Executive Summary
Executive Summary
This case study looks at how anthropogenic environmental change and human behavior at numerous scales increases the risk of typhoid fever and the transmission of other waterborne diseases on the Pacific island nation of Fiji. This includes industrial activities such as upstream deforestation and cattle-farming, poor sanitation standards in riverside villages, and poor household practices around water, sanitation, and hygiene. The setting for this case study is rural communities on a small island nation, a setting where people are particularly dependent on healthy river catchments for their water, food, and livelihood needs.
Further, customary land tenure and vanua (the ways in which people identify with the land and sea) are deeply important in Fijian culture. Erosion of these customary rights can have a negative effect on natural resource management and subsequently increase the spread of disease.
In addition to better acknowledging customary rights, reducing disease transmission requires interventions at household, village, river basin, and national levels, and the involvement of community members and policymakers alike. To that end, the Watershed Interventions for Systems Health project, led by a multidisciplinary team of academic researchers, NGO staff, and government officials, is one example of ongoing work to improve and restore river catchment health in Fiji.
Introduction
Introduction
Waisea Naisilisili is talking about the value of the natural world when he comes across part of it about to be destroyed. It's an October afternoon, and Naisilisili is driving a large black pick-up truck down from the highlands of Viti Levu, Fiji's largest island. Fiji is an archipelago of more than three hundred thirty-two islands in the middle of the Pacific Ocean.
He slows the truck to inspect the land-clearing happening near the riverbank-one man, maybe two, with chainsaws in hand. "This is my family's customary land, and these guys are clearing it," he explains, snapping photos of the scene. "They bought the lease and now this guy is doing big-scale farming." Naisilisili sits back in the driver's seat, shaking his head.
Naisilisili is a Fisheries and Operations Support Officer with the Fiji branch of the Wildlife Conservation Society. Before he was interrupted by the scene at hand, he was describing his love of nature and this land that he and generations of his family have called home: "To me, nature is identity, and to protect nature simply means you're protecting yourself," he shares matter-of-factly. He refers to the significance of totems-the trees, animals, and birds that ground iTaukei (Indigenous Fijians) in their connection to the Earth.
"Our traditional belief is that the totems signify who we are and where we are from. They're very sacred," Naisilisili explains. This Indigenous wisdom isn't exclusive to his village or clan alone. Oral narratives across Fiji speak of how observations of plant and animal behavior have been used to predict an oncoming cyclone or tsunami, and offer methods of coping with these risks. This knowledge is important for both the advice it offers and the cultural identity it supports. Naisilisili's grandmother was a custodian of this knowledge, and his family's connection to nature is a message Naisilisili is now passing to his own children. He and his family live in Nabukavasi, a small village located along a river of the same name.
The relationship between planetary and human well-being is nothing new to the iTaukei. A connectedness with the Earth is what has historically influenced the way in which clans manage and respect their natural resources-though those beliefs are now being tested by increased connection to the outside world, loss of community self-sufficiency, and the pressures of economic development.
Those development stressors involve a range of human activities: gravel extraction, mining, and what Naisilisili witnessed today: deforestation to prepare land for agriculture and cattle farming. These challenges are compounded at a global scale by climate change and an increase in storm severity and frequency, and at a local scale by the growing population of riverside communities with inadequate access to water, sanitation, and hygiene. These changes are more than an affront to Naisilisili's customary land-research in Fiji has confirmed that these various scales of environmental change and behaviors can lead to freshwater contamination. As a result, villages like Nabukavesi are increasingly affected by infectious disease transmission, especially typhoid. This is where one of Naisilisili's colleagues comes into the picture. Dr. Aaron Jenkins has spent the past several years researching the effects of anthropogenic activities on river ecosystems and human health. A fisheries ecologist by training, Jenkins was frustrated by what he found when he first came to Fiji in nineteen ninety-six: sediment and nutrients from upstream activities, manure, sewage, and trash flowing into river basins. This human-produced waste wreaked environmental havoc along the coast and disturbed coral reefs and other marine ecosystems. "That's when I knew I better start working upstream so I could understand the connection between what was happening on the reef and what was going on in the river," explains Jenkins.
That run-amuck waste was having human health implications in villages like Nabukavesi where Waisea Naisilisili lives with his family. The river is an integral part of these rural, often remote communities, and people depend on it as an essential source of water for household consumption. "Reading the newspapers, I'd notice a particular area had been quarantined because of a massive typhoid outbreak and I'd think 'wow, the outbreak is next to this really degraded river catchment where there were no fish and the water quality was crap," Jenkins recalls.
While the transmission and prevalence of typhoid fever and other water-borne diseases had been well-researched and documented in other parts of the world, there was still a question mark around the local risk factors affecting people living in isolated Pacific island countries like Fiji. Not only that, but it was still unclear how anthropogenic changes could further impact those risk factors.
Today, a team called Watershed Interventions for Systems Health is investigating that relationship between the intersection of environmental change and human health-and is attempting to mitigate the negative health outcomes for riverside villages and the river catchments on which they depend.
The Republic of Fiji is one tiny piece in the Pacific puzzle that makes up the region of Oceania. Sometimes referred to as the Blue Pacific continent, the region is home to more than a dozen island nations, the likes of which appear miniscule and isolated when looking at a map of the world. Oceania lies in both northern and southern hemispheres, and covers an area of eight point five million square kilometers. Exclude Australia, New Zealand, and Papua New Guinea, and you have an ocean area greater than that of continental United States, with the landmass of small islands composing an area roughly the size of Cuba.
Fiji and other Pacific island nations are often considered a microcosm for the world. Their isolation, vulnerability to climate change, and size mean the feedback loops that exist between anthropogenic actions and human health are more rapidly apparent than those interactions on continental ecosystems. "Tinker with one part of an island system and almost immediately people downstream are having muddy water and getting more diarrhea. I think this is what makes small island systems an important place to do planetary health research," says Aaron Jenkins.
Oceania includes groupings of low islands-coral atolls like the countries of Kiribati and Tuvalu which sit barely above sea level- to what's known as high islands. High islands are characterized by steep slopes and rolling hills, a testament to their volcanic origin.
The Pacific high islands are unique beyond their geographic immensity: their size lends itself to better water resources. Surface water comes from freshwater rivers and lakes, and groundwater spurts from aquifers in highland and coastal areas. These water sources are also replenished by generous precipitation. The increased water availability in high islands means soil is more fertile than that of low islands, and is better suited for supporting human settlements, agriculture, and mineral extraction.
The verdant green folds of Fiji's highlands are a stark contrast to the turquoise waters that offer a more quintessentially tropical scene. Fijian islands vary in size, from the largest of Viti Levu where the capital city of Suva is located, to more than five hundred islets-the name for landmasses that are no more than rock or coral protruding from the ocean. Even Viti Levu is just one hundred forty-six kilometers from east to west, and a medium-sized propeller plane will get you from the country's main international airport in Nadi to the capital city in a prompt thirty minutes. Press your forehead to the window and you'll see water systems snaking their way to the coast, the geometrics of agricultural plots, overgrown logging roads and, as you land into Suva, the river delta where the muddy, brackish waters of the Rewa River belch into the Pacific Ocean. The obvious interconnectedness between interior and coastal ecosystems observed from the air becomes out-of-sight, out-of-mind as you enter the city.
Fiji's population is becoming increasingly urban. Located on opposite coasts of Viti Levu, Nadi and Suva are the country's major urban centers. Consistent with global trends, national census data from twenty seventeen indicate that fifty-five point nine percent of Fiji's population of eight hundred eighty-four thousand eight hundred eighty-seven live in urban areas, up nearly ten percent from two decades earlier. The country is ethnically diverse, with iTaukei (Indigenous Fijians) making up fifty-six point eight percent of the population, and Indo-Fijians composing another third.
Those who don't live in coastal cities often dwell in rural river catchment areas in island interiors. That includes in Central Division, a region in the southeastern part of Viti Levu. Central Division is the most populous of the country's four divisions, and is home to forty-two percent of the country's population. Here, most people live along two river corridors: the Suva-Nausori corridor near the capital city, and along the Navua River corridor that runs through various subcatchments on its path from the highlands to the coast. Those two river corridors are part of the twenty-six river subcatchments that split Central Division into a quilt-work of informal boundaries.
These twenty-six subcatchments are the focal point of planetary health research in Fiji. Aaron Jenkins says he believes these smaller sections of river catchments are the ideal place to look not only at the public health effects of upstream land-use change, but also the environmental and socio-economic determinants of health at community and household levels. Influenced by these many factors, Jenkins is not alone in his assessment that river catchments-and the water that runs through them-are the most appropriate place to promote community resilience and prevent the spread of disease.
The health vulnerabilities of downstream communities are significant. Central Division residents have been exposed to typhoid fever, with two hundred seventy-nine cases reported between twenty fourteen and twenty seventeen. Of these cases, rural highland villages had the highest incidence rate of disease and nearly as many cases of typhoid fever as urban and peri-urban areas, despite having a significantly smaller population.
A young girl stands in the doorway of her home in Nabukavesi on Viti Levu. Nabukavesi is just one of many rural communities that relies on its local river when the reservoir in the village runs dry. It's also one of the villages that has faced rising typhoid outbreaks in recent years.