Another problem with shrinking land is the threat to agriculture. Most i-Kiribati are subsistence farmers, especially on the outer islands, but this has been declining in recent years.
Fishing has also been affected. With impact from overpopulation and climate to reef fisheries, coastal fisheries will soon not be able to meet food needs. Overall Kiribati is estimated to need 50 per cent more food by 2030 to sustain the growing domestic demand.
Food insecurity is not only due to extreme weather; lifestyles are changing. Many young people no longer produce and prepare food in traditional ways, but prefer the convenience of imported foods.
Fresh produce is not widely accessible. A pumpkin can cost AU$30, and a watermelon AU$50 - well out of reach for most people, considering minimum wages are around AU$1.60 per hour. It is not surprising then, that almost all i-Kiribati people miss out on the recommended servings of fruit and veg.
A move away from traditional diets of fish, babai (swamp taro), breadfruit and coconuts (with pork for special celebrations/party time) has implications for people’s health. The majority of people now eat white rice as a staple with the addition of imported sugary drinks, as well as canned and processed foods.
It’s estimated that 38 per cent of men and 54 per cent of women are obese, while among children under age five, 25 per cent are underweight. Of the risk factors for NCDs, 70 per cent or adults 18-69 have three or more.
The climate crisis is a health crisis
Human health is dependent on the health and sustainability of the environment. Nowhere is this more evident than for people living within the constraints of an island.
“Here you see the collision of planetary health and non-communicable diseases (NCDs) that is unseen anywhere else,” says Dr Lachlan McIver, MSF tropical diseases and planetary health advisor. McIver calls small island states the ‘canaries in the coalmine of climate change’.
Seventy-five percent of deaths in the Pacific region are due to NCDs, and NCDs are now recognised as the leading cause of health problems in Kiribati.
The rates of diabetes in Kiribati are high and increasing: among women aged 45-69, more than 44 per cent have diabetes.
In addition to a poor-quality diet, hypertension, lack of exercise and smoking contribute to these high rates of disease.
“Diabetes in pregnant women is of particular concern as the condition can be high risk for mums and babies, who require access to secondary (specialist) care for management during labour, delivery, and after birth,” says MSF’s project medical referent in Kiribati, midwife Sandra Sedlmaier-Ouattara.