Many coastal peri-urban and urban populations in Oceania are heavily reliant on terrestrial and marine ecosystem services for subsistence and wellbeing. However, climate change and urbanisation have put significant pressure on ecosystems and compelled nations and territories in Oceania to urgently adapt. This article, with a focus on Pacific Island Oceania but some insight from Aotearoa New Zealand, reviews key literature focused on ecosystem health and human health and wellbeing in Oceania and the important potential contribution of nature-based solutions to limiting the negative impacts of climate change and urbanisation. The inextricable link between human wellbeing and provision of ecosystem services is well established. However, given the uniqueness of Oceania, rich in cultural and biological diversity and traditional ecological knowledge, these links require further examination leading potentially to a new conceptualisation of wellbeing frameworks in relation to human/nature relationships. Rapidly urbanising Oceania has a growing body of rural, peri-urban and urban nature-based solutions experience to draw from. However, important gaps in knowledge and practice remain. Pertinently, there is a need, potential—and therefore opportunity—to define an urban design agenda positioned within an urban ecosystem services framework, focused on human wellbeing and informed by traditional ecological knowledge, determined by and relevant for those living in the islands of Oceania as a means to work towards effective urban climate change adaptation.