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Planet Earth and its growing human population are challenged by the health impacts of industrial policies that drive global emissions production and cause climate change. The health-care industry has capacity and responsibility to adopt environmentally sustainable policies and practices. Bioethicists have a responsibility to support environmental sustainability through their clinical, research, educational, and policy work. They communicate complex ideas to diverse stakeholders and can communicate similarly to improve understanding about emissions and the value of environmentally sustainable policy. A growing bioethics literature addresses climate change in collaboration with human and veterinary medicine and other disciplines. Pursuing environmental sustainability with the vigor that made autonomy a norm would help to reduce global emissions production in health care and make it a role model for other industries. Making environmental sustainability a health-care norm would be as significant an accomplishment as doing so for individual autonomy.

Health promotion involves social and environmental interventions designed to benefit and protect health. It often harmfully impacts the environment through air and water pollution, medical waste, greenhouse gas emissions, and other externalities. We consider potential conflicts between health promotion and environmental protection and why and how the healthcare industry might promote health while protecting environments. After probing conflicts between promoting health and protecting the environment we highlight the essential role that environmental resources play in health and healthcare to show that environmental protection is a form of health promotion. We then explore relationships between three radical forms of health promotion and the environment: (1) lowering the human birth rate; (2) transforming the food system; and (3) genetically modifying mosquitos. We conclude that healthcare and other industries and their institutions and leaders have responsibilities to re-consider and modify their priorities, policies, and practices.

This article outlines challenges to benefitting developing countries that are hosts of international research. In the context of existing guidance and frameworks for benefit-sharing, it aims to provoke dialog about socioeconomic factors and other background conditions that influence what constitute benefits in a given host setting, and about the proportionality between benefits to hosts and benefits to sponsors and researchers. It argues that capacity-building for critical thinking and negotiation in many developing country governments, institutions, and communities is a benefit because it can help to overcome background conditions that impinge on equitable international research negotiations, partnerships, and benefits. Enhancing the capacity for both critical thinking and negotiation can, like other targets of capacity-building, nurture respectful and trusting partnerships that benefit all stakeholders in international research.

BackgroundPalliative and end-of-life care development is hindered by a lack of information about the circumstances surrounding dying in developing and resource-poor countries. Our aims were to develop and obtain face and content validity for a self-administered questionnaire on end-of-life care provision and medical decision-making for use in population-based surveys.MethodsModelled on validated questionnaires from research in developed countries, our questionnaire was adapted to the cultural sensitivity and medico-legal context of Trinidad and Tobago. Two sets of semi-structured face-to-face cognitive interviews were done with a sample of physicians, sampling was purposive. Phase 1 assessed interpretation of the questions, terminology and content of the questionnaire. Phase 2 was tested on a heterogeneous group of physicians to identify and fix problematic questions or recurring issues. Adjustments were made incrementally and re-tested in successive interviews.ResultsEighteen physicians were interviewed nationwide. Adaptations to questionnaires used in developed countries included: addition of a definition of palliative care, change of sensitive words like expedited to influenced, adjustments to question formulations, follow-up questions and answer options on medications used were added, the sequence, title and layout were changed and instructions for completion were included at the beginning of the questionnaire.ConclusionA new instrument for assessing and documenting end-of-life care and circumstances of dying in a small, resource-poor Caribbean country was developed and validated, and can be readily used as a mortality follow-back instrument. Our methods and procedures of development can be applied as a guide for similar studies in other small developing countries.

Context Empirical information on circumstances of dying from advanced illness in developing countries remains sparse. Evidence indicates that out-of-hospital end-of-life care can have significant benefits such as increased satisfaction for the patient and caregivers and cost-effective for a health-care system. Services that are aimed to deliver care at private homes may be a good model for low- and middle-income countries or other low-resourced settings. Objectives To examine specialized, generalist, and informal palliative care provision and to describe the end-of-life care goals and treatments received. Method A mortality follow-back study with data obtained from general practitioners certifying a random sample of death certificates of adult decedents who died between March and August 2018. The questionnaire inquired about the characteristics of care and treatment preceding death. Results Three hundred nine questionnaires were mailed, and the response rate was 31% (N = 96), of which 76% were nonsudden deaths. Of these cases, 27.4% received no palliative care, 39.7% received it from a general practitioner, and 6.8% from a specialized palliative care service. Comfort maximization (60.3%) was the main goal of care in the last week of life, and analgesics (53.4%) were the predominant treatment for achieving this goal. In addition, 60.3% received informal palliative care from a family member. Conclusion The largest part of end-of-life care at home in Trinidad and Tobago is provided by family members, whereas professional caregivers feature less prominently. To ensure quality in end-of-life care, better access to analgesics is needed, and adequate support and education for family members as well as general practitioners are highly recommended.

To identify common themes documented in the literature on palliative and end-of-life care in English-speaking Caribbean small island developing states (SIDS), and to describe barriers, improvement strategies, and suggested ways forward.In 2015, we conducted a systematic scoping review of relevant literature identified through the MEDLINE and Web of Science databases. We supplemented that with searches of other electronic and hard-copy sources to map key concepts and summarize themes.Primary data and other literature from and about English-speaking Caribbean nations are relatively scarce. The available literature offers an overview of the existing situation in the region and explores why palliative and end-of-life care is limited there. This review identified barriers in five main areas recurring across this literature: i) culture and attitudes of health care providers, patients, and those close to them towards terminal illness and death; ii) opioid availability and use; iii) limited development of palliative care services; iv) unmet palliative care needs; and v) limited research on palliative or end-of-life care.Our analysis helps to document the need for palliative and end-of-life care in Caribbean SIDS and highlights suggestions for moving forward with related practice, policy, and research.Establecer los temas comunes documentados en la bibliografía sobre los cuidados paliativos y al final de la vida en los pequeños estados insulares en desarrollo del Caribe de habla inglesa, y describir los obstáculos, las estrategias de mejora y los pasos futuros que se sugieren.En el 2015, realizamos un examen sistemático exploratorio de la bibliografía pertinente encontrada por medio de MEDLINE y las bases de datos de Web of Science. Complementamos el examen con búsquedas de otras fuentes electrónicas e impresas para esquematizar los conceptos fundamentales y resumir los temas.Los datos primarios y otra bibliografía sobre las naciones del Caribe de habla inglesa o provenientes de ellas son relativamente escasos. La bibliografía disponible ofrece un panorama de la situación existente en la región y explora las razones por las que los cuidados paliativos y al final de la vida son limitados en estas naciones. La presente revisión detectó obstáculos en cinco áreas principales, recurrentes en toda la bibliografía:Nuestro análisis ayuda a documentar la necesidad de cuidados paliativos y al final de la vida en los pequeños estados insulares en desarrollo del Caribe de habla inglesa, y pone de relieve sugerencias para avanzar en la práctica, la política y la investigación relacionadas.Identificar temas comuns documentados na literatura científica sobre cuidados paliativos e de pacientes terminais nos pequenos Estados insulares em desenvolvimento do Caribe e descrever barreiras, estratégias de melhoria e rumos a serem tomados.Em 2015, foi realizada uma revisão sistemática do tipoOs dados primários e outros dados da literatura provenientes e acerca dos países de língua inglesa do Caribe são relativamente escassos. A literatura disponível oferece um panorama geral da situação da região e examina por que os cuidados paliativos e dos pacientes terminais são limitados. A revisão permitiu identificar barreiras em cinco áreas principais recorrentes nos estudos: i) cultura e atitudes dos profissionais da saúde, dos pacientes e das pessoas próximas que acompanham o paciente com doença terminal e morte; ii) disponibilidade e uso de opioides; iii) progresso restrito dos serviços de cuidados paliativos; iv) necessidades da atenção paliativa não atendidas e v) pesquisas pouco extensas sobre cuidados paliativos e dos pacientes terminais.Nossa análise contribui para documentar a necessidade de cuidados paliativos e dos pacientes terminais nos pequenos Estados insulares em desenvolvimento do Caribe e sugere o rumo a ser tomado com relação a práticas, políticas e pesquisas.

Should physicians take action in the political realm to address climate change? There are many historical examples of physician advocacy in the political sphere, both individually and as a collective, and many have argued that it is important for health professionals to advocate on a variety of issues. But which criteria should be used to determine when and how health professionals should take on particular advocacy issues, and is climate change an appropriate-or even obligatory-arena for physician advocacy? We propose a seven-part deliberative framework for making this determination.

Climate change threatens health, health care, and the industries and resources upon which these depend. The growing prevalence and severity of its health consequences and economic costs are alarming health professionals and organizations as their professional obligations, grounded in the core value of health, include protecting against these harms. One means of fulfilling these obligations is to lead or support sustainability initiatives that are built upon current, reliable, accurate, and unbiased evidence and collaboratively tailored to meet specific needs and respond to specific contexts. We consider why and how health professionals and organizations should lead or support such initiatives.

Decisions about environmental health policy often deal with contentious issues. David Resnik and colleagues (2018) highlight some such issues, arguing that the accountability for reasonableness (AF...

Decades of evidence from a range of disciplines shows that industrial energy releases greenhouse gas emissions and contributes extensively to climate change. Energy delivers water, food, and other goods to billions of people, but through emissions it also harms health and environments that support health. These harms vary and have different practical and ethical significance for different populations and environments. A public health ethics concerned with whether and how to respond to conditions that harm health must address these harms. This chapter reviews evidence that the primary cause of climate change is emissions released during industrial production and use of energy. It highlights the health impacts of climate change, defines emissions as health determinants with ethical implications, and discusses how and why ethically informed health policy and other interventions should integrate social justice and social responsibility.

L’histoire de James Dwyer au sujet d’une Commission GAIA fictive met en évidence les préoccupations concernant la portée de la bioéthique, en particulier en ce qui concerne la répartition de la responsabilité au niveau international face aux impacts des changements climatiques sur la santé. Ce commentaire traite de l’impact potentiel d’un individu sur les émissions de gaz à effet de serre et l’importance des réponses institutionnelles afin d’avoir un impact significatif., James Dwyer’s story about a fictional GAIA Commission highlighted unresolved concerns about the scope of bioethics, specifically regarding the global distribution of, and responsibility for, the health impacts of climate change. This commentary discusses the potential impact of an individual on greenhouse gas emissions and the importance of engaging institutional responses in order to have meaningful impacts., Commentaire / Commentary

Climate change has substantial impacts on public health and safety, disease risks and the provision of health care, with the poor being particularly disadvantaged. Management of the associated health risks and changing health service requirements requires adequate responses at local levels. Health-care providers are central to these responses. While climate change raises ethical questions about its causes, impacts and social justice, medicine and bioethics typically focus on individual patients and research participants rather than these broader issues. We broaden this focus by examining awareness among health-care providers in the Caribbean region, where geographic and socioeconomic features pose particular vulnerabilities to climate change. In focus groups, Caribbean providers described rises in mosquito-borne, flood-related, heat-related, respiratory and mental illnesses, and attributed these to local impacts of climate change. Their discussions showed that the significance of these impacts differs in different Caribbean nations, raising policy and social justice questions. Bioethics and public health ethics are situated to frame, inform and initiate public and policy dialog about values and scientific evidence associated with climate change. We urge readers to initiate such dialog within their own institutions about the context-dependent nature of the burdens of climate change, and values and policies that permit it to worsen.

This article presents empirical data on the limited availability of hospice and palliative care to the 6 million people of the English-speaking Caribbean. Ten of the 13 nations therein responded to a survey and reported employing a total of 6 hospice or palliative specialists, and having a total of 15 related facilities. The evolving socioeconomic and cultural context in these nations bears on the availability of such care, and on the willingness to report, assess, and prioritize pain, and to prescribe opiates for pain. Socioeconomics and culture also impinge on what medications and modalities of care are routinely available for pain or other conditions and can challenge professionalism, empathy, and responsiveness to patients’ unrelieved pain. Although all respondents report having a protocol for pain management, hospice, or end-of-life care, their annual medical use of opiates is well below the global mean. The International Narcotics Control Board (INCB), which monitors such use, encourages Caribbean and other low- and middle-income countries to increase their use of opiates to treat pain, and to overcome both unfounded fears of addiction and overly restrictive interpretation of related laws and regulations. Contextual considerations like those described here are important to the success of policies and capacity-building programs aiming to increase access to hospice and palliation, and perhaps to improving other aspects of health and healthcare. Exploring and responding to the realities of socioeconomic and cultural conditions will enhance public and policy dialogue and improve the design of interventions to increase access to palliative and hospice care. Improving access to palliative and hospice care in the Caribbean demonstrates beneficence and helps to fulfill human rights conventions.

Objective: Undertreated pain around the world includes the acute and chronic pain caused by sickle cell disease (SCD). In collaboration with a Caribbean association that aims to provide assistance to those diagnosed with SCD, we surveyed adults with SCD about pain management and impact of SCD pain. Methods: Participants were recruited from a group of 55 adults with SCD. A survey was administered to those who agreed to participate. Questions centred on their self-assessed level of pain due to SCD, the extent to which that pain interferes with daily activities, and how they seek and obtain pain relief. Results: Responses were received from 39 participants (female: n = 28, 72%, male: n = 11, 28%; mean age: 31.6 (SD ± 13.7) years. Sickle cell disease pain significantly disrupts participants’ daily activities (62%), mood (72%), work (64%) and sleep (69%). Prescription medicine was ineffective for 41% and about half (n = 19) sought alternate means of relief. Conclusion: Sickle cell disease pain is undertreated in the Caribbean, disrupts daily activities and affects quality of life by impinging on education, employment and marital status. Sickle cell disease and other types of pain can be clinically managed safely, effectively and inexpensively. By failing to palliate and overcome the problem of undertreated pain, healthcare systems and providers contribute to socio-economic amongst other repercussions for sufferers, their families and caregivers, and their nations.

Climate change harms health and damages and diminishes environmental resources. Gradually it will cause health systems to reduce services, standards of care, and opportunities to express patient autonomy. Prominent public health organizations are responding with preparedness, mitigation, and educational programs. The design and effectiveness of these programs, and of similar programs in other sectors, would be enhanced by greater understanding of the values and tradeoffs associated with activities and public policies that drive climate change. Bioethics could generate such understanding by exposing the harms and benefits in different cultural, socioeconomic, and geographic contexts, and through interdisciplinary risk assessments. Climate change is a bioethics problem because it harms everyone and involves health, values, and responsibilities. This article initiates dialog about the responsibility of bioethics to promote transparency and understanding of the social values and conflicts associated with climate change, and the actions and public policies that allow climate change to worsen.

This paper examines pain and pain relief in the Caribbean, where pain is widely perceived as an unavoidable part of life, and where unnecessary suffering results from untreated and under treated pain. Barriers to pain relief in the Caribbean include patient and family attitudes, inadequate knowledge among health professionals and unduly restrictive regulations on the medical use of opioids. Similar barriers exist all over the world. This paper urges medical, nursing and public health professionals, and educators to examine attitudes towards pain and pain relief and to work towards making effective pain relief and palliation more accessible. It recommends that i) health professionals and officials be better educated about pain, palliation and opioids, ii) regulatory restrictions be updated in light of clinical and scientific evidence, iii) opioid procurement policies be adjusted to facilitate increased medical use, iv) medical charts and records be modified to routinely elicit and document patients levels of pain, and v) educational campaigns be developed to inform the public that moderate and severe pain can be safely relieved at the end of life and other stages of life. The professional, respectful, and beneficent response to patients in pain is to provide rapid and aggressive pain relief or to urgently consult a pain or palliative specialist. When a health system hinders such efforts the ethical response is to identify, facilitate and advocate for overcoming barriers to improvement.

Disabling pain or symptoms can occur at any age from many different causes. Pain and palliative specialists are able to relieve most pain and symptoms, although repeated adjustments to modalities, medications and doses may be needed. Because pain and palliative specialists comprise only a small percentage of physicians, many patients find it difficult to access them or obtain pain relief. Globally, there are too few such specialists to meet existing needs. Most are affiliated with hospice and palliative units, so their accessibility to patients without terminal conditions is negligible. Doctors outside pain and palliative specialties are often unfamiliar with pain guidelines and sceptical about patient reports of unrelieved pain. They are therefore likely to undertreat it. Undertreating pain, however, violates respect for persons and beneficence. This paper reviews literature supporting these claims and offers a narrative description of the author's attempts to find relief from shingles and postherpetic neuralgia. It argues that physicians in most specialties are not, but should be, familiar with palliative evidence and guidelines so that they are equipped to relieve pain and symptoms quickly and effectively. Such information should be routinely introduced in medical curricula to encourage the mastery of knowledge, attitudes and skills necessary to upholding ethical principles and to ensure that more doctors in any discipline are willing to believe and be compassionate to patients whose pain is unresponsive to initial treatments. Routinely exposing students to such information would better prepare them to fulfil their professional duties to patients and society.

CONTEXT Medical, technological and societal developments influence doctors' professional responsibilities and present challenges to educating medical students about professionalism. Medical education about professionalism generally focuses on behaviours and competencies which are taught primarily by clinicians in clinical courses and settings. DISCUSSION Many professional competencies in medicine parallel those in science. We consider here whether medical professionalism can also be taught through the basic science courses which often initiate medical education, and which are typically taught by scientists. CONCLUSIONS Like doctors, basic science faculty staff can teach professional competencies to medical students. Science faculty are well situated to teach professional competencies and should do so. They can model how to pursue evidence and manage conflicting information. They can also provide explicit messages to students about professional competencies and their value, and create learning objectives that reinforce those messages.

For decades, scientists from many disciplines have documented changes in earth’s atmosphere, oceans, soil, weather patterns, and ecosystems that collectively reflect climate change. The websites of national and international health organizations, and other influential institutions, document their concerns about health impacts of climate change. These are seldom addressed in bioethics, despite bioethics practical and scholarly dedication to medicine, health, and wellbeing. The premise of this book is that medical and research ethics, and other disciplines, can and should embrace Van Rensselaer Potter’s global bioethics. This bioethics is concerned with dependencies and relationships between humans and other living things, and extends beyond environmental ethics and public health ethics to human health and wellbeing and other realms. Integrating it into medical and research ethics, and related practical and scholarly activities will facilitate studies of, deliberation about, and deeper understanding of the causes and impacts of climate change; and help to identify and implement the most promising, effective, and fair responses to it. This Chapter develops and supports this premise; introduces some readings for understanding the ethics of climate change; and provides an overview of the book’s aims, contributors, and contents.

The production of even small quantities of greenhouse gas emissions worsens climate change and accentuates the unequal, and often unfair, distribution of emission-associated benefits and harms. The relative inattention of bioethics to climate change is surprising given its roots and concern with health, wellbeing, and autonomy. Bioethics could improve understanding among policymakers and others that autonomy is expressed and health is experienced within natural environments and ecosystems. Such understanding could strengthen efforts to reduce emissions and help make Western lifestyles more accessible globally. Processes of globalization and socioeconomic development sometimes improve health determinants and indicators, but simultaneously increase production of emissions that harm health. Bioethicists have the capacity, influence, and responsibility to deepen understanding that emissions harm health, health systems, and natural resources on which these rely; and to inform related analyses and policies.

The Polar Regions (PR) and Small Island Developing States (SIDS) are distant and relatively undeveloped. They differ in cultures, socioeconomics, geographies, flora and fauna, and annual average temperatures. Despite their differences, they are similar in having small percentages of global population, limited economic and political influence, growing reliance on imported food and goods, and producing relatively small amounts of greenhouse gas emissions. The Arctic encompasses about four million people and 30 different Indigenous Peoples. There, warming has increased exposure to infectious, vector-borne, and mental illnesses; reduced food and water security; and displaced communities through scarcity, rising sea levels, and melting permafrost that damages infrastructure. Combined, the Small Island Developing States (SIDS) have over 60 million people. Their extensive and low lying coastal areas make them particularly vulnerable to sea level rise and extreme weather. Changes in temperatures and precipitation patterns in Caribbean SIDs contributed to outbreaks of infectious diseases including cholera in Haiti, malaria in Jamaica, and H1N1 influenza virus in Barbados. Previously confined to SIDS of the Indian Ocean, Chikungunya (CHIKV) appeared across Caribbean SIDS in 2013, causing significant morbidity. We review health impacts of climate change in the PR and SIDS, contrast the environmental contexts in which these are occurring, and discuss regional and global causes and consequences.

One manifestation of climate change is the increasingly severe extreme weather that causes injury, illness and death through heat stress, air pollution, infectious disease and other means. Leading health organisations around the world are responding to the related water and food shortages and volatility of energy and agriculture prices that threaten health and health economics. Environmental and climate ethics highlight the associated challenges to human rights and distributive justice but rarely address health or encompass bioethical methods or analyses. Public health ethics and its broader umbrella, bioethics, remain relatively silent on climate change. Meanwhile global population growth creates more people who aspire to Western lifestyles and unrestrained socioeconomic growth. Fulfilling these aspirations generates more emissions; worsens climate change; and undermines virtues and values that engender appreciation of, and protections for, natural resources. Greater understanding of how virtues and values are evolving in different contexts, and the associated consequences, might nudge the individual and collective priorities that inform public policy toward embracing stewardship and responsibility for environmental resources necessary to health. Instead of neglecting climate change and related policy, public health ethics and bioethics should explore these issues; bring transparency to the tradeoffs that permit emissions to continue at current rates; and offer deeper understanding about what is at stake and what it means to live a good life in today's world.

There is international recognition of the need for sustainable research ethics committees to provide ethical review of human subjects research in developing countries but many developing countries do not have such committees (often called `IRBs). Theoretical and practical uncertainties encountered by an IRB on the Caribbean island of Grenada offer insight into ethical review of research in developing countries. Theoretical uncertainties include questions about whether means of ensuring confidentiality and obtaining informed consent will be effective in local settings and whether deviations from Western norms are justifiable. International guidelines are helpful in addressing these concerns but are subject to interpretation. Guidelines are less helpful in practical areas like selecting members or chairs. They do not address what sort of procedures and paperwork will work in a developing country or IRBs relationships to governments that have no mandate for them. Experiences presented here show that IRBs in developing countries can sustainably adhere to international standards. Sustainability requires knowledge personal commitment and an official mandate to uphold international standards. Capacity building must therefore focus on educational programs to make developing country leaders knowledgeable about the value of international guidelines to their nations. Such knowledge is needed before people will become motivated to promote implement and uphold the guidelines. People in developing countries must help design bridges to help their nations put international standards into practice. The structure of such bridges may of necessity vary in different settings. (authors)

Professions typically formulate codes of ethics. Medical students are exposed to various codes and often are expected to recite some code or oath at their graduation. This article reports the findings of a study of one large medical class, asked upon entry to medical school and again at the beginning of their fourth term, which of 13 specified professional, religious, and secular codes of ethics they would turn to for moral guidance in their practice of medicine. The study finds great diversity in the students' choices and no clear pattern of change by their fourth term. Very few students chose the oath they would be asked to recite at their graduation. The article probes the problems this creates for school administrators and professors as well as students. It asks the implications for professional oath-taking at graduation and in the practice of the profession.

This paper explores the evolution of the Universal Declaration on Bioethics and Human Rights (UDBHR), which was adopted by the United Nations Educational, Scientific and Cultural Organization (Unesco) in 2005. While the draft UDBHR generated controversy among bioethicists, the process through which it evolved excluded mainstream bioethicists. The absence of peer review affects the declaration's content and significance. This paper critically analyses its content, commenting on the failure to acknowledge socioeconomic and other factors that impede its implementation. The UDBHR outlines ideal standards but fails to provide guidance that can be readily applied in different settings. It strives for universality but does not contribute to understanding of universal or global bioethics.

We appreciate Ford’s documentation of the many ways in which climate change threatens the traditional lifestyles and health of indigenous and other populations.1 As Ford states, the impacts of climate change on indigenous peoples are primarily studied in Australia and the Arctic, leaving much unknown about their global scale and manifestations in other regions.1 We believe that small island communities such as the Caribbean are also vulnerable to climate change because of their coastal-dependent geographies and lifestyles. The Caribbean population was estimated at 37.5 million in 2000,2 and Caribbean nations constitute approximately half of the 39 members of the Association of Small Island States.3 Like much of the world,4 the Caribbean is already experiencing increased salinity of drinking water, sea level rise, decreased habitable and agricultural land area, disrupted fisheries, and diminished food security.5 Its limited infrastructure and socioeconomic resources leave it at least partly reliant on foreign aid for climate mitigation and preparedness efforts. In one of our qualitative studies, Caribbean islanders described their personal experiences and perceptions about climate change as increased average temperatures, severity of weather events, and changes in rainfall patterns. They had observed geographic changes including beach erosion, sea level rise, drying rivers, and reduced vegetation and ground cover. They discussed the growing regional attention to disaster preparedness since the devastation of Hurricane Ivan in 2004, including efforts to digitize and archive legal and historical documents to prevent losses like those caused by Hurricane Ivan. Participants identified subsequent regional business opportunities in conservation and alternative energy, government efforts to promote the use of drought resistant crops after the severe drought of 2010, and a policy on climate change education being considered for public schools. Participants noted that relatively high rates of interisland movement and population growth stretch Caribbean social services and encroach on diminishing areas of habitable land. The discussion itself seemed to galvanize participant recognition that climate change threatens natural resources, such as rushing rivers and sandy beaches, that they take for granted. Although preliminary, our data show that climate change is altering Caribbean life. Further research on the health impacts of climate change on indigenous peoples and in unique geographic, economic, and sociocultural contexts is needed. Governments, industries, and individuals are unlikely to respond to climate change until it threatens things they value in their own lives. Ford’s article, and findings like ours, may help them to appreciate the urgency of doing so.