This NBR report examines key issues confronting the subregion of Micronesia within the Pacific Islands and considers strategic avenues for strengthening future U.S. engagement amid climate and health security challenges and U.S.-China competition. The report draws on the Pacific Islands Strategic Dialogue convened by NBR in May 2022 in Tamuning, Guam, in partnership with the University of Guam and with support from the Defense Threat Reduction Agency Strategic Trends Research Initiative.