Environmental health and adaptation responses in localflood-prone communities; A case study in the village of Sriwulan, Central Java, lndonesia

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Laura van de Beld

s4453921

Bachelorthesis Geografie, Planologie & Milieu (GPM) Faculteit der

Managementwetenschappen June 2018

Environmental health and

adaptation responses in local

flood-prone communities

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Environmental health and accompanied adaptation responses in

local flood-prone communities

A case study in the village of Sriwulan, Central Java, Indonesia

Author: Laura van de Beld Student number: s4453921

Bachelor Thesis Geografie, Planologie & Milieu (GPM) Faculteit der Managementwetenschappen

Radboud Universiteit Nijmegen

Supervisor: A. Kolar MSc June 2018

Cover image: view from the street through a coastal house demolished by floods in the village of Sriwulan, Indonesia. Private collection. 24 March 2018.

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Preface

Dear readers,

In front of you lies my Bachelor's thesis, written to complete my Bachelor's degree in Geography, Planning and Environmental studies at Radboud University. I am very happy that I have been given the opportunity to travel to Indonesia, to do research in a local context that was unfamiliar to me and therefore even more interesting and impressive. Semarang is such a nice welcoming city; I would take any future opportunity to go back some time again. Together with my travel buddy Rowie, it was an unforgettable experience.

This thesis was realized through local fieldwork, made possible by the researchers and their assistants from UNIKA in Semarang. I am extremely grateful for this. Specifically, I would like to thank Mrs. Retno so much for all her time, effort and support. She gave me the confidence I needed. I would also like to thank Cindy and Alfiana for their time, effort and fun during the field trips. Maybe I will ever see one of you back in the Netherlands.

Apart from Indonesia, I gained a lot of help back in the Netherlands. Especially my supervisor Kolar Aparna, who gave me the extra help and feedback I needed. And obviously my friends and family, which calmed me down in times of stress. And my boyfriend, who has also given me some extra feedback and listened to all my stories and struggles. Thank you so much for that.

I sincerely hope that someday in the future, the situation of the inhabitants of Sriwulan will start to improve and their worries will slowly start to fade away.

Thank you and enjoy your reading, Laura van de Beld

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Summary

This thesis zooms in on Sriwulan, a small village with about 12.500 inhabitants. It is located directly across the eastern border of the city of Semarang on the northern coast of the island of Java, Indonesia. Tidal floods have been forming a large threat Sriwulan and its inhabitants for the past years. Tidal floods are caused by high tides. This is a natural phenomenon. However, in Sriwulan and its surroundings, the effects of this phenomenon are further enhanced by two ongoing processes:

 Sea level rise, as caused by climate change

 Land subsidence, mainly caused by the extraction of groundwater from the soil and the weight of buildings in the adjacent city of Semarang.

Especially because of these processes, it is expected that floods in and around Sriwulan will get worse in the future, both regarding the severity and the frequency of floods. Moreover, since Sriwulan is a relatively poor village in which especially the poorest people live closest to the sea, the risk of floods becomes even higher. Their poverty in combination with their high level of exposure makes them the most vulnerable on many different levels. An important one of these levels is the concept of environmental health. Floods can negatively affect drinking water, sanitation, access to healthcare and safe food. Without at least one of these factors, one can easily get sick, making it difficult to impossible for people to go to school or work, enabling them to go to school or work.

To overcome these conditions, one can make use of different adaptation strategies. Adaptation is important for people to protect themselves against (increasing) floods and therefore reduce their vulnerability and increase their resilience.

In order to gain more knowledge on these concepts under the worst circumstances, the following research question is formulated:

''How are the inhabitants of Sriwulan adapting to the negative effects that tidal flooding has on their environmental health?''

An answer to this research question is found by the method of an exploratory case study, conducted on both primary and secondary data. The primary data were gained through the use of surveys and observational studies. Secondary data was used as background knowledge, retrieved from literature studies. Exactly 100 respondents were used for filling in the survey, selected by purposive sampling. This way, respondents were used from both the poorest and exposed areas of the village and from less vulnerable areas further inland. Analysis of these data showed that the vast majority of the respondents had in fact experienced tidal floods. Many of these respondents had already been suffering from tidal floods for more than nine years, usually four to nine times per month. These floods last no longer than one day on average, and do not exceed a flooding level of 0,5 meters.

However, these floods do show significant impacts on the environmental health of the inhabitants of Sriwulan; it reduces their access to healthcare and it negatively affects their drinking water, sanitation systems, and the quality and availability of their food. Moreover, 40% of the people experienced actual illnesses within their households in times of floods. Especially skin diseases were an issue here. When correlating the environmental health indicators with the illnesses, it becomes clear that the indicators do in fact cause the

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6 occurrence of illnesses in times of floods. The skin diseases in specific are caused significantly by the effects of flooding on sanitation systems. These environmental health effects are especially an issue for the people experiencing the worst and most frequent floods. This most likely corresponds to the people living in the lowest lying areas closest to the sea.

To prevent floods from entering homes and public spaces, the inhabitants of Sriwulan use multiple forms of adaptation, both on the household level, the community and the top down government level. Especially the building of dams and the elevation of floors, houses and streets are commonly used adaptation measures. However, the extent to which a person is capable of adapting is determined by its adaptive capacity; both the income and education level of people form significant impacts on the adaptation measures and strategies. The higher the income and education level of people, the more capable they are of implementing adaptation measures.

Lastly, when correlating the used adaptation measures to the environmental health in Sriwulan, adaptation does not have a clear positive influence on the environmental health, especially of the most vulnerable people. Even though the people of Sriwulan who spend the most time and money on their adaptation, still remain the most vulnerable regarding their environmental health.

To answer the main research questions shortly the inhabitants of Sriwulan experience many negative effects on their environmental health. To try and reduce effects such as these, they use many different adaptation strategies. However, there are no clear correlations between the adaptation measures taken and the effects people experience on their environmental health; the environmental health state of many of the inhabitants of Sriwulan is still nowhere near desirable. However, we do not know how the state will be without any of these adaptation measures. In other words, despite the people still being vulnerable, regarding their environmental health it would probably be worse without adaptation.

Since this research was relatively small scaled, future studies are recommended on a larger scale. Therefore, both the reliability and the validity of this research can be increased. Also, more qualitative studies can be used to dig further into the issues in Sriwulan. For example, through more qualitative studies, one could discover ways to possibly increase the adaptive capacity of the inhabitants of flood-prone villages like Sriwulan. Another option could be to cooperate with top down institutions to find ways for the inhabitants to reduce their general vulnerability to floods.

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1. Introduction

All over the world, the sea level is rising as a result of climate change. This continuous process, of which the end is not nearly in sight, has the consequence of possibly devastating floods. According to the IPCC (2014), the global sea level rise is expected to rise from at least 20 cm to 100 cm within the current century. This picture of the future forms a major threat, specifically to vulnerable lying countries such as Indonesia. It is also these low-lying countries where the vast majority of the population lives in the coastal areas, further increasing the devastating consequences of so called coastal floods (Doornkamp, 1998). Many Asian countries have been experiencing floods as the most frequent environmental hazard. In Indonesia, coastal floods are also forming the greatest threat regarding climate hazards. In fact, compared to other Asian countries, Indonesia is in third place regarding the frequency of floods, as also shown on figure 1.1 below. Only China and India experience a total higher number of floods (Guha-Sapir et al., 2017). However, Indonesia is especially vulnerable to floods, since most of its inhabitants live in densely populated cities near the coastal sides (figure 1.2). If a flood occurs in areas like these, the consequences will be even worse (Yusuf & Fransisco, 2009).

Moreover, both the frequency and severity of these floods are expected to increase further in the future (Arnell & Gosling, 2014).

Figure 1.1 Top 10 countries worldwide by occurrences of different types of environmental hazards (Guha-Sapir et al., 2017)

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10 Figure 1.2 Population density Indonesia (UN OCHA, 2008)

1.1 Problem Statement

This thesis will focus specifically on the coastal village of Sriwulan, located directly across the eastern border from the city of Semarang on the northern side of Java; the most densely populated island of Indonesia, as also shown on figure 1.2 above. Floods are a growing problem in Semarang and surrounding coastal areas, which will only get worse in the future, both in terms of frequency and severity (Harwitasari & van Ast, 2011; Marfai & King, 2007). In addition to this, the absolute ground level in and around Semarang is dropping, further increasing the risk of floods in the future. This process is also called land subsidence. In the case of Semarang, this is caused by groundwater extraction from the soil, together with fast urbanization and industrialization, putting a high pressure on the soil below (Marfai & King, 2007). This land subsidence is not just limited to the city of Semarang, but also drags down surrounding coastal areas, like the village of Sriwulan.

In Sriwulan, the worst floods occur as tidal floods; these are caused by a combination of coastal floods and flood tides. This is then further reinforced by possible waves and sea level rise (Marfai et al., 2007). The tidal floods have a major impact on the coastal areas in Sriwulan, Semarang and its surroundings. In both a physical and social way, floods cause a threat to all levels of society; from individuals to the community as a whole (Measey, 2010). The high level of exposure in combination with the devastating consequences requires strict adaptation measures to protect the Indonesian population. Through adaptation the vulnerability of the inhabitants and the severity of the consequences are reduced as much as possible. However, unlike many developed Western countries, Indonesia does not have the resources to adapt to the changing climate, characterized by the increasing number and severity of floods (Measy, 2010).

The extent to which one can adapt depends on a number of factors, such as financial resources and knowledge about both technology and the state of the environment. Some of these measures are preventive, others are reactions to the events, during or after they take place (Smit & Pilifosova, 2003). Especially the preventive measures require special attention in and around Sriwulan and Semarang. Since the floods are expected to further increase in frequency and severity, it is important to be prepared. By preventive adaptation, coastal

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11 inhabitants can reinforce their climate vulnerability, which helps to reduce negative effects of future floods (Dutta & Herath, 2004).

As already mentioned, floods are especially a risk to the Javanese people living closest to the sea. Not only because they are the most exposed, but also because this is where the poorest people live (Measey, 2010). Their poverty in combination with their high level of exposure makes them the most vulnerable (Kelly & Adger, 2000). Environmental health is an important factor within the subject of vulnerability, since a healthy environment and a healthy life is at the start of every development in the life of any individual, household or society (Prüss-Üstün et al., 2016). This healthy environment involves for example safe drinking water, hygiene, access to safe food and medicines. Without at least one of these factors, one can easily get sick, making it difficult to impossible for people to go to school or work. This jeopardizes their ability to have an income which further increases their general environmental vulnerability (WHO, n.d.; Menne, Brown & Murray, 2014). These factors surrounding environmental health can worsen in times of bad environmental conditions, including floods (Menne, Brown & Murray, 2014).

There is not much information available about the small village of Sriwulan. Let alone about its environmental health, which is one of the most important subjects in the development of a person, a household or community. Guaranteeing the safety of people, including flood protection and a good health is mostly a responsibility of the government. However, the local government within the regency of Demak does not show much interest for its local people, especially in the poorest coastal districts, like the village of Sriwulan (Purnaweni, 2016). This means that the residents themselves must ensure that they adapt to the threat of flooding. In addition, there is no public knowledge on the conditions in which these people live, which leads to a need for research, to find out in which conditions the Sriwulan people live, and especially how their environmental health is doing.

1.2 Research objective and relevance

The objective of this research is to gain insight in the adaptation strategies the inhabitants of the village of Sriwulan take to reduce the negative effects of flooding on their environmental health.

Scientific relevance

The above mentioned research objective is relevant in a scientific way. Researchers from UNIKA Soegijapranata, one of the universities in Semarang, are currently doing research on adaptation strategies to coastal floods in Sriwulan. Specifically, this team of civil engineers and environmental researchers looks at the way in which the inhabitants of Sriwulan apply certain adaptation measures locally to limit the negative effects of flooding on various aspects of their community. In this case, there is still a knowledge gap within this research team when it comes to the effects of flooding on the environmental health of the inhabitants of Sriwulan. This thesis aims to close this knowledge gap. The effects of environmental health are hereby put into relation to the existing adaptation strategies, in order to contribute to a local goal and solution-oriented approach.

The research is carried out in one of the villages where flood risks and climate vulnerabilities are among the highest. In this way, the most extreme cases are already known and the information obtained is suitable to be passed on to other flood prone areas, both within Java and in other underdeveloped coastal areas in the rest of the world.

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12 Social relevance

As mentioned earlier, the (local) government does not show much attention to the village of Sriwulan or other less developed areas and villages in the area. It has little idea what is going on and what the local population needs, especially during a period of flooding. This research is socially relevant because it provides more knowledge and insight into the risks and consequences of flooding. This specific research focuses on the most extreme flood areas. The knowledge about these most extreme cases can help external parties, such as the local government to design more targeted policies and top down adaptation strategies to limit the flood risks for the most vulnerable part of the community. Moreover, especially the focus on environmental health has multiple benefits:

 To be able to keep track of developments in climate and climate change;

 To be able to keep track of developments in human health as a result of climate-related developments;

 For the making of suitable policy strategies;

 To be able to compare different countries and regions with one another on the same factors, in order to determine where possible help is most necessary;

 To keep track of the effects of the effects of environmental and health-related policies;

 To raise awareness among stakeholders, such as political and commercial actors, the media and health professionals (Hambling, Weinstein & Slaney, 2011; Briggs, 1999).

1.3 Research questions

As explained above, the objective and relevance are concerned with the increasing flood risks due to a combination of climate change and land subsidence in Sriwulan. This creates an increasing vulnerability of the people in the risk area, threatening the environmental health of these residents. With this information in mind, the following main question for this thesis was formulated:

How are the inhabitants of Sriwulan adapting to the negative effects that tidal flooding has on their environmental health?

To be able to answer the main question, two sub questions need to be answered first:

- What are the negative environmental health consequences of tidal flooding on the

inhabitants of Sriwulan?

- What are the adaptation methods that the inhabitants of Sriwulan use to cope with the

negative effects of tidal flooding?

To be able to answer the questions stated above, this research will make use of both primary and secondary data resources. The primary data will be quantitative, based on questionnaires designed specifically for the target group. This will be accompanied with data from observations. The content of these questionnaires and the scope of the observations depend on secondary data sources from existing literature.

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1.4 Thesis outline

To answer the above-mentioned main and sub-questions, this thesis is divided into several steps:

 Chapter 2 will start with the theoretical framework; this will elaborate on the concept of climate change and the related flood risks and land subsidence. In addition, theories on environmental health and the associated vulnerability and adaptation strategies will be discussed. Lastly, all these concepts will be operationalized and merged into a conceptual framework, with the intention of applying this information to the village of Sriwulan.

 Chapter 3 will explain and justify the methodology for this research, with which the data to answer all main and sub-questions is collected.

 Chapter 4 will give a more detailed case description for this research.

 Chapter 5 is entirely dedicated to all the results of the research. In this chapter, the data will be briefly analyzed and correlations will be found between the indicators to find specific connections.

 Chapter 6 finally draws the conclusions from the results and analyses from the previous chapters, on which the sub-questions and then the main question are subsequently answered and possible recommendations will be pronounced.

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2. Theoretical Framework

This chapter will discuss the existing concepts and theories that play a role around the components of this research. To begin with, the theories and concepts surrounding coastal flooding and how it fits within the concept of climate change are discussed in more detail. Subsequently, the concept of environmental health and the associated adaptation and vulnerability are discussed further. All these discussed subjects will then be summarized in their own sub-frameworks. Ultimately, all these concepts are then merged into one conceptual framework.

This chapter has two specific goals. First, a part of this chapter will function as background information, to give a more clear idea of the processes behind the situation in Sriwulan, for example on how tidal floods occur. Secondly, this chapter will aim for an operationalization of the relevant variables and indicators for the execution of this research.

2.1 Coastal floods

This first paragraph of the theoretical framework will focus on climate change as the driving force behind floods all over the world. After this, the concept of coastal flooding and its characteristics will be discussed. Since coastal flooding manifests itself differently all over the world, the focus here will be narrowed down to the regional scale of Semarang and its surroundings. In addition, this paragraph will look further into the concept of land subsidence as a relevant topic in the increasing effects of coastal flooding.

2.1.1 Climate change and sea level rise

Now that the climate is changing and the earth is warming up, greater threats will arise for coastal areas. The sea level rises due to a rise in the temperature of the ocean water, as a result of which the total volume of the water rises. This is also called thermal expansion. In addition, the ice caps are melting, increasing the ocean water volume even more (Church et al., 2013; Nicholls & Cazenave, 2010).

A part of this sea level rise is caused by natural climate fluctuation. However, the current extreme rise in sea level is mainly caused by human activity (Patz et al., 2005).

With the use of different climate models, projections are made to predict the sea level rise up to the year 2100, pictured in graphs in figure 2.1 below. These climate models show a predicted sea level rise from 0.28 to 0.98 meter within the coming century, from best case to worst case scenario. However, sea level rise does not stop here; it is predicted to keep rising far beyond the year 2100 (Church et al., 2013).

The projected sea level rise could increasingly impact the occurrence of floods, especially in the most exposed areas of the world. The higher the sea level rises, the more the flood risk increases (Nicholls, 2002).

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15 Figure 2.1 Global mean sea level rise relative to 1986-2005 by different model projections (Church et al., 2013).

2.1.2 The concept of tidal floods

Tidal floods: ''The combination of high tide, wave action and accelerated sea level rise.''

(Marfai & King, 2007)

High tides are a consequence of solar and lunar gravitation, in combination with the rotation of the earth. High tides occur all over the world, but are not the same everywhere; the timing and extent of high tides are influenced regionally by wind patterns and coastal contours (Spanger-Siegfried, Fitzpatrick & Dahl, 2014). However, twice a month, the earth, the sun and the moon are aligned, during full and new moon. This causes the gravitational force of the sun and the moon to increase even further, causing higher tides than normal: the so-called spring tides. A few times a year, these situations surrounding full and new moon get even worse. In these cases, the moon is closest to earth, causing the extent of high tides to become greater. These high tides are also called king tides (Spanger-Siegfried, Fitzpatrick & Dahl, 2014).

Moreover, the extent of tidal floods is further enhanced by factors such a sea level rise and land subsidence (further elaborated in paragraph 2.1.3). When sea level rise and land subsidence keep increasing, the tidal floods will also increase, both in terms of frequency and extent. This is also the case in the low-lying coastal areas in and around the city of Semarang (Harwitasari & van Ast, 2011; Spanger-Siegfried, Fitzpatrick & Dahl, 2014). However, these areas are especially vulnerable to tidal floods, not only because these areas are the most exposed, but also because these densely populated areas are inhabited by the

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16 most poor and vulnerable people. Population explosions, urbanization and high land prices inland cause an increased population pressure on the flood prone coastal areas. Again, this is also an issue in and around Semarang (Harwitasari & van Ast, 2011).

Multiple researches have been done in the past to find out how tidal floods exactly occur. Most of the relevant researches for this thesis have focused on the inundated areas within the city of Semarang.

Total time of tidal flood experience:

According to Harwitasari & van Ast (2011), tidal floods were a relatively new concept for most people living in the inundated areas of Semarang; over 50% of the people had been experiencing tidal floods for less than four years.

Frequency:

Half of the people (50%) experiencing tidal floods indicated that tidal floods occur four to ten times per month. Only a small percentage (< 20%) experienced tidal floods less than once a month (Harwitasari & van Ast, 2011).

Duration:

However, the flood water does seem to flow away quickly, since over 80% of the respondents in the inundated areas of Semarang indicated that floods generally do not take longer than one day (Harwitasari & van Ast, 2011). (Marfai et al., 2007) looked at this duration more precisely. The largest share of the respondents in their research (54%) mentioned that an average flood takes about three to six hours.

Flood depth:

Moreover, only in the lowest areas, the flood depth gets higher than 0,5 meters. Less than 30% of the respondents in Semarang seemed to suffer from a flood depth higher than 0,5 meters (Harwitasari & van Ast, 2011). To be more precise, the most common flood depths in the inundated areas of Semarang are between 25 and 50 cm, for 46% of the respondents (Marfai et al., 2007).

However, the data from these researches were obtained some years ago. Since sea level rise and land subsidence (explained below) are continuing processes, it is expected that these numbers and percentages will be further increased today.

2.1.3 Land subsidence

Together with tidal floods, the coastal areas in and around the city of Semarang also suffer from land subsidence. Together with the global sea level rise, this process increases the effect of tidal floods. Therefore, this is also a relevant subject to discuss further. The process of land subsidence means that the soil level decreases relative to the original level (Damen & Sutanta, 2013). Land subsidence can have various causes, which underlie both human and natural activities and processes. Examples of factors that cause land subsidence are:

 Natural consolidation of clay-bearing soils;

 Groundwater extraction;

 Soil vibrations due to earthquakes;

 Weight of buildings;

 Industrialization.

These factors all cause a form of pressure on the soil (Damen & Sutanta, 2013; Doornkamp, 1998). Especially when multiple factors play a role at the same time in the same area. When,

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17 for example, soil water is extracted from a clay-bearing soil, the process of land subsidence is further accelerated because the water-containing pores in the clayey soil disappear (Damen & Sutanta, 2013). This is also the case in Semarang and the area to its east where the village of Sriwulan is located. In this case, the land subsidence is even further enhanced by the urbanization of the city of Semarang (Marfai & King, 2007).

Land subsidence on its own can have negative consequences for the environment. This mainly concerns damage to infrastructure such as roads, railways, sewers, drainage channels and bridges, damage to buildings, both public and private and pollution of drinking water sources (Jago-on et al., 2009). However, if a certain area is exposed to land subsidence, the relative level of the water relative to the soil will increase in times of a possible flooding. This will strengthen the effect of this flood (Doornkamp, 1998).

2.1.4 Flooding framework

The sub-theoretical framework below (figure 2.2) describes the concept of (increasing) tidal floods in a more simplistic way. All processes, terms and concepts causing tidal floods are summarized in this figure.

Figure 2.2 Theoretical framework of tidal floods (Harwitasari & van Ast, 2011)

2.2 The concept of environmental health

Environmental health: ''Those aspects of human health, including quality of life, that are

determined by physical, chemical, biological, social and psychosocial factors in the environment. It also refers to the theory and practice of assessing and controlling factors in the environment that can potentially affect health.'' (WHO, 1989)

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18 The global climate change creates major threats to human health; an increasing number of environment-related diseases emerge among humans. This is caused by the increasing number of extreme weather conditions and the greater variability of the climate around the world (Ebi, Smith & Burton, 2006). It is recognized that these manifestations of climate change are both directly and indirectly responsible for the outbreaks of various diseases, transmitted for example by food, water and parasites (also referred to as food- water- and vector borne diseases). These diseases also show a significant impact on the economy and general public health of a certain country or region (Jones et al., 2008).

2.2.1 Environmental health indicators

Environmental health indicator: ''An expression of the link between environment and

health targeted at an issue of specific policy or management concern and presented in a form, which facilitates interpretation for effective decision making.'' (Nurminen, Corvalán & Briggs, 1997)

An environmental health indicator provides information about the relationship between a certain environmental hazard and its health consequences. In other words, an environmental health indicator always had two sides (see figure 2.3). Environmental hazards are in this case defined as physical, biological, chemical and radiological environmental factors that have a direct and indirect effect on human health. An indirect result will then depend on any underlying social, economic, political and technical problems (Kjellström & Corvalán, 1995).

Figure 2.3 The range of environmental health indicators (Corvalán, Briggs & Zielhuis, 2000):

 A. Environmental health indicators;

 B. Environmental indicators that could potentially affect human health;

 C. Health indicators that could potentially have an environmental cause;

 D. Clear environmental indicators;

 E. Clear human health indicators.

From the above demarcation of the concept of environmental health indicators, the specific indicators can be derived and elaborated. Environmental health indicators can originate from different phases of environmental health development; from the driving forces behind environmental change, to the exposure of people, to the actual health effects. The following paragraph will further elaborate these specific environmental health indicators, and their relations with the actual health impacts.

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2.2.2 Effects of floods on environmental health

Flooding as caused by climate change causes its own environmental health issues. These environmental health issues as caused by floods are generally divided into two categories: direct effects and indirect effects. Direct health effects are caused by the flood water itself, involving for example drowning and injuries. Indirect health effects are caused by other structures that experienced damage from floods. These health effects include for example water- or vector-borne diseases and a declined availability of food. Table 2.1 shows a more complete list of all direct and indirect environmental health effects (Menne et al., 1999; Kovats & Ahern, 2013).

Table 2.1 Direct and indirect effects of floods on human environmental health (Menne et al., 1999; Kovats & Ahern, 2013)

Direct impacts

Flood-related health hazards

Cause Health impact

Physical  High level of floodwater;

 fast-flowing floodwater;

 floodwater debris

(boulders, trees, building materials);

 collapsed and damaged buildings

 Drowning and injuries (cuts, scratches, broken bones);

 electrocution

 Direct contact with floodwater

 Respiratory diseases

 Loss of water and

sewage treatment works

 Loss of safe drinking water

Biological  Direct contact with

polluted floodwater

 Skin, eye and respiratory infections;

 Wound infections;

 Water- vector- and rodent-borne diseases

 Presence of marine predators and venomous species

 Critical and non-critical bites and stings

Physical, biological, chemical, radiological

 Emotional stress  Stress;

 Fear;

 Mental health disturbances

Indirect impacts

Physical  Loss of access to and

damage of healthcare services

 Loss of access to necessary care

 Disruption of

environment and income;

 Disruption of

communication networks

 Stress

 Anxiety

Physical, biological  Damage to water-supply and sewage systems and

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20 sewage disposal damage

Biological  Standing waters;

 Heavy rainfall  Vector-borne diseases (malaria, dengue) Physical, biological, chemical  Release of hazardous chemical material (e.g. pesticides and industrial chemicals)

 Acute or chronic effects of chemical pollution

 Disruption of agriculture: destruction of food products

 Declined food availability and quality, leading to nutritional deficiencies and malnutrition

The largest number of flood injuries are sustained in the aftermath of a flood, where people start clearing out all the damage and debris (WHO, 2002). The proportion of actual fatalities is much smaller in the event of a flood. Only the most extreme floods are life-threatening, in combination with certain behavioral characteristics of people. These behavioral characteristics mainly refer to risk perception and willingness to evacuate (Rufat et al., 2015). Some other health effects persist in the long term, such as psychological problems. Other health effects on the other hand require acute care, such as most water-food and vector-borne diseases, especially among small children and elderly people. Hygienic drinking water is one of the most important factors in preventing these diseases (WHO, 2002). The Ministry of Health of Indonesia (2010) has drawn up physical criteria for this, so people can measure the quality of their drinking water themselves, namely, the water should be:

 Clean;

 Clear;

And the water should have:

 No color;

 No taste;

 No smell;

 A temperature between 20°C en 30°C.

Moreover, chemical and microbial criteria are equally important to the quality of drinking water. For example, clean drinking water must contain no chemical and no microbial elements (e.g. E. coli or cholera) (Ministry of Health of Indonesia, 2010). In addition to the pollution of drinking water, flood water also infiltrates sewage systems, causing them to clog and then flood. This sewage water contains harmful substances that can seriously threaten human health (WHO, 2002).

Both internal and external stakeholders such as the community, the government and emergency workers can take action to limit the effects of floods on health, both before, during and after a flood (WHO, 2002). These so-called adaptation measures are discussed below in the next paragraph 2.3.

2.3 Adaptation to climate change

Adaptation: ''Adjustment in natural or human systems in response to actual or expected

climatic stimuli or their effects, which moderates harm or exploits beneficial opportunities.'' (IPCC, 2007)

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21 Adaptation to the climate is no new concept. For centuries, one has been trying to adapt to the changing climate by which it is surrounded. However, the current effects of climate change mean that people must adapt increasingly to rapidly changing and increasing variability of climates (UNFCCC, 2007). These adaptation strategies may differ from each other; some are more robust and resilient, more advanced or equipped with better resources than others. This causes some people to be more vulnerable than others (Adger et al., 2003). As an example, the adaptation strategies with regard to sea level rise of developed countries such as the Netherlands can be compared with those of developing countries such as Indonesia.

The central goal of adaptation is to reduce the vulnerability to both physical and socio-economic risks, in combination with increasing the resilience for everyone involved. Possible adaptation strategies meet at least one of these two sub goals. In addition, the concept of adaptation can be categorized in multiple ways. The most widely used ones will be discussed within this chapter.

2.3.1 Vulnerability

Vulnerability: ''The degree to which a system is susceptible to, and unable to cope with

adverse effects of climate change, including climate variability and extremes.'' (IPCC, 2007) The vulnerability of a certain person, household or community depends on three factors:

 Exposure;

 Sensitivity;

 Adaptive capacity (IPCC, 2007).

When seeing vulnerability as part of the concept of adaptation, its definition stands directly opposed to resilience (Engle, 2011). The three factors of vulnerability by the IPCC given above will be used within this theoretical framework and will be elaborated further. Understanding and applying these three factors can help assess the severity of climate-related threats, identify the specific causes of vulnerability, and then enable people to be targeted in helping to reduce their vulnerability (Marshall et al., 2010).

First, exposure is defined as: ''The extent to which a region, resource or community experiences changes in climate.'' (Marshall et al., 2010)

The degree of exposure depends on several factors. First, the strength of regional climate change is an important factor (Williams et al., 2008). This specifically involves the strength, frequency, duration and spatial distribution of a particular climate event or pattern (Marshall et al., 2010). Secondly, exposure is determined by the extent to which a community can reduce the full exposure at local level. This is also called microhabitat buffering. An example of this is the so-called boulder fields; here, the surface of the soil is covered with large stones, so that the temperature variability is reduced (Williams et al., 2008, Shoo et al., 2010).

Secondly, sensitivity is defined as ''the degree to which a system is affected by, or responsive to, climate stimuli.'' (McCarthy et al., 2001)

Sensitivity to climate change and climate events can be interpreted in two ways: sensitivity of natural ecological systems and sensitivity of social systems (Marshall et al., 2007). For ecological systems, climate sensitivity mainly concerns the physical tolerance of climate events and patterns. With social systems, this climate sensitivity concerns the economic,

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22 political and cultural status and the sensitivity of these to certain climate events (Smit & Wandel, 2006). Examples in which sensitivity is relatively high are areas in which people live in low-lying areas, adjacent to or near a sea or river (Adger, 2003), especially where people depend on resources that are sensitive to climate change themselves as well. When looking at possible adaptation strategies in such a community, it is important to look at the factors that are most sensitive to climate change (Marshall et al., 2007).

The last determining factor within the concept of climate vulnerability is adaptive capacity: ''The ability of a system to adjust to climate change to moderate potential damages, to take advantage of opportunities, or to cope with the consequences.'' (IPCC, 2007)

As well as for the previous concept of climate sensitivity, adaptive capacity can also be interpreted in the two same ways; adaptive capacity of ecosystems and social adaptive capacity. Adaptive capacity of ecosystems is mostly determined by the genetic and biological diversity of species and heterogeneity of ecosystems to give room to natural processes (Marshall et al., 2007; Vos et al., 2009). For social adaptive capacity, a number of specific determinants have been formulated as well (Smit & Pilifosova, 2003):

 Economic resources (financial means);

 Technology (the ability to develop and access technology for adaptation);

 Information and skills (recognition of adaptation necessities and knowledge about adaptation strategies);

 Infrastructure (strength of both physical and social infrastructures);

 Institutions (strong, well organized institutions and effective policy);

 Equity (equal distribution of access to resources).

A large adaptive capacity reduces the climate vulnerability of people (Engle, 2011); It enables people to adapt. However, adaptive capacity does not guarantee any actual adaptation actions (Adger & Barnett, 2009). Sometimes, people are unconscious of their adaptive capacity (Marshall et al., 2007). Apart from this, another factor that causes a gap between adaptive capacity and adaptation actions is the fact that adaptive capacity and climate risks are often very location-specific, regarding the social, economic, political, technological and ecological context. This requires adaptation to also be location-specific. This is also referred to as community based adaptation (Smit & Pilifosova, 2003).

2.3.2 Resilience

Resilience: ''The ability of a social or ecological system to absorb disturbances while

retaining the same basic structure and ways of functioning, the capacity for self-organization, and the capacity to adapt to stress and change.'' (IPCC, 2007)

As already mentioned, the concept of resilience is opposite to the concept of vulnerability; when a person or community is resilient, it is not sensible for climate change. However, the same elements that make up the concept of vulnerability describe the aspects of resilience as well (Marshall et al., 2007). Therefore, there is no need to elaborate this concept further.

2.3.3 Types of adaptation

As already mentioned in the introduction to this chapter, the concept of adaptation can be categorized in multiple ways, of which the most important ones will be discussed further below. The first categorization is based on the intentions of adaptation (Bryan & Behrman, 2013) and is used most in climate science literature:

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 Autonomous adaptation;

 Planned adaptation.

First, anticipatory adaptation means that the adaptation measures were taken before certain climate events could take place or show any effects. This is also called proactive adaptation (IPCC, 2007).

The second type of adaptation, autonomous adaptation, is often confused with the third type: planned adaptation (Eisenack & Stecker, 2012). The difference however is that autonomous adaptation, also called spontaneous or reactive adaptation (Smit & Pilifosova, 2003; Engle, 2011), takes place after impacts of harmful climate events have already shown. These measures are taken without the initiative or assistance from public institutions (Smit & Pilifosova, 2003). This form of adaptation is most common (Tompkins & Adger, 2005). Planned adaptation on the other hand can be both anticipatory and reactive (Smit & Pilifosova, 2003). Moreover, planned adaptation measures are initiated top down by institutional policies, in which impacts by certain climate events are either expected or recognized. Adaptation by top down institutions is then considered necessary to maintain or strengthen the current state (IPCC, 2007; McCarthy et al., 2001).

Other common examples of adaptation categorizations are based on:

 Spatial scale (i.e. on community level, on regional level or

 Time scale (i.e. short term, long term)

 Type of adaptation measure (i.e. behavioral, technological, institutional)

 Effect (i.e. improve resilience or stability) (Bryan & Behrman, 2013).

2.3.4 Adaptation framework

The following sub-theoretical framework explains the concept of adaptation in a more simplistic way. All processes, terms and concepts surrounding adaptation are summarized in this figure 2.5.

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24 Figure 2.5 Theoretical framework of adaptation

2.4 Adaptation to floods and health

The APFM (2015) and Gentry-Shields & Bartram (2000) have drawn a list of possible adaptation strategies, specifically with the aim of reducing the impact of floods on environmental health. These adaptation strategies all affect at least one of the established health hazards, as shown below in table 2.2. However, a precondition for a large number of these strategies is that they are implemented top-down; a local community does not always have the means to implement many of these adaptation strategies themselves (APFM, 2015).

In addition, other sources of literature also consider migration as an ultimate measure of adaptation (McLeman & Hunter, 2006).

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25 Table 2.2 Correlation between adaptation strategies to floods and health hazards (APFM, 2015; Gentry-Shields & Bartram, 2000)

1

Flood proofing has the goal to either reduce or prevent the negative consequences of floods to structures. Examples of flood proofing as an adaptation strategy are elevation of structures above flood level, creating materials and structures that are resilient to floods and flood damage and avoid floodwater from entering the structure (Linham & Nicholls, 2010).

2

Land use planning and regulation as an adaptation strategy prevents important buildings and facilities from being affected by floods. Therefore, for example health care facilities are moved away from flood-prone areas (APFM, 2015).

3

Community participation involves the active collaboration of members of the a community to create certain adaptation programs themselves. This makes communities more resilient to floods, because they can better prepare themselves, respond and recover in case any external top-down assistance is absent (APFM, 2015).

Flood-related health hazard Adaptation strategies to floods

Phy s ic a l Biological Che m ic a l Rad io lo gi c a l Wa te r-bo rne di s e a s e s Wa te r-w a s he d di s e a s e s Ve c tor -bo rne di s e a s e s Struc tura l a d a pta ti on s trate gi e s Construction of dikes

Construction of flood barriers and dams

Improving the sanitation system

Providing safe drinking water systems

Flood proofing1 Non -s truc tura l a da pt a tio n s trate gi e s

Flood risk awareness

Flood-related health campaigns and hygiene promotion

Flood forecasting and early warning systems (EWS)

Flood hazard mapping

Land use planning and regulation2

Community participation3

Emergency response and assessment

Disaster risk reduction

Health systems management

Significant correlation No significant correlation

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2.5 Main conceptual framework

Figure 2.6 below shows the main conceptual framework for this thesis. It combines all discussed topics within this theory chapter in a more clear and simplified way.

Figure 2.6 Conceptual framework surrounding environmental health as caused by flooding and possible adaptation options.

This thesis focuses on the impacts of tidal floods on environmental health and how people consequently adapt to these impacts. Increasing tidal floods are caused by a combination of sea level rise, land subsidence and regular tidal movements. The tidal floods have a large impact on people living in coastal areas. One important factor which tidal floods have such a large impact on is the factor of environmental health. By using adaptation strategies, the negative impacts of tidal floods on environmental health can be reduced. The adaptive capacity of a person can determine the level of success of a certain adaptation strategy. From the literature discussed in this theory chapter, the concepts treated within this research are operationalized to the following indicators:

 Flooding characteristics;

 Period of experienced flooding;

 Flooding frequency;  Flood level;  Flood duration;  Environmental health;  Occurrence of illnesses;  Access to healthcare;

 Coverage by health insurance;

 Effects on drinking water;

 Effects on sanitation;

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 Adaptive capacity;

 Financial capital/income;

 Knowledge/education;

 Adaptation

 Adaptation measures by household;

 Adaptation measures by community;

 Adaptation measures by government;

 Consideration of migration as an adaptation measure.

In the next research methodology chapter, these indicators will be adjusted to the research questions within this thesis, specifying them further.

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3. Research Methodology

This chapter will describe and justify all scientific research methods used for this thesis. This thesis will be conducted in the form of an exploratory case study. An exploratory research involves the exploration of the underlying context and processes of a certain social phenomenon (Vennix, 2011). This exploratory case study will be implemented in a quantitative way. The research will be based primarily on primary data. Primary, directly observed data is collected through empirical research and surveys. On the other hand, the research is formed by secondary, external background data, retrieved from literature and data from institutional actors.

3.1 Primary data collection

For collecting this data, quantitative surveys will be taken first, to assess the experience of people in Sriwulan regarding floods, their environmental health and their strategies for adaptation. A quantitative research method is most suitable here to get a clear overall image of the whole village, especially regarding the concept of environmental health. Because this research is dealing with a larger population, the specific research areas will be selected by the method of purposive sampling. This means that the research areas or respondents are selected on their representativeness, based on specific characteristics of these respondents (Creswell, 2013). In this case, respondents will be used both in the poorest areas closest to the shore and in the relatively more developed areas further away from the shore. The respondents within the research area are then selected by random sampling, which means selection based on coincidence (Creswell, 2013). There is too little information about individual people in the research area beforehand, so a selection based on purposive sampling will not be possible here.

The survey as presented in appendix 1 is made especially for the coastal population of Sriwulan. Prior to the research execution, it was already clear from both literature and local researchers that the village of Sriwulan is not highly developed. Therefore, more formal survey approaches are avoided within this research; survey answers are adjusted to a lower income and lower educated population. For example, bwhen questioning the used adaptation measures, it was assumed that these would not be highly technologically innovative because of the low financial and capacity and knowledge.

The village of Sriwulan is the most suitable for this research, because the flood risk here is one of the highest in the entire coastal region around Semarang. A worst case like this is also called an outlier case (Thomas, 2011). In this case it is important to gain knowledge about the worst case, since this gives the most interesting information. It gives clearer information about possible causes and can better help possible policy to be adjusted to this worst case. Moreover, a more practical reason is that the village of Sriwulan is close to Semarang, making it one of the most accessible areas. More detailed information about Sriwulan and its inhabitants will be given in the following chapter 4: 'case description'.

3.2 Variables and indicators

Both the variables and indicators used for this research are derived from the (sub) research questions and the theoretical framework. The variables and indicators identified are

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29 Table 3.1 Variables and indicators for research

Research topics Variables Indicators Research method

General information Characteristics of respondents

 Income level

 Education level

 Survey

Flood prone area  Share of respondents affected by floods

 Survey Characteristics of floods  Years of suffering by

respondent  Flooding frequency  Flood level  Flood duration  Survey Negative environmental health consequences of tidal flooding

Illness  Share of respondents experiencing illness due to flooding

 Types of illnesses experienced4

 Survey

Healthcare  Access to healthcare

 Coverage by health insurance

 Survey

Drinking water  Type of water supply

 Effect of floods on drinking water  Types of effects of floods on drinking water  Alternative to clean drinking water  Survey  Observations

Sanitation  Effect of floods on sanitation

 Types of effect of floods on sanitation

 Survey

 Observations

Dietary consequences  Effects of floods on food availability  Effects of floods on food quality  Alternatives to food availability  Survey Adaptation measures to negative effects of flooding

Structural damage  Experience of structural damage to housing

 Survey

 Observations Adaptation  Share of respondents

that took adaptation measures

 Types of adaptation measures taken on the household level

 Frequency of taking adaptation measures  Survey  Observations 4

In this case, the types of illnesses experienced only involve physical illnesses. Mental illnesses are excluded, because these are too abstract for a survey and they would make the survey too complex and time-consuming. Other complex illnesses caused by for example nutritional deficiencies are also left out of the survey for the above reasons.

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30  Cost of adaptation measure  Types of adaptation measures taken by community  Types of adaptation measure taken by government  Usefulness of adaptation measures  Share of respondents looking at migration as a possible adaptation strategy

3.3 Data analysis

The quantitative data retrieved from the questionnaires is prepared for analysis by importing all the data into SPSS. The data analysis will be executed in three steps. First, the

characteristics of tidal flood and the respondents are analyzed. By using frequency tables, graphs and charts, the data is analyzed for each specific variable and indicator on its own. The second and the third step will consist of correlating the variables and indicators

according to the theoretical framework designed in the theory chapter.

The second step will therefore connect the characteristics of tidal floods to the general environmental health indicators. Then, these environmental health indicators are connected to the occurrence of specific illnesses.

The third step will then treat the other side of the theoretical framework, consisting of adaptive capacity and adaptation. Therefore, the characteristics of the respondents are connected to the adaptation measures and strategies that are used by the inhabitants of Sriwulan. Then these adaptation measures are again connected to the environmental health.

3.4 Reliability and validity

To ensure the reliability of this research, least a hundred respondents had to be gathered from the village of Sriwulan. Considering the large size of the population this research focuses on and the desired error margin of maximum 10% and confidence level of 95%, this research needed at least a total of hundred respondents.

Also, the validity of this research is guaranteed through the use of multiple research methods. Observational methods were combined with surveys, which were then compared to secondary data from literature. Also the questions asked in the survey were based on literature research. Anywhere possible, the survey provided open answer possibilities to stay open to more location specific or unexpected answers. The survey was prepared to suit all respondents, both through the prepared questions and answer option as well as the intended simplicity of the questionnaire itself.

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4. Case description

As previously mentioned, the focus of this thesis will be on the village of Sriwulan. As the map on figure 4.1 below shows, this village is located on the northern coast of Java, Indonesia, right across the border of the city of Semarang. Sriwulan is located in the district of Sayung, within the regency of Demak. It is a small rural village with about 12.500 inhabitants (Central Bureau of Statistics Indonesia, 2010), Many of these inhabitants live along the widespread coastline. When focusing on tidal floods (also called 'rob' by locals), Sriwulan is one of the most affected coastal villages around Semarang. Residents of the coastal areas of Sayung are relatively poor. And since corruption within the (local) government in Sayung plays a major role, little attention is paid to underdeveloped regions like these to provide decent measures against the floods.

Figure 4.1 Map of study area

4.1 Climate

The village of Sriwulan has a tropical climate, containing both wet periods and dry periods. These periods are alternated every six months. In this case, especially the months

December and January are relevant, since the most rainfall happens within these two months. These are also the months in which the coastal floods are the most common and worst. Tropical climate are also known for their high humidity and high temperature levels. This is also the case in Sriwulan. The temperature in Sriwulan is high all year round, fluctuating around 28°C (Climate-Data.org). The humidity and hot temperature are also

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32 relevant for this thesis, since it can indirectly affect the human environmental health,

especially in times of floods (Hales, Edwards & Kovats, 2003).

4.2 Tidal floods in Sriwulan

Tidal flooding occurs during periods of high tides. In Sriwulan, these tidal floods mostly occur during the rainy season, increasing the negative effects of floods. The village of Sriwulan is especially exposed to tidal floods, since the surface is relatively flat. Current altitudes go from 0 meters above sea level for the coastal areas, till about 7 meters above sea level for the areas more inland (Muryani, Nugraha & Prihadi, 2016).

The tidal floods are increasing, due to both sea level rise and the process of land subsidence (Harwitasari & van Ast, 2011), further elaborated below.

4.2.1 Sea level rise

Sea level rise increases the negative effects of tidal floods in Sriwulan. First of all, tidal floods only caused land to be inundated temporarily in the past. Sea level rise has currently caused parts of the village to be inundated permanently. Also, sea level rise increases the eroding effects of floods, it disrupts human activities and it causes the destruction of physical structures like homes and roads and flood protection measures.

The sea level rise in Sriwulan is predicted to increase further in the future with a rate of about 5 centimeters per year (Marfai, 2012). According to the IPCC (1998), a sea level rise of 30 centimeters causes an increase in damage of 36% to 58%. It also causes a lot of lost land, especially in the lowest lying areas (see figure 4.2 below) (Nehren et al., 2014).

Figure 4.2 Loss of land due to expected sea level rise (Nehren et al., 2014)

4.2.2 Land subsidence

Land subsidence in Sriwulan has multiple causes. First, Sriwulan has a clay soil. Clay soils compress naturally. This process is in this case further enhanced by the extraction of groundwater from the clay soil and the weight of construction in the city of Semarang (Harwitasari & van Ast, 2011); it also drags down the soil in areas close to it, such as Sriwulan. The extraction of ground water and the weight of construction is still increasing

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33 today with the economic development and population growth in Semarang. This causes a further increase in land subsidence as well (Marfai & King, 2007).

The map below shows the extent of land subsidence within the city of Semarang. The land subsidence is the highest in the north eastern parts of the city, in which the ground level can drop more than 8 centimeters per year (Putranto, Hidajat & Susanto, 2017). According to the research team from UNIKA, the village of Sriwulan also experiences land subsidence at a rate at least as fast as this 8 centimeters. As mentioned before, Sriwulan is located right at the north eastern border of Sriwulan. If the pattern of land subsidence below would be extended further eastward, the high levels of land subsidence would also show in Sriwulan.

Figure 4.3 Land subsidence in the city of Semarang (Putranto, Hidajat & Susanto, 2017)

4.3 Flooding issues in Sriwulan

The poorest and most vulnerable inhabitants of Sriwulan live closest to the coast. Some of these people's homes are directly touched by the sea. Parts of the village are currently permanently inundated. Some other parts of the village flood temporarily, especially during the rainy season and during flood tides. Every year, 10% of the population is forced to move from its homes, because they are no longer habitable due to structural damage and high water levels (Muryani, Nugraha & Prihadi, 2016). The local population tries to adapt to the increasing floods themselves by, for example, increasing the level of roads and floors of houses.

Despite the fact that houses are being permanently destroyed by the sea water, the government does not see the seriousness, and thus keeps aloof (Muryani, Nugraha & Prihadi, 2016). A research team from UNIKA University in Semarang examines the consequences of floods in Sriwulan. According to this research team, an indirect reason for the increased number of floods specifically in and around Sriwulan is the coastal abrasion of

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34 the off coast mangrove forests. These forests used to provide Sriwulan with a natural flood protection.

The increasing number and severity of floods cause large threats to the environmental health of the inhabitants of Sriwulan, specifically due to water pollution and the impact of the changing climate (Muryani, Nugraha & Prihadi, 2016).

Environmental health and adaptation responses in localflood-prone communities; A case study in the village of Sriwulan, Central Java, lndonesia

Laura van de Beld

s4453921

Environmental health and

adaptation responses in local

flood-prone communities

Environmental health and accompanied adaptation responses in

local flood-prone communities

Preface

Summary

Table of contents

1. Introduction

1.1 Problem Statement

1.2 Research objective and relevance

1.3 Research questions

1.4 Thesis outline

2. Theoretical Framework

2.1 Coastal floods

2.2 The concept of environmental health

2.3 Adaptation to climate change

2.4 Adaptation to floods and health

2.5 Main conceptual framework

3. Research Methodology

3.1 Primary data collection

3.2 Variables and indicators

3.3 Data analysis

3.4 Reliability and validity

4. Case description

4.1 Climate

4.2 Tidal floods in Sriwulan

4.3 Flooding issues in Sriwulan