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Sea-Level-Rise Disaster in Micronesia: Sentinel Event for Climate Change?

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Objectives: To describe the impact of an acute-onset sea-level-rise disaster in 2 coral atoll populations and to generate hypotheses for further investigation of the association between climate change and public health. Methods: Households of Lukunoch and Oneop islands, Micronesia, were assessed for demographics, asset damage, food availability, water quantity and quality, hygiene and sanitation, and health status. Every fourth household on Lukunoch was randomly selected (n = 40). All Oneop households were surveyed (n = 72). Heads of each household were interviewed in the local language using a standard survey tool. Prevalence data were analyzed, and 95% confidence intervals were calculated. Results: A total of 112 total households were respondents representing 974 inhabitants. On Lukunoch, roughly half of all households surveyed reported at least a partial loss of their primary dietary staple and source of calories (taro and breadfruit). Six (15%) of 40 Lukunoch households surveyed (95% CI, 6%-30%) reported a complete loss of taro and four (10%) of the 40 households (95% CI, 3%-24%) reported a complete loss of breadfruit. On Oneop, nearly all households reported at least a partial loss of these same food staples. Twenty four (31%) of all 76 Oneop households reported a complete loss of taro and another 24 (31%) households reported a complete loss of breadfruit. One third of all households surveyed reported a complete loss. On Lukunoch 11 (28%) of 40 households, (95% CI, 15%-43%) reported damage from salination, but none were damaged to the point of a complete loss. Forty-nine (64%) of 76 Oneop households reported salination and five (6%) reported complete loss of their well. Conclusion: On March 5, 2007, an acute-onset, sea level rise event resulting in coastal erosion, shoreline inundation, and saltwater intrusion occurred in two coral atoll islands of Micronesia. The findings of this study suggest that highly vulnerable populations of both islands experienced disastrous losses involving crop productivity and freshwater sources. These findings reveal the need for effective public health research and sustainable interventions that will monitor and shape the health of small island populations predicted to be at high risk for adverse health effects due to climate change.(Disaster Med Public Health Preparedness. 2010;4:81-87)
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SPECIAL FOCUS
Sea-Level-Rise Disaster in Micronesia: Sentinel Event
for Climate Change?
Mark E. Keim, MD
ABSTRACT
Objectives: To describe the impact of an acute-onset sea-level-rise disaster in 2 coral atoll populations and to
generate hypotheses for further investigation of the association between climate change and public health.
Methods: Households of Lukunoch and Oneop islands, Micronesia, were assessed for demographics, asset dam-
age, food availability, water quantity and quality, hygiene and sanitation, and health status. Every fourth house-
hold on Lukunoch was randomly selected (n=40). All Oneop households were surveyed (n=72). Heads of
each household were interviewed in the local language using a standard survey tool. Prevalence data were
analyzed, and 95% confidence intervals were calculated.
Results: A total of 112 total households were respondents representing 974 inhabitants. On Lukunoch, roughly half
of all households surveyed reported at least a partial loss of their primary dietary staple and source of calories (taro
and breadfruit). Six (15%) of 40 Lukunoch households surveyed (95% CI, 6%-30%) reported a complete loss of
taro and four (10%) of the 40 households (95% CI, 3%-24%) reported a complete loss of breadfruit. On Oneop,
nearly all households reported at least a partial loss of these same food staples. Twenty four (31%) of all 76 Oneop
households reported a complete loss of taro and another 24 (31%) households reported a complete loss of bread-
fruit. One third of all households surveyed reported a complete loss. On Lukunoch 11 (28%) of 40 households, (95%
CI, 15%-43%) reported damage from salination, but none were damaged to the point of a complete loss. Forty-nine
(64%) of 76 Oneop households reported salination and five (6%) reported complete loss of their well.
Conclusion: On March 5, 2007, an acute-onset, sea-level-rise event resulting in coastal erosion, shoreline inun-
dation, and saltwater intrusion occurred in two coral atoll islands of Micronesia. The findings of this study
suggest that highly vulnerable populations of both islands experienced disastrous losses involving crop pro-
ductivity and freshwater sources. These findings reveal the need for effective public health research and sus-
tainable interventions that will monitor and shape the health of small island populations predicted to be at
high risk for adverse health effects due to climate change.
(Disaster Med Public Health Preparedness. 2010;4:81-87)
Key Words: Climate change, natural disasters, sea-level rise, Pacific islands, vulnerable population, Small Island
Developing States
Populations living on several remote coral atolls of
the Lower Mortlock region of the Federated States
of Micronesia (FSM) report that on March 5, 2007,
islands were inexplicably flooded by ocean water twice in
1 day. The inundation of seawater was described as occur-
ring “like a rising tide”—slowly and with minimally de-
structive force. In many places, the sea level covered the
island to a height estimated at 12 to 18 inches deep and
then receded within a few hours. These events were not
associated with tsunamis, storms, or the timing of the tides.
Major agricultural losses were reported due to shore-
line inundation and salinity intrusion. Because food
sources on these remote atolls are largely locally de-
rived, the damage prompted concerns about the poten-
tial for hunger.
BACKGROUND
The most important direct physical effects of a sig-
nificant rise in mean sea level are coastal ero-
sion, shoreline inundation, and salinity intrusion, pri-
marily into estuaries and groundwater aquifers.1
Coastal erosion destroys shorelines, marshlands,
and mangroves, affecting property and island ecologi-
cal systems. Shoreline inundation may damage shel-
ter and contaminate soil with salinity, resulting in
crop failure. Saltwater intrusion can be particularly
damaging to the groundwater aquifers of small
islands.
The aquifer lens of an ocean island is normally composed
of a layer of fresh water derived from rainfall and floating
on a denser layer of salt water (derived from the ocean).
When saline intrusion occurs, salt water from the inunda-
tion mixes with fresh water of the aquifer to create a brack-
ish solution throughout that adversely affects palatability,
vegetation, and agriculture. This report describes the ef-
fects of 1 acute-onset sea-level-rise disaster on 2 coral atoll
populations.
Disaster Medicine and Public Health Preparedness 81
(Reprinted) ©2010 American Medical Association. All rights reserved.
METHODS
Study Design
A cross-sectional survey was performed among the disaster-
affected populations of Lukunoch and Oneop islands. Institu-
tional review board requirements were waived according to a
standard protocol wing to the emergency nature of the re-
quest. Procedures followed were in accordance with US and FSM
institutional and national ethical standards on human experi-
mentation and with the Helsinki Declaration. Informed con-
sent to perform the study was obtained from the traditional lead-
ership of the island and from each individual survey respondent.
All respondents remained anonymous.
A 2-page survey instrument was developed to assess asset dam-
age and needs at the household level. The household survey
evaluated the following indicators: demographics; asset dam-
age; food availability; availability of water, ie, sources, treat-
ment, storage, and use; sanitation; existence of a toilet and soap;
health status; and crude mortality.
Population and Setting
Lukunoch Island and Oneop Islands are crescent-shaped islands
located 7 miles apart within the Lukunor atoll, in the remote Lower
Mortlock region of FSM. Lukunoch is 2.3 miles long and 1800
feet wide at its widest diameter. Oneop is 1 mile long and 1600
feet wide. Each island is composed of 1 very large central com-
munal taro garden surrounded by a tree-lined perimeter of homes.
On Lukunoch, this garden was 0.9 miles long and 1000 feet wide.
On Oneop, the main garden was 0.7 miles long and 600 feet wide.
The government of FSM estimated the census of Lukunoch to
be 1500 persons living among approximately 150 homes and the
census of Oneop to be 600 persons living in approximately 60
homes. Baseline health and demographic data were not avail-
able for either population. There is 1 local primary health care
worker on each island. The dispensary had scant medications in
stock at the time of this assessment. Health records included a
reporting of births and deaths, but not clinical encounters.
Sample Size Calculation
A sample of 61 households was calculated as necessary to achieve
a 95% confidence level and a 5% confidence interval (CI) among
approximately 72 households on Oneop Island. All 72 house-
holds were surveyed. A sample of 113 households was calcu-
lated as necessary to achieve a 95% confidence level and a 5%
CI interval among approximately 160 households on Luku-
noch. Unfortunately, logistical constraints and inclement
weather severely limited the amount of time available on-site,
and only 40 households were surveyed. This resulted in poor
statistical power (95% CI, 13.5) for Lukunoch data.
Data Collection
On Lukunoch, all homes were located along a single path that
encircled the entire island. Starting with the communal house,
every fourth household was selected for an interview by use of a
systematic random sampling method. A total of 40 Lukunoch Is-
land households were assessed. All 72 households on Oneop were
surveyed. Representatives of the government of the FSM inter-
viewed heads of each household in the local language regarding
damages and needs for the entire household after receiving 15 min-
utes of instruction. Respondents consulted with other house-
hold members for consensus regarding their responses. Subject mat-
ter experts from the US Forest Service (USFS) and US Geological
Survey performed a simultaneous on-site inspection of island ag-
riculture and hydrology as another means of evaluating damage
to island crops and groundwater.
Statistical Analysis
Prevalence data were analyzed for Lukunoch and Oneop popu-
lations, and 95% CIs were produced for Lukunoch data by use
of EPI-INFO, version 3.4 (Centers for Disease Control and Pre-
vention, Atlanta, Georgia).
RESULTS
Demographics
All 974 inhabitants of the 112 total households interviewed on
both islands were Micronesian and spoke the Chuukese dialect.
The mean number of persons per household in Lukunoch was 9.5
and was 8.3 in Oneop. All households were supported by farm-
ing and fishing within a subsistence economic system. Table 1 and
Table 2 detail the demographics of the study population.
Structural Losses
No respondents reported a complete loss of their home due to struc-
tural damage from floodwaters. On Lukunoch, eight (20%) of 40
households (95% CI, 9%-36%) reported that flood water caused
partial damage to their home. Nineteen (20%) of all 76 house-
holds on Oneop reported partial damage to their homes.
TABLE 1
Population Demographics for Lukunoch Island
Age, y Males Females Total Percentage of Total
0-5 26 31 57 15.1
6-18 54 58 112 29.6
19-60 100 90 190 50.3
Older than 60 10 9 19 5.0
Total 190 188 378 100.0
Sea-Level-Rise Disaster in Micronesia
82 Disaster Medicine and Public Health Preparedness VOL. 4/NO. 1
(Reprinted) ©2010 American Medical Association. All rights reserved.
On Lukunoch, none of the respondents interviewed reported com-
plete loss of their well due to salination and 11 (28%) of 40 house-
holds (95% CI, 15%-43%) reported damage from salination. Five
(6%) of all households on Oneop reported complete loss of their
well and 49 (64%) of 76 households reported well salination. Rain
catchment systems, in general, were poorly maintained, but not
affected by the floodwaters.
Food Losses
On Lukunoch, half of all households reported at least partial
loss of their primary dietary sources of carbohydrates: taro and
breadfruit. Of the Lukunoch households, 15% (95% CI, 6%-
30%) reported a complete loss of taro and 10% (95% CI, 3%-
24%) reported a complete loss of breadfruit. On Oneop, nearly
all households reported at least a partial loss of taro and bread-
fruit. Of all Oneop households, 31% reported a complete loss
of taro and 31% reported a complete loss of breadfruit. USFS
inspections revealed that the taro crops located in the very large
communal garden in the center of Lukunoch were nearly com-
pletely destroyed, along with most of the breadfruit trees. The
taro garden on Oneop had less damage, mostly confined to one
end of the patch (Figure 1 and Figure 2). Table 3 and Table 4
list the degree of agricultural losses on Lukunoch and Oneop,
according to food source.
Water Quality and Quantity
On Lukunoch, 43% (95% CI, 27%-59%) of households
reported the use of water purification techniques. The aver-
age amount of water reportedly consumed by each person per
day was 1.1 gallons. On Oneop, 97% of all households
reported using water purification. The average amount of
water reportedly consumed by each person per day was 1.8
gallons.
The populations of both islands obtain water through a vari-
ety of means, including covered wells, open wells, and water
catchment systems. All households reported access to a well.
On Lukunoch, 25% (95% CI, 13%-41%) of households were
able to store 500 to 650 gallons of rainwater; 55% (95% CI,
39%-71%) of households had a storage cistern capable of stor-
ing 1000 gallons of rainwater. Of all Oneop households,
64% were able to store 500 to 650 gallons of rainwater; 3% of
Oneop households reported having a cistern capable of stor-
ing 1000 gallons of rainwater. No cisterns were damaged by the
inundation.
Sanitation and Hygiene
On Lukunoch, 13% (95% CI, 4%-27%) of households reported
use of a water-seal flush toilet, 33% (95% CI, 19%-49%) re-
TABLE 2
Population Demographics for Oneop Island
Age, y Males Females Total Percentage of Total
0-5 58 90 148 24.8
6-18 80 90 170 28.5
19-60 124 132 256 43.0
Older than 60 14 8 22 3.7
Total 276 320 596 100.0
FIGURE 1
Lukunoch villager showing taro spoiled by saline
intrusion.
Photograph by John Quidachay, US Forest Service. Used with permission.
FIGURE 2
A portion of the large taro patch on Lukunoch revealing
extensive damage.
Photograph by John Quidachay, US Forest Service. Used with permission.
Sea-Level-Rise Disaster in Micronesia
Disaster Medicine and Public Health Preparedness 83
(Reprinted) ©2010 American Medical Association. All rights reserved.
ported using pit latrines dug into land, and 38% (95% CI, 23%-
54%) reported use of outhouses perched over the water shore-
line. Eighteen percent Of the Lukunoch households, 18% (95%
CI, 7%-33%) reported not having a toilet, routinely engaging in
open bush or reef defecation instead. People on Lukunoch re-
portedly used an average of 1.1 bars of soap per person per month.
On Oneop, 22% of all households reported use of a water-seal flush
toilet. No households reported using pit latrines, and 72% re-
ported use of outhouses perched over the water shoreline. None
of the households on Oneop reported not having a toilet. People
reportedly used an average of 0.6 bars of soap per person per month.
Health Status
Mortality and Natality
Respondentsreported that since March5, 2007, 1 death(a 6-month-
old)had occurred on Lukunoch and 1 (a5-month-old) had occurred
on Oneop. There were 8 live births reported in Lukunoch and 1
live birth reported in Oneop since March 5, 2007.
Morbidity
Respondents were surveyed about the incidence of new-onset
symptoms consistent with infections that have occurred since
the sea-level-rise event. These data were not categorized ac-
cording to age. Many respondents described an increase in the
TABLE 3
Agricultural Losses as Reported by Lukunoch Island Heads of Householda
Food Source No Damage/Loss Partial Damage/Loss Complete Loss
Taro 22/40 (55; 39-71) 12/40 (29; 15-44) 6/40 (16; 6-30)
Breadfruit 18/40 (45; 29-62) 18/40 (45; 29-62) 10/40 (10; 3-24)
Coconut 24/40 (60; 43-75) 13/40 (32; 19-49) 3/40 (8; 2-20)
Garden 25/40 (62; 45-77) 14/40 (35; 21-52) 1/40 (3; 0.1-13)
Livestock 30/40 (75; 59-87) 10/40 (25; 11-39) 0 (0)
aData are given as number (percentage; 95% confidence interval, in percentages).
TABLE 4
Agricultural Losses as Reported by Oneop Island Heads of Householda
Food Source No Damage/Loss Partial Damage/Loss Complete Loss
Taro 9 (13) 43 (56) 24 (31)
Breadfruit 16 (22) 36 (47) 24 (31)
Fish 30 (39) 44 (58) 2 (3)
Coconut 23 (30) 40 (53) 13 (17)
Garden 6 (8) 38 (50) 32 (42)
Livestock 11 (14) 38 (50) 27 (36)
aData are given as number (percentage).
TABLE 5
Percentage of Households Reporting at Least 1 Case of New-Onset Illness Since the Sea-Level-Rise Eventa
Any New Cases 1 New Case 2 New Cases 3 New Cases
Lukunoch
Cough 37/40 (93) 8/40 (20; 9-36) 11/40 (28; 15-44) 8/40 (20; 9-36)
Diarrhea 22/40 (55) 7/40 (18; 7-33) 9/40 (23; 11-39) 4/40 (10; 3-24)
Fever 26/40 (65) 16/40 (40; 25-57) 6/40 (15; 6-30) 3/40 (8; 2-20)
Eye infection 2/40 (5) 2/40 (5; 1-17) 0 (0) 0 (0)
Skin rash 24/40 (60) 15/40 (38; 23-54) 8/40 (20; 9-36) 1/40 (3; 0.1-13)
Oneop
Cough 70/76 (92) 32/76 (42) 11/76 (14) 5/76 (6)
Diarrhea 71/76 (94) 33/76 (44) 14/76 (19) 2/76 (2)
Fever 76/76 (100) 36/76 (47) 5/76 (6) 11/76 (14)
Eye infection 13/76 (17) 11/76 (14) 2/76 (3) 0 (0)
Skin rash 70/76 (92) 43/76 (56) 5/76 (6) 2/76 (3)
aData are given as number (percentage) or number (percentage; 95% confidence interval, in percentages).
Sea-Level-Rise Disaster in Micronesia
84 Disaster Medicine and Public Health Preparedness VOL. 4/NO. 1
(Reprinted) ©2010 American Medical Association. All rights reserved.
incidence of such infections after the sea-level-rise event, al-
though this frequency was not measured. Table 5 lists the per-
centages of households reporting at least 1 case of new-onset
illness since the March 5, 2007, event. Table 6 lists the per-
centages of households reporting a preexisting chronic illness
or vulnerable condition among household members.
DISCUSSION
The impact of the sea-level rise that occurred in the FSM seems
to follow a pattern that has been predicted by experts to be a
result of climate change. Global warming is predicted to result
in an increase in the number and severity of many extreme
weather and sea-level rise events. It is considered likely that a
trend of increased incidence of extremely high sea levels has
already occurred during the late 20th century and will con-
tinue through the 21st century as a result of climate change.2
The following trends are projected with high confidence2:
Coasts will be exposed to such increasing risks as coastal ero-
sion due to climate change and sea-level rise.
In low-latitude regions, crop productivity is expected to de-
crease, thus increasing the risk for hunger, particularly in
Africa and Small Island Developing States.
By 2020, between 75 and 250 million people will be ex-
posed to decreased sources of water as a result of droughts
and sea-level rise.
The communities predicted to be most vulnerable to cli-
mate change are the poor coastal communities that are de-
pendent on local water and food sources.2,3
Demographics
The population of Lukunor atoll can be generally described as
young and impoverished. Inhabitants working within such a
cash-poor subsistence economies could easily be expected to
place in the lowest World Bank gross domestic product cat-
egory ($976 per year).4
On Lukunoch, 45% of the study population was younger than
18 years. On Oneop, this number was even higher, constitut-
ing 54% of the population. In comparison, the relative propor-
tion of this age group in the population is double that for the
same age group in the United States (21%).5The proportion
of the study population older than 60 years was 5% on Luku-
noch and 4% on Oneop (comparable to the national estimate
of 5%).6This proportion is 3 times smaller than that of the same
age group in the United States.
Structural Losses
Structural damage seems limited and involved mostly simply
constructed open wells and traditional thatch “local houses”
that were hand constructed of traditional materials and pri-
mary residences made of concrete and/or wood. Wells de-
scribed as damaged were contaminated by salination and con-
tained brackish water, but well structures were not physically
disrupted.
Food Losses
The USFS agricultural assessment of the islands of Lukunoch
and Oneop confirmed the loss of nearly all standing taro crops
and many of the breadfruit trees on both islands. Livestock
(mostly chickens and pigs) seemed mildly affected in the short-
term but could be expected to compete with wildlife and hu-
mans for limited food and water sources in the future. Respon-
dents described coping mechanisms that included a diet mostly
composed of fish and coconut, supplemented on occasion with
a few garden vegetables and (less preferably) with foraged greens.
Respondents also reported eating partially rotted taro.
The USFS agricultural experts inspecting food availability on
Lukunoch and Oneop found that no household food stores were
present and expect crop production to be very low for the next
several years before sufficient rainfall adequately dilutes the sa-
linated island soil. The US Geological Survey estimates that
it will likely require 1 year of normal rainfall to replenish the
freshwater aquifer lens of these affected islands. It was deemed
that anthropometric measurement would not add signifi-
cantly to the evidence of major losses to the primary food sup-
ply of these populations.
Water Quantity and Quality
Access to fresh water for cooking, drinking, and hygiene did
not seem to be a substantial public health concern among the
populations of Lukunoch and Oneop. Lukunoch and Oneop
households reported average daily water consumption less than
the internationally accepted daily water ration for humanitar-
ian assistance.7However, these amounts may also represent ad-
equate quantities of water consumed through ingestion and cook-
TABLE 6
Percentage of Households Reporting a Preexisting Chronic Illness or Vulnerable Condition in at Least 1 Household Membera
High-risk Factor Lukunoch Oneop
Chronic obstructive pulmonary disease or asthma 18/40 (45; 29-62) 21/76 (28)
Diabetes 7/40 (18; 7-33) 5/76 (6)
Physical disability 9/40 (23; 11-39) 6/76 (8)
Newborn younger than 3 mo 4/40 (10; 3-24) 2/76 (3)
Nursing mothers 4/40 (10; 3-24) 2/76 (3)
Pregnant females 4/40 (10; 3-24) 13/76 (17)
aData are given as number (percentage) or number (percentage; 95% confidence interval, in percentages).
Sea-Level-Rise Disaster in Micronesia
Disaster Medicine and Public Health Preparedness 85
(Reprinted) ©2010 American Medical Association. All rights reserved.
ing. It is difficult to interpret reports of low consumption when
much of the water requirements for cleaning and hygiene are
also easily met by way of quick access to the ocean and sali-
nated wells as sources of “gray water.” At the present levels of
normal rainfall, even a poorly efficient use of water catchment
systems seemed able to sustain the population’s current needs
for potable water. However, the island is now more vulnerable
to water stress in the future because the contaminated aquifer
is no longer available as a reserve during drought. Drought is
also expected to occur in Micronesia with greater frequency and
severity in the future as a result of climate change.3
Water quality did not seem to pose a significant health hazard
to the disaster-affected populations at the time of this assess-
ment. Nearly half of the households in Lukunoch reported using
water purification techniques. Almost all households on Oneop
reported treatment of their drinking water. The US Geologi-
cal Survey tested the salinity of the water aquifer on Luku-
noch and Oneop islands 10 weeks postinundation and found
both island aquifers to be 7 times higher than accepted US drink-
ing standards.8The palatability of the ground water was poor;
however, it was still being used for drinking. There is limited
expected health impact from drinking the brackish tasting
water.
Hygiene
Households from both islands reportedly used approximately
half the soap than is currently recommended during an acute
health emergency.7This seems to be an indigenous practice,
not impacted by the disaster event. During emergency condi-
tions, however, hand washing is known to prevent the spread
of skin, respiratory, and diarrheal infections.9-11 This practice
may make this population more vulnerable to outbreaks and
future such disasters.
Sanitation
Although less than adequate for effective disease control, sani-
tation measures on Lukunoch and Oneop seemed unaffected
by the sea-level-rise event. More than half of all households
surveyed on both islands had toilet practices that resulted in
the deposition of sewage on the open land or on the nearby beach
or atoll reef. This indigenous practice may place inhabitants
at higher risk for fecal-oral transmission of gastrointestinal in-
fections on a regular basis, not merely after disasters.9
Health Status
Mortality
The death of 2 infants (one 6-month-old and one 5-month-
old) is notable and deserves further surveillance to better es-
tablish the comparability of this statistic with baseline mortal-
ity rates that are not currently available for this population.
Morbidity
As illustrated in Table 5, a majority of households reported a
new onset of multiple cases of illness consistent with skin, res-
piratory, and gastrointestinal infections occurring during the
10 weeks following disaster impact. However, preimpact base-
lines are unknown for the islands.
Many households included members of vulnerable popula-
tions known to be more susceptible to disaster-related morbid-
ity and mortality.9-11 These populations included people with
chronic illness such as emphysema, asthma, and diabetes. The
survey population also included people who require special care
or feeding, such as physically disabled people, pregnant fe-
males, nursing mothers, and newborns. These factors may
contribute to the overall vulnerability of these populations to
future disasters.
Subsequent Reports of Other Sea-level Disasters
in the Region
Since this March 2007 event, the US Federal Emergency Man-
agement Agency has performed 2 more preliminary damage as-
sessments for sea-level-rise events: another in Micronesia in 2008,
and one in the nearby Republic of Marshall Islands in 2009.12
On December 8 through 12, 2008, islands throughout all 4 states
of FSM experienced widespread ocean inundation. The tradi-
tional chief of Kapingamarangi (a coral atoll located 300 miles
south of Lukunoch and Oneop and severely impacted by the
2008 event) estimated that 90% of the taro was lost during the
flooding there, a degree of crop loss similar to the magnitude
that USFS experts observed on Lukunoch and Oneop just 18
months earlier.12
LIMITATIONS
Although this case report is less scientifically rigorous than con-
trolled data involving a larger sample, it may be argued to have
scientific value in that it permits reporting of new health ef-
fects with a high sensitivity for detecting novel situations (like
climate change) in which historical precedence does not ex-
ist. The results of this survey are limited as a result of several
sources of potential bias. First, the relatively small sample of
the population on Lukunoch precludes accurate interpreta-
tion of those data. However, findings using an acceptable sample
size on Oneop were consistent with results from the Lukunoch
survey. Case reports are also commonly associated with recall
bias. However, respondent replies regarding loss of food and wa-
ter resources were verified by direct physical inspection by USFS
and US Geological Survey experts. Finally, it is not possible to
accurately interpret trends among morbidity and mortality data
among such a small population and in the absence of preevent
baseline health information for comparison.
CONCLUSIONS
On March 5, 2007, an acute-onset, sea level rise event result-
ing in coastal erosion, shoreline inundation, and saltwater in-
trusion occurred in two coral atoll islands of Micronesia. The
findings of this study suggest that highly vulnerable popula-
tions of both Lukunoch and Oneop islands experienced disas-
trous losses in crop productivity and freshwater sources. While
it is not possible to extrapolate the results of this study to all
SIDS in general, the findings associated with this event are con-
Sea-Level-Rise Disaster in Micronesia
86 Disaster Medicine and Public Health Preparedness VOL. 4/NO. 1
(Reprinted) ©2010 American Medical Association. All rights reserved.
sistent with events that have been predicted to occur as a re-
sult of climate change.1,2 These findings reveal the need for ef-
fective public health research and sustainable interventions that
will monitor and shape the health of small island populations
predicted to be at high risk for adverse health effects due to cli-
mate change.
RECOMMENDATIONS
Effectively addressing the health risks of climate variability and
change will require wide-ranging responses from federal and state
agencies and departments. Costs would need to be determined
by the individual agencies, but would likely exceed $100 mil-
lion annually.13 A comprehensive surveillance and moni toring
system to address the health risks of climate change is neces-
sary to provide the information needed to implement timely
and appropriate programs and activities to reduce the health
risks of climate change.13 Key public health research catego-
ries that address these essential services include surveillance and
monitoring; field, laboratory, and epidemiologic research; model
development; development of decision support tools; and edu-
cation and capacity building of the public and public health
and health care professionals.14 The findings of this study sug-
gest that the need for this research has become even more ur-
gent.
About the Author
Author Affiliations: National Center for Environmental Health, Agency for
Toxic Substances and Disease Registry, Centers for Disease Control and Pre-
vention, Atlanta, Georgia.
Correspondence: Mark Keim, MD, National Center for Environmental Health,
Centers for Disease Control and Prevention, 4770 Buford Hwy, MS-F29, At-
lanta, GA USA 30341-3724.
Funding/Support: This survey was supported by funds from the Centers for
Disease Control and Prevention, Coordinating Office for Terrorism Prepared-
ness and Emergency Response.
Disclaimer: The material in this article reflects solely the views of the author.
It does not necessarily reflect the policies or recommendations of the Centers
for Disease Control and Prevention or the US Department of Health and Hu-
man Services.
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Sea-Level-Rise Disaster in Micronesia
Disaster Medicine and Public Health Preparedness 87
(Reprinted) ©2010 American Medical Association. All rights reserved.
... For this reason among others, these islands and the livelihoods of the people who inhabit them have been characterized as uncommonly exposed to impacts from recent and future climate change (BOM 2011;FAO 2008;Fletcher and Richmond 2010). Yet there have been only a few isolated reports of observed climate-change impacts on the coasts of FSM islands (Keim 2010;Pam and Henry 2012). This may suggest that either claims of FSM vulnerability have been exaggerated or that there is more resilience built into the environmental and human systems of FSM coasts than is widely acknowledged. ...
... The converse situation applies during La Niña events when sea level in FSM is as much as 15 cm higher than average during winter (October-February) resulting in coastal inundation (BOM 2011;Chang et al. 2013). Most of the 'marine inundation' events to have affected low islands in FSM (Fletcher and Richmond 2010;Keim 2010) occurred during La Niña events; none occurred during El Niño events. Yet inundation does not necessarily equate to coastal change, especially around high Pohnpei Island where almost every part of the shoreline is fringed by mangrove forest that traps sediments and absorbs wave energy. ...
... It would be expected that this uncommonly high rate of sea-level rise, sustained over at least two decades, would have had conspicuous effects on the coast of Pohnpei, as it appears to have had in other parts of FSM (Keim 2010;Nunn et al. 2017;Pam and Henry 2012). Yet no clear widespread evidence for effects attributable to sea-level rise has been reported from Pohnpei despite visits by several scientists interested in coastal change (notably Bloom 1970, Dickinson 2000. ...
Article
Full-text available
Those parts of the northwest Pacific Ocean where sea level has been rising fastest over the past few decades include islands in the Federated States of Micronesia. To understand the possible effects of rapid sea-level rise, coastal surveys were undertaken within Pohnpei State in October 2014. The high volcanic island of Pohnpei was targeted along with 10 reef-edge island groups on its surrounding barrier reef as well as islands on Ant Atoll, 15 km southwest. Evidence of shoreline erosion attributable to sea-level rise is found only in a few places along the main island’s northeast (windward) coast. High rainfall has led to the accumulation of terrestrial sediment along the coast that is covered with mangrove forest 2–3 km broad in places shielding the island’s coast from wave erosion. A different picture is found on reef-edge islands around which erosion over the last few decades can mostly be explained by recent sea-level rise. Islands have disappeared within living memory, others drastically reduced in size in the past decade, while others – their sand cover washed away – are being reduced to a skeletal (boulders anchored by mangrove) state. The coasts of Ant Atoll appear little affected by erosion ascribable to sea-level rise. In summary, fewer effects than might be expected from recent sea-level rise were seen in Pohnpei, largely for reasons of natural coastal resilience or a lack of record, especially for reef-edge islands. The importance of mangrove conservation and an understanding of sediment dynamics on the broad reef-lagoon shelf surrounding the main island is manifest.
... Impacts of acute sea inundation events are particularly severe among small island populations. These populations are particularly vulnerable to acute disruptions involving crop productivity and access to freshwater (Keim 2010b). Most morbidity and mortality associated with CRD-related disease are attributable to injury. ...
... Source: Adapted from Keim (2002Keim ( , 2010aKeim ( , 2010b ...
Presentation
Guest Lecturer, Disaster Medicine 201: Post-Earthquake Medical Challenges in the New Madrid Seismic Zone Title: The public health impact of climate change and Concept of operations for mass casualty management Festus, MO March 18-19, 2010
... Although the spread of disease is not the primary impact of disasters [1], epidemics of disease occur after disasters in developing countries because of inadequate management of sanitation, waste, and drinking water [2,3]. The impact of disasters varies, from the extreme destruction of water, sanitation, and hygiene (WASH) infrastructure and services to a decline in the quality and quantity of water resources [4,5]. Thus, emergency WASH interventions are required to avoid the transmissions of infectious diseases, such as diarrhoea or cholera, and limit susceptibility to disease-bearing vectors [6]. ...
Article
Full-text available
Emergency water, sanitation, and hygiene (WASH) interventions are critical to avoid transmission of infectious diseases and limit susceptibility to disease-bearing vectors. Non-Governmental Organisations (NGOs) play a critical role in developing WASH programs, working with government organisations (GOs), specifically during the post-disaster phase, whether during recovery or reconstruction periods. Developing effective collaboration between GOs and NGOs can form a well-focused relationship leading to effective outcomes. Lack of collaboration may result in negative outcomes, including significant infrastructure destruction, loss of life and property, and lack of access to WASH service. The aim of the paper is to identify the factors influencing collaboration between GOs and NGOs to provide WASH services in the post-disaster phase. The research methodology is underpinned by qualitative approach using data collected using semi-structured interviews. The result obtained from analysing data from thirty interviewees support the preconditions, processes, and structural factors of collaboration. The findings suggest that the increasing complexity of disasters and the lack of capacity of GOs alone to manage these disasters have created interdependency between GO and NGOs. Moreover, good relationship history and a shared vison between GOs and NGOs are key preconditions for effective collaboration. The structures for effective GO-NGO collaboration require good coordination, good legislation, and an administrative system with legitimised coordinators/administrators, backed up by clear descriptions of the roles and responsibilities of stakeholders. The processes relating to planning, developing mutual understanding, communication, and cooperation is key for collaboration between GOs and NGOs. Furthermore, the findings identified trust and power as the mediator factors integrating with the precondition, process, and structure variables for GO-NGO collaboration for the effective delivery of public services in times of crisis.
... Atoll islets and reef islands: Given their low elevations and open exposure, atolls and reef islands are particularly susceptible to accelerated sea-level rise. This is recognized as a problem of increasing significance on many low-lying Micronesian islands (Keim 2010;Pam and Henry 2012). However, it is expected that small islands and atolls will show varying responses to sea-level rise due to island geomorphology, culture, ecosystems, and populations (Barnett and Campbell 2010;Nurse et al. 2014). ...
Chapter
The biophysical and socioeconomic conditions in the coastal zone of the Yap Islands is highly vulnerable to climate-related changes in precipitation, sea level, storm surges, coastal erosion, and salinity. The climatic changes are affecting every aspect in the lives of coastal communities due to the small size of the islands and atolls, their low elevation, and extensive coastal areas. Climate risks are further amplified by the regional El Niño Southern Oscillation phenomena that threaten the food and water security of island communities. Further changes are projected to manifest in the coming decades because of increased temperature, decreased rainfall, rising sea levels, and ocean acidification. Recurrences of disasters and crises threaten food security through impacts on traditional agriculture, causing the forced migration of coastal communities to highlands in search of better living conditions. As many of the projected impacts are now unavoidable, implementing some degree of adaptation is essential to enhance food security, strengthen livelihoods, and increase the resilience of coastal communities to future climate risks. This paper highlights the outcomes of an ongoing project on ‘Climate Adaptive Agriculture and Resilience,’ and presents a three-pronged adaptation model to enhance the adaptive capacity and climate resilience of coastal communities in Yap. The potential of sustainable soil management practices, water conservation and management, and mosaic restoration activities in enhancing the livelihood opportunities of displaced coastal communities is highlighted. Through this adaptation model, coastal communities can moderate the harm of current and future climate risks and take advantage of new opportunities.
... Given that most people in Yap occupy island coasts and consume mostly food from these areas, both onshore and offshore, coastal change directly impacts subsistence in many places. This is recognized as a problem of increasing seriousness on low-lying Micronesian islands (Keim 2010;Pam and Henry 2012), but is also causing concern for coastal dwellers on higher islands like those in Yap Proper. Given its lower elevations and the existence of lowelevation gaps connecting the west and east coasts, the problem is most widespread in Gilmaan, the southernmost part of the main island, where there is comparatively little high ground. ...
Article
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The characterization of Pacific Islands as especially vulnerable to climate change often undervalues the cultural resilience of their inhabitants. On many Micronesian islands, coastal stone-built structures are the most visible type of tangible cultural resilience and have endured for perhaps 1000 years or more. A distinction is recognized between older structures, likely built in response to sea-level rise during the Medieval Warm Period (AD 750–1250), and more recent structures that likely took advantage of the lowered sea level during the Little Ice Age (AD 1350–1800). Detailed studies of Micronesian responses to recent coastal change were undertaken in the islands of Yap (Proper). The positioning and maintenance of coastal men’s houses (faluw) reflect either pragmatic responses to unmanageable coastal change or a cultural determination to resist this. The long history of traditional responses to climate variability and coastal change for terrestrial food production on Yap is also discussed. Future adaptation pathways on Yap and other higher islands in Micronesia need to combine scientific knowledge of climate change with traditional responses to historical change, including the stonework tradition and the cultural determination to resist undesired coastal change.
... Apart from changes in rainfall intensity, frequency and reliability, also to be considered are altered patterns of winds, hailstorms, forest fires, and other extreme weather events, such as cyclones and hurricanes. Sea level rise is already harming food production in some low-lying islands (Keim 2010), while warmer temperatures are reducing nutrient mixing and fishery productivity in LakeTanganyika (Tierney et al. 2010). Despite warming, the pattern and even frequency of frosts may change, for example by reduced seasonal rainfall and cloudiness. ...
Article
The Pacific Islands, a group of Small Island Developing States (SIDS), are thought to be particularly vulnerable to the consequences of climate change, highlighting the critical need for holistically assessing risks, especially those relevant to the health and wellbeing of local communities. This scoping review assesses the state of peer-reviewed literature on the health risks associated with climate change in the 21 Pacific Island states, analyzing quantitative and qualitative studies focusing explicitly on health outcomes, as well as studies focusing on health determinants or potential mediators along the climate-health pathway. The evidence in the Pacific is limited and largely geographically centred on a select few states, but highlights that climate change indicators are associated with a wide range of health outcomes, including but not limited to diarrhea, leptospirosis, typhoid fever, and mental distress. With respect to mediators, the review also reveals that infrastructural systems and policies are not sufficient to protect communities from potential health consequences in the states studied. By matching the review findings to the recommendations of the WHO Framework for Building Climate Resilient Health Systems, the paper highlights critical gaps in evidence regarding components of the framework such as climate-resilient technology, infrastructure, and climate-resilient financing. Although limited, the evidence reveals priority areas for climate adaptation. Further research that includes a focus on quantitative assessments of climate-related interventions will be critical to building resilience in one of the most at-risk regions of the world.
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Pacific Island Countries (PICs) lag behind global trends in water, sanitation and hygiene (WaSH) development. We conducted a systematic search of all English language papers (published before February 2015) about WaSH in PICs to evaluate the state of the peer-reviewed literature and explore thematic findings. A total of 121 papers met the criteria for full-text review following an initial search result of more than 6,000 papers. Two reviewers independently assessed the quality and relevance of each article and consolidated their findings according to four emergent themes: public health, environment, emergency response and interventions, and management and governance. Findings indicate a knowledge gap in evidence-guided WaSH management strategies that advocate for human health while concurrently protecting and preserving drinking water resources. Extreme weather events threaten the quantity and quality of limited freshwater resources, and cultural factors that are unique to PICs present challenges to hygiene and sanitation. This review highlights the strengths and weaknesses of the peer-reviewed literature on WaSH in PICs, addresses spatial and temporal publication trends, and suggests areas in need of further research to help PICs meet development goals.
Article
Sixteen species of reptiles (two sea turtles, seven geckos, six skinks, and one monitor lizard) are recorded from Lukunor Atoll, Federated States of Micronesia. None is endemic to the atoll, and nearly all are widespread in Micronesia, and in many cases well beyond. The gecko Perochirus ateles has the highest incidence of occurrence, being recorded on 17 of the 18 islands, followed by the skink Lamprolepis smaragdina (14 islands), and the gecko Gehyra oceanica (13 islands). The skinks Emoia caeruleocauda and E. impar were among the most common lizards wherever they occurred on the atoll but were observed on only eight and six of the islands, respectively, and occurred together on only two of them. The Pacific monitor, Varanus indicus, was introduced during the Japanese administration, and the common house gecko, Hemidactylus frenatus, probably sometime after World War II. Origins of the other species are less certain; some possibly arrived by natural dispersal and others assisted by humans.
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Climate change impacts are expected to produce more frequent, longer and unpredictable drought periods with further saltwater intrusion in the Marshall Islands. As a result, a significant return to traditional food cropping is unlikely. This will lead to an increased dependence on food aid, especially in the outer atoll populations. An examination of the nutritional content of food aid suggests it is likely to lead to poor health outcomes. Dependence on food aid has gradually increased over the past 70 years in the Marshall Islands, starting with population relocation because of war and nuclear testing and most recently because of climate change. The authors argue that the health impacts of the supplemental imported diet, combined with migration to population centers, may result in an even greater prevalence of chronic diseases, and exert pressures that lead to more communicable disease, further exacerbating the syndemics in the Marshall Islands. The authors conclude that food aid donors and the Republic of the Marshall Islands (RMI) government have human rights obligations to ensure that the people in the Marshall Islands have access to adequate nutrition. Accordingly, donors and the government should re-examine the content of food aid and ensure it is of sufficient quality to meet the right to health obligations.
Article
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1 Both "hard" and "soft" structural responses are presented. The term hard structures refers tostructures such as seawalls and levees. Soft structural responses include artificial beach nourishment to counter erosion and flooding or injection of water into a well along the coast to develop a saltwater intrusion, barrier in an aquifer. Both the cost and the effectiveness of any structural control method are extremely site dependent and quite variable from site to site. The next section of this chapter covers methods for the control of erosion and inundation, while the third discusses control of salinity intrusion. Inundation is a major cause of, and is difficult to separate from, shore erosion where erosion is active; thus the two are presented together. Each section discusses, as necessary, the processes involved in coastal erosion, inundation, and salinity intrusion; the basic approaches used to control these phenomena; and details of the specific control methods including their costs and effectiveness. The final section of the chapter summarizes the key points and suggests how these control methods might be applied at a given site.
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The need to identify and try to prevent adverse health impacts of climate change has risen to the forefront of climate change policy debates and become a top priority of the public health community. Given the observed and projected changes in climate and weather patterns, their current and anticipated health impacts, and the significant degree of regulatory discussion underway in the U.S. government, it is reasonable to determine the extent of federal investment in research to understand, avoid, prepare for, and respond to the human health impacts of climate change in the United States. In this commentary we summarize the health risks of climate change in the United States and examine the extent of federal funding devoted to understanding, avoiding, preparing for, and responding to the human health risks of climate change. Future climate change is projected to exacerbate various current health problems, including heat-related mortality, diarrheal diseases, and diseases associated with exposure to ozone and aeroallergens. Demographic trends and geophysical and socioeconomic factors could increase overall vulnerability. Despite these risks, extramural federal funding of climate change and health research is estimated to be < $3 million per year. Given the real risks that climate change poses for U.S. populations, the National Institutes of Health, Centers for Disease Control and Prevention, U.S. Environmental Protection Agency, and other agencies need to have robust intramural and extramural programs, with funding of > $200 million annually. Oversight of the size and priorities of these programs could be provided by a standing committee within the National Academy of Sciences.
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The relationship between natural disasters and communicable diseases is frequently misconstrued. The risk for outbreaks is often presumed to be very high in the chaos that follows natural disasters, a fear likely derived from a perceived association between dead bodies and epidemics. However, the risk factors for outbreaks after disasters are associated primarily with population displacement. The availability of safe water and sanitation facilities, the degree of crowding, the underlying health status of the population, and the availability of healthcare services all interact within the context of the local disease ecology to influence the risk for communicable diseases and death in the affected population. We outline the risk factors for outbreaks after a disaster, review the communicable diseases likely to be important, and establish priorities to address communicable diseases in disaster settings.
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There is scientific consensus that the global climate is changing, with rising surface temperatures, melting ice and snow, rising sea levels, and increasing climate variability. These changes are expected to have substantial impacts on human health. There are known, effective public health responses for many of these impacts, but the scope, timeline, and complexity of climate change are unprecedented. We propose a public health approach to climate change, based on the essential public health services, that extends to both clinical and population health services and emphasizes the coordination of government agencies (federal, state, and local), academia, the private sector, and nongovernmental organizations.
Article
Objective: This article outlines a number of important areas in which public health can contribute to making overall disaster management more effective. This article discusses health effects of some of the more important sudden impact natural disasters and potential future threats (e.g., intentional or deliberately released biologic agents) and outlines the requirements for effective emergency medical and public health response to these events. Conclusion: All natural disasters are unique in that each affected region of the world has different social, economic, and health backgrounds. Some similarities exist, however, among the health effects of different natural disasters, which if recognized, can ensure that health and emergency medical relief and limited resources are well managed.
The Public Health Consequences of Disasters
  • J Malilay
  • Floods
Malilay J. Floods. In: Noji ER, ed. The Public Health Consequences of Disasters. New York, NY: Oxford; 1997:287-300.
Tidal Swell Washes Over Pacific Islands. The Kaselehlie Press
  • B Jaynes
Jaynes B. Tidal Swell Washes Over Pacific Islands. The Kaselehlie Press. Dec 24, 2008. http://www.fm/news/kp/2008/dec08_5.htm. Accessed February 10, 2010.
Tidal Swell Washes Over Pacific Islands
  • Jaynes