Climate change, overcrowding and non-communicable diseases: The 'triple whammy' of tuberculosis transmission risk in Pacific atoll countries

Abstract: The atoll nations of Kiribati, Marshall Islands and Tuvalu are home to the highest rates of tuberculosis in the Pacific region. These countries also have very high rates of poverty, overcrowding and non-communicable diseases such as smoking and diabetes mellitus, which are all well-established risk factors for tuberculosis transmission. In addition, these three countries are among the most vulnerable in the world to the impacts of climate change, due to, inter alia, their very low elevation and extreme susceptibility to sea-level rise and extreme weather events such as cyclones, droughts and storm surges. Tuberculosis transmission rates have been linked to climate activity, such as changing seasons, yet tuberculosis has not hitherto been seriously discussed in the international literature as an infectious disease considered susceptible to climate change. This paper highlights the unique and unprecedented convergence of social and environmental risk factors for tuberculosis transmission risk in these three Pacific atoll countries, which demonstrate that tuberculosis is indeed a 'climate-sensitive' disease warranting international support for climate policy and public health intervention.