Small island developing states (SIDS) face unique challenges in preventing and managing NCDs and mental health conditions due to their geography, population size, vulnerability to climate change and food security, among other key factors. Building on the momentum from the 2007 Port of Spain Declaration on NCDs, 2014 SIDS Accelerated Modalities of Action (SAMOA) Pathway, 2021 WHO SIDS Summit for Health and other milestone events, WHO, PAHO and the Government of Barbados convened the SIDS Ministerial Conference and the SIDS High-level technical meeting on NCDs and mental health in 2023. As a result, the 2023 Bridgetown Declaration on NCDs and mental health was launched along with an online SIDS commitment page for NCDs and mental health. These efforts provide significant inputs into the preparatory process leading to the fourth UN High-level meeting on NCDs in 2025. WHO is leading dedicated action to support SIDS Member States in operationalizing their commitments in line with ongoing regional and national workplans and frameworks, to accelerate progress toward achieving the SDG 3.4 target.