Introduction Humanity entered a new millennium with unprecedented challenges on a planetary scale. Carbon dioxide emissions, loss of biodiversity, loss of forests, water use and ocean acidification have all been rapidly increasing for the past 100 to 200 years. At the same time, we have never had so many options to steer the planet on a sustainable path of development and to eliminate poverty everywhere. The future will assess us, not just on what we did, but also on what we failed to do. One area where we must be judged by what we did well is in the protection – in particular, health protection – of people in Small Island Developing States (SIDS). Small islands are fragile ecosystems populated by resilient people who have been able to cope with environmental threats over millennia. However, the challenges that climate change brings today are unprecedented, and small islands are the places where the physical and social impacts of climate change are becoming most evident. The Earth Summit in Rio de Janeiro in 1992 was the birthplace of the United Nations Framework Convention on Climate Change (UNFCCC). Since then, several global conferences and meetings have followed, with limited but steady progress made towards addressing our planetary challenges. The Rio+20 Conference in 2012 renewed national commitments and accelerated actions towards sustainable development. Importantly, the conference’s outcome document recognized that health is a precondition for and an outcome and indicator of all three dimensions of sustainable development, that is, the social, environmental and economic dimensions (UN, 2012). We must, therefore, put health at the centre of sustainable development in SIDS. More recently, 2015 saw major national commitments to transition to more climateresilient and sustainable societies, by preparing for the challenges and opportunities of additional climate change. These include the Paris Agreement under the UNFCCC; the 2030 Agenda for Sustainable Development; and the Sendai Framework for Disaster Risk Reduction 2015–2030 (Box 1).
1.1 Over 20 years of international health action The World Health Organization (WHO) has played a key role for over 20 years in raising awareness of and implementing actions to manage the health risks of climate change within Member States. SIDS were among the first countries to become concerned about the health impacts of climate change. The first SIDS workshop on climate change and health in the Pacific was held by WHO in Apia, Samoa, in partnership with UN Environment and the World Meteorological Organization (WHO, 2000). This was followed by similar workshops for the Caribbean in Barbados in 2002 (WHO & PAHO, 2003) and in the Maldives in 2003 (WHO, 2004). Since then, evidence has continued to increase regarding the impacts of unhealthy environments, including climate change, on health.
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