Oceania can be characterized by a richness of culture, biodiversity and natural resources and a particular future that the changing climate will bring to islands, livelihoods and ecosystems. We reviewed literature detailing the limitations of siloed approaches to public health and conservation action for regional sustainability, highlighting opportunities for regional integration as place-based, through activities that are locally relevant, innovative engagement across a broader variety of sectors and working with indigenous peoples’ knowledges. We present three case studies that extend and redefine the boundaries of the fields of public health and conservation, enabling collaborators to better respond to complex issues impacting biodiversity and human health. These case studies make explicit the links between nutrition, catchment management, water resources, fisheries, marine protected areas and communicable and non-communicable diseases. Public health and conservation are more meaningfully connected in place-based, reciprocal and compassionate activities, using common language to draw on the well-developed instruments of both sectors. These will include health impact assessments and combine health and ecological economics, which together will contribute to responding to an emergent set of challenges, namely human population increase, urbanization, overfishing and more severe aspects of climate change.

Despite a growing body of literature on integrated land–sea management (ILSM), very little critical assessment has been conducted in order to evaluate ILSM in practice on island systems. Here we develop indicators for assessing 10 integrated island management principles and evaluate the performance of planning and implementation in four island ILSM projects from the tropical Pacific across different governance structures. We find that where customary governance is still strongly respected and enabled through national legislation, ILSM in practice can be very effective at restricting access and use according to fluctuations in resource availability. However, decision-making under customary governance systems may be vulnerable to mismanagement. Government-led ILSM processes have the potential to design management actions that address the spatial scale of ecosystem processes and threats within the context of national policy and legislation, but may not fully capture broad stakeholder interests, and implementation may be poorly coordinated across highly dispersed island archipelagos. Private sector partnerships offer unique opportunities for resourcing island ILSM, although these are highly likely to be geared towards private sector interests that may change in the future and no longer align with community and/or national objectives. We identify consistent challenges that arise during island ILSM planning and implementation and offer recommendations for improvement.