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.
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Braiding & Layering Funding to Sustain Cross-Cutting Efforts that Benefit Multiple Programs and Funding Streams
In this four-part online course designed for local, state, and island area health agencies, you will explore key components and tools for braiding and layering funding.
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Island Areas Health Equity Framework
This webpage shares the framework, which builds on current health equity frameworks to reflect the culture, experiences, and strengths of island communities more authentically.
Explore the Framework
Including Island Areas in Federal Public Health Datasets
Public health datasets inform effective decision-making. This report and addendum identify where the island areas are missing in U.S. public health datasets and share recommendations to address barriers.
Read the Report
ASTHO and NAMD Call on Congress to Fully Fund Medicaid and CHIP in U.S. Territories
In a joint letter to Congress, ASTHO and the National Association of Medicaid Directors urged Congress to fully fund Medicaid and Children's Health Insurance Programs in the U.S. territories.
Read the News Release
Improving Indirect Cost Rate Use in Island Jurisdictions
Indirect cost rates (ICRs) are a critical component of effective financial management for public health agencies. This report and guide outline how island jurisdictions can improve their ICR use and maximize federal funding.
Read the ReportLatest Island Areas Resources
Strengthening Leadership, Risk Communications, and Preparedness in the Islands
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Using Health Equity Indicators to Guide Community Health Improvement in U.S. Territories and Freely Associated States
Learn MoreCollaborations
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.
- Pacific Islands Health Officers Association
- CDC Foundation
- World Health Organization
- Western Pacific Health Organization
- Puerto Rico Science, Technology & Research Trust
- Partners in Health U.S.
ASTHO also manages two committees that support policy efforts in the island areas.
- The Insular Affairs Committee provides a forum for ASTHO’s island members to exchange information on policy challenges and solutions.
- Two key priorities of this committee are territorial Medicaid parity and fully funding the renegotiated Compacts of Free Association.
- The Island Areas Workgroup aims to work with federal and non-profit partners to improve administrative, procedural, or programmatic policies that impact the island areas.
- In Oct. 2022, the workgroup developed a report highlighting the need to represent Island Area data within federal public health datasets.