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 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

  • 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 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.

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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 Island Jurisdiction Resources

An ambulance racing on a stormy night with motion-blurred lights

State, Territorial Health Policies Strengthening Emergency Preparedness Efforts

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Close-up photo of a mosquito with a red sitting on a leather couch

Public Health Confronts the Mosquito: Special Considerations for United States Territories and Freely Associated States

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Illustration conveying a large group of people discussing heart health

Leveraging Health Official Authority and Influence for Systems Improvement

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The Puerto Rico and USVI OT21-2103 teams with CDC, and ASTHO staff at the 2022 Atlantic Health Equity Action Institute in Puerto Rico.

Sharing Island Stories on Health Equity: Setting the Stage for Equity in the Island Areas

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A depressed woman sits on the couch making a phone call, a box of tissues, glass of water, and overturned bottle of pills in front of her.

Guam Behavioral Health and Wellness Center: A Pandemic Lifeline

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Thumbnail for How-To Guide: Engaging Island Jurisdiction Partners

How-To Guide: Engaging Island Jurisdiction Partners

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U.S. Capitol dome and buildings from the west at sunrise

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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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 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. 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.