16.4.5 Human settlements and well-being
The concentration of large settlements along with economic and social activities at or near the coast is a well-documented feature of small islands. On Pacific and Indian Ocean atolls, villages are located on low and narrow islands, and in the Caribbean more than half of the population live within 1.5 km of the shoreline. In many regions of small islands, such as along the north coast of Jamaica and along the west and south coasts of Barbados, continuous corridors of development now occupy practically all of the prime coastal lands. Fishing villages, government buildings and important facilities such as hospitals are frequently located close to the shore. Moreover, population growth and internal migration of people are putting additional pressure on coastal settlements, utilities and resources, and creating problems in areas such as pollution, waste disposal and housing. Changes in sea level, and any changes in the magnitude and frequency of storm events, are likely to have serious consequences for these land uses. On the other hand, rural and inland settlements and communities are more likely to be adversely affected by negative impacts on agriculture, given that they are often dependent upon crop production for many of their nutritional requirements.
An important consideration in relation to settlements is housing. In many parts of the Pacific, traditional housing styles, techniques and materials were resistant to damage and/or could be repaired quickly. Moves away from traditional housing have increased vulnerability to thermal stress, slowed housing reconstruction after storms and flooding, and in some countries increased the use of air-conditioning. As a result, human well-being in several major settlements on islands in the Pacific and Indian Oceans has changed over the past two or three decades, and there is growing concern over the possibility that global climate change and sea-level rise are likely to impact human health and well-being, mostly in adverse ways (Hay et al., 2003).
Many small island states currently suffer severe health burdens from climate-sensitive diseases, including morbidity and mortality from extreme weather events, certain vector-borne diseases, and food- and water-borne diseases (Ebi et al., 2006). Tropical cyclones, storm surges, flooding, and drought have both short- and long-term effects on human health, including drowning, injuries, increased disease transmission, decreases in agricultural productivity, and an increased incidence of common mental disorders (Hajat et al., 2003). Because the impacts are complex and far-reaching, the true health burden is rarely appreciated. For example, threats to health posed by extreme weather events in the Caribbean include insect- and rodent-borne diseases, such as dengue, leptospirosis, malaria and yellow fever; water-borne diseases, including schistosomiasis, cryptosporidium and cholera; food-borne diseases, including diarrhoeal diseases, food poisoning, salmonellosis and typhoid; respiratory diseases, including asthma, bronchitis and respiratory allergies and infections; and malnutrition resulting from disturbances in food production or distribution (WHO, 2003a).
Many small island states lie in tropical or sub-tropical zones with weather conducive to the transmission of diseases such as malaria, dengue, filariasis, schistosomiasis, and food- and water-borne diseases. The rates of many of these diseases are increasing in small island states for a number of reasons, including poor public health practices, inadequate infrastructure, poor waste management practices, increasing global travel and changing climatic conditions (WHO, 2003a). In the Caribbean, the incidence of dengue fever increases during the warm years of ENSO cycles (Rawlins et al., 2005). Because the greatest risk of dengue transmission is during annual wet seasons, vector control programs need to target these periods to reduce disease burdens. The incidence of diarrhoeal diseases is associated with annual average temperature (Singh et al., 2001) and negatively associated with water availability in the Pacific (Singh et al., 2001). Therefore, increasing temperatures and decreasing water availability due to climate change may increase burdens of diarrhoeal and other infectious diseases in some small island states.
Outbreaks of climate-sensitive diseases can be costly in terms of lives and economic impacts. An outbreak of dengue fever in Fiji coincided with the 1997/1998 El Niño; out of a population of approximately 856,000 people, 24,000 were affected, with 13 deaths (World Bank, 2000). The epidemic cost US$3 million to 6 million. Neighbouring islands were also affected.
Ciguatera fish poisoning is common in marine waters, particularly reef waters. Multiple factors contribute to outbreaks of ciguatera poisoning, including pollution and reef degradation. Warmer sea surface temperatures during El Niño events have been associated with ciguatera outbreaks in the Pacific (Hales et al., 1999).