What are the most significant health challenges facing residents of insular areas of the Pacific?

• Health and economic status much worse than United States as a whole, with FAS worse than the territories.
• Health disparities related to urbanization, diet shifting from traditional, local foods to low-quality imported food products, social pathology due to breakdown of traditional systems, and environmental factors such as lack of clean water and proper sewer systems, pollution, and climate change.
• Some areas have high rates of infectious diseases that are rarely seen in developed countries: leprosy, dengue fever, Zika virus, measles, cholera, typhoid fever, TB, and syphilis.
• Micronutrient deficiencies and obesity are caused by poor diet and decreased physical activity.
• High prevalence of adult diabetes.
• USAPI leads the world in obesity-related illness.
• Marshall Islands: radiation exposure from U.S. nuclear testing.
• Frequent natural disasters: tsunamis, typhoons, drought, and rising sea levels.
• Limited capacity of health and relief services; staffing shortages and lack of equipment and supplies.
• Wide dispersion and remote location of populations make delivery of health services difficult; supply lines are logistically difficult and expensive over long distances.
• Limited telecommunications and technology.
• Treatment of chronic diseases requires referrals to other locations, draining health budgets.
• Poor sanitation.
• Epidemics of certain diseases can be more severe since the population in remote areas was not previously exposed.
• High rates of TB, lymphatic filariasis, leprosy, rheumatic heart disease, leptospirosis, intestinal helminths, and diarrheal diseases.