The Health Predicament of The U.S.­Associated Pacific Islands: What Role for Primary Health Care?

PURPOSE OF THE PAPER. The purpose of this paper is to provide a perspective on the evolution and development of the health systems in the U.S.­Associated Pacfic Islands and how that development has adversely impacted the health status of the peoples of these areas. SUMMARIES OF METHODS UTILIZED. The authors have reveiwed documents pertaining to the health system from these areas, as well as the published literature. In addition, both authors have lived and worked in the U.S.­Associated Pacific Islands and draw from their experience and observations. PRINCIPAL FINDINGS. Features of the U.S. medical model that have been adopted in the Pacific Islands are an emphasis on curative medicine, recourse to outside referral, and displacement of the responsibility for health away from the individual. The resulting problems include the following: the diseases of underdevelopment co­exist with those of development. Benefits are felt by only a small proportion of the populace. Costs rise as inappropriate technology is applied. The situation fosters unrealistic expectations and dependency. KEY WORDS. Pacific Islander, health status, dependency, primary health care