At the intersection of climate and health
The Caribbean is a watery part of the world, with some 30 diverse countries and more than 100 inhabited islands. There are 40 million Spanish-, French-, English- and Dutch-speaking residents (population range 5,000 to 11,000,000) and 50 million visitors annually. Most countries are small island and low-lying developing states (SIDS), characterised by vulnerability to external natural and human-made shocks, including climate change. Most are now middle income, but their small size severely limits capacity, so the region has a long history of cooperation with regional organisations including the Caribbean Community (CARICOM) and the Caribbean Public Health Agency.
Although emissions of greenhouse gases from the Caribbean region are negligible, regional climate change and rising sea levels threaten the existence of several small islands and countries with low-lying coasts. The Caribbean is already experiencing gradual warming, leading to hotter, drier weather, an increased frequency of Category 5 hurricanes and periodic inundations. The social, environmental and economic implications are profound, with a country’s entire annual gross domestic product wiped out in some cases by one hurricane, from which it will take a decade to recover.
The obvious health impacts are the devastating effects of major storms. Hurricane Matthew in 2016 affected more than 10 territories, but especially Haiti. In 2017, Hurricane Maria devastated Dominica and Puerto Rico. Such storms cause immediate injuries and deaths from high winds, flooding and falling trees, and also damage homes and businesses. In the aftermath, many more people may die as supplies of medications for chronic illnesses can be disrupted. Many recent large storms have spawned civil unrest, looting and increased aggression in populations; sometimes the damage can be as bad as the hurricane itself. In addition, the vulnerability of health facilities is a special concern, and many health centres are near the coast, although hospitals recently constructed to withstand stronger storms have fared much better.
These storms are planetary alarm bells sounding the need for people to change.
Hidden impacts
Less obvious health impacts are related to mental stress and food and water insecurity as climate change advances. Warming oceans and widespread coral reef bleaching undermine food security as reefs are the nurseries for many species of fish and marine life. The more frequent storms damage agriculture, leading to increased dependence on cheap, low-quality imported foods. Water insecurity is heightened as hotter weather becomes the norm, with increased periods of drought like those that have affected Haiti and Jamaica since 2015.
Climate-sensitive disease vectors, such as mosquitoes, are also causing increasingly adverse impacts. In the past 20 years, dengue fever has increased in frequency and severity in the Caribbean. In 2014 and 2016 respectively, region-wide epidemics of Chikungunya and Zika virus occurred, despite governments and businesses mounting major campaigns of education and vector control. These trends underline the vulnerability of this tourism-dependent region. All three diseases have the same main vector, Aedes aegypti.
Transportation is largely by motorised vehicles that use fossil fuels. Moving away from them to alternative transport such as biking and walking, which use the existing built environment, brings potential co-benefits to health, energy security and the planet.
Raising awareness of the issues
CARPHA in collaboration with the School of Public Health and Tropical Medicine at Tulane University convened an expert panel to address climate-related public health issues. The panel includes regional institutions working on climate change, disaster and emergency response, agriculture, crime and security, and international partners such as the Pan American Health Organization (PAHO) and the World Health Organization (WHO), the National Institutes of Health in the United States and the American Public Health Association. It prepared a roadmap for climate and health with five strategic imperatives, the first of which is raising awareness of the population and especially health professionals on the issue of climate and health. Community-based, technology-enabled resilience, such as using cellphones to coordinate response and recovery, is the second priority. The third is integrating health, climate and other data and gathering partners around that information. Fourth is reducing health facility vulnerability by constructing stronger, more energy-efficient buildings, and PAHO/WHO’s ‘SMART’ hospital programme is a leader in this regard. Finally, fifth is leveraging the built environment, as seen in the boardwalk built on top of coastal defences in Barbados, which has become a popular walking and jogging facility for locals and tourists.
CARPHA also works with partners such as Germany on ‘ridge to reef’ approaches to mitigate and adapt to climate change, including watershed management, reforestation, collaboration with farmers to reduce pollution of waterways, and coastal and marine management improvements.
G7 leaders meeting in Charlevoix can best help by recognising that the Caribbean countries are extremely vulnerable – they are the canaries in the coal mine. They can support a micro tax approach on visitors of, for example, $5 per passenger, to ensure the sustainability of the Caribbean regional institutions working in public health and environmental monitoring, crime and security, disaster and emergency response, all of which underpin resilience and a successful tourism experience and business. These provisions also reduce the risk of large numbers of persons migrating. G7 members can provide grants and technical assistance to climate-proof health facilities and develop alternative transportation systems such as biking and walking and rapid mass transport.
