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.


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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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

Aerial view of Salinas, Puerto Rico

Leveraging the SPACECAT: An Island Areas Resource

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Using Boundary Spanning Leadership to Improve Population Health

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Illustration of the dengue virion

Dengue Preparedness in the U.S. Territories and Freely Associated States

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A wooden cutout of a person is posed as if climbing up ever-higher piles of gold coins

Centralizing Grant Management Functions: Puerto Rico’s Work and Vision

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View of the sea and cliffs in Pago Pago, American Samoa

Building an Island Health Equity Framework for the Future

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Islands Health Equity Framework

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Some of Palau's islands from the air

ASTHO Reports from Palau Equity Summit

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Main reading room at the Library of Congress. ASTHO Federal Health Policy Update banner in upper left.

Hearing the Hill

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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.