On February 26, the House Government Reform Subcommittee on Wellness and Human Rights held a hearing on health care disparities in Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands (CNMI).
In his opening statement, Chair Dan Burton (R-IN) explained that September 11 and its impact on tourism has taken a great toll on the economies of the U.S. Pacific Island Territories. Drastically increased rates of unemployment have left “tens of thousands of men, women, and children without proper health insurance or the means for medical care…territorial governments are unable to afford the much needed equipment and qualified health professionals required to properly tend to the medical needs of their people.”
Del. Madeleine Bordallo (D-Guam) explained that the territories are subject to caps in Medicaid, Medicare, and the State Children’s Health Insurance Program (SCHIP), and therefore receive much less health care funding than the continental states.
Testifying on behalf of the Office of Insular Affairs at the Department of the Interior, David Cohen explained that a number of serious diseases faced by residents of the U.S. territories are precipitated by lifestyle choices, such as obesity and diabetes. “Obesity is one of the major causes of diabetes and other life-threatening diseases in the islands. Over the last 50 years, our island populations have increasingly adopted our mainland diet, with its emphasis on processed foods that are high in fat, high in carbohydrates, and low in fiber,” he stated. Mr. Cohen also noted that island residents have moved toward more sedentary work and are smoking more. Of particular importance to women, he pointed out that breast and cervical cancer rates are higher in the CNMI than in the continental United States.
Nathan Stinson of the Office of Minority Health at the Department of Health and Human Services (HHS) underscored the remoteness of the U.S. territories, pointing out that insulin and other medical products take weeks to arrive and are often in short supply. He also noted that a woman with breast cancer in Guam is more likely to undergo a mastectomy because other cancer treatments are unavailable.
The Governor of Guam, Felix Camacho, told the subcommittee that cancer is a huge concern. “When our cancer incidence rates are age-adjusted, we see that our liver cancer rates for both men and women are double to triple those in the United States. Our oral and stomach cancer incidence rates for women are higher than the United States as well. This is a serious concern given that the island has no oncology radiation services. Patients with these illnesses must travel off-island for care at great expense, even if the individual has medical insurance.”
Governor Togiola Tulafono of American Samoa explained that rapid population growth and changes in migration patterns have led to an escalation of immigrant families with greater health needs. He said that American Samoa has improved its health and family planning programs, but expressed his concern that the programs are not reaching the communities with the highest birth rates.
William McMillan of the Guam Memorial Hospital Authority, the only civilian hospital on the island, told of having to request help from “the cavalry” at HHS when the neonatal intensive care unit had reached maximum capacity. “Our unit had a capacity of four neonates, and in the middle of January the census climbed from two, to four, to six, passing through nine and ultimately hit twelve premature infants…we literally had nowhere to turn to.”
