Marshall Alexander | metoffice@cwdom.dm
Dr Roché Mahon | rmahon@cimh.edu.bb
Dominica is a volcanic island located between the Caribbean Sea and Atlantic Ocean. It has a mountainous terrain, with 90% of Dominica’s population of approximately 71 000 people living along the shore (1–3). Dominica’s natural park system protects much of the island’s biodiversity and rainforests, and promotes eco-tourism. The country is colloquially known as the Nature Island of the Caribbean. Rain-fed agriculture, particularly banana, citrus and coconut production, is a significant proportion of Dominica’s income, accounting for 17% of gross domestic product (GDP) and 14% of employment (2,3). However, despite the fertility of the soil, much of Dominica’s food consumption comes from imports, creating challenges to food security.
Climate change is projected to result in increased temperatures, rising sea levels, changing precipitation patterns, and more extreme weather events. Dominica is particularly vulnerable to climate change because so much of the population lives along the coast and the country’s income is dependent upon agriculture and tourism. Threats to the health of the population include heat stress, food insecurity, vector-borne diseases, salt intrusion of fresh water aquifers, death and injury, and damage to environmental determinants of health from extreme weather events, and loss of marine and terrestrial habitats.
The Government of Dominica is committed to sustainability and established the Environmental Coordinating Unit in 1999. Dominica’s nationally determined contribution (NDC) recognizes the climate risks posed to human health, especially via extreme weather events. The implementation of climate change policies is the joint responsibility of the Ministries of Health and Social Services, and Environment, providing excellent opportunities for maximizing health co-benefits of mitigation and health adaptation actions (4).
Country-specific projections are outlined up to the year 2100 for climate hazards under a ‘business as usual’ high emissions scenario compared to projections under a ‘two-degree’ scenario with rapidly decreasing global emissions (see Figures 1–5). The climate model projections given below present climate hazards under a high emissions scenario, Representative Concentration Pathway 8.5 (RCP8.5 – in orange) and a low emissions scenario (RCP2.6 – in green). 1 1Model projections are from CMIP5 for RCP8.5 (high emissions) and RCP2.6 (low emissions). Model anomalies are added to the historical mean and smoothed.
The text describes the projected changes averaged across about 20 global climate models (thick line). The figures 2 2Analysis by the Climatic Research Unit, University of East Anglia, 2018. also show each model individually as well as the 90% model range (shaded) as a measure of uncertainty and the annual and smoothed observed record (in blue).3 3Observed historical record of mean temperature is from CRU-TSv3.26 and total precipitation is from GPCC. Observed historical records of extremes are from JRA55 for temperature and from GPCC-FDD for precipitation. In the following text the present-day baseline refers to the 30-year average for 1981–2010 and the end-of-century refers to the 30-year average for 2071–2100.
Modelling uncertainties associated with the relatively coarse spatial scale of the models compared with that of small island States are not explicitly represented. There are also issues associated with the availability and representativeness of observed data for such locations.
Under a high emissions scenario, the mean annual temperature is projected to rise by about 2.9°C on average by the end-of-century (i.e. 2071–2100 compared with 1981–2010). If emissions decrease rapidly, the temperature rise is limited to about 0.9°C.
Total annual precipitation is projected to decrease by about 20% on average under a high emissions scenario, although the uncertainty range is large (-50% to +6%). If emissions decrease rapidly there is little projected change on average: a decrease of about 4% with an uncertainty range of -15% to +8%.
The percentage of hot days4 4A ‘hot day’ (‘hot night’) is a day when maximum (minimum) temperature exceeds the 90th percentile threshold for that time of the year. is projected to increase substantially from about 25% of all observed days on average in 1981–2010 (10% in 1961–1990). Under a high emissions scenario, almost 100% of days on average are defined as ‘hot’ by the end-of-century. If emissions decrease rapidly, about 85% of days on average are ‘hot’. Note that the models tend to overestimate the observed increase in hot days (about 30% of days on average in 1981–2010 rather than 25%). Similar increases are seen in hot nights (not shown).
The proportion of total annual rainfall from very wet days5 5The proportion (%) of annual rainfall totals that falls during very wet days, defined as days that are at least as wet as the historically 5% wettest of all days (about 28% for 1981–2010) could decrease a little by the end-of-century (to around 25% on average with an uncertainty range of about 5% to 40%), with little change if emissions decrease rapidly. Total annual rainfall is projected to decrease (see Figure 2).
The Standardized Precipitation Index (SPI) is a widely used drought index which expresses rainfall deficits/excesses over timescales ranging from 1 to 36 months (here 12 months, i.e. SPI12). Under a high emissions scenario, SPI12 values are projected to decrease to about -0.3 on average by the end of the century (2071–2100), with a number of models indicating substantially larger decreases and hence more frequent and/or intense drought. Year-to-year variability remains large with wet episodes continuing to occur into the future.6 6SPI is unitless but can be used to categorize different severities of drought (wet): above +2.0 extremely wet; +2.0 to +1.5 severely wet; +1.5 to +1.0 moderately wet; +1.0 to +0.5 slightly wet; +0.5 to -0.5 near normal conditions; -0.5 to -1.0 slight drought; -1.0 to -1.5 moderate drought; -1.5 to -2.0 severe drought; below -2.0 extreme drought.
Dominica has already experienced severe drought conditions. The 2010 drought led to: loss of 18% of GDP and 27% of employment; 43% drop in banana exports in the first 11 weeks of 2010; 160 fires in the first quarter of 2010; and damage to 23 000 hectares of agricultural land (8)
Hurricanes and tropical storms have repeatedly set back economic development in Dominica, notably Hurricane David in 1979, in which around 75% of the population was rendered homeless (9). Particularly damaging are events associated with excessive or prolonged rainfall, which provokes flooding and landslide activity. Within the past four years there have been two major tropical cyclones with devastating impacts on human development, the health system, the economy and infrastructure: Tropical Storm Erica (27 August, 2015) and Hurricane Maria (18 September, 2017). The following table shows that the damage caused by Hurricane Maria cost more than double the annual GDP of the country. The figures on mortality account only for immediate deaths from injury or drowning; total mortality resulting from Hurricane Maria is likely to be higher if deaths resulting from reduced access to health care and sanitation are taken into account (10).
It is anticipated that the total number of tropical cyclones may decrease towards the end of the century. However, it is likely that human-induced warming will make cyclones more intense (an increase in wind speed of 2–11% for a mid-range scenario (i.e. RCP4.5, or about 5% for 2˚C global warming). There are better than even odds that the most intense events (i.e. category 4 and 5) will become more frequent (although these projections are particularly sensitive to the spatial resolution of the models). It is also likely that average precipitation rates within 100 km of the storm centre will increase – by a maximum of about 10% per degree of warming. Such increases in rainfall rate would be exacerbated if tropical cyclone translation speeds continue to slow.
Sea level rise is one of the most significant threats to low-lying areas on small islands and atolls. Research indicates that rates of global mean sea level rise are almost certainly accelerating as a result of climate change.
The average change in Caribbean sea level over the period 1993–2010 (22) is projected at 1.7 mm/year (± 1.3), with substantial spatial variability across the region. A further 0.5–0.6m rise is expected in the Caribbean by the end of the century (23) with variation amongst models and emissions scenarios.
The relatively long response times to global warming mean that sea level will continue to rise for a considerable time after any reduction in emissions.
Potential impacts of sea level rise include:
Some of the world’s most virulent infections are also highly sensitive to climate: temperature, precipitation and humidity have a strong influence on the life-cycles of the vectors and the infectious agents they carry, and influence the transmission of water- and foodborne diseases (24,25).
Small island developing States (SIDS) are vulnerable to disease outbreaks. Climate change could affect the seasonality of such outbreaks, as well as the transmission of vector-borne diseases. Figure 7 presents modelled estimates for Dominica of the potential risk of dengue fever transmission under high and low emission scenarios.7 7a A suite of mathematical models was systematically developed, then applied and interpreted by a team of researchers at Umeå University (Sweden) to assess the potential for mosquito-borne disease outbreaks (e.g. dengue, chikungunya, Zika and malaria) in terms of climate-dependent VC. The baseline year is 2015, Climatic Research Unit CRU-TSv4.01. Future projections are represented for two emissions futures (Representative Concentration Pathways: RCP2.6, RCP8.5), five climate change projections (Global Climate Models: gfdlesm2m, hadgem2-es, ipsl-cm5a-lr, mirocesm-chem, noresm1-m). (2018) Umeå University, Sweden. The seasonality and prevalence of dengue transmission may change with future climate change, but Dominica is consistently highly suitable for dengue transmission under all scenarios and thus vulnerable to outbreaks (26–29).8 8Given the climate dependence of transmission cycles of many vector-borne diseases, seasonality of epidemic risk is common; however, many SIDS, due to tropical latitudes, tend to have less seasonality than more temperate areas. 9 9The actual occurrences/severity of epidemics would be quite different for each disease in each setting and could depend greatly on vector- and host-related transmission dynamics, prevention, surveillance and response capacities that are not captured in this model.
The following figures (Figures 8 and 9) present numbers of reported dengue cases for 2008 to 2018. The 10-year figures show outbreaks in 2010 and 2013, but no overall trend. Weekly reported dengue figures for 2018 show a cluster of cases in December.
Small island developing States (SIDS) face distinct challenges that render them particularly vulnerable to the impacts of climate change on food and nutrition security including: small, and widely dispersed, land masses and populations; large rural populations; fragile natural environments and lack of arable land; high vulnerability to climate change, external economic shocks, and natural disasters; high dependence on food imports; dependence on a limited number of economic sectors; and distance from global markets. The majority of SIDS also face a ‘triple-burden’ of malnutrition whereby undernutrition, micronutrient deficiencies and overweight and obesity exist simultaneously within a population, alongside increasing rates of diet-related NCDs.
Climate change is likely to exacerbate the tripleburden of malnutrition and the metabolic and lifestyle risk factors for diet-related NCDs. It is expected to reduce short- and long-term food and nutrition security both directly, through its effects on agriculture and fisheries, and indirectly, by contributing to underlying risk factors such as water insecurity, dependency on imported foods, urbanization and migration, and health service disruption. These impacts represent a significant health risk for SIDS, with their particular susceptibility to climate change impacts and already overburdened health systems, and this risk is distributed unevenly, with some population groups experiencing greater vulnerability.
In Dominica, temperature rise and changes in weather patterns have impacted the viability of key sectors: agriculture, fisheries and tourism (among others). The drought in 2010 caused massive losses in the agriculture sector. Changing temperatures are altering marine ecology and the viability of fish species. In 2005, a mass coral bleaching event destroyed 75% of the coral colonies in Dominica (8,33). In 2017, Hurricane Maria destroyed most of the foliage, leaving a brown and barren-looking landscape; most agricultural crops were destroyed and reliance on processed food imports grew, increasing susceptibility to noncommunicable diseases as well as generally affecting nutritional quality (34).
The following section measures progress in the health sector in responding to climate threats based on country reported data collected in the 2021 WHO Health and Climate Change Country Survey (48).
| Question | questioncategory | question | Answer |
|---|---|---|---|
| Has a national health and climate change strategy or plan been developed ? | NO | ||
| Are the health co-benefits of climate change mitigation action considered in the strategy/plan? | N/A | ||
| Level of implementation of the strategy/plan? | N/A | ||
| Portion of estimated costs to implement the strategy/plan covered in the health budget | N/A | ||
| Are health adaptation priorities identified in the strategy/plan? | N/A |
Is there an agreement in place between the ministry of health and this sector which defines specific roles and responsibilities in relation to links between health and climate change policy?
| Question | questioncategory | question | Answer |
|---|---|---|---|
| Is there an agreement in place between the ministry of health and this sector which defines specific roles and responsibilities in relation to links between health and climate change policy? | Transportation | NO | |
| Is there an agreement in place between the ministry of health and this sector which defines specific roles and responsibilities in relation to links between health and climate change policy? | Electricity generation | NO | |
| Is there an agreement in place between the ministry of health and this sector which defines specific roles and responsibilities in relation to links between health and climate change policy? | Household energy | NO | |
| Is there an agreement in place between the ministry of health and this sector which defines specific roles and responsibilities in relation to links between health and climate change policy? | Agriculture | NO | |
| Is there an agreement in place between the ministry of health and this sector which defines specific roles and responsibilities in relation to links between health and climate change policy? | Social services | NO | |
| Is there an agreement in place between the ministry of health and this sector which defines specific roles and responsibilities in relation to links between health and climate change policy? | Water, Sanitation & Waste-water management | NO |
| Question | questioncategory | question | Answer |
|---|---|---|---|
| Has an assessment of health vulnerability and impacts of climate change been conducted at a national level? | YES | ||
| → Level of influence of the assessment findings on policy prioritization to address the health risks of climate change | MINIMAL | ||
| → Level of influence of the assessment findings on human and financial resource allocation to address the health risks of climate change | NO |
| Climate-sensitive diseases and health outcomes | qid | Health surveillance system is in place (a) | Health surveillance system includes meteorological information (b) |
|---|---|---|---|
| Thermal stress (e.g. heat waves) | 22111 | NO | NO |
| Vector-borne diseases | 22121 | YES | YES |
| Foodborne diseases | 22131 | YES | NO |
| Waterborne diseases | 22141 | YES | NO |
| Nutrition (e.g. malnutrition associated with extreme-climatic events) | 22151 | NO | |
| Injuries (e.g. physical injuries or drowning in extreme weather events) | 22161 | NO | NO |
| Mental health and well-being | 22171 | NO | NO |
| Airborne and respiratory diseases | 22181 | NO |
| Climate hazard | qid | Health early warning system (HEWS) in place? | Health sector response plan in place? | Health sector response plan includes meteorological information? |
|---|---|---|---|---|
| Heat waves | 23111 | NO | Unknown | NO |
| Storms (e.g. hurricanes, monsoons, typhoons) | 23131 | YES | YES | YES |
| Flooding | 23141 | YES | YES | YES |
| Drought | 23161 | NO | NO | YES |
| Air quality (e.g. particulate matter, ozone levels) | 23171 |
| Question | questioncategory | question | Answer |
|---|---|---|---|
| Is there a national curriculum developed to train health personnel on the health impacts of climate change? | NO | ||
| Does your human resource capacity as measured through the International Health Regulations Monitoring Framework (IHR) adequately consider the human resource requirements to respond to climate-related events? | Unknown |
| Question | questioncategory | question | Answer |
|---|---|---|---|
| Has there been a national assessment of the climate resilience of health infrastructure and technology? | |||
| Have measures been taken to increase the climate resilience of health infrastructure and technology? | |||
| Is there a national initiative/programme in place to promote the use of low-carbon, energy-efficient, sustainable technologies in the health sector? |
| Question | questioncategory | question | Answer |
|---|---|---|---|
| Is your government currently accessing international funds to support climate change and health work? | NO* |
Greatest challenges faced in accessing international climate funds
| Question | questioncategory | question | Answer |
|---|---|---|---|
| Greatest challenges faced in accessing international climate funds | Lack of information on the opportunities | YES | |
| Greatest challenges faced in accessing international climate funds | Lack of country eligibility | ||
| Greatest challenges faced in accessing international climate funds | Lack of connection by health actors to climate change processes | YES | |
| Greatest challenges faced in accessing international climate funds | Lack of capacity to prepare country proposals | ||
| Greatest challenges faced in accessing international climate funds | Lack of success in submitted applications | ||
| Greatest challenges faced in accessing international climate funds | None (no challenges/challenges were minimal) | ||
| Greatest challenges faced in accessing international climate funds | Not applicable | ||
| Greatest challenges faced in accessing international climate funds | Other (please specify) |
Develop a national health and climate change plan, including a Health National Adaptation Plan (H-NAP), ensuring that adaptation priorities are specified, health co-benefits from mitigation and adaptation measures are considered, necessary budget requirements are allocated and regular monitoring and review of progress will support its full implementation.
Expand upon existing health monitoring and surveillance systems, ensuring meteorological information is integrated. Dominica is expected to be affected by a range of health threats due to climate change, including heat stress, nutrition challenges, and mental health and well-being issues, which should be added to existing risk surveillance and early warning systems. The system should have the capacity to measure environmental risk. The purpose will be to develop a comprehensive monitoring and surveillance system, linking climate with health information, permitting early warning and tailored responses to health outcomes of climate change and their environmental determinants. Strengthening of environmental risk measurement will also assist in diagnosis and medical treatment.
No international funding is currently being accessed to aid with health and climate change initiatives. Additional funding would help to further the development and implementation of policies and to expand risk surveillance and early warning systems.
Measures can be taken to prevent the potentially devastating impacts of climate change on health service provision, including: conducting hazard assessments; climate-informed planning and costing; strengthening structural safety; climate-resilient storage of medications; contingency planning and back-up systems for essential services (electricity, heating, cooling, ventilation, water supply, sanitation services, waste management and communications); strengthening transport routes and systems; and developing staff capacity to address climate-related risks in communities surrounding health care facilities. A commitment towards low-emission, sustainable practices to improve system stability, promote a healing environment and to mitigate climate change impacts can also be taken.
Community resilience can be enhanced by involving them actively in the design of health care facilities and services and, by strengthening their capacity for health care responses. Dominica State College and other national, regional and international educational institutions and technical support agencies should develop capacity in areas such as surveillance and reporting of climate-sensitive health conditions; computerization and dissemination of surveillance, monitoring and evaluation data; sampling and testing of environmental determinants of health; and environmental impact assessment and psychological support following disasters.
WHO/HEP/ECH/CCH/20.01.04
© World Health Organization and the United Nations Framework Convention on Climate Change, 2020
Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence
All reasonable precautions have been taken by WHO and UNFCCC to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO and UNFCCC be liable for damages arising from its use.
Most estimates and projections provided in this document have been derived using standard categories and methods to enhance their cross-national comparability. As a result, they should not be regarded as the nationally endorsed statistics of Member States which may have been derived using alternative methodologies. Published official national statistics, if presented, are cited and included in the reference list.
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