The islands of the U.S. Affiliated Pacific Islands (USAPI) are scattered across the immense Pacific Ocean north and south of the equator spanning one million square miles and five time zones that include the international dateline. Each of the USAPI jurisdictions and territories is rich in culture, history and language, but small in population. The islands are fragile and diverse but have a long past offering plentiful, sustainable eco-systems that supported their indigenous populations.

While the economic, health and political environment of the ten USAPI jurisdiction and territories are related, each island nation has its own unique strengths as well as challenges. The current health infrastructure in the USAPI suffers from severe resource limitations. Health status indicators demonstrate significant disparities for almost all non-communicable diseases, including most cancers. Factors influencing policy issues, political relationships, the economy, the environment, diverse cultures, stressed health systems, education, limited human resource development and the sheer physical isolation of these islands all contribute to the enormous challenges in achieving health equity in the USAPI.

One of the most dramatic illustrations of the severe resource limitations in the USAPI that contribute to health disparities is the per capita total health expenditure. Significant variations occur even between the ten jurisdictions. When compared to the United States the difference is enormous.

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), hypertension and, cardiovascular disease (34% in American Samoa and 21% in the Pohnpei).