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Climate change and gastroenterology: from the frontline
  1. Mai Ling Perman
  1. School of Medical Sciences, Fiji National University College of Medicine Nursing and Health Sciences, Suva, Rewa, Fiji
  1. Correspondence to Dr Mai Ling Perman, School of Medical Sciences, Fiji National University College of Medicine Nursing and Health Sciences, Suva, Rewa, Fiji; mai.perman{at}

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Despite contributing minimally to global greenhouse gas emissions,1 Pacific Island nations are at the frontline of climate change impacts.2 Their heightened vulnerability stems from their geographical dispersal across the expansive Pacific Ocean, which leaves them encircled by vast bodies of water. This unique geological position subjects these island communities to climate-related threats, including rising sea levels, coastline erosion, ocean acidification, loss of biodiversity, food and water insecurities and extreme weather events, jeopardising their existence and way of life.

Pacific Island countries (PICs) and territories

Oceania comprises Australia, New Zealand and the PICs and territories (see figure 1). The three ethnogeographic regions (Melanesia, Micronesia and Polynesia) form the PICs. Of these, 13 are sovereign nations, while others maintain unique political associations with France, New Zealand and the USA.

Figure 1

Map of Oceania (Source: map-oceania-05.gif (720×410) (

The self-governing nations have almost 13 million people but only about 2.7 million live on the smaller islands.3

They are classified as low-income and middle-income countries.3 These include the Federated States of Micronesia, Fiji, Kiribati, the Republic of the Marshall Islands (RMI), Nauru, Papua New Guinea, Samoa, the Solomon Islands, Tonga, Tuvalu and Vanuatu. Each country boasts a unique blend of culture, tradition, history and political systems.

Rising sea levels and coastal erosions

As Earth becomes warmer due to climate change, sea levels rise via two main mechanisms: expanding heated seawater and melting ice sheets and glaciers.2

Because some PICs are low-lying atolls, they face the potential existential threat of vanishing underwater with rising sea levels. The countries with the most significant threat of ‘sinking’ first are Tuvalu, Kiribati and the Republic of the Marshall Islands. Their highest elevations vary from atoll to atoll, but, generally, they are mostly under 5 m above sea level. The only bridge, which is the highest peak (<10 m above sea level) in Majuro, Republic of the …

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  • Contributors MLP is the sole author of this commentary.

  • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.