Several measures can be taken to better design human environments to cope with potential health stresses resulting from climate change. These measures include:

• Air conditioning and other measures to reduce exposure to heat
  
• Limiting exposure to disease vectors by measures such as use of screens on doors and windows and restriction of vector habitats (especially near waterways and urban wetlands)
  
• Land-use planning to minimize ecological factors that increase vulnerability to potential climate changes, such as deforestation, which increases runoff and the risk of flood-related injury and contamination of water supplies; animal stock pressures on water catchments; and settlement of marginal or hazardous areas such as semi-tropical coastal areas that are prone to storms and close to good vector breeding sites.

Woodward et al. (1998) have argued that the effects of climate change on health will be most severe in populations that already are marginal. For these populations, climate change and sea-level rise impacts will be one more cause for "overload." In general, indigenous people in Australia and New Zealand are vulnerable to the effects of climate change because they tend to be excluded from mainstream economic activity and modern technological education and experience higher levels of poverty, lower rates of employment, and higher rates of incarceration than the overall population. These factors have widespread and long-term impacts on health (Braaf, 1999).

For example, Northern Territory health data for 1992-1994 show that the mortality rate for indigenous people was 3.5-4 times greater than that for nonindigenous people. Life expectation at birth was 14-20 years lower for indigenous Australians than for nonindigenous Australians (Anderson et al., 1996). The indigenous population displays diseases and health problems that are typical of developed and developing nations. This includes high rates of circulatory diseases, obesity, and diabetes, as well as diarrheal diseases and meningococcal infections. High rates of chronic and infectious diseases affect individual and community well-being and reduce resilience to new health risks (Braaf, 1999).

A changing climate has implications for vector-borne and waterborne diseases in indigenous communities. In the "Top End" of the Northern Territory during the wet season, hot and humid conditions are conducive for vectors of infectious diseases endemic in the region. Vectors include flies, ticks, cockroaches, mites, and mosquitoes. Flies can spread scabies and other diseases. Mosquitoes are vectors for Australian encephalitis and endemic polyarthritis. Giardia and shigella are water-borne diseases that are common among indigenous children in the region. Both can be spread from infected people to others through consumption of infected food and untreated water. Existing and worsening overcrowded housing conditions, poor sanitation, and poor housing materials create breeding grounds for infection. Climate changes and sea-level rise—which create conditions that are suitable for new vectors (such as malaria) or expand distributions of existing vectors—may expose such vulnerable populations to increased risks.

In New Zealand, the gap between the health of indigenous people and the remainder of the population is less marked than in Australia but is substantial nevertheless. In 1996, life expectancy at birth was 8.1 years less for Maori females than for non-Maori females and 9.0 years less for Maori males than for non-Maori males (Statistics New Zealand, 1998a). As in Australia, this difference is associated with and partly caused by poorer economic circumstances and lack of appropriate, effective services (Durie, 1994). Consequently, Maori are at greater risk of health problems related to climate variability and climate change. An example is the lack of reticulated water supplies in the East Cape of the North Island, an area in which the population is predominantly Maori and in many cases cannot afford to truck in water in times of drought.

Impact assessments that consider only biophysical relationships between climate and health will be inadequate in evaluating indigenous health outcomes. The possibility—or, indeed, likelihood—that people may have very different views concerning what makes them vulnerable to climate change, which impacts may be significant, and what responses may be implemented also will need to be considered (Braaf, 1999).

The present social circumstances of indigenous peoples provide a poor basis on which to build adaptation responses to climate change threats. Thus, policies that aim to improve resilience to climate change impacts could encompass efforts to reduce relevant social liabilities—poverty, poor education, unemployment, and incarceration—and support mechanisms that maintain cultural integrity. Adaptive strategies could pursue economic development of these communities while sustaining the environments on which these populations are dependent (Howitt, 1993).

In other parts of the Pacific, there are many countries that are particularly susceptible to the effects of climate change—especially low-lying island states, which are likely to be severely affected by sea-level rise and increases in storm activity. Australia and New Zealand have close relations with many of the Pacific island states. For example, New Zealand has particular responsibilities for Niue, the Cook Islands, and Tokelau and contains substantial expatriate communities from most of the islands. Climate-related threats to these islands (see Chapter 17) would impact immediately on Australia and New Zealand.

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