Social determinants of health and climate change factors in Chuukese migration to Guam

Social Determinants Of Health (SDoH), such as economic stability, access to education and healthcare, and environmental conditions, greatly shape overall well-being. While climate change is traditionally viewed as an isolated environmental driver of human migration, emerging research suggests it exacerbates existing socioeconomic vulnerabilities, particularly within low-income Pacific Island communities. Geographically remote and low-lying, inner and outer lagoon islands in Chuuk State, Federated States of Micronesia, face increasingly severe environmental pressures, leading to significant migration to Guam. Existing studies frequently label these individuals strictly as climate refugees or climate migrants. However, this narrow classification overlooks the lived realities of migrants, specifically how climate change operates in the background to influence social determinants of health before and after migration. This mixed-methods comparative case study examines the relocation experiences of inner and outer lagoon Chuukese islanders currently living in Guam. Data collection focuses on capturing the myriad reasons for migration alongside post-relocation outcomes. By evaluating changes in livelihood, food security, environmental and climate conditions, and community networks, the study shows how climate change intersects with traditional socioeconomic migration drivers. Preliminary analysis shows that Chuukese migrants to Guam do not view climate change as the main reason for their relocation; Rather, employment and educational opportunities are the primary drivers. However, climate change may act as an unrecognized push factor, as participants acknowledge its impact both in their homeland (and in Guam) but do not consider it a key reason for their move. After relocating, participants report changes in their SDoH. While they face increased financial and social challenges, they also observe more employment opportunities, better healthcare, and homes designed to withstand climate change. Additionally, Guam's ability to recover quickly after severe weather events ultimately enhances their overall sense of safety. These preliminary findings challenge climate refugees or climate migrants labels by demonstrating that climate change acts as a background influence on social determinants of health rather than a standalone displacement trigger. Additionally, this research shows that while migration can both positively and negatively impact the social determinants of health, overall migrants are satisfied with their decisions to relocate. These findings may guide policymakers and the public health community in developing programs to address the specific challenges faced by Chuukese migrants, such as economic instability and difficulties in community and social integration.

Michelle Budwitz is an assistant professor of public health at Hartwick College and an expert in global health and epidemiology. She holds a Ph.D. in public policy and social change and an MPH in epidemiology. Her international work focuses on infectious disease surveillance, health systems strengthening, and capacity building. As a professor and researcher, Budwitz is interested in understanding and addressing the health needs of vulnerable and disenfranchised populations, while training the next generation of public health professionals in applied research, epidemiology, and community health strategies.