Displaying 1-20 of 104 results for

Easily download web pages for offline access, allowing you to view ASTHO resources anytime, even with limited internet. Follow our instructions tailored for your device and browser.

Explore ASTHO’s policy support for U.S. territories and freely associated states, helping address health challenges and advance equity through strategic partnerships.

Island Areas Glossary Use this guide as a quick reference for unique terminology related to the U.S. territories and freely associated states. The U.S. territories and freely associated states (T/FAS) come with their own unique terminology. This page is designed as a quick reference to get new readers up to speed or give old hands a referesher. All entries are alphabetical. If you are looking for something specific, hit "Control+F" to open a search box in your browser's window. <!--   --> website False

About Public Health in the U.S. Territories and Freely Associated States Public Health in the U.S. Territories and Freely Associated States Learn about public health needs in the U.S. territories and freely associated states, and ASTHO’s work to support them. The U.S. territories and freely associated states are home to unique populations, rich with history and culture. Their customs, geography, and history contribute to their many strengths — but also add nuance and complexity to the public health landscape. ASTHO works closely with island public health officials to understand, increase awareness about, and champion their needs. The team’s efforts help secure island voices at the table and representation in essential U.S. public health programs. What Are the U.S. Affiliated Territories and Freely Associated States? There are eight U.S. territories and freely associated states, consisting of six Pacific islands and two Caribbean territories. The six islands in the Pacific include three territories — Guam, America Samoa, and the Commonwealth of the Northern Mariana Islands (CNMI) — and three freely associated states: the Republic of the Marshall Islands (RMI), the Federated States of Micronesia (FSM), and the Republic of Palau. Meanwhile, Puerto Rico and the U.S. Virgin Islands (USVI) make up the two territories in the Caribbean. The U.S. territories and freely associated states are often left out of the family picture. However, residents of the territories are U.S. citizens or nationals, and residents of the freely associated states can live, work, and travel in the United States without a visa. Moreover, they have some of the highest per capita rates of U.S. military enlistment. Importantly, these island health systems are also eligible for many domestic health programs, but they may differ from the states (e.g., Medicaid in the territories is capped, and freely associated states do not have Medicaid). Public Health Challenges in the Islands Island issues are state issues. Like many states, the U.S. territories and freely associated states have high rates of chronic diseases and must contend with caring for aging populations. That said, there are important differences — such as ineligibility for certain federal programs, available data, existing workforce, and local infrastructure — requiring care in tailoring public health response and prevention strategies. Given some of these limitations, people from the U.S. territories and freely associated states often travel to the states for health care services and some must move to Hawaii or the continental U.S. Still, they have a dedicated public health and health care workforce, tight-knit communities, and regional partnerships lending to their success addressing certain public health challenges (e.g., COVID-19). Karl Ensign - Page - About T/FAS How Is Public Health Unique in the U.S. Territories and Freely Associated States? Disease, geography, and demographics are unique parts of public health in the U.S. territories and freely associated states. Disease Oceans do not protect these areas from the public health challenges that the states contend with, like infectious disease. Infectious disease is one of the main issues across all island jurisdictions, including diseases that the continental U.S. does not often see (e.g., tuberculosis, leprosy, Zika). In addition, the introduction of canned foods and spam in the Pacific and Caribbean islands have disrupted the indigenous diets of fish and fruit, contributing to a significant chronic disease problem — with the Pacific experiencing some of the highest obesity rates in the world. Chronic diseases are the leading causes of morbidity and mortality across both states and territories. However, the prevalence and incidence of key chronic diseases can be orders of magnitude higher in the territories. For example, an estimated 8.5% of adults in the states have diabetes, while the prevalence is more than four times that (34% in 2018) in American Samoa. Geography and Demographics Further, differences in geography and demographics bring novel public health challenges. Most of the U.S. territories and freely associated states are made up of multiple islands, with small island masses, which means delivering public health care might require multiple modes of transportation (e.g., a ferry, boat, ship and/or small plane) and significant costs and staff time to provide services to outlying islands. Many of the Pacific islands are across the international dateline as well, making it difficult to join calls based on stateside working hours. The geography in territories and freely associated states also leaves them at increased risk for severe weather events (e.g., hurricanes and typhoons) and the resulting immediate and long-term public health impacts. Their tropical climate also raises health risks that are less common in the mainland (e.g., dengue). In addition, many of the territories and freely associated states consist of small population sizes and residents who speak different languages (e.g., Spanish, Haitian, Creole, Marshallese, Filipino, Chuukese, Palauan). Therefore, meaningful, locally-based public health work often looks different than it does in the continental U.S., even if it follows the same principles. How Does ASTHO Support Public Health in the U.S. Territories and Freely Associated States? ASTHO’s Island Support team dedicates its time and work to advancing public health in the U.S. territories and freely associated states — working closely with these jurisdictions’ health leaders and their teams to tell their story, serve their needs, and ensure their access to the vital public health programs available to states. Policy The team supports island policy priorities, targeting legislative and administrative change: The Insular Affairs Committee to ASTHO’s Board of Directors highlights islands’ unique legislative policy needs and engages key stakeholders on Capitol Hill. The ASTHO-led Island Areas Workgroup works to address the key administrative challenges affecting health outcomes in the territories and freely associated states through collaboration across health agencies, federal agencies, and partners. Including Island Area Data Sets - Page - About T/FAS Partnership The Island Support team also works cross-functionally across the organization and with external regional and national partners to best serve the islands, including: Engagement across ASTHO teams to increase awareness of the islands and how to work more effectively with these populations. Collaboration with partners to increase awareness of and effectively address islands’ priority public health needs. Technical Assistance and Capacity Building In addition, the Island Support team provides health officials from the territories and freely associated states with direct, specialized support for their public health efforts: Technical assistance supporting the implementation of new systems, processes, and skills. Development of resources (i.e., reports, briefs, etc.) to support health officials in the territories and freely associated states in addressing their priority issues and to advocate to their peers and Congressional leaders. Alex Wheatley - Page - About T/FAS Get in Touch Are you a public health leader in the Caribbean or the Pacific looking for assistance? Or perhaps you’re stateside working to include island needs and views in your programs. In any case, if you’d like to connect with ASTHO’s Island Support team, we’d love to hear from you and are here to help. Email the Island Support team at islandsupport@astho.org. Padding Block - Medium article

On Oct. 4, 2023, ASTHO responded to a Request for Information from the U.S. House of Representatives' Ways and Means Committee on the subject of improving access to healthcare and rural and underserved areas, including the island jurisdictions.

The bill provides $27.1 million to address shortfalls in Medicaid funding in the Northern Mariana Islands and extends critical autism-related programs.

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.

Establishing an Office of Health Equity or Minority Health Learn how to establish, structure, and fund a health equity or minority health office. A dedicated office of health equity or minority health can provide a focus on cross-cutting efforts and strategies that help to improve services, outreach, and engagement with marginalized communities. This report delves into the typical scope for setting up a health equity or minority health office, including how to establish, structure, and fund it—providing a blueprint to island areas working to build one or considering establishing one in the future. In addition, it explores lessons learned from state offices of health equity or minority health, including California, Michigan, Nebraska, Nevada, New Jersey, New York, Ohio, Vermont, and Washington. Get the Report (PDF) website yes

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.

U.S. Territories and Freely Associated States Supporting U.S. Territories and Freely Associated States Association of state and territorial health officials, astho, us territories, improve population and community health, freely associated states, territorial support, public health territorial support, insular areas, island jurisdictions, pacific and Atlantic jurisdictions, population health needs, public health services, territorial health officials, Medicaid in the territories, Medicaid financing for us territories, public health topics, insular areas, health equity, freely associated states, federated states of micronesia, guam behavioral health and wellness center, free association with the united states, united states territories, world health organization, public health services, guam behavioral health, american samoa, advance health equity, united states, compacts of free, republic of palau, marshall islands, pacific islands, permanently inhabited, northern mariana islands, health disparities, health services, public health system, virgin islands, free association with the united states, wake island, public health, health and wellness center, 50 states, federated states of micronesia fsm Find tools designed to support U.S. territories and freely associated states in addressing their unique public health needs. ASTHO supports public health leaders across the U.S. territories and freely associated states — including the chief health officials (ASTHO members) — in their efforts to improve the health and well-being of their communities. The territories are under the jurisdiction of the U.S. government, while the freely associated states are independent nations that have entered into Compacts of Free Association with the United States. Note: ASTHO collectively refers to these eight jurisdictions as the territories and freely associated states, T/FAS, island areas, or island jurisdictions. article

Puerto Rico Program Supports Vulnerable Populations ASTHO Island Support Learn how Puerto Rico addresses social determinants of health and promotes equity among vulnerable populations. The Puerto Rico Department of Health’s Health Equity Program implemented an innovative initiative to support diverse institutions, with the goal of addressing social determinants of health and promoting health equity among vulnerable populations. This provided opportunities for a wide range of sectors including private non-profit organizations, universities, and hospitals. The project evolved throughout its duration, demonstrating the power of local funding and the importance of flexibility in program administration. Project Kickoff Grant Awarding and Training Process During the second request for proposal, 30 organizations expressed interest in submitting applications. However, given the detailed and rigorous rubric, six applied, of which four grants were awarded. The team scored the proposals based on the rubric, and allocated funds to support vulnerable populations such as individuals living in rural areas, people with disabilities, pregnant women, and older adults. Implementation and Best Practices Once the Health Equity Program awarded grants, they designed a detailed work plan, including key indicators for monitoring and tracking the progress of beneficiary organizations. They implemented a SharePoint-based system for the submission of reports and documentation. In addition, they held monthly meetings to ensure cohesion and effective communication among all stakeholders. This collaborative approach enabled efficient and transparent monitoring processes. “It was a collaborative process since the institutions know their populations best. We just wanted to ensure a systematic and consistent plan because these matters are crucial for project progress and monitoring.” — Miguel Cruz, PhD, Co-Principal Investigator Project Evolution The program initially funded one institution and due to its positive impact, additional opportunities emerged to provide funding for up to four additional institutions. The main topic revolved around health literacy as a strategy to reach health equity among people living in rural areas, older adults, people experiencing homelessness, individuals with functional diversity, and those experiencing a mental health challenge. These four new institutions covered the west, central, and other rural areas broadening coverage within traditionally underserved communities. Administrative Flexibility and Communication Strategies Administratively, the program had to be flexible during pre-award and award processes, ensuring compliance with state and federal regulations. This included revising announcements and creating plans. Additionally, the program created documentation, like templates, and provided technical assistance to clarify compliance guidelines to ensure transparency and proper use of funds. The program implemented effective communication strategies to inform institutions about funding opportunities, including announcements via mass media and the Department of Health’s official social media platforms. They also created an external technical committee as an official communication channel to evaluate proposals. For this purpose, the creation of a detailed rubric facilitated its proper, unbiased, and timely assessment. Technological Challenges and Solutions One key challenge throughout the project was the use of technology to receive, process, and manage documentation. To mitigate obstacles, a SharePoint webpage facilitated electronic documentation acquisition between each subgrantee and the program. Additionally, the program provided clear instructions and developed a Q&A guide based on the needs that various institutions identified. In case of new inquiries, the Health Equity Program also shared responses collectively to ensure all organizations received consistent information, enabling them to complete the process smoothly and with equal opportunity. Lessons Learned A final evaluation of the process revealed that anticipating challenges was key to the project’s success. However, there are still areas for improvement: One of these is the optimization of financial processes by the organizations. It is critical to submit evidence of fund use in a timely manner and ensure accuracy in reconciling invoices within the allocated period. Organizations should also align internal processes with the parameters set when they receive funds. Adhering to these parameters can streamline the process on the Department of Health's side. Although beneficiaries get an assigned accounting professional, the documentation must still go through the Fiscal Office for review. Another challenge faced by institutions was retaining participants in the training sessions provided as part of the grant. Therefore, mechanisms need to be in place to ensure active and continuous participation in future interventions. The Health Equity Program also identified the opportunity to standardize the evaluation processes for organizations. While each institution worked on diverse projects, evaluations were based on their respective work plans and progress reports. However, a standardized evaluation process could improve efficiency in future interventions. Sustainability and Recommendations Many institutions that received funds have used them as a starting point to develop larger initiatives while others have used them to develop internal resources (i.e., digital libraries, trainings). “Organizations used this funding as seed money for projects that are now receiving greater financial support. Others have developed internal resources that allow them to continue addressing key health issues. For instance, they have optimized the use of digital libraries, expanded training reach, and replicated projects funded by this grant in other municipalities.” — Miguel Cruz, PhD, Co-Principal Investigator For other agencies looking to implement similar programs, the recommendation is clear: Streamline efforts to maintain consistency and coherence. Additionally, explore other agency or office supports for fostering an organizational culture that prioritizes continuous monitoring and process improvement, emphasized Cruz, PhD. Conclusion Clear, transparent communication and flexible administration with a focus on health equity generate a positive impact on vulnerable populations — as evidenced by increased knowledge, improved participant skills, attitude changes, inclusion in services, greater technology use among older adults, and enhanced equity skills among workers. This project demonstrates how health departments can collaborate with other sectors to address social determinants and ensure equitable access to resources. article yes

Learn about the art of storytelling in public health and how to tell stories to secure support/funding for critical public health initiatives.

While COVID-19 is still present and ever-changing, public health professionals must also grapple with new challenges such as monkeypox, increasing firearm homicide, and widespread heat waves. In the wake of such emergencies, public health preparedness is more critical than ever.

The COVID-19 pandemic presented an opportunity for an existing behavioral health resource—the Guam Behavioral Health and Wellness Center’s Crisis Hotline—to become a household name. During the pandemic, the hotline became a lifeline for a community in crisis greatly in need of information.

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.

Spanish language version of "Embedded: Puerto Rico’s Public Health Emergency Preparedness Academy" blog post.

In the late fall of 2021, ASTHO leadership visited select jurisdictions in the Pacific and the Atlantic for the first time since COVID-19 curtailed travel to these regions. It was a fantastic to reconnect with our leadership and dedicated staff. Unsurprisingly, we heard about the jurisdictions’ challenges, including chronic ones related to funding and infrastructure, as well as new challenges resulting from the global pandemic.

A groundbreaking “all-of-government” approach is getting underway in the U.S. Virgin Islands to more efficiently manage and expend federal grant funding for social determinants of health and overall population health improvement. The initiative follows findings that public health agencies encounter redundant, multi-layered review and approval processes that hamper their ability to efficiently procure needed goods and services that address long standing and emerging public health needs. Moreover, such processes hinder the ability to quickly stand up critical programs and respond to public health emergencies.