Abstract
Small Island Developing States (SIDS) are disproportionately vulnerable to the adverse effects of climate change, with public health systems facing unprecedented threats from rising sea levels, extreme weather events, and shifting disease patterns. This study evaluates the extent to which climate change adaptation (CCA) strategies are integrated into the national health policies of 15 SIDS across the Caribbean and Pacific regions as of January 2024. Using a systematic document analysis of National Health Strategic Plans (NHSPs) and National Adaptation Plans (NAPs), we assessed policy alignment, thematic focus, and implementation barriers. Our findings reveal that while 87% of analyzed documents acknowledge climate change as a critical health threat, only 34% include specific, funded adaptation actions within their health sector budgets. Thematic analysis indicates a preoccupation with vector-borne diseases and disaster response, while mental health and non-communicable diseases (NCDs) exacerbated by climate stress remain largely neglected. Furthermore, financial constraints and a reliance on external international funding continue to hinder the mainstreaming of health-climate policies. We find that regional organizations play a pivotal role in bridging the gap between international climate finance and local health outcomes. The study concludes that achieving health resilience in SIDS requires a shift from reactive disaster management to proactive, ecosystem-based adaptation and the institutionalization of climate-sensitive health surveillance systems. These results provide a critical baseline for policymakers to enhance the coherence of cross-sectoral adaptation frameworks and secure sustainable health outcomes in the face of escalating climatic risks.