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SPECIAL FOCUS
Challenges and Strategies for Climate Change Adaptation
Among Pacific Island Nations
Mollie J. Mahany, MPH; Mark E. Keim, MD
ABSTRACT
Few regions of the world are at higher risk for environmental disasters than the Pacific Island countries and
territories. During 2004 and 2005, the top public health leadership from 19 of 22 Pacific Island countries and
territories convened 2 health summits with the goal of developing the world’s first comprehensive regional strat-
egy for sustainable disaster risk management as applied to public health emergencies. These summits followed
on the objectives of the 1994 Barbados Plan of Action for the Sustainable Development of Small Island Devel-
oping States and those of the subsequent Yokohama Strategy and Plan of Action for a Safer World. The outputs
of the 2004 and 2005 Pacific Health Summits for Sustainable Disaster Risk Management provide a detailed de-
scription of challenges and accomplishments of the Pacific Island health ministries, establish a Pacific plan of
action based upon the principles of disaster risk management, and provide a locally derived, evidence-based
approach for many climate change adaptation measures related to extreme weather events in the Pacific region.
The declaration and outputs from these summits are offered here as a guide for developmental and humanitarian
assistance in the region (and for other small-island developing states) and as a means for reducing the risk of
adverse health effects resulting from climate change.
(Disaster Med Public Health Preparedness. 2011;5:(doi:10.1001/dmp.2011.44))
Key Words: climate change adaptation, minority health, health disparity, public health emergency,
disaster risk reduction
Disaster risk reduction is considered an integral
part of climate change adaptation.1Disaster
reduction has emerged as a core element of
sustainable development.2The 2002 World Summit
on Sustainable Development concluded that “An
integrated multi-hazard, inclusive approach to address
vulnerability, risk assessment and disaster manage-
ment, including prevention, mitigation, preparedness,
response and recovery, is an essential part of a safer
world in the twenty-first century.”3Reducing risk
requires long-term engagement in the development
process.4Disaster risk reduction is largely a task for
local actors (in this case, Pacific Island health minis-
tries), albeit with support from national and interna-
tional organizations, particularly when undertaking
humanitarian actions.1The United Nations Interna-
tional Strategy for Disaster Reduction defines disaster
risk management as the “systematic process of using
administrative directives, organizations, and opera-
tional skills and capacities to implement strategies,
policies, and improved coping capacities in order to
lessen the adverse impacts of hazards and the possibility of
disaster.”5This term is an extension of the more gen-
eral term risk management to address the specific issue
of disaster risks. Disaster risk management aims to
avoid, lessen, or transfer the adverse effects of hazards
through activities and measures for prevention, mitiga-
tion, and preparedness.5Reducing vulnerability is a
key aspect of reducing climate change risk.4A disaster
risk management plan, then, selects appropriate con-
trols or countermeasures to manage each risk. The risk
management plan should propose applicable and effec-
tive controls for managing the risks as applied to the
reduction of both hazards and human vulnerability. A
good risk management plan should contain a schedule
for control implementation and list the people respon-
sible for those actions.
Few regions in the world are at higher risk for envi-
ronmental disasters than Pacific Island countries and
territories (PICTs).6,7 During 2004 and 2005, the
public health leadership from 19 of 22 PICTs devel-
oped the first comprehensive regional strategy for sus-
tainable disaster risk management as applied to pub-
lic health emergencies. These summits followed on
the objectives of the 1994 Barbados Plan of Action
for the Sustainable Development of Small Island
Developing States8and those of the subsequent
Yokohama Strategy and Plan of Action for a Safer
World.9PICTs have developed a risk management
plan that, if implemented, would guide regional disas-
ter risk management activities for health during the
next decade. This plan was developed in the form of
a regional declaration and a set of comprehensive
project proposals that would implement the 10-year
plan. The following describes the process methodol-
ogy used to develop a consensus document in the
form of a regional declaration.
Disaster Medicine and Public Health Preparedness, Published online June 30, 2011 E1
©2011 American Medical Association. All rights reserved.
PROCESS METHODOLOGY
First Pacific Health Summit for Sustainable Disaster
Risk Management
In June 2004, the Centers for Disease Control and Prevention
(CDC) hosted the first Pacific Health Summit for Sustainable
Risk Management in Honolulu, Hawaii. This summit was at-
tended by Pacific Island health ministry leaders of 16 PICTs
and by representatives from 15 international and regional pre-
paredness and response organizations. With the assistance of
an experienced facilitator, the participants achieved consen-
sus in prioritizing issues relevant to the Pacific and in devel-
oping a 10-year plan of action. Together, they produced the Dec-
laration of the Pacific Health Summit for Sustainable Disaster
Risk Management.10 The declaration describes the challenges
of the Pacific; presents the current status of the Pacific in re-
gard to 4 categories: preparedness, response, mitigation, and
recovery; and proposes a Pacific plan of action comprising 8
regional objectives for each of the 4 categories.11 See http:
//www.pacifichealthdialog.org.fj/Volume%2013/No1
/Declaration%20of%20the%20Pacific%20HS%20for%20SDR
%20Management.pdf for more information regarding the 2004
Summit declaration.
Second Pacific Health Summit for Sustainable Disaster
Risk Management
In June 2005, CDC hosted the second Pacific Health Summit
for Sustainable Risk Management in Sigatoka, Fiji. The goal of
this summit was to advance the declaration from the 2004 sum-
mit into workable planning proposals and projects. Pacific Is-
land public health officials from 19 nations and representatives
from 13 international and regional organizations met to achieve
this goal. Sixteen concept papers for risk management projects
were developed from the objectives of the 2004 Declaration of
the Pacific Health Summit. The table contains a description of
project objectives. See http://www.pacifichealthdialog.org.fj
/index.php?option=com_content&view=article&id=87 for more
detailed information regarding the 2005 Summit projects.
The following is a transcript of the entire Declaration of the
2004 Pacific Health Summit for Sustainable Disaster Risk Man-
agement, as written by 19 health ministers and health secre-
taries of the Pacific region.
DECLARATION OF THE 2004 PACIFIC HEALTH SUMMIT
FOR SUSTAINABLE DISASTER RISK MANAGEMENT
I. PREAMBLE
A. Challenges of the Past
We, the family of Pacific nations, claim as our home over 1/3
of the world’s surface spread across 10 time zones of Pacific ex-
panse. We are 32 million people living in 22 separate island
nations connected by water.
Pacificans carry the highest environmental disaster burden in
the entire world. Pacific populations lead the world in mortal-
ity rates, per capita disaster costs, and proportion of total people
affected by environmental disasters, understanding that all di-
sasters, particularly in the face of poverty, have a greater ad-
verse impact on sustainable development for all Pacificans.
Some of our Pacific challenges include:
1. The Pacific tectonic plate is the most seismically active
in the entire world and volcanic eruptions and tsunamis are fre-
quent occurrences;
2. During the International Decade of Natural Disaster Re-
duction (1990–1999), the top 10 earthquakes (in terms of Rich-
ter scale seismic data) in the world occurred in the Pacific;
3. The 1998 US Institute of Medicine Report identified se-
rious deficiencies in the Pacific related to health care, the medi-
cal workforce, and health facilities;
4. Studies and experience have revealed high vulnerability
to disaster hazards among Pacific health sectors;
5. Most of the world’s nations threatened by rising sea lev-
els as a result of global warming are located in the Pacific; Global
warming may also have other impacts such as rising rates of ma-
laria;
6. The El Nino phenomenon dramatically affects the Pa-
cific Islands through prolonged drought and increased danger
of forest fires;
7. The Pacific basin is the site of the numerous and fre-
quent cyclonic storms;
8. Pacificans simultaneously suffer heavy burdens from both
communicable and non-communicable diseases; and
9. Reliance upon air and shipping transport increases vul-
nerability to transportation delays and mishaps.
As many of us live on isolated Pacific islands, our health suf-
fers disproportionately (when compared to other areas of the
world) when confronted with disasters, because of the dispar-
ity between the magnitude of the disaster and our limited re-
sources and capabilities to cope.
Here in the Pacific, we routinely suffer from disasters such as
cyclonic storms, tsunamis, floods, earthquakes, volcanic erup-
tions, drought, landslides, and rising sea levels resulting from
global warming. While progress has been made in the control
of some infectious diseases, others like HIV/AIDS, malaria, and
TB, are serious problems in the Pacific. The alarming in-
creases in prevalence of non-communicable diseases, road in-
juries, and substance abuse are disasters of a more insidious na-
ture that also threaten the sustainable development of our island
nations.
Scarce resources, which are earmarked to meet daily needs, must
often be diverted in an emergency fashion to deal with dra-
matic disasters. Because of the rule of rescue in the face of such
emergencies, resources available for mitigation and prepared-
ness are used to respond to episodic disasters. For developing
nations, the baseline normal capacity to address essential daily
health care needs would be considered inadequate and unac-
ceptable by most developed nations and according to the widely
accepted Sphere Project minimum standards for disaster
response. Even in the best of times, there is wide disparity
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TABLE
Concept Paper Topics From the 2005 Pacific Health Summit for Sustainable Risk Management
Landslide Hazard Mapping—A Lifesaving Tool: A Concept
Proposal for Preparedness in Chuuk, Micronesia
The overall goal of the 1-y landslide hazard map implementation. A project in Chuuk is
to build on existing knowledge and apply preexisting basic hazard-mapping tools,
existing hazard maps, and landslide vulnerability assessments to develop evacuation
plans and procedures and raise awareness in the community.
Analysis of Tsunami/Storm Surge Hazards in Saipan of the
Northern Marianas Islands and Landslide Hazards in
Kosrae of the Federated States of Micronesia
This 5-y Natural Hazard Analysis Project aims to reduce the loss of life and the rate of
injury to islanders by (1) performing systematic analyses of the hazards that affect
these populations—the storm surge and tsunami hazard on Saipan in the Northern
Marianas Islands and the landslide hazard on Kosrae in the Federated States of
Micronesia, and (2) constructing hazard maps for those islands.
Reducing Vulnerability of Communities in Tuvalu and
Tokelau to Health Risks During Disaster Emergencies
Through Community Empowerment
A project to reduce vulnerability of the isolated communities in the 2 Pacific Island
countries Tuvalu and Tokelau through improved preparedness and community
empowerment in health disaster management. One objective is to produce replicable
models and materials for use on other islands.
Strengthening the Resilience of Health Facilities to
Emergencies/Disasters
A project to ensure fully functional health facilities that will provide continuity of
services to patients and the community in times of emergencies and disasters.
Pacific Learning From Emergencies and Disasters A project to strengthen health disaster management in Pacific Island countries and
territories through evaluating efforts undertaken and disseminating lessons learned.
Empowering Community with Training on Psychosocial
Support: A Pilot Project in Pohnpei, Federated States
of Micronesia
This 2-y project will be conducted by and sustained in local communities on the island
of Pohnpei. The overall goal of the project is to build the capacity of the
communities to deal with the psychosocial impact of disasters.
Disaster Risk Management Training in Health in the Pacific A project to train disaster risk managers in health for the Pacific who, as public health
managers, will provide the leadership role in addressing all health aspects of Pacific
disasters, including mitigation, preparedness, response, recovery, and the ability to
identify needs, available resources to address those needs, and manage both
internal and external assistance.
Develop Community Capacity to Support Inclusion of Health
Issues in Establishment and Management of Emergency
Settlements
A project to raise awareness and empower communities to address key health issues in
the establishment of emergency settlements in 22 Pacific Island countries and
jurisdictions in a 2-y period. These emergency settlements are expected to provide
the necessary support for affected populations during the process of recovery from
a natural disaster until they can move back to their homes.
Strengthened National Influenza Preparedness A project to build on existing efforts and strengthen national and regional capacity to
prevent, prepare for, respond to, and recover from outbreaks of influenza (eg,
severe acute respiratory syndrome).
Developing Resilience and Reducing Vulnerability in the
Pacific: A Head Start on Health Disaster Risk
Management Through Pacific Schools
A project to gather available information and materials, including traditional knowledge,
and incorporate these in the development of a curriculum in health disaster risk
management and strengthen related teaching capacity for schools in the region.
The Pacific Health Team: Establishment of Regional Surge
Capacity Among Medical and Public Health Personnel
in the Pacific
A project to develop the capacity in the Pacific to respond to health emergencies and
natural disasters through training of health personnel in a variety of specializations
and maintenance of a rapid response roster to ensure that qualified personnel are
available.
Pacific Regional Network for Training and Support in
Disaster Risk Management
A project to reinforce the awareness of and preparation for health emergencies in the
Pacific islands. Regional teamwork will improve the capacity of national health
systems to take action on and respond to specific requirements in relation to
disasters. The Regional Network for Training and Support in Disaster Risk
Management will develop training activities for national and local risk managers.
Pacific Public Health Emergency Operations Planning A project to introduce standardized public health emergency operations planning and
hazard assessment formats throughout the Pacific region. The project will support
the millennium development goals by developing global partnerships for emergency
operations planning that promote environmental sustainability and sex equality,
combat disease outbreaks, and reduce mortality.
Pacific Health Risk Communication and Information
Management
A project to develop the knowledge and skills of disaster managers to address issues of
risk communications and disaster information management that will help public
health officials and public health communication professionals effectively prepare
for and respond to public health emergencies.
A Project to Prepare a Manual on Health Emergency
Response for the Region
A project to develop an emergency response manual for the region that acknowledges
the differences in culture developed and used in the 22 Pacific Island countries and
territories.
Establishment of Community Disaster Recovery in Health
for Communities in 22 Pacific Islands and Territories
The overall goal is to empower local communities to manage the primary and public
health problems associated with the recovery phase of natural disasters and develop
the capability to reduce and minimize any negative effects. This project will address
the training needs through a series of regional, national, and local level training
events that will transfer skills and enable local recovery health committees to
identify their own needs and use available resources and local knowledge to address
their own unique primary and public health problems.
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between the need for health care services and locally available
resources.
B. A Pacific Plan of Action for the Future
In spite of these challenges, many Pacific nations are making
progress in identifying and utilizing local and regional re-
sources to improve our readiness for disasters. Notwithstand-
ing the progress made thus far, we are mindful that additional
resources are required to enhance our capacity to lessen the im-
pact of disasters particularly through mitigation and prepared-
ness initiatives.
Our aim is to improve the core capacity of our public health
and medical systems to deal with both routine health needs and
chronic emergencies. Improved core capacity will enhance our
ability to deal with episodic disasters and catastrophes as they
arise. Therefore, local disaster mitigation, preparedness, re-
sponse and recovery capacities must be built on the existing pub-
lic health and medical care systems. It is imperative to strengthen
existing systems that can then respond appropriately to daily
needs as well as to unpredictable disasters.
During the 2004 Pacific Island Health Summit for Sustainable
Disaster Risk Management a Pacific-appropriate strategic plan
was developed, which, when fully implemented, will accom-
plish this overall goal. This plan includes:
• a situational analysis of current readiness,
• realistic objectives,
• assessment of current resources, and
• identification of additional resources needed to fully imple-
ment a sustainable health risk management plan.
We believe that this plan builds upon the past contributions
of previous international conferences to promote sustainable
development and disaster reduction. It is designed to be the
health component of the broader Pacific Regional Action Plan
facilitated by the South Pacific Applied Geoscience Commis-
sion (SOPAC) and will be presented at the Second World Con-
gress for Disaster Reduction in Hyogo, Japan in January 2005.
C. Our Approach
Our approach to improving the health of Pacific populations
will include a comprehensive model for disaster risk manage-
ment involving mitigation, preparedness, response, and recov-
ery. Our actions will address the full range of hazards that we
face, including the causes and effects of both natural and tech-
nological disasters.
II. MITIGATING HEALTH DISASTERS
A. The Current Status of Disaster Mitigation in the Pacific
The current conditions in the Pacific region in the area of di-
saster mitigation show both successes and challenges. Among
the accomplishments of the past two years are: the ongoing con-
duct of community disaster awareness campaigns; the enhance-
ment of regional emergency management support as a backup
for individual countries; initial steps have been taken to train
and develop professional expertise to support the institution-
alization of disaster mitigation; and, assessments of health and
medical vulnerabilities have been completed in six PICTs. How-
ever, much more remains to be done.
The economic support base is currently not diversified enough
for mitigation to adequately reduce the public health dangers
associated with the range of potential hazards. Very little is being
done to train local communities to prepare for disasters. Exist-
ing government disaster management planning efforts often do
not include mitigation strategies and insufficient training for
those responsible for disaster planning and management ham-
pers planning efforts. In addition, donor mitigation planning
processes do not complement existing national plans. Donor
organizations and agencies do provide support in emergency situ-
ations, but often donors establish their own independent pri-
orities. These priorities not only determine what kind of sup-
port they provide, but also which jurisdictions they are willing
to assist.
While political commitment to disaster management does ex-
ist, efforts to mitigate the effects of disasters are overshadowed
by other concerns. For example, locally appropriate building
codes are not always in place and, where building codes do ex-
ist they are not being adequately enforced. Locally appropriate
building materials may not be available in sufficient quantities
at affordable prices to assure that disaster-resistant structures
are constructed.
Adding to the complexity of the situation is the presence in
some places of unresolved political, societal, and military con-
flicts. Insufficient work is being done to analyze the root causes
of conflict and to identify appropriate measures to prevent or
resolve conflict.
B. Disaster Mitigation Objectives
To improve the disaster mitigation situation, especially as it re-
lates to improving mitigation in the area of public health, the
delegates to the Pacific Health Summit for Sustainable Disas-
ter Risk Management identified an overall objective for disas-
ter mitigation in the region and nine specific objectives to ad-
dress the issues identified above. The overall objective is: All
countries have effective, integrated, culturally appropriate and
adaptable disaster mitigation plans in place. To achieve this over-
all objective, mitigation-specific objectives were identified and
will be pursued over a ten-year period.
1. Politicians, both in the Pacific and in donor countries are
well informed and commit resources for disaster mitigation re-
lated to health.
2. Mitigation is part of government policy at the national
level with allocations in national budgets.
3. Mitigation criteria are applied to all long-term health sec-
tor planning and development efforts and include donor/
recipient coordination of long-term disaster mitigation plan-
ning and implementation.
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4. Training is provided for those involved in building trades
and the enforcement of building codes; and the quality of build-
ing materials is standardized and their availability increased for
the health sector.
5. National and local economies are diversified.
6. All disaster assistance complements local and national di-
saster mitigation policies.
7. Emergency relocation areas are designated and included
in land-use planning and management efforts in all countries.
8. Communities are empowered and play an active role in
emergency health management within the “Healthy Island” ap-
proach
9. Risk management training is fully implemented among
the health sectors.
10. Conflict mitigation strategies are incorporated in devel-
opment planning efforts.
III. PREPARING FOR HEALTH DISASTERS
A. The Current Status of Disaster Preparedness in the
Pacific
A number of noteworthy accomplishments have been made in
the area of disaster preparedness in the Pacific in the past two
or three years. These include:
1. Hazard maps have been developed for Chuuk following
the Chata’an Cyclone in 2002.
2. Cyclone evaluation plans have been included in the tele-
phone directories.
3. The Centers for Disease Control (CDC) Pacific Emer-
gency Health Initiative (PEHI) has been launched and is pro-
viding support to the Pacific community. Examples of the sup-
port provided by PEHI include: The publication of an issue of
the regional public health journal dedicated to emergency health;
four international conferences on public health preparedness
have been conducted; a simultaneous regional emergency drill
has been performed by 4 PICTs; public health evaluations have
been conducted in 6 Northern and 2 South Pacific countries;
public health emergency plans have been developed in 7 PICTs
and an automated tool for public health disaster planning has
been tested in 3 PICTs.
4. Weather monitoring systems have been developed or are
being developed.
5. A warehouse for medical equipment and supplies has been
established in Fiji.
6. The Pacific Public Health Surveillance Network has de-
veloped a network of Public Health Laboratory services, Lab-
Net, and a network of national/territorial response teams, EpiNet,
to be prepared to respond to epidemic communicable diseases
affecting the Pacific Island region.
7. Airport emergency drills have been conducted.
8. Emergency drills have been conducted in a number of PICT
Hospitals.
Although these accomplishments have contributed signifi-
cantly to improved preparedness in the region, there are a num-
ber of key issues and concerns that remain to be addressed. Five
general issues cut across all aspects of disaster preparedness. The
number of qualified emergency management personnel is lim-
ited and does not approach the number required to prepare for
and manage natural and human-made disasters. Disaster man-
agement information is not adequately disseminated through-
out the region. The capabilities and vulnerabilities of local com-
munities have not been assessed and communities have not been
empowered and equipped to participate effectively in disaster
preparedness and response efforts. Coordination among exter-
nal actors, national and local government agencies and orga-
nizations, and local communities is not well established and
where established, is often not effective. The lack of effective-
ness is directly linked to the absence of clearly defined and mu-
tually agreed roles and responsibilities. Emergency manage-
ment plans, systems and tools are not adequate to meet the
existing needs in the region. Where plans do exist, there have
been few efforts to conduct local or national emergency exer-
cises to test the viability of the plans. Hazard warning systems
are not widely available and those that do exist are not being
upgraded and tested. Emergency preparedness planning and ca-
pacity building efforts are not adequately linked to the public
health sector. Information on the types and quantities of re-
sources required in emergency situations is either not readily
available or easily accessible. Related to the above, data col-
lection and analysis capacities need to be improved so that in-
formation gathered in emergency assessments is linked to emer-
gency management decision-making processes. Finally, hazard
maps have not been prepared for most PICTs.
B. Disaster Preparedness Objectives
To improve the disaster preparedness capacity in the region,
especially as it relates to improving preparedness in the area of
public health, the delegates to the Pacific Health Summit for
Sustainable Disaster Risk Management identified an overall ob-
jective for disaster preparedness in the region and specific ob-
jectives to address the issues identified above. The overall pre-
paredness objective is: Public health is protected and promoted
through the development of a comprehensive disaster prepared-
ness framework. To achieve this overall objective, specific pre-
paredness objectives were identified. These objectives, which
are stated below, will be pursued over a ten-year period.
1. Hazards maps and “capability and vulnerability assess-
ments” are produced and utilized to reduce public health risks.
2. Plans are developed, implemented, and evaluated at all
levels with health as an integral factor.
3. Functioning, multi-sectoral systems are in place with clearly
defined and mutually agreed roles and responsibilities at all levels.
4. Information is used to promote and protect the public’s
health.
5. Adequate human and material resources are available to
ensure optimal preparedness.
6. Warning systems are enhanced and utilized to protect the
population’s health against all hazards.
7. Response mechanisms ensure broad-based cooperation and
coordination.
8. Regular exercises and drills are conducted to exercise and
enhance the health response to disasters.
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IV. RESPONDING TO HEALTH DISASTERS
A. The Current Status of Disaster Response in the Pacific
A number of accomplishments and a range of issues that re-
main to be addressed characterize the current disaster re-
sponse situation in the Pacific region. Among the accomplish-
ments of the past two or three years are: establishment of a
regional center for emergency health education in Palau; over
400 Pacificans trained in public health and medical emer-
gency response; and, a fire protection training exchange pro-
gram established.
While these accomplishments indicate that interest in improv-
ing emergency response is high, a number of issues and con-
cerns remain. There are no regional emergency management
teams available in the Pacific. Some inadequacies include: poor
communication, lack of policy, procedures and training, inad-
equate monitoring and evaluation, and limited coordination
at all levels.
Traditional groups exist in some countries, which are capable
of providing psychosocial support for disaster victims. There are
regional institutions and existing infrastructure to build upon,
for example SOPAC and the Secretariat of Pacific Communi-
ties (SPC). Emergency operation centers are not optimally de-
veloped.
Emergency relief is frequently ad hoc and lacking coordina-
tion. Supplies, storage facilities and distribution methods are
limited even in baseline conditions. Given the extreme geo-
graphical isolation in the region, supply chain management is
even more critical. Externally available medical supplies may
not be appropriately packaged, identified, dated, matched to
the local need, or available in a timely manner. Plans are not
drafted and understood by all stakeholders including vulner-
able populations. The management of the emergency re-
sponse supply chain is inadequate. Training in planning skills
is needed and this training should include the use of imple-
mentation checklists and other tools. There are no transition
strategies (response to recovery) included in disaster response
actions at the national level. Operation manuals are necessary
to facilitate implementation of plans.
Care is limited for medical and psychosocial needs that are likely
to be increased by disasters. Limitations in the area of psycho-
social support include: lack of understanding of and linkage to
traditional coping mechanisms, religious groups and family struc-
tures, limited staff, insufficient delivery mechanisms, limited
awareness, and the limited availability of high quality training
programs. Psychosocial needs of the emergency responders are
also poorly addressed, if they are addressed at all. Search and
rescue capacity for casualties and mortuary services is ex-
tremely limited and must be strengthened to reach the level of
need. Assistance received from external sources is often not rel-
evant to the local needs. Security requirements often increase
in a disaster situation and adequate security personnel may not
be available through local resources.
Existing logistical transport and supply services are often inad-
equate to meet the needs of a disaster situation. Improved plan-
ning for alternate or augmented means of transport, storage and
distribution is essential and required. Local communication is
insufficient to allow for adequate coordination. Local support
and local volunteers are available but the number is limited and
volunteers need training.
The vast distances of the Pacific create the necessity to have
good communication systems. Technology is mismatched to lo-
cal conditions and hard to maintain. Planning of communica-
tion systems needs to be improved. Proper protocol for chan-
nels of communication is not widely understood. Warning and
alert systems need to reach a greater proportion of the popula-
tion. Health information systems and management informa-
tion systems, if they exist, are not often integrated. Trained per-
sonnel and/or qualified professionals are required for emergency
information management including survey design, data collec-
tion, analysis, and dissemination.
Due to extended response times from external rescue agencies,
search and rescue needs to be performed locally. Local rescue
teams do not have adequate numbers of qualified personnel, regu-
lar training or equipment. Public education regarding debrief-
ing, self-protection and hazard-avoidance are not widely avail-
able.
Options for large evacuations of people are particularly lim-
ited for the Pacific islands. Evacuation plans are rare and fre-
quently do not include identification of hazards, routes for evacu-
ation, staff support, or known safe havens. Plans may not be
validated through drills and exercises. Public awareness about
emergency evacuation is inadequate. Options for shelter and
re-settlement are restricted by failure to properly identify haz-
ards, inadequate training and resources for mass care, includ-
ing social management. The size of the Pacific islands limits
options for re-settlement sites and safe havens, thus requiring
the identification of unique and creative solutions. In some cases,
monitoring and warning systems for evacuation are inad-
equate.
B. Disaster Response Objectives
To improve the disaster response capacity in the region, espe-
cially as it relates to improving responsiveness in the area of
public health, the delegates to the Pacific Health Summit for
Sustainable Disaster Risk Management identified an overall ob-
jective for disaster response in the region and specific objec-
tives to address the issues identified above.
The overall response objective is: The relevant national disas-
ter management authority is primarily responsible for emer-
gency response, including coordination at the local level. Quali-
fied regional teams are available to strengthen and support
national emergency management efforts. To achieve this over-
all objective, specific response objectives were identified and
will be pursued over a 10-year period.
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1. Relief plans and staff development processes are cultur-
ally relevant and incorporate all components of medical/
public health supply chain management.
2. Standardized assessment formats and procedures are de-
veloped and serve as the bases for training of emergency per-
sonnel.
3. Psycho-social support builds upon existing traditional
mechanisms and includes referral systems and debriefing pro-
cesses for relief workers.
4. Emergency logistics support systems include storage and
transport systems, which build upon local capacity and re-
sources.
5. Search and Rescue capabilities and equipment are avail-
able, regularly tested and backed-up to assure effective perfor-
mance when required.
6. Health Information Systems, Management Information
Systems, and Health Evidence Reporting are fully developed,
reliable, integrated, and updated regularly by qualified personnel.
7. All communities, which are subject to hazards requiring
evacuation, locate essential structures in hazard free zones and
have designated evacuation sites and routes. Evacuation pro-
cedures are regularly rehearsed.
V. RECOVERING FROM HEALTH DISASTERS
A. The Current Status of Disaster Recovery in the Pacific
Disaster recovery, which includes physical reconstruction, and
social and individual rehabilitation, is not a strong feature of
emergency management in the Pacific Region. Nonetheless, a
number of accomplishments can be cited in the last couple of
years. These include the fact that after Hurricane Iniki in Ha-
waii, houses were reinforced with hurricane-proof roofing. A
new bridge with increased security features was built in Palau
after the first one collapsed. Also, in some countries, im-
proved water supply systems have been put in place as a result
of El Nino occurrences.
These accomplishments notwithstanding, there are a number
of issues and concerns that remain to be addressed. Damage as-
sessment lacks standardized methods. Tools and systems are not
transparent and rarely include community input. Health ca-
pacity assessments are often inadequate or not done at all. Re-
covery planning and decision making is hampered by limited
coordination among governmental and nongovernmental or-
ganizations (NGOs). There are some provisions for income gen-
erating activities, eg, restoration of public infrastructure, agri-
cultural and forest restoration, and rebuilding of the subsistence
economy, but resources vary significantly among nations.
B. Disaster Recovery Objectives
To improve the disaster recovery capacity in the region, espe-
cially as it relates to improving recovery in the area of public
health, the delegates to the Pacific Health Summit for Sustain-
able Disaster Risk Management identified an overall objective
for disaster recovery in the region and specific objectives to ad-
dress the issues identified above. The overall recovery objec-
tive is: Effective recovery capacity is operational with coordi-
nation among all stakeholders to ensure full and rapid recovery
and remediation. To achieve this overall objective, specific re-
covery objectives were identified and will be pursued over a 10-
year period.
1. Comprehensive, impartial and transparent assessment of
social and physical damage includes procedures, which are de-
veloped and standardized for public health and medical sys-
tems.
2. Appropriate capacity assessment systems are in place with
trained personnel, and public health and physical resources to
facilitate recovery.
3. Disaster recovery is managed by a formally designated body
with authority to coordinate recovery and remediation activi-
ties of government, NGOs, donors, and communities.
4. Income Generating Activities (IGA) are identified, well
established, and fully supported as part of all recovery plans for
health and medical systems. IGAs support the existing medi-
cal system.
5. IGAs are directed toward rebuilding local self-reliant and
subsistence economies.
DISCUSSION
The outputs of the 2004 and 2005 Pacific Health Summits for
Sustainable Disaster Risk Management provide a detailed de-
scription of current challenges and accomplishments of the Pa-
cific health ministries, and they establish a Pacific plan of ac-
tion based upon the principles of disaster risk management.
Although the conference is somewhat dated, there is a grow-
ing relevance and an urgency to disseminate this declaration
because it provides a unique precedent for implementation of
a locally derived, evidence-based approach for climate change
adaptation in the Pacific. In addition, sources for accessing the
Declaration are now lost because the local medical journal, Pa-
cific Health Dialog, has ceased publication.11 The declaration and
plan of action are unique in that they establish a strategy for
disaster risk reduction for an entire region; however, imple-
mentation has been slow. To date, only 1 of 16 proposed proj-
ects has been funded. Awareness of the declaration and its out-
puts needs to be improved, especially within the setting of climate
change. The declaration should be considered as a guide for de-
velopmental and humanitarian assistance in the region and as
a means for reducing the risk of adverse health effects caused
by climate change. The Pacific plan of action, if implemented,
would guide regional disaster risk management activities for
health during the next decade. As such, this plan was devel-
oped in the form of a regional declaration and a set of compre-
hensive project proposals that would implement the 10-year plan.
The Pacific as a Hazard-Prone Region
The risk for disasters occurs when vulnerable populations are
exposed to environmental hazards (eg, extreme weather events
associated with climate change). Pacific Islanders carry the high-
est environmental disaster burden of nearly any other region
in the world. Figures 1 to 3 illustrate that from 1990 to 2007,
Pacific Islanders led the world in the number of disasters per
capita.6,7 This high incidence of hazard exposure translates into
Climate Change Adaptation Among Pacific Island Nations
Disaster Medicine and Public Health Preparedness, Published online June 30, 2011 E7
©2011 American Medical Association. All rights reserved.
a high human and economic burden on Pacific societies. From
1990 to 2007, the disaster-related mortality rates in Oceania
were second only to Asia. During this period, the Democratic
People’s Republic of Korea (North Korea) experienced a cata-
strophic famine and more than 200 000 people died in the 2004
Indian Ocean earthquake and tsunami.6,7 Per capita disaster losses
resulting from environmental disasters in Oceania were sec-
ond only to the Americas, which experienced Hurricanes An-
drew, Mitch, Katrina, and Rita during this time frame.6,7
Global warming is predicted to have a significant negative im-
pact on the health of Pacific Islanders.12 Disasters, including
more severe and frequent droughts, typhoons, floods, land-
slides, wildfires, and crop failures, are expected to increase. The
United Nations predicts that American Samoa and the Fed-
erated States of Micronesia will be among the worst affected
areas in the world.12
Vulnerable Populations
Along with a relatively high burden of disaster hazards, Pacific
Islanders also experience a high degree of public health and medi-
cal vulnerability. The 1998 Institute of Medicine report Pa-
cific Partnerships for Health: Charting a Course for the 21st Cen-
tury identified serious deficiencies specific to the quality and
accessibility of health care, medical workforce training, avail-
ability, and health facility maintenance and management among
US-associated Pacific Island nations. These deficiencies have
not been rectified.13 Infants in the US-associated Republic of
the Marshall Islands have a mortality rate that is 5 times higher
than their US counterparts.13 The US-Associated Pacific Is-
lands comprise some of the most geographically isolated popu-
lations among all US states, territories, and tribes. Nearly all
of these islands are located several thousand miles from even
the closest university or schools of public health and medi-
cine. As an added challenge to effective aid, organizational and
technological solutions to environmental emergencies devel-
oped in industrialized nations are not practical for any small
island where human and technological resources are scarce and
expensive.
Lessening the Risk of Disaster
Many believe that measures directed toward the underlying mac-
rolevel causes of climate-change vulnerability should be inte-
grated into development policy, not into explicit adaptation
strategies that respond only to the consequences of climate
change.14 According to a United Nations report, “Climate
change adaptation needs to become part and parcel of com-
prehensive risk management.”9Risk management, as applied
to disasters, first seeks to assess disaster risk in terms of hazards,
vulnerability, and capacity.15 Once this assessment is com-
pleted, informed decisions can be made regarding how best to
manage the risk in a cost-effective manner. Risk may be pre-
vented, treated, transferred, or retained in a more sustainable
manner. Disaster reduction has emerged as a core element of
sustainable development.2Sustainable communities are “where
people and property are kept out of the way of natural hazards,
FIGURE 1
Number of environmental disasters per capita, by
world region (1990–2007).
Number, ×10–4
Africa OceaniaEuropeAsiaAmericas
4
2
6
8
10
0
12
Number of disasters per capita, 1990-2007
FIGURE 2
Environmental disaster mortality rate, by world region
(1990–2007).
Number, ×10–4
Africa OceaniaEuropeAsiaAmericas
1
0.5
1.5
2
3
2.5
3.5
0
4
Mortality rate due to environmental disasters, 1990-2007
FIGURE 3
Per capita losses resulting from environmental
disasters, by world region (1990–2007).
Number, ×10–4
Africa OceaniaEuropeAsiaAmericas
200
100
300
400
500
0
600
Per capita losses due to environmental disasters, 1990-2007 ($USD)
Climate Change Adaptation Among Pacific Island Nations
E8 Disaster Medicine and Public Health Preparedness, Published online June 30, 2011
©2011 American Medical Association. All rights reserved.
where the inherently mitigating qualities of natural environ-
mental systems are maintained, and where development is de-
signed to be resilient in the face of natural forces”16 As one work-
group put it, “Critically important for effective climate change
adaptation will be factors that directly shape the health of popu-
lations such as education, health care, public health preven-
tion, and infrastructure”17
CONCLUSIONS
The outputs of the 2004 and 2005 Pacific Health Summits for
Sustainable Disaster Risk Management provide a comprehen-
sive, consensus-based 10-year plan for disaster risk manage-
ment for health throughout the Pacific region. The Pacific dec-
laration provides a detailed evaluation of current challenges and
accomplishments in the Pacific with respect to disaster risk man-
agement. This indigenous plan of action should guide future
international developmental and humanitarian assistance as a
means of reducing the risk of human health effects caused by
climate change. The document may equally apply to similar at-
risk island nation-states in other regions of the world.
Author Affiliations: Ms Mahany is senior public health advisor for the Na-
tional Center for Environmental Health, Agency for Toxic Substances and
Disease Registry, Centers for Disease Control and Prevention, and Dr Keim is
senior science advisor.
Correspondence: Address correspondence and reprint requests to Mark Keim,
MD, National Center for Environmental Health, Centers for Disease Control
and Prevention, 4770 Buford Hwy, MS-F09, Atlanta, GA 30341-3724
(e-mail: mjk9@cdc.gov).
Published Online: June 30, 2011. doi:10.1001/dmp.2011.44
Received for publication September 3, 2009; accepted March 3, 2011.
Disclaimer: This material reflects solely the views of the authors. It does not
necessarily reflect the policies or recommendations of the Centers for Disease
Control and Prevention or the US Department of Health and Human Ser-
vices.
Hard copies of the Declaration of the Pacific Health Summit for Sustainable
Disaster Risk Management and project concept papers are available free of charge
by e-mail request to Mark Keim at mjk9@cdc.gov.
Author Disclosures: The authors report no conflicts of interest.
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