Pacific Territories, Commonwealth, and Freely Associated States

The United States has special relationships with six areas in the Pacific. The total population of these jurisdictions is approximately 480,000 people, spread across the ocean covering an area larger than the continental United States.

All of the U.S. affiliated Pacific jurisdictions share some challenges related to healthcare. Similar to many other rural areas, they struggle with maintaining an adequate health workforce. They also face difficulties in financing healthcare, and some spend a large portion of their healthcare budgets transporting patients off-island to receive care that is not available locally. The jurisdictions must address both the health concerns of developing nations in treating malnutrition and infectious diseases such as tuberculosis, as well as the chronic health problems faced by developed nations, such as diabetes and cancer.

Three of these jurisdictions, consisting of one commonwealth and two territories, are part of the United States:

• American Samoa (territory)
• Commonwealth of the Northern Mariana Islands
• Guam (territory)

Residents of these three jurisdictions tend to have better health and socio-economic status than those living in the three jurisdictions that are not part of the U.S.

The other three jurisdictions are independent nations that have special relationships with the U.S. through individual agreements, the Compact of Free Association. These countries were formerly part of the UN Trust Territory of the Pacific Islands, administered by the United States. The original Compacts have been amended over time and are now Amended Compacts of Free Association. These locations are sovereign states:

• Federated States of Micronesia
• Republic of the Marshall Islands
• Republic of Palau 

The United States provides assistance to these nations for health services through the Compacts and also through discretionary grants from the U.S. Department of Health and Human Services.

Data Sources
Pacific Partnerships for Health: Charting a New Course; U.S. Affiliated Pacific Basin Jurisdictions: Legal, Geographic and Demographic Information