Climate change is the greatest threat to human health and development today. The risk amplification of climate change as a threat to global physical, social, economic and environmental development has been recognised in the recently created Sustainable Development Goals (SDGs), which implores party states to “Take urgent action to combat climate change and its impacts.” Pacific Island nations are particularly vulnerable to the effects of climate change on human health by nature of their relatively small landmasses, largely underdeveloped and agrarian communities, and their cultural and economic dependence on coastal environments. Their health systems are already largely overrun due to the burdens of infections and chronic non-communicable diseases (NCDs), and all projections point to climate change compounding these problems and magnifying the demands on resource-poor national budgets. For these reasons, the nexus of climate change and its negative impacts on health needs to be addressed in the context of implementing universal development agreements such as the SDGs (adopted in September 2015), and in the development aid agenda of donor countries operating in the Pacific region, such as Australia.
Fighting for lives amidst rising tides: Public health implications of climate change for Pacific Island nations
Non-communicable diseases, nutrition and obesity
In light of genetic predispositions and post-colonial Pacific lifestyles, the burden of NCDs poses a “human, social and economic crisis requiring an urgent and comprehensive response.” NCDs include chronic cardiovascular disease, chronic lung diseases, cancer, diabetes and mental illness, and share four common risk factors of physical inactivity, poor nutrition, tobacco smoking and the harmful consumption of alcohol.
NCDs are a massive spectre of morbidity and mortality in the Pacific Islands, accounting for almost 70-75 per cent of all deaths. Of these, many are premature (before 60 years of age) and preventable. Much of this burden can be attributed to a high prevalence of diabetes and obesity among Pacific Island peoples. Of all nations in the world, eight of the top ten countries for diabetes prevalence are Pacific Island nations with comparative prevalence rates of 20-40 per cent of the population.
Climate change threatens to accelerate some of the risk factors leading to and health complications derived from NCDs. Inadequate exercise, coupled with inappropriate diets resulting in caloric surplus, are deemed to be major mechanisms for developing diabetes and heart diseases through the storage of excess ingested energy as body fat. It is presumed that these behaviours will become more prominent in light of climate change. Extremes of heat and hotter daily average atmospheric temperatures will lead to a deepening of sedentary behaviours due to discomfort in the heat.
The nutrition of Pacific people will also suffer as a result of climate change. Healthy crops will be damaged or lost due to natural disasters, salinisation and soil erosion. This will lead to an increased reliance on processed, packaged and imported foods, with poor nutritional content and large carbon footprints. In turning to these calorie rich foods, Pacific people will be adopting diabetogenic and obesogenic diets and ultimately suffer from more NCDs due to over-nutrition, while simultaneously increasing their own carbon footprints through the importation and refrigeration of these foods.
Pacific Island nations are particularly prone to severe storms and cyclones: of the natural disasters suffered in the Pacific, 76 per cent of reported disasters between 1950 and 2004 were cyclones. Projections with respect to natural disasters currently suggest that while the frequency of such extreme weather events will decrease, the scale and damage, particularly the amount of precipitation involved, will increase into the future. So too would the impacts on health and development.
The greatest health impacts of cyclones flow on from destruction of buildings and infrastructure. Loss of safe dwellings leads to overcrowding in remaining spaces. The combination of scarce safe drinking and washing water and the accumulation of stagnant or contaminated water sources due to inundation, leads to the propagation of infectious diseases, such as food and water-borne diarrhoeal illnesses, to which children and the elderly are particularly vulnerable. In addition, disaster related trauma often leads to mental health reactions from grief to depression.
Pacific healthcare systems operating at full capacity are overstretched due to poverty and the double epidemiological burden of communicable (infectious) diseases and chronic NCDs. Critical infrastructure for healthcare such as medical centres and hospitals are damaged in the wake of severe cyclones, and the demands of patients subsequently presenting for care related to injuries and illnesses, can see disrupted delivery of other essential health services.
Sea level rise, flooding and the impacts of groundwater salinisation on health and sanitation
It is virtually certain that sea levels will change in the Australasian region in the coming century with sea levels estimated to rise by up to half a metric metre by this century’s end. Between sea level rise, warm seas associated with La Niña events, and a rise in severity of floods and storms, coastal areas are likely to undergo expedited shoreline erosion, salinisation of the groundwater lens, and inundation of human habitation and agricultural resources, interrupting water and food supplies and rendering homelands and farmlands unlivable. This inundation will force the displacement of coastal settlements, occasioning forced migration.
Lack of access to safe drinking water and sanitation facilities is still a major health hazard in the Pacific. Despite some evident national improvements, the region is set to fall short of the seven Millennium Development Goals (MDG) targets related to increased access to improved drinking and washing water. Deaths related to unsafe water sources are significant, with figures for children (under 5 years old) in the Pacific Island countries indicating that about 10 per cent of all deaths can be attributed to diarrhoeal diseases, and 90 per cent of these result from a lack of sanitation, drinking-water and hygiene. These preventable deaths related to hygiene and water access will only grow in the absence of adequate public health responses to the impact of climate change to safe water access, such as building robust water delivery systems designed to withstand the effects of natural disasters, inundations, and erosion.
Infectious diseases in the context of climate change in the Pacific
Warming of the atmosphere and increased levels of precipitation and humidity provide the substrate for rapid reproduction of infective microbes and their hosts and vectors, thus escalating the burden of infectious diseases in the tropics. Malaria and Dengue are two prominent vector-borne diseases in the tropics, transmitted by mosquitoes. These vectors are climate sensitive, and while environmental conditions have historically dictated their distribution, climate change is quickly permitting infections to proliferate beyond the borders of the traditional tropical territories that defined them.
An example of this may be seen in Papua New Guinea (PNG) with the inland encroachment of arthropod-borne virus infections due to the spread of their natural vector, Aedes species mosquitoes. One of Oceania’s most populous island nations, PNG has large inland communities, usually protected by isolation from vectors for which the climatic profile is unfavourable. As the atmospheric conditions change these populations may increasingly find themselves subject to arboviruses such as Dengue and Chikungunya viruses, with their associated risks of death and disease. Grassroots communities and clinicians unused to seeing such cases may delay identification and appropriate treatment of emerging epidemics and rapid responses. Transmission rates of other major infectious diseases such as HIV/AIDS, Malaria and Tuberculosis are set to escalate by domestic overcrowding, a symptom of the poverty and urban slumming caused by housing damage, sustained through sea level rise and natural disasters.
Climate change and health in existing and proposed global development agreements
Of many existing regional and global development agreements, the two that are best positioned to address the issue of climate change and health with respect to the Pacific are the ‘Healthy Islands’ model of integrated health policy and promotion, issued by Pacific Health Ministers in 1995, and the Small Islands Developing States Accelerated Modalities of Action (SAMOA) Pathway, which was an outcome of the Third International Conference on Small Island Developing States from 2014.
Healthy Islands was a declaration issued by fourteen Pacific Health ministers to promote and protect both human and environmental health in their respective nations. The final product unites human and environmental health as an ecological “whole.” Healthy Islands stated that “health care processes need to change, becoming more holistic and better integrated and linked through networks to meet the complex challenges of the future.” However, of the commitments made, there is no explicit reference to climate change or global warming nor the impacts these will have on health. This is most likely owing to the embryonic level of climate science and advocacy in the late twentieth century.
The Healthy Islands declaration has significantly influenced health policy in the Pacific over the twenty years since its promulgation. It was recently reviewed by Pacific Health ministers who reaffirmed their commitment to the document, with addenda related to the epidemics of obesity and NCDs. It calls for greater aid investment, but there is no clear message on what climate change is doing to human health and what its impact will require of communities, governments and aid agencies. Failing to place climate change front and centre of the regional Pacific health agenda is a missed opportunity for “mainstreaming” climate change into public health policy making, and consequently provides UN agencies and aid donors with an opportunity to neglect featuring climate change in social development aid.
Small Islands Developing States Accelerated Modalities of Action (SAMOA) Pathway
The Third International Conference on Small Island Developing States (SIDS Conference) was held in Apia, Samoa in September 2014 with the theme of sustainable development of Small Island Developing States through partnership. The outcome statement iterated that while “health is a precondition for and an outcome and indicator of all three dimensions of sustainable development…SIDS remain constrained in meeting their goals in all three dimensions of sustainable development” due to particular vulnerabilities. Furthermore, it is acknowledged that the impacts of climate change compound pre-existing threats and challenges which SIDS face. The framework of the SDGs has implanted further burdens on SIDS. The document bemoaned the lack of adequate financial resources to implement climate change adaptation and mitigation projects, and went on to praise efforts to increase the allocation of climate finance to adaptation projects in developing countries, but failed to further elaborate on the nexus of climate change and its direct and indirect impacts on human health and healthcare systems.
Australian development policy with respect to health in the Pacific
Australia is the largest donor of overseas development aid for Pacific Island countries and territories, funding some 60 per cent of total aid programming in Oceania. As such, Australian government responses to multinational agreements have great impacts on the ability of the region to collaborate in achieving their objectives. Health development in particular is a policy area, which currently stands in a considerable state of flux as the global community transitions from MDGs to SDGs, starting in 2015.
The current ‘Health for Development Strategy’ from Australia’s Department of Foreign Affairs and Trade (released in June 2015), is designated for the period 2015-2020, encompassing five years beyond the end-date of the MDG timeline. The five designated priorities for Australian development aid with regards to health are:
- Core public health systems and capacities in key partner countries;
- Combatting health threats that cross national borders;
- A more effective global health response;
- Access to clean water, sanitation, hygiene, and good nutrition as pre-conditions for good health; and
- Health innovation, and new approaches and solutions that benefit our region.
However, the agenda contained therein makes no mention of the SDGs, or the implications of climate change as a threat to health, despite the critical regional impact that climate change will have on each of those priority areas as a risk multiplier and obstacle to implementation.
Australia’s failure to identify the relationship between climate change and health in its existing development agenda also misreads the priorities of the aid recipients themselves, who said at the Pacific Island Leaders Forum in 2009, “For Pacific Island states, climate change is the great challenge of our time. It threatens not only our livelihoods and living standards, but the very viability of some of our communities.”
For their part, Pacific Island nations are ramping up efforts to convey to the international community their eagerness for ambitious emission reduction targets and global partnerships to assist in climate change adaptation. On the 30th April 2015, fifteen Oceanic state leaders issued the strongly worded Lifou Declaration, calling for a “global revolution” to “save Oceania” in the lead up to the final Conference of Parties (COP-21) negotiations in Paris in December 2015. Fiji’s Prime Minister Frank Bainimarama has been an outspoken critic of Australia’s inaction on climate change, labelling the government as party to a “coalition of the selfish” and pleading with Prime Minister Turnbull at a recent Climate Change resilience meeting to place Pacific Island welfare in equal priority with the energy sector. Pacific nations will remain vocal, using this period to address the nexus of climate change and health, and the immediacy of the threat posed to the Pacific without the material support of their closest neighbours, such as Australia.
The post-2015 development agenda, with the SDGs at its centre, is the opportune forum in which to address the nexus of climate change and health in Australia’s Pacific aid policy. With its ambitious spectrum of development goals, and the emphasis on multi-sectoral partnerships in the achievement of these, the early days of SDGs are the perfect opportunity to capitalise on political will, by building climate change mitigation and adaptation into the Australian development agenda.
Policy recommendations integrating climate change and health in Australia’s Pacific aid agenda
Listed below are three recommended crosscutting interventions for multi-sectoral development, which will significantly address climate change and health in the Pacific. In doing so, these will fulfill various sustainable development targets. Each of these additionally satisfies the Australian Aid ‘Health for Development’ priorities.
Ensure access to disaster-proof, climate-change resilient water storage and delivery systems and sanitation facilities, thus reducing child and maternal mortality and other human diseases implicated in water security and hygiene.
Leverage science and technology in order to optimise and expand agriculture, aquaculture and localised food production in Pacific nations. In doing so, this can create farms immune to the effects of climate change and reducing NCD prevalence through decreased dependence on imported, packaged and preservative-laden foods.
Invest in the construction of modern, low-carbon and climate resilient healthcare facilities with integrated green spaces for leisure and promotion of exercise, increasing access to universal healthcare and protecting facility users and workers against NCDs.
With its broad spectrum of development goals, and the centrality of international partnerships in the achievement of these, the early days of the SDGs are the perfect opportunity to reinvigorate our own sustainable development efforts and build climate change adaption into the Australian aid agenda, especially in light of our own burden of greenhouse gas emissions, and our prosperity acquired on the back of mining exports. It is hoped that the SDGs, and the post-2015 era shaped by them, will see the ascendancy of Australian leadership on intelligent, integrated development aid for our Oceanic siblings. The intersecting measures recommended herein thus provide holistic adaptive responses to the challenge of climate change and its impacts on human health. The cost to Pacific health will be too high to do otherwise.
Dr Matt Bray is a resident medical officer practicing in Canberra whilst studying a Masters in Public Health and Tropical Medicine at James Cook University.
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