This chapter provides an overview of the history of Public Health in the English-speaking Caribbean from the seventeenth to the twenty-first century. The Columbian Exchange introduced infectious diseases that decimated the indigenous population. This led to the trans-Atlantic slave trade and enslavement of Africans to work on the plantations throughout the Caribbean under brutally harsh and inhumane conditions. Diseases like smallpox, yellow fever, and malaria devastated enslaved Africans, and there was little investment in preventive care. Post-emancipation in the nineteenth century saw the arrival of indentured labourers from China and India, worsening conditions for freed slaves, as poverty, cholera, poor nutrition and inadequate sanitation fuelled high mortality rates. The 1920s marked a turning point, with improved sanitation and disease control programmes. However, depressed economic conditions and low wages led to labour unrest and riots in the 1930s which led to the Moyne Commission and national movements for independence. Following independence, Caribbean countries established health systems with a focus on primary care and public health programmes and made significant advancements such as the elimination of several childhood diseases preventable by immunisation. PAHO, CARICOM, CAREC and CARPHA provided leadership and support to Caribbean countries. In the twenty-first century, the focus has shifted to combating non-communicable diseases, addressing the impacts of climate change and improving healthcare equity. However, infectious diseases such as COVID-19, HIV/AIDS, tuberculosis and dengue continue to challenge public health systems. Our history clearly shows the need for us to focus efforts on healthcare quality, equity and social justice in tackling current and future Public Health challenges.