Pacific Territories, Commonwealth, and Freely Associated States
The United States has special relationships with six
areas in the Pacific. The total population of these
jurisdictions is approximately 480,000 people, spread
across the ocean covering an area larger than the
continental United States.
All of the U.S. affiliated Pacific jurisdictions share
some challenges related to healthcare. Similar to many
other rural areas, they struggle with maintaining an
adequate health workforce. They also face difficulties in
financing health care, and some spend a large portion of
their healthcare budgets transporting patients
off-island to receive care that is not available locally.
The jurisdictions must address both the health concerns
of developing nations in treating malnutrition and
infectious diseases such as tuberculosis, as well as the
chronic health problems faced by developed nations, such
as diabetes and cancer.
Three of these jurisdictions, consisting of one
commonwealth and two territories, are part of the United
Residents of these three jurisdictions tend to have
better health and socio-economic status than those living
in the three jurisdictions that are not part of the U.S.
The other three jurisdictions are independent nations
that have special relationships with the U.S. through
individual agreements, the Compact of Free Association.
These countries were formerly part of the UN Trust
Territory of the Pacific Islands, administered by the
United States. The original Compacts have been amended over
time and are now Amended Compacts of Free
Association. These locations are sovereign
The United States provides assistance to these nations for
health services through the Compacts and also through
discretionary grants from the U.S. Department of Health and
Partnerships for Health: Charting a New Course;
Pacific Basin Jurisdictions: Legal, Geographic and
Last Reviewed: 10/20/2021