The Global Small ISLAND Initiative: Investing in Structural and Lasting Action on Noncommunicable Diseases

A SIDS‑led answer to the syndemic of NCDs and climate change — across the Caribbean & Atlantic and the Pacific & Indian Ocean.

Small Island Developing States face a dual crisis of climate change and noncommunicable diseases — a syndemic whose roots lie in shared commercial, structural and trade‑related drivers. The Global Small ISLAND Initiative is a structured, country‑driven partnership that translates SIDS' own priorities, as set out in the 2023 Bridgetown Declaration and the 2025 UN Political Declaration on NCDs and Mental Health, into accelerated implementation. It is delivered through two parallel regional branches: the Caribbean & Atlantic and the Pacific & Indian Ocean.

39SIDS WHO Member States
10 of 10highest-obesity countries are Pacific SIDS
>½of all deaths in SIDS are premature and from NCDs
⅔of countries with worst climate-disaster losses are SIDS

The challenge

The climate emergency and the noncommunicable disease epidemic in SIDS are not separate crises. They share a common root in unsustainable, health‑harming commercial practices that continue unimpeded because of global power inequities, disproportionate commercial influence, and trade‑related barriers to action. The same dynamics that have displaced traditional diets with imported ultra‑processed food are also locking SIDS into fossil‑fuel dependence, eroding food security and weakening health‑system resilience.

SIDS are disproportionately represented among countries with the highest probability of dying prematurely from the four main NCDs. Two‑thirds of countries that suffer the highest relative losses from climate disasters each year are also SIDS. Their health and food systems are pressed from both sides at once, in places where economic resources and skilled health personnel are scarce.

Premature deaths (under 70) attributable to the five major modifiable risk-factor categories, across both SIDS regional groupings, 2023. Hover any bar for the exact count. Source: SIDS Initiative analysis of the Global Burden of Disease Study 2023.

What's driving these premature deaths

The major modifiable risk factors fall into five categories. The sunbursts below decompose each region's risk‑attributable premature deaths into category (inner ring) and individual risk factor (outer ring), placed side‑by‑side for direct comparison. Tobacco, poor diet quality and alcohol dominate both regions; the precise mix is shaped by local food environments, regulatory history and trade exposure.

Premature deaths (under 70) attributable to risk factors, by category and individual risk factor, Caribbean & Atlantic vs Pacific & Indian Ocean, 2023. Hover any wedge for the count, share within category, and share of risk‑attributable total. Source: SIDS Initiative analysis of the Global Burden of Disease Study 2023.

The Initiative

The Initiative does not invent a new framework. It takes the priorities SIDS themselves set out in Annex 1 of the Bridgetown Declaration and elaborates them against the 2025 UN Political Declaration, the 2023 updated WHO NCD Best Buys and the 2024 Compendium of WHO and other UN guidance in health and environment. These are then paired and synergised with regional and country‑specific commitments, priorities, frameworks and processes. It is delivered through four action areas, each with a menu of policy options for countries to choose from:

Strengthen governance.

Address public‑sector vulnerabilities to undue influence and the structural barriers to policy adoption and implementation. Conflict‑of‑interest frameworks, access‑to‑information legislation, public‑health communication, and sustained surveillance of commercial influence.
Build resilient health and food systems.

Integrate climate risks into health‑system planning, infrastructure, and zoning codes. Transition away from health‑harming product industries toward sustainable local food production that strengthens both food‑system resilience and the health environment.
Create health‑promoting environments.

Counter the commercial practices that drive NCDs — fiscal policy and excise reform, marketing restrictions, warning labels, availability regulation and reformulation, across tobacco, alcohol, unhealthy foods and beverages, and fossil fuels.
Strengthen financing, procurement and surveillance.

Earmark health‑tax revenue for NCD management. Pool procurement of essential medicines and diagnostics regionally. Strengthen NCD and commercial‑determinant surveillance, including civil registration and vital statistics, cancer registries and behavioural risk factor surveys.

Call on all countries to provide financial and capacity building assistance to SIDS to address the impact of NCDs and mental health conditions in SIDS, including in addressing the environment‑nutrition nexus.
Bridgetown Declaration on NCDs and Mental Health, 16 June 2023

Two regional branches

The Initiative runs as two coordinated regional pilots. Each branch convenes its own SIDS‑to‑SIDS policy network, supports up to seven priority countries through an intensive policy accelerator, and channels learning back into the global SIDS grouping. The branches share methodology, technical packages and an evidence backbone, and diverge where regional context demands. Partners may support one branch, the other, or both — the joint Initiative is structured for either.

Caribbean & Atlantic

Regional Frameworks2007 CARICOM Declaration of Port‑of‑Spain: “Uniting to Stop the Epidemic of Chronic NCDs”, PAHO/WHO–CARICOM Subregional Cooperation Strategy 2025–2029, and the Caribbean Cooperation in Health framework.
Headline burdenNoncommunicable diseases cause more than three‑quarters of all deaths across the Caribbean.
Regional anchorsCARPHA, PAHO, PAHO/WHO Caribbean Subregional Program, CARICOM and Healthy Caribbean Coalition.
Indicative prioritiesHealth taxes on sugar‑sweetened beverages and tobacco; front‑of‑pack warning labels; restrictions on marketing of unhealthy foods to children; hypertension control programmes; climate‑resilient health‑system financing.

Country breakdown — premature deaths (under 70) attributable to the five risk-factor categories, as % of all-cause, Caribbean & Atlantic SIDS, 2023. Sorted by total attributable share, descending. Hover any country for its full breakdown.

Pacific & Indian Ocean

Regional FrameworksThe Pacific Islands NCD Roadmap and its 2025 review by the Pacific Heads of Health Meeting, the Pacific Legislative Framework for NCDs, and the Pacific Islands–WHO Multi‑country Cooperation Strategy.
Headline burdenThe ten countries with the world's highest adult obesity prevalence are all Pacific SIDS.
Regional anchorsPacific Islands Forum, SPC, WHO Western Pacific and South‑East Asia Regional Offices, WHO Office for the South Pacific, Pacific NCD Alliance.
Indicative prioritiesTobacco control scale‑up under the WHO FCTC; front‑of‑pack labelling; childhood obesity prevention in schools; pooled regional procurement of essential NCD medicines; climate‑resilient food‑system policy; conflict‑of‑interest frameworks.

Country breakdown — premature deaths (under 70) attributable to the five risk-factor categories, as % of all-cause, Pacific & Indian Ocean SIDS, 2023. Sorted by total attributable share, descending. Hover any country for its full breakdown.

Detailed country‑by‑cause burden mapping and prioritisation methodology for each branch are set out in the full proposal and its annexes.

The model: a SIDS‑to‑SIDS Network and Policy Accelerator

The Initiative's delivery model is adapted from the WHO‑convened Partnership for Healthy Cities — a network that has accelerated NCD and injury policy adoption across 74 cities comparable in population and geographic size to most SIDS. Each participating country receives an implementation grant, intensive technical assistance on policy design and enactment, and a seat in a peer network where SIDS learn directly from one another's wins and setbacks. South‑South cooperation, made operational.

…there are unique vulnerabilities for people living in developing countries, including in small island developing States, where noncommunicable diseases are increasingly becoming the main cause of mortality, and that small island developing States have among the highest rates of obesity worldwide and are disproportionately represented among the countries with the highest risk of dying prematurely from noncommunicable diseases.
Political Declaration of the 4th UN High‑Level Meeting on NCDs and Mental Health, 25 September 2025

The aim of the Initiative is to fill policy and implementation gaps across these areas, with initial comparable scoping — to be used in prioritisation and priority selection by SIDS — already available via WHO and UN datasets with cross‑referencing against the menu.

Initial comparable scoping across the eight policy domains for all SIDS, drawn from WHO and UN datasets cross‑referenced against the Initiative's menu of interventions. Coral shades indicate Caribbean & Atlantic countries; blue shades indicate Pacific & Indian Ocean countries; darker shading indicates higher implementation. Hover any cell for the country, domain, score, and per‑sub‑indicator detail.

The ask

Phase I runs over an initial two‑year period from the beginning of 2027, supporting up to seven SIDS per branch — drawn from a four‑dimensional prioritisation across need, risk, vulnerability and readiness. Phase II runs through to the end of 2030, aligning with the UN Secretary‑General's 2030 progress report and feeding evidence into the 5th UN High‑Level Meeting on NCDs in 2031.

What partners can expect by the end of Phase I.

Two new or significantly improved laws, regulations or policies — including revitalisation through implementation — in each of up to fourteen participating SIDS, protecting populations from the commercial drivers of NCDs and from climate‑related health risks.
Direct contribution to 2025 Political Declaration targets OP 41, 46, 63, 68, 69 and 75, and to SDG 3.4.
A peer‑reviewed evidence base and case‑study set, suitable for replication across SIDS and other constrained policy environments.
Support for SIDS momentum and leadership into the post‑2030 development agenda and the 5th UN High‑Level Meeting on NCDs in 2031.
Recognition as a foundational partner of a flagship SIDS‑led initiative, with full participation in governance and evaluation.

Express interest

If you would like to discuss partnering with the Initiative — at any level, on either branch or both — please share a few details below and we will respond within five working days with a tailored briefing and an invitation to a structured discussion.

The Global Small ISLAND Initiative