PIHOA is lead by and represents the collective interests of the Ministers, Directors and Secretaries of Health of the USAPI. The USAPI include the three U.S. Flag Territories of Guam, the Commonwealth of the Northern Mariana Islands, and American Samoa, as well as the three Freely Associated States (independent nations in a special compact relationship with the United States) of the Republic of Palau, the Republic of the Marshall Islands, and the Federated States of Micronesian (Pohnpei, Kosrae, Chuuk, and Yap).
The USAPI are populated by more than 500,000 inhabitants who live on hundreds of remote islands and atolls spanning millions of square miles of the Pacific Ocean and crossing five time zones, including the international dateline. These islands are culturally and linguistically diverse with more than a dozen spoken languages. While the indigenous peoples of the USAPI are rich in culture they are considerably small in population. The islands are socially, politically and economically fragile but they are bountiful with rich marine and land-based eco-systems and numerous wildlife that cannot be found anywhere else on earth.
Despite the distance and isolation between islands, multiple complex factors contribute to the severe health disparities and outcomes. The current health infrastructure in the USAPI suffers from severe resource limitations. Health status indicators demonstrate significant disparities from across the Public Health spectrum. Factors influencing policy issues, political relationships, the economy, the environment, diverse cultures, stressed health systems, education, limited human resource development and the sheer physical isolation of these islands all contribute to the enormous challenges in achieving health equity. Colonization and rapid westernization have adversely affected many of the social, cultural, and environmental structures and practices that traditionally supported and protected the health of the islands, their waters and their people.