This research focuses on coral reef health in the South Pacific region, an area of high global coral diversity. Coral reef health surrounding four island case studies in the Cook Islands and Fiji have been assessed in areas that have not been previously surveyed. This study compares four islands with barrier and fringing reefs that have different levels of economic development, population pressure, land-use practices, and marine management practices. This interdisciplinary research methodology includes both ecological and social data collection to further understanding of human environment interactions. In comparing the reefs with different socio-economic factors, this research shows that reefs with traditional systems of resources management are healthier, population pressure is not the main factor causing the demise of the reefs and agro-industry is the main industry causing the degradation of the reef in these four South Pacific Islands. In addition, researchers need to use a whole reef perspective to examine coral reef health.