providing health care to older individuals with chronic conditions as well as to younger individuals fighting acute infectious diseases.

Demographic Characteristics of the Region


Roughly half a million people (454,118) live in the six jurisdictions of the U.S.-Associated Pacific Basin (American Samoa, CNMI, Guam, Federated States of Micronesia [FSM], Republic of the Marshall Islands [RMI], and the Republic of Palau [Palau]) (see Table 2.1). Although the islands cover an area of the Pacific Ocean that is larger in size than the continental United States, most people live on a handful of densely populated islands. Currently, Guam, with 155,225 people has the largest population of the six jurisdictions; Palau, with only 17,225 people, has the smallest population (PIHOA, 1997). (For more information on population for each of the jurisdictions, see Appendix D.)

Overall, the region has experienced a high rate of population growth since 1950 (the approximate start of U.S. involvement and administration in all jurisdictions), and that growth is projected to continue to increase rapidly over the next few years (see Figure 2.1). The increase in the total population and projected population growth result from several factors: higher life expectancy (see Figure 2.2); lower infant mortality (see Figure 2.3); and, in some jurisdictions such as CNMI and Guam, high rates of immigration.

One change typical of a completed demographic transition is a decline in fertility rates and a resulting increase in the median age. As indicated in Figures 2.4 and 2.5 respectively, however, several of the jurisdictions have not completed their demographic transition because they continue to have high fertility rates and low median ages. In RMI, for example, the median age is 16.2 years. This means that half of the population of RMI is under the age of 16. This could have a tremendous impact on growth rates as more and more women reach childbearing age.

Migration is another factor that has contributed to population changes in the jurisdictions, as well as in the Pacific region in general. In search of better economic opportunities, Pacific islanders have migrated to Australia, New Zealand, and the United States, including its territories.2 High rates of


According to the 1990 U.S. census, 56,153 Micronesians (49,345 Guamanians and 6,808 "other Micronesian") were residing in the United States (Bureau of the Census, 1990). The census also shows that Samoans numbered 62,964 in 1990. Although not counted in the census, numbers of citizens from the freely associated states living in American Samoa, CNMI, Guam, and Hawaii have been estimated to assess the impact of the Compacts of Free Association on Hawaii and U.S. territories. For a discussion of these population estimates, see Appendix D, under either CNMI or Guam.

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