<p>Health equity – defined as the absence of unfair and avoidable differences in health outcomes- is a critical concern for Small Island Developing States (SIDS) such as Saint Lucia where limited fiscal space, demographic transition and environmental vulnerability converge. Although Saint Lucia has made notable investments in health infrastructure and service expansion, inequities persist along socio-economic, geographic, gender and linguistic lines. This policy-oriented paper situates Saint Lucia within the global and Caribbean health equity literature and uses a health equity framework to examine how structural determinants (income, employment, education, housing), health system arrangements (financing, service organization, human resources) and cultural-linguistic factors (Saint Lucian Creole, trust in institutions, gender norms) interact to shape health outcomes. Drawing on national statistics, regional reports and emerging local research, the paper highlights persistent inequities in non-communicable diseases, maternal and child health, and access to preventive and specialist care between urban and rural communities and between income groups. It also documents recent progress, including mental health reform and community integration, steps towards Universal Health Coverage and National Health Insurance, and the expansion of social protection and equity-oriented governance initiatives. Building on these experiences, the paper proposes a set of context-specific pathways for advancing health equity in Saint Lucia, centred on equity-focused policy and planning, strengthened primary health care, cross sectoral action on social determinants, fair health financing, culturally competent care, and improved use of disaggregated data. The Saint Lucian case illustrates how a small island state can begin to operationalise health equity as both a justice imperative and a core metric of health system performance in a resource-constrained setting.</p>