Strengthen Implementation of Policy and Plans
Finalize and implement the National Health and Climate Change Plan 2020–2024.
Tuvalu is a sovereign state located in the South Pacific Ocean with a land mass of 26 square kilometres across a group of nine coral atolls and a mean elevation of 2m above sea level (1). Considered one of the smallest and most remote countries on Earth, Tuvalu is both a small island developing state and a least-developed country.
Disasters continue to pose a threat to the Tuvaluan way of life. When Cyclone Pam hit Tuvalu in 2015, around 45% of the population were affected as the country suffered from substantial losses amounting to US$ 10.3 million, equivalent to 26.9% of its GDP (2). All of Tuvalu’s atolls experience spring tides and tropical cyclones often with flooding damaging agriculture and infrastructure. Tropical cyclones affect Tuvalu mainly between November and April and are most frequent in El Niño years and least frequent in La Niña years (3).
Climate data indicates that Tuvalu is already experiencing increasing temperatures, sea level rise and ocean acidification consistent with climate change (3). The key health vulnerabilities sensitive to the effects of climate change in Tuvalu include diarrhoeal disease (due to contaminated food and/or water), respiratory disease (infective and obstructive), compromized food security (with impacts on nutrition and noncommunicable diseases (NCDs)), vector-borne diseases, mental health/psychological problems, injuries and deaths from extreme weather events, fish poisoning (ciguatera) and skin infections/infestations (4). Heat stress (see page 9) is increasingly being recognized as a key health threat due to climate change in Tuvalu.
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, mean annual temperature is projected to rise by about 2.9ºC 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 increase by about 9% on average under a high emissions scenario, although the uncertainty range is large (-15% to +48%). If emissions decrease rapidly the increase is smaller: 5% on average with an uncertainty range of -6% to +20%.
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 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 75% of days on average are ‘hot’. Note that for the last few years the models tend to over-estimate the observed increase in hot days. Similar increases are seen in hot nights (not shown).
Under a high emissions scenario, 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 30% for 1981–2010) could increase a little by the end-of-century (to almost 40% of days on average with an uncertainty range of about 15% to 60%), with little change if emissions decrease rapidly. These projected changes are accompanied by small projected increases in total annual rainfall (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).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. It shows how at the same time extremely dry and extremely wet conditions, relative to the average local conditions, change in frequency and/or intensity.
Under a high emissions scenario, SPI12 values are projected to increase to about 0.4 on average by the end of the century (2071–2100), with a number of models indicating substantially larger increases and hence more frequent and/ or intense wet episodes. Year-to-year variability remains large with dry episodes continuing to occur into the future.
Tropical cyclones affect Tuvalu mainly between November and April. An average of eight cyclones per decade developed within or crossed the Tuvalu Exclusive Economic Zone (EEZ) between the 1969/70 and 2010/11 cyclone seasons (see Figure 6). Tropical cyclones were most frequent in El Niño years and least frequent in La Niña years (3).
Sea level rise is one of the most significant threats to low lying areas on small islands and atolls. Research indicates that global mean sea level rise rates are almost certainly accelerating as a result of climate change. A further 0.4-0.9m sea level rise is expected in Tuvalu by 2090 under a high emissions (RCP8.5) scenario (3). 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:
Vector-borne diseases are highly sensitive to climate, with increased temperature potentially leading to faster mosquito breeding and viral replication and rainfall leading to wider availability of mosquito breeding habitats, up to the point where flooding flushes breeding sites away (23,24). In Tuvalu, there are currently two main vector-borne diseases of concern: dengue fever and lymphatic filariasis (LF) (25). Increased temperatures, expected higher tides, inundations and tropical cyclones due to climate change threaten to increase the risk of vector- and waterborne disease in the coming decades. A recent study has also investigated the effect of drought on diarrhea transmission in Tuvalu (26). The findings demonstrated the need to better understand the link between severe drought and disease outbreaks.
As climate conditions are projected to become significantly more favourable for the transmission of infectious disease, there is a risk that recent progress in reducing the burden of infectious disease will slow. As a result, there will be an increase in populations at risk if control measures are not maintained or strengthened.
Case study: Dengue-1 Outbreak, Tuvalu, 2019
Data from a recent dengue-1 outbreak in Tuvalu demonstrates the association between weekly rainfall and incidence of dengue-1 cases over the period of January to June, 2019 (see Figure 7) (27). Although only a short time period is presented, the data illustrate how periods of high rainfall (blue line) can be followed by peaks in confirmed dengue-1 cases (red line). Children were particularly vulnerable to contracting the dengue-1 virus during this outbreak, with a majority of the 210 confirmed cases being in children between the ages of 5 and 9 years old (see Figure 8) (27).
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/maritime populations; fragile natural environments and lack of arable land; high vulnerability to climate change, external economic shocks, 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 triple-burden 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.
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 (20).
| Question | questioncategory | question | Answer |
|---|---|---|---|
| Has a national health and climate change strategy or plan been developed ? | Under Development | ||
| Are the health co-benefits of climate change mitigation action considered in the strategy/plan? | TBA | ||
| 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? | TBA |
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 | YES |
| Question | questioncategory | question | Answer |
|---|---|---|---|
| Has an assessment of health vulnerability and impacts of climate change been conducted at a national level? | NO | ||
| → Level of influence of the assessment findings on policy prioritization to address the health risks of climate change | N/A | ||
| → Level of influence of the assessment findings on human and financial resource allocation to address the health risks of climate change | N/A |
| 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 | N/A |
| Vector-borne diseases | 22121 | YES | YES |
| Foodborne diseases | 22131 | YES | YES |
| Waterborne diseases | 22141 | YES | YES |
| Nutrition (e.g. malnutrition associated with extreme-climatic events) | 22151 | YES | |
| 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 |
| 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 | NO | N/A |
| Storms (e.g. hurricanes, monsoons, typhoons) | 23131 | YES | Unknown | Unknown |
| Flooding | 23141 | N/A | N/A | N/A |
| Drought | 23161 | YES | NO | N/A |
| 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? | Under Development | ||
| 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? | Partially |
| 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? | YES |
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 | YES | |
| 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) |
Finalize and implement the National Health and Climate Change Plan 2020–2024.
Complete a national assessment of health vulnerability, impacts and adaptive capacity in Tuvalu. Ensure results of the assessment are used to inform policy prioritization and allocation of resources.
Integrate heat stress (see page 9) into existing monitoring systems and develop health sector response plans for climate-related events.
In Tuvalu, the main barriers have been identified as a lack of information on climate financing opportunities, a lack of connection by health actors to climate change processes and a lack of capacity to prepare country proposals.
Apply measures 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; contingency planning for essential systems (electricity, heating, cooling, ventilation, water supply, sanitation services, waste management and communications). 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.
WHO/CED/PHE/EPE/19.3.3
© 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.
Design by Inís Communication from a concept by N. Duncan Mills
Photos: Tuvalu Ministry of Health
