All 14 Pacific Developing Member Countries (DMCs) are considered small island developing states (SIDS), of which seven demonstrate the effects of fragility (Table 1). Of the 14 Pacific DMCs, seven (the Cook Islands, Fiji, the Marshall Islands, Nauru, Niue, Palau, and Tuvalu) have over half of their population living in urban areas. Except for the Cook Islands and Samoa, urbanization rates are increasing in all Pacific DMCs.
People are increasingly attracted to towns, as these urban areas become centers of commerce, seats of government, and places of opportunity and hope. Informal settlements dominate urban growth and are now a permanent feature of the urban landscape in many Pacific towns and cities. These informal settlements are usually characterized as having inadequate levels of basic services and infrastructure, such as water, sanitation, and waste disposal. Utility providers often have no obligation to provide services to settlements, with insecure land tenure further hindering efforts to improve services to residents.
Urban concentration in many Pacific DMCs contributes to public health risks. This is reflected in statistics for the prevalence of diseases related to poor water, sanitation, and hygiene, such as diarrhea, gastroenteritis, dysentery, typhoid, conjunctivitis, tinea, and ringworm. Compact urban centers, while ideal for providing efficient services, require careful consideration during design to allow for sufficient public space, provisions that target enhanced community well-being, and systematic upgrading of urban health services to be able to respond to health emergencies and pandemics. Large household sizes are also common across Pacific DMCs, with an average of 8.2 people per household in the Marshall Islands and 6.2 people per household in Kiribati. These household sizes increase the likelihood of transmission of communicable diseases.