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The small island nations, territories, and states dotting the Pacific are among the most disproportionately affected populations worldwide in the face of climate change. Sea level rise coupled with increased tropical storms contribute to seawater incursion, flooding, personal injury, trauma, and death. They face an existential threat due to the consequences of global warming, specifically ice melt resulting in sea level rise, repercussions for which they are not historically culpable. Along with these environmental threats, Pacific Island communities are further burdened with high rates of adverse health conditions such as diabetes and obesity yet have limited healthcare resources due to minimal economic development. The Republic of the Marshall Islands (RMI) has one of the highest amputation rates worldwide due to advanced diabetes from lifestyle factors, limited healthcare infrastructure, financial disparities, and a culturally based hesitancy to seek medical attention, all of which lead to an increased incidence of diabetic complications. Challenges posed by non-communicable chronic diseases include diabetes and infectious diseases like tuberculosis, hepatitis, malaria, and Zika. Just as crucial to the narrative of the Marshallese people is a fundamental indigenous knowledge of their surroundings and an inseparable relationship to the environment, aquatic animals, and communities around them, denoting a holistic living system. Though the outlook is precarious, solutions centering on lifestyle interventions that are informed by Indigenous cultural strengths can provide a responsive framework and a ray of hope, offering potential solutions to these two. This short perspective highlights the RMI as a case study of the challenges the Pacific Island nations bear, from a legacy of annexation to the modern threat of climate change, compounded by health disparities.