The secretary-general of the Pacific Islands Forum, Noel Levi, has told a special review group that many Pacific nations face being cast adrift by the whirlpool of change.
An Eminent Persons Group, set up to review the Forum, is currently in Suva.
In his welcoming address, Mr Levi said the region was struggling to deal with the fact that Pacific Island countries have some of the highest suicide rates in the world, an extremely high rate of diabetes, obesity and other lifestyle diseases plus growing poverty and increased alcohol and drug use.
Mr Levi said the Forum had originally been set up with an island focus to advance Pacific island country's common political and trade interests.
But he said the two biggest members, Australia and New Zealand, now used the body to pursue their own foreign policy goals.
Mr Levi called for Civil Society to participate in the decision making processes and urged the Forum to continue advocating differential treatment to help support small and vulnerable economies.