Territories and Freely Associated States

ASTHO supports the U.S. territories and freely associated states to improve population and community health. ASTHO's members include the chief health officials of the five U.S. territories and three sovereign nations with compacts of free association with the United States, which are collectively referred to as the Insular Areas or Island Jurisdictions.

U.S. Territories

  • Puerto Rico
  • U.S. Virgin Islands
  • American Samoa
  • Commonwealth of the Northern Mariana Islands
  • Guam

Freely Associated States

  • Federated States of Micronesia
  • The Republic of the Marshall Islands
  • The Republic of Palau

Providing public health services in remote islands in the Pacific and the Atlantic is often more costly than in the states. Due to differences in services configuration, eligibility for federal funding and programs, population health needs, and increased susceptibility to climate crisis, their policy needs are complex and often substantially different than those of the states. Given the uniqueness of each jurisdiction, we work to ensure our resources and technical assistance are tailor to their needs.


What Territorial Health Officials Need to Know about Grants Management

These introductory materials provide territorial health officials and their leadership teams with an overview of grants management—an essential health department function.

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Avoiding the Cliff: Financing Medicaid in the Territories

Medicaid plays a critical role in providing access to health services for low-income U.S. citizens in the territories. This podcast discusses the need for a permanent funding solution.

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Key Strategies to Engage Communities During COVID-19

This two-part video series highlights how states and territories have worked with community members in their responses to COVID-19.

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Watch Part 2

Latest Resources

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How-To Guide: Engaging Island Jurisdiction Partners

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Jurisdictions Using Policy to Address Unique Island Area Health Challenges

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COVID-19 in the Pacific: What We’ve Learned and Where We’re Going

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Integrado: Academia de Preparación para Emergencias de Salud Pública de Puerto Rico

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Embedded: Puerto Rico’s Public Health Emergency Preparedness Academy

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Reflections From the Field: Pacific and Atlantic Jurisdictions Remain Resolute Amid Adversity

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Interagency Collaboration to Improve Business Processes in the U.S. Virgin Islands

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What December Means for a Beloved Nutrition Program

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ASTHO and the island jurisdictions are supported by multiple organizations representing an array of public health topics. Below are a few partner organizations that work with us to support our island jurisdiction members.

ASTHO also manages two committees that supports policy efforts in the insular area jurisdictions. The Insular Areas Affairs Subcommittee provides a forum for ASTHO’s insular area island members to exchange information on policy challenges and solutions. The Island Insular Areas Workgroup aims to work with federal and non-profit partners to improve administrative, procedural, or programmatic policies that impact the insular areas island jurisdictions.