Introduction: Over the past forty years, the World Health Organization (WHO) has methodically implemented the "healthy settings" approach. It has successfully shifted the focus from isolated individual behavior to the systemic improvement of the social, organizational, and physical environments where people live, learn, work, play, and love. The most developed healthy settings include cities, schools, universities, hospitals, regions, workplaces, prisons, and islands. In this context, the need for a systematic study of the theoretical foundations and the practical application of the individual initiatives naturally arises.
Aim: The aim of this article is to trace the historical development and present the theoretical framework — the strategic documents, vision, and frameworks for action of the "Healthy Islands" initiative.
Materials and Methods: A literature search for articles published from 1994 to 2025 was conducted in PubMed and Google Scholar, using the keywords "healthy islands", "vision", and "framework for action" in both Bulgarian and English. The official websites of the WHO and the WHO Regional Office for the Western Pacific were also reviewed.
Results: The historical development is presented chronologically from the inception of the initiative to the end of 2025. The retrieved articles and documents have been systematized and analyzed.
Conclusion: The "Healthy Islands" initiative continues to develop sustainably with the support of the WHO and the political will of island governments. The strategic documents of the initiative have been successfully adapted to local health issues and global challenges, such as climate change and health crises.
Бончева П. Места за промоция на здраве. МУ-Варна; Варна, 2026. ISBN 978-619-221-590-3.
de Leeuw E, Stevenson A, Jolley G, McCarthy S, Martin E. Healthy Cities, Urbanisation, and Healthy Islands: Oceania. In: de Leeuw E, Simos J, editors. Healthy Cities: The Theory, Policy, and Practice of Value‑Based Urban Planning. Cham: Springer; 2017.
WHO. Framework of Action for Revitalization of Healthy Islands in the Pacific. 2013. Available from: https://iris.who.int/server/api/core/bitstreams/f30ede49-2c2b-4045-b519-70b1eba29f3b/content
Galea G, Powis B, Tamplin SA. Healthy Islands in the Western Pacific—International settings development. Health Promot Int. 2000;15(2):169–78. doi:10.1093/heapro/15.2.169
WHO. Healthy Cities and Healthy Islands in the Western Pacific Region 1991–1996. Available from: https://iris.who.int/server/api/core/bitstreams/01920cc6-a6d0-45a6-84c5-acb49e20b2f7/content
WHO. Healthy Islands vision towards 2050. Available from: https://cdn.who.int/media/docs/default-source/wpro---documents/dps/healthy-islands/healthy_islands_vision.pdf
McIver L, Bowen K, Hanna E, Iddings S. A ‘Healthy Islands’ framework for climate change in the Pacific. Health Promot Int. 2017;32(3):549–57. doi:10.1093/heapro/dav094
Nutbeam D. Healthy Islands—A truly ecological model of health promotion. Health Promot Int. 1996;11(4):263–4. doi:10.1093/heapro/11.4.263
WHO. Ottawa charter for health promotion. Health Promot Int. 1986;1(4):405. doi:10.1093/heapro/1.4.405
WHO. Outcome of the Thirteenth Pacific Health Ministers Meeting, Tahiti, French Polynesia. 2019. Available from: https://iris.who.int/server/api/core/bitstreams/0a2575c9-302a-465c-991c-33874f09e7f6/content
WHO. Outcome of the Twelfth Pacific Health Ministers Meeting. 2017. Available from: https://iris.who.int/server/api/core/bitstreams/c50ebe94-6b92-48ef-b971-c3e70123ec8b/content
Ratu A, Tu’itahi S, Naivalulevu T, Wilson D, Barnes HM, Patrick R, et al. Healthy Islands at 30: Revitalising an ecological framework for planetary health. Lancet Planet Health. 2025;9(12):e101381. doi:10.1016/j.lanplh.2025.101381
Ritchie J, Rotem A, Nine B. Healthy Islands: From concept to practice. Pac Health Dialog. 1998;5(1):180–6.
Papua New Guinea Department of Health. The Papua New Guinea vision of healthy islands. 2013. Available from: https://pacifichealthdialog.nz/pre-2013-archive/Volume206/No220Health20of20Tongans20and20other20Pacificans/Review20Papers/The20PNG20vision20of20healthy20islands.pdf
WHO. The Rarotonga Agreement Towards Healthy Islands. 1997. Available from: https://iris.who.int/server/api/core/bitstreams/6b37592c-0a3e-4680-80bf-8e6b7436eac0/content
WHO Regional Office for the Western Pacific. Yanuca Island Declaration on health in Pacific island countries and territories: Eleventh Pacific Health Ministers Meeting, 15–17 April 2015. 2015. Available from: https://www.who.int/publications/i/item/PHMM_declaration_2015
WHO Regional Office for the Western Pacific. 2050 Strategy for the Blue Pacific Continent. Pacific Islands Forum Secretariat; 2025. Available from: https://forumsec.org/2050
WHO Regional Office for the Western Pacific. Apia outcome: Tenth Pacific Health Ministers Meeting, 2–4 July 2013. 2013. Available from: https://www.who.int/publications/i/item/9789290616351
WHO Regional Office for the Western Pacific. Conference of Ministers of Health for the Pacific Islands, Suva and Yanuca Island, Fiji, 6–10 March 1995: report. 1995. Available from: http://iris.wpro.who.int/handle/10665.1/10788
WHO Regional Office for the Western Pacific. Eleventh Pacific Health Ministers Meeting. 2015. Available from: https://www.who.int/westernpacific/about/how-we-work/pacific-support/pacific-health-ministers-meeting/pacific-health-ministers-meeting-archive/PHMM-11
WHO Regional Office for the Western Pacific. Healthy Islands. 2025. Available from: https://www.who.int/westernpacific/about/how-we-work/pacific-support/healthy-islands
WHO Regional Office for the Western Pacific. Madang Commitment to Healthy Islands. 2001. Available from: https://policycommons.net/artifacts/486728/lengagement-de-madang-en-faveur-des-iles-sante/1461510/
WHO Regional Office for the Western Pacific. Madang commitment. 2009. Available from: https://iris.who.int/items/a37f5f46-0c98-40de-95c1-f2ff90aec7d8
WHO Regional Office for the Western Pacific. Outcome of the Fifteenth Pacific Health Ministers Meeting, Nuku’alofa, Tonga, 20–22 September 2023. 2023. Available from: https://www.who.int/publications/i/item/WPR-2024-DPS-001
WHO Regional Office for the Western Pacific. Outcome of the Fourteenth Pacific Health Ministers Meeting, virtual meeting hosted by Tuvalu, 22–24 March 2022. 2022. Available from: https://www.who.int/publications/i/item/WPR-2022-DPS-001
WHO Regional Office for the Western Pacific. Pacific Islands action plan on climate change and health. 2018. Available from: http://iris.wpro.who.int/handle/10665.1/14236
WHO Regional Office for the Western Pacific; Secretariat of the Pacific Community. Samoa commitment: Achieving healthy islands: conclusions and recommendations. Meeting of Ministers of Health for the Pacific Island Countries, Manila; 2005.
WHO Regional Office for the Western Pacific. The vision of healthy islands for the 21st century: Regional implementation guidelines. 2002. Available from: https://iris.who.int/items/1f0383c4-c66c-47e2-890a-44d2181c3d61
WHO Regional Office for the Western Pacific. Third Pacific Health Ministers Meeting. 1999. Available from: https://www.who.int/westernpacific/about/how-we-work/pacific-support/pacific-health-ministers-meeting/pacific-health-ministers-meeting-archive/PHMM-03
WHO Regional Office for the Western Pacific. Vanuatu commitment. 2007. Available from: https://iris.who.int/items/a0603fd5-6c15-4f46-9b22-b3c9dd8eddec
Бончева П. Места за промоция на здраве. МУ-Варна; Варна, 2026. ISBN 978-619-221-590-3.
de Leeuw E, Stevenson A, Jolley G, McCarthy S, Martin E. Healthy Cities, Urbanisation, and Healthy Islands: Oceania. In: de Leeuw E, Simos J, editors. Healthy Cities: The Theory, Policy, and Practice of Value‑Based Urban Planning. Cham: Springer; 2017.
WHO. Framework of Action for Revitalization of Healthy Islands in the Pacific. 2013. Available from: https://iris.who.int/server/api/core/bitstreams/f30ede49-2c2b-4045-b519-70b1eba29f3b/content
Galea G, Powis B, Tamplin SA. Healthy Islands in the Western Pacific—International settings development. Health Promot Int. 2000;15(2):169–78. doi:10.1093/heapro/15.2.169
WHO. Healthy Cities and Healthy Islands in the Western Pacific Region 1991–1996. Available from: https://iris.who.int/server/api/core/bitstreams/01920cc6-a6d0-45a6-84c5-acb49e20b2f7/content
WHO. Healthy Islands vision towards 2050. Available from: https://cdn.who.int/media/docs/default-source/wpro---documents/dps/healthy-islands/healthy_islands_vision.pdf
McIver L, Bowen K, Hanna E, Iddings S. A ‘Healthy Islands’ framework for climate change in the Pacific. Health Promot Int. 2017;32(3):549–57. doi:10.1093/heapro/dav094
Nutbeam D. Healthy Islands—A truly ecological model of health promotion. Health Promot Int. 1996;11(4):263–4. doi:10.1093/heapro/11.4.263
WHO. Ottawa charter for health promotion. Health Promot Int. 1986;1(4):405. doi:10.1093/heapro/1.4.405
WHO. Outcome of the Thirteenth Pacific Health Ministers Meeting, Tahiti, French Polynesia. 2019. Available from: https://iris.who.int/server/api/core/bitstreams/0a2575c9-302a-465c-991c-33874f09e7f6/content
WHO. Outcome of the Twelfth Pacific Health Ministers Meeting. 2017. Available from: https://iris.who.int/server/api/core/bitstreams/c50ebe94-6b92-48ef-b971-c3e70123ec8b/content
Ratu A, Tu’itahi S, Naivalulevu T, Wilson D, Barnes HM, Patrick R, et al. Healthy Islands at 30: Revitalising an ecological framework for planetary health. Lancet Planet Health. 2025;9(12):e101381. doi:10.1016/j.lanplh.2025.101381
Ritchie J, Rotem A, Nine B. Healthy Islands: From concept to practice. Pac Health Dialog. 1998;5(1):180–6.
Papua New Guinea Department of Health. The Papua New Guinea vision of healthy islands. 2013. Available from: https://pacifichealthdialog.nz/pre-2013-archive/Volume206/No220Health20of20Tongans20and20other20Pacificans/Review20Papers/The20PNG20vision20of20healthy20islands.pdf
WHO. The Rarotonga Agreement Towards Healthy Islands. 1997. Available from: https://iris.who.int/server/api/core/bitstreams/6b37592c-0a3e-4680-80bf-8e6b7436eac0/content
WHO Regional Office for the Western Pacific. Yanuca Island Declaration on health in Pacific island countries and territories: Eleventh Pacific Health Ministers Meeting, 15–17 April 2015. 2015. Available from: https://www.who.int/publications/i/item/PHMM_declaration_2015
WHO Regional Office for the Western Pacific. 2050 Strategy for the Blue Pacific Continent. Pacific Islands Forum Secretariat; 2025. Available from: https://forumsec.org/2050
WHO Regional Office for the Western Pacific. Apia outcome: Tenth Pacific Health Ministers Meeting, 2–4 July 2013. 2013. Available from: https://www.who.int/publications/i/item/9789290616351
WHO Regional Office for the Western Pacific. Conference of Ministers of Health for the Pacific Islands, Suva and Yanuca Island, Fiji, 6–10 March 1995: report. 1995. Available from: http://iris.wpro.who.int/handle/10665.1/10788
WHO Regional Office for the Western Pacific. Eleventh Pacific Health Ministers Meeting. 2015. Available from: https://www.who.int/westernpacific/about/how-we-work/pacific-support/pacific-health-ministers-meeting/pacific-health-ministers-meeting-archive/PHMM-11
WHO Regional Office for the Western Pacific. Healthy Islands. 2025. Available from: https://www.who.int/westernpacific/about/how-we-work/pacific-support/healthy-islands
WHO Regional Office for the Western Pacific. Madang Commitment to Healthy Islands. 2001. Available from: https://policycommons.net/artifacts/486728/lengagement-de-madang-en-faveur-des-iles-sante/1461510/
WHO Regional Office for the Western Pacific. Madang commitment. 2009. Available from: https://iris.who.int/items/a37f5f46-0c98-40de-95c1-f2ff90aec7d8
WHO Regional Office for the Western Pacific. Outcome of the Fifteenth Pacific Health Ministers Meeting, Nuku’alofa, Tonga, 20–22 September 2023. 2023. Available from: https://www.who.int/publications/i/item/WPR-2024-DPS-001
WHO Regional Office for the Western Pacific. Outcome of the Fourteenth Pacific Health Ministers Meeting, virtual meeting hosted by Tuvalu, 22–24 March 2022. 2022. Available from: https://www.who.int/publications/i/item/WPR-2022-DPS-001
WHO Regional Office for the Western Pacific. Pacific Islands action plan on climate change and health. 2018. Available from: http://iris.wpro.who.int/handle/10665.1/14236
WHO Regional Office for the Western Pacific; Secretariat of the Pacific Community. Samoa commitment: Achieving healthy islands: conclusions and recommendations. Meeting of Ministers of Health for the Pacific Island Countries, Manila; 2005.
WHO Regional Office for the Western Pacific. The vision of healthy islands for the 21st century: Regional implementation guidelines. 2002. Available from: https://iris.who.int/items/1f0383c4-c66c-47e2-890a-44d2181c3d61
WHO Regional Office for the Western Pacific. Third Pacific Health Ministers Meeting. 1999. Available from: https://www.who.int/westernpacific/about/how-we-work/pacific-support/pacific-health-ministers-meeting/pacific-health-ministers-meeting-archive/PHMM-03
WHO Regional Office for the Western Pacific. Vanuatu commitment. 2007. Available from: https://iris.who.int/items/a0603fd5-6c15-4f46-9b22-b3c9dd8eddec
