358: The Health Emergency Hiding in Rising Seas

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Ofa Kaisamy (guest, Commonwealth Blue Charter Advisor): Thank you so much for that question. And it's a personal question to me because I grew up in Tonga, I have lived experience. In the context of this work on the impacts of sea-level rise on health, as Sandro has mentioned, I think it's something that we, it's happening, but the awareness needs to be escalated. And the best awareness is the lived experience, and talking about it and sharing about it. In the Pacific, in my community, I've seen the direct physical health risk of sea-level rise. There's injuries and deaths from flooding. We've lived through category 5 cyclones, storm surges. We live through increased exposure to extreme weather events. And also, we've seen the physical damage to our health infrastructure in the Pacific. The saltwater intrusion is something that is really normal in the Pacific. That also leads to diarrhea diseases, to skin infections, to stangy and malaria, and of course poor hygiene conditions. In the context of other impacts, food insecurity and more nutrition as well, there's loss of cost of agriculture and fisheries. Our coral reef and ecosystem are damaged, which means our food supply is going to be reduced, or has already been reduced. There's also impacts on the entire food chain and food security of the Pacific communities.

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Christiana Figueres: What? Walk me through that, Ofa. Walk me through that.

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Ofa Kaisamy (guest, Commonwealth Blue Charter Advisor): So, you know, we rely very much on tourism and agriculture. The food insecurity, when there's loss of agriculture and fisheries, then that means our food supply is reduced, because most of the Pacific communities are backbone for family livelihoods, is actually from agriculture and fisheries. And so when they are greatly impacted, you can then see the impacts first hand of that in the livelihoods of our families.

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Christiana Figueres: So saltwater intrusion means farming and agriculture and food production is directly impacted.

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Ofa Kaisamy (guest, Commonwealth Blue Charter Advisor): But by sea-level rise, but also there's another context that I wanted just to point out here is the mental health impacts of the impacts of sea-level rise. And when we say mental impacts, in my perspective, we're talking about displacement, moving people from their land towards further inland or moving them, relocating them to a place where they're more secure, but also they're not too exposed to the impacts of sea-level rise. So the loss of land and identity, I would say, actually is a direct impact on the mental well-being of my community. Particularly speaking for the Pacific, where the culture is land, is our identity. So when we have to relocate, because of the impacts of sea-level rise, also has a lot of impacts on the mental well-being of the communities as well. The other thing that I wanted to talk about is the cultural loss and the impacts on the social cohesion and well-being of the communities as well, because the land is actually ancestral in our communities.

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Christiana Figueres: Thank you so much. And Anne, I would love to invite you to go further into it. What does it mean when there is loss of place, loss of areas, regions that have been occupied and lived in for hundreds and thousands of years by ancestors? Could you paint that picture for us and perhaps even through a specific example?

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Anne Poelina (guest): Yeah. Look, I think one of the things globally that a lot of people don't realize, is that in Australia, indigenous Australians are living in fourth-world conditions, and so they're highly reliant on living on the land, that hybrid economy to sustain their life, their living, their life ways, and their livelihood. We are the ones who have contributed least to what we see now globally as climate chaos, climate wars, climate uncertainty, and what we're saying is that we really need to look at this conversation around, everything is about relationship, everything is about place-based relationship with the land, with the water, with everything, because we also, as indigenous people in Australia, we have a saying, everything is alive. So the sacred places, they're living, they're living systems. We talk about water as a living water system, because it holds memory, it builds memory. So all of those things in terms of just watching what's happening on countries, as I said, people who are heavily reliant on that hybrid economy, our seasonal calendars are all out of whack. We create seasonal calendars that says when a flower is dropping, we know the crocodile eggs are hatching, but all of that is out of whack. And so trying to, you know, care for your family, care for your community, go out, go out and hunt and gather and supply those resources. They're not there. So in a way, there is also this impact that as a contributor to that community, if you're not gathering that food, if you're not gathering that medicine, you're letting your people down. And so your families and your communities are really reliant on that hybrid economy. I think one of the things about places that we see the land and the waters and our non-human kin as living systems. And so when they are in stress, we are in distress. Some of the work that we've been looking at is how can we work with indigenous wisdom to look at biocultural indicators to show us not just how country is changing, but to feel how the land and the living waters are changing. When we go to a living water body, are there birds singing in the trees? What is the wind telling us? How is the wind blowing? What are the flowers showing? Does the land feel lonely? And so these sorts of concepts that we have had from the beginning of time in terms of relationship, respect, seeing non-human kin as family. And so when they're distressed, we're distressed. We have an amazing fish that starts off in the river that goes out to sea that is 21 feet. But when the times are changing, that creature, the sawfish, goes into hibernation. So all of these things impact, they're interrelated. Everything is interconnected. Everything is intrinsically entwined. We need to see this as a whole system, a living system. And that's really what's impacting on a lot of people, particularly on women, because we are the ones that mainly go out and harvest things. And then, you know, with the other complicatedness of, you know, I live in the Kimberley and this place is really showing that the Kimberley will be the most impacted in this country besides the Torres Strait Island people in regards to sea level rise. We are in a place where the sea and the atmosphere creates the heat engine of this country. So everything starts here and then goes back. And, you know, we talked about sea level rise, saltwater intrusion. So along the coast, many of the indigenous people rely on living water systems. They're all now being filled with saltwater intrusion. And so that balance is all out of whack. It's all out of harmony. And so it changes everything in terms of, you know, even going out from the river to the sea and harvesting from the sea. We need to walk a lot further. So we're exposing ourselves to huge saltwater crocodiles that we've got to watch. And it just sounds like a bit of a, we can laugh about it, but these are predators that are out there. So you're competing with the environment. You've got to watch around you what's coming, both from the sea and from off the land. And yeah, everything's hungry, but in the wrong way.

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Christiana Figueres: Everything's hungry, but in the wrong way. And could you illustrate what you've just told us with the story of this 21-foot fish? How is that out of whack?

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Anne Poelina (guest): Yeah, well, what happens is that the living water systems, like our river is an ephemeral river. It flows in the wet season when the cyclones comes and builds up the river to flood, but then it recedes. And so within that receding, it naturally forms what we call billabongs or small pockets along the river that sustain life while we're waiting for the next flood. And then what happens is we have these big creatures that are born into the sea, the saltwater, the saltfish. You know, just the just the soil is about sometimes six feet long. So who could believe that a river can produce a creature that grows to 21 feet out to sea? But what we are finding and what we know is that when these creatures understand that the systems in stress, they go into stress and they don't reproduce, they don't propagate. And so you've got a whole supply that is not coming around in the next season. And so, you know, it's really interesting to watch the observation. I mean, that's how we've lived on this world for so long and in balance and harmony. Everything is observational. Everything is when we taught as a young kid to look up in the sky and look down in the ground, to be observational and look peripheral. So we are reading the signs from a very young age. And even the little people are really even just someone who's been alive six, seven years, is saying, how come this is happening? Why is that going on that way? And so to be able to, you know, soothe the spirit and talk to the young people and say, you know, in a way, man has done this. And we're hoping that man can also come up with the solutions. But it is all about observation. It is all about context. It's all about the fact that this is really impacting on the most vulnerable, particularly relying on that hybrid economy to sustain their life. We create everything from the land, the weapons, the tools, the medicines, all of that. I mean, we've got plants here that one plant has got 30 times the property of morphine. It's a natural antibiotic. It's an antiseptic. It's all of these things. And yet, because the seasonal calendars are out, because the environment's changing, our medicine supply as well for very vulnerable populations is also changing. So it's totally unbalanced and at a rhythm. And so, you know, trying to soothe the elders, because a lot of them are thinking, oh, where are we going to die? We're going to pass away because we're old, but what are we leaving our young people? What is the hope for the intergenerational equity? How will our young people learn the ceremonies, the songs, how to read the land, and how to feel the land if those knowledge systems are unbroken?

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Christiana Figueres: Wow, thank you. Thank you, Anne. Sandro, I would love to invite you to pick up from where Anne has taken us into health, because it seems to me that Anne has put out two things. And Ofa, they have both said it is impacting our health conditions now, our food, our housing, our fresh water supplies. But also, the other piece about health here is cutting off traditional health medicines that have been available to these cultures for hundreds and thousands of years and that may no longer be available to them. So, could you talk to us about this health crisis? And how do you see that it is raising its ugly head? And especially, how can we address this?

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Dr. Sandro Demaio (guest, WHO Asia Pacific Center for Environment and Health): Yeah, we were certainly seeing the health impacts unfold in countries all across our region and it's across all parts of the life course. And it's the mental and it's the physical health. For example, sea-level rise on its own, saltwater intrusion. You know, we're seeing fresh water infrastructure, things like wells being poisoned with salt in many coastal communities across the region. So it becomes an urgent issue of access to fresh water because as the sea levels rise even slightly, it inundates the fresh water supply, the wells that have been there for decades. And suddenly access to fresh water becomes an issue. Saltwater going into our coastal agriculture, putting salt into our food supply, and whether it's in our water or in our food itself has profound impacts. It impacts on the risks of the unborn child in a pregnant mother. It impacts on cardiovascular disease through blood pressure. And we're seeing this occurring actually showing up in pregnant women, as well as in adults and young people in Mekong countries, in Pacific countries, in archipelago countries all across the region. But we're also seeing that salt is simply killing crops directly. You know, salt is toxic to most of our agriculture. So even small increases, 5, 10, 15 centimeters, it doesn't sound like much, but coastal community crops then get inundated at king tides or high tides, killing crops, increasing food insecurity, which in turn makes them more reliant on food imports, ultra-processed foods. And so you get this cascade effect of food and water insecurity, chronic disease. In the Philippines and Vanuatu, in many countries, we're seeing flooding become more and more common, more and more severe. Diseases like leptospirosis, dengue, and diarrheal diseases spread in those floodwaters, floodwaters that are made worse by rising sea levels. And at the same time, we know that about 60 percent of health systems in the Pacific are within 500 meters of the coastline. Now it makes sense that we would build our hospitals and our clinics, our maternal child health services on the coastline because the ocean is...

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Christiana Figueres: That's how you get there.

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Dr. Sandro Demaio (guest, WHO Asia Pacific Center for Environment and Health): That's how you get there. The ocean is the freeway. It's the way. It's the road. It's the path. But as sea levels rise, we're now seeing entire hospitals needing to be relocated, putting countries into debt, but also risking health services. There are countries that are having to literally raise the floor level of their hospitals as an interim adaptation measure. Communities being completely relocated, causing loss of place, mental health, cultural and social issues. The challenges are far reaching and much more indirect, Christiana, than I think I ever realized even as a doctor and working in public health. Salt enters our food system and ends up influencing the next generation through pregnant women. It cuts off fresh water and leads to children turning to other drinks, like more sugary drinks and ultra-processed foods, because fresh foods become more expensive. Crops get killed, fresh water gets salinated, and infectious diseases spread into new areas, areas that are not prepared, health systems that are not prepared, all while health systems are becoming increasingly under threat, under strain, and even underwater.

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Christiana Figueres: Wow. Thank you, Sandro. That was very, very clear of the impacts. A question to all three of you, because we sadly have to bring this to a close. I'm not going to ask you what should governments do, because the answer is pretty simple. Governments should be responsible, especially those governments of countries that are the highest emitting. That's absolutely clear. I'm going to ask you a more difficult question. What would you like our listeners to understand differently, now that we've had this conversation, from before the conversation? What mental window would you like to open up in our listeners through the conversation that we've just had? Ofa, would you like to take a first stab at that?

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Ofa Kaisamy (guest, Commonwealth Blue Charter Advisor): Thank you, Christiana. Very difficult question.

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Christiana Figueres: Yes, I'm sorry. But you three are brilliant. And so we have the luxury of asking you that question.

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Ofa Kaisamy (guest, Commonwealth Blue Charter Advisor): I think for me would be, this is not a climate crisis only. This is a health crisis. The direct impacts we've been listening to, we've lived it. I don't know what more evidence is there for us to actually declare that this is an emergency. This is a health emergency. This is a health crisis, our time. I mean, as Anne mentioned, we brought about all these impacts. I'm sure there are solutions out there from youth, from students, from women, from up to our government, at all layers of where we are, I think we can make an influence. They say leadership is influence, nothing more and nothing less. And I think we all have that influence in our different spheres, whether we are working in different sectors. But I think the impacts is crosscutting. Health is crosscutting. And so I think we need to make decisions, good decisions, in the interests of our communities, in the interests of our well-being, in the interests of the generations that are coming up. And so I think when we understand that this is a health crisis, not just a climate crisis, we then can influence where we are being brought to actually influence, whether it's government, whether it's NGOs, whether it's the private sector, whether it's the youth, whether it's church, in the Pacific, church is a powerful platform. And I think if you can influence in that sphere as well, I think that we can then see the change in this context of building the resilience in our communities.

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Christiana Figueres: Thank you, thank you, Ofa. And what would you add to that?

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Anne Poelina (guest): Yeah, I kind of like the idea that we are in a point in time where we are recognizing that this is man-made. Human beings have caused this. And when I look at this, I think of the root cause, and I kind of go back to something that is really creating the problem, which is the politics of economics. So I think, you know, we need to come to this, that it is a wicked problem. We need to have collective wisdom. We need science, but we also need the legal scholars to look at how can we respond to our system, why do we always need to go from thesis to topos, from talking to punishment, why can't we as good and decent human beings come up with the remedies and say, really, where can we, where are we going and where can we step back? I'm really, you know, showcasing where I live as we should be an incentive zone for the new economies, global geo-parks, biosphere reserves, culture conservation economy, bioprospecting, we should be seen as an incentive zone, not a sacrifice zone. Absolutely. And so these are the things that are occurring where we're trading off lives for profit. And I think somehow, you know, I've just finished a paper called How to Teach an Ethics to Care, not an Ethics of Care, but to care. And I think that's some of the things that we're saying as Indigenous people, First Nations people, Pacifica, is that, you know, we have got so much to share with the world in terms of our knowledge, our wisdom, the celebration of our lives, how we can help you to be fully human and do all the wonderful things and reach your full potential. And so part of this is what we call Wake Up the Snake. How do you wake up the consciousness of the people to bring the people with you, so that then we can say that collectively we can continue to dream and believe that our young people can have a future and that intergenerational equity is not some mystic phenomena, that we should be having that as an ethics of care, to care for young people not born yet. So, you know, just trying to bring in that indigenous wisdom, that ancient learning to say that we are here, we have knowledge, we have lived with the environment from the beginning of time. Our science is based on this place-based knowledge and wisdom. And we just want to share it because we see ourselves as coming from a world of we and not me, and this is not about individualism, this is about humanity and planetary health and the opportunity to give Mother Earth a climate chance.

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Christiana Figueres: Fantastic. Thank you, Anne. Well, Sandro, I'm almost feeling sorry for you because these two ladies-

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Dr. Sandro Demaio (guest, WHO Asia Pacific Center for Environment and Health): I'm sorry, I'm doing this myself.

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Christiana Figueres: These two ladies have made it a very hard act to follow.

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Dr. Sandro Demaio (guest, WHO Asia Pacific Center for Environment and Health): Thank goodness for editing.

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Christiana Figueres: Yeah. But what would you add to that, Sandro?

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Dr. Sandro Demaio (guest, WHO Asia Pacific Center for Environment and Health): Look, fundamentally, I think the message is that Sea-Level Rise is reshaping the very foundations of health for our region and for our planet. And we expect that up to 410 million people could and probably will live below high tide levels by 2100. This is happening now. It's accelerating. It's unequal. But how we respond is not beyond our control. I'm a big believer that what gets measured gets done. And that's why we've got the best scientists, 26 of the best scientists, the United Nations Agency for Health, at the request of Pacific Island ministers and countries and communities to really try to answer this question and bring momentum and a spotlight and accountability. But I really invite your listeners, Christiana, to get involved. We're just starting this journey and we're wanting to really build this out as a bigger, very ambitious piece of work that truly transforms the way we see this issue, the way we respond and the health and lives of communities across the planet. So if listeners are interested in joining, in supporting, in collaborating, we would love to hear from them.

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Christiana Figueres: Thank you to all three of you. Thank you so much for taking us down roads that are so critical and that we usually are quite blind to. I look forward to continuing to support the work of the Lancet Commission and of all of you commissioners. Thank you so much.

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Tom Rivett-Carnac: Christiana, what amazing conversations and such important topics and reframing of this incredibly consequential issue. I'd love to just ask you what you left those discussions with.

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Christiana Figueres: Well, honestly, hugely impacted, Tom, because of the injustice of this. All of these people, they are not responsible for climate at all. They're not responsible for any of the increase, for the original greenhouse gas emissions or certainly not for the increase. And so, it's just, it honestly just breaks my heart to hear how they are every single day facing worse and worse conditions. The fact that Pacific health infrastructure is already having to be moved. The fact that many of these homes are already, they're already built on stilts. And even so, they're having to be moved further inland. The fact, and they didn't speak about this, Tom, but I know of so many villages in the Pacific who have had to migrate, leaving the cemeteries where they are. Do you know what it is for people who have this very, very deep legacy and ancestral tradition to leave the bones of their ancestors behind? I mean, it's almost like cutting off your two hands. This is just incredibly painful, incredibly painful. And Anne calls this that they're living in fourth world conditions. I had never heard the term fourth world conditions, but I totally understand it. Totally understand when she says these are fourth world conditions.

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Tom Rivett-Carnac: Yeah. I mean, the justice element, as you say, Christiana, is just heartbreaking. And as we talked about last week on the podcast, this comes at a moment when there is just less and less support being provided by the international community in terms of finance and other means that would enable them to be able to, as far as possible, given some of this stuff is just baked in, respond to it. I'd like to ask you, how do we frame this conversation now, do you think? What did you leave with to ensure that people realize the long-term health consequences of this? It hasn't really until now been labelled a health crisis, but it clearly is. How can we help that really sink in with general populations around the world?

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Christiana Figueres: Well, I think what this is helpful is to move away from what I would call the strictly scientific abstract language of centimeters, future projections, temperatures, because all of that is true and we should never forget it, but it makes it sound like a technical challenge, something that engineers and planners have to grapple with. But that's not so. Rising seas are actually about damaging bodies, minds, livelihoods, cultures. Sea-level rise is a health crisis today, and the mix of physical, financial, emotional, cultural, and spiritual harm that these people are exposed to is just heartbreaking. So what I'm hoping that this report is going to do is to take the discussion on rising emissions, rising temperatures, rising sea levels, out of the technical impersonality and make it really human. What is the human impact of this? It's about safety. It's about dignity. It's about continuity. It's about belonging. It's about identity, memory, kinship, past and future. Those are things that are not quantifiable. You can't measure them in centimeters or degrees. But honestly, it is what is at the very basis of who we are as humans. It is at the basis of our common humanity. So I'm really hoping that this is going to be a... There never is a silver bullet for sure. But I'm hoping that this is going to be an important contribution to humanizing what we're seeing with climate change.

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Tom Rivett-Carnac: Yeah. Christiana, that's such a wonderful point. Because that's actually the thing we struggle with, right? We often find that we're somewhat dehumanized by this process. So you ending in that way is more than appropriate. Thank you. This has been an amazing episode. And yeah, what we can do, we'll have to try to do. So thank you, Christiana. This has been great. Thank you, everybody. We'll see you next week. Bye.