Heart Disease and Stroke Prevention in the Pacific Territories
March 11, 2024 | Marcus Plescia
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 1: USAPIs HDSP Learning Collaborative Essential Policy Efforts, 2022 – 2023
| Island | Key Accomplishments |
|---|---|
| CNMI | Engaged with technology and clinical sectors to draft a policy that tracked all chronic disease patients and incorporated other social determinants of health, including tobacco use, mental health, and housing. |
| RMI | Developed plans for a “minute clinic,” which provided fast health screenings for hypertension and diabetes as well as on-the-spot clinician and community program referrals. |
| Guam | Created several educational resources and used creative outreach efforts to promote low-sodium diets in the University of Guam nutrition program, discourage smoking and vaping as well as share the Tobacco Free Guam Quitline phone number, and spread the word about village-based exercise classes. |
| Republic of Palau | Procured several blood pressure machines to help patients with self-management. Also, worked with nutrition and physical activity experts to run “lunch and learn” and physical activity sessions at workplaces and in the community. |
ASTHO’s Tools for Change website captures resources and best practices from island and state learning collaborative activities. This hub is a go-to source that helps health agencies across the states and islands motivate data-driven action, standardize clinical practice, improve community-clinical linkages, and develop sustainable systems to address hypertension control.
Spotlight: Republic of the Marshall Islands
The first time I visited the Pacific territories in 2018 was with our heart disease program, and I was deeply impressed with the work they were doing. In recent years, RMI specifically has made notable accomplishments through our learning collaborative that I would like to highlight.
First, RMI developed an ambitious, community-centered plan to reduce blood pressure in hypertensive patients. This involved a mass awareness campaign, consisting of 15 community consultations at churches and villages throughout RMI, including on the remote Outer Islands with underserved communities. These consultations promoted heart disease education and offered chronic disease screening and treatment program enrollment. I remember thinking that was a fantastic way to improve the connection between the community and clinicians. I was also impressed with the collaboration between nurses at the Ministry of Health and workers at the Wellness Center as they enrolled community members in lifestyle change classes to improve risk factors.
RMI also implemented a billboard campaign around the island that raised awareness about heart disease prevention and control. In addition, the Ministry of Education and Sports, Sports Enrichment Program, and Parks and Recreation Service have partnered to make sports events fun and educational—offering screenings and collecting weight, sugar, and blood pressure data on the sidelines at games.
Moving Forward
It has been gratifying to see ASTHO support RMI and all USAPIs in our HDSP learning community. Leaders meet community members where they are in creative ways and provide them with the educational and clinical tools necessary to prioritize their heart health—key hallmarks of an effort that advances health equity.
As USAPIs HDSP Learning Collaborative achievements show, it is critically important to support communities developing holistic, equitable, and culturally appropriate strategies to address cardiovascular disease risk factors. Moving forward, we hope that territorial and state public health leaders will look to ASTHO’s Essential Policies for Chronic Disease Prevention and Control for policy-oriented approaches to improving heart health and strengthening the ties between healthcare and communities.