Island Areas 101

ASTHO's members include the chief health officials of the five U.S. territories and three freely associated states (FAS). These eight jurisdictions are collectively referred to as the island areas or island jurisdictions.

Each island jurisdiction has a unique history, culture, government structure, and relationship with the United States. When working with the island areas, it is important to understand the differences among and between island jurisdictions and the contiguous United States.

Sovereignty is a significant difference between the U.S. territories and FAS. The FAS are independent nations connected to the U.S. through the Compacts of Free Association, under which the U.S. government agreed to provide economic and technical assistance, ensure U.S. military defense support, and allow unrestricted travel to and from the United States for these non-resident FAS citizens. In return, the FAS agreed to give the U.S. Government unlimited and exclusive use of their land and waterways for strategic purposes. The U.S. territories are under the jurisdiction of the U.S. government, and territorial residents are U.S. citizens or nationals.

Other distinctions include citizenship and differences in federal program and funding eligibility such as Medicaid, Medicare, SSI, and Veterans Affairs. The chart on this page summarizes these differences in political status, citizenship, visa requirements, and Medicaid and Medicare eligibility between the island jurisdictions.