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The human colonization of Near Oceania has an antiquity of over 40,000 years but colonization of Remote Oceania, including Vanuatu, did not begin until around 3200–3100 BP. Just before this time a distinctive form of dentate-stamped pottery known as the Lapita style appeared in the Bismarck Archipelago northeast of the island of New Guinea. The only direct evidence of health in these Remote Oceanic settlers is their skeletal remains, but until recently only small samples of late Lapita skeletons have been found. Here we report the preliminary findings on some aspects of health of the first large sample (36 individuals) of early Lapita-associated skeletons from Teouma, Vanuatu, dated to ca. 3100–3000 BP. Dental health, trauma and degeneration of joints show they were well adapted to the rigors of island life and lived a physically active life while coping with a significant disease burden. The discovery of skeletal remains of pioneer settlers on islands is extremely rare. The Teouma sample provides insights into the possible biological cost of such a colonization and is applicable to other contexts where human migration into virgin landscapes may have demanded biological adaptation to ensure success.