Introduction. In contrast to continental nations, the world’s 52 small island developing states (SIDS) experience disproportionate challenges to public health and sustainable development related to their geography, small size, and physical isolation. While SIDS nations contribute only infinitesimally to climate change, they bear an outsized burden of the global consequences. Methods. The salient public health challenges for achieving effective disaster risk reduction and risk management (DRR/DRM) for the SIDS nations are reviewed within the context of United Nations guidance, the Sendai Framework, and the Sustainable Development Goals. Results. SIDS nations experience early and exaggerated impacts associated with climate change, sea level rise, natural disasters (tropical cyclones, earthquakes, tsunamis, volcanoes), and marine hazardous materials spills. The disaster risk landscape is shaped by three defining features of SIDS: 1) small size and correspondingly limited resources; 2) elevated disaster frequency and severity based on tropical geography, geophysics (seismicity, volcanic activity, proximity to tectonic plate boundaries), topography (sea level elevation, 360-degree coastal perimeter, steep terrain in many of the SIDS); and 3) physical isolation (precisely because SIDS are island nations). Cyclone Winston’s direct impact on Fiji in 2016, and Cyclone Pam’s landfall over Vanuatu in 2015 - immediately following a combination earthquake, tsunami, and volcano mega-disaster - illustrate the special vulnerabilities of the SIDS. Conclusions. The trifecta of 1) natural disaster vulnerability, 2) climate change, and 3) rising ocean levels interrelate synergistically to elevate SIDS’ disaster risks. Dispersed broadly throughout the oceans of the world, the SIDS act as an early warning network for emerging global threats. Therefore, public health and DRR/DRM strategies must be tailored to the unique constellation of disaster hazards and vulnerabilities that characterize the SIDS. Urgent imperatives for SIDS nations include 1) formation of robust alliances among counterpart island nations and 2) infusion of international support to enhance disaster resilience.