This paper examines macroeconomic performance and policies in small Pacific island economies (SPIEs). These economies are highly prone to various supply shocks and face severe obstacles to development arising from their geography and demography. However, the paper contends that their lacklustre growth performance over the last two decades has also been due to excessively conservative macroeconomic policies. That is, a confluence of supply shocks and policy-induced constrained demand has resulted in poor economic performance. Given a very weak private sector, poor state of infrastructure and low-level human capital, the paper argues for the leading role of the government. It then elaborates on the elements of macroeconomic policies within a state-led development strategy.