In 2017, at the 23rd COP (_COP23)_ of the UNFCCC in Bonn, WHO launched a Special Initiative on Climate Change and Health in Small Island Developing States (_SIDS)_ in collaboration with UNFCCC and the Fijian Presidency of the COP23. The Initiative recognizes that SIDS are on the front line facing a range of acute and long-term risks caused by climate change. Most SIDS have made a very small contribution to the overall global emissions that cause climate change and yet they are amongst the most affected countries . This report serves as the background document to the Pacific Island Action Plan on Climate Change and Health (_http://iris.wpro.who.int/handle/10665.1/14236)_ with some updates surrounding four strategic lines of action: (_1)_ Empowerment; (_2)_ Evidence; (_3)_ Implementation; and (_4)_ Resources. This report also complements the previous comprehensive publication on Human Health and Climate Change in Pacific Island Countries.