This report serves as the background document to the Special Initiative on Climate Change and Health in Small Island Developing States (‎SIDS)‎, which was launched by WHO in collaboration with UNFCCC and the Fijian Presidency of the COP23 in 2017. 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.