Case Synopsis

This case takes place in the Bahamas and surrounds a complex toxic illness, Ciguatera Fish Poisoning (CFP). It discusses how CFP is contracted and where it is most common, as well as prevention and diagnosis methods. It then goes into the context of the Bahamas, setting the stage in terms of health care, health of the population, government, and various employment industries. Due to its location in the Caribbean, the Bahamas has a large number of tourists each year contributing to the number of CFP cases, as well as affecting the local populations in a variety of ways. This case analyzes an environmental health issue, tourism, and social determinants of health.

Case Objectives

  1. To consider the social, economic, and public health consequences of a complex toxic illness. CFP is a complex toxic illness with environmental, social, and community health implications. An objective of this case is to encourage students to identify solutions that are outside the normal public health sphere of influence.
  2. To identify how climate change may contribute to emerging issues of public health concern. CFP represents a problem where systems thinking is required for both understanding the problem and finding a solution. Therefore, an objective of this case is to provide an opportunity for students to learn the intricacies of multiple systems working together to find a solution.
  3. To introduce the concept of “decision making in a world of uncertainty”. Most of these terms would be new to Master of Public Health students (a great reminder that MPH is a path, not a destination).

Case Study Questions

  1. Who are the different stakeholders involved in this issue?
  2. What could each department/stakeholder contribute or suggest to mitigate this issue?
  3. Looking at the entire picture, what are the first steps to be taken to improve the situation?
  4. How could tourism be involved to decrease the rates of CFP?
  5. What could be done to improve surveillance and reporting, as well as proper diagnosis?
  6. Create an influence diagram to show influencing factors and negative effects of CFP.


environmental health, food borne illness, social determinants of health, eco-health, climate change, stakeholders, developing country, surveillance, reporting

Additional Author Information

Molly Dion, BA, MPH

Patricia Huston, MD, MPH, Editor-in-Chief, Canada Communicable Disease Report

Lloy Wylie, PhD, Assistant Professor

Charles Trick, PhD, Professor



Recommended Citation

Dion, M., Huston, P., Wylie, L., Trick, C. (2016). Ciguatera Fish Poison: An Emerging Risk Associated with Climate Change?. in: Terry, A.L. & John-Baptiste, A. [eds] Western Public Health Casebook 2016. London, ON: Public Health Casebook Publishing.