Since being first settled by humans more than 3000 years ago, the Pacific Islands region has experienced innumerable changes in climate that have affected livelihoods, something that underlines the sensitivity of such comparatively small and resource-constrained landmasses to extraneous change but also helps explain why their inhabitants developed resilience strategies that remain important today. During the past 100 years, the region has been affected by increased temperatures and sea-level rise, together with other climate-linked changes including variability in ENSO periodicity and tropical-cyclone frequency. Owing to the increasing pace of globalisation in the region during the same period, together with growing populations and demands on island resources, it is difficult to isolate changes ascribable to climate change; some of the clearest of these are the increases in coral bleaching, incidences of coastal flooding and shoreline erosion. Despite knowledge about the causes and effects of climate-related environmental (and related) changes in the region, supported by considerable financial aid and other external assistance, the awareness of most Pacific people about climate change and the extent of community buy-in to appropriate adaptation agendas have been negligible. Many governments have been unable to effectively disseminate awareness about climate-change stressors and adaptive solutions; most community-level decision-makers are unable to make informed decisions about long-term adaptation to observed changes. Warming and sea-level rise are both expected to accelerate within the next 100 years or so, causing profound changes to environments, societies and development aspirations within the region. Re-location of people from vulnerable to less-vulnerable locations within the region is unavoidable and should be planned for sooner rather than later. International partners of Pacific Island nations should become more aware of the pathways for embedding effective adaptation in the region. Regional agencies and governments should challenge and re-define their roles in promoting and disseminating climate-change adaptation strategies within the region. Awareness-raising should focus on persons of influence in Pacific Island communities to allow them to make informed and sustainable decisions about the environments they occupy.