The United States took responsibility tives (34 percent) are the most likely to smoke. 

The U.S.-Associated Pacific for the health, education, and wel­ However, using local data we can see 

fare of the people of three Pacific Is­ that almost all groups of Samoans and GuaThe U.S. Associated Pacific consists of three land jurisdictions under a United Nations manians have higher smoking rates than cited 

Flag Territories and three Freely Associated Trusteeship in 1947. Samoa and Guam were in HP2010. While the data are not necessarStates, each with its own distinct language, already U.S. territories at that time. Although ily comparable, the discrepancies highlight 

culture, history and politico-economic de­ the trust jurisdictions have subsequently be­ some of the frustrations of planning approvelopment. come Independent Nations, with Compacts priate prevention programs, and of getting 

of Free Association with the United States, federal attention for health programs in the 

• The “Flag Territories” are: their health and welfare is still dependent on Pacific. 

· American Samoa the U.S. The United States has a responsibil­ Despite rising trends in cigarette use, 

· Territory of Guam ity to ensure that it honors its historical rela­ there are few appropriate tobacco prevention 

· The Commonwealth of the Northern tionship to these Nations and territories. programs due to geographic distance, a lack 

Mariana Islands (CNMI) The health systems subsequently insti­ of culturally appropriate models for the Patuted in these jurisdictions were modeled af­ cific, and multiple health crises occurring si­

• The Freely Associated States are: ter the United States health system. These multaneously.Tobacco advertising is resource 

· Federated States of Micronesia (FSM): systems tended to be hospital based with little rich, aggressive, and uses established cultural 

Truk (Chuuk), Kosrae, Pohnpei, Yap emphasis on prevention or public health. Pres­ norms (linking tobacco to betel nut use). Re­

· Republic of Palau (ROP) ently, a large disparity in health status exists cent cigarette advertising campaigns have in­

· Republic of the Marshall Islands (RMI) between these six jurisdictions and the United cluded free tee-shirts in exchange for 15 

States as a whole. There are also large health empty cigarette packs, cash sweepstakes with 

disparities between jurisdictions. a grand prize of $1,000 in Truk and FSM; Other Health Disparities* The disparity in health between the and cash prize raffles of $10,000 in the RMI. 

U.S. and its associated Pacific jurisdictions The Pacific compact nations suffer many Life Expectancy at Birth can best be understood by examining some of the ills of American society, without the US 76.1 yrs of the common health indicators, as well as benefits of access to first world health care. Guam 74.0 yrs the Healthy People 2010 Objectives. To­ The data reveal that the compact nations tend CNMI 72.8 yrs bacco is one example. to have poorer health statistics than the Flag American Samoa 71.6 yrs territories, who generally have access to more ROP 67.0 yrs Tobacco use in the Pacific resources than their neighbors. America can­ FSM 67.0 yrs not turn its back on the health of these fledg­ RMI 64.2 yrs The first barrier to effective health care ling nations whose current state is due, in 

Infant Deaths per 1000 live Births is the paucity of health data. Healthy People part, to our own carelessness. 

US 7.2 2010 has baseline measures for Hawaiians Dr. Palafox is co-chair of the Department 

Guam 8.9 and Pacific Islanders (NHPI) for only 1 of 18 of Family Medicine and Community Health 

CNMI 9.3 applicable objectives related to tobacco use. at the John A. Burns School of Medicine, UniAmerican Samoa 13.0 According the HP2010, 21 percent of versity of Hawai‘i. Dr. Ka‘anoi is a faculty 

ROP 26.0 NHPIs 18 and older smoke. This makes development fellow with the JABSCOM family 

RMI 26.7 NHPI’s the second least likely ethnic group practice residency program and the Native HaFSM 46.0 to smoke. American Indians and Alaska Na- waiian Center of Excellence.

Fertility Rates per woman Children Under 2 fully Immunized Health Care Expenditures Per Capita Guam 2.0 ROP 92.4 ROP $633 US 2.1 FSM 84.1 Guam $510 Guam 2.2 US 75.0 RMI $128 ROP 2.7 American Samoa 72.0 Yap $178 FSM 3.9 Guam 70.0 FSM $132 American Samoa 4.2 CNMI 56.4 Pohnpei $143 RMI 6.8 RMI 54.4 Kosrae $151 

*Source: Institute of Medicine Pacific Partnerships for Health Report, 1998. Truk (Chuuk) $92 

Office of Minority Health Resource Center U.S. Department of Health and Human Services 

Health Disparities Among Pacific Islanders 

By Neal A. Palafox, MD, MPH, and Momi Kaanoi, MD


Closing the Gap, Pacific Islander Health • June/July 2000