climate change. As ancestral lands are lost to rising seas and erosion, and traditional prac- tices are disrupted, many communities are experiencing a sense of displacement and dis- connection from their cultural identities (CDC, 2024a). Mental health eects include stress, anxiety, depression, grief, sense of loss, strains on social relationships, substance abuse, and post-traumatic stress disorder (PTSD) (Dod- gen et al., 2016). These mental health condi- tions can also manifest into physical health concerns such as changes in fitness and activ- ity level, heat-related illness, allergies, and increased exposure to waterborne and vector- borne illnesses (Dodgen et al., 2016). The psy- chological toll of watching one’s home and way of life being threatened cannot be overstated. Following the Hawaii wildfires in 2023, the Maui Wildfire Exposure Cohort Study (Maui- WES) found that 55% of participants were exhibiting depressive symptoms (Juarez et al., 2024). The number of individuals likely to need counseling following the Maui wildfires, coupled with contextual factors such as the loss of transportation, is anticipated to burden an already overtaxed behavioral healthcare system (Holliday et al., 2024). Moreover, 49% of Maui- WES participants reported that their health is now worse since the wildfires, and 24% reported that they do not have reliable access to medical care (Juarez et al., 2024). Furthermore, relocation or separation from family or com- munities following the event reduces individu- als’ ability to receive social support (Holliday et al., 2024). Only 24% of MauiWES participants remained in their pre-wildfire homes, with 65% in temporary homes and 11% in new perma- nent homes (Juarez et al., 2024).
which often rely heavily on natural resources for their livelihoods and cultural practices, are facing disproportionate risks (Frazier et al., 2023). As a result, there are exacerbated mental health consequences, particularly for rural populations, socioeconomically disad- vantaged populations, and people with dis- abilities (CDC, 2024a). Women, who bear the brunt of caregiving responsibilities and are often on the front lines of climate adapta- tion eorts, also face heightened challenges due to the significant roles they play in eco- nomic activities, safety, health, and liveli- hoods (CDC, 2024a). The cumulative eects of these environ- mental health threats are putting immense pressure on the already limited resources and capacity of the USAPI region (Frazier et al., 2023). Addressing these challenges will require a concerted eort to build resilience, support adaptation, and prioritize the needs and voices of the individuals who are most at risk (McIver et al., 2016). Urgent action is needed to protect the health, safety, and well-being of Pacific Islander communities in the face of the climate crisis (Pacific Islands Forum Secretariat, 2019). Resilience and Adaptation Pacific Islander communities, particularly Indigenous Peoples, have a long history of resilience and adaptability in the face of environmental challenges (Nunn et al., 2016). Today, as the impacts of climate change intensify, these communities are drawing on traditional knowledge, cultural values, and their deep connections to the land and sea to build climate resilience and protect their health and way of life (Frazier et al., 2023). Sproat (2016) discussed that the key fac- tor in the resilience of Indigenous commu- nities is their right to self-determination; by exercising this right, Indigenous Peoples can respond to climate change in ways that meet their unique needs and aspirations. As stated by the Oce of Science and Technol- ogy Policy (OSTP, 2022), their ability to do so, however, is often undermined by institu- tions and policies shaped by the legacy of settler colonialism, which is reflected in the current Hawaiian water law that is a distinct departure from the ancient Hawaiian water- management system of ahupua‘a (Harvard Law Review, 2024).
Ahupua‘a was a system ruled over by the Ali‘i (chiefs), with water viewed as a “true public trust resource.” Management of the system was overseen by the Konohiki (resource stewards), and water was appor- tioned according to the need and amount of labor provided. It was customary that during times of scarcity, those with sucient access would share any excess with those in need. This system sustained approximately 200,000 Indigenous Peoples for nearly a millennium. The arrival of Western settlers in 1778, however, resulted in the segmentation and privatization of the land, with sugar planta- tions weaponizing the water law. This change allowed for the diversion of a significant amount of water out of the watershed perma- nently, meaning the plantations were appro- priating water beyond the amount tied to the land under the ahupua‘a system. The same colonial agriculture and ranching operations also destroyed native vegetation and intro- duced highly flammable non-native plants. These issues were further exacerbated when plantations ceased operations and left large grasslands unmanaged. The role of these contributing factors to the devastating Hawaii wildfires in 2023 has received great criticism and could provide the political momentum needed to reform Hawaii’s water law, with a greater infusion of Native Hawaiian history, culture, and tradition (Harvard Law Review, 2024). This example of Hawaii’s water law demonstrates how colonial institutions and policies can undermine the ability of Indigenous communities to exercise self-determination in managing their resources and responding to climate change. Expanding support from federal and state governments to uphold the right of Indig- enous Peoples to self-determination is crucial for guiding eective and equitable climate resilience eorts (OSTP, 2022). As a result of location-specific climate exposures and unique societal and demographic characteristics, each region of the U.S. experiences dierent health impacts due to climate change. A report by CDC (2024a), Preparing for the Regional Health Impacts of Climate Change in the United States, provides a summary of health eects, resources, and adaptation examples from health depart- ments funded by the CDC Climate and Health Program. The report supports states, counties, cities, tribes, and territories in assessing how climate change will aect their community by
Communicating Danger: This wildfire danger sign in Saipan informs community members of the current risk level. Certain populations within the USAPI are particularly vulnerable to these climate change impacts. Indigenous communities,
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May 2025 • Journal of Environmental Health
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