Territories and Freely Associated States

ASTHO supports public health leaders across the U.S. territories and freely associated states (T/FAS) in their efforts to improve the health and well-being of their communities. ASTHO's members include the chief health officials of the five U.S. territories and three freely associated states. The freely associated states are independent nations that have entered into Compacts of Free Association with the United States, while the territories are under the jurisdiction of the United States government. ASTHO collectively refers to these eight jurisdictions as the Island Areas, Island Jurisdictions, or T/FAS.

Due to differences in services configuration, eligibility for federal funding and programs, population health needs, and increased susceptibility to severe weather events, T/FAS public health needs are complex and often substantially different than those of the states. Given the uniqueness of each jurisdiction, we work to ensure our resources and technical assistance are tailored to their needs.

Featured

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Braiding & Layering Funding to Sustain Cross-Cutting Efforts that Benefit Multiple Programs and Funding Streams

This four-part online course, housed in ASTHO's e-Learning Center, is designed for local, state, and island area health agencies. Users will explore key components and tools for braiding and layering funding.

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Island Areas Health Equity Framework

The framework builds on current health equity frameworks to reflect the culture, experiences, and strengths of island communities more authentically.

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Including Island Areas in Federal Public Health Datasets

Public health datasets inform effective decision-making. This report and addendum identify where the island areas are missing in U.S. public health datasets and share recommendations to address barriers.

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ASTHO and NAMD Call on Congress to Fully Fund Medicaid and CHIP in U.S. Territories

In a joint letter to Congress, ASTHO and the National Association of Medicaid Directors urged Congress to fully fund Medicaid and Children's Health Insurance Programs in the U.S. territories.

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Improving Indirect Cost Rate Use in Island Jurisdictions

Indirect cost rates are a critical component of effective financial management for public health agencies. This report and guide outline how island jurisdictions can improve their indirect cost rates use and maximize federal funding.

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Leveraging Island-Centric Strategies to Address Workforce Challenges

This report highlights the innovative practices implemented during a series of Learning Labs and the ongoing needs shaping public health workforce development in island jurisdictions.

Latest Island Areas Resources

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Tools That Support Community Health Worker Programs in Island Jurisdictions

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The Insular Affairs Committee on Capitol Hill during ASTHO Spring Leadership Forum, 2025
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Island Policy Support

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Programa de Puerto Rico Apoya a las Poblaciones Vulneradas

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Puerto Rico Program Supports Vulnerable Populations

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Supporting Community Health Workers in Territories and Freely Associated States

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State and Territorial Health Leaders Convene on Capitol Hill to Advocate for Sustained Funding

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Leveraging Island-Centric Strategies to Address Workforce Challenges

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Balancing Structure and Flexibility for Effective Public Health Planning

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