Fragile Paradise: Health Impacts of Climate Change in Pacific Island Countries

Pacific island countries are among the most vulnerable in the world to the impacts of climate change, including the many and varied effects on human health. The vast majority of these health impacts are expected to be negative and the burden of climate change-attributable ill-health will be maldistributed, with the greatest suffering likely to be experienced by the poor. The objectives of the research described in this thesis were: a) To critically appraise various methods of assessing climate change and health vulnerabilities in Pacific island countries; b) To establish the key climate-sensitive health risks in each country; and c) To develop an evidence base for health systems adaptation to climate change in the Pacific region. Thirteen countries participated in this regional climate change and health vulnerability assessment and adaptation planning project between 2011 and 2013: Cook Islands, Federated States of Micronesia, Fiji, Kiribati, Marshall Islands, Nauru, Niue, Palau, Samoa, Solomon Islands, Tonga, Tuvalu and Vanuatu. This project, supported by the World Health Organization South Pacific office, employed a range of quantitative and qualitative techniques in the assessment and stratification of climate change and health risks for each country and the development of regional and country-specific adaptation strategies. The thesis presents the results of these analyses and describes in detail the predominant risks to health posed by climate change in the Pacific. These include: injuries and trauma; compromised safety and security of water and food (leading to malnutrition and gastrointestinal infections); vector-borne diseases; heat-related illnesses; zoonoses; respiratory ailments; psychological and emotional ill-health; increasing morbidity and mortality from non-communicable diseases; population pressures; and increased strain and pressure on health systems in these small island developing states. Correspondingly, the adaptation themes common across the region relate to improving the safety and security of food supplies and water, sanitation and hygiene facilities; enhancing infectious disease surveillance and response capabilities; building resilience within health systems and of health infrastructure; and increasing the accuracy and efficiency of communication and collaboration between the health sector and other agencies. The results of these assessments have been compiled into national climate change and health adaptation plans for each country, and synthesised in a World Health Organization report published in late 2015. The thesis summarises the main categories of adaptation strategies planned around the region and the health systems and policy landscape within which adaptation is taking place. In doing so, the thesis combines overviews of the vulnerabilities and adaptation plans from a regional perspective, along with examples of specific countries, including Federated States of Micronesia, Fiji, Kiribati and Vanuatu. The overall aim of this work is to enhance the ability of individuals, communities and health systems in the region to withstand the pressures and hazards posed by climate change, by providing a body of scientific evidence and a basis for sound policies aimed at protecting the health of Pacific Island people. It is clear that this will necessarily involve substantial support from wealthier countries – the messages are increasingly clear; the audience is global; and the timing is urgent

International approaches to rural generalist medicine: a scoping review

Background: Contemporary approaches to rural generalist medicine training and models of care are developing internationally as part of an integrated response to common challenges faced by rural and remote health services and policymakers (addressing health inequities, workforce shortages, service sustainability concerns). The aim of this study was to review the literature relevant to rural generalist medicine. Methods: A scoping review was undertaken to answer the broad question 'What is documented on rural generalist medicine?' Literature from January 1988 to April 2017 was searched and, after final eligibility filtering (according to established inclusion and exclusion criteria), 102 articles in English language were included for final analysis. Results: Included papers were analysed and categorised by geographic region, study design and subject themes. The majority of articles (80%) came from Australia/New Zealand and North America, reflecting the relative maturity of programmes supporting rural generalist medicine in those countries. The most common publication type was descriptive opinion pieces (37%), highlighting both a need and an opportunity to undertake and publish more systematic research in this area. Important themes emerging from the review were: - Definition - Existing pathways and programmes - Scope of practice and service models - Enablers and barriers to recruitment and retention - Reform recommendations There were some variations to, or criticisms of, the definition of rural generalist medicine as applied to this review, although this was only true of a small number of included articles. Across remaining themes, there were many similarities and consistent approaches to rural generalist medicine between countries, with some variations reflecting environmental context and programme maturity. This review identified recent literature from countries with emerging interest in rural generalist medicine in response to problematic rural health service delivery. Conclusions: Supported, coordinated rural generalist medicine programmes are being established or developed in a number of countries as part of an integrated response to rural health and workforce concerns. Findings of this review highlight an opportunity to better share the development and evaluation of best practice models in rural generalist medicine

Water-Borne Diseases and Extreme Weather Events in Cambodia: Review of Impacts and Implications of Climate Change

Cambodia is prone to extreme weather events, especially floods, droughts and typhoons. Climate change is predicted to increase the frequency and intensity of such events. The Cambodian population is highly vulnerable to the impacts of these events due to poverty; malnutrition; agricultural dependence; settlements in flood-prone areas, and public health, governance and technological limitations. Yet little is known about the health impacts of extreme weather events in Cambodia. Given the extremely low adaptive capacity of the population, this is a crucial knowledge gap. A literature review of the health impacts of floods, droughts and typhoons in Cambodia was conducted, with regional and global information reviewed where Cambodia-specific literature was lacking. Water-borne diseases are of particular concern in Cambodia, in the face of extreme weather events and climate change, due to, inter alia, a high pre-existing burden of diseases such as diarrhoeal illness and a lack of improved sanitation infrastructure in rural areas. A time-series analysis under quasi-Poisson distribution was used to evaluate the association between floods and diarrhoeal disease incidence in Cambodian children between 2001 and 2012 in 16 Cambodian provinces. Floods were significantly associated with increased diarrhoeal disease in two provinces, while the analysis conducted suggested a possible protective effect from toilets and piped water. Addressing the specific, local pre-existing vulnerabilities is vital to promoting population health resilience and strengthening adaptive capacity to extreme weather events and climate change in Cambodi

Assessment of Climate-sensitive Infectious Diseases in the Federated States of Micronesia

Background: The health impacts of climate change are an issue of growing concern in the Pacific region. Prior to 2010, no formal, structured, evidence-based approach had been used to identify the most significant health risks posed by climate change in Pacific island countries. During 2010 and 2011, the World Health Organization supported the Federated States of Micronesia (FSM) in performing a climate change and health vulnerability and adaptation assessment. This paper summarizes the priority climate-sensitive health risks in FSM, with a focus on diarrheal disease, its link with climatic variables and the implications of climate change. Methods: The vulnerability and adaptation assessment process included a review of the literature, extensive stakeholder consultations, ranking of climate-sensitive health risks, and analysis of the available long-term data on climate and climate-sensitive infectious diseases in FSM, which involved examination of health information data from the four state hospitals in FSM between 2000 and 2010; along with each state’s rainfall, temperature and El Nino-Southern Oscillation data. Generalized linear Poisson regression models were used to demonstrate associations between monthly climate variables and cases of climate-sensitive diseases at differing temporal lags. Results: Infectious diseases were among the highest priority climate-sensitive health risks identified in FSM, particularly diarrheal diseases, vector-borne diseases and leptospirosis. Correlation with climate data demonstrated significant associations between monthly maximum temperature and monthly outpatient cases of diarrheal disease in Pohnpei and Kosrae at a lag of one month and 0 to 3 months, respectively; no such associations were observed in Chuuk or Yap. Significant correlations between disease incidence and El Nino-Southern Oscillation cycles were demonstrated in Kosrae state. Conclusions: Analysis of the available data demonstrated significant associations between climate variables and climate-sensitive infectious diseases. This information should prove useful in implementing health system and community adaptation strategies to avoid the most serious impacts of climate change on health in FSM

Assessment of the Health Impacts of Climate Change in Kiribati

Kiribati—a low-lying, resource-poor Pacific atoll nation—is one of the most vulnerable countries in the World to the impacts of climate change, including the likely detrimental effects on human health. We describe the preparation of a climate change and health adaptation plan for Kiribati carried out by the World Health Organization and the Kiribati Ministry of Health and Medical Services, including an assessment of risks to health, sources of vulnerability and suggestions for highest priority adaptation responses. This paper identifies advantages and disadvantages in the process that was followed, lays out a future direction of climate change and health adaptation work in Kiribati, and proposes lessons that may be applicable to other small, developing island nations as they prepare for and adapt to the impacts of climate change on health

Fragile paradise: health and climate change in the South Pacific

Island countries of the South Pacific are among the most vulnerable in the world to the effects of climate change, including the likely detrimental impacts on health. In general, the burden of these impacts falls disproportionately to particular subsectors of the population, such as the socio-economically deprived, certain occupational groups, those with pre-existing illnesses and residents of areas of high exposure to climate-related phenomena such as floods, droughts and sea level rise. Thus, climate change has the potential to exacerbate social and health inequalities further. As part of a suite of adaptations integrated across sectors, protection of Pacific Island communities from climate change-related health threats requires an evidence-based approach that incorporates a context-based assessment of vulnerability. Pioneering work by McMichael and colleagues in the 1990s and early 2000s provided templates for performing assessments of vulnerability and compiling plans for adaptation to protect human health from the effects of climate change. This chapter reviews the inclusion of the human health dimension in the climate change impact and adaptation research landscape. We summarise the mixed methods approaches employed to assess climate change and health vulnerabilities and adaptation opportunities in the Pacific region. Results of these assessments are provided, key themes are identified and we map the planned direction of health adaptation to climate change in the Pacific

Climate change: a brief overview of the science and health impacts for Australia

The scientific relationship between atmospheric CO2 and global temperatures has been understood for over a century. Atmospheric concentrations of CO2 due to burning of fossil fuels have contributed to 75% of the observed 1°C rise in global temperatures since the start of the industrial era (about 1750). • Global warming is associated with intensifying climatic extremes and disruption to human society and human health. Mitigation is vital for human health as continued current emission rates are likely to lead to 4°C of warming by 2100. Further escalation of Australia’s hot and erratic climate will lead to more extreme climate-related disasters of heatwaves, droughts, fires and storms, as well as shifts in disease burdens

Small island states: canaries in the coal mine of climate change and health

This chapter describes the geography, population and demography, economy and health status of small island developing states (SIDS). The drivers of the vulnerability of SIDS to the impacts of climate change (natural disasters, extreme weather events) and some of the key health risks and adaptive options these nations face are discussed. Examples and case studies cited are taken predominantly from Pacific island nations, although their plight is shared more broadly across developing island nations of the Caribbean and Indian Ocean regions

Review: the nexus of climate change, food and nutrition security and diet-related non-communicable diseases in Pacific Island Countries and Territories

Climate change and non-communicable diseases (NCDs) are two of the most important global health challenges of this century. Pacific island countries and territories (PICTs) are particularly vulnerable to the adverse impacts of climate change and face an increasingly high burden of NCDs. This review synthesizes the evidence for the links between climate change, food and nutrition security (FNS) and NCDs in the Pacific region and outlines the possible implications of these relationships. A comprehensive search was performed on global databases including PubMed, SCOPUS and ScienceDirect, the grey literature and reference lists. Four dominant pathways between climate change, FNS and NCDs emerged from the literature: the impact of climate change on agriculture, fisheries, migration and humanitarian food assistance. These pathways, if not addressed, are likely to lead to impaired FNS and an increased burden of NCDs in PICTs. There is little doubt that Pacific nations will experience adverse impacts of climate change exacerbating existing health risks and other socio-cultural, political and economic drivers of food and nutrition insecurity and NCDs. Further research is needed to strengthen the evidence and develop integrated, context-specific solutions. It is, however, imperative to take action to address these issues via a cross-sectoral, no-regrets, health-in-all-policies approach