The reality is that in the future, the Tuvaluan community is likely to be fragmented among many different countries.
Immigration to New Zealand presents several health problems that are exacerbated by social disparities. In interviews the first author conducted with community members in June and July , Tuvaluan immigrants reported that due to the high cost of food, their diet changed from mostly fish to one of significantly more chicken and rice, few fruits and vegetables though slightly more than in Tuvalu due to increased availability , and many more processed and fast foods. In addition, they stated that portion sizes in New Zealand are larger than in Tuvalu, possibly due to the more ready availability and better taste of food.
This dietary change is not unique to Tuvaluan immigrants and, as a result, Pacific Islander immigrants have a significantly higher prevalence of obesity and diabetes compared to New Zealanders overall [11, 12]. Walking was common on the islands; in New Zealand, Tuvaluans reported that they must drive everywhere and that with the exception of periodic sports events organized by the community, their level of physical activity is low.
These concerns are magnified by the fact that many immigrants find themselves unqualified for work outside of farms, leading to precarious month-to-month incomes as laborers .
Accessibility of health care also differs in the two countries. In Tuvalu, health care is provided free to patients either at small clinics on the outer islands or at the one hospital on Funafuti, the main island.
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However, throughout Tuvalu, medical facilities function as urgent care clinics, and there is no significant primary care presence. Similarly, in New Zealand, Tuvaluans with permanent residence interviewed by the first author reported generally only seeking health care when a problem arises. Unlike in Tuvalu, however, in New Zealand there is a need for an appointment and a copay to see primary care physicians for both residents and nonresidents. Therefore, many Tuvaluan immigrants reported either delaying care until illness sequelae become worse or presenting to emergency rooms for free care.
The end result of social disparities in diet, health care access, health literacy, and employment opportunities is significant health inequalities. Among other differences, Pacific Islanders have a roughly five-year shorter life expectancy compared to New Zealanders overall . A good example is a recent campaign by New Zealand Pacific clinics—primary care clinics that specifically serve Pacific Islanders—to raise awareness about the danger of rheumatic fever . Through the use of consistent, translated, and culturally appropriate messaging, a number of the Tuvaluans and clinicians interviewed by the first author reported that this campaign had changed how many Pacific Islanders viewed not only rheumatic fever but also the role of primary care more generally in promoting wellness.
If accessible, the health care Tuvaluans receive in New Zealand is superior to that in Tuvalu, making not only primary care but also early detection and treatment for serious conditions like cancer and chronic kidney disease finally possible. Moving to New Zealand provides benefits for Tuvaluans besides improved health education and superior health care quality.
If they are able to leave their homeland in a planned manner, they can optimize preservation of their economic, social, and cultural assets. Given the limited employment opportunities in Tuvalu, many Tuvaluans who immigrate are able to find work for the first time in their lives, even if those jobs are primarily on farms.
In addition, Tuvaluan culture in Auckland is robust, with community gatherings occurring near daily. The problem with Tuvalu, as with any other community faced with climate change relocation, is that it is a disaster in slow motion. The insidious nature of the effects of climate change makes it possible for life to persist on the islands for a long time before it suddenly becomes inhospitable, requiring emergent evacuation.
Although many who choose to remain in Tuvalu do so out of pride in their land and culture, some do so because they lack the money to pay for immigration or lack awareness of the fact that the sea will overtake the island. While individuals have the right to remain in their homeland if they wish, optimally this decision should be well informed regarding the risks and benefits of staying. Many Tuvaluan immigrants to New Zealand who came using a visa program known as the Pacific Access Category Scheme reported in interviews with the first author that they received no information or aid from the government about immigration options.
Some even described loved ones whose applications were denied due to misinformation or errors on the part of the government. One interviewed immigrant who was formerly a Tuvalu government employee described the Tuvalu government as quelling concerns over and education about climate change out of a fear that a mass exodus would trigger a decrease in international aid, a major source of government revenue . What, then, is the role of physicians and the international community in mitigating knowledge and opportunity gaps?
Since the majority of Tuvaluans currently remain in Tuvalu, the focus of physicians both in Tuvalu and abroad must be on the health risks facing the island population as climate change worsens.
In particular, Tuvaluan medical practitioners can play a crucial role in educating those in Tuvalu who are less aware of the effects of climate change about the risks and benefits of staying in the country as the seas rise. These education and advocacy efforts might place physicians in the role of mediator between the government and those who might wish to leave Tuvalu. By assuming this role, physicians can help bridge these opposing sides and help foster the self-determination of the Tuvaluan people, allowing them to decide for themselves their future course as a nation.
Effective international interventions will depend on an intimate knowledge of Tuvaluan culture, language, and norms. Tuvaluans are proud of their heritage and culture, and any perceived unwanted intrusion into their close community by foreigners would only be met with apathy.
Ethical issues surrounding climate change relocation are complex and varied. Physicians can play many roles, including mediation between Tuvaluans and policymakers and addressing health disparities resulting from relocation. Fulfilling such roles will require physicians to become educated about the health risks of climate change and associated relocation.
Tuvaluans are only one of many communities who will be displaced by the effects of climate change. Understanding the culture and history of such communities and the socioeconomic challenges of immigration will be crucial in bettering the lives of those who will bear the greatest burden of climate change.
As physicians grapple with the social and health concerns of these new populations, the case of Tuvaluan immigration provides lessons regarding adapting care delivery to different levels of health literacy and health-seeking behaviors, modifying messaging to be culturally and linguistically appropriate, and expressing structural competency in caring for populations facing climate change-induced immigration and social and health disparities in a new country.
When future Tuvaluan migrants arrive in New Zealand, some will experience journeys similar to that of Vaioleta.
Tuvalu Archives - Pacific Women Shaping Pacific Development
As she visited the now abandoned and dilapidated farm where she spent the first two years of her life in Auckland, she reflected that, overall, the move to New Zealand had been positive for her. She is now 24 years old, has studied social work at the university, and works at a local health clinic that serves Pacific Islanders in Auckland.
She is married and is involved in her Tuvaluan church youth group in Auckland. She is Tuvaluan to the core, even identifying herself first as Tuvaluan, despite growing up most of her life in New Zealand and speaking with a New Zealand accent. Although nostalgia for their former island life is palpable, very few regret moving, but all do worry about those still at home who have not yet left. Physicians are tasked with helping to ensure that the health of Tuvaluans and the community of Tuvalu outlasts the islands themselves.
Tuvalu Central Statistics Division. Population—census and surveys: summary of population indicators Tuvalu census Accessed November 1, Stas NZ New Zealand. Estimated resident population ERP , subnational population by ethnic group, age, and sex, at 30 June , , , and Stats NZ New Zealand. Accessed September 20, Central Intelligence Agency. Everyone has talents and abilities to contribute to the development of our nation.
The launch also featured members of the Fusi Alofa Association performing humorous skits that focused on the topics of accessibility and people with disabilities having families. As a testament to inclusion, the study engaged people with disabilities as fieldworkers and research assistants. Following the completion of the study last year, Mr Uatea shared that while mobility was an initial challenge, there were no barriers between him and the work of the research:. I guess that my personal disability helped me a lot to win the trust of other people with disabilities.
Members of the Fusi Alofa Association at the report launch.
Photo credit: Pacific Women Support Unit. It was also emphasised that women also carry the majority of the burden as caregivers:. There are no activities in the past that I know of which targeted women with disabilities.
I think the study will guide Fusi Alofa to do more for women with disabilities. Gender and disability should be a focus in the future and we could do more activities. The Gender Affairs Department have also used the study to inform the integration of disability into their work. The findings are also providing the basis of recommendations to enhance social protection for the wider community. The Government of Tuvalu has used the study to develop the first policy on disability as well as the first national policy on hardship:.
The study team was led by short-term technical adviser Helen Tavola. With the study completed, the government will use the report and the recommendations to guide policy development and initiatives that support the improvement of the lives of people with disability, including providing financial support to Fusi Alofa Association.
'Sinking' Pacific nation is getting bigger: study
Efforts are underway to find culturally sensitive ways to work with schools, communities and pregnant girls to ensure these girls do not miss out on the opportunity for an education. In a small island state like Tuvalu, there are limited learning opportunities.
The information package was delivered as part of a public awareness campaign by education officers on eight islands. Representatives from the Gender Affairs Department were invited to present at an Education Department Planning workshop, on gender cross-cutting issues and social inclusion. Ms Makhoul also assisted with the development of human rights guidelines to be adopted as school rules.
The Education Department is now leading this project and is also working on drafting a child protection policy and bill. The common Tuvaluan response to pregnant schoolgirls is to question how the community can accept pregnant girls going back to school if this is not acceptable under culture and tradition. Ms Makhoul responds to these concerns as follows:.
However, there are some cases where cultural norms can have negative impacts on individuals.