American Samoa

American Samoa is a United States territory in the western Pacific. It lies on the same side of the international date line as the continental U.S.

Government

The U.S. president is considered the head of state and the governor is the head of government. While American Samoa is a U.S. territory, its residents are U.S nationals instead of U.S. citizens; however, neither citizens nor nationals of U.S. territories vote in federal elections or pay federal taxes.

Geography

American Samoa is geographically isolated from the rest of the U.S.-Affiliated Pacific Islands (USAPI): the territory is located in the southern region of the Pacific (Polynesia), while the rest of the USAPI are in the northern region (Micronesia).

American Samoa maintains significant ties with the independent nation of Samoa, which is only a thirty-minute flight west across the international date line. Due to their cultural and historical links, Samoans also share a special affinity for their “brothers and sisters” in the U.S. territory of American Samoa; nearly one-third of American Samoa’s workforce hails from Samoa, and the two jurisdictions engage in frequent cultural exchange.

Health Care and Facilities

American Samoa’s health care system is administered and subsidized by the government. American Samoa has a Department of Public Health and the American Samoa Medical Center Authority; these operate as two separate systems. American Samoa has one hospital, the LBJ Tropical Medical Center, which is a general acute care hospital with approximately 150 beds, and six primary health centers.

American Samoa operates a Medicaid program to support care for low-income residents. Territorial Medicaid programs are underfunded relative to the states. Unlike state Medicaid programs, territorial Medicaid programs have (1) a cap on total federal contributions and (2) a federal funding match set by law rather than based on per-capita incomes. Notably, American Samoa also uses presumptive eligibility, allowing residents to access care immediately while their full Medicaid application is processed — an approach unique among U.S. territories.

Key Priorities

American Samoa, like the rest of the Pacific, faces a noncommunicable diseases crisis and a significant communicable disease burden. In the 2023 ASTHO Environmental Scan, the territories and freely associated states shared the following top priorities:

• Communicable disease control.
• Access to and linkage with care.
• Noncommunicable disease prevention and treatment.
• Organizational capacities.
• Emergency preparedness and response.
• Data modernization and informatics.
• Workforce development.

Disease Burden

As of 2019, heart disease, diabetes, and stroke were the top three health issues for the islands. The estimated top five causes of death in 2023 were:

• Ischemic Heart Disease
• Diabetes
• Stroke
• Chronic Kidney Disease
• Chronic Obstructive Pulmonary Disease