Climate change will bring mixed fortunes to Earth’s inhabitants. The inherent interconnectedness of Earth’s ecosystems, and their dependence on a stable climate, means that anthropogenic perturbations in the climate system will inevitably disturb the ecosystem
services which underpin all human existence. The rate of change in the global climate, and the difficulty in predicting with precision its future effects, thus pose a hazard to our global community’s capacity to work and rest, feed and flourish. If some regions do benefit from climate change, such benefits may be comparatively limited in terms of area and population involved. At the other extreme are regions and populations that will experience, precipitously and substantively, the negative effects of the numerous manifestations of a warming world. As they herald the unfolding future for the rest of the planet, highly climate-sensitive regions such as small island developing states (SIDS)1 are, in effect, the ‘canaries in the climate change coal mine’. In this chapter, we detail the drivers of the vulnerability2 of SIDS to the impacts of climate change and outline some of the key health risks and adaptive options these nations face. Examples and case studies cited will be taken predominantly from Pacific island nations, although their plight will be shared more broadly across developing island nations of the Caribbean and Indian Ocean regions.