Abstract and Introduction
Abstract
Background: Emerging environmental pressures resulting from climate change and globalization challenge the capacity of health information systems (HIS) in the Pacific to inform future policy and public health interventions. Ciguatera, a globally common marine food-borne illness, is used here to illustrate specific HIS challenges in the Pacific and how these might be overcome proactively to meet the changing surveillance needs resulting from environmental change.
Objectives: We review and highlight inefficiencies in the reactive nature of existing HIS in the Pacific to collect, collate, and communicate ciguatera fish poisoning data currently used to inform public health intervention. Further, we review the capacity of existing HIS to respond to new data needs associated with shifts in ciguatera disease burden likely to result from coral reef habitat disruption.
Discussion: Improved knowledge on the ecological drivers of ciguatera prevalence at local and regional levels is needed, combined with enhanced surveillance techniques and data management systems, to capture environmental drivers as well as health outcomes data.
Conclusions: The capacity of public HIS to detect and prevent future outbreaks is largely dependent on the future development of governance strategies that promote proactive surveillance and health action. Accordingly, we present an innovative framework from which to stimulate scientific debate on how this might be achieved by using existing larger scale data sets and multidisciplinary collaborations.
Introduction
The capacity of Pacific Island nations to provide fish that are safe for consumption and trade will be challenged in the face of climate change. Although climatic drivers of coral reef disturbance are beyond our immediate control, their impact on public health could be minimized if an adaptive governance strategy were established to support health policy making, regulation, and coral reef and fish stock management. Health information systems (HIS) in the Pacific are designed to inform policy and public health intervention; however, their performance is being challenged by emerging problems such as environmental change (Goater et al. 2011). By way of example, we use the case study of ciguatera fish poisoning (referred to here as ciguatera), which is common throughout intertropical regions where coral reef systems occur (Lehane et al. 2000). Pacific island countries and territories (PICTs) rely heavily on coral reef fish stocks for food, export, and tourism because they provide a cheap, readily accessible natural resource for exploitation (Madin et al. 2008). Population growth, urbanization, pollution, and global pressures to meet industry and tourism demands are all forces shaping society and the environment in PICT areas (Gatti et al. 2008). The surrounding warm waters support a large percentage of the world's coral reefs and are subject to cyclic or episodic changes caused by natural and anthropogenic events. With ecological disruption likely a key trigger for ciguatera outbreaks, the cumulative effects of globalization and climate change render ciguatera a priority health issue not only within the Pacific but potentially also on a global scale (Madin et al. 2008). Here, we investigated health surveillance data sets that are available to capture the disease burden of ciguatera in the Pacific and the reporting systems that are in place. We also assessed how these data are managed, analyzed, and disseminated to inform policy and public health interventions. Lastly, we have proposed an alternative approach to existing HIS, within a three-phase conceptual framework to stimulate debate over an optimal risk return for HIS and ciguatera in the Pacific.