Since 2018, the Pacific RISA team has collaborated with the Marshall Islands Ministry of Health and Human Services, the US National Oceanic and Atmospheric Administration (NOAA), and the University of Hawai’i Sea Level Center on Pacific Islands climate change, health, and migration. The aim of the project was to improve climate information delivery to the health sector in the Republic of the Marshall Islands (RMI) and to inform health service providers in Hawai’i about migration, health, and climate change in the Pacific Islands region. This work is affiliated with the Pacific RISA’s Climate-Induced Migration projectand was funded by NOAA’s International Research and Applications Project.
As citizens of one of the lowest-lying nations in the world, residents of the RMI are experiencing changes that may affect the very habitability of their land. Storms and sea-level rise threaten island infrastructure such as homes, hospitals, roads, and essential health services. Drought and rising temperatures reduce freshwater supplies, while heavy rainfall increases the risk of floods and vector-borne diseases. Food supplies are reduced by ocean acidification, and increasing reliance on imported goods can exacerbate existing problems with diabetes and obesity.
The island of Majuro, as seen from United Airlines flight 154, the “Island Hopper”. Credit: MikeRTW
The health sector is particularly influenced by sub-seasonal and seasonal changes in temperature, rainfall, and extreme events, as well as longer-term impacts such as sea-level rise and ocean acidification. With a population spread across two million square kilometers, the Marshall Islands’ healthcare system may be unprepared to cope with these changes. Recent work by Pacific RISA found that 25–45 percent of households on three islands have experienced health-related impacts due to climate stress over the past five years (see below). As communities adapt, migration has also increased. More than three-quarters of Marshall Islanders now live in the urban centers of Majuro and Kwajalein. More than 25,000 Marshallese currently live in the US—an increase of 400 percent since 2000. About 10,000 Marshallese live in the state of Hawai’i, where many lack access to healthcare, are affected by unique diseases, require translation services, and may face discrimination within the system. As this population increases, so does the health sector’s need for information about them.
Percent of surveyed households affected by climate-related stressors in the last five years
The goals of this project were to:
Identify and provide climate information and services to the Marshall Islands health sector. This was achieved through interviews and a workshop involving healthcare professionals, administrators, and policy makers in the RMI based on the Pacific Islands Climate Services Dialogs.
Analyze survey data from the RMI (sending location) households and US (receiving location) households to extract the health indicators of migration.
Improve partnerships to adapt to climate impacts and protect against risks to human health and the effects of climate-induced migration.
Key Project Activities
Survey Data Analysis
Data from a Marshall Islands household survey were analyzed and two publications (see Resources, below) were produced on the findings. These publications summarized information from 199 households about their past migrations, health outcomes, and expectations to migrate in the future. Using hierarchical clustering analysis and logistic regression, we identified groups among those surveyed with significantly different profiles of vulnerability, health outcomes, and migration agency. In particular, we found that climate change and its impacts were not experienced evenly across the population, with differing associated health and migration outcomes. Furthermore, migration within and beyond the RMI may be related to a changing climate but is also a complex composite of many factors. Read the full report here. Publications associated with this project have informed the forthcoming Pacific Islands Regional Climate Assessment report for the RMI and Fifth National Climate Assessment, as well as the Marshall Islands National Adaptation Plan.
A conceptual framework of the nexus between climate change, health, and migration in Pacific Islands. From Krzesni and Brewington 2022.
Stakeholder Engagement and Training
One outcome of stakeholder engagement through this project was increased and improved use of climate information, such as seasonal forecasting tools and future projection assessment products. The University of Hawaiʻi Sea Level Center provided training on the use of their seasonal sea level forecasting product and collaborated on CMIP6-based climate assessments. These activities were requested by the RMI National Disaster Management Office and the National Weather Service, and were delivered at the virtual Pacific Islands Climate Change Forum in April 2022.
First National Climate Change and Health Dialogue for the Marshall Islands
On 30–31 January 2020, the First National Climate Change and Health Dialogue was held in Majuro, RMI. Organized by Pacific RISA staff and the RMI Ministry of Health and Human Services, the two-day meeting was held in collaboration with the RMI Office of Environment, Planning, Policy, and Coordination (which has since been renamed the Climate Change Directorate), the World Health Organization, and the US National Oceanic and Atmospheric Administration (NOAA). The dialogue was attended by RMI President-Elect David Kabua, outgoing President Hilda Heine, the Minister of Health and Human Services Bruce Bilimon, the Secretary of the Ministry of Health and Human Services Jack Neidenthal, the Chief Secretary of the Office of Environmental Planning and Policy Coordination Clarence Samuel, and representatives of other organizations, including the Ministry Of Natural Resources and Commerce, the Marshall Islands Red Cross Society, the Marshall Islands Marine Resources Authority, the RMI Ministry of Finance, the College of the Marshall Islands, the Marshall Islands Council of Non-Governmental Organizations, the International Organization for Migration, the RMI National Disaster Management Office, the Ministry of Culture and Internal Affairs, several high school classes, and other interested individuals. ReliefWeb’s press release on the dialogue can be found here.
This two-day meeting was based on the Climate Services Dialogues model. Created by the Pacific Regional Climate Services Director for NOAA (and East-West Center Adjunct Senior Fellow) Dr. John Marra, Climate Services Dialogues are a participant-driven group process designed to be appropriate for Pacific cultures. Dialogues solicit the relevant experiences and knowledge of meeting participants to create accessible, understandable “climate stories” meant to share key messages and best practices. Participants at the 1st National Climate Change and Health Dialogue shared their experiences related to climate and health, created common timelines of events, and discussed past successes and failures in small groups. The work conducted at these meetings, guided by Pacific RISA staff, was used to create the climate and health stories that are a key component of this project. Dialogue proceedings, presentations, and climate and health stories can be found under Resources.
Participants at RMI’s 1st national Climate Change and Health Dialogue, January 30-31, 2020 in Majuro, Marshall Islands
2020 Humanism, Empathy, Social Justice, and Global Health Symposium
On 14 February 2020, the East West Center co-sponsored the 2020 Humanism, Empathy, Social Justice, and Global Health Symposium, along with the University of Hawai‘i’s System Global Health and Social Justice Work Group, the University of Hawaii’s John A. Burns School of Medicine, Noguchi Medical Research, Inc., the Office of Public Health Studies, and Dr. Yoshihisa Asano. Held at the University of Hawaii’s John A. Burns School of Medicine, this year’s symposium focused on Pacific Islander health. Beginning with a networking event for professionals interested in global health and the Pacific Islands on the evening of 13 February, the symposium went on to include a full day of oral and poster presentations of research and projects from the region, culminating with a keynote address by Dr. Sheldon Riklon. The Medical Director for the Center on Pacific Island Health at the University of Arkansas for Medical Sciences Northwest and a University of Hawai’i alumni, Dr. Riklon is one of only two US-certified medical doctors from the Marshall Islands. In addition, the East-West Center’s Vice President and Director of Research, Ambassador Karena Lyons served as judge for the Best Poster Award, selecting Dr. Jennifer Chin’s “Urine Drug Screening on Labor and Delivery” as the winner from 12 participating posters.
Research Team
Laura Brewington, Research Fellow, Arizona State University, East-West Center John Marra, NOAA Regional Climate Services Director, Fellow, East-West Center Victoria Keener, Research Fellow, East-West Center Matthew Widlansky, Associate Director, University of Hawaii Sea Level Center
Resources
Final Project Report on the intersection of climate change, health, and migration in the RMI
Policy briefing on climate-induced migration and the Compact of Free Association: limitations and opportunities
Fact sheet on Marshallese perspectives about migration in the context of climate change
The Pacific Islands Climate Storybookcontaining “climate stories” outputs from climate services dialogs conducted by NOAA and the US Agency for International Development (USAID)
A resource booklet created by University of Hawaii School of Public Health containing information about the healthcare options available to Marshallese residents in Hawaii and their family members
Our Vision
Resilient and sustainable Pacific Island communities using climate information to manage risks and support practical decision-making about climate variability and change.
Climate, Health, and Migration
Since 2018, the Pacific RISA team has collaborated with the Marshall Islands Ministry of Health and Human Services, the US National Oceanic and Atmospheric Administration (NOAA), and the University of Hawai’i Sea Level Center on Pacific Islands climate change, health, and migration. The aim of the project was to improve climate information delivery to the health sector in the Republic of the Marshall Islands (RMI) and to inform health service providers in Hawai’i about migration, health, and climate change in the Pacific Islands region. This work is affiliated with the Pacific RISA’s Climate-Induced Migration project and was funded by NOAA’s International Research and Applications Project.
As citizens of one of the lowest-lying nations in the world, residents of the RMI are experiencing changes that may affect the very habitability of their land. Storms and sea-level rise threaten island infrastructure such as homes, hospitals, roads, and essential health services. Drought and rising temperatures reduce freshwater supplies, while heavy rainfall increases the risk of floods and vector-borne diseases. Food supplies are reduced by ocean acidification, and increasing reliance on imported goods can exacerbate existing problems with diabetes and obesity.
The health sector is particularly influenced by sub-seasonal and seasonal changes in temperature, rainfall, and extreme events, as well as longer-term impacts such as sea-level rise and ocean acidification. With a population spread across two million square kilometers, the Marshall Islands’ healthcare system may be unprepared to cope with these changes. Recent work by Pacific RISA found that 25–45 percent of households on three islands have experienced health-related impacts due to climate stress over the past five years (see below). As communities adapt, migration has also increased. More than three-quarters of Marshall Islanders now live in the urban centers of Majuro and Kwajalein. More than 25,000 Marshallese currently live in the US—an increase of 400 percent since 2000. About 10,000 Marshallese live in the state of Hawai’i, where many lack access to healthcare, are affected by unique diseases, require translation services, and may face discrimination within the system. As this population increases, so does the health sector’s need for information about them.
The goals of this project were to:
Key Project Activities
Survey Data Analysis
Data from a Marshall Islands household survey were analyzed and two publications (see Resources, below) were produced on the findings. These publications summarized information from 199 households about their past migrations, health outcomes, and expectations to migrate in the future. Using hierarchical clustering analysis and logistic regression, we identified groups among those surveyed with significantly different profiles of vulnerability, health outcomes, and migration agency. In particular, we found that climate change and its impacts were not experienced evenly across the population, with differing associated health and migration outcomes. Furthermore, migration within and beyond the RMI may be related to a changing climate but is also a complex composite of many factors. Read the full report here. Publications associated with this project have informed the forthcoming Pacific Islands Regional Climate Assessment report for the RMI and Fifth National Climate Assessment, as well as the Marshall Islands National Adaptation Plan.
Stakeholder Engagement and Training
One outcome of stakeholder engagement through this project was increased and improved use of climate information, such as seasonal forecasting tools and future projection assessment products. The University of Hawaiʻi Sea Level Center provided training on the use of their seasonal sea level forecasting product and collaborated on CMIP6-based climate assessments. These activities were requested by the RMI National Disaster Management Office and the National Weather Service, and were delivered at the virtual Pacific Islands Climate Change Forum in April 2022.
First National Climate Change and Health Dialogue for the Marshall Islands
On 30–31 January 2020, the First National Climate Change and Health Dialogue was held in Majuro, RMI. Organized by Pacific RISA staff and the RMI Ministry of Health and Human Services, the two-day meeting was held in collaboration with the RMI Office of Environment, Planning, Policy, and Coordination (which has since been renamed the Climate Change Directorate), the World Health Organization, and the US National Oceanic and Atmospheric Administration (NOAA). The dialogue was attended by RMI President-Elect David Kabua, outgoing President Hilda Heine, the Minister of Health and Human Services Bruce Bilimon, the Secretary of the Ministry of Health and Human Services Jack Neidenthal, the Chief Secretary of the Office of Environmental Planning and Policy Coordination Clarence Samuel, and representatives of other organizations, including the Ministry Of Natural Resources and Commerce, the Marshall Islands Red Cross Society, the Marshall Islands Marine Resources Authority, the RMI Ministry of Finance, the College of the Marshall Islands, the Marshall Islands Council of Non-Governmental Organizations, the International Organization for Migration, the RMI National Disaster Management Office, the Ministry of Culture and Internal Affairs, several high school classes, and other interested individuals. ReliefWeb’s press release on the dialogue can be found here.
This two-day meeting was based on the Climate Services Dialogues model. Created by the Pacific Regional Climate Services Director for NOAA (and East-West Center Adjunct Senior Fellow) Dr. John Marra, Climate Services Dialogues are a participant-driven group process designed to be appropriate for Pacific cultures. Dialogues solicit the relevant experiences and knowledge of meeting participants to create accessible, understandable “climate stories” meant to share key messages and best practices. Participants at the 1st National Climate Change and Health Dialogue shared their experiences related to climate and health, created common timelines of events, and discussed past successes and failures in small groups. The work conducted at these meetings, guided by Pacific RISA staff, was used to create the climate and health stories that are a key component of this project. Dialogue proceedings, presentations, and climate and health stories can be found under Resources.
2020 Humanism, Empathy, Social Justice, and Global Health Symposium
On 14 February 2020, the East West Center co-sponsored the 2020 Humanism, Empathy, Social Justice, and Global Health Symposium, along with the University of Hawai‘i’s System Global Health and Social Justice Work Group, the University of Hawaii’s John A. Burns School of Medicine, Noguchi Medical Research, Inc., the Office of Public Health Studies, and Dr. Yoshihisa Asano. Held at the University of Hawaii’s John A. Burns School of Medicine, this year’s symposium focused on Pacific Islander health. Beginning with a networking event for professionals interested in global health and the Pacific Islands on the evening of 13 February, the symposium went on to include a full day of oral and poster presentations of research and projects from the region, culminating with a keynote address by Dr. Sheldon Riklon. The Medical Director for the Center on Pacific Island Health at the University of Arkansas for Medical Sciences Northwest and a University of Hawai’i alumni, Dr. Riklon is one of only two US-certified medical doctors from the Marshall Islands. In addition, the East-West Center’s Vice President and Director of Research, Ambassador Karena Lyons served as judge for the Best Poster Award, selecting Dr. Jennifer Chin’s “Urine Drug Screening on Labor and Delivery” as the winner from 12 participating posters.
Research Team
Laura Brewington, Research Fellow, Arizona State University, East-West Center
John Marra, NOAA Regional Climate Services Director, Fellow, East-West Center
Victoria Keener, Research Fellow, East-West Center
Matthew Widlansky, Associate Director, University of Hawaii Sea Level Center
Resources
Final Project Report on the intersection of climate change, health, and migration in the RMI
Publication in Climate Action on the intersection of climate change, health, and migration in the RMI
Publication in AsiaPacific Issues on climate change, health, and migration in the Pacific, with examples from RMI
Official proceedings of the First National Climate Change and Health Dialogue held in January 2020
Climate Stories on water-borne and vector-borne disease in the RMI
Presentations from the First National Climate Change and Health Dialogue
Case study report and companion publication in the journal Climatic Change on Marshallese migration and the role of climate change and ecosystem services
Policy briefing on climate-induced migration and the Compact of Free Association: limitations and opportunities
Fact sheet on Marshallese perspectives about migration in the context of climate change
The Pacific Islands Climate Storybook containing “climate stories” outputs from climate services dialogs conducted by NOAA and the US Agency for International Development (USAID)
COVID-19 resources published in a variety of Pacific Island and Asian languages, available from the State of Hawaii Department of Health Website
A resource booklet created by University of Hawaii School of Public Health containing information about the healthcare options available to Marshallese residents in Hawaii and their family members
Our Vision
Resilient and sustainable Pacific Island communities using climate information to manage risks and support practical decision-making about climate variability and change.
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