At the February 2000 meeting of the Pacific Island Health Officers Association (PIHOA), the Centers for Disease Control and Prevention (CDC) proposed a regional strategy for promotion of emergency environmental health in the Pacific. This CDC Pacific Emergency Health Initiative (PEHI) called for a pro-active partnership of governmental institutions, international agencies, Pacific nations, the Pacific Basin Medical Association and PIHOA. The mission of PEHI is to "strengthen the capacity for emergency health preparedness and response among Pacific island nations". This article describes the history and development of PEHI and offers insight into future efforts.