The small, isolated island countries of the Pacific are extremely vulnerable to the effects of climate change and face a long term threat to their very existence from rising sealevels. At the same time, these „nano-countries‟ are experiencing an unprecedented wave of urbanization, the drivers and short term impacts of which are not dissimilar to those in other regions. The paper argues that regardless of this climate change backdrop, the political commitments and national priorities that shape physical investments in the Pacific are at heart anti-urban and weighted in favor of outer island, rural priorities. Furthermore, that it is the regressive or absent urban and housing policies and management systems - seemingly justified if, in the long term, the towns will be inundated by rising sea levels, and that have resulted in the parlous and immediate public health challenges that face urban residents. The paper explores this lacuna of policy and how it plays out in the Pacific and in the specific case study of Kiribati. It concludes with takeaways for practice by identifying entry points at the technical, governance and programmatic levels aimed at redirecting urban dialogue in the region in a more constructive
direction.