For the last 20 years, the world's highest incidence of ciguatera poisoning has been reported in Rarotonga, which is located in the southern Cook Islands. Therefore, Rarotonga is an ideal location to understand the socioeconomic consequences of ciguatera poisoning on small-island communities. In 2011, information on protein consumption preferences was collected from 179 Rarotongan households and compared with previous food consumption studies. This study showed that ciguatera poisoning halved the per-capita fresh fish consumption, from 149 g/person/day in 1989 to 75 g/person/day in 2006. Consequently, the consumption of alternative proteins, particularly imported meats, increased from 1989 to 2006. The cost-savings-and-avoidance valuation technique, used to estimate the direct loss in value of marketable goods and services, showed that the economic consequences of ciguatera poisoning amounted to approximately NZD $750,000 per year. Approximate costs associated with dietary shifts amounted to NZD $1 million per year. With the decline in cases of ciguatera poisoning in recent years, fresh fish has returned to the menu of residents, and the per-capita fresh fish consumption increased to 104 g/person/day in 2011. Yet over the last two decades, the impact of ciguatera poisoning on the local Rarotongan community may have had long-term health-related consequences, and may have changed the social, cultural, and traditional characteristics of a once subsistence fishing lifestyle.