About the Island Health Program

Key points

  • Chronic conditions and health risk behaviors are common in the U.S. territories and freely associated states.
  • CDC is working to reduce these challenges so that island populations can be as healthy as possible.
Two women in an island setting with their young children.

Overview

Chronic conditions and health risk behaviors are common in the U.S. territories and freely associated states—U.S. Virgin Islands, Puerto Rico, American Samoa, Guam, Commonwealth of the Northern Marianas Islands (CNMI), Republic of the Marshall Islands (RMI), Federated States of Micronesia (FSM), and Republic of Palau (Palau).

Because of their location and factors related to economic and cultural development, these islands have higher rates of chronic diseases and premature death compared to other U.S. population groups.

Examples of island health disparities

Compared to the overall US population:A

Additional surveillance data on noncommunicable disease (NCD) indicators collected through NCD Hybrid Surveys in the U.S.-Affiliated Pacific Islands can be found on the Pacific Island Health Officers Association website.

Reasons for island health disparities

Island health disparities arise from historical traumas (e.g., colonialism), natural disasters (resulting in loss of services), limited healthy food access, constrained public health infrastructure, and challenges in health care systems (shortages of workers, high costs for specialized care). CDC's National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) is working to reduce these challenges so that island populations have the opportunity to be as healthy as possible. For more information on these and other factors, please visit CDC's U.S. Territories and Freely Associated States page.

Priorities

Starting in 2014, CDC's Islands Program began coordinating funding across multiple divisions of NCCDPHP to allow for the most efficient use of resources and public health staff in island jurisdictions.

Building surveillance systems to close data gaps

Data on chronic diseases and associated risk factors are lacking or outdated in most of the U.S. territories and freely associated states. The Islands Program is working to provide local public health staff with the skills to collect the data they need to:

  • Develop and use effective interventions.
  • Identify and address gaps in program delivery.
  • Monitor progress in achieving program goals.

For example, the Islands Program supported an innovative approach to collect adult population data on NCD indicators through the NCD Hybrid Survey in the U.S. Affiliated Pacific Islands. Questions from the Behavioral Risk Factor Surveillance System, National Health and Nutrition Examination Survey, and WHO STEPS surveys were combined in one questionnaire. In addition, participants' height, weight, blood sugar, cholesterol, and blood pressure were measured.

The NCD Hybrid Survey was implemented in CNMI in 2016, Palau in 2017, RMI and American Samoa in 2018, and the FSM states of Kosrae and Pohnpei in 2019. More than 6,900 people participated in the first surveys. Survey data showed that the Affiliated Pacific Islands continue to have worse NCD outcomes compared to the overall U.S. population.

Reducing risk factors for chronic diseases

With CDC funding, the islands are implementing proven environmental strategies to promote health in schools, worksites, and communities. These strategies will reduce secondhand smoke exposure, improve oral health, and help residents prevent and manage type 2 diabetes, high blood pressure, and high cholesterol.

The Chronic Disease Self-Management Program (CDSMP) is a 6-week series of workshops for people with arthritis, diabetes, heart disease, lung disease, and other health problems. Proven benefits of CDSMP include less pain, more energy, more physical activity, better communication with health care providers, and more confidence in managing chronic diseases. In 2016, CDC supported training for CDSMP for the U.S.-Affiliated Pacific Islands. By the end of 2018, nine master trainers had trained 20 people to conduct CDSMP workshops in their communities, and 100 people had completed the program.

Type 2 diabetes prevention and management in Palau

In November 2019, Palau's World Diabetes Day event attracted over 200 participants. Eighty received health screenings for tobacco use, high blood pressure, obesity, prediabetes, and diabetes, and were connected to support services if appropriate. Fifty joined the National Diabetes Prevention Program. The event, broadcast live, raised awareness and showcased Palau's commitment to healthier lifestyles through education and screening.

American Samoa's path to a smoke-free future

American Samoa's Smoke Free Environmental Act of 2010 and its Tobacco Prevention and Control Program's continual education efforts on the dangers of secondhand smoke have resulted in:

  • Better compliance with smoke-free laws.
  • Decreased tobacco consumption.
  • Increased awareness of the dangers of smoking and secondhand smoke.

CDC provided funding, training resources, and expertise, extending the program's effectiveness and reach. These efforts were nationally recognized at the 2019 National Tobacco Convention.

Preventive oral health services among schoolchildren in Puerto Rico

In 2017, Puerto Rico passed the Law to Ensure Access to Oral Health Services for All Patients in Puerto Rico. This law requires that students entering kindergarten, 2nd, 4th, 6th, 8th, or 10th grades submit an oral health certificate to show that they went to the dentist in the past year. The Puerto Rico Oral Health Program monitors compliance with the law. The law was not implemented until the spring of 2019 because of Hurricane Maria. Only 22.8% (47,803) of students submitted their oral health certificate before starting school that spring. The second year (2019–2020), 30.0% (63,586) of the students submitted their oral health certificate.

A March 2021 evaluation of oral health care data claims showed that:

  • Claims rose 11.5% overall from 2016 to 2019, with the highest increase among beneficiaries aged 5 to 16.
  • The increase in oral health claims in 2019 was mainly during July through October, concurrent with the start of the school year.
  • In 2019, the most common oral health claims among beneficiaries 16 or younger were for preventive services.
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Content Source:
National Center for Chronic Disease Prevention and Health Promotion
  1. The Hybrid Survey compares data collected from the USAPIs and compares it to data collected from other sources. Depending on the other source, the “U.S.” may include the 50 states, the District of Columbia, Guam, and Puerto Rico.