The moral arithmetic of the Pacific situation is stark. Pacific Island countries contribute just 0.02 percent of global greenhouse gas emissions, yet their communities have long ranked among those most acutely harmed by the consequences of a changing climate. Rising seas, intensifying storms, shifting rainfall patterns and warming oceans are transforming coastlines, food systems and freshwater supplies across the region. Hosting negotiations in this setting forces delegates to confront the human stakes of their decisions directly, rather than through the abstract language of tonnes of carbon and degrees of warming that has traditionally dominated conference halls.

Health, the authors argue, provides perhaps the most immediate and human barometer of the escalating crisis. Across the Pacific, climate change is increasing risks to food and water security, altering patterns of vector-borne, food-borne and water-borne disease, exposing populations to extreme heat, eroding mental health and wellbeing, and placing additional pressure on health services that are already stretched thin. These impacts are not evenly distributed. Displacement separates people from land, culture and identity, while damage to ecosystems undermines traditional sources of food, livelihoods and knowledge. Climate impacts deepen existing inequities, including those experienced by women, children, older people, people with disabilities and communities with the fewest resources to adapt.

The physical vulnerability of the region’s health infrastructure illustrates the problem in concrete terms. A review of 76 hospitals across 14 Pacific island countries found that 62 percent were located within 500 metres of the sea or a river, making them particularly susceptible to damage from sea level rise and storm surges. In other words, the very institutions charged with protecting communities from climate-related harm are themselves in the front line. Conventional measures of climate change, which typically track emissions and temperature anomalies, often fail to capture these true losses to communities, and the authors argue that such dimensions should influence not only how consequences are described but how solutions are designed.

The Pacific has not waited for the international community to act. For decades, Pacific countries have demonstrated global climate leadership, from Fiji’s presidency of COP23 and the development of the Talanoa Dialogue to some of the world’s strongest advocacy for ambitious mitigation, adaptation and climate justice. Across the region, governments and communities are shaping health national adaptation plans, strengthening climate-informed surveillance, making health facilities more resilient, improving water security and introducing renewable energy into health infrastructure. Fiji has helped pioneer climate-resilient and environmentally sustainable health-care facilities, offering a working model of what adaptation looks like when it is embedded in health systems rather than bolted on afterwards.

Regional innovation has also demonstrated that climate action and health improvement are mutually reinforcing. Across the Western Pacific, a recent Climate and Health Co-Benefits Challenge documented how action outside the health sector, from cleaner energy and transport to healthier food systems and urban planning, can simultaneously reduce emissions and improve health. Eliminating fossil fuel combustion delivers cleaner air and fewer deaths from air pollution. Designing cities and towns around public and active transport reduces emissions while increasing physical activity, improving mental health and reducing noncommunicable disease. More sustainable food systems ease environmental pressures while addressing malnutrition, and better-designed homes, workplaces and communities can protect people from extreme heat and cold.

The authors describe these gains not merely as co-benefits but as core benefits: tangible returns from climate investment that people can experience now, rather than promises deferred to future generations. This reframing carries significant implications for negotiation strategy. Health, they argue, cannot be seen only as a sector requiring urgent protection from climate change. It is also one of the strongest drivers of climate ambition and a measurable indicator of successful climate action. Framing climate policy in terms of lives saved and communities strengthened may prove more persuasive, and more politically durable, than framing it solely in terms of avoided emissions.

From this analysis, the article distils three priorities that the Pre-COP should carry from the Pacific to COP31 and beyond. First, health should be recognised as a powerful driver of climate action and a defining measure of climate ambition and accountability. Climate policies should be assessed not only by tonnes of emissions avoided but by whether they protect lives and create healthier, safer and more resilient communities. Integrating health across adaptation, mitigation and resilience planning, Nationally Determined Contributions, and the second Global Stocktake, which will commence at COP31, can help build public support, strengthen the case for investment and accelerate climate action.

Second, climate-health commitments must be translated into investment and implementation. Despite the scale of the threat, health attracts less than 0.5 percent of multilateral climate finance, a figure the authors present as grossly disproportionate to the burden. Investment is needed in climate-resilient health facilities, climate-informed surveillance and early-warning systems, health workforces, water and sanitation, and community resilience, the foundations that allow health services to continue functioning when climate shocks occur. Climate finance should also better recognise and measure the health gains delivered through investments in energy, food systems and sustainable transport, while access to climate finance for health must become simpler and more responsive to the needs of climate-vulnerable countries, particularly small island states, with support to ensure absorptive capacity, effective implementation and infrastructure sustainability.

Third, those most affected must help shape the response. Women and girls frequently experience disproportionate health and social consequences from climate shocks while remaining underrepresented in decision making, and the authors argue that Indigenous knowledge, Pacific knowledge systems and the experiences of communities living at the climate frontier should inform policy and investment. A more equitable climate response, they stress, is not achieved simply by identifying vulnerable populations; it requires sharing power with them in designing solutions. The Pacific tradition of talanoa, an inclusive dialogue grounded in listening, storytelling and collective understanding, offers an appropriate model for these discussions, and the international community should arrive in the Pacific prepared not only to speak but to listen.

The journey from the Pacific to COP31 must ultimately be about implementation, the authors conclude. Governments already possess substantial evidence of the dangers of climate change; what communities need now is action on a scale commensurate with those dangers. Health can help bridge that gap because it translates degrees of warming, tonnes of carbon and financing commitments into outcomes that matter in people’s daily lives. It can demonstrate that climate action is not solely about avoiding a more dangerous future but about enjoying healthier societies today. When the world gathers in the Pacific this October, success should be measured not only by the ambition of the commitments made but by what those commitments ultimately mean for people, because a healthier future and a safer climate, the authors write, go hand in hand.

Subject of Research: The role of health in Pacific climate diplomacy ahead of COP31

Article Title: When global climate diplomacy comes to the Pacific, health must be at the table

Article References: Lalabalavu, R. A. R., Demaio, S., Jacobs, M., Bennett, E., & Piukala, S. M. (2026). When global climate diplomacy comes to the Pacific, health must be at the table. The Lancet Regional Health – Western Pacific, Article 102003. https://doi.org/10.1016/j.lanwpc.2026.102003

Image Credits: AI Generated

DOI: 10.1016/j.lanwpc.2026.102003

Keywords: climate change, Pacific Islands, COP31, global health, climate finance, health adaptation, talanoa dialogue, UNFCCC, health equity, climate resilience, small island states, air pollution