A public health perspective on climate change and small island developing states: the Caribbean region
The Caribbean Public Health Agency is mandated to support its member states in strengthening national health systems and coordinating regional responses to public health threats, inclusive of the impacts of climate change on health. Caribbean small island developing states are prone to natural disasters, such as hurricanes, flooding and earthquakes. Of the 26 members supported by CARPHA, 23 qualify as SIDS. The United Nations Office for Disaster Risk Reduction indicates that the Latin American and Caribbean region is the second most disaster-prone region globally. Climate change is the main driver behind the increasing severity of hydrometeorological events, as seen by the number of Category 4 and 5 storms experienced by the region over the past five years, as well as longer, more intense drought periods. The impacts from such storms include loss of lives and livelihoods, decreased human resources, heavy damage to infrastructure, reduced ability to provide public services and increasing incidence of disease. Other impacts of climate change involve reduced food security through changes in arable land available for agriculture, rising sea levels, oceanic acidification and saltwater intrusion into water reservoirs.
An October 2019 Intergovernmental Panel on Climate Change report acknowledged that the targets set in the Paris Agreement and countries’ nationally determined contributions are not sufficiently ambitious, and will not bring significant reductions in climate change impacts, particularly on the marine environment. Global temperature rises beyond a warming limit of 1.5°C is estimated to destroy up to 99% of tropical coral reefs, and current projections by the World Meteorological Organization predict that this limit could be temporarily exceeded as early as 2026.
Increasingly extreme events
There are two main pathways through which Caribbean populations and health systems remain highly vulnerable to the impacts of climate change. The first is mediated through natural systems and overall ecosystem change; the other is linked to human activities, such as migration.
In the first pathway, shifting weather patterns and extreme climate events, such as hurricanes, droughts, floods, heat waves and Saharan dust incursions result in adverse health outcomes. Those outcomes include increased transmission of vector-borne diseases, such as dengue, chikungunya and Zika virus; a higher incidence of respiratory disease, as well as water- and food-borne disease (from contamination of safe water supplies), and heat-induced conditions such as heat stress and heatstroke, which can trigger cardiovascular conditions. Natural disasters such as hurricanes result in injuries, fatalities and mental health impacts that have long-lasting implications for regional healthcare systems. As the Caribbean archipelago lies on the Atlantic Hurricane Belt, it is faced annually by the threat of high intensity storms causing widespread damage. In 2024, the National Oceanic and Atmospheric Administration predicted an above-normal hurricane season with 17–25 named storms. Hurricane Beryl, which severely affected the islands of the Grenadines, was the earliest Category 5 storm on record to hit the Atlantic basin. The devastation to these islands was significant, with more than 98% loss of infrastructure recorded on Carriacou.
In the second pathway, climate-driven human migration and population displacement can lead to loss of livelihood, heightened poverty levels, reduced work capacities and productivity. Taken together, these effects limit progress towards attainment of the Sustainable Development Goals by the Caribbean SIDS.
Hence, climate adaptation and mitigation strategies across a range of sectors are essential to ensuring the future resilience of the region. To support this effort, SIDS have long called for greater advocacy, supporting partnerships, evidence building, predictable and sustained access to low-cost, long-term financing and climate justice.
Adaptation and mitigation
In assessing the vulnerabilities of Caribbean health systems to the onslaught of climate change and linking to the selection of appropriate resilience, adaptation and mitigation measures, the generation and implementation of health national adaptation plans are key. Such plans outline infrastructural investment and strategic actions that can protect health and build climate-resilient health systems. Inherent in this is the anticipation and transformation of public health to adapt to a changing climate, to protect populations and manage health risks. One key measure currently being explored in the Caribbean is strengthening surveillance systems through integrated surveillance. Other adaptation efforts have involved the development of climate-integrated food and water resiliency plans. This initiative between CARPHA, the Pan American Health Organization and Caribbean states looks at securing a safe and secure supply of food and water, and considers the expected climate changes over a 30-year period.
Climate-integrated early warning systems for health
In recent years, work on developing health early warning systems in the Caribbean has focused on four CARPHA members deemed ready to accept these interventions. However, this work is not being conducted in isolation. Under donor-funded projects, CARPHA in collaboration with partners can holistically approach the strengthening of climate-resilient health systems in the Caribbean. The WMO has established the Caribbean Institute for Meteorology and Hydrology, which works with CARPHA on early warning systems and impact-based forecasting process, and is also responsible for hosting the semi-annual Caribbean Climate Outlook Forum, which provides key weather information to sectoral stakeholders including health, agriculture, tourism, water and disaster risk management, to aid work programming.
National climate-resilient food and water safety plans
Between 2022 and 2024, CARPHA and PAHO have been working with Barbados and Trinidad and Tobago to develop national food and water safety plans. These efforts have been multisectoral and involved stakeholders from health, agriculture, environment, meteorological services, works and infrastructure, national security, finance, gender and child affairs, as well as certain non-governmental organisations. Selected high-priority catchment areas in each country were examined in terms of food production and consumption, water usage, supply chains, infrastructure and other factors. The next step will be ministerial and financial review, as well as the establishment of national oversight committees to monitor progress post implementation. CARPHA and PAHO will likely continue to provide technical support during the aforementioned period. CARPHA has already secured funding to develop climate-resilient waste safety plans for two additional Caribbean states.
Health national adaptation plans and infrastructure greening
PAHO in conjunction with the Caribbean Community Climate Change Centre has been leading the process for developing health national adaptation plans, which is a critical strategy for assessing country readiness levels and proposing key strategic actions and financial planning required to sustain measures for strengthening health systems. In terms of infrastructural investment, PAHO has also been leading the smart hospital initiative through financing from the United Kingdom’s Foreign, Commonwealth and Development Office.
Progress on efforts to mitigate the effects of climate and build regional resilience has been challenging. The environmental and health impacts of climate change are still being explored. In some cases, there is not yet a clear causal relationship between the changes and the attributed health impacts. This uncertainty makes decision-making difficult. Political leaders may not have good evidence to aid advisers in giving clear guidance. The diversity in the region’s geography, geology and demography means countries have different needs and priorities. These competing priorities of communicable diseases, trade, tourism and education, among others, means the financial resources available at the country level can be scarce.
If well studied and well understood, the impacts of climate change, the utilisation of appropriate adaptation and mitigation measures, and the lessons learnt in the Caribbean region will point to better strategies for other island and non-island communities and countries. There is a strong need to integrate health considerations into climate policy for promoting public health and equity. Increased funding will ensure the region does not lose the small gains that have been made, and can amplify them into greater gains in the coming years. Furthermore, a holistic approach that recognises the interconnectedness of human, animal and environmental health will be crucial in safeguarding health for current and future generations.
Note: This article has been edited due to space constraints. The full-length version is available here.
