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•Tuvalu faces triple threats of obesity, climate change, and food insecurity.•The nutritional status, health and climate factors in Tuvalu are understudied.•Prevalence of obesity was consistently high in Tuvalu, while food consumption patterns varied between the two surveys.•Climate changes in Tuvalu predict increasing trends in temperature and sea level.•Precision public health interventions are needed within the context of the triple threat faced in Tuvalu. The aim of this study was to analyze temporal trends of food consumption patterns, attitudes, and health-related knowledge in Tuvalu, a small Pacific Island country facing the triple threat of obesity, climate change, and food insecurity. Two waves of the COMmunity-based Behavior and Attitude (COMBAT) survey were conducted in 2020 and 2022. Descriptive characteristics of changes in obesity proportion, food intake, and sociodemographic factors were assessed. Additionally, this study also integrates individual climate data utilizing satellite-based prediction models, and estimates historical temperature, precipitation, and sea level trends among all islands in Tuvalu. The study revealed a high obesity proportion among adults (69.5% in 2020, 73.2% in 2022) and an increase in the percentage of adolescents with a high waist circumference. Variations in food intake were also observed between the two waves of the survey. The data collected in the COMBAT study provides valuable insights for future epidemiological research to elucidate the associations and causal relationships between climate change, food security, and non-communicable diseases in Tuvalu.

Pacific Island countries and territories (PICTs) face unique challenges in delivering health care and sustaining digital health systems. These challenges include geographically dispersed populations and service delivery points, workforce shortages, and poor infrastructure. National electronic health records (EHRs) can strengthen health systems by facilitating continuity of care but are only available in 47% of countries worldwide. The status of national EHRs in PICTs has not been previously described in the published literature. This study aimed to map national EHR coverage in 14 PICTs of the World Health Organization (WHO) Western Pacific Region classified as Small Island Developing States (SIDS). This included the presence or absence of a national EHR; identification of EHR software used; coverage nationally and across primary, secondary, and tertiary facilities; presence or absence of supporting digital health or health information system strategies and policies; comparison of national EHR coverage in PICTs with national EHR coverage globally; and exploration of a relationship between EHR coverage and country income in PICTs. Given the absence of peer-reviewed literature on EHRs in PICTs, an environmental scan methodology was selected to review gray literature sources. We conducted a 3-stage environmental scan to systematically search publicly available websites across government, bilateral, multilateral, and philanthropic organizations for documents describing the status of national EHR implementations in the aforementioned 14 PICTs. Of the 14 PICTs assessed, 12 countries (86%) have an EHR implemented at some level of the public health system, and 8 (57%) have a single national system implemented at more than one facility. Although this is higher than national EHR coverage rates globally (57/122, 47%), average coverage across the 12 PICTs using EHRs was only 39% (median 16%). We also identified a positive relationship between EHR coverage and country income status and generally medium to high EHR coverage across tertiary hospitals (19/41, 46%) and secondary care facilities (29/77, 38%) but low implementation at primary care facilities (61/4158, 1.5%). EHR coverage across all facilities in the 14 countries assessed was 2.5% (108/4267). EHR software used includes Tamanu (Nauru, Palau, Samoa, Kiribati, Fiji [Aspen Medical public-private partnership hospitals]), Medtech (Cook Islands, Niue), Vesalius (Tonga), PATIS Plus (Fiji), and custom systems. Our findings demonstrate, for the first time, that EHRs are being implemented in PICTs, including at scale in some settings. Despite high apparent coverage in some PICTs, the success of implementation and health worker usage remains unclear. Gray literature indicates that some EHRs currently available are failing or incapable of scaling nationally. To support sustainability of national EHRs in PICTs, governments should prioritize the implementation of fit-for-purpose, open-source, and scalable EHRs, and future studies should assess the success of EHR adoption and impact in the region.

Historically, Persons with Disabilities (PwDs) are disproportionately affected by disasters. In Pacific Island Countries (PICs), the risks and vulnerabilities of PwDs arise from social inequalities, as well as environmental barriers. As the frequency and intensity of disasters will increase over the next decade, it is critical that the challenges faced by PwDs are addressed and that they are prepared. This study explores disaster preparedness, perceptions, and experiences with disasters among PwDs in Tuvalu. This qualitative study was carried out among people with physical and sensory disabilities and without post-traumatic stress disorder (PTSD), who are aged 21 and above. Using grounded theory methodology, semi-structured in-depth interviews were conducted with 24 participants, with 7 then participating in a Focus Group Discussion (FGD). A total of 31 PwDs participated, of which 65% were male and 35% female, with a mean age of 44 ±15.70. The results showed how the PwDs ability to prepare, their perceptions, and experiences with disasters have contributed to their resilience to disasters. This study highlights the importance of understanding PwDs lived disaster experience to improve their preparedness and resilience for future disasters. This knowledge will assist government and non-government organisations, communities, and families to develop policies and plans that will enhance the preparedness of PwDs for disasters.

This entry paper explores the multifaceted oral health crisis in the Pacific island nation of Tuvalu, a remote archipelago of nine coral atolls. It delves into the severe burden of oral diseases, such as early childhood caries (ECC) and periodontitis, which are rampant within its population of just over 11,000. The analysis investigates the primary drivers of this crisis, including a significant dietary transition towards imported, ultra-processed foods, compounded by profound socioeconomic challenges and a lack of public health literacy. The paper critically examines the systemic failures of the national healthcare system, characterized by the absence of a formal oral health policy and a critically inadequate dental workforce, which forces residents to seek complex care abroad. Furthermore, it highlights how extreme geographic isolation and severely limited air connectivity function as direct barriers to accessing essential services, rendering specialized treatments like orthodontics and effective management of dental emergencies virtually impossible. In response to these challenges, the paper discusses innovative, forward-looking solutions, including the potential of teledentistry to bridge service gaps, the strategic development of regional medical or dental hubs in proximity to the biggest airports to centralize care, and the necessity of integrating oral health into broader strategies for economic development and climate resilience.

As increasing global temperatures lead to sea level rise and associated impacts (e.g. flooding, erosion, saltwater intrusion), the relocation of people and assets away from sites of coastal risk has been viewed by some as a certainty. However, many people affected by emerging coastal changes remain in sites of residence. Here we examine the experiences of residents in three low-lying villages across two small island states: Dreketi and Karoko in Fiji, and Funafala in Tuvalu. Analysis of qualitative data from interviews shows that residents are concerned about local coastal changes, and largely attribute them to climate change. While some anticipate future relocation and retreat, and a few households have retreated short distances away from the coast, for now residents remain in and move to these sites to maintain livelihoods, practices, well-being, and sense of belonging. These are places that people value and plan to live in as long as possible. The contribution of this paper is to highlight the vernacular explanations of overlapping drivers of immobility and translocality in sites of coastal risk. It indicates the need to move away from the binaries of immobility/mobility and of trapped/voluntarily immobile populations and to examine the multiplicities of human (im)mobility.

Environmental stewardship is crucial for fostering sustainable development, particularly in vulnerable small-island developing states like Tuvalu. Government policies and frameworks play a vital role in shaping the education system, but inconsistencies in policy alignment often hamper efforts to embed Environmental Stewardship Education (ESE) into the national curriculum. We aimed to answer four questions: 1. What formal policies shape Environmental Stewardship Education (ESE) in Tuvalu? 2. Are national educational and environmental policies mutually consistent? 3. Are these national policies consistent with regional and global policies? 4. What challenges hinder the implementation of ESE in Tuvalu? These questions were addressed using a study of regional, international, and Tuvaluan online-available documentary assessments of national policies and frameworks in conjunction with those obtained from the Education Department. Our findings revealed that a combination of Tuvalu’s environmental and educational policies was instrumental in shaping ESE. Nationally, educational and environmental policies are internally inconsistent, as well as being inconsistent externally with regional and international policies. Recommendations for improving policy alignment and the sustainable integration of ESE into the curriculum are provided. The second part (Part 2) of our review covers the development and delivery of effective curricula for ESE.

This article examines the risks posed by climate change to Tuvalu, a Pacific Island nation highly vulnerable to rising sea levels. It explores a series of short-term and long-term risks, such as the potential disappearance of its territory and the resulting displacement of its population, alongside impacts on natural resources, coastal erosion, saltwater intrusion, and extreme storms. The article discusses measures that the Government of Tuvalu, in collaboration with the international community, has implemented to strengthen community resilience so far. These actions include the use of adaptation technologies to mitigate the impacts of climate hazards, as well as the search for legal and financial solutions to compensate for losses or plan for possible migration in the future. The article concludes by reflecting on the implications for national governance and the international community. Are these interventions effective or, on the contrary, are they perpetuating global inequalities in the fight against climate change?

In the geopolitics of climate change the low-lying islands of Tuvalu are a ‘weak actor’. They are often referred to as the ‘canary in the mine’ concerning the planet’s future in the midst of a superwicked problem. The islands are overwhelmingly Christian in profession: the default practice is to turn to the book of Job and Noah in seeking to understand their plight. They are seldom referred to in theological works beyond the ‘liquid continent’ of Oceania. There is no theological college on any one of these eight atolls and reef islands. In this kind of context the prospective theologian is likely to be a climate activist, a political figure and an advocate for indigenous knowledge. This coming together of formative influence leads to an embodied public theology that draws upon themes to do with what does it mean to be a good neighbour.

This commentary is the second in a two-part series on Environmental Stewardship Education (ESE) in Tuvalu. While Part 1 examined the alignment between education and environmental policies, this follow-up focuses on how those policies are—or are not—translated into formal curriculum and classroom practice. Drawing on both academic research and professional experience in government, this article explores the gap in curriculum design, student engagement, and teaching strategies. It argues for the early integration of ESE in primary education, greater inclusion of traditional ecological knowledge, and participatory teaching approaches. These insights are grounded in Tuvalu’s context but offer valuable lessons for other small island developing states striving to align sustainability policy with educational delivery.

Soft drink consumption has become a significant public health concern that is associated with various adverse health outcomes.We aim to examine the association between soft drink consumption and aggressive behavior among adolescents.We used open access data from 79 studies in 64 countries, including 263,890 adolescents aged 12–18 years who completed the global school-based student health survey (GSHS). Self-reported data on past 30-day carbonated soft drink consumption (number of times per day) and past 12-month physical fighting were utilized for analysis. Of the 263,890 participants (48% boys) aged 12–18 years, the weighted mean frequency of soft drink consumption varied from 0.5 in Kiribati to 2.5 times/day in Surname, while the weighted prevalence of frequent aggressive behavior varied from to 2.7% in Laos to 49.2% in Tuvalu. We found that each increment of soft drink consumption (time/day) was associated with an 11% (95%CI 10–13%) increase of the likelihood of frequent physical fighting. This result remained significant after adjusting for various covariates. In this large pooled sample of multinational data, there is a significant positive association between soft drink consumption and aggressive behavior among adolescents. Reducing soft drink consumption may help reduce aggressive behavior, a major risk factor for violence.