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The 2024 Lancet Countdown report on Small Island Developing States (SIDS) highlights the critical health and climate challenges faced by these regions, which are particularly vulnerable to extreme weather and climate change. The report emphasizes the urgent need for a health-centered response, calling for international action to reduce greenhouse gas emissions from high-income countries, as SIDS collectively contribute low emissions. Rising temperatures pose significant health risks, especially for infants and the elderly, with increased heatwave exposure leading to higher mortality rates and economic losses. Despite some adaptation strategies, such as urban greening initiatives, these measures have not sufficiently mitigated high urban temperatures. Additionally, climate change exacerbates food insecurity and unhealthy diet trends, negatively impacting the overall health and productivity of SIDS populations. Adapting to heat through targeted efforts remains crucial yet underexplored, with only one relevant Green Climate Fund project approved from 2015 to 2023. Limited early-warning systems for heat-related health risks and inadequate surveillance of heat-sensitive conditions further complicate the situation, leading to substantial economic losses and increased food insecurity. Labor-intensive sectors must adjust working conditions to safeguard worker health and productivity. Moreover, the intensified risk of infectious diseases and the destabilization of food systems reveal that most SIDS are ill-prepared to effectively manage climate-related health threats. Transitioning to sustainable agricultural practices and renewable energy sources is essential for enhancing resilience and overall health outcomes in these regions.