Territories and Freely Associated States

ASTHO supports the work of 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 that have entered into Compacts of Free Association with the United States, which are collectively referred to as the Island Areas or Island Jurisdictions.

U.S. Territories

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

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 tailored to their needs.


A picturesque view of a coastal scene in Puerto Rico, featuring multicolored houses along the shore, waves crashing against the rocky coast, and a distant lighthouse under an overcast sky.

Developing a Data Dashboard to Address Health Equity Concerns: Insights from Puerto Rico

The Puerto Rico Department of Health's Health Equity Program developed a social determinants of health data dashboard to identify health equity concerns, sharing insights and recommendations for similar public health initiatives.

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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.

Explore the Module
Bronze statue of Lady Justice on an orange background. ASTHO Federal Health Policy Update banner in the upper-right corner

Bringing the U.S. Territories Closer to Medicaid Equity

After years of advocacy, ASTHO and our partners are celebrating the recently signed Consolidated Appropriations Act.

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Cover slide for Key Strategies to Engage Communities During COVID-19

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.

Watch Part 1

Watch Part 2

Latest Island Areas Resources


Using Business Process Improvement to Address Procurement Challenges in Guam

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Woman in a blue patterned short-sleeved shirt sitting near a window with sunlight streaming in, the heading ‘Health Policy Update’ in the upper left corner.

Island Areas Public Health Policies in 2024

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Burnout and Workplace Well-Being for Community Health Workers Presentation Slides

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Mid-section of medical professional placing a stethoscope on a person's chest

Heart Disease and Stroke Prevention in the Pacific Territories

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feedNews Release

Public Health Leaders Will Visit Congress and Stress the Need to Invest in Infrastructure, the WIC Program, and Island Priorities

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City street lined with palm trees and flooded by hurricane

Why It’s Never Too Early to Prep for Hurricane Season

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Smiling mom leaning over baby in a pink dress laying on a table.

Strengthening Maternal and Infant Health Data in the U.S. Territories

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Aeriel view of Palau

Lessons Learned from Palau's Journey to Develop Health Equity Indicators

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ASTHO and the Island Areas 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 support policy efforts in the island areas.