The challenges stemming from climate change are multifaceted. Climate change has numerous (in)direct implications, especially for the effective enjoyment of human rights such as the right to life, the right to the highest attainable standard of health, and related obligations concerning access to safe drinking water and sanitation. While these are all global implications, certain vulnerable segments of the population are impacted most acutely by climate change. Accordingly, this article aims to focus on populations living in the Pacific Island Countries (PICs), which is a region facing existential challenges – such as the palpable possibilities of complete evacuation, dispersed resettlement, and cultural annihilation. Additionally, rising sea levels signify that low-lying island nations such as Kiribati, the Marshall Islands and Tuvalu may become uninhabitable. Although these 57 PICs differ greatly in terms of traditions, culture, geography, or socio-economic circumstances, they all share certain development challenges, including smallness, remoteness, and proneness to natural disasters.
Focusing on the PICs, this article addresses the impact of climate change on the right to (physical) health of the population. This is due to the imminent and prevalent impact on health, as for instance, it has been estimated that by the 2030s, approximately 250,000 additional deaths will occur every year from malnutrition, malaria, diarrhea and heat stress directly attributable to climate change. Although this is a general global impact on health, it is assumed that these impacts will be experienced more acutely in the PICs, due to their relatively small land area, geographical isolation, proximity to the ocean, high population density and dependence on local ecosystems for subsistence.
The first section of this article delves into the adverse (physical) health impacts on the population located in the PICs. Accordingly, the second section examines adaptation strategies for such imminent negative impacts, with a primary focus on strategies tailored towards reducing the impact on the right to health.
Adverse Health Impacts in the Pacific Islands
A well-known, expansive definition of health includes “complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The Constitution of the World Health Organization (WHO) has established the “highest attainable standard of health” as a “fundamental right.” Gradually, this notion has been further incorporated into various human rights instruments on the regional and international levels, including the Universal Declaration of Human Rights (UDHR; 1948), the International Covenant on Economic, Social and Cultural Rights (ICESCR; 1966), the United Nations Framework Convention on Climate Change (UNFCCC; 1992), the preamble of the Paris Agreement, and The Committee on Rights of the Child.
For the purposes of this article, it is important to consider the precise manner(s) in which climate change is impacting the right to health of individuals residing in PICs. Undernutrition is a big issue in parts of Melanesia and other remote islands, as well as continual malaria and dengue fever outbreaks. Frequent occurrences of natural disasters also cause serious injuries and loss of life, especially due to diarrhoea and other water borne diseases such as cholera in numerous islands within the region. A study found that in the Pacific Islands between 1986 and 1994, there was a positive association between the average annual temperatures and the rate of diarrhoea. These effects were especially prevalent in low-lying atolls such as Tokelau, Tuvalu, and Kiribati which have the highest annual average temperatures, the lowest water availability, and the highest rates of diarrhoea disease. In Fiji, the impacts of tropical storms and floods were investigated in terms of their association with climate-sensitive infectious diseases, and a strong relationship was found between extreme weather events and outbreaks of dengue fever and diarrhoea disease.
Additionally, PICs are highly vulnerable to ciguatera poisoning, a tropical and subtropical disease which is not widely understood, and is under-appreciated as a cause of acute health issues in the island community. Ciguatera fish poisoning occurs after consuming contaminated coral reef fish, and includes reported symptoms ranging from acute neurologic, gastrointestinal, and cardiac symptoms, with some even experiencing chronic neurologic symptoms lasting several months. The prevalence of ciguatera poisoning in the South Pacific increases starkly whereby average sea surface temperatures are at least between 28 to 29 degrees Celsius. Rising sea surface temperatures which are associated with global warming are believed to be exacerbating the extent, severity and range of ciguatera.
Water-borne and other diseases are becoming increasingly common in PICs due to rising sea levels and other effects of climate change. In relation to internationally recognized instruments on the right to health, Article 12 of the Covenant is severely violated due to these impacts of climate change in PICs. The drafting history and phrasing of article 12(2) acknowledges the right to health incorporating a wide range of socio-economic factors contributing to a healthy life, such as adequate nutrition, access to safe and potable water and sanitation, and a healthy environment. Accordingly, in order to cope with such adverse impacts and changes, adequate adaptation strategies are of necessity. These forms of adaptation to climate change in PICs will be explored in the forthcoming section.
Climate change adaptation refers to adjustments in ecological, social, and economic systems as a response towards actual or expected climatic stimuli and impacts. Adaptation is important in order for the dangerousness of climate change to be modified by various forms of adaptation, and it is also considered an important policy strategy for responding to climate change.
Until now, three main obstacles have been identified in traditional environmental adaptation; namely a lack of awareness among key community decision makers, inadequacy of traditional decision-making methods for addressing the complexity of climate-driven environmental changes, and short-term peripheral views of resource management and sustainability shared by community decision makers. These obstacles have further exacerbated the impacts of climate-driven environmental changes in the PICs. The adaptation measures which are to be given prioritized attention include improving security of food and water resources, developing early warning systems for climate disasters, improving sanitary facilities, and ensuring that health considerations are fully incorporated into adaptation activities across several sectors.
The main adaptation strategy to climate change is the formation of a climate-resilient health system, which is “a health system that is capable to anticipate, respond to, cope with, recover from and adapt to climate-related shocks and stress, so as to bring sustained improvements in population health, despite an unstable climate”. Resilience building adopts a logical approach by focusing on the system-wide capacities required to address climate-specific health risks. This system will be specifically applicable to climate-related health risks in PICs, by way of strengthening capacities adequately to manage a range of health risks, from disease outbreaks to health emergencies; and also empowering communities to play a role in assessment and responses to climate-induced health issues. In order for the climate resilient health system to be an efficient protection of the health of the population in PICs, a holistic governmental approach is to be followed in conjunction with varying sectors of water and sanitation, energy, food and agriculture, environment, transport, education and urban planning. Accordingly, only by way of accurate collaboration and coordination between these health and non-health sectors will climate-resilient health systems excel towards their aims of climate adaptation.
For the adoption of a climate-resilient health system, the Ministry of Health in these PICs should take the lead in adopting the health-in-all policies approach. Nevertheless, it must be kept in mind that each country in this region is different in terms of vulnerabilities and adaptation strategies, so they should individually take timely and effective measures to protect and promote the health and well-being of the community members. Lastly, the courts have time and again taken the matters into their own hands to tackle environmental problems.
It is vital to acknowledge the inequalities involved within the PICs in relation to vulnerabilities and adaptation to climate change. The PICs have made minimal contributions to the exacerbation of anthropogenic climate change, yet they are amongst the harshest sufferers of its consequences. Accordingly, the fairest strategy to mitigate and adapt to the existing effects of climate change on health in this populations would be for industrialized countries to have a clear responsibility in providing the necessary support to developing countries to rebuild their coping strategies. At the same time, traditional adaptation strategies should still be reformed in line with growing complexities of climate-related health issues in the PICs.
This article delved into the adverse (physical) health impacts on the population located in the PICs, and examined adaptation strategies for these negative impacts, with a primary focus on strategies tailored towards reducing the impact on the right to health. It was found that varying water-borne diseases such as diarrhoea and ciguatera are becoming increasingly common in PICs due to rising sea levels and other effects of climate change, violating several international human rights law instruments focusing on the right to health. Subsequently, appropriate adaptation strategies are of necessity to cope with such adverse impacts and changes. Out of these adaptation strategies, building a climate-resilient health system was the most suited, as long as this strategy is then further tailored in accordance with the vulnerabilities and communities of various PICs. Therefore, future research on the topic should focus on these strategies tailored towards differing countries in the region.
 United Nations Human Rights Council Resolution 10/4: Human Rights and Climate Change. 25 March 2009. Retrieved from http://ap.ohchr.org/documents/E/HRC/resolutions/A_HRC_RES_10_4.pdf
 Trevelyan Wing, ‘Submerging Paradise: Climate Change in the Pacific Islands’ (2017) The Climate Institute, 1.
 Carola Betzold, ‘Adapting to climate change in small island developing states’ (2015) 133 Climatic Change 481, 482.
 World Health Organization (2014), ‘Quantitative risk assessment of the effects of climate change on selected causes of death, 2030s and 2050s.’
 Rokho Kim, Anthony Costello & Diarmid Campbell-Lendrum, ‘Climate change and health in Pacific island states’ (2015) 93 Bull World Health Organ 819.
 Constitution of the World Health Organization (Preamble), Entered into force 7 April 1948.
 Universal Declaration of Human Rights (adopted 10 December 1948 UNGA Res 217 A(III)) (UDHR) art 25.
 International Covenant on Economic, Social and Cultural Rights (Adopted by General Assembly resolution 2200A (XXI) of 16 December 1966; Entry into force 3 January 1976) art 12.
 United Nations Framework Convention on Climate Change (1992) art 4(1)(f).  The Committee on the Rights of the Child, General Comment No. 15 (2013) The Right of the Child to the enjoyment of the highest Attainable Standard of Health (Art. 24).
 Jon Barnett, ‘Dangerous climate change in the Pacific Islands: food production and food security’ (2011) 11 Regional Environmental Change S229, S235.
 Reena B.K. Singh et al., ‘The Influence of Climate Variation and Change on Diarrheal Disease in the Pacific Islands’ (2001) 109 Economic Health Perspectives 155, 156.
 World Health Organization, ‘Human Health and Climate Change in the Pacific Island Countries’ (2015) p. 28
 Lehane L, Lewis RJ, ‘Ciguatera: recent advances but the risk remains’ (2000) 61 Int J Food Microb, 91–125.
 Mark P. Skinner et al., ‘Ciguatera Fish Poisoning in the Pacific Islands (1998 to 2008)’ (2011) 12 PLoS Negl Trop Dis, e1416.
 Llewellyn L, ‘Revisiting the association between sea surface temperature and the epidemiology of fish poisoning in the South Pacific’ (2010) 56 Toxicon, 691–697.
 Chateau-Degat ML et al., ‘Prevalence of chronic symptoms of ciguatera disease in French Polynesian adults’ (2007) 77 Am J Trop Med Hyg, 842–846.  Office of the High Commissioner on Human Rights, CESCR General Comment No. 14: The Right to the Highest Attainable Standard of Health (Art. 12) para. 4.  Barry Smit et al., ‘An Anatomy of Adaptation to Climate Change and Variability’ (2000) 45 Climatic Change 223.
 Ibid, 223-224.
 Patrick D. Nunn et al., ‘Beyond the core: community governance for climate-change adaptation in peripheral parts of Pacific Island Countries’ (2014) 14 Regional Environmental Change 221.
 World Health Organization (n 16) p. 45.
 Ibid, p. 44.
 Ibid, p. 128.