Closing Health Disparities in the U.S. Pacific Islands 

Guest Editorial by Ferdinand Aranza, Director, Office of Insular Affairs, U.S. Department of the Interior


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


Hidden within the aggregate data customarily collected on 

AAPIs are numbers that reveal surprising lags in the health 

and well-being of people residing in the Pacific Basin. Higher 

infant mortality, lower life spans, higher fertility, and sky-high rates of 

diabetes and other chronic diseases among middle-aged adults are 

some of the indicators that fall on the shady side of the American 

norm. Others are rapid population growth, lower educational levels, 

depressed incomes, and double-digit unemployment. Infant mortality rates in 

By so doing, he formalized a mechanism to bring together senior 

officials from throughout the federal government to work with the 

Secretary of the Interior, to clarify the concerns of American Samoa, 

the Commonwealth of the Northern Mariana Islands, and Guam, as 

well as those of their Caribbean counterpart, the U.S. Virgin Islands. 

The IGIA seeks to improve cross-cutting policy coordination, increase 

Federal responsiveness to insular area issues, and recommend policy 

and program remedies to the President. 

As a first step the IGIA, in consultaAmerican Samoa, for example, are almost For many Pacific Islanders, the tion with island leadership, has focused its 

twice as great as the U.S. average, while road to health equity is attention on areas that promote sustainper capita income is less than one quarter able growth consistent with the sound 

the U.S. average. strewn with potholes management of natural and fiscal resources, 

For many Pacific Islanders, the road and on improving the general welfare of and obstacles. to health equity is strewn with potholes 

and obstacles. Those who live in American Samoa, the Commonwealth of the Northern Mariana Islands, 

and Guam know that their remoteness from Hawaii and the U.S. 

mainland creates enormous barriers that transcend geographic distance. Better access to health services and trained professionals, though 

extremely important, is only part of the solution. 

To succeed, the goal of improved health for Pacific Islanders 

requires the creation of multifaceted opportunities in and outside the 

traditional realm of health care. It also entails a reorientation to issues 

that vary considerably from stateside experience, and the development of supportive policies to help overcome isolation. 

Sustainable economic development is key. Pacific Islanders understand all too well that their livelihoods and well-being are extremely vulnerable to global environmental and economic forces that 

are beyond their control. Natural disasters often take a particularly 

heavy toll on their islands’ finite resources and fragile ecosystems, and 

recovering from super typhoons and hurricanes takes years. Islands 

like Guam and the Northern Mariana Islands, for example, are within 

the “typhoon belt.” It is not unusual for their communities to experience two or three typhoons a year, often with winds of over 100 

m.p.h. Resources that would ordinarily go to supporting health care 

instead must be spent on rebuilding. Unresolved land use disputes 

and the negative effects of changes in foreign markets and terms of 

trade worsen the problem. Indeed, the impact seems disproportionately large in comparison to the small size of the islands. 

In recognition of these and other compelling issues, President 

Clinton established the Interagency Group on Insular Affairs (IGIA) 

by Executive Memorandum on August 9, 1999. 

the islands to be on par with U.S. health, 

social, and economic indicators. The IGIA 

has also developed a comprehensive inventory of Federal regulatory, 

financial, and technical assistance programs for which the territories 

are eligible but do not now participate. 

Issue clusters provide the IGIA with a roadmap for closer interdepartmental collaboration to address follow-up items, and lay out the 

framework for the work that remains. Broadly, these include economic 

planning and trade mission assistance, tax incentives, immigration 

and visa issues, job training assistance, budget and management controls, and new economic initiatives. The improvement of statistical 

capacity, land usage, solid and wastewater management, environmental hazard mitigation and clarification of disaster assistance round out 

the clusters. 

Over the next few months, the IGIA will bring closure to as 

many of these issues as possible by engaging insular area representatives in discussions and negotiations with federal officials. It will not 

be alone in that effort. The IGIA’s work to create a supportive and 

effective policy environment for the Pacific insular areas, is fully complemented by the White House Initiative on Asian Americans and Pacific 

Islanders. These two interlinked groups create a synergy that will forward the health agenda of Pacific Islanders. Working together, these 

groups can ensure that health-making opportunities not only exist 

temporarily, but are created for many years to come. 

For more information on the IGIA, visit the Office of Insular Affairs 

Web site: http://www.doi.gov/oia.

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