farming and fishing to one that is market and consumer oriented. Attempts to address these health conditions and challenges come at a time when U.S. federal government aid to the region has begun to decrease, a trend that is likely to continue.

These challenges are also embedded in the islands' many strengths and resources: cultures that remain vibrant even after years of foreign occupation and influence, strong familial ties and roles for women, highly developed and organized communities, traditional health practices, and powerful religious beliefs.

Origins Of This Report

The Institute of Medicine (IOM) was asked by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services to examine these issues and suggest possible approaches to improve the health care situation. Specifically, IOM was to:

  1. collect and examine all readily available information on the status of health service programs in the Pacific Basin, including the recently concluded Pacific Basin Medical Officers' Training Program (described in Chapter 2 and Appendix D);
  2. develop assumptions about benchmarks to be used to assess needs and services in those jurisdictions (discussed in Chapter 3);
  3. assess the accomplishments, adequacy, and shortcomings of health services programs and related health interventions compared to the baseline assumptions (described in Chapter 2 and Appendix D); and
  4. develop a strategic plan to address the problems and inadequacies, and reinforce the successes, in health services (described in Chapter 3).

Additional financial support for this project was provided by the Office of Insular Affairs of the U.S. Department of the Interior and the Archstone Foundation.

Study Approach

To undertake the requested study, IOM's Division of Health Care Services and Board on International Health convened a 12-member study committee, with experts in primary health care, education, international health, mental health, and public health (see Appendix A for a complete list of committee members and their brief biographies). The committee met three times between January and August 1997. The committee's second meeting occurred in April 1997 on Saipan, CNMI, in conjunction with a workshop with health officers from the region (see Appendix B for the workshop agenda and a list of



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