There is increasing recognition that non-communicable diseases (NCDs) are an important international and development issue globally, undermining health gains and imposing financial and economic costs on governments and households. NCDs are an important health challenge in the Pacific. First, (NCDs) can impose large but often preventable health, financial, and economic costs on countries. This is particularly important in the Pacific, where government already finances and provides the bulk of health services. Second, risk factors in the Pacific are feeding a pipeline of potentially expensive-to-treat NCDs, including diabetes and heart disease, but governments are already fiscally constrained in how much more they can provide to the health system. Third, from a public health and public finance perspective, many of the NCDs are avoidable or their health and financial costs can at least be postponed through good primary and secondary prevention. This will require a more coherent approach to health system financing and to health system operations, more generally. Improving both allocative efficiency ("doing the right things") and technical efficiency ("doing things right") are critical strategies to improve health outcomes in a financially sustainable way in the resource-constrained Pacific.