Pacific Partnerships for Health : Charting a title: Course for the 21st Century author: Feasley, Jill C.; Lawrence, Robert S. publisher: National Academies Press isbn10 | asin: 0309059488 print isbn13: 9780309059480 ebook isbn13: 9780585025575 language: English Public health--Islands of the Pacific, Health subject Services, Health Planning, Asian Americans. publication date: 1998 lcc: RA557.P33 1998eb ddc: 362.1/0996 Public health--Islands of the Pacific, Health subject: Services, Health Planning, Asian Americans. Pacific Partnerships for Health Charting a Course for the 21st Century Committee on Health Care Services in the U.S.-Associated Pacific Basin Division of Health Care Services and Board on International Health INSTITUTE OF MEDICINE Jill C. Feasley Robert S. Lawrence, Editors NATIONAL ACADEMY PRESS Washington, D.C. 1998 NATIONAL ACADEMY PRESS · 2101 Constitution Avenue, N.W. · Washington, DC 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. Support for this project was provided by the Health Resources and Services Administration, U.S. Department of Health and Human Services, with additional support provided by the Archstone Foundation and the U.S. Department of the Interior. The opinions expressed in this report are those of the Committee on Health Care Services in the U.S.-Associated Pacific Basin and do not necessarily reflect the views of the funders. International Standard Book Number: 0-309-05948-8 Additional copies of Pacific Partnerships for Health: Charting a Course for the 21st Century are available for sale from the National Academy Press, 2101 Constitution Avenue, N.W., Box 285, Washington, DC 20055. Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area) or visit NAP's on-line bookstore at www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at www.nas.edu/iom. Copyright 1998 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The sperpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Cover artwork: Women and Children, by Valerie Hunton. Cover design by Francesca Moghari. Page iii Committee On Health Care Services In The U.S.-Associated Pacific Basin Robert S. Lawrence* (Chair), Associate Dean for Professional Education and Programs and Professor of Health Policy, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland Dyanne D. Affonso,* Dean and Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia Carolyne K. Davis,* International Health Care Consultant, Ernst and Young, Washington, D.C. William H.J. Haffner, Professor and Chair, Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, Maryland Glen E. Haydon, International Consultant, Des Moines, Iowa Francis X. Hezel, Director, Micronesian Seminar, Chuuk, Federated States of Micronesia Dean T. Jamison,* Professor, Center for Pacific Rim Studies, University of California at Los Angeles, Los Angeles, California (resigned from committee in July 1997) Agnes Manglona McPhetres, President, Northern Marianas College, Saipan, Commonwealth of Northern Marianas Islands Hon. Tosiwo Nakayama, Vice President for Governmental Affairs, Bank of Guam, Chuuk, Federated States of Micronesia Paul W. Nannis, Commissioner of Health, City of Milwaukee Health Department, Milwaukee, Wisconsin Terence A. Rogers, Dean Emeritus, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii David N. Sundwall, President, American Clinical Laboratory Association, Washington, D.C. Study Staff Jill Feasley, Program Officer Annice Hirt, Research Assistant Heather Callahan, Project Assistant Evelyn Simeon, Administrative Assistant Clyde Behney, Deputy Executive Officer Christopher Howson, Director, Board on International Health *Institute of Medicine member. Page v Preface The people of the U.S.-Associated Pacific Basin live half a world away from me and from the health policy makers in Washington, D.C. Yet, we are all linked through decades-old economic, legal, social, and cultural ties and a shared aspiration for better health for our families and children. Members of the committee that the Institute of Medicine convened to carry out the project described in this report are from several parts of the United States, and three members currently live in the region itself. Some of us had relatively little knowledge of the region; others had spent years living and working to improve the overall well-being and health care of people living on the islands of the Pacific Basin. All of us were able to visit at least two of the jurisdictions during our site visits. We were struck by the tremendous differences between the health care services available to most people in the 50 U.S. states compared to those in the Pacific Basin region. Even within the region, the differences were striking: the relative abundance of services and providers in Guam and the Commonwealth of the Northern Mariana Islands compared with the dearth of either in places like Chuuk. Yet, we also saw similarities. The damage and suffering wrought by alcohol and substance abuse, unhealthy diets, and unintended injuries are the same-whether they occur in Milwaukee, Majuro, Guam, or Georgia. On both sides of the Pacific, people at all levels are trying to figure out how to spend health care dollars more wisely. We all struggle with how to make available and provide access to certain basic health care services for the entire population, because we know that some of our vulnerable citizens are falling through the holes in the safety net. We recognize the need to shift our health care focus away from disease treatment and toward disease prevention and health promotion, but we lack the will to reallocate the necessary funds. In many respects, we are not so very different at all. Page vi This report charts a course for health care services in the region for the coming years. It calls for a strengthening of community-based primary care, better coordination of efforts between the United States and the island jurisdictions, greater involvement of local communities and individuals in promoting health, and improved education and training for the health care workforce. Change is rarely easy. Some of the recommendations that we have made will require the U.S. government and the island jurisdictions to make very difficult decisions about what is truly important and which activities can no longer be supported. Our report comes at a time, however, when discussions about these decisions have already begun. Some communities are farther along and are better-equipped than others to make these meaningful changes. The committee and I believe that the recommendations contained in this report, if adopted, will make a substantial contribution toward the goal of current health reforms to create healthy islands and island populations for many years to come. Robert Lawrence, M.D. Chair