Optimising small island developing states and overseas countries and territories classification for comparative...

Aiming to investigate small island resilience in public health emergencies, we found existing classifications of Small Island Developing States (SIDS) failed to provide a homogeneous group suitable for comparative studies. While SIDS classifications highlight small states' challenges globally, they include countries with vast differences in geography, population, economy and health systems, making them ineffective for studying public health emergency resilience. Islands classified as Overseas Countries and Territories (OCTs) face similar challenges to SIDS. Considering both in comparative research offers deeper insights into shared vulnerabilities and strengths, policy effectiveness and the variability in response strategies. As global health efforts focus on pandemic preparedness, a more precise classification system is essential to identify patterns across similar small island contexts. To improve comparability for public health research, we propose an alternative classification method that integrates SIDS and OCTs, using clear, data-driven criteria.We applied three criteria to identify islands with comparable characteristics relevant to public health emergency resilience: population size≤1.5 million, insularity and Gross Domestic Product per capita≤US$30 000. This data-driven approach identified 51 islands forming a more homogeneous group for comparative analysis. Despite limitations in data availability, indicator reliability and the application of not universally standardised thresholds, our method offers a pragmatic response to the lack of uniform classification and highlights the need for standardised, context-sensitive data collection. While acknowledging the need for ongoing refinement and broader multidimensional indicators, this approach allows for more accurate research on public health emergency resilience, enabling small islands to better advocate for tailored support.