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An estimated 2.7 million additional people across 26 Small Island Developing States (SIDS) were pushed into moderate to severe food insecurity because of more frequent droughts and heatwaves in 2023, while 4.4 billion potential work hours were lost to extreme heat in 2024, the highest annual loss since tracking began in 1990, according to a new report.
Heatwaves were associated with a 5.74 percentage point increase in food insecurity, while droughts contributed an additional 3.53 percentage point increase. Lower income households and countries heavily dependent on imported food were found to be particularly vulnerable.
Released ahead of this year's Pacific pre-Conference of the Parties (COP) meetings, the 2025 Lancet Countdown on Health and Climate Change in the SIDS report said the climate crisis is exacting an increasingly severe toll on the health, livelihoods and food security of island nations that collectively contribute less than 1 per cent of global greenhouse gas emissions.
The report, which tracks 28 indicators covering climate-related health impacts, adaptation, mitigation, finance and political engagement, found that clinically vulnerable populations are facing unprecedented heat exposure. Between 2015 and 2024, infants experienced seven times more heatwave days and adults aged 65 years and above experienced five times more heatwave days than during 2000 to 2009.
In 2024, ambient heat posed a record average of 3,000 hours of moderate risk of heat stress during light outdoor exercise, 41 per cent higher than the average observed during 1990-1999. Extreme heat also resulted in an estimated 4.4 billion potential work hours lost, with agriculture accounting for more than 1.3 billion lost hours.
"Heat is becoming one of the defining health challenges for Small Island Developing States," said Georgiana Gordon Strachan, regional director, Lancet Countdown SIDS.
"This report shows that protecting people from rising temperatures must now be a core priority for climate and health policy. We know what works. The challenge is ensuring that SIDS have the resources to implement solutions at the scale and speed that this crisis demands," she said.
Climate change is also increasing the transmission potential of mosquito-borne diseases such as dengue and chikungunya by creating more favourable conditions for Aedes aegypti and Aedes albopictus mosquitoes.
Ocean warming is adding further pressure on livelihoods and nutrition. The report found that coastal regions across SIDS recorded a 0.61°C increase in sea surface temperatures during the 2022 to 2024 average compared with the 1981 to 2010 baseline period. The warming threatens fisheries, marine ecosystems and food security across island nations that depend heavily on fish for income and protein.
Despite mounting climate impacts, adaptation remains limited. Only 10 of the 58 SIDS have dedicated national health and climate adaptation plans, while only 25 countries have health systems engaged in climate monitoring, an important component for surveillance of climate sensitive health outcomes. The report said limited institutional capacity, fragmented climate finance and insufficient investment continue to constrain adaptation efforts.
A dedicated chapter on climate finance found that international funding available to SIDS remains well below what is needed to protect health and strengthen resilience. Many countries continue to depend on loans, increasing debt burdens, while nearly half of identified climate financing needs remain uncosted, suggesting that actual investment requirements are substantially higher than current estimates.
The report nevertheless highlighted signs of progress. Solar photovoltaic electricity capacity across SIDS has increased 2.3 times since 2020, early warning systems have improved and deaths from extreme weather events have declined, indicating stronger disaster preparedness and resilience. The report also recognised SIDS for their continued leadership in global climate diplomacy, including the landmark International Court of Justice advisory opinion on states' obligations regarding climate change, driven by Pacific Island countries.
"The Pacific pre-COP meetings are an opportunity to put health at the centre of climate negotiations," said Roannie Ng Shiu, working group 1 lead, Lancet Countdown SIDS.
"SIDS have long led on climate action and justice. Now the international community must respond with the finance and partnerships needed to turn that leadership into lasting resilience," she said.