Life and death on a tiny island: Health impacts and adaptation in small communities

Abstract

Rabi Island is a powerful example of how intersecting conditions produce heightened vulnerability to climate change. This remote Fiji island is home to 5000 Banaba Islanders originally from Kiribati who retain Banaba culture and language. Rabi is largely typical of Pacific island vulnerability to climate change – underlying poor health, poverty and exposure to extreme events such as cyclones – but with the added complexity of comprising an ethnic minority isolated from the rest of the country. Income is very low and houses are crowded. Health is characterised by communicable diseases such as tuberculosis, diarrhoeal and vector-borne disease, and by non-communicable, diet-related disease such as diabetes. While there is growing evidence regarding health impacts at country level, little is known about their precise shape – and how best to manage them – in distinct communities such as Rabi. We conducted a 156-item household questionnaire investigating the specific health vulnerabilities to climate change. We collected detailed information on local environment, health, behaviour, attitudes, sociodemography, and livelihoods. We found food security and communicable disease to be areas of particular vulnerability. With the exception of rice, nearly all food is locally sourced, mostly fish and root crops. Warming seas and increasing ocean acidity will affect the abundance of local fish and increase the risk of ciguatera. Lengthening annual dry seasons are reducing agricultural output and changing farming practices. Increasing water scarcity is associated with diarrhoea, putting children at particular risk. Lower rainfall and warmer temperatures increase dengue transmission. Without urgent adaptation, climate change will worsen already poor health on the island, through its effects on food, water and disease vectors. Improving water security, sanitation and waste management, and ensuring adaptive fishing and agricultural practices, will reduce the adverse health impacts.