2010 Report: Public Health Preparedness
Overview of Preparedness in the U.S. Insular Areas: Territories, Commonwealths, and Freely Associated States
The United States has strategic and economic pacts with two jurisdictions in the Atlantic Ocean and six in the Pacific Basin. Jointly referred to as insular areas, they include territories, commonwealths, and freely associated states. The pacts between the United States and these islands include the provision of federal assistance. CDC’s Public Health Emergency Preparedness (PHEP) cooperative agreement provides funding for preparedness activities to health departments on these islands, many of which face diverse challenges related to their isolated geographical locations and socioeconomic conditions.
The U.S. insular areas receiving PHEP preparedness funding are the territories of American Samoa, Guam, and U.S. Virgin Islands; the commonwealths of the Northern Mariana Islands and Puerto Rico; and the three freely associated states of the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau.47 These areas also received funding specifically for pandemic influenza preparedness through the pandemic influenza supplement in 2006- 2008 and, more recently, through the Public Health Emergency Response grant in response to the 2009 H1N1 influenza pandemic.
Preparedness Challenges and Focus
Public health preparedness efforts in the insular areas differ from the U.S. mainland due to their isolation. Methods for communicating about preparedness range from word of mouth and distributing flyers door-to-door to the use of telephones, cell phones with solar chargers, and HAM radios. Internet connectivity is limited and costly. PHEP funds are used primarily for building and maintaining basic capabilities. The current focus is on obtaining equipment, planning, and exercising emergency response plans, with some emphasis on training.
A Range of Surveillance Systems
Disease surveillance and reporting methods in the islands range from well developed, electronic systems connected to CDC’s secure Epidemic Information Exchange (Epi-X) system and the Health Alert Network (HAN) to more basic, paper-based systems that can be effective in smaller, more remote island communities where electricity may not be available. As of July 2009, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands all responded to HAN test messages within the target time of 30 minutes. The ability of public health staff to receive urgent emerging health information helps ensure that local problems are contained and national events are detected sooner.
Limited Laboratory Capability
Laboratory capability – the ability to analyze biological and chemical specimens – is very limited in the islands. Challenges include large travel distances, slow or little communication between the islands, difficulties in transporting specimens, and lack of training and resources. Another important challenge is the lack of physical infrastructure to support laboratory requirements such as controlled environments and stable power sources. Most of the islands send specimens for confirmatory testing to reference laboratories in the United States and Australia, a practice that is time-consuming; receiving results can take from a week to more than a month.
Improved Planning for Emergencies
PHEP cooperative agreement funding has been instrumental in supporting the development and exercising of emergency response plans for all insular areas. This has resulted in greater preparedness of the public health workforce as well as the communities they serve.
As with states and localities, insular areas receiving PHEP funding are required to report on exercising and improving their response plans. Table 10 presents FY 2008 data submitted by the eight U.S. insular areas. (For a fuller explanation of these data points, see appendix 1.)
Table. Public Health Preparedness Activities in U.S. Insular Areas; 2007-2008
View full-sized version of table.
- Page last updated September 21, 2010
- Page last reviewed September 21, 2010
- Content source: Office of Public Health Preparedness and Response (OPHPR, formerly the Coordinating Office for Terrorism Preparedness and Emergency Response [COTPER])