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Rural Health Information Hub

U.S. Territories, Commonwealths, and Freely Associated States

The United States has special relationships with two areas in the Atlantic and six areas in the Pacific Basin. The total population of these eight jurisdictions is approximately 3.8 million people, spread across an area larger than the continental United States.

All of the U.S. affiliated jurisdictions share some challenges related to healthcare. Similar to many other rural areas, they struggle with maintaining an adequate health workforce. They also face difficulties in financing healthcare, and some spend a large portion of their healthcare budgets transporting patients off-island to receive care that is not available locally. The jurisdictions must address both the health concerns of developing nations in treating malnutrition and infectious diseases such as tuberculosis, as well as the chronic health problems, such as diabetes and cancer.

Five of these jurisdictions, consisting of two commonwealths and three territories, are part of the United States:

The other three jurisdictions are independent nations that have special relationships with the U.S. through individual agreements, the Compacts of Free Association. These countries were formerly part of the U.N. Trust Territory of the Pacific Islands, administered by the United States. The original Compacts have been amended over time and are now Amended Compacts of Free Association. These locations are sovereign states:

The United States provides assistance to these nations for health services through the Compacts and also through discretionary grants from the U.S. Department of Health and Human Services.

Data Sources
Pacific Partnerships for Health: Charting a New Course; U.S. Affiliated Pacific Basin Jurisdictions: Legal, Geographic and Demographic Information