Planned Relocation and Health: A Case Study from Fiji.

In Fiji, low-lying coastal villages are beginning to retreat and relocate in response to coastal erosion, flooding and saltwater intrusion. Planned relocation is considered a last resort as a form of adaptation to the impacts of climatic and environmental change. The health impacts of planned relocation are poorly understood. This paper draws on data from multi-year research with residents of the iTaukei (Indigenous) Fijian village of Vunidogoloa. We used qualitative research methods to examine experiences of planned relocation, including residents' accounts of their health and quality of life. In-depth interviews and group discussions were conducted with villagers living in a site of relocation, at four points in time (2015, 2016, 2019, and 2020). Twenty-seven people in Vunidogoloa, Fiji, participated in in-depth interviews, several on more than one occasion. Six group discussions with between eight to twelve participants were also conducted. Qualitative analytic software (NVivo) was used to analyse interview transcripts and identify themes. Villagers report both health benefits and challenges following planned relocation. Key facilitators for good health include movement away from some environmental risks to health, adequate drinking water and sanitation, food security including through farms and kitchen gardens, livelihood opportunities, improved access to schools and health services, and appropriate housing design. However, residents also refer to unanticipated risks to health including increased consumption of packaged goods and alcohol, disruptions to social structures and traditional values, and disrupted place attachment following movement away from a coastal site of belonging with consequences for mental wellbeing. Therefore, planned relocation has altered the social determinants of health in complex ways, bringing both health opportunities and risks. These results highlight the need for context-specific planning and adaptation programs that include meaningful involvement of community members in ongoing decision making, and call for an understanding of diverse social determinants of health that emerge and evolve in contexts of planned relocation.