Written by Alistair Woodward.

The south east corner of the Pacific, the area covered by the Secretariat for the Pacific Community, is home to about ten million people. It is responsible for a tiny fraction, less than 0.03 percent of global greenhouse emissions, but includes five of the fifteen countries most open to harm from floods, droughts and tsunamis. There is a colossal mismatch here between liability and vulnerability.

Climate change acts as a risk multiplier. What this means is that in the short-term, the effects on health are most likely to occur by the aggravation of present problems. For this reason, the best guide to the health of Pacific island nations in a climate-changed world tomorrow may be the state of health statistics today .

The impacts of climate change on the Pacific have enormous significance: this is the largest eco-system on the planet. It covers a third of the Earth’s surface, and on account of its depth and breadth is the engine house for the world’s weather.

There is a great deal of variability between and within island nations. But in general, population health in this part of the Pacific is falling behind. There have been some important gains in recent decades, in infant mortality for instance. However advances have not occurred as quickly as elsewhere.  And, in some places, improvements have stalled or even reversed.  Life expectancy trends have been flat in recent years in Fiji and Papua Guinea, and have deteriorated in Nauru, for example.

Old-fashioned public health problems related to poor sanitation and lack of secure shelter are present in many places. Only 60 percent, approximately, of the population has access to safe water. Typhoid and other enteric infections are endemic in many islands.  In addition, chronic diseases such as diabetes and cardiovascular disease are on the rise and the cost of long term care for these conditions is a huge drain on national economies.

The region has many strengths. They include robust cultures, abundant natural resources and high degree of connectivity within and beyond the region. The health system in some countries does very well given the resources available to it – as shown by high rates of immunisation and enrolment in primary care in Fiji, for instance.  Historic connections with Pacific rim countries may be a mixed blessing in some respects, but they do provide important opportunities for trade, education and income.

What is holding the region back? There is political instability in many places: Noumea and Tonga were without governments this year, and Papua New Guinea is chronically afflicted by division and disorder. There are serious social issues in some countries, especially among young people: about 80 percent of young men in the Marshall islands are without a formal job.

The impacts of climate change on the Pacific have enormous significance: this is the largest eco-system on the planet. It covers a third of the Earth’s surface, and on account of its depth and breadth is the engine house for the world’s weather. It contains some of the world’s biggest fisheries – roughly two thirds of the global tuna catch comes from the Pacific.

Sea level rise attracts attention, given the multitude of low-lying atolls in the Pacific. South Tarawa, the main island in Kiribati (maximum altitude three metres, population about 50,000) and Funafuti in Tuvalu are commonly cited. Thermal expansion of the oceans threatens the long term viability of these and other Pacific island nations, and the impacts are compounded by other stressors.

In Tarawa, there are population pressures associated with high fertility and in-migration from outer islands, economic adversity, and inadequate, and in some instances, quite inappropriate infrastructure. Water-flushed sewerage for instance was installed with good intentions, but is hardly the best choice on a crowded drought-prone atoll.

In the short-term, other aspects of climate change may be larger threats than sea level rise. I am referring to storms, droughts and other extreme weather events, as well as increasing acidity of the ocean.

Rising levels of greenhouse gases in the atmosphere are energising the global climate and increasing the severity of storms in the form of tropical cyclones, which are already a significant threat to many Pacific islands. Winston, in 2016, caused about $900 million damage to Fiji. When Tropical Cyclone Pam hit Vanuatu in 2015, the losses added up to about two thirds of the country’s annual GDP. As well as the immediate impacts on injury and disease, there are long-lasting effects due to disrupted health care, shortage of secure housing, and compromised supplies of safe food and water. Mental health is not well-studied, but likely to be particularly important when the social settings are already adverse.

Heavy rainfall tends to be associated with increased risk of some vector-borne diseases, such as dengue fever (mosquitoes) and leptospirosis (spread by rodents). Water-borne illnesses, including typhoid, are also more difficult to control when the climate is variable and intense. These conditions already pose significant threats to health in the islands, and are projected to become a greater problem in the future.

Higher temperatures, stronger storms, and ocean acidity (projected to double by the end of this century) are potent threats to coral reefs, critically important sources of food, cultural capital and economic activity.

Climate change in other words will magnify health problems already present in the region, and will likely add materially to obstacles in the way of economic and social development. In its most recent assessment, the IPCC concluded “the most effective measures to reduce vulnerability in the near term are programmes that implement and improve basic public health measures”.  This is certainly true in the Pacific, where priorities include provision of clean water and sanitation, ensuring there is access for all to the elements of essential health care, increased capacity for disaster preparedness and response, and alleviation of poverty.

The highest priority of all is primary prevention, which means taking necessary actions to avoid dangerous climate change. The Pacific Island nations have a part to play, but the major responsibility for mitigation lies elsewhere, in high-consuming and heavy-polluting countries on the Pacific rim and further afield.

Alistair Woodward is Professor of Epidemiology and Biostatistics at the University of Auckland. He graduated MMedSc from the University of Nottingham in 1981, and has worked on environmental health topics ranging from cell phones and brain cancer to second hand tobacco smoke to climate change. He was a coordinating lead author for the 5th assessment report of the Intergovernmental Panel on Climate Change and writes frequently for Public Health Expert. Image Credit: Mel Stoutsenberger/Flickr