Presenter Disclosures

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Presenter Disclosures
James Rarick

• (1) The following personal financial
  relationships with commercial interests relevant
  to this presentation existed during the past 12
  months

No relationships to disclose
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Public Health Issues for Hawaii and the U.S.-
affiliated Pacific Islands
Presenter James Rarick, MPH
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The American Public Health Association
works to Ensure access to health
care Protect funding for core public health
services Eliminate health disparities
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U.S.-affiliated Pacific Islands
American Samoa Guam Commonwealth of the
Northern Mariana Islands Federated States of
Micronesia (Pohnpei, Chuuk, Yap, Kosrae)
Republic of the Marshall Islands Republic of
Belau (Palau)
Flag Territories
Freely Associated States (FAS)
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(No Transcript)
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Guam and American Samoa
A Village on Guam Prior To World War II
Pago Pago Harbor, American Samoa
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THE CREATION OF THE U.S. TRUST TERRITORIES OF THE
PACIFIC ISLANDS
TTPI Established in 1947 Republic of the
Marshall Islands (RMI) and Federated States of
Micronesia (FSM) established in 1979, and signed
CFA with U.S. in 1986 Northern Mariana Islands
established as commonwealth in political union
with U.S. in 1978 Republic of Belau established
in 1981, signs CFA with U.S. in 1994
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BRAVO SHOT March 1,1954
Total Yield Largest hydrogen bomb ever tested in
the U.S. Approx 7,200 Hiroshima bombs Equal 1.6
Hiroshima bombs per day 12 year test span 6.3
billion of curies of I-131 released into the
atmosphere 42 x Nevada, 150 x Chernobyl
incident Ignited an international controversy
Led to US-USSR Limited Nuclear Test Ban Treaty
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OUTCOMES
SHORT TERM - Direct fallout on people of two
atolls and more - causing acute radiation
poisoning and radiogenic related illnesses LONG
TERM - Long term contamination of lands and food
chain - Destruction of culture/ communities,
social structure - Loss of ability to self
sustain Source Presentation of Dr Wilfred
Alik, Marshallese Physician, at the 2005
Pacific Global Health Conference
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A LEGACY OF MISTRUST
US Position - Lots of money - You had your
chance - Legal Document - Other Priorities -
Nuclear Issue Settled
RMI Position - Nuclear issues not resolved - All
aspects must be settled - Never had enough in the
first place - Inadequate settlements - Standard
of care -- not equitable
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Disparities between USAPIs
Source Pacific Islands Health Officers
Association
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Life Expectancy at Birth American Samoa
Guam CNMI FSM RMI Palau
U.S.

Infant Mortality Rate American Samoa Guam
CNMI FSM RMI Palau U.S.
8.7 6.5 6.7 27.0 26.4
3.7 6.3 Source CIA World
Factbook, 2008 est.
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Forging a new type of relationship with the U.S.
the Compact of Free Association
Defines the relationship that the FSM, RMI, and
ROP, as sovereign states, have entered into as
associated states with the U.S. Initial
agreements provided guaranteed financial
assistance over a 15-year period administered
through the Office of Insular Affairs in exchange
for certain defense rights. In 2003, the
Compacts between the RMI and FSM were renewed for
20 years. These new Compacts provide 3.5 billion
in funding for both nations. U.S. 30 million
was also provided to Guam, Hawaii, and the
Northern Mariana Islands as "Compact Impact"
funding. U.S. treats these nations uniquely by
giving them access to many U.S. domestic
programs, including disaster response and
recovery and hazard mitigation programs under
FEMA. The new Compacts also changed certain
immigration rules. RMI and FSM citizens traveling
to the U.S. are now required to have passports,
but they do not have to apply for visas for U.S.
entry. Current CFA for Palau expires in 2009.
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Pacific Islanders in U.S. Armed Forces
Highest Fatality Rates in Iraq Conflict through
March 26, 2008
Source Time Magazine, April 7, 2008
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Impact of FAS emigration
Change in Ethnic Composition of Guams
Population, 1980 - 2000
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Challenges for CFA Population in Hawaii
CFA Population (1997) Adults who are H.S. Grads
43.6 Adults in Workforce - 44.6 Per Capita
Income - 3,759 Speak English at Home - 15.8
HI Pop. (1999-2000) Adults who are H.S. Grads
84.6 Adults in Workforce - 64.5 Per Capita
income - 21,525 Speak English at Home - 73.4
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Burden of healthcare costs for Hawaii
In 2002, Hawaii Dept. of Human Services saw a 20
increase as compared to 2001 in the number of FAS
migrants served, at a cost of over 11 million in
financial assistance (4,521,240) and medical
assistance (6,746,008) Federal Personal
Responsibility and Work Opportunity
Reconciliation Act of 1996 (PRWORA) made FAS
migrants ineligible for federal public
assistance State now covers the entire costs of
the FAS migrant when they enroll in QUEST (a
managed care Medicaid program) and other medical
and financial assistance programs. Under PRWORA,
only treatment of emergency medical conditions
may be submitted for federal reimbursement. Sou
rce Impacts of the CFA on Hawaiis Healthcare
System, A Policy Brief prepared by the Hawaii
Uninsured Project, 2004
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Micronesian Homeless in Hawaii
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Biennial Pacific Global Health Conference
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Micronesian Voices Conference, April 2008
Recommendations Establish centralized place
for information sharing/dissemination Need more
accurate data on Micronesians in Hawaii
Increase clarity from State of Hawaii regarding
the programs/services Micronesians qualify for
Establish pool of qualified interpreters in all
major languages Support more cultural
competence training for providers Have more
meetings/conferences to promote dialogue among
stakeholders Increase the number of
mentoring/bridging programs for Micronesian
youth Increase collaboration between Hawaii
State government and CFA governments.
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www.hawaiipublichealth.org
Mahalo Nui Loa Si Yuus Maase
(Chamorro) Faafetai Tele (Samoan) Kommol tata
(Marshallese) Kulo maluhlap (Kosraen) Kam Magar
(Yapese) Kelangan (Pohnpeian) Kili So Chapur
(Chuukese) Sulang (Palauan) Thank You Very Much!