Headline: Human health and climate change in the Pacific: a review of current knowledge

Observed climate changes in Pacific island countries (PICs) are causing detrimental effects on the health of communities. Increased frequency and intensity of cyclones, more extremely hot days, and changes in rainfall patterns can change the geographic distribution of vector-borne diseases, decrease food and water security and safety, and strain health service capacity. These impacts are projected to worsen with additional climate change in the absence of strong and effective mitigation and adaptation measures. Health vulnerability and adaptation assessments conducted in twelve PICs in 2014 highlighted significant knowledge gaps on the national health risks of climate change and on adaptation implementation and policy translation. We synthesize recent research to identify approaches to support evidence-based policymaking to increase resilience of health systems in the Pacific. Broad areas where further and substantial investment and support are needed include: (i) health workforce capacity development; (ii) enhanced surveillance and monitoring systems, and (iii) research to enhance understanding of risks and effective interventions and their subsequent translation into practice and policy. Finally, health facilities need urgent upgrades; many are old and located in coastal areas, and are heavy users of coal-fired electricity.