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This brochure was developed by RMI Ministry of Health to provide information on hypertension and high blood pressure to residents.

Learn how territorial and freely associated state health agencies can support community health workers and their vital work in this brief.

Collecting and sharing data are crucially important to improving health equity, because those datasets inform effective policymaking. Despite having some of the most challenging population health outcomes, the U.S. island areas are often absent within federal public health datasets.Federal, island, and nonprofit partners should prioritize efforts to increase their inclusion.

Learn how increasing the use of indirect cost rates in the territories and freely associated states can help improve public health financing in these jurisdictions.

This report aims to highlight the unique vector-borne disease challenges faced by Island Areas and to dive into the key components of a mosquito control program, that are relevant to these unique jurisdictions.

This toolkit is designed to support public health leaders in leveraging the policy development process to achieve health equity in their jurisdiction.

Heart Disease and Stroke Prevention in the Pacific Territories heart disease, stroke prevention, american heart month, cardiovascular health, chronic disease, pacific territories, environmental infrastructure, disease epidemic, tobacco use, mental health, united states, physical activity, health problems, leading cause of death, health conditions, american heart, cardiovascular disease, chest pain, type of heart disease, coronary heart disease, heart health, flow to the heart, risk of heart disease, heart disease and stroke, prevent heart disease, astho, association of state and territorial health officials Marcus Plescia Heart disease and stroke prevention in the pacific territories. Each February, American Heart Month raises awareness for heart disease and cardiovascular health—a matter that warrants attention year-round. In ASTHO’s 2023 Environmental Scan, territorial health officials highlighted chronic disease prevention and treatment as top current public health program and service priorities, emphasizing heart disease and stroke as key focus areas. As such, I want to highlight heart disease as a public health issue in the U.S. territories, which have played an important role in ASTHO’s chronic disease prevention efforts. Several years ago, ASTHO CEO Mike Fraser pointed out Mark Durand’s work in the Pacific territories. Durand developed a list of prioritized chronic disease-related health policies and a matrix to map progress across six jurisdictions. This ultimately provided the basis for ASTHO’s Essential Policies for Chronic Disease Prevention and Control—which served as a foundation for ASTHO’s Heart Disease and Stroke Prevention (HDSP) Learning Collaborative—and led to the launch of ASTHO’s technical packages in all program areas. Heart Disease and Stroke Prevalence in the Pacific In the United States, heart disease is the first leading cause of death and stroke is the fifth. Disparities exist across several demographic lines, including race, ethnicity, and nationality. U.S.-Affiliated Pacific Islands (USAPIs) adults have the second-highest death rate from cardiovascular disease in the country. Additionally, in all USAPIs involved in ASTHO’s HDSP Learning Collaborative—Commonwealth of Northern Mariana Islands (CNMI), Federated States of Micronesia (FSM), Republic of the Marshall Islands (RMI), Guam, and Republic of Palau—heart disease and stroke are in the top three leading causes of death, with cases soaring in recent years. The U.S. territories are home to small and diverse populations with rich history, cultural practices, and languages. Unfortunately, the long-lasting impacts of colonialism have weakened the social, cultural, and environmental infrastructure that has historically protected the health of USAPIs communities. In recent decades, health threats have shifted from infectious diseases to preventable chronic diseases; the Pacific Island Health Officers Association even declared a Regional State of Emergency in 2010 because of their non-communicable disease epidemic. Since this declaration, there has been increased interest in and efforts toward policy and health system interventions in USAPIs, which ASTHO has been proud to support through our learning collaborative. Heart Disease and Stroke Prevention Learning Collaborative: Key Accomplishments Since 2013, ASTHO has partnered with CDC to develop and sustain the HDSP Learning Collaborative, focused on improving rates of hypertension. In all, 36 participating states, territories, and freely associated states have implemented innovative strategies through systems, policy, and quality improvement processes. Historically, this learning collaborative—open to both states and islands—has focused on the design and implementation of hypertension control programs. In USAPIs, program efforts evolved to address and improve cardiovascular health more broadly. Although USAPIs workplans differ from each other, they all have advanced health equity by understanding community needs and adapting to health system capacity. Table-CMO Heart Disease Stroke Prevention in the Pacific Tools for Change/Spotlight-CMO Heart Disease Stroke Prevention in the Pacific website yes

Strengthening Leadership, Risk Communications, and Preparedness in the Islands Strengthening Public Health Preparedness in the Islands Sidnie Christian, Alyssa Boyea Key strategies in on leadership, risk communications, and preparedness, can help island jurisdictions prepare for and respond to emerging public health threats. ASTHO convened a two-day, in-person workshop in Honolulu from June 25 – 26, bringing together public health preparedness staff from American Samoa, the Commonwealth of the Northern Mariana Islands, the Federated States of Micronesia, Guam, Hawaiʻi, the Republic of the Marshall Islands (RMI), and Palau, as well as federal partners from CDC, the Department of Homeland Security, and the Administration for Strategic Preparedness and Response. The workshop focused on leadership and workforce development, risk communications, administrative preparedness, and more to support island areas as they prepare for and respond to natural disasters and other emerging public health threats, of which emerged key learnings that can benefit all island jurisdictions. Leadership and Workforce Development Leading through change requires transparency, trust, and collaboration. Planned change involves assessing readiness for change, identifying resources needed, securing buy-in, and determining a path forward. However, sometimes change can leave little to no time for preparation. Island jurisdictions have encountered challenges in the face of change, with many workshop participants sharing firsthand challenges around retaining institutional knowledge, infrastructure, and receiving assistance from the mainland United States in a timely fashion. As such, change readiness, succession planning, and effective change management practices are of utmost importance in the islands. Key recommendations and takeaways include: Utilizing a reputable framework, such as Kotter 8-Step Change Model, is pivotal for improving change readiness and change management. Change management frameworks and methods can assist with different types of change including structural change, strategic operational change, people-centric change, etc. Trust is hard to build, but easy to lose. Participants spoke about characteristics of high trust relationships including open communication, consistency, good judgement or expertise, and cultural sensitivity, while low trust relationships characteristics include lack of communication, inconsistency, and lack of teamwork. Succession planning is important to ensure institutional knowledge and capabilities remain in the wake of staff turnover or retirement. Identifying the necessary expertise, skills, and capabilities for each role is vital in the case of unplanned changes in staffing. Promising practices include annual review of critical positions, conducting talent calibration sessions, defining action plans, and obtaining buy-in from leadership and relevant partners. Risk Communications The island jurisdictions face emergencies that require creative response efforts. Both Hawaiʻi and RMI demonstrated innovative approaches in risk communications during COVID-19, finding success in forming critical partnerships, utilizing trusted voices within the community, and bridging communication gaps: Hawaiʻi utilized social media to showcase individuals such as doctors, pastors, social media influencers, and even local sports teams getting vaccinated, and utilized trusted voices to deliver messages. Additionally, they translated their materials into three languages (Marshallese, Samoan, and Hawaiʻian), modeling that no one gets forgotten, the true meaning of “ohana.” RMI created a working group with a mix of partners that curated press releases, educational materials, and sitreps, and served as a liaison between RMI Ministry of Health and Human Services and the community. It also partnered with several media outlets (e.g., radio stations, local papers, and other private sectors) and utilized mass text messaging to spread information quickly. The latter proved to resonate with most island jurisdictions who struggle with staying connected to hard-to-reach populations, namely those in more rural and disconnected communities. RMI was able to connect with these populations through WhatsApp to keep them updated throughout the COVID-19 response. Administrative Preparedness Improving administrative preparedness plans and processes ensure timely and efficient access to needed resources for a public health response. Most workshop participants are currently in the process of updating existing administrative preparedness plans, while some are working with other departments to create and implement new plans. Attendees discussed key partnerships for collaboration including other departments, Medical Reserve Corps, and other volunteer organizations. One common key challenge that emerged was around staffing (e.g., finding qualified people to fill vacancies, hiring process issues, making sure positions are competitive, etc.). To address this issue, island jurisdictions can work closely with other departments or jurisdictional agencies to streamline current processes, establish memorandums of understanding with different partners/facilities to assist with emergency procurement, and ensuring staffing vacancies are competitive and match public health classifications. Disease Forecasting A survey on state and territorial expertise and needs for infectious disease forecasts, models, and other outbreak analytic techniques—implemented by ASTHO with support from CDC’s Center for Forecasting and Outbreak Analytics—revealed that respondents from island jurisdictions experienced several barriers that led to limited use of infectious disease forecasts to inform communication and decision making. Challenges noted include limited software access, limited disease modeling capacity or skills, and lack of uniform reporting systems. Through a discussion-based exercise, workshop participants shared their challenges and considerations for ASTHO and CDC to assist with disease forecasting in the island jurisdictions moving forward. Challenges include but are not limited to: Delays with sending samples to labs and receiving results in a timely manner. Without timely results, it is challenging to take swift action. Lack of staff / staff wearing many hats with limited capacity. In most cases, there is no specific communication plan for disease forecasting within the departments. Communication can be challenging without clear processes and channels. Participants noted the desire for additional disease forecasting training and opportunities for collaboration. They suggested an integrated training session with island epidemiologists and other relevant staff to enhance disease forecasting knowledge and communication, as well as strengthen collaboration. Preparing for and Responding to Climate Events From hurricanes to typhoons to volcanic eruptions, the island jurisdictions are no strangers to the effects of changing climate. Willliam “Brandon” Aydlett, science and operations officer at the National Weather Service, and Shelbi Davis, Senior Analyst on the Environmental Health team at ASTHO, offer the following recommendations to island jurisdictions for preparing and responding to unprecedented climate events, as discussed with workshop participants: Create or update standard operating procedures for various climate related responses unique to the island. Always prepare for a category higher storm than is expected. Consider conducting regular vulnerability assessments to better understand areas where the island or its people may be most susceptible to adverse health impacts from climate events. Jurisdictions can learn from one another and find a sense of camaraderie in their preparedness efforts, much like the workshop participants. For example, one island jurisdiction noted that they currently do not have a warehouse to store equipment but are working on a plan to secure one; another jurisdiction, having recently revamped their warehouse, noted that they could assist their island neighbor in this endeavor and provide lessons learned as well as strategies to help secure a warehouse that will fit their needs. Looking Toward the Future Sharing lessons learned with one another and reflecting on how to apply those learnings in respective communities is crucial. Workshop participants shared their intent to share and utilize resources and information shared throughout the workshop with their leadership and team to begin implementing in their jurisdictions, as well as using strategies and skills learned to enhance partnerships. To all the participants and our Hawaiʻian hosts, we say mahalo. Related Resources Modernizing Infrastructure and Facilities for Readiness and Response | ASTHO PH-HERO Workforce Resource Center | ASTHO ASTHO STAR Center | ASTHO Evidence-Based Strategies to Enhance Public Health Emergency Preparedness and Response | JPHMP article yes

As COVID spread through the country and infection rates rose in every state, many of the the U.S. Affiliated Pacific Islands (USAPI) received media attention for remaining relatively COVID-free. The USAPI’s unified response in the face of a global pandemic is a history-making tale of collaboration, communication, and partnership. The successes of public health leaders provide important lessons for preventing, preparing for, and responding to future public health emergencies.

The 2020 holiday season is coinciding with a nationwide surge of COVID-19 cases. With great concern that holiday travel to see loved ones may exacerbate community spread of the virus, many states are increasing public health measures before the winter holiday season. As of November 16, 2020, 13 states and D.C. had a quarantine requirement for out-of-state travelers. The U.S. territories also have instituted travel restrictions to limit the spread of COVID-19.

Both the Pacific and Caribbean are on the front lines of the dengue health security threat. As a result, many island areas, especially in the USAPI and Puerto Rico, are doing great work to combat dengue.

ASTHO has several members from the territories and Freely Associated States—jurisdictions with unique challenges, and do not fall under the category of a state or federal district. This post is a brief look at some of the public health related legislation introduced during recent legislative sessions.

Each year, ASTHO tracks and analyzes key legislation that impacts public health, and highlights the emerging trends for our members. While the bulk of the tracked legislation arises in state legislatures, ASTHO also follows legislation from the territories and Freely Associated States, jurisdictions collectively referred to as the insular areas. The insular areas often face different challenges than the states, while also sharing many common concerns. This post contains a brief look at some of the public health related legislation introduced in the insular areas during their current legislative sessions.

The U.S. Affiliated Pacific Islands mounted a unique response to the COVID-19 pandemic as it started to sweep the globe. We discuss that approach and its successes with some of the region’s experts.

This report is on the overlap of climate change and environmental justice.

Discover public health efforts in the Marshall Islands, including health challenges and ASTHO’s support for building stronger health systems.

This ASTHOReport provides an overview of the SPACECAT regional data for island areas, paired with foundational first steps to improve capacity in key opportunities for growth.

On November 14, 2023, the U.S. House of Representatives approved a two-tiered short-term continuing resolution to keep the government open and avoid a shutdown later in the month.

Learn about recent public health legislation in the islands areas related to access to nutritional foods, deterring substance use, and promoting healthy aging.

This blog describes the island areas COVID-19 successes and their cultural and historical context.