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This Millennium Development Goals Report (MDGR) is designed to be a tool for awareness raising, advocacy, alliance building, and renewal of political commitments at the national level, as well as building capacity for monitoring and reporting on goals and targets. This MDGR is, therefore, primarily a public affairs document, especially since during its preparation there was limited consultation with the non state actors and the private sector as key partners in achieving the MDGs. As a living document, the MDGR will be revised periodically, based on consultation with development partners.

In terms of national aggregates, the Cook Islands have already achieved two of the Millennium Development Goals (MDG's): Goal 4 on Reducing Infant Mortality and Goal 5 on Maternal Health. With the exception of Goal 7 on environmental sustainability and an additional Goal 9 on Improving Governance, the Cook Islands is capable of achieving most of the other MDG's by the year 2015.

Asia-Pacific is a region of contrasts. It has some of the fastest-growing economies of the world while, at the same time, the Least Developed Countries (LDCs) continue to face persistent challenges. As a whole,the region has made significant inroads into poverty reduction with progress toward the internationally agreed Millennium Development Goals (MDGs). China and India, together accounting for nearly 40 percent of the world's population and ranking among the fastest-growing countries, account for most of this progress, along with the "tiger" economies of East and South-East Asia. Due to the tyranny of averages, the relatively poor performance of the Asia-Pacific LDCs gets overshadowed. Only a more disaggregated appraisal reveals the far more limited gains in the LDCs1. Thus, the dynamism of Asia represents both a challenge and an opportunity. It could increase inequalities that contribute to growing tensions. It also could generate resources and opportunities. Attainment of the MDGs in Asia and the Pacific as a whole will be marked by the far more limited progress made by the 14 LDCs of the region.

Climate variability is the variation around the average climate, including seasonal variations as well as large-scale variations in atmospheric and ocean circulation such as the EI Nino/Southern Oscillation (ENSO). Climate change operates over decades or longer. Changes in climate occur as a result of internal variability within the climate system and external factors (natural and anthropogenic). Although climate is always changing, over the past 10,000 years it has been both relatively stable and warm.

Small island states are the countries likely to be most vulnerable to climate variability and long-term climate change, particularly extreme weather and climate events (such as cyclones, floods and droughts) and sea-level rise. Many small island states share characteristics that increase their vulnerability, these include their small sizes, isolation,limited fresh water and other natural resources, fragile economies, often dense populations,poorly developed infrastructures and limited financial and human resources. To understand better the potential health impacts of climate variability and change in small island states and to build capacity to cope with climate change through adaptation planning, a series of workshops and a conference were organized by the World Health Organization (WHO) in partnership with the World Meteorological Organization (WMO) and the United Nations Environment Programme (UNEP)(WHO 2000; Aron et al. 2003; WHO 2003). This report synthesizes the information presented and identifies key recommendations for improving the health sector’s capacity to anticipate and prepare for climate variability and change. There is ample evidence that many small island states currently are vulnerable to climate variability. Climate change projections increase the level of concern because models suggest that small island states will experience not only warmer temperatures, but also increased climate variability. The consequences of increased climate variability are likely to be related to changes in rainfall, soil moisture budgets, prevailing winds (speed and direction), regional and local sea levels and patterns of wave action. El Niño events are likely to strengthen the short-term and inter annual variations. In addition, global mean sea level is projected to increase by0.09 m to 0.88 m by 2100. To understand better the potential human health consequences o fthese projected changes, the following questions were addressed

The Cook Islands has already achieved the targeted two third reduction of under 5 year olds mortality rate from 26 per 1000 live births in 1991 to 7.7 in 2001. The infant mortality rate dropped from 31.3 infants per 1000 live births in 1991 to 9.8 in 2001.Whilst the maternal health indicators for Cook Islands women were rated amongst the best in the region, there remain some worrying statistics. Teenage pregnancies had been on the increase in the past with a quarter of childbearing women reportedly having children during their teenage years. In general, key health issues affecting mothers and women include the relatively high incidences of cervical and breast cancers, and increasing prevalence of non-communicable disease (NCDs) such as diabetes, obesity, hypertension, circulatory illnesses and their complications resulting from changing lifestyles of the Cook Islands population. NCD’s are now the major cause of morbidity and mortality in the adult Cook Islands population.There are no officially recorded cases of HIV/AIDS in the Cook Islands although there are 2 resident HIV/AIDS cases (one male, one female) in the Cook Islands. Prevention and awareness raising programmes on the modes of transmission and risks of HIV/AIDS in the Cook Islands need to be maintained and further strengthened.

In 2003, the ADB conducted a summary review of the MDGs in the RMI. The ADB described the progress of the RMI in meeting the specific targets of the MDGs as “slow” (ADB, 2003:13). In some areas, particularly in reducing infant and maternal mortality and increasing gender equality in education, the RMI was praised for making marked improvements. However, in other areas, the RMI was seen as making little or only moderate progress, particularly in terms of access to clean water and sanitation, combating communicable diseases such as HIV/AIDS, TB, other sexually transmitted diseases, diabetes, influenza, etc., and addressing specific poverty reduction strategies such as access to employment opportunities and reducing development gaps between the urban centers and rural outer-islands.