Kiribati

Freshwater security and food safety given extremely limited arable land and freshwater lens capacity are the dominant and increasingly urgent One Health priorities.

Rising non-communicable disease linked to limited local food production and reliance on imported food, alongside worsening freshwater scarcity, represent the core health challenges.

Kiribati's health system is extremely limited in scale, with most complex care requiring referral or evacuation to larger regional centers given the country's minimal land area and population dispersion.

Saltwater intrusion into the freshwater lens, worsening with sea level rise, is an existential environmental health threat directly affecting drinking water and agricultural viability.

Formal veterinary infrastructure is minimal given the country's very limited agricultural base, with food security concerns centered almost entirely on imported food access.

Kiribati faces among the most severe sea level rise exposure of any country globally, with long-term habitability of some atolls now an active subject of national adaptation and, in some cases, planned relocation planning.

National surveillance capacity is minimal and depends almost entirely on regional Pacific health institutions and international technical support.

Freshwater security investment and long-term adaptation planning, including land elevation and potential relocation strategies, are explicit and unusually existential national priorities.

Kiribati is heavily dependent on international climate adaptation financing, with growing access to loss-and-damage and adaptation funds specifically tied to its extreme sea level rise exposure.

Australia, New Zealand, the World Health Organization, the Pacific Community, and multilateral climate funds anchor Kiribati's health and climate adaptation support.

Climate-resilient WASH infrastructure investment planning cycles remain mismatched with the pace of freshwater lens degradation already occurring, leaving current infrastructure investment perpetually behind the risk curve.

Kiribati is the clearest case globally for treating health infrastructure planning and climate adaptation as literally the same planning exercise, because for atoll nations, there is no meaningful distinction between the two.