Perfect storm: a scoping review of interventions and preparedness strategies at the intersections of climate change, migrant worker health and health systems.

Objectives: To map and synthesise evidence on interventions and preparedness strategies addressing climate-related occupational health risks among migrant workers and to identify gaps across five domains: formal health sector; health surveillance systems; regulations or policies; corporate and public procurement and worker, employer, non-governmental organisation (NGO) and academic strategies. Design: Scoping review conducted in accordance with the Arksey and O'Malley framework and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews. Data sources: Ovid MEDLINE and Ovid Global Health, searched for peer-reviewed studies published from 1 January 2000 to 28 March 2025, in any language. Expert consultations were used to identify five intervention domains and to supplement database searches. Eligibility criteria: Peer-reviewed studies reporting on interventions or preparedness strategies at the intersection of climate change, occupational health and migrant worker populations. Studies of any design were eligible. Studies focusing solely on internal migrants or addressing general climate-related health risks without explicit reference to occupational health or migrant workers were excluded. Data extraction and synthesis: Title, abstract and full-text screening was conducted independently by at least two reviewers, with discrepancies resolved through discussion. Data were charted using a standardised extraction sheet and analysed descriptively and thematically. Results: 19 studies met the inclusion criteria. Most (15) were from the USA; four were from Egypt, Guatemala, UAE and Kuwait. Studies focused primarily on agriculture. Interventions were found for the formal health sector (n=3); regulations or policies (n=4) and workers, employers, NGOs and academics (n=12). We found a critical lack of health sector preparedness to address rising climate-related migration and worker morbidity. Despite the protection potential of policies, regulations and cross-border agreements, only four studies evaluating these approaches were identified. No intervention studies were found for corporate and public procurement or health surveillance. This likely reflects broader gaps in data systems, which rarely collect or disaggregate climate-related health outcomes for migrant workers, especially in low- and middle-income countries. Conclusions: Health systems remain critically underprepared to detect, foresee and respond to climate-related illness among migrant workers. Migrant-inclusive public health requires surveillance systems that capture this population, stronger protections against exploitative labour conditions that exacerbate climate vulnerability, and demand-side accountability from corporate and procurement actors. Applying just transition principles will promote workers' participation in decisions shaping their own health, rights and livelihoods.