Over 10% of the world’s population lives on islands. Yet in global health policy and systems research (HPSR), islands remain overlooked peripheries. This holds especially true for small, often formerly colonised, partially independent and generally tropical islands or island archipelagoes.
Summary
- Global health policy and systems research largely ignores small non-sovereign islands, despite these islands facing significant and unique challenges.
- Existing frameworks generally exclude islands or compress them into a single narrative with metropolitan political economies.
- Health system challenges on non-sovereign islands stem from political relationships with metropolitan states, not smallness alone.
- Decolonising global health requires research that treats islandness as an analytic category by itself.
- A decolonial research agenda for non-sovereign islands must be rooted in island priorities.
SOURCE: BMJ Global Health, Commentary by Robert AJ Borst. Vol.11, Issue 8. 12 August 2026. Open access.