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Project Leader	Dr. Nancy D. LEWIS Director of Studies East-West Center 1601 East-West Center Road Honolulu, HI 96848-1601 USA Tel: +1-808-944-7245 Fax: +1-808-944-7399 Email: Lewisn@eastwestcenter.org Dr. Michael P. HAMNETT Director Social Science Research Institute Social Science Bldg. Suite 704 University of Hawaii 96822 USA Tel: +1-808-956-7469 Fax: +1-808-956-2884 Email: Hamnett@hawaii.edu
Funding	US $15,000
Participating countries	Cook Islands, Federated States of Micronesia, Fiji, United States

Introduction/Background
Researchers from the University of Hawaii organized the workshop to finalize plans for a research project aimed at increasing the capacity of Pacific Island Countries to address health problems resulting from climate variability and change. The workshop brought together researchers, meteorological service officials, and public health officials from the University of Hawaii, the Fiji School of Medicine and the Governments of the Cook Islands, Federated States of Micronesia (FSM) and Fiji as potential participants in the research effort proposed to the Office of Global Programs at the National Oceanic and Atmospheric Administration (NOAA). The project has since been approved for funding by NOAA/OGP (US $70,000). The workshop provided an opportunity to assess data availability and future data needs and to develop a common protocol for research in Cook Islands, Fiji, and FSM.  Because of funding limitations the work is being initiated in Fiji and the Cook Islands.

The larger research project is aimed at gaining a better understanding of the relationship between climate variability and health in Cook Islands and Fiji. These nations have been chosen because they have reasonably good climate and epidemiological data, which is available at the sub-national level. They also have climate regimes, and island geomorphologies and ecologies representative of much of the rest of the Pacific Island region.

The specific objectives of the larger research project are to (1) determine if the relationship between climate variability and the risks of vector-borne diseases (including dengue fever), diarrhoeal diseases, respiratory diseases, and other conditions can be clearly established at the local level in two Pacific Island Countries; (2) develop simple analytical tools for assessing the relationship in other countries; and (3) make recommendations to governments and regional organizations on the development of systems to make more effective use of climate forecast and applications information to reduce the public health risks posed by climate variability and change.

A by-product of the proposed project will be a better understanding of local-level climate variability.  This will include an understanding of the impact of ENSO events of varying strength on rainfall and temperature at the sub-national level and the impact of the Pacific Decadal Oscillation on ENSO events and local climate variability.  This understanding will be of value for climate applications in health and other sectors.

Outline of activities conducted
The workshop was held July 25-26, 2001 at the Fiji Meteorological Service in Nadi, Fiji.  A workshop agenda was shared with participants; participating governments and organizations in advance of the workshop and participants were asked to bring readily available climate and health data.

The organisers of the workshop reviewed their earlier NOAA funded regional project on climate variability (ENSO) and water-borne and vector-borne disease in the Pacific region and discussed the impact of the 1997-1998 El Nino on health in the Pacific Islands. The meteorological service officials from Cook Islands, Fiji, and FSM presented overviews of seasonal and inter-annual variability in climate in their countries. The health service officials added their observations on the influence of seasonal and inter-annual climate variability on the incidence of important diseases. In order to assure that all members of the interdisciplinary teams had a basic understanding of the processes involved, an overview on climate forecasting concluded the first day of the workshop. An important premise of the proposed project is the need for a clearer understanding of climate and disease dynamics for the application of forecast information in the health sector.

Workshop participants reviewed the goals, objectives and the scientific framework for the project proposed to NOAA OGP and agreed that they were appropriate and achievable.  Participants addressed a number of questions including the disease and climate data that needed to be compiled and analysed, the degree of temporal and spatial resolution, the retrospective time period to be covered, initial analyses to be conducted, the contextual data to be gathered and analysed, and policies on the use and sharing of data.  Agreement was reached on all of these issues and a workshop report has been produced and shared with all participants, participating governments and organizations.

Outcomes/Products
The initial product was the workshop and the refinement of the research protocol. An additional related outcome was the approval for funding by NOAA (US $70,000) to conduct the research in Fiji and the Cook Islands.

The diseases the participants identified for inclusion in the project are: dengue fever, diarrhoeal disease (0-4; 5 and over), leptospirosis, cholera, acute respiratory infection (ARI), influenza, fish poisoning (ciguatera), pneumonia, and filariasis.

The initial analysis will consist of spatial and temporal correlations of the meteorological station data with the health data for the available time periods for each of the two countries, with appropriate lead and lag relationships taken into account. A comparison will be made of the meteorological station data to the large-scale NCAR/NCEP Reanalysis Dataset to determine the accuracy of coarse resolution grid data as compared to station data, which is dependent on local-scale variations.  Composites of both meteorological and health data for ENSO events (El Nino and La Nina) will be made to give an initial determination of the association of disease with climate impacts resulting from ENSO.  Variations in ENSO strength (i.e. Nino 3 SST anomaly and SOI) between events will then be taken into account, and specific events

will be analysed in terms of the magnitudes of the climate variations and the subsequent health impacts.

The variability of strength and timing of warm and cold events (which has been termed the "flavours" of El Nino) can significantly affect the resulting climate impacts for the Pacific Island Countries. Some countries, such as Fiji, are located very near to the "zero-line" of temperature and precipitation changes associated with warm events.  Shifts in the magnitude and timing from normal of a particular ENSO index (i.e. the Nino 3 SST anomaly or SOI) during a warm event can greatly change the magnitude of, for instance, the austral winter drought in Fiji.  Building on compilations of data already in existence, e.g. He, Hilton, and Barnston's A Precipitation Climatology for Stations in the Tropical Pacific Ocean, an analysis of such shifts in the climate impacts is planned.  This will provide greater knowledge of the finer details of expected climate impacts resulting from a variation in the strength and timing of a particular warm (or cold) event. This will have utility beyond the health sector.

Once the spatial and statistical analyses are complete, the patterns will be analysed with respect to contextual data and our understanding of the vector ecologies and disease processes involved. Climate is only one of a myriad of factors potentially influencing the distribution of a given disease.  The feasibility of extending the research to other Pacific Island locations including the Federated States of Micronesia will be assessed. The Global Environment Fund (GEF) has indicated interest in this research. If the project in Fiji and the Cook Islands is successful, we will seek funds to expand the research. Recommendations will be made to island governments on the development of climate information and application systems to reduce health risks posed by climate variability and change. The NOAA OGP proposal included a request for funding for a region-wide dissemination workshop, but funding was secured for the research phase only. A proposal has been submitted to the APN for funding the dissemination workshop.

Future Directions/Follow-up work
We have initiated data analysis for Fiji and the Cook Islands, and baring unexpected circumstances, we expected to have an initial analysis complete by mid-year 2002. Assuming funding is secured from APN or other sources, we plan to hold a dissemination workshop in September 2002.