Pacific Cancer Programs

U.S Affiliated Pacific Islands

U.S. Affiliated Pacific Islands (USAPIs)

The islands of the USAPI are scattered across the immense Pacific Ocean north and south of the equator spanning one million square miles across five time zones including the international dateline. The islands are culturally and linguistically diverse with more than a dozen spoken languages. While the indigenous peoples of the USAPI are rich in culture they are small in population. The islands are fragile but in the past they have been plentiful, rich eco-systems. Multiple complex factors contribute to the severe health disparities in these islands. Colonization and rapid westernization have adversely affected many of the social, cultural, and environmental structures and practices that traditionally supported and protected the health of the islands, their waters and their people. Within only the last two decades the epidemiologic profile in the Pacific has shifted dramatically from predominantly infectious diseases to among the highest incidence and prevalence of preventable chronic diseases in the world, such as diabetes (47.3% in American Samoa) and hypertension, cardio-vascular disease (34% in American Samoa and 21% in the Pohnpei). Cancer mortality is now the second most common cause of death in nearly all USAPI jurisdictions.

On May 25, 2010 the Pacific Island Health Officers Association (PIHOA) declared a Regional State of Health Emergency in the United States Affiliated Pacific Islands (USAPI) due to the epidemic of non-communicable diseases (NCDs). “These islands have some of the highest rates of non-communicable disease in the world. Diabetes, heart diseases, strokes, cancer and other NCDs are killing off Pacific peoples, placing a significant burden on their daily functionality, and threatening the national security of these island countries and territories,” explained Dr. Stevenson Kuartei, PIHOA President and Minister of Health of the Republic of Palau. “Non-communicable diseases impair workers, increase absenteeism and cause untold suffering to patients and families but also lead to increased health care costs, including off island medical referrals.”

Below is a video presentation given by Dr. Buenconsejo-Lum on the topic of Comprehensive Cancer Control in the U.S. Pacific.

American Samoa Community Cancer Coalition

American Samoa Community Cancer Coalition

American Samoa was defined by an 1899 treaty between the United States of America, the United Kingdom of Great Britain and Northern Ireland, and Germany, which gave the United States of America control of all Samoan islands east of 171ºW. In 1978, the first popularly elected Samoan governor was inaugurated. In 2008, American Samoa had an estimated population of 66 107.

The Department of Health and the National Hospital continue to co-exist as two separate systems. The Department of Health is responsible for public health issues, communicable disease control (including tuberculosis and HIV/AIDS) and health dispensaries at district and community levels. The national hospital in Pago Pago is under the management of the Hospital Board, designated by the Governor, and is subject to the federal rules and regulation of the United States of America (i.e. the hospital does not have to report to the Department of Health). Nevertheless, coordination between the Department of Health and the National Hospital is generally well conducted at the technical level. Most public health programmes continue to be funded by federal grants.
The territorial health priorities are as follows:

  1. Increase the capacity of the health system to meet the health challenges of the 21st century by:
    • improving health policy development mechanisms,
    • developing the health workforce,
    • improving management processes at all levels, and
    • strengthening long-range health planning and programme planning.
  2. Identify emerging and re-emerging diseases and implement effective interventions.
  3. Implement effective interventions to decrease the burden of chronic diseases related to unhealthy lifestyles, especially cardiovascular disease, cancer and diabetes mellitus.
  4. Actively implement the Healthy Islands concepts of health promotion, health protection and primary health care in priority settings, particularly through community health centres and school-linked programmes.
  5. Increase the effectiveness of public investment in health through development of decision-oriented information systems, applied research, effective deployment of the health workforce, application of appropriate technology, and increased allocation of funding for health promotion, health protection and primary health care.
Guam Comprehensive Cancer Control Program

Guam Comprehensive Cancer Control Program

Guam is an island in the western Pacific Ocean and is an organized, unincorporated territory of the United States. It is one of five U.S. territories with an established civilian government. Guam is the largest and southernmost of the Mariana Islands.The population of Guam was estimated to be 175,991 in 2008. Population density is 325 per square kilometer.
Guam is dedicated to the attainment of health for all by 2010. In 1992, the Guam Health Planning and Development Agency identified 13 health service priority areas to be strengthened:

  • human resource development;
  • health planning;
  • wellness promotion;
  • health information systems;
  • communicable disease control;
  • disposal of hazardous and toxic materials;
  • availability and accessibility of health services;
  • environmental protection;
  • drug and alcohol abuse;
  • chronic disease prevention and control;
  • injury prevention;
  • maternal and child health

Although some improvement has been made in the area of health information systems, wellness promotion and communicable disease control, the remaining areas continue to be top priorities.

  • Additional information from our partners in Guam
Marshall Islands

National Comprehensive Cancer Control Program - Republic of the Marshall Islands

The Republic of the Marshall Islands covers an area of 181 square kilometres and comprises 29 atolls and five major islands that form two parallel groups: the Ratak (sunrise) chain and the Ralik (sunset) chain. The Marshallese are of Micronesian origin. The matrilineal culture revolves around a complex system of clans and lineages tied to land ownership. The last census took place in 1999 and the next is scheduled for 2009. An indirect presidential election was held in the Marshall Islands on 7 January 2008. The Minister for Health is the Honourable Amenta Matthew. The country is affected by rising sea levels, desertification, pollution from ships, coral reef erosion and infrequent typhoons. Bikini and Enewetak atolls are former United States nuclear tests sites (67 atmospheric bomb tests from 1946 to 1958).

The Northern Mariana Islands is a commonwealth of the United States of America, formed in 1978 and was formerly the United Nation’s Trust Territory of the Pacific Region of Micronesia within Oceania. Negotiations for territorial status began in 1972 and a covenant to establish a commonwealth in political union with the United States of America was approved in 1975. Residents (excluding foreign contract workers) are United States citizens but do not vote in federal elections and do not pay United States taxes. The Commonwealth of the Northern Mariana Islands (CNMI), its governing system and its infrastructure as an independent entity within a commonwealth agreement with the United States are only 30 years old. CNMI comprises 14 islands with a total land area of 454.8 square kilometres spread out over 683 760 square kilometres of the Pacific Ocean. The Commonwealth’s population lives primarily on three islands; Saipan, the largest and most populated island, is 20.1 kilometres long and 8.8 kilometres wide. The other two populated islands are Tinian and Rota, and the nine far northern islands are very sparsely inhabited, with a combined population of about six people.

Palau Cancer Prevention and Control Program

Republic of Palau Cancer Prevention and Control Program

Palau is a democratic republic with directly elected executive and legislative branches. Presidential elections take place every four years to select the President and the Vice-President. The estimated multi-ethnic population of Palau in 2008 was 20 729, with an estimated annual population growth rate of 0.6%. The population consists of 69.9% Palauans (who are a conglomeration of Micronesian with Malayan and Melanesian admixtures), 15.3% Filipinos, 4.9% Chinese, 2.4% other Asian, 1.9% Causacian, 1.4% Carolinian and 4.2% other or unspecified groups (2000 estimate). The 2006 estimate indicates a population density of 46 persons per square kilometre. Palau’s real per capita gross domestic product (GDP) of US$ 8423 (2007 estimate) makes it one of the wealthier Pacific island states. The economy consists primarily of tourism, subsistence agriculture and fishing. The Government is the major employer, relying heavily on financial assistance from the United States of America. Business and tourist arrivals numbered 89 151 in 2007. Long-term prospects for the key tourist sector have been greatly bolstered by the expansion of air travel in the Pacific, the rising prosperity of leading East Asian countries, and the willingness of foreigners to finance infrastructure development.

FSM National Comprehensive Cancer Control Coalition

FSM National Comprehensive Cancer Control Coalition

The Federated States of Micronesia is a constitutional federation of four states: Chuuk, Kosrae, Pohnpei and Yap, with the capital located in Palikir, Pohnpei. The Constitution provides for three separate branches of government at the national level: executive, legislative and judicial. It has a Declaration of Rights, similar to the Bill of Rights of the United States of America, specifying basic human rights standards consistent with international norms. It comprises approximately 607 small islands with a population of 107,000 (2000 census). The Division of Health is part of the Department of Health, Education and Social Affairs. The Secretary for Health, Education and Social Affairs is a Cabinet-level position, nominated by the President and requiring congressional confirmation. Currently, the Government is considering a proposal to split the Department into two Cabinet-level departments, one for Health and one for Education and Social Affairs.
The Division of Health has established five strategic health goals with the objective of improving health services:

  • to improve primary health care services;
  • to improve secondary health care services;
  • to prioritize health promotion and services for major health problems;
  • to develop a sustainable health care financing mechanism; and
  • to improve capacity and accountability systems.

Ten outcome measures were developed and used during the period from 2003 to 2005 to indicate progress in meeting these goals. In 2005, modifications were proposed involving the addition of four new measures. These modifications will be effective when endorsed by all four State Directors, the Secretary, Assistant Secretary and programme managers, and will be effective for the next five years. The proposed outcome measures involve increasing access to health services, improving immunization coverage, improving the availability of essential drugs, increasing the functionality of biomedical equipment, decreasing the average hospital stay, reducing infant mortality, reducing mental illness, increasing the number of individuals enrolled in a health insurance plan, reducing off-island medical referral costs, increasing the number of children under seven years of age receiving tooth sealant, reducing the incidence of diarrhoeal disease, reducing the incidence of hospitalization for diabetes, and implementing an efficient quality assurance system in all states. Baseline data have been collected in each of these areas and specific goals have been established to measure progress.

  • Additional information from our partners in the FSM
Chuuk State Comprehensive Cancer Control Program

1. Chuuk State Comprehensive Cancer Control Program

The 2001-2002 cancer needs assessment in Chuuk revealed that cancer was the third leading cause of mortality in Chuuk. Many of Chuuk’s people remain unaware of the burden of cancer in Chuuk and are unable to relate these results with their lifestyle, diet, habits, and behaviors. Most of the people of Chuuk people do not understand what cancer is, its risk factors and its negative impact on families, the community and the country. Public systems for mass communication about health issues are limited The single public broadcasting radio station only operates from 7:00 am to 11:30 am each day due to power limitations. There are only a few health educators, and none dedicated to cancer awareness and education programs. The public school systems do not have regular health education curricula. Chuukese now enjoy their western type lifestyles, and are consumers of unhealthy western products and foods. The have lost many of their valuable traditions which promoted healthy lifestyles and diets. The consequences of this change have resulted in a surge of chronic illnesses, including cancer which the present health system is unprepared. New systems to deal with cancer in Chuuk are needed. These include modes of cancer education, prevention, risk reduction, treatment, caring for the people and the families who suffer from cancer, and improving cancer data management. A comprehensive cancer plan which accounts for the economy, geography, culture, disparity, available human resource, and the level of infrastructure development is needed.

  • Additional information from our partners in Chuuk
Kosrae Comprehensive Cancer Control Partnership

2. Kosrae Comprehensive Cancer Control Partnership

The Kosrae Comprehensive Cancer Control Partnership held seven large coalition meetings since its establishment to develop the Kosrae Comprehensive Cancer Control Plan. There were also countless phone calls, emails, faxes and meetings of smaller workgroups as well as one on one meetings between members and the coordinator in between meetings for plan development. The first phase in the development process for the plan focused on increasing partner’s awareness and understanding of the CDC’s comprehensive approach to cancer control, the basics of cancer and the burden of cancer in Kosrae. Phase two of plan development was the strategic planning component. The Partnership agreed on the vision and mission statements and the organizing framework for cancer control through group activities utilizing multi-voting, brainstorming and other tools from the CDC Comprehensive Cancer Control Guidebook. The third phase involved the drafting of goals, objectives and strategies across the whole continuum of cancer care. Extensive discussions, revisions and changes were made to the proposed short-term and long-term goals, measurable objectives and strategies to arrive at the current version. Finally, partners identified and committed support to implementation of specific strategies in the Kosrae Comprehensive Cancer Control Plan. The Kosrae Comprehensive Cancer Control Partnership adopted by-laws and articles of incorporation that sets out all procedures and processes for membership, leadership selection and replacement, voting, prioritization, etc. The by-laws established an Executive Committee comprising of presiding officers of the partnership and appropriate representatives from the Health Department to conduct business on behalf of the organization when needed. It is the Executive Committee that will oversee and continually review and evaluate the plan for needed revision or changes.

  • Additional information from our partners in Kosrae
Pohnpei State Comprehensive Cancer Control Program

3. Pohnpei State Comprehensive Cancer Control Program

Pohnpei State Department of Health Services has been tackling the health problems of cancer in a rather ineffective multidimensional and a poorly collaborative fashion. This is largely due to its fragmented system of budgeting, resulting in many of its public health programs focusing on different elements of cancer awareness, prevention, treatment, and management. Before the establishment of Pohnpei Cancer Program, much of the existing public health programs such as Maternal & Child Health and Family Planning programs primarily focused their prevention efforts on the needs of mothers and children and cancers associated with motherhood. The Tobacco Control Program provides awareness and prevention programs for tobacco related cancers and serves mainly as advocates to tobacco free legislations and policies. Substance Abuse & Mental Health Programs provide education and awareness of drugs and substances related to cancer. However, none of these severely understaffed. There is no current network of programs that deals with cancer in terms of data management, prevention, planning, and treatment. A large number of cancers in the Pohnpeian population are preventable cancers and cause significant amounts of early death. Moreover, dealing with cancer from the individual existing public health program’s perspective does not improve overall cancer. Collaboratively addressing cancer prevention, early detection, and effective management is essential to provide of Cancer in Pohnpei.

  • Additional information from our partners in Pohnpei
Yap Cancer Coalition

4. Yap Cancer Coalition

The Yap CCC Program aims to complement existing public health programs in delivery of services by coming together in a collaborative effort to incorporate cancer awareness, prevention and screening activities. The current public health programs, such as Substance Abuse and Mental Health, Immunization, Family Planning, Sexually Transmitted Infections, Non- Communicable Diseases and Maternal Child Health all cover aspects of lifestyle behavior related to risk factors for developing cancer including tobacco and alcohol use, nutrition, obesity and lack of physical exercise to name a few. Very often, the obstacles to maximize delivery of these services are insufficient manpower and lack of effective coordination among all stakeholders. It is hoped that the Yap CCC Program can take the lead in this coordination effort and be proactive rather than reactive. The Yap CCC Program will ensure that all the goals, objectives and strategies within the Yap CCC Plan are achieved in a timely manner according to the plan framework. We are focused on prevention through public education and awareness of cancer as a disease and the associated risk factors. We will expand our early detection efforts by doing more outreach work and screening. We can improve access and delivery of cancer treatment to all of Yap’s citizens, especially those in the outer islands. We are determined to help cancer patients and their families have the best possible quality of life with the help of a support network. To accomplish all of this and more, we must also enhance and expand our existing data collection and data quality by establishing a cancer registry program. Our message needs to be visible in all of the island communities, in the health care system, within churches, within schools and within the workplace. Our plan cannot target only the mainstream population, which is Yap Proper, but must also include the underserved and at risk populations in the Outer Islands of Yap.

  • Additional information from our partners in Yap

Pacific Island Health Officers Association (PIHOA)

The Pacific Island Health Officers Association (PIHOA) is dedicated to the health and well-being of the Pacific Island populations. PIHOA serves as a unifying voice and credible authority on issues of regional public health significance. Execution of this charge is attained through collaborative and cooperative efforts in capacity building, advocacy and policy development, to provide medical care, promote healthy lifestyles, prevent disease and injury, and protect the environment.

PIHOA (a non-profit association) represents the collective health interests of the three U.S. Flag Jurisdictions {the Territory of Guam, the Commonwealth of the Northern Mariana Islands (CNMI), and Territory of American Samoa}, and the three Freely Associated States {the Federated States of Micronesia (FSM), the Republic of the Marshall Islands (RMI), and the Republic of Palau (ROP)}.

PIHOA is an association of the six principal/executive health officers from the six United States Pacific Jurisdictions; this is the PIHOA Board of Directors. PIHOA’s other members are its Associate, Affiliate, and Honorary Members. PIHOA’s Associate Members include the health directors from the Federated States of Micronesia’s four states (Yap, Chuuk, Kosrae, and Pohnpei); the Director of Guam’s Department of Mental Health and Substance Abuse; the Chief Executive Officer of American Samoa’s LBJ Tropical Medical Center; the Secretary of Health from the Republic of the Marshall Islands; the Palau’s Director, Bureau of Hospital and Clinical Medicine; Palau’s Director of Public Health; CNMI’s Deputy Secretary of Public Health; the CEO/Hospital Administrator of the Guam Memorial Hospital.

PIHOA’s Affiliate Members are non-profit Pacific health related organizations contributing to PIHOA’s cause. PIHOA’s present affiliate members are the Pacific Basin Medical Association (PBMA), the American Pacific Nursing Leaders Council (APNLC), the Pacific Basin Dental Association (PBDA), the Pacific Substance Abuse Mental Health Collaborating Council (PSAMHCC), the Cancer Council of the Pacific Islands (CCPI), and the Pacific Islands Primary Care Association (PIPCA).

For the past 20 years, PIHOA has served as the regional health policy body for the U.S. affiliated Pacific Islands. The Association has been able to bring together (at our semi-annual meetings) Pacific Island health leaders with representatives of federal agencies to discuss issues of mutual concern. At these meetings, officials from the U.S. Federal Government, i.e., the Department of Health and Human Services (DHHS) and its Health Resources and Services Administration (HRSA), the Centers for Disease Control and Prevention (CDC), the Office of International and Refugee Health (OIRH), the Department of Interior (DOI), and the DHHS Region IX offices have been able to have substantial dialog with Pacific Island health leaders.

Funding for this website was made possible by a cooperative agreement from the Centers for Disease Control and Prevention, through the following:
Pacific CEED, award #: 5U58DP000976,USAPI Community Health Interventions Project (CHIP), award #: 1U58DP005810,
Pacific Regional Central Cancer Registry, award #: 5U58DP003906; Regional Comprehensive Cancer Control Program, award #: U55/CCU923887.
The views expressed on this site do not necessarily reflect the official policies of the Department of Health and Human Services;
nor does mention of trade names, commercial practices, or organizations imply endorsement by them or the U.S. Government.
Funding Sources: PRCCR: #: 5U58DP003906  | Pacific REACH: #: 1U58DP005810 | RCCC: #: U55/CCU923887 

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