Deck 10: Public Health in Us-Affiliated Tribes, Territories, and Freely Associated States

Question 1

What are the most significant health challenges facing residents of insular areas of the Pacific?

Answer 1

-Health and economic status much worse than United States as a whole, with FAS worse than the territories.
-Health disparities related to urbanization, diet shifting from traditional, local foods to low-quality imported food products, social pathology due to breakdown of traditional systems, and environmental factors such as lack of clean water and proper sewer systems, pollution, and climate change.
-Some areas have high rates of infectious diseases that are rarely seen in developed countries: leprosy, dengue fever, Zika virus, measles, cholera, typhoid fever, TB, and syphilis.
-Micronutrient deficiencies and obesity are caused by poor diet and decreased physical activity.
-High prevalence of adult diabetes.
-USAPI leads the world in obesity-related illness.
-Marshall Islands: radiation exposure from U.S. nuclear testing.
-Frequent natural disasters: tsunamis, typhoons, drought, and rising sea levels.
-Limited capacity of health and relief services; staffing shortages and lack of equipment and supplies.
-Wide dispersion and remote location of populations make delivery of health services difficult; supply lines are logistically difficult and expensive over long distances.
-Limited telecommunications and technology.
-Treatment of chronic diseases requires referrals to other locations, draining health budgets.
-Poor sanitation.
-Epidemics of certain diseases can be more severe since the population in remote areas was not previously exposed.
-High rates of TB, lymphatic filariasis, leprosy, rheumatic heart disease, leptospirosis, intestinal helminths, and diarrheal diseases.

Question 2

What are the most significant health challenges facing American Indian/Alaska Native populations?

Answer 2

-Death rates are higher for many causes compared to the general U.S. population, including deaths due to chronic liver disease/cirrhosis, diabetes mellitus, chronic lower respiratory disease, unintentional injuries, assault/homicide, and suicide, and life expectancy is four years less.
-Compared with other groups, AI/AN adults are more likely to experience poor health and psychological distress, to have unmet medical needs due to cost, to have diabetes and activity limitations, and to be smokers and binge drinkers.
-More than half the AI/AN population has limited or no access to IHS services.
-IHS is chronically underfunded and so is limited in its capacity to provide care and services to AI/AN populations.
-Geographic isolation and economic factors contribute to poorer health outcomes.

Question 3

What are the most significant health challenges facing residents of insular areas of the Caribbean?

Answer 3

-Gap in life expectancy between males and females is eight years, compared with four years in the United States due to high level of homicides and vehicular injuries among adolescent and young adult Puerto Rican males.
-Residents of PR and USVI experience similar rates of chronic disease as mainland
United States Heart disease, cancer, cerebrovascular disease, and diabetes are leading causes of death.
-High preterm birth rates in PR and USVI.
-HIV/AIDS is major public health issue in PR and USVI.
-Infectious diseases are also major issues: endemic dengue fever, TB, and chikungunya. Dengue and chikungunya are difficult to diagnose due to limited access to lab tests and symptoms that resemble other diseases such as influenza.
-Impact of environmental events: hurricanes and large dust clouds containing particles that enter airways.
-Presence of toxic waste sites.