Human Health Vulnerability to Climate Change in Fiji

aInformation Paper: Human Health Vulnerability to Climate Change in Fiji

Human Health Vulnerability to Climate Change in Fiji

1 Introduction 12 Background- Key Health Indicators for Fiji 23 Observed Impacts of Historical Climate Variability on Human Health in Fiji 3 3.1. Communicable Disease 3 A. Dengue Fever 3 B. Diarrhoeal illnesses 5 C. Typoid Fever 7 D. Leptospirosis 8 E.SexuallyTransmittedInfections 9 3.2 Non- Communicable Diseases 10 A. Heart-related illness 10 B.Malnutrition-relatedillness 10 C. Death and Injury from extreme events 11 D. Psychological impacts 11 3.3 Access to Health Services 124 Projected Impacts of Climate Change on Human Health in Fiji 135 AdaptationMeasures 14 A.Healthsectoradaptationmeasures 14 B.Naturaldisaster-specificmeasures 14 C.Adaptationinothersectors-water,agriculture, 15 ruraldevelopment,housing,environment,communityempowerment andlivelihoods,energy,etc.6 Conclusion 167 References 17

Contents

This information paper is an output from the Piloting Climate Change Adaptationto Protect Human Health (PCCAPHH) project in Fiji, 2013”.

1Information Paper: Human Health Vulnerability to Climate Change in Fiji

Climate changenegatively impacts thebasic determinants of humanhealth- clean air, safe and sufficient

water,foodandshelter.Directimpactsofclimatechangeonhealthincludeinjury,diseaseanddeathfrom

extremeheatandcold, cyclones,floodsanddroughts. Indirect impacts include increases in vector-borne,

water-borne, cardiovascular, respiratoryand renaldiseasesandpsychosocial impacts from increase in the

rangeandnumberofdiseasespreadingvectors,compromisedfoodandwatersources,livelihoodlossesand

populationdisplacement.Fijiisespeciallyvulnerabletoadversehealthimpactsofclimatechange,duetoits

smallgeographicalsize,exposuretoextremeclimateeventsandasmalleconomythatdependslargelyon

natural resources.

This information paper demonstrates the impacts of climate variables, like temperature and rainfall and

extremeeventsonhumanhealthinFijiandlistssomeadaptationmeasuresthatneedtobeimplemented.

Thereareclear linksbetweenclimateandcommunicablediseases(CDsor infectiousdiseases) likedengue

and typhoid fevers, leptospirosis anddiarrhoeal illnesses andbetweenextremeclimateevents likefloods

anddroughtsandmalnutrition.Anecdotalevidencefromhealthpractitionersalsosuggestsalinkwithnon-

communicablediseases(NCDs),particularlythoserelatedtonutritionaldeficiencies.Whilefurtherresearchis

requiredtoidentifythetrueburdenofclimate-attributablehealthrisksinFiji,enoughevidenceexistsglobally

tounderscoreadaptationandmitigation inthehealthandrelatedsectors(inparticular,energy,transport,

water,housingandagriculture).

1. Introduction

2 Information Paper: Human Health Vulnerability to Climate Change in Fiji

Inrecentyears,Fiji’spopulation(868,000in2011)hasincreasedat1%peryear.Inthepast50years,therural

populationhasdecreasedfrom70%tojustunder50%ofthetotal,whichhasputsignificantstrainonservices

inurbanareas,inparticularwaterandsanitation.Grossnationalincomepercapitahasbeenstableataround

$4500overthepast5years.Overall,23%ofthepopulationliveonlessthat$2perday(US$PPP);43%ofrural

populationand18%oftheurbanpopulationlivebelowthepovertyline.Incomeisunequallydistributed:the

top20%ofearnersreceive50%oftheincome,whilethepoorest20%receiveonly6%(WorldBank,2012).

Governmenthealthexpenditureisapproximately3.7%ofgrossdomesticproductannually(Snowdon,2012).

In2010,thetop2causesofmortalitywerediseasesofthecirculatorysystemandendocrine,nutritionaland

metabolicdiseases.Childmortalityfellfrom23.2/1000livebirthsin2009to17.7/1000livebirthsin2010.

Maternalmortalityfellfrom27.5/100,000livebirthsin2009to22.6/100,000livebirthsin2010(Ministryof

Health,2011).Poverty,theinabilityofmanytobuysufficientfoodandunhealthydietshavecausedsignificant

amountsofmicronutrient(especiallyiodineandiron)malnutrition(Snowdon,2012).Asurveyofyouthinthe

Suva-Nausoricorridorrevealedthat26%offemalesand17%ofmaleswereoverweight,morethan30%of

Indo-Fijianstudentswereunder-weightandlessthan30%ofstudentsengagedinanyphysicalactivity(Tuiketei

etal.,2010).

Approximately 82% of all deaths in Fiji are attributed to NCDs (WHO, 2011). Of these, 42% are from

cardiovasculardiseasesalone.AspertheFijiNCDSTEPSSurveyreport2002,theprevalenceofdiabeteswas

16.2%andprevalenceofhypertensionwas19.1%(MinistryofHealth,2005).Theseratesareanticipatedto

haveincreasedinthe2011NCDSTEPSSurvey.Interestingly,thoughunfortunately,mortalityduetodiabetes

for2011wasrecordedtobe53.5%morethanin2010.Theprevalenceofcancersin2011wasnotedtobe

10.9%withthefemaletomaleratiobeing3:1(MoH,2012a).

WithregardstoCDs,theincidenceoftuberculosis,adiseaseofpoverty,declinedbetween2009and2010

(MinistryofHealth,2011).Inthelast50years,aboutsixdistinctoutbreaksofdenguewereexperiencedin

thecountry.Onaverage,about20-100casesofleptospirosisarereportedinthecountryannually.Whiledata

showsthattheincidence(numberofcasesper100,000ofpopulation)oftyphoidfevermaybeincreasing,

improveddiagnosisandreportingsince2005mayhelpexplaintheriseinnumbers.Together,denguefever,

leptospirosisandtyphoidfeverareconsideredthecountry’s“ThreePlagues”andwithdiarrhoea,aremajor

publichealthconcerns(PCCAPHH,2012).In2010,19,234casesofdiarrhoeawererecordednationally(Ministry

ofHealth,2011).Between1995and2010,theincidenceofdiarrhoeawasnearlyalwaysmorethan500cases

permonth(PCCAPHH,2012).Whilediarrhoeaisknowngloballytobesensitivetoclimateconditions,poor

waterandsanitationconcernsalsoplayamajorrole.Nearlyallofthepopulationissaidtohaveaccessto

improvedwatersources,but70%oftheruralpopulationdonothaveimprovedsanitation(WorldBank,2012).

2. Background- Key Health Indicators for Fiji


3. Observed Impacts of Historical Climate Variability on Human Health in Fiji

Evidenceisgrowinggloballyofvarioushealthoutcomesbeingsensitiveto,ornegativelyaffectedby

climatevariabilityandchange.Globalevidencealsoshowsthatclimatechangewillnegativelyimpact

environmentalandsocio-economicdeterminantsofhealth,whichinturnwillresultinahigherglobal

burdenofcommunicableandnon-communicablediseases(WHO,2009).Resultsofstudiesonthe

climate-sensitivityofdiseasesandhealthdeterminantsinFijiaresummarisedhereafter.


3.1 Communicable Diseases

A. Dengue fever

Inastudyconducted in1999,positivecorrelationswere indentified fordengueandLaNinaconditions in

thePacific(Halesetal.,1999).OftheeightdengueoutbreaksthatoccurredinFijioverthelast50years,7

occurredduringperiodsofLaNina(wetconditions),whilethe1998outbreakoccurredduringtheanElNino

(dryconditions)period(PCCAPHH,2012). It isthoughtthiswasduetopeoplestoringwater inun-covered

containersclosetotheirhomesandthatthesecontainerswereidealbreedingsitesfortheAedesmosquito

(FMS,2003a).FollowingthefloodsinJanuaryandMarch,2012,theincidenceofdenguefeverwasveryhighin

theWesternDivision.Vectorindicesanddenguecasenumbersbothpeakedamonthfollowingtherespective

floods.ThehighestnumberoflaboratoryconfirmedcaseswerenotedintheLautokaandNadisub-divisions

(MinistryofHealth,2012b).DengueoutcomesinLautokafollowingthefloodswereconsistentwiththeresults

forLautokainTable1below.

ThejointMinistryofHealth-WHO-UNDPPilotingClimateChangeAdaptationtoProtectHumanHealthutilised

historical monthly climate and communicable disease data from 1995-2009 and identified the following

associationsbetweendengueandclimateconditions.

Table 1: Summary of Poisson Regression Between Monthly Dengue Fever Cases and Monthly ClimateVariables in Four Medical Sub-Divisions in Fiji

Medical Sub-division

Climate variable/modela Strength of Association (pseudo r2 value)b

Notes:a Seasonallyadjusted,usingadummy variable for months.bAllresultsaresignificanttothe5%level(p-values≤0.05)c Lagsrefertotherelationshipbetweendiseasenumbersinaparticularmonthandclimateconditionsofthesamemonth(lag0),or1,2,3monthsprior(lags1,2,3)respectively.d Maximum temperaturee Minimum temperature

Ba Rainfall(mm)-lagc1,2,3Maxtemp(°C)d-lag0,1,2,3Mintemp(°C)e- lag 2RelativeHumidity(%)-lag1

BestModel:Rainfall,Maxtemp,Humidity at lag 1

0.3,0.27,0.320.29,0.38,0.32,0.290.250.340.39

Bua Rainfall-lag0,1,2Maxtemp-lag0,2,3Mintemp-lag0,1,2,3Humidity- lag 0

Bestmodel:Rainfall,Maxtemp,Mintemp at lag 0

0.4,0.3,0.370.37,0.33,0.310.35,0.30,0.32,0.310.330.52

Lautoka Rainfall- lag 1Maxtemp- lag 1Mintemp- lag 1

Bestmodel-Rainfall,Maxtemp,Mintemp at lag 1

0.420.530.270.54

Suva Rainfall- lag 2Maxtemp- lag 3Mintemp-lag0,2Humidity- lag 2

Best model- All four climate variables at lag 2

0.470.500.57,0.520.470.6

(Source:PCCAPHH,2012)


Wherehigherr2valuesareseen(Lautoka,SuvaandBua)climateconditionscanbesaidtoexplaindengue

feveroutcomestoagreaterextent.Inothersub-divisions,theassociationswereweakerbutstillstatistically

significant.

Relationshipsbetweendengueandclimateappearedtobenonlinear.Forexample,intheBuasub-division,

night-timetemperaturesaboveathresholdofapproximately25°Cappearconducivetodenguetransmission,

withatimelagof2months(Figure1).

Fig. 1: Monthly dengue cases vs. Average Monthly Minimum Temperature Two Months Prior in Bua


Furtherworkwasdonetodeterminetheassociationbetweendenguefeverandextremeclimateeventslike

droughts,cyclonesandfloods.ThelikelihoodofadengueoutbreakinBa,onemonthafterfloodscausedby

tropicaldepressionswas10timesmorethanmonthswhennotropicaldepressionoccurred.Furthermore,

thelikelihoodofadengueoutbreakinBaduringdroughtmonthswas5timesmorethanmonthswithout

droughts.

B. Diarrhoeal Illnesses

Singhetal.(2001)undertookastudyofdiarrhoeaininfantsinFijiandshowedpositiveassociationswithvery

lowandveryhighrainfallandincreasingtemperature(laggedbyonemonth).Singhetal.noteda3%increase

indiarrhoeacasesforevery1⁰Cincreaseintemperature,controllingforseasons.Highertemperaturescreate

conditionsthatallowpathogenstoproliferatewhilewatersupplyandsafety,aswellassanitationandhygiene

arecompromisedduringperiodsofdroughtsandfloods.FollowingtheMarch2012floods intheWestern

Division,watersupplyandsafetywerecompromisedinbothurbanandruralflood-affectedareas,resultingin

ahighincidenceofdiarrhoea.Inmanyareas,watertruckssuppliedwatertoaffectedfamilies;2779WASHkits

(containingwaterpurificationtablets,watercontainersandsoap),40largetanksandbladders,7,000water

containers,and9600sachetsofOralRehydrationSalts(ORS)werealsodistributed(UNOCHAPacific,2012).

AnalysisbythePCCAPHHproject(2012)producedthefollowingassociationsbetweenclimateanddiarrhoea.

Table 2: Associations Between Monthly Diarrhoeal Illnesses and Monthly Climate Variables in Three Medical Sub-Divisions in Fiji, 1995-2009



Notes:aSeasonallyadjusted,usingadummy variable for months.bAllresultsaresignificanttothe5%level(p-values≤0.05)cLagsrefertotherelationshipbetweendiseasenumbersinaparticularmonthandclimateconditionsofthesamemonth(lag0),or1,2,3monthsprior(lags1,2,3)respectively.d Maximum temperaturee Minimum temperature

Ba Rainfall- lag 1Maxtemp- lag 3Mintemp-lag 3Humidity- lag 1

Bestmodel:Allforclimatevariablesabove

0.10.060.070.14

0.17

Bua Rainfall- lag 0Maxtemp-lag0,1,2Mintemp- lag 0-3Humidity- lag 2

Bestmodel:Rainfall,Maxtemp,Mintemp at lag 0

0.12All ~0.10All ~0.100.12

0.13

Suva Rainfall-lag1,3Maxtemp-lag0,3Mintemp- lag 3

Bestmodel:Threeclimatevariablesabove at lag 3

~0.4~0.4~0.4

0.41


It is clear from theabove table thatother than in the Suva sub-division, the linear associationsbetween

monthlydiarrhoeaandmonthlyclimateconditionsarequiteweak.Whenthesamedatawasanalysedusing

theLowesssmoothingfortheSuvasub-divisionhowever,thefollowingU-shapedcurvewasnoted,similar

tofindingsbySinghetal.(2001)(Fig.2).ThisshowsthatintheSuvasub-division,diarrhoeacasesarehigher

duringperiodsofverylowandveryhighrainfall,butmorepronouncedduringdrierperiods(PCCAPHH,2012).

Fig. 2: Monthly Diarrhoea Cases vs. Average Monthly Rainfall in the same Month in Suva

InterestingassociationswerealsonotedwithminimumtemperatureinSuvaforthesamemonthandaone-

monthlag(Fig.3below).Bothgraphssuggestthat25⁰Cisthethresholdminimum(night-time)temperature,

beyondwhichdiarrhoeacasesincreaseintheSuvasub-divisions(PCCAPHH,2012).Itisimportanttoconsider

minimumtemperaturesascoldertemperatureswillinhibittheproliferationofcertainpathogens.

Fig. 3. Association between Monthly Diarrhoea Cases and Minimum Temperature at Lags 0 (left) and 1 (right) in Suva


Analysis also revealed strongpositiveassociationswithextremeevents likefloodsandcyclones in theBa

medicalsub-division.ThelikelihoodofadiarrhoeaoutbreakinBaonemonthafterfloodingcausedbytropical

depressions is 9timesmore thanmonths inwhich tropical depressionsdonotoccur. In comparison, the

likelihoodofadiarrhoeaoutbreakonemonthafterallfloods is3.5timeshigher thanallmonthswithout

flooding(PCCAPHH,2012).

Analysisaboveshowstheneedtodesignadaptationmeasurestobothabruptandon-goingchangesinthe

climate,notingallthewhilethecommunicablediseasestotendtorisefollowingnaturalclimatedisasters.

C. Typhoid Fever

Typhoidfever isendemic inFiji.Outbreakshavebeennotedfollowingfloodsand2monthsaftercyclones

(Jenkins, 2010;Ramet al., 1983) andmass fooddistributionevents.Outbreaks in Koroboya andNaitasiri

(Tavuamedicalsub-division)andNanoko(Nadroga-Navosasub-division)in2012demonstratedthatpoverty,

poorsanitationandhygieneandthemovementofhealthycarriersarealsosignificantriskfactors.TheWestern

Division experienced typhoid outbreaks following the January and March 2012 floods, with the highest

numberofcasesreportedintheBasub-division,followedbytheNadiandLautokasub-divisions.Particularly

followingfloodsandcyclones,thecloseproximityofpeopleinevacuationcentresandcompromisedsanitary

andhygienefacilitiesinevacuationcentresalsocontributestotransmissionoftyphoid.TheMinistryofHealth

launchedapubliccampaignfollowingthefloodsanddistributedmorethan8000information,educationand

communicationmaterialsonpreventingtyphoidfeverandonmaintaininggoodhealthduringnaturaldisasters

(MinistryofHealth,2012b).




Notes:a Seasonallyadjusted,usingadummy variable for months.bAllresultsaresignificanttothe5%level(p-values≤0.05)cLagsrefertotherelationshipbetweendiseasenumbersinaparticularmonthandclimateconditionsofthesamemonth(lag0),or1,2,3monthsprior(lags1,2,3)respectively.d Maximum temperaturee Minimum temperature

Ba Rainfall-lag1,2,3Maxtemp-lag0,3Mintemp-lag1,2,3Humidity-lag0,1,2,3

Best model- Rainfall and Mintemp at lag 2

0.47,0.63,0.490.47,0.490.46,0.52,0.460.48,0.46,0.47,0.5 0.66

Bua Rainfall- lag 0Mintemp-lag0,3Humidity- lag 3

Best model- Rainfall and Mintemp at lag 0

0.350.36,0.360.35

0.36

AnalysisbythePCCAPHHproject(2012)producedthefollowingassociationsbetweenclimateandtyphoid

fever.

Table 3: Summary of Poisson Regression Between Monthly Typhoid Fever Cases and MonthlyClimate Variables in Two Medical Sub-Divisions in Fiji, 1995-2009

Typhoid outbreaks in the Ba sub-division are explained to a significant extent by rainfall and minimum

temperature of the area. Results for the Bua sub-division illustrate that other socio-economic determinants

can explain typhoid outbreaks in the area.

D. Leptospirosis

Over the last 15 years, between 20-100 cases of leptospirosis have been reported in Fiji annually.While

leptospirosisisendemicinFiji,outbreaksalsooccur.Globally,leptospirosisisknowntobesensitivetohigher

temperaturesandhigherrainfallpatternsintropicalareas.InFiji,youngmalefarmersareathigherriskastheir

occupationsexposethemtoinfectedanimalsorsoilandwatercontaminatedbyfaecesofinfectedanimals.It

isthoughtthatespeciallyfollowingfloodsandcyclones,peopleandleptospirosisvectors(domesticanimals,

rats)comeintocloserproximity,increasingtheriskoftransmission(PCCAPHH,2012).

Forexample,leptospirosisoutbreakswerenotedfollowingfloodsinJanuaryandMarch2012intheWestern

Division. In some cases, outbreaks occurred in evacuation centreswhere peoplewere in close proximity.

Furthermore,rodentsinBatownarethoughttohavecausedoutbreaksintownareasfollowingtheJanuary

andMarchfloods in2012 (MinistryofHealth,2012c). Thehighestnumbersof cases following thefloods

werereportedfromtheLautokasub-division,followedbytheBa,NadiandNadroga-Navosasub-divisions.The

highestnumberofdeathsduetoleptospirosiswasalsofromtheLautokaDivisionalHospital.Healthpromotion

messages to prevent leptospirosis were aired on Fiji TV and FBC,while approximately 6200 information,

education and communicationmaterials on the same subjectwere distributed to the public (Ministry of

Health,2012b).


AnalysisbythePCCAPHHprojectproducedthefollowingassociationsbetweenclimateandleptospirosis.

Table 4: Summary of Poisson Regression Between Monthly Leptospirosis Cases and Monthly Climate Variables in Two Medical Sub-Divisions in Fiji, 1995-2009



Notes:aSeasonallyadjusted,usingadummy variable for months.bAllresultsaresignificanttothe5%level(p-values≤0.05)cLagsrefertotherelationshipbetweendiseasenumbersinaparticularmonthandclimateconditionsofthesamemonth(lag0),or1,2,3monthsprior(lags1,2,3)respectively.d Maximum temperaturee Minimum temperature

Ba Rainfall- lag 2Maxtemp-lag1,2Humidity-lag1,2

Bestmodel:Rainfalllag2andMintemp lag 1

0.30.32,0.30.3,0.3

0.35

Bua

Rainfall-lag0,2,3Maxtemp-lag0,3Mintemp-lag0,1,2,3Humidity-lag0,1Bestmodel:Rainfall,Maxtemp,Mintempatlag3

0.42,0.4,0.480.38,0.450.4(all)0.45,0.40

0.59

Thestrongestcorrelationbetweenaveragemonthlyclimateconditionsandmonthlyleptospirosiswasnoted

fortheBuasub-division,withamodelthatcombinedrainfall,maximumtemperateandminimumtemperature

at a lag of 3 months.

E. Sexually Transmitted Infections

While no quantitative studies have been undertaken to determine the association between sexually

transmittedinfections(STIs)andtheclimateinFiji,someobservationsfollowingtheJanuaryandMarchfloods

intheWesternDivisionarenotedbelow.Medicalpractitionersnotedanincreaseinunsafesexualactivities,

particularlyamongteenagersandyouths,andespeciallysoinevacuationcentres.Asaresult,groupactivities

likeyaqonaconsumptionwerebannedinmostevacuationcentrestoencourageparentstosupervisetheir

children.Furthermore,casesof rapeand incestwerealsonoted,especiallyonunaccompaniedwomen in

evacuationcentres.Topreventfurthercases,policeofficerswerepostedatevacuationcentresandwhere

necessary,womenwerehoused in separate rooms inevacuations centresandprovidedpoliceprotection

(MinistryofHealth,2012c).

11InformationPaper:HumanHealthVulnerabilitytoClimateChangeinFiji

3.2 Non-Communicable Diseases

Whilenon-communicablediseases(NCDs)areknowngloballytobesensitivetodiet,noquantitativestudies

havebeenundertakentodemonstrateassociationsbetweenNCDsandtheclimateinFiji.Thus,thisisanarea

ofresearch,especiallyassomeexamplesofassociationsarestartingtobecomemorevisibleandasNCDs

aresignificanthealthproblems.SomeofthepathwaysinwhichclimatechangecanaffectNCDsareexplored

below.

A. Heat-related illnesses

WhileFijidoesnotexperienceheat-waveslikethoseexperiencedinmanytemperatecountries,hotterdays

areexpectedtocreateconditionswherepeopleengageinlessphysicalactivity(workingonfarmsorexercising

outside).Thiscanleadtoariseinobesity,whichisariskfactorformanyNCDslikediabetes,cardio-vascular

illnesses,musculo-skeletaldisorders(likegoutandosteoarthritis)andsomecancerslikeendometrial,breast,

rectalandcoloncancer(NationalFoodandNutritionCentreandMinistryofHealth,2009). Increasedheat

levelscouldalsocauseincreasedrestlessnessinhighbloodpressurepatients,creatingconditionsforincrease

in related illnesses.

B. Malnutrition-related illnesses

Perhapsthemost importantpotentialpathway linkingclimatechangeandNCDs isvia foodandnutrition.

Currently,endocrine,nutritionalandmetabolicdiseasesarethesecondmostcommoncauseofmortalityin

Fiji(MinistryofHealth,2011).Extremetemperatures,aswellasnaturaldisasterslikedroughts,cyclonesand

floodscausesignificantdamagetoagriculturaloutput.Morethan12,000farmers lost theircropsandthe

agriculturesectoroverallincurredalossofmorethanFJD16maftertheMarch2012floods(UNOCHAPacific,

2012).ThisresultedinfreshfruitandvegetableshortagesthroughouttheWesternDivision.TheMinistryof

HealthdistributednutritionalsupplementsthatincludedVitaminAandmicronutrientstoavoidmalnutrition

inflood-affectedfamilies(UNOCHAPacific,2012).Wherefarmsareunabletorecoverfromnaturaldisasters,

long-termshortagesoffresh,localfruitsandvegetablesareexperienced.Asaresult,peopleconsumecanned

andpreservedfood,whichareoftenhighinsaltandsugar.Excessiveamountsofsaltandsugarincreasethe


riskofillnesseslikehigh-bloodpressure,strokesandcardio-vasculardiseases,diabetesandobesity.Anecdotal

evidencesuggestsanincreaseindiabeticfoot-sepsisamongpeopleintheEasternDivisiontwoyearsafter

CycloneTomas’destructionoffarmsinthearea.

Climate change is also causing sea surface temperatures and sea levels to rise and altering the mixing of ocean

layers which reduce nutrient availability and fish supply. Rising sea surface temperatures, and increasing

variabilityintheformoftheElNinoSouthernOscillationwillnegativelyimpactcoralreefs,leadingtofurther

reductioninfisheries(FAO,2008).SeafoodisanimportantsourceofproteininFijiandthelackoffreshfishwill

furtherpushconsumerstobuycannedfish,whicharenormallyhighinsalt.

Inthelong-term,damagessufferedbytheagricultureandfisheriessectorsmaycreatesignificantfoodsecurity

issues,includingverylargeincreasesinNCDsandveryhighdependenceonimportedfoods.

C. Death and injury from extreme events

Drowning fromswimming infloodedrivers,or trying tocrossfloodedcrossings isamajorcauseofdeath

duringfloodsandcyclones.Asummaryofdeathsfromrecentmajorcyclonesandfloodsispresentedbelow.

Table 5: Deaths During Major Recent Cyclones and Floods

Deathscausegriefandsorrowinaffectedfamiliesandiffamilieslosetheirbread-winners,thentheirlossesare

greater. Related impact on the mental health of family and friends is varied yet quite notable. The possibility

ofdepressionandstressincreasesduringsuchtimes.

D. Psychological impacts

A largely neglected health impact of climate change and extreme climate events, the UNOCHA Pacific

coordinatedHumanitarianResponseTeamrecognisedthisasan importantareafollowingtheMarch2012

floods (UNOCHAPacific,2012).Psychological stressanddepressioncanarise from lossof livelihoods (e.g.

droughtdamagetocrops),deathoforimmobilisinginjurytofamilymembers,lossofhomestofloodsand/or

cyclones,theinabilitytorecoverfromdisasters,conflictoverlimitedresourceslikewater/productivelandand

therelocationordisplacementofpopulationstolessvulnerable,andinsomecasesmorevulnerableareas.

Itcanaffectadults,childrenandyouthandcantaketheformof“socialisolation,mentaldisorders,reduced

socio-economicstatusandassociatedhealthproblems”(WHO,2009:12).

Extreme Event No. of deaths Source

HurricaneAmi(January2003) 17 FMS,2003b.

FloodsduetoTropicalDepression(January2009) 11 McGreeatal.,2010.

TropicalCycloneMick(December2009) 9 ABCNews,2009.

FloodsduetoTropicalDepression(March2012) 4 UNOCHAPacific,2012.


3.3 Access to Health Services

HurricaneAmi(January2003)causedFJD857,000ofdamagetohealthinfrastructure(FMS,2003b).TheMarch

2012 floods caused FJD607,000 damage to health infrastructure (UNOCHA, 2012). Buildings, equipment,

drugsandrecordsgetdamagedfromwaterandwindandreplacementcostsareveryhigh.Electricityand

watercutsalsoseverely limit theoperabilityofhealth facilities. Inaddition,access tohealth facilitiesand

affectedcommunitiesisalsocut-offbyfloodedroadsandbridges.Transportingemergencycasestohospitals

becomesdifficultduringsuchtimes(MinistryofHealth,2012c)andhealthpractitionersareforcedtoattend

toemergencycasesatgreatpersonal risk.TheMinistryofHealthrecently reviewed itsHealthEmergency

andDisasterManagementActionPlan (HEADMAP),which includesStandardOperatingProcedures (SOPs)

toaddresssomeoftheissuesraisedhere.Currentpracticeduringdisastersisforhealthteams,comprising

medicalofficers,nurses,environmenthealthofficersanddieticians,toundertakeshiftclinicsandoutreachin

evacuationcentresandcommunitiestomaintainpopulationaccesstohealthservices.



4. Projected Impacts of Climate Change on Human Health in Fiji

Fiji’s climate is projected to continue towarmover the coming century.Days andnights are expected to

becomewarmer,with35⁰Cdaysandover16⁰C-21⁰Cnightsbecomingregularoccurrencesby2100.Generally,

thecountry isprojectedtogetdrierandsea levelsareexpectedtorise (GovernmentofFiji,2012).These

changeswillhaveprofoundimpactsonavailabilityofwater,agriculture,foodandlivingconditions.Inother

words,climatechangewillcontinuetocompromisethebasicdeterminantsofhumanhealth.

Studies undertaken using the PACCLIM model in 2005 (Government of the Fiji Islands, 2005) projected

increasesintheincidenceofdenguefever,diarrhoeaandnutritionrelatedillnessesinFiji.Using1990asthe

baseline,43%ofVitiLevuwasfoundtobeat lowriskofadengueoutbreak.By2100,evenundertheB2

(sustainabledevelopment)scenario,only21%ofVitiLevu(interioroftheisland)wasprojectedtobeatlow

riskofadengueoutbreak,withtheremainderofthepopulationestimatedtobeatmoderatetohighriskof

anoutbreak.Whentheworstcasescenario(A2)wasconsidered,45%ofVitiLevu’spopulationwasprojected

tobeathightoextremeriskofanoutbreakby2100.Thestudyalsoconcludedthatasaresultofwarming,the

frequencyofepidemicsmayincrease,epidemicsmayceasetobeseasonal(occuratanytimeoftheyear)and

evenbecomeendemic,andthemorbidityandmortalityfromepidemicscouldrisesignificantly.

ThesamestudyconcludedthatasFijitrendstowardsawarmerclimatewithmorefrequentdroughts,water

andsanitationwouldbecompromisedleadingtoincreaseddiarrhoealoutbreaks.Nutritionrelatedillnesses

werealsoprojectedtoincreaseasextremeeventsoccurmorefrequentlyandincreaseinintensity.Finally,

thestudyprojectedserioushealthimpactsifclimatechangedisruptedFiji’ssocial,economicandecological

systems(GovernmentoftheFijiIslands,2005).

Failure to adapt locally and mitigate globally would result in the above impacts being felt in Fiji. Some

adaptationmeasurestoprotecthumanhealthfromclimatechangearelistedbelow.


5. Adaptation Measures

Somemeasures to protect human health against the impacts of climate change are outlined below. It is

important tonote that improvedhumanhealthoutcomeswilldependonadaptationandprogress inALL

developmentsectors.AtarecentglobalWebinaronclimatechangeandhealth,Prof.KrisEbi,aninternational

expertonthesubjectmadethefollowingcommentsabouthealthadaptation.Firstly,itwillhavetobeiterative

i.e.measureswillhavetomodifiedasclimatechangesinthefuture.Secondly,thereisenoughevidenceto

startimplementingadaptationactivities,includingmanywin-winactivities(AlertNet,2012).

A. Health sector adaptation measures

Manyadaptationoptionsforthehealthsectorinvolvestrengtheningexistingdiseasesurveillance,monitoring

andcontrolmeasureswhileothersrequiresystematicallyincorporatingclimateinformationinhealthplanning

andinterventions.SomehealthadaptationmeasuresforFijiinclude:

• Continuoushealthvulnerabilityassessmentforcommunicableandnon-communicablediseasesandfor

safetyandaccessibilityofhealthfacilities/healthcare.

• Improveaccesstoprimaryhealthcare.

• Integratedvectormanagementbybuildingorstrengtheningpartnershipswithrelevantstakeholders.

• Facilitaterapidandaccuratediseasenotification.

• Identifyandprotect thehealthof themostvulnerablemembersof society (elderly,disabled,women,

children,poor).

• Vaccinate humans against diseases like typhoid fever and livestock and pets against diseases like

leptospirosis.

• On-goingeducationandtrainingonclimatechange,disasterriskreduction,communityhealthadaptation,

etc.

• Incorporateclimatechangeintoexistinghealthpoliciesandplans.

B. Natural disaster-specific measures

• Strengthendisasterriskreduction,recoveryandresponseprogrammes.ThisincludesStandardOperating

Procedures and health staff and facilities being adequately resourced (funding, personal protective

equipment,foodrations,electricity,water,communications).

• Improvecoordinationamonginter-sectoralpartners(DISMACandUNHumanitarianAssistancegroup).

• Developorstrengthenearlywarningsystems.

• Climate-proofhealthinfrastructure.Thisincludesrelocatinghealthfacilitiesiftheyareinvulnerableareas,

ensuringfacilitieshaveback-uporrenewableelectricity,water(e.g.installationofwatertanks),sufficient

drugs and supplies during natural disasters and undertaking regular repair and maintenance.


C. Adaptation in other sectors- water, agriculture, rural development, housing,

environment, community empowerment and livelihoods, energy, etc.

TheWHOarguesthathumanhealthshouldbethebottomlineofalladaptationactivitiesandprogrammes

(WHO,2009).Ahealthypopulationisaresilientpopulationandforthesereasons,ALLdevelopmentsectors

inFijimustaimtoimprovehumanhealthoutcomesthroughtheiradaptationactivities.Someprioritysectoral

andinter-sectoraladaptationmeasuresarehighlightedbelow.

• Providecleanwater, improvedsanitationandhouseholddisinfectionespecially inareaswheredisease

incidence is higher.

• Improvesocialindicatorslikeeducation,women’sempowerment,improvedhousingandequitableaccess

todevelopmentopportunities.

• Improveeconomicindicatorslikeemploymentrate,alternativelivelihoodsandaccesstomarkets.

• Enhancecommunityresilienceagainstclimatechangeanddisasters.

• Encourageagriculturaldiversificationandsustainableagriculture.Discouragefarminginmarginalareas.

• Thenaturalenvironmentisasourceoffood,shelter,medicine,cleanwaterandair.Italsoactsasabuffer

againstextremeclimateeventslikefloodsandcyclones.Moreover,anunpollutedenvironmentissafefor

humanhabitationwhereasanalteredenvironmentmaycreateconditionsfordiseasemicrobesandvectors

tospread.(Corvalanetal.,2005).Forthesereasons,ecosystemsmustbeprotectedfromunsustainable

use.

• Localmitigationmeasures like increaseduseofpublic transportation,walking/cycling insteadofusing

fossil-fuelpowered transport,useofefficientwood-stoves thatemit lesssmokecreateco-benefits for

healthwhilereducinggreenhousegasemissions.

(MinistryofHealth,2012c;WHO,2009)


6. Conclusion

Tosummarise,healthfacilitiesandhealthcareservices,communicableandnon-communicablediseasesandall

thebasicdeterminantsofhealtharesensitivetoclimateconditions.Impactsareprojectedtobecomeworseas

climatechangecontinues.Thishighlightstheneedforurgentadaptationinthehealthandotherdevelopment

sectorsandurgent,up-scaledmitigationofgreenhousegasesglobally.Toconclude,humanhealthshouldbe

thebottom-lineofalladaptationactivitiesandincreasedfundsarerequiredtosecurethenecessaryhuman

andotherresourcesforadaptationtotakeplaceattherequiredrate.


References:

ABCRadioAustralia.2009.DamagedandDisplacedafterFijiCyclone,15December2009.Accessedon3rd

November2011,viaURL:http://www.radioaustralia.net.au/pacbeat/stories/200912/s2771752.htm

AlertNet. 2012. Hunger Might be Largest Health Impact of Climate Change- Expert. Accessed on 2nd October

2012,viaURL:http://www.trust.org/alertnet/news/hunger-may-be-largest-health-impact-of-climate-change-

expert/

Corvalan,C.,Hales,S.andMcMichael,A.2005.EcosystemsandHumanWell-Being:HealthSynthesis:Areport

oftheMillenniumEcosystemAssessment.WHO,Geneva.

FijiMeteorologicalService.2003a.InformationSheetNo.126.ListofDroughtsthathaveOccurredinFijisince

1965.FMS,Nadi.

- 2003b.InformationSheetNo.123.ListofTropicalCyclonesinFiji.FMS,Nadi.

FoodandAgricultureOrganisation.2008.ClimateChangeandFoodSecurityinPacificIslandCountries.FAO,

Rome.

GovernmentofFiji.2012.RepublicofFijiNationalClimateChangePolicy.SPC,Suva.

- 2005.Fiji’sInitialNationalCommunications.PacificIslandsClimateChangeAssistanceProgramme,Apia.

Hales,S.,Weinstein,P.,Soures,Y.andWoodward,A.1999.ElNinoandtheDynamicsofVector-borneDisease

Transmission.EnvironmentHealthPerspectives107(2):99-102.

Jenkins,K.TyphoidfevercontrolinFiji.ProceedingsoftheEcohealthForum,Suva,Fiji26thNovember2010.

McGree,S.,Yeo,S.W.andDevi,S.2010.FloodingintheFijiIslandsBetween1840and2009.RiskFrontiers,

MacqaurieUniversity,Sydney.

MinistryofHealth.2005.FijiNonCommunicableDiseases(NCD)STEPSSurveyReport.MinistryofHealth,Suva

- 2011.AnnualReport2010.MinistryofHealth,Suva.

- 2012a.HealthInformationUnitData.MinistryofHealth,Suva.

- 2012b. Integrated Communicable Disease Report. Issue 1 Jan-May 2012. Ministry of Health, Suva

(unpublishedreport).

- 2012c.SWOTAnalysisoftheMinistryofHealth’sResponsetoFloodingintheWesternDivisioninJanuary

andMarch2012.MinistryofHealth,Suva(unpublishedreport).

NationalFoodandNutritionCentreandMinistryofHealth.2009.NutritionandNCDFactsheets.NFNCand

MinistryofHealth,Suva.

PCCAPHH. 2012. Fiji: Protecting Health from Climate ChangeWorking Paper: Climate-Sensitive Infectious

DiseasesinFiji.2011SummaryreportfromFiji’sPilotingClimateChangeAdaptationtoProtectHumanHealth

project.WHO-SPandFijiMinistryofHealth,Suva.


Ram,P.,Mataitoga,V.,Seruvatu,L.1983.TyphoidFeverinFijiin1982:EpidemiologicalAspects.FijiMedical

Journal1983(11):124-128.

Singh,R.B.K.,Hales,S.,deWet,N.,Raj,R.,Hearnden,M.andWeinstein,P.2001.TheInfluenceofClimate

VariationandChangeonDiarrhoealDiseaseinthePacificIslands.EnvironmentHealthPerspectives109(2):

155-159.

Snowdon,W. 2012. Legislation toMandate the Supply of Fortified Flour in Fiji: DesktopReviewof Policy

DevelopmentProcess.ConsultancyReportfortheNationalFoodandNutritionCentreandMinistryofHealth.

NFNCandMinistryofHealth,Suva.

Tuiketei,T., Snowdon,W.,Wade,G.,Kremer,P., Schultz, J.andVanualailai,N.2010.ObesityPrevention in

Community (OPIC) Project- Fiji Report 2004-2008. Deakin University, Melbourne and the Fiji School of

Medicine,Suva.

UNOCHAPacific.2012.Fiji.FloodingTropicalDepressionTD17F-2012.SituationReportNo.4.12thApril2012.

UNOCHAPacific,Suva.

WHO.2009.ProtectingHealthfromClimateChange:ConnectingScience,PolicyandPeople.WHO,Geneva.

WorldBank.2012.DataFiji.AccessedonSeptember28th2012viaURL:data.worldbank.org./country/Fiji


Photoscourtesyof:Fiji Times LiveandLearn,FijiMinistry Of HealthWorldHealthOrganization

Designedby:PasifikaCommunication


Documents

Human Health Vulnerability to Climate Change in Fiji