Our first comprehensive study on health and climate change in small island developing states shows that the lack of climate action is endangering lives and livelihoods – despite island states spearheading international attention on climate and health.

• More than a million people across SIDS are living in coastal areas that lie less than 1m above current sea level
• During the record-breaking summer heat of 2023, infants aged one year and younger experienced 48 times more heatwave days than the average in 2000–04 and older adults aged 65 and over experienced 36 times more heatwave days.

•  Compared with the period 1981-2010, an additional 2.6 million people reported moderate or severe food insecurity as a consequence of drought and heatwave days in 2022
• At the United Nations General Assembly in 2022, 64% of all climate and health statements came from leaders of Small Island Developing States

The report draws on data from the indicators of the 2023 and 2024 global Lancet Countdown reports to offer deeper insight into climate change-related impacts, mitigation, adaptation, economic capacity, and engagement specific to the 59 countries, states, and territories classified as UN member and associate-member Small Island Developing States (SIDS).

The inaugural indicator report of the Lancet Countdown Small Island Developing States (SIDS) represent a collaborative effort involving 35 authors from the Pacific, Caribbean, Indian Ocean, Europe, the Americas, Oceania, and Asia.