Until recently, poverty and hardship have not generally been recognized as serious policy issues for the Pacific Island Governments to address. However, the impact of globalization, increasing labour mobility and domestic economic reforms are leading to the monetizing of even the remotest parts of the islands and are bringing about significant changes to societies. Rising youth unemployment and weakening traditional structures are also causing growing concerns for social welfare. Rates of economic growth have been low and poverty and inequality appear to be rising. This article argues that committed implementation of pro-poor policies are urgently required to address these issues. Poverty reduction and hardship alleviation interventions must be aimed directly at achieving pro-poor growth and meeting the Millennium Development Goals (MDGs). Those interventions need to be adapted to specific country circumstances, also according due attention to the needs of the most disadvantaged segments of the population.