We examined how New Zealand activities impact on health in Pacific Island Countries and Territories (PICTs) in two domains: the provision of development assistance and the impact of trade. The available evidence suggests that New Zealand's official development assistance (ODA) is capably and strategically administered by its development agency, NZAID. However, New Zealand contributes comparatively little of its economic capacity to ODA; only 0.30% of gross national income, with a relatively small proportion spent in the health sector. Increasing this level of ODA and proportional spending on health is likely to be important for enhancing the long-term impact and credibility of the country's development assistance programme. New Zealand has a liberalised trade policy toward the PICTs which is likely to provide economic benefits. However, the country also exports health-damaging products to PICTs such as high-fat mutton flaps and tobacco. Permitting such exports may undermine non-communicable disease control strategies and are a significant area of policy incoherence given other support provided (e.g. for tobacco control). Overall there remains significant scope for New Zealand to contribute more effectively via aid and trade to health in the South Pacific.