Populations Living in Island Communities
Rural populations living in island communities that are only accessible via air and water face challenges in accessing health and human services. Examples of island communities include:
- Hawaii (U.S. State)
- Northern Mariana Islands (Commonwealth)
- Puerto Rico (Commonwealth)
- American Samoa (Territory)
- Guam (Territory)
- U.S. Virgin Islands (Territory)
- Federated States of Micronesia (Sovereign State)
- Republic of the Marshall Islands (Sovereign State)
- Republic of Palau (Sovereign State)
- Other island communities in the contiguous United States
These communities are geographically isolated, and may need to allocate significant resources to facilitating “off-island” care for residents when local services are not available. Some island communities have very few health care providers and services, and lack specialty services. These rural communities may also lack the necessary workforce and equipment to implement quality improvement interventions for services integration. In addition, limited resources may lead to a lack of care coordination and continuity of care.
These challenges have been exacerbated by recent natural disasters. For example, in the months following Hurricane Maria (2017), rural community health centers in Puerto Rico have struggled with access to medication, equipment, electricity, and potable water. Hurricanes Irma and Maria also caused major structural damage to health care facilities and worsened workforce shortages in the U.S. Virgin Islands. Health care providers are projecting long-term financial deficits for the health care system that will impact service delivery in the future.
The Pacific Chronic Disease Council implemented the Pacific Care Model in order to address the fragmentation of health services in Pacific island nations. The Council includes representatives from American Samoa, Guam, the Northern Mariana Islands, the Federated States of Micronesia, the Republic of Palau, and the Republic of the Marshall Islands. The Pacific Care Model involves increased care coordination through improved information technology systems and “one-stop shop” care. The model has been successful at increasing diabetes self-management among participants and increasing screening rates for co-morbid conditions.
Island communities in the contiguous United States are also integrating services in an effort to address transportation challenges, workforce shortages, and high costs of health care in rural areas. For example, Island Hospital on Fidalgo Island in Washington State is integrating primary care and behavioral health and providing school-based health services in order to meet mental health needs in the rural town of Anacortes.
Resources to Learn More
The Pacific Island Health Care Project
This journal article describes the Pacific Island Health Care Project, a program that provides telemedicine to U.S. Associated and Affiliated Pacific Islands.
Author(s): Person, D.
Citation: Frontiers in Public Health, 2, 175