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Fiji Lancet Countdown on Health and Climate Change Data Sheet 2023

Enabling environment for integrated risk monitoring and climate-informed early warning systems in Fiji

The Caribbean Health Climatic Bulletin is the result of partnership-driven climate services for health

Climate change and health resilience actions in São Tomé and Príncipe

EU/CARIFORUM Caribbean Climate Change and Health Leaders Fellowship Training Program

Human Climate Horizons (HCH)

Bulletin Climat-Santé – Madagascar

Sea-Level Rise: Checklists to Assess Vulnerabilities in Health Care Facilities in the Context of Climate Change

A review of mental health and wellbeing under climate change in small island developing states (SIDS)

Small island developing states (SIDS) are often at the forefront of climate change impacts, including those related to health, but information on mental health and wellbeing is typically underreported. To help address this research lacuna, this paper reviews research about mental health and wellbeing under climate change in SIDS. Due to major differences in the literature’s methodologies, results, and analyses, the method is an overview and qualitative evidence synthesis of peer-reviewed publications. The findings show that mental health and wellbeing in the context of climate change have yet to feature prominently and systematically in research covering SIDS. It seems likely that major adverse mental health and wellbeing impacts linked to climate change impacts will affect SIDS peoples. Similar outcomes might also emerge when discussing climate change related situations, scenarios, and responses, irrespective of what has actually happened thus far due to climate change. In the context of inadequate health systems and stigmatisation of mental health diagnoses and treatments, as tends to occur globally, climate change narratives might present an opening for conversations about addressing mental health and wellbeing issues for SIDS.

Using implementation science for health adaptation: Opportunities for Pacific Island countries

The health risks of a changing climate are immediate and multifaceted. Policies, plans, and programs to reduce climate-related health impacts exist, but multiple barriers hinder the uptake of these strategies, and information remains limited on the factors affecting implementation. Implementation science-a discipline focused on systematically examining the gap between knowledge and action-can address questions related to implementation and help the health sector scale up successful adaptation measures in response to climate change. Implementation science, in the context of a changing climate, can guide decision makers in introducing and prioritizing potential health adaptation and disaster risk management solutions, advancing sustainability initiatives, and evaluating and improving intervention strategies. In this article we highlight examples from Pacific Island countries and outline approaches based on implementation science to enhance the capacity of health systems to anticipate, prepare for, respond to, and recover from climate-related exposures.

Scrambling for safety in the eye of Dorian: Mental health consequences of exposure to a climate-driven hurricane

As climate change alters the behavior of Atlantic hurricanes, these storms are trending stronger, wetter, and slower moving over coastal and island populations. Hurricane Dorian exemplified all three attributes. Dorian’s destructive passage over the Abaco Islands, Bahamas, on September 1, 2019, exposed residents of its capital, Marsh Harbour, to a prolonged encounter with the storm’s core. After Dorian’s fierce front eyewall and towering storm surge tore apart shanty town habitats and eviscerated concrete homesites, residents desperately sought refuge during the brief respite when Dorian’s eye passed directly overhead. The category 5 winds then resumed abruptly and Dorian continued its relentless destruction. This article focuses on the storm’s mental health consequences, drawing on observations of on-site clinicians as well as findings from previous research on the mental health effects of Atlantic hurricanes and the transformation of hurricane hazards resulting from climate change. To protect island and coastal populations against climate-driven storms, disaster planning policy should emphasize resilience-focused prevention and mitigation strategies. In the aftermath of these events, health system response should include community outreach, case finding, and evidence-based interventions that optimize the use of mental health professionals.

Subaltern learnings: Climate resilience and human security in the Caribbean

The United Nations’ invocation of ‘human security’ a generation ago promised a world increasingly governed by a ‘people-centred’ security agenda. In this paper we focus on arguably the most vital global security challenge faced throughout the planet today: climate resilience. We outline how advancing smart climate action and securing climate resilience can be aided by securitization practices that recall the earlier emphases of the United Nations’ human security concept. The paper draws upon evidence from the Caribbean as a territory defined dominantly as part of the Global South, yet offering vital knowledge of productive climate security governance that can be instructive to the Global North. The impacts of global warming are particularly evident for the people of small island developing states such as those located in the Caribbean. By analysing the case of Cuba as a country increasingly resilient to extreme weather events, and by interrogating the genealogy of the broader Caribbean’s hurricane culture, we show how an effective human security vision for climate justice and resilience can be achieved by recognizing and integrating the valuable forms of locally attuned knowledge that continue to emerge and coalesce in vulnerable geographies.

Management of chronic noncommunicable diseases after natural disasters in the Caribbean: A scoping review

Extreme weather events in the Caribbean region are becoming increasingly severe because of climate change. The region also has high rates of poorly controlled chronic noncommunicable diseases (NCDs), which were responsible for at least 30 percent of deaths after two recent hurricanes. We conducted a scoping review of literature published between 1974 and 2020 to understand the burden and management of chronic NCDs in the Caribbean after natural disasters. Of the twenty-nine articles included in this review, most described experiences related to Hurricanes Dorian (2019) and Irma and Maria (2017) and the Haiti earthquake (2010). Challenges included access to medication, acute care services, and appropriate food, as well as communication difficulties and reliance on ad hoc volunteers and outside aid. Mitigating these challenges requires different approaches, including makeshift points of medication dispensing, disease surveillance systems, and chronic disease self-management education programs. Evidence is needed to inform policies to build resilient health systems and integrate NCD management into regional and national disaster preparedness and response plans.

Climate change, mental health, and well-being for Pacific peoples: A literature review

In this literature review, we analyze existing research on climate change and its impact on mental health and well-being, primarily among Pacific Islanders. To compensate for a lack of research in this area, we also address some of the projected mental health implications resulting from disasters linked to climate change, such as flooding, hurricanes, and cyclones. This broader scope enables the identification of areas where more research into mental health concerns related to climate change in the Pacific is needed. In closing, we provide recommendations for further research into the mental health and well-being of Pacific peoples and suggest ways to develop resilience to the effects of climate change.

The long goodbye on a disappearing, ancestral island: A just retreat from Isle de Jean Charles

Climate change will necessitate evermore frequent and complex managed retreats in the future, and drafting policies that are equitable and just for those residents who are relocating will be essential. The USA’s first federally funded, community-scale, climate-driven resettlement is currently underway in coastal Louisiana. In January 2016, the U.S. Department of Housing and Urban Development (HUD) awarded the state of Louisiana $48.3 million to plan, design, and implement a structured, just, and scalable resettlement with former and current Isle de Jean Charles residents. Most Island households are multi-generational and directly descended from Jean Marie Naquin, after whose father the Island is named. Using interviews, ethnographic data, and policy documents, this paper will delineate and analyze the dimensions of sense of place, which, in this case, prompted policy changes dramatically different from standard relocation policies: assurance that the properties and land from which residents are departing will remain in their possession as long as the land remains. For most Island residents, this was non-negotiable. The intangible connection to place-feelings of belonging, lifestyle, family connections, and culture-plays a central role in many families’ decision to stay or go. The choice to relocate is rooted in this complex entanglement of identity, familial ties, land loss, historical and current marginalization, and a way of life passed on by multiple generations. In forthcoming community resettlements, continued access and ownership of the properties being left behind should be considered as a critical component for planning just retreats.

Retrospective assessment of pregnancy exposure to particulate matter from desert dust on a Caribbean island: Could satellite-based aerosol optical thickness be used as an alternative to ground PM(10) concentration?

Desert dust transported from the Saharan-Sahel region to the Caribbean Sea is responsible for peak exposures of particulate matter (PM). This study explored the potential added value of satellite aerosol optical thickness (AOT) measurements, compared to the PM concentration at ground level, to retrospectively assess exposure during pregnancy. MAIAC MODIS AOT retrievals in blue band (AOT(470)) were extracted for the French Guadeloupe archipelago. AOT(470) values and PM(10) concentrations were averaged over pregnancy for 906 women (2005-2008). Regression modeling was used to examine the AOT(470)-PM(10) relationship during pregnancy and test the association between dust exposure estimates and preterm birth. Moderate agreement was shown between mean AOT(470) retrievals and PM(10) ground-based measurements during pregnancy (R(2)?=?0.289). The magnitude of the association between desert dust exposure and preterm birth tended to be lower using the satellite method compared to the monitor method. The latter remains an acceptable trade-off between epidemiological relevance and exposure misclassification, in areas with few monitoring stations and complex topographical/meteorological conditions, such as tropical islands.

Multi-dimensional parametric coastal flood risk assessment at a regional scale using GIS

Coastal floods are the most prominent natural disaster causing severe damages to the local communities regarding food security, economy and shelter. Risks can be defined by physiographical sensitivity and vulnerability associated with socio-economic, demographic and infrastructure aspects of the region. Population with poor socio-economic status and high dependence on natural resources for livelihood in coastal dwellings of rural India are extremely vulnerable to flood hazards. Policy formulation to reduce coastal flood risks necessitates quantifying hazard vulnerability at an administrative scale. In this context, we propose a method for evaluating the coastal flood risk of an island located in the habited part of Sundarbans, West Bengal. Extending up to 282 sq. km, Sagar Island has been a keystone in harbouring and supporting both local and migrant population since the 1880s. Land-use classification of the island indicates an increase of 1.7% to 3.6% in the built-up class, almost double in the past eight years (2012-2020). A considerable rise in area under the water bodies is also seen from 6.6 to 8.6%, signifying fair evidence of a coastal breach. Flood risk assessment of Sagar Island was carried out using high spatial resolution data from Indian remote sensing satellites and census data. This assessment was performed by modifying the established MCDA technique considering the data limitations and accounting accessibility to infrastructure as a novel variable to a multi-dimensional framework. The framework maps spatial vulnerability of the region using sub-factors such as socio-demographic, economic, infrastructure and accessibility. The exposure profile of the area is drawn with the help of topographic factors and classified land-use results. Literature evidence was used to develop classification rules for data standardization from very high to very low based on their flood sensitivity. Further, the factors and sub-factors were ranked using AHP by a panel of experts belonging to diverse fields such as disaster management, regional planning, environment, hydrology and social science. The weighted sum technique was used to quantify total vulnerability and exposure parameters, respectively. The total risk map generated is the product of the hazard and vulnerability map of the region. The findings reveal the dominance of economic and accessibility parameters in defining the vulnerability of the regional population towards coastal flood risks. Proximity to coastline and tidal creeks enhances disaster sensitivity due to frequent inundation, erosion, saltwater intrusion and complete submergence of land area. Water bodies engulfing the coastline emerge as a serious threat to sustenance given the present rate of submergence of about 6 m/year. The research highlights the pressing need for grassroots development through social and economic upliftment. It also advocates the undeniable need for proactive adaptation such as flood resilient housing and coastline protection by stabilizing sandbars and planting/nurturing/maintaining native species (mangroves).

Maintaining quality of care among dialysis patients in affected areas after Typhoon Morakot

Natural disasters have negative health impacts on patients who need dialysis in affected areas. Severely affected areas are usually rural, with limited basic infrastructure and a population without optimal dialysis-specific care after a disaster. A population-based longitudinal case-cohort study enrolled 715,244 adults from the National Health Insurance Registry who lived in areas affected by a major natural disaster, Typhoon Morakot, in 2009. The observation period was from 2008 to 2011. A total of 13,268 patients (1.85%) had a history of end-stage renal disease (ESRD). Of the ESRD patients, 1264 patients (9.5%) received regular dialysis. Only eight patients missed dialysis sessions in the first month after the disaster. Compared to the moderately affected areas, the incidences of acute cerebrovascular and cardiovascular diseases were higher in patients in severely affected areas. Male dialysis patients aged 45-75 years had a higher mortality rate than that of the general population. Among the affected adults receiving regular dialysis, patients with diabetes (adjusted hazard ratio (aHR): 1.58, 95% confidence interval (CI): 1.20-2.08) or a history of cerebrovascular disease (aHR: 1.58, 95% CI: 1.12-2.21), chronic obstructive pulmonary disease (COPD) or asthma (aHR: 1.99, 95% CI: 1.24-3.17) in moderately affected areas had significantly elevated mortality rates. Additionally, among dialysis patients living in severely affected areas, those with a history of cerebrovascular disease (aHR: 4.52 95% CI: 2.28-8.79) had an elevated mortality rate. Early evacuation plans and high-quality, accessible care for cardiovascular and cerebrovascular diseases are essential to support affected populations before and after disasters to improve dialysis patients’ health outcomes.

Integrated flood vulnerability assessment of villages in the Waimanu River Catchment in the South Pacific: The case of Viti Levu, Fiji

This paper uses a holistic approach within a catchment scale, through the application of both climatic and non-climatic parameters, to analyze the impacts of river floods on the human security needs of rural riverine communities in the Waimanu Catchment situated in Nausori, Fiji. Consideration of both climatic and non-climatic factors is required since non-climatic factors could be controlled to build resilience against floods. The indicator-based flood vulnerability index methodology is applicable worldwide, but the indicators used in this study were specifically related to the Pacific Island context. In the context of fluvial flood vulnerability, effects of land management and climate change are not mutually exclusive of each other. Consequently, vulnerability assessments should consider the connection between people’s actions and ecosystems for the entire catchment area since upstream land use practices influence flood vulnerabilities downstream. In our research, a community-based flood vulnerability index system in conjunction with rainfall variability and land use assessments was used to quantitatively and qualitatively analyze the flood vulnerability, and it was found that increased rainfall, poor agricultural practices, gravel extraction, and improper waste management predominantly increased the exposure and sensitivity of midstream and downstream communities to river floods by modifying river morphology. Midstream communities in the Waimanu Catchment were most vulnerable to river floods due to their very low adaptive capacity in terms of poor ecosystem health and lack of natural resources to cope with the subsequent impacts of floods, being most sensitive to changes in land use and land cover.

Implementation of national health adaptation policy: A case study of policy principles and implementation barriers in the Philippines

Health risks from climate change are increasing and becoming a critical global concern. Implementation of health adaptation policies is vital, particularly in settings with high socioeconomic vulnerability and physical exposure to climate-risks, such as the Philippines. We identified from the literature a set of reference principles and categories of barriers to the implementation of national health adaptation policy. These were then used to assess the extent to which these policy principles and barriers are evident in Philippine national health adaptation. This assessment was undertaken based on data and information from policy analysis, key informant interviews, and an expert workshop. The results suggest that the Philippines have made notable progress on health adaptation by establishing a strong policy framework. However, implementation remains challenging and requires continued commitment. The health adaptation policy principles identified in the Philippines are policy congruence, mainstreaming, multi-sectoral approach, multiscale approach, adaptive management, and evidence-based decision-making. The most important implementation barriers are uncertain leadership, appropriateness and longevity of the governance structures within the Department of Health, and data and evidence. The value of considering policy principles alongside implementation barriers is twofold. First, this enables understanding of how implementation barriers relate directly to policy principles. Second, it facilitates identification of future implementation barriers that may arise in relation to current policy principles. Multi-sectoral governance and the integration of evidence in decision-making arose as potential future challenges in the Philippines. These areas may require special consideration in future policy design and planning.

Identifying and mitigating risks to completion of small grant climate change adaptation projects: Evidence from the Pacific

Over recent decades, substantial funding from a variety of sources has been directed towards climate change adaptation projects in Pacific Island countries. There remains, however, considerable uncertainty about which factors influence adaptation project completion, as a pre-cursor to effective adaptation. In this study, we empirically establish the links between project attributes (duration, funding, cash co-financing, in-kind contributions, location, and adaptation approach) and whether a project is likely to complete or be terminated. We examine this issue by developing a logistic regression model to predict the probability of completion for small-scale climate change adaptation projects using a new dataset of 190 projects in the South Pacific (with end dates ranging from November 1995 to May 2016) that were financed through the Global Environment Facility Small Grants Programme. Empirical results suggest that all else equal, such a project was more likely to complete if it was shorter, received more co-financing cash input and in-kind support from other donors and project partners, was explicitly targeted towards climate change adaptation, focused on a single adaptation approach, and was undertaken in Micronesia or Fiji. Our results can be used to help funders and project proponents design projects to mitigate the risks of non-completion, particularly in high-risk settings. These findings should not be misinterpreted to undermine the importance of continued investment in adaptation projects across the whole of South Pacific region.

Detection and correlation analysis of shellfish pathogens in Dadeng Island, Xiamen

Food poisoning is caused by pathogenic bacteria in water and aquatic products, especially bivalves (e.g., oysters, clams), which can bioaccumulate pathogenic bacteria. Polluted water and aquatic products thus pose a serious threat to human health and safety. In this study, the types of pathogenic bacteria in water samples and shellfish collected from the Dadeng offshore area in Xiamen were examined. We also analyzed the relationships between dominant pathogens and major climate and water quality parameters. Our objective was to provide reference data that may be used to help prevent bacterial infections and to improve aquatic food hygiene in Xiamen and its surrounding areas to safe levels, thus ensuring the health of Xiamen residents. We found that the main pathogenic bacteria were Vibrio and Bacillus, with the dominant pathogen being Vibrio parahaemolyticus. Physical and chemical indexes (water temperature, salinity, pH, dissolved oxygen, and turbidity) of water bodies and the 3-day accumulated rainfall were found to be important factors affecting the occurrence and abundance of V. parahaemolyticus.

Cascading loss and loss risk multipliers amid a changing climate in the Pacific Islands

Human society has experienced, and will continue to experience, extensive loss and damage from worsening anthropogenic climate change. Despite our natural tendencies to categorise and organise, it can be unhelpful to delineate clean boundaries and linear understandings for complex and messy concepts such as loss and damage. Drawing on the perspectives of 42 local and regional Pacific Islander stakeholders, an underexplored resource for understanding loss and damage, we explore the complexity and interconnectedness of non-economic loss and damage (NELD). According to participants, Pacific Islander worldviews, knowledge systems and cosmologies often make it difficult to separate and evaluate NELD independently, challenging the nomenclature of NELD categories developed through international mechanisms. Instead, NELD understandings are often centred on the interdependencies between losses, including the cascading flow-on effects that can occur and the nature of some losses as risk multipliers (i.e. one loss creating the risk for further losses). Most notably, losses to biodiversity, ecosystem services and land are critically linked to, and have cascading effects on, livelihoods, knowledge, ways of life, wellbeing, and culture and heritage. We argue that loss and damage is not always absolute, and that there are NELD that are arguably reparable. Concerning, however, is that biodiversity loss, as a risk multiplier, was considered the least reparable by participants. We put forward that NELD understandings must consider interconnectivity, and that biodiversity and ecosystem conservation and restoration must be the focus for interventions to prevent irreparable and cascading losses from climate change in the Pacific Islands.

Children’s environmental health and disaster resilience in Puerto Rico and the U.S. Virgin Islands

The environment plays a significant role in the global burden of disease for children. Climate-related disasters such as the 2017 Atlantic hurricane season are increasingly contributing to this burden. United Nations designated Small Island Developing States (SIDS) like Puerto Rico and the U.S. Virgin Islands are particularly at risk due to environmental health hazards caused by natural disasters, and health care structure vulnerabilities. United Nations’ Sustainable Development Goals (UN SDG), specifically UN SDG 3, 13 and 17, focus on climate impacts via promotion of health preparedness and building partnerships between different sectors of society, respectively. The Pediatric Environmental Health Specialty Unit’s (PEHSU) work is consistent with these most notably via the delivery of environmental health services along with training nurses, doctors, and other health professionals, formation of partnerships and linking resources. Therefore, training a diverse array of health professionals and linking these groups to relevant community resources is of utmost importance and has the potential to enhance the effective management and early prevention of top environmental health (EH) risks. Nursing is identified as a key health sector to engage for this initiative. This article describes the work of the Federal Region 2 PEHSU in Puerto Rico and the U.S. Virgin Islands that supports health professionals’ knowledge building, development of environmental health services, and promotion of wide scale access to such services for children and families. The PEHSU’s work is consistent with these most notably with regards to the delivery of environmental health services in pediatrics.

Beyond virology: Environmental constraints of the first wave of COVID-19 cases in Italy

Global warming and air pollution affect the transmission pathway and the survival of viruses, altering the human immune system as well. The first wave of the COVID-19 pandemic dramatically highlights the key roles of climate and air chemistry in viral epidemics. The elongated form of the Italian peninsula and the two major islands (the largest in Europe) is a perfect case study to assess some of these key roles, as the fate of the virus is mirroring the industrialization in the continental part of our country. Fine particulate matter (PM(2.5)), geography, and climate explain what is happening in Italy and support cleaner air actions to address efficiently other outbreaks. Besides the environmental factors, future works should also address the genetic difference among individuals to explain the spatial variability of the human response to viral infections.

Assessing how ecosystem-based adaptations to climate change influence community wellbeing: A Vanuatu case study

Climate change poses significant threats to wellbeing and livelihoods of people and the ecosystems in many Small Island Developing States (SIDS). Adaptation solutions must counteract these threats while also supporting development in vulnerable SIDS. Suitable options need to ensure that connections between the social, economic, and environmental dimensions of socio-economic systems are defined in a way that can support how decisions are made (and by whom) and how these can impact on other parts of these systems. This is particularly important in many Pacific SIDS, where communities practise customary natural resource management and continue to rely on local natural resources. In this study, we model the anticipated impacts of climate change and the benefits of the ecosystem-based adaptation (EbA) approaches on community wellbeing in Vanuatu. To do this, we applied participatory and expert elicitation methods to develop a Bayesian network model, which was designed to evaluate community wellbeing responses at four explicit spatial scales. The model includes both acute and chronic impacts of climate change, the impact of coral bleaching, and the potential loss of Vanuatu’s fringing coral reefs. The model predicts that all proposed EbA interventions will have a positive impact on wellbeing in all four locations to some degree, by either directly improving the integrity of Vanuatu’s ecosystems or by protecting these ecosystems as a positive spill-over of related actions. Significantly, it also predicts that if climate change exceeds 1.5 degrees C of warming, the costs of achieving the same level of wellbeing are increased.

An investigation into the relationship between climate change anxiety and mental health among Gen Z Filipinos

Climate change and mental health concerns are both defining issues of the generation of today. It has been established that the worsening climate causes many environmental disasters and physical health problems. However, its psychological impacts are still not well understood. Climate change has brought about an emerging psychological phenomenon termed ‘climate anxiety’ or ‘eco-anxiety,’ which has been described as a “chronic fear of environmental doom” (Clayton et al., 2017, p. 68) due to the impact of climate change. This predictive cross-sectional study investigated the link between climate change anxiety and mental health among 433 Filipinos. A total of 145 males and 288 females aged 18 to 26 completed the Climate Change Anxiety Scale and the Mental Health Inventory (MHI-38). Results show a significant relationship between climate change anxiety and mental health, with climate change anxiety predicting 13.5% of the overall Mental Health Index variance. Significantly, climate change anxiety was associated with the MHI-38’s global scale of Psychological Distress but not with the global scale of Psychological Well-being. The findings are discussed concerning the broader context of research on the mental health impacts of climate change.

Understanding the preferences of rural communities for adaptation to 21st-century sea-level rise: A case study from the Samoan islands

This paper explores the perceived adaptation preference of rural island communities in addressing future climate change risks, particularly those concerning sea-level rise. The research explores the role of culture and local politics, and differences among various age and gender groups within the community regarding preferred adaptation pathways for coping with the impacts of future sea-level rise. A participatory action approach, in the form of a community workshop, was employed, which separated participants into community identified groupings. Differences in community groups’ adaptation preferences emerged, though the range of adaptation measures considered were limited, probably due to the participants’ limited exposure to adaptation mechanisms in their immediate surroundings. Overall, the communities surveyed tended to be conservative, especially in their attitudes towards western adaptation solutions developed in non-island contexts.

The mental health impacts of climate change: Findings from a Pacific Island atoll nation

BACKGROUND: Climate change is anticipated to have profound effects on mental health, particularly among populations that are simultaneously ecologically and economically vulnerable to its impacts. Various pathways through which climate change can impact mental health have been theorised, but the impacts themselves remain understudied. PURPOSE: In this article we applied psychological methods to examine if climate change is affecting individuals’ mental health in the Small Island Developing State of Tuvalu, a Pacific Island nation regarded as exceptionally vulnerable to climate change. We determined the presence of psychological distress and associated impairment attributed to two categories of climate change-related stressors in particular: 1) local environmental impacts caused or exacerbated by climate change, and 2) hearing about global climate change and contemplating its future implications. METHODS: The findings draw on data collected in a mixed-method study involving 100 Tuvaluan participants. Data were collected via face-to-face structured interviews that lasted 45?min on average and were subjected to descriptive, correlational, and between-group analyses. RESULTS: The findings revealed participants’ experiences of distress in relation to both types of stressor, and demonstrated that a high proportion of participants are experiencing psychological distress at levels that reportedly cause them impairment in one or more areas of daily life. CONCLUSIONS: The findings lend weight to the claim that climate change represents a risk to mental health and obliges decision-makers to consider these risks when conceptualizing climate-related harms or tallying the costs of inaction.

The effect of weather variables on mosquito activity: A snapshot of the main point of entry of Cyprus

Mosquitoes are vectors of pathogens, causing human and animal diseases. Their ability to adapt and expand worldwide increases spread of mosquito-borne diseases. Climate changes contribute in enhancing these “epidemic conditions”. Understanding the effect of weather variables on mosquito seasonality and host searching activity contributes towards risk control of the mosquito-borne disease outbreaks. To enable early detection of Aedes invasive species we developed a surveillance network for both invasive and native mosquitoes at the main point of entry for the first time in Cyprus. Mosquito sampling was carried out for one year (May 2017-June 2018), at bimonthly intervals around Limassol port. Morphological and molecular identification confirmed the presence of 5 species in the study region: Culex. pipiens, Aedes detritus, Ae. caspius, Culiseta longiareolata and Cs. annulata. No invasive Aedes mosquito species were detected. The Pearson’s correlation and multiple linear regression were used to compare number of sampled mosquitoes and weather variables for three most numerous species (Cx. pipiens, Ae. detritus and Ae. caspius). The population densities of the most numerous species were highest from February to April. Number of Cx. pipiens (-0.48), Ae. detritus (-0.40) and Ae. caspius (-0.38) specimens sampled was negatively correlated with average daily temperature. Monthly relative humidity showed positive correlation with the numbers of the species sampled, Cx. pipiens (0.66) Ae. detritus (0.68), and Ae. caspius (0.71). Mosquito abundance of Cx. pipiens (0.97) and Ae. detritus (0.98) was strongly correlated to seasonal precipitation as well. Our work is a stepping stone to further stimulate implementation of International Health Regulations and implementation of early warning surveillance system for detection of invasive Aedes mosquitoes, native mosquitoes and arboviruses they may transmit. A network for the surveillance of both invasive and native mosquito species at the main point of entry for the first time in Cyprus was developed. Number of mosquitoes sampled was correlated with weather factors to identify parameters that might predict mosquito activity and species distribution to the prevention of international spread of vector mosquitoes and vector-borne diseases.

Simulation models of dengue transmission in Funchal, Madeira Island: Influence of seasonality

The recent emergence and established presence of Aedes aegypti in the Autonomous Region of Madeira, Portugal, was responsible for the first autochthonous outbreak of dengue in Europe. The island has not reported any dengue cases since the outbreak in 2012. However, there is a high risk that an introduction of the virus would result in another autochthonous outbreak given the presence of the vector and permissive environmental conditions. Understanding the dynamics of a potential epidemic is critical for targeted local control strategies. Here, we adopt a deterministic model for the transmission of dengue in Aedes aegypti mosquitoes. The model integrates empirical and mechanistic parameters for virus transmission, under seasonally varying temperatures for Funchal, Madeira Island. We examine the epidemic dynamics as triggered by the arrival date of an infectious individual; the influence of seasonal temperature mean and variation on the epidemic dynamics; and performed a sensitivity analysis on the following quantities of interest: the epidemic peak size, time to peak, and the final epidemic size. Our results demonstrate the potential for summer and autumn season transmission of dengue, with the arrival date significantly affecting the distribution of the timing and peak size of the epidemic. Late-summer arrivals were more likely to produce large epidemics within a short peak time. Epidemics within this favorable period had an average of 11% of the susceptible population infected at the peak, at an average peak time of 95 days. We also demonstrated that seasonal temperature variation dramatically affects the epidemic dynamics, with warmer starting temperatures producing large epidemics with a short peak time and vice versa. Overall, our quantities of interest were most sensitive to variance in the date of arrival, seasonal temperature, transmission rates, mortality rate, and the mosquito population; the magnitude of sensitivity differs across quantities. Our model could serve as a useful guide in the development of effective local control and mitigation strategies for dengue fever in Madeira Island.

Measuring the impact of infectious diseases on tourists’ willingness to pay to visit island destinations

The occurrence of infectious diseases may change tourists’ perceptions of a destination’s image and value. This article proposes and empirically tests a choice model to measure the effect of the risk of infectious disease outbreaks caused by climate change on tourists’ willingness to pay for holidays to island destinations. With this aim, an online survey was administrated to 2538 European frequent travellers at their country of residence. Tourists were presented with a hypothetical situation whereby they had to choose among eleven well-known European island destinations for their next holiday. The choice cards included the probability of the occurrence of infectious disease events in the context of other potential risks caused by climate change (i.e., forest fires, floods, heat waves, etc.). The results show infectious disease is the risk that more negatively affects tourists’ willingness to pay to visit islands, followed by forest fires. The results have implications for tourism policy, highlighting the importance of prevention and response strategies, and the design of climate-oriented services, which may raise opportunities to work towards the enhancement of those health and environmental conditions of tourist destinations that ensure their sustainability in the longer term.

Evidence for the range expansion of ciguatera in French Polynesia: A revisit of the 2009 mass-poisoning outbreak in Rapa Island (Australes Archipelago)

Ciguatera poisoning (CP) results from the consumption of seafood contaminated with ciguatoxins (CTXs). This disease is highly prevalent in French Polynesia with several well-identified hotspots. Rapa Island, the southernmost inhabited island in the country, was reportedly free of CP until 2007. This study describes the integrated approach used to investigate the etiology of a fatal mass-poisoning outbreak that occurred in Rapa in 2009. Symptoms reported in patients were evocative of ciguatera. Several Gambierdiscus field samples collected from benthic assemblages tested positive by the receptor binding assay (RBA). Additionally, the toxicity screening of ?250 fish by RBA indicated ?78% of fish could contain CTXs. The presence of CTXs in fish was confirmed by liquid chromatography tandem mass spectrometry (LC-MS/MS). The potential link between climate change and this range expansion of ciguatera to a subtropical locale of French Polynesia was also examined based on the analysis of temperature time-series data. Results are indicative of a global warming trend in Rapa area. A five-fold reduction in incidence rates was observed between 2009 and 2012, which was due in part to self-regulating behavior among individuals (avoidance of particular fish species and areas). Such observations underscore the prominent role played by community outreach in ciguatera risk management.

Climate change risk assessment for Kurunegala, Sri Lanka: Water and heat waves

Sri Lanka is experiencing various social and environmental challenges, including drought, storms, floods, and landslides, due to climate change. One of Sri Lanka’s biggest cities, Kurunegala, is a densely populated city that is gradually turning into an economic revitalization area. This fast-growing city needs to establish an integrated urban plan that takes into account the risks of climate change. Thus, a climate change risk assessment was conducted for both the water and heat wave risks via discussions with key stakeholders. The risk assessment was conducted as a survey based on expert assessment of local conditions, with awareness surveys taken by residents, especially women. The assessment determined that the lack of drinking water was the biggest issue, a problem that has become more serious due to recent droughts caused by climate change and insufficient water management. In addition, the outbreak of diseases caused by heat waves was identified as a serious concern. Risk assessment is integral to developing an action plan for minimizing the damage from climate change. It is necessary to support education and awareness in developing countries so that they can perform risk assessment well and develop both problem-solving and policy-making abilities to adapt to a changing climate.

Age-specific epidemiology of human leptospirosis in New Caledonia, 2006-2016

With over one million cases worldwide annually and a high fatality in symptomatic forms, human leptospirosis is a growing public health concern for the most vulnerable populations, especially in the context of global warming and unplanned urbanization. Although the Asia-Pacific region is particularly affected, accurate epidemiological data are often lacking. We conducted an eleven-year retrospective laboratory-based epidemiological survey of human leptospirosis in New Caledonia. From 2006 to 2016, 904 cases were laboratory-confirmed, including 29 fatalities, corresponding to an average annual incidence of 30.6/100,000 and a case fatality rate of 3.2%. Over the period, there was a major shift from indirect serological diagnosis by MAT to direct diagnosis by real-time PCR, a more specific and sensitive test when performed early in the course of the disease. The systematic implementation of genotyping informed on the variety of the infective strains involved, with a predominance of serogroups Icterohaemorrhagiae and Pyrogenes. The epidemiological pattern showed a marked seasonality with an annual peak in March-April. Interestingly, the seasonal peak in children of school age was significantly earlier and corresponded to school holidays, suggesting that attending school from February on could protect children from environment-borne leptospirosis.

Caribbean Action Plan on Health and Climate Change

Bulletin de Surveillance de la Qualité de l’air Madagascar

Madagascar Climate and Health Working Group

Flood related mortality in a touristic island: Mallorca (Balearic Islands) 1960-2018

Ambulance services associated with extreme temperatures and fine particles in a subtropical island

Using dengue epidemics and local weather in Bali, Indonesia to predict imported dengue in Australia

Urban and rural sanitation in the Solomon Islands: How resilient are these to extreme weather events?

There’s not really much consideration given to the effect of the climate on NCDs: Exploration of knowledge and attitudes of health professionals on a climate change-NCD connection in Barbados

Spatiotemporal characterisation and risk factor analysis of malaria outbreak in Cabo Verde in 2017

Spatial and temporal variation of dengue incidence in the island of Bali, Indonesia: An ecological study

Natural hazards and well-being in a small-scale island society

Managed retreat as a strategy for climate change adaptation in small communities: Public health implications

Integrating mental health and disaster preparedness in intervention: A randomized controlled trial with earthquake and flood-affected communities in Haiti

Health impact of Hurricanes Irma and Maria on St Thomas and St John, US Virgin Islands, 2017-2018

Forecast: Increasing mental health consequences from Atlantic hurricanes throughout the 21st century

Four year surveillance of the vector hard ticks for SFTS, Ganghwa-do, Republic of Korea

Extreme desert dust storms and COPD morbidity on the island of Crete

First reported human cases of leptospirosis in the United States Virgin Islands in the aftermath of Hurricanes Irma and Maria, September-November 2017

Environmental foundations of typhoid fever in the Fijian residential setting

Distressing encounters in the context of climate change: Idioms of distress, determinants, and responses to distress in Tuvalu

Clinicoepidemiologic characteristics of scrub typhus and murine typhus: A multi-center study in southern Taiwan

Climate change and livelihood vulnerability of the local population on Sagar Island, India

Analysis of transportation disruptions from recent flooding and volcanic disasters in Hawai’i

Nonlinear and delayed impacts of climate on dengue risk in Barbados: A modelling study

Well-being and mental health impact of household flooding in Guyana, the Caribbean

Understanding island residents’ anxiety about impacts caused by climate change using Best-Worst Scaling: a case study of Amami islands, Japan

The impact of urban and forest fires on the airborne fungal spore aerobiology

The impact on food security and future adaptation under climate variation: A case study of Taiwan’s agriculture and fisheries

The economic value of groundwater irrigation for food security under climate change: Implication of representative concentration pathway climate scenarios

Role of environmental factors in shaping spatial distribution of Salmonella enterica serovar Typhi, Fiji

Resource extractivism, health and climate change in small islands

Projections of rising heat stress over the western Maritime Continent from dynamically downscaled climate simulations

Public health and mental health implications of environmentally induced forced migration

Potential influence of temperature and precipitation on preterm birth rate in Puerto Rico

New approach to identifying proper thresholds for a heat warning system using health risk increments

Mortality and morbidity associated with ambient temperatures in Taiwan

Modelling the distribution in Hawaii of Angiostrongylus cantonensis (rat lungworm) in its gastropod hosts

Influence of latitude on the prevalence of Kawasaki disease: A retrospective cohort study from the Taiwan national health insurance database and review of the literature

Incorporating long-term satellite-based aerosol optical depth, localized land use data, and meteorological variables to estimate ground-level PM2.5 concentrations in Taiwan from 2005 to 2015

Heading for the hills: Climate-driven community relocations in the Solomon Islands and Alaska provide insight for a 1.5 degrees C future

Exploring the economic impacts of adapting abstraction policies in response to climate change and variability: Application for Small Island Developing States

Exploring trade-offs in climate change response in the context of Pacific Island fisheries

Evaluating future joint probability of precipitation extremes with a copula-based assessing approach in climate change

Enhanced near-surface ozone under heatwave conditions in a Mediterranean island

Development of hydro-meteorological hazard early warning system in Indonesia

Association of meteorological factors and air NO2 and O3 concentrations with acute exacerbation of elderly chronic obstructive pulmonary disease

Association between diurnal temperature range and mortality modified by temperature in Japan, 1972-2015: Investigation of spatial and temporal patterns for 12 cause-specific deaths

Adaptation to climate change and freshwater resources in Vusama village, Viti Levu, Fiji

The role of traditional knowledge in building adaptive capacity for climate change: Perspectives from Vanuatu

The interaction effects of meteorological factors and air pollution on the development of acute coronary syndrome

The climate impact on female acute pyelonephritis in Taiwan: A population-based study

Social and cultural issues raised by climate change in Pacific Island countries: An overview

Socio-environmental exposures and health outcomes among persons with sickle cell disease

Socioeconomic and environmental determinants of dengue transmission in an urban setting: An ecological study in Noumea, New Caledonia

Relationship between emergency care utilization, ambient temperature, and the pollution standard index in Taiwan

Pacific climate change adaptation :The use of participatory media to promote indigenous knowledge

Malaria early warning tool: Linking inter-annual climate and malaria variability in Northern Guadalcanal, Solomon Islands

Long-term dust aerosol production from natural sources in Iceland

Fatalities in wildland fires from 1945 to 2015 in Sardinia (Italy)

Exploring the effects of high temperature on mortality in four cities in the Philippines using various heat wave definitions in different mortality subgroups

Epidemiological investigation of a diarrhea outbreak in the South Pacific island nation of Tuvalu during a severe La Nina-associated drought emergency in 2011

Emotion, coping, and climate change in Island Nations: Implications for environmental justice

Climate change and migration in the Pacific: options for Tuvalu and the Marshall Islands

A comparative analysis of Chikungunya and Zika transmission

An effective public health program to reduce urban heat islands in Quebec, Canada

The epidemiology of Rift Valley Fever in Mayotte: insights and perspectives from 11 years of data

Risk to water security for small islands: An assessment framework and application

Mitigating uncertainty and enhancing resilience to climate change in the fisheries sector in Taiwan: Policy implications for food security

Increased rotavirus prevalence in diarrheal outbreak precipitated by localized flooding, Solomon Islands, 2014

Impact of climate change on Shihmen reservoir water supply

Human leptospirosis infection in Fiji: An eco-epidemiological approach to identifying risk factors and environmental drivers for transmission

Heat-related mortality in Cyprus for current and future climate scenarios

Health impacts of climate change in Pacific Island countries: A regional assessment of vulnerabilities and adaptation priorities

Forecasted impact of climate change on infectious disease and health security in Hawaii by 2050

Economic impact of climate change and climate change adaptation strategies for fisheries sector in Solomon Islands: Implication for food security

Defining population health vulnerability following an extreme weather event in an urban Pacific Island environment: Honiara, Solomon Islands

Cross sectoral impacts on water availability at +2¡C and +3¡C for east Mediterranean island states: The case of Crete

Climate factors as important determinants of dengue incidence in Curacao

Climate change trends in Malta and related beliefs, concerns and attitudes toward adaptation among Gozitan farmers

A sequence of flushing and drying of breeding habitats of Aedes aegypti (L.) prior to the low dengue season in Singapore

A spatial hierarchical analysis of the temporal influences of the El Nino-Southern Oscillation and weather on dengue in Kalutara District, Sri Lanka

A methodology to assess the impact of climate variability and change on water resources, food security and economic welfare

Where does climate fit? Vulnerability to climate change in the context of multiple stressors in Funafuti, Tuvalu

The use of participatory modeling to promote social learning and facilitate community disaster planning

The legacy of migration in response to climate stress: Learning from the Gilbertese resettlement in the Solomon Islands

Socio-economic and climate factors associated with dengue fever spatial heterogeneity: A worked example in New Caledonia

Saharan dust, climate variability, and asthma in Grenada, the Caribbean

Potential impacts of climate change on agriculture and food safety within the island of Ireland

Migration or forced displacement?: The complex choices of climate change and disaster migrants in Shishmaref, Alaska and Nanumea, Tuvalu

Mental health issues from rising sea level in a remote coastal region of the Solomon Islands: Current and future

Influenza seasonality in Madagascar: The mysterious African free-runner

I-C-SEA Change: A participatory tool for rapid assessment of vulnerability of tropical coastal communities to climate change impacts

Future sea changes: Indigenous women’s preferences for adaptation to climate change on South Goulburn Island, Northern Territory (Australia)

Food security in the island Pacific: Is Micronesia as far away as ever?

Effects of trophic status on microcystin production and the dominance of cyanobacteria in the phytoplankton assemblage of Mediterranean reservoirs

Effect of meteorological and geographical factors on the epidemics of hand, foot, and mouth disease in island-type territory, East Asia

Development, global change and traditional food security in Pacific Island countries

Disasters and climate change in the Pacific: Adaptive capacity of humanitarian response organizations

Dengue on islands: A Bayesian approach to understanding the global ecology of dengue viruses

Climate change trends and its impact on tourism resources in Mu Ko Surin Marine National Park, Thailand

Caribbean heat threatens health, well-being and the future of humanity

Assessment of climate-sensitive infectious diseases in the Federated States of Micronesia

Adaptation analysis for environmental change in coastal communities

The influence of social factors towards resurgent malaria and its mitigation using Sri Lanka as a case-study

Small islands, valuable insights: Systems of customary resource use and resilience to climate change in the Pacific

Rising oceans, climate change, food aid, and human rights in the Marshall Islands

Predictiveness of disease risk in a global outreach tourist setting in Thailand using meteorological data and vector-borne disease incidences

No change from climate change: Vulnerability and small island developing states

Hydroclimatic assessment of water resources of low Pacific islands: Evaluating sensitivity to climatic change and variability

Health impacts of climate change in the Solomon Islands: An assessment and adaptation action plan

Disaster management and climate change adaptation: A remote island perspective

Assessment of the health impacts of climate change in Kiribati

Assessing climate variability effects on dengue incidence in San Juan, Puerto Rico

Accounting for health in climate change policies: A case study of Fiji

Health, the global Ocean and Marine Resources

Climate Change and Health in Small Island Developing States: A WHO special initiative, Pacific island countries and areas

Climate change and health in Small Island Developing States: background document

Poverty and death: disaster mortality, 1996-2015

Human health and climate change in Pacific Island countries

Pacific islands action plan on climate change and health

Climate change and health in small island developing states

Safeguarding vulnerable island water supplies from the impacts of climate change

Planning Safe Water Supply in Kiribati

The Caribbean Regional Climate Centre (CariCOF) Dry Spell Outlook

Caribbean Advanced Flood Forecasting

Eastern Caribbean Dust and Air Quality Forecasting System

Caribbean Regional Climate Centre (CariCOF) Temperature Outlooks

The Caribbean Regional Climate Centre (CariCOF) Heat Outlooks