Tuvalu

Freshwater security is effectively the entirety of Tuvalu's practical One Health priority set, given the country's extremely limited land area and negligible agricultural sector.

Rising non-communicable disease linked to reliance on imported food and worsening freshwater scarcity represent the core health challenges facing one of the world's smallest health systems.

Tuvalu's health system is minimal in scale, with the vast majority of complex care requiring evacuation or referral to larger regional health centers given the country's tiny land area and population.

Saltwater intrusion into an already minimal freshwater lens is an acute and worsening environmental health threat with no viable long-term local solution beyond adaptation and desalination investment.

Formal veterinary infrastructure is effectively nonexistent given the country's negligible agricultural sector.

Tuvalu faces the most extreme sea level rise exposure of any nation, with credible long-term scenarios involving significant loss of habitable land, making it a global reference case for climate-driven displacement planning.

National surveillance capacity is negligible in absolute terms and depends entirely on regional Pacific health institutions and international technical support.

National survival and adaptation planning, including a pioneering digital nation initiative anticipating potential future displacement, dominates Tuvalu's long-term policy planning in a way with few global parallels.

Tuvalu is essentially entirely dependent on international climate adaptation and loss-and-damage financing, given negligible domestic fiscal capacity relative to its existential climate exposure.

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

Long-term health infrastructure investment planning is complicated by genuine uncertainty about the country's long-term habitability, a planning challenge with essentially no precedent elsewhere.

Tuvalu forces a question few other countries have to confront directly: what does health infrastructure investment even mean for a nation planning seriously for the possibility of losing its own territory. That's not a rhetorical question for Tuvalu's government, and financing partners need to take it just as seriously.