ADVANCEMENT OF THE SCIENCE
al., 2022). While drought is often not the sole contributor to food insecurity and poverty, it does amplify existing challenges. Drought poses numerous health-related and economic challenges that often induce internal (within-country) and external (between-country) migration. Typically, drought-related migration consists of men from rural, agricultural communities seek- ing alternative income sources in urban areas—areas that might also be experienc- ing drought-related health impacts (Defrance et al., 2023; Gray & Mueller, 2012). Migra- tion as an adaptive strategy, however, is often a temporary last resort (Jülich, 2011). Drought-related migration is a contributor to global migration and accounted for 10% of the global increase in migration between 1970 and 2000 (Zaveri et al., 2021). Some subpopulations—notably women and the poor—are unable to migrate due to finan- cial or other barriers and instead face other health-related challenges of drought (Bor- gomeo et al., 2021; Defrance et al., 2023; Gray & Mueller, 2012). Individuals who do migrate also experience a variety of negative health outcomes. Migrants, when not appro- priately supported by the nation-state gov- ernments receiving them, face an increased risk of infectious diseases—notably, tubercu- losis, AIDS, and waterborne and foodborne illnesses (Gushulak & MacPherson, 2007). Mental health challenges, including but not limited to depression, also persist in migrant communities (Bhugra, 2004). Drought also affects the mental health of nonmigrant communities. Again, drought increases food insecurity, a risk factor for men- tal distress (Friel et al., 2014). Other stressors, including financial distress and social isola- tion, pose challenges (Sartore et al., 2008; Vins et al., 2015). Farmers and their families thus report increased stress and depression dur- ing droughts (Dean & Stain, 2010; Sartore et al., 2008; Vins et al., 2015). Drought-related mental health challenges can be so severe as to increase suicides, especially in rural men (Hanigan & Chaston, 2022). The culminat- ing economic and health-related challenges of drought have severe consequences on rural mental health, compounding the public health burden of drought. Our study examines the health-related consequences of drought in two regions, the Po River Basin (PRB) in Northern Italy and
FIGURE 2
The Colorado River Basin (CRB) in the Southwestern United States
Source: Lincoln Institute of Land Policy.
the Colorado River Basin (CRB) in the West- ern U.S. The 661-km (410-mi) Po River forms the 71,000 km 2 (27,000 mi 2 ) PRB, providing water for 17 million people in Italy and Swit- zerland (Figure 1). The 2,220-km (1,400- mi) Colorado River forms the 630,000 km 2 (240,000 mi 2 ) CRB, providing water for 40 million people across 7 states (Arizona, California, Colorado, Nevada, New Mexico, Utah, and Wyoming), 30 federally recognized tribes, and Mexico (Figure 2). Both rivers are sourced largely from snowmelt, and as such are threatened by rising temperatures due to climate change. In the PRB, decreased precip- itation and snowmelt, along with increased evapotranspiration (likely due to higher temperatures), have led to periodic drought conditions. Similarly, warming trends in the CRB have decreased snowpack, leading to a sustained drought since 2000. To prioritize avenues for public health and other policy interventions, we explore the
severity of the potential health-related conse- quences of drought in both the PRB and the CRB. Additionally, we compare the severity of each consequence between both regions to demonstrate how geography and exist- ing policies influence the degree to which droughts impact communities. Methods Our study examined the severity of PM 10 , PM 2.5 , coccidioidomycosis, groundwater nitrate infiltration, WNV, and relative pov- erty in the PRB and CRB. To assess these health-related consequences of drought, we used publicly available data sets. The 2013–2021 PM 10 and PM 2.5 data from Italy originated from the European Environ- ment Agency (2025a, 2025b), while the U.S. Environmental Protection Agency (2023) sourced the 2013–2022 U.S. data. The Ari- zona and California 2013–2022 county- level coccidioidomycosis data originated
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Volume 87 • Number 10
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