Chronic conditions and health risk behaviors are common in the US territories and freely associated states—the US 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.
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 US population groups. Contributing factors include:
- Social determinants of health: Historical traumas such as colonialism have contributed to poverty, unemployment, and poor housing, conditions that are known to increase the risk for unhealthy behaviors and chronic diseases.
- Natural disasters: Typhoons and hurricanes often result in loss of water, electricity, housing, and health services.
- Healthy food access: Isolated jurisdictions may have limited access to fresh produce because their economies have moved away from farming and fishing. Shipping costs for these foods make them unaffordable for most residents.
- Public health infrastructure: Island jurisdictions have limited staff with public health training. Distance from the continental United States can make in-person training unfeasible. Technology limitations, such as reliable internet connections and phone lines, can limit access to virtual training and other technical assistance.
- Health care systems: Some of the factors that limit preventive health care are shortages of health care workers, an emphasis on hospital-based acute care, and the enormous costs of sending patients off-island 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.