Modernization, considered as a composite of interactions of numerous physical, biological and sociocultural processes, has been investigated as a factor possibly related to health in a Pacific island population. Cross-sectional survey methods were employed in the study of three groups experiencing modernization in clearly different degrees. Examination of 510 adult Palauans included interviews regarding health and sociocultural characteristics, a screening physical examination including height, weight, skinfold thicknesses and blood pressure, and serum samples assayed for levels of cholesterol, triglycerides, glucose and uric acid. A 12-lead electrocardiogram was performed, and a subsample of persons in each of the three areas was interviewed regarding recent dietary intakes. Results analyzed with and without geographic grouping showed consistent associations between modernization and health-related factors, with the most modern area having the least desirable health attributes, especially in regard to blood pressure, serum lipids, and obesity.