Malnutrition. Climate change and related environmental conditions, such as droughts and floods, are likely to adversely affect the ability to grow sufficient amount of food for rap- idly increasing populations. As a result, food and nutrition security will likely worsen, especially for poor people living in low-income countries. The prevalence of acute and chronic childhood under- nutrition, with accompanying adverse effects on physical and mental development, is likely to increase, especially in those low-income countries already seriously affected by malnutrition.67 There are many other reports and studies addressing food insecurity and malnutrition.

68-71 Increases in food

prices resulting from climate change will also adversely affect the nutritional status of children and other vulnerable populations.72

Vector-borne Diseases. Climate change, along with human population growth, increased urbanization, political and demographic changes, and increased international movement of people and materials, has a profound impact on the distribution and abundance of vectors and the pathogens that they can transmit. As a result, there have already been, and will continue to be, major changes in the patterns of vector-borne diseases, including malaria,73-75 Rift Valley fever,76,77 tick-borne encephalitis,78,79 and West Nile virus disease.80-82 In general, people in low-income countries and impoverished people in high-income countries are more vulnerable to these diseases. Waterborne and Foodborne Diseases. Climate change affects the occurrence of waterborne and foodborne disease in a number of ways.83 Heavy rainfall and resultant floods can contaminate water supply systems and result in increased gastro- intestinal illness84; for example, a study in India found an association between extreme precipitation and hospital admissions related to gastrointestinal illness.85 Droughts can reduce the availability of safe drinking water; for example, a global study found that childhood diarrhea may increase in incidence

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when there is decreased rainfall, suggesting that when water availability is lower, poor hygiene could account for increased gastrointestinal illness.86 In addition, storm events can overwhelm deteriorating sewer infrastructure in urban areas.87

Collective Violence. Climate change likely increases the global frequency of collective violence, which includes war and other forms of armed conflict, state-sponsored violence (such as genocide and torture), and organized violent crime (such as gang warfare).88 Meta-analyses provide strong evidence of a causal association between climate change and violence; for example, a meta-analysis and review based on 50 quantitative studies of the association between climate variables and violent conflict (as well as sociopolitical instability) found that when temperature is high and there is extreme precip- itation, there are increases in both sociopolitical instability and conflict.89 This meta-analysis dem- onstrated that the best designed studies found strong associations between anomalies of climate and both social instability and conflict; it also found that climate events can influence various types of conflict on a broad range of spatial scales.89

Scarcity of key environmental resources, such as farmland, forests, river water, and fish, can contrib- ute to violent conflict, such as by generating social stresses that lead to urban unrest, clashes among ethnic and cultural groups, and insurgency cam- paigns.90 Collective violence is more likely to adversely affect populations in low-income countries and poor people in mid- and high-income countries. Findings from a recent study in St. Louis suggest that, even in high-income countries, neigh- borhoods with higher levels of social disadvantage probably experience higher levels of violence because of unusually warm temperatures.91

Mental Health Problems. Mental health impacts of climate change include (a) direct impacts of extreme weather events, disasters, and a changed environ- ment; (b) indirect vicarious impacts, based on obser- vation of global events and concern about future risks; and (c) indirect psychosocial impacts at the community and regional levels.92,93 These mental health impacts disproportionately affect people of lower socioeconomic status.


Strategies to address climate change fall into 2 broad categories: (a) mitigation (primary prevention), which consists of measures to stabilize or reduce the

production of GHGs; and (b) adaptation (secondary prevention), which consists of measures to reduce the public health impact of climate change. The 2015 Lancet Commission on Health and Climate Change has identified the necessary policy responses to the impacts of climate change to “ensure the high- est attainable standards of health for populations worldwide.”94 Because climate change adversely affects human rights, these rights need to be consid- ered in designing and implementing mitigation measures95-97 and adaptation measures.98-101

International organizations and governments at the national, state/provincial, and local levels should ensure that human rights are considered in developing and implementing mitigation and adaptation measures. Nongovernmental and humanitarian organizations need to hold governments accountable in protecting and promoting these human rights. When human rights violations occur, governments should develop and implement monitoring systems to detect and respond to any further violations. Governments should coordinate multisectoral participation of agencies and organizations, ensuring a focus on protecting vulnerable populations. Governments should not only address immediate problems but also develop long-term strategies and programs to protect and promote human rights that are threatened by climate change.5

Mitigation. Mitigation of climate change is necessary to attain health-protective solutions that will last.102

Stabilizing or reducing GHG production can be done by implementing policies and using tech- nologies. Policies to promote and facilitate mitigation can be developed and implemented in most sectors of society, producing large gains in efficiency in the energy, transportation, and agriculture sectors. Energy policies can promote use of renewable energy, decrease use of fossil fuels, and reduce energy demand. Transportation policies can promote walk- ing and bicycling (active transport) as well as use of fuel-efficient vehicles. Agriculture policies can help to decrease meat production and meat consumption, appropriate development of biofuels, and reduce methane …

Attachment 3


The Aftermath of Humanitarian Crises: A Model for Addressing Social Work Interventions With Individuals, Groups, and Communities

Eileen A. Dombo 1

and Frederick L. Ahearn 2


This article reviews the aftermath of displacement caused by natural calamities such

as hurricanes, earthquakes, and man-made disasters such as war, ecological degrad-

ations, and political, religious, and ethnic persecution. These are traumatic events for

individual, families, and communities that require social work interventions.

Specifically, the authors will (a) explore the effects of displacement on individuals,

families, and communities; (b) propose an explanatory model of the effects of

trauma, loss, stress, and separation on behavioral outcomes as mediated by social

supports and coping styles; and (c) suggest humanitarian intervention strategies

conceptualized by the multilevel public health prevention model, with emphasis on

interventions at the individual, group, and community levels.


disasters, humanitarian interventions, loss, separation, coping, trauma, social work

interventions, psychosocial wellness

Illness, Crisis & Loss

2017, Vol. 25(2) 107–126

! The Author(s) 2015

Reprints and permissions:


DOI: 10.1177/1054137315606830


1 National Catholic School of Social Service, The Catholic University of America, Washington, DC, USA

2 Center for International Social Development, National Catholic School of Social Service, The Catholic

University of America, Washington, DC, USA

Corresponding Author:

Eileen A. Dombo, National Catholic School of Social Service, The Catholic University of America,

Washington, DC 20064, USA.

Email: [email protected]

There has been growing attention to the emotional and psychological plight (behavioral outcomes) of survivors of natural and human-induced disasters. Human displacement is the result of these forces, often beyond the control of individuals, families, and communities, requiring social work interventions within humanitarian settings. One might ask, “What happens to an ordinary individual, group, family, or community who has go through an extraordinary experience?”

This article attempts to answer this query by (a) reviewing the emotional and behavioral effects of displacement on individuals, families, and communities; (b) presenting an explanatory model of the interactive effects of trauma, stress, loss, and separation, as these are mediated by social and emotional supports and one’s coping style; and (c) proposing an array of social work intervention stra- tegies with individuals, groups, and communities viewed through the lens of the public health model of primary, secondary, and tertiary levels of intervention.

Effects of Displacement on Individuals, Families, and Communities

As of 2013, there are an estimated 42.9 million refugees, stateless, and internally displaced persons in the world, the largest number in the past 15 years. The bulk of refugees are found in Africa and the Middle East, while the stateless, mostly Palestinians, are located in the Middle East, and one finds the majority of internally displaced persons in the Americas, especially Columbia and South America (UNHCR Statistics, 2013). Social work practice with these populations has been greatly influenced by the various psychosocial theories popularized in recent years by mental health professionals. These theories are theories of trauma, loss, separation, stress, coping, and social supports. Three of these, loss, separation, and stress, often result from the traumatic experiences that cause displacement and are interactive, often leading to negative psychosocial consequences. We refer to these as the interactive variables. The theories of social support and coping are mediating factors that often soften the effects of the negative outcomes.

Interactive Variables

In this section, we will explore the role of trauma in the experience of displace- ment and discuss the interactive factors of loss, separation, and stress.

Trauma. Contemporary trauma theory asserts that a traumatic experience is defined as a situation that overwhelms the normal ability to cope. Traumatic stressors cause neurological as well as biological reactions, causing the indivi- dual to shut down or numb out due to an inability to process and integrate the experiences. These experiences are understood to be normal, expected reactions

108 Illness, Crisis & Loss 25(2)

to unexpected events. Trauma theory shifts the focus from individual pathology to include a systemic, societal issue that requires intervention. Through this lens, it is not just the individual’s mental health needs that must be addressed (Weaver & Burns, 2001). Social workers also attend to the traumatized community, restoring social systems and community structures that have been destroyed, so that basic needs can be met. The traumatic reactions of individuals are under- stood to be symptoms of distress that occur following overwhelming and terrify- ing experiences. It is not the individual who is sick, so much as it is the environment in which the displaced person exists.

An additional understanding of trauma is that individuals can adapt by tap- ping into their own strengths and capacity to heal. This concept of posttraumatic growth is a critical part of understanding resilience as reflected by the internal resources displaced persons may bring to bear on their own adaptation. The role of culture, traditional medicine, spiritual and religious practices, and other inter- nal resources will be crucial in helping survivors acknowledge that they hold the ability to heal themselves and that they may not require intensive psychosocial interventions.

Social work practice with survivors of war, disasters, and other forms of displacement frequently refers to traumatization and posttraumatic stress dis- order. Given the stresses of displacement and acculturation, social work inves- tigators found that a long-term vulnerability to trauma results from experiences of separation (Cohen, 2008), flight and uprooting (Khawaja, White, Schweitzer, & Greenslade, 2008), persecution, oppression, and torture (Weaver & Burns, 2001), natural disasters (Mathbor, 2007), and other stressful life events (Davies, 2008). Trauma is both a cause of problems in social functioning of those displaced as well as an effect of the displacing experience. Due to the subjective nature of trauma, the experience of displacement that involves loss, stress, and separation may or may not have a lasting traumatic impact. In sum, we find that trauma has been associated with displacement, flight, persecution, oppression, torture, and war and related to ones culture and religion. In turn, studies reveal that the manifestations of trauma are seen in emotional, physical, and biological reactions and behaviors as well as the traumatic effects of com- munity and organizational damage and destruction. In exploring the effects of displacement, we explore the interactive concepts of loss, separation, and stress.

Loss. Fried (1963) studied former residents who grieved for their lost homes which were destroyed to make way for a new highway and upscale apartments. More recently, Landau and Saul (2004) and Keller (2011) reported similar find- ings, stressing the importance of resiliency when community members have experienced loss, as they rely on natural supports and relationships. Another key variable is the importance of helping networks that mitigate the loss from neighborhood dislocation. Zinner and Williams (1999) documented this by refer- ring to group survivorship when a community weeps.

Dombo and Ahearn 109

Studies in the area of disaster intervention highlight the interrelationship of loss and grief (Iravani & Ghojavand, 2005). Loss of family members, relatives, and property are associated with increased anxiety, stress, and depression (Suar, Mandal, & Khuntia, 2002) and substance use problems (Cepeda, Valdez, Kaplan, & Hill, 2010). Significant losses may occur before, during, and after the disaster (Dow, 2011). These include change of personal status and plans for the future and loss of family members, loved ones, one’s culture and language, and freedom. War survivors of Sierra Leone (Kline & Mone, 2003), Cambodia (Rousseau & Drapeau, 2003), and Bosnia (Miller, Worthington, Muzurovic, Tipping, & Goldman, 2002), all suffered loss of parents, home, and the effects of migration and displacement. Keller (2011) reported similar findings, stressing the importance of resiliency when community members have experienced loss, as they rely on natural supports and relationships.

This is because the loss is not just in the physical environment but is also connected to a loss of internal world; a loss of meaning and purpose and identity (Alcock, 2003). Therefore, as these populations experience loss in flight, in seek- ing asylum, or in resettlement after a disaster, they will react by experiencing the various stages of bereavement, which often create serious adjustment problems for an individual and the community as a whole.

Separation. The impact of displacement on families must be understood within the context of separation and forced restructuring of the realms of family life, such as internal relationships, external community connections, roles and obligations, and communication patterns. If and when the family is reunited and made whole again, a process of finding a new normal creates a new stressor in itself (Doostgharin, 2009). One recalls the work of Freud and Bellingham (1943) which revealed that English children, removed from cities during the German blitz of World War II for the safety of the countryside, fared worse than those children who stayed in the war-affected area with their parents. There are consequences of separation and loss. It has been shown, for example, that separation and displacement are major life events that impact one’s well-being that often lead to anger and cultural bereavement (Cohen, 2008). In other studies, it was found that Middle Eastern refugee children exhibited anxiety, sleep disturbance, and depressed mood resulting from separation from parents (Montgomery, 2011). Finally, we know that the “Lost Boys of Sudan,” separated from their parents, coped using both emotional- and problem-focused strategies with strong support from their peers and elders (Luster, Qin, Bates, Johnson, & Rana, 2009). Similarly, lost boys resettled in Belgium had a greater risk of trauma compared with other refugee adolescents who resettled with their parents (Dertuyn, Mels, & Broekaert, 2009).

It is evident that separation is a form of displacement, often cited as a major event that has a serious impact on structures of community affecting the well- being of individuals. These experiences may result in trauma, guilt, anger, coping deficits, and other emotional manifestations.

110 Illness, Crisis & Loss 25(2)

Stress. In the 1970s, we witnessed considerable theoretical work dealing with the topic of stress. Stress, conceptualized as a multifaceted element in mental health, creates a burden for the individual that may be expressed by physical or psy- chological symptoms. On one hand, stress may be caused by outside agents (events or life situations) or as an internal process where stress is produced by the actions or thinking of an individual. Stress may manifest itself as (a) a stimulus or an event or class of events; (b) a response that is accompanied by bodily changes, physical and emotional such as sweating, anxiety, or fear; or (c) a blending of the two through interaction. Stresses may be endemic or chronic and cumulative. The processes of displacement and resettlement are frequently viewed as stressors, while the reactions of individuals to these events are seen as stresses. For example, researchers have found that Vietnamese adults and youth who have suffered from premigration and acculturation stresses were also prone to depression, nightmares, and physical illness (Weaver & Burns, 2001). For displaced persons, these stressors result from change, acculturation, bereave- ment, family and intergenerational conflict, occupational and economic uncer- tainty, discrimination, poor physical health, and cultural adjustment (Orley, 1994).

In the disaster literature, there are similar report of the association of stress and a variety of psychological symptoms. The degree of exposure to the stresses of Hurricane Katrina by women led to increased psychological distress (Lowe & Rhodes, 2013) and partner abuse (Schumacher et al., 2010). Partner abuse was also found to increase after the Sichuan earthquake (Chan & Zhang, 2011). In doing clinical assessment, authors have recommended attention to stress, apprai- sal, and coping theories in forming an intervention plan (Matthieu & Ivanoff, 2006).

The literature on stress reveals that displacement causes endemic and cumu- lative stressors that are frequently associated with a variety of physical and emotional symptoms, such as sleeping disorders, nightmares, depression, inabil- ity to relate to others, and physical illness.

Mediating Factors

Social Supports. An additional body of literature has developed regarding social supports that serve as mediating factors that facilitate adjustment or readjust- ment. Individual characteristics, such as intelligence, personality, age and experi- ence, resilience and fortitude, and belief system, serve as guides to navigating daily life. External supports that are most significant for individuals include the family, relatives, friends, neighbors, the school, church, or civic or mutual aid associations (Renner, Laireiter, & Maier, 2012). The availability of and acces- sibility to community resources, services, and networks are also important sources of support in confronting and coping with stressful life events. Lack of social support and social interactions has been linked with poor educational

Dombo and Ahearn 111

and employment outcomes, and anxiety and depression for displaced persons (Finn, 2012; Renner, et al., 2012).

Social supports strengthen one’s capacity to deal with displacement and the concomitant problems in daily living, including psychological and emotional behaviors. These supports may be the family, a significant relative or friend, and the external programs and services.

Coping. Paralleling the theoretical work of the stress theorists is the early work of Pearlin and Schooler (1978), who posited that coping behaviors protect people from further psychological harm. They presented three fundamental ways by which persons cope with the trauma of loss and stress: (a) control, (b) tolerance, and (c) minimization. Noting the importance of appropriate developmental tasks, Davies (2008) found that inadequate coping skills were one factor that hindered educational and psychological developmental in adolescence among Sierra Leonean refugees in New York City public schools. Furthermore, the significance of coping strategies among Sudanese refugees was highlighted by Khawaja et al. (2008), who found that individuals used religiosity, cognitive strategies, and hope for the future as well as social supports to aid in coping.

More recently, religion and spirituality have been understood to be the key factors in coping. Religious faith is often an underlying mechanism for adjust- ment to adversity, and spiritually based group support is effective in teaching adaptive coping skills and has also been established as a coping mechanism among African torture survivors (Leaman & Gee, 2012) and with Hindu Bhutanese who have been resettled to the United States (Benson, Sun, Hodge, & Androff, 2012).

Often overlooked in assessing coping is the role that resilience plays in mitigating long-term psychosocial problems. Resilience is not a zero-sum phenomenon, where it is either present or absent. Resilience is transactional and contextual; elements of resilience can be found in individuals, families, and communities who have experienced the most profoundly traumatizing events. The inability to distinguish between normal reactions to displacement and true psychological trauma has caused a Western belief that all displaced persons are vulnerable, powerless, and in need of being rescued (Pupavac, 2008). Therefore, when assessing and understanding the level of coping, it is essential to look for expressions of resilience (Khawaja et al., 2008). By highlighting and validating the internal resilience in the individual, family, or community, the social worker is starting where the client is and working from a strengths perspective.

It is our conclusion that a defining characteristic of those in need of huma- nitarian aid is the experience of displacement caused by man-made and natural disasters. In turn, as we have seen, displacement is characterized by community disorganization and destruction that can lead to psychosocial outcomes

112 Illness, Crisis & Loss 25(2)

associated with trauma, stress, loss, and separation for some members of the community. How displacement is experienced depends on many things, such as the nature and degree of the disastrous event; what was going on in a person’s life before, during, and after the disaster; and the availability of social supports and one’s coping style that may lead to resolution and adjustment. Here, we extend this review of findings in the literature to an explanatory model of psy- chosocial outcomes.

Explanatory Model of Psychosocial Outcomes

The explanatory model presented in Figure 1 illustrates the causative nature of traumatic incidents on the displacement. The experiences of loss, separation, and stress are mediated by the presence or absence and strength or weakness of social and community supports and coping abilities. These variables will have a sig- nificant impact on psychosocial outcomes that may require social work inter- ventions not only at the individual but also the community levels in the aftermath of a humanitarian crisis. Social workers can utilize this model to deepen their understanding of the effects of displacement. Expressions of beha- vioral and psychological problems can be understood as an inability to cope with the traumatic experience of displacement, such as the stress of adaptation to the loss of home, loss of life, and separation from family and community. Additionally, it will help to inform problem formulation and the selection of appropriate interventions within humanitarian settings that can be chosen from the prevention model described in the next section.

Traumatic Event

Displacement Psychosocial


Community Social Supports and Individual Coping

Loss Stress


Figure 1. Explanatory model of psychosocial outcomes from displacement.

Dombo and Ahearn 113

Social Work Intervention Strategies Conceptualized by the Multilevel Public Health Prevention Model

We have demonstrated that social work practitioners and researchers are very much attuned to the concepts of trauma, stress, crisis, loss, coping, and social supports systems as concepts to guide them in the understanding the experiences of displacement, the nature and extent of the problems, and ways in which to intervene to give assistance to survivors. Social workers often used crisis inter- vention techniques and rapid and short-term strategies designed to return the person to his or her previous functioning. Some employed play therapy with children, psychotherapy with individuals, family treatment, social group work, informal support from peers and elders, and the removal barriers to accessing services in the environment (Finn, 2012). Practitioners have expanded their psychosocial interventions to include connecting the individual and family with social, economic, and educational resources they need to reestablish them- selves, as well as rebuilding community supports and structures while promoting individual and community empowerment.

However, given the nature of the extensive needs of displaced individuals, some researchers have suggested that social workers form interdisciplinary part- nerships with teachers, church representatives, job counselors, employers, and court personnel in solving the many day-to-day problems (Xu, Bekteshi, & Tran, 2010). Historically, the conception of social work with these groups came to include considerable community work as well as clinical services. Montero and Dieppa (1987) advised that social work practitioners assist displaced persons with their daily coping skills and also work with indigenous, mutual assistance agencies to connect with language, employment, and cultural resources, approaches not dissimilar from those that began in the settlement houses in the 19th century. Adding to an emphasis on family treatment, case management, and empowerment, social workers may also consider (a) work with ethnic orga- nizations and (b) a focus on policies impacting displaced persons.

Toward a Model of Social Work Interventions in the Aftermath of Humanitarian Crises: Transferable Insights From the Past

It is apparent from this review of social work practice with displaced persons that treatment interventions must combine both clinical and community strate- gies. Given the stresses and losses associated with displacement, individuals and families may experience social, psychological, and economic problems while communities are involved in the rebuilding of social structures and supports. Both the individual and the community are targets for social work intervention, but the intervention must not come from a Westernized view of displaced per- sons as helpless and powerless (Pupavac, 2008). To integrate these approaches,

114 Illness, Crisis & Loss 25(2)

we propose the utilization of the schema of public health prevention levels view- ing social work practice methods, clinical and community, as means to (a) pre- vent problems from occurring, (b) intervene rapidly to restore balance and homeostasis, and (c) promote long-term assistance and rehabilitation. These roles can be infused into an existing or newly created program. In many ways, the public health model supports social work’s person-in-environment perspec- tive in that it recognizes targeting for intervention individual, families, and communities. Marsella (2011) clearly argues for health promotion and commu- nity action when working in developing countries. This approach:

consists of social educational, and political actions that: enhance public awareness

of health; foster healthy life styles, and community action in support of health: and

empower people to exercise their rights and responsibilities in shaping environ-

ments, systems, and policies that are conducive to health and wellbeing Marcella.

(Marsella, 2011, p. 7)

As this model is presented in Table 1, we illustrate the levels of prevention in an actual case example as personally experienced by one of this article’s authors.

Case Example: Cuban Refugees in America

In 1980, Fidel Castro publically announced that any Cuban who wished to leave

the island could do so. When the exodus became enormous and embarrassing for

the regime, Castro emptied prisons and mental institutions and rounded up people

considered to be undesirables such as homosexuals, street kids, and Seventh day

Adventist to send as well. One hundred and twenty-five thousand (125,000) refu-

gees landed in Florida and were hastily screened by the U.S. Army. Of these, 19,000

were sent on to a Pennsylvania National Guard camp, Fort Indiantown Gap,

where a mental health program was set up alongside the general health system

(Mariel Boatlift, 2015).

Primary Prevention: This massive migration of Cubans to the United States was

sudden and caught Americans by surprise. However, many departments of the U.S.

government had prepared for mass emergencies due to nature disasters and forced

migrations. Plans had been made in the case of an emergency. Practice simulations

involved many governmental and nongovernmental organizations preparing for

such a calamity as each of the organizational entities coordinated their roles with

other responders. This is just what happened when the thousands of Cubans landed

on the shores of Florida. The military were on hand to provide security, personnel

for the State Department registered the newcomers, medical staff of the Public

Health Service conducted cursory medical examinations, and the Red Cross was

on hand in an attempt to contact relatives to vouch for and sponsor individuals and

Dombo and Ahearn 115

Table 1. Model for Social Work Practice With Displaced Persons.

Intervention phases Social work interventions

Primary phase Purpose: to prevent

psychosocial problems arising from displacement.

1. Advocacy of humane immigration policies as well as policies that prevent, avoid, or mitigate the effects of displacement.

2. Education of and information for individuals and groups at the appropriate levels to facil- itate cultural understanding and acceptance.

3. Integration of social and economic policies and programs that strengthen displaced indivi- duals, their families, and communities.

4. Training of mental health professionals to understand and identify trauma sequelae in displaced persons.

Secondary phase Purpose: to intervene

rapidly when psychosocial problems occur.

1. Advocacy to change and rectify policies that contribute to the negative effects of displacement.

2. Planning of social and economic programs that strengthen the existing social fabric of com- munities, their structures, and institutions.

3. Repairing social networks, strengthening families, and enhancing of resources and support.

4. Assessment for initial indicators of trauma such as shock, numbness, and dissociation. Refer for crisis intervention if needed to strengthen adaptive coping.

Tertiary phase Purpose: to provide

long-term interventions when psychosocial problems become chronic.

1. Advocacy of policies that seek peace, reconci- liation, human rights, and social justice.

2. Planning of social and economic programs that rebuild communities and revitalize structures, culture, and values.

3. Rehabilitation of communities that have suf- fered from the chronic problems from displacement.

4. Long-term psychological treatment to address the traumatic impact of loss, stress, and separation.

116 Illness, Crisis & Loss 25(2)

families out of the camp. Those not sponsored were then sent to other camps in

Arkansas, Wisconsin, and Fort Indiantown Gap, Pennsylvania.

The first step in the creation of the mental health program in the camp was the

recruitment of qualified staff. Through the Public Health Service and the National

Institute of Mental Health, a call was put out for mental health volunteers, drawing

scores of social workers, psychologists, and psychiatrists who donated weeks of

their time for the effort. Overtime, it became evident that there were also mental

health professionals among the refugee population who were then recruited,

oriented, and teamed with an American mental health professional. The Cuban

and American teams focused on primary prevention activities each morning, train-

ing, and orienting the camp and barrack leaders to this mental health resource for

refugees under their command or in their area. This was done to facilitate case

finding and case follow-up.

An organizational chart for mental health services in an inpatient and outpatient

system was designed; cooperative agreements set with other actors in the camp; and

a plan for the training and supervision of staff established. Space was located,

required permissions sought and granted. The program was ready for take off.

Secondary Prevention: An outpatient clinic for individual and group treatment was

opened daily in the afternoon. Attached to the clinic was a pharmacy that dis-

pensed medications. In addition to the professional mental health staff, two groups

in the refugee population were also brought into the system to assist the mental

health clinic. One was the serendipitous discovery that next door to the clinic was a

facility for body builders. A number of these men were recruited and trained as

guards at the front door to maintain order and at the dispensing window to prevent

robbery of medication from patients. The other group to be involved as collabora-

tors was the curanderos, or local medicine men or women. They agreed to refer

clients in need to the mental health clinic and in turn the clinic staff, where appro-

priate, could call upon a curandero for assistance.

Tertiary Interventions: As soon as the camp opened, there was a need for an

inpatient system, as hundreds of former mental patients, most without their med-

ications, were in crisis, acting out, and becoming dangerous to themselves and

others. This required the immediate establishment of an inpatient psychiatric facil-

ity to support these individuals. Some obviously required continuing care, while

others were immediately stabilized with medication and returned to the general

camp population.

Three months later, the camp closed as all but 3,000 refugees were sponsored out of

the camp by relatives or friends. The remainder of the refugees were sent to Federal

psychiatric or prison facilities in the United States.

Dombo and Ahearn 117

How, then, might we apply the lessons of this case to situations that social planners and practitioners may meet today? Viewing Table 1, one can begin to see the many social …