Advancing and Sustaining Pacific Interventions to Reach Equity (ASPIRE) - The USAPI are comprised of two US territories American Samoa (AS) and Guam, the Commonwealth of the Northern Mariana Islands (CNMI) and three freely associated states (FAS) (Republic of the Marshall Islands (RMI), Federated States of Micronesia (FSM), and the Republic of Palau (ROP)). The USAPI population is estimated to be approximately 480,000 people living on hundreds of remote islands, atolls, and islets. The islands are culturally and linguistically diverse with more than a dozen spoken indigenous languages. This 5 year project entitled Advancing and Sustaining Pacific Interventions to Reach Equity (ASPIRE) is designed to improve health, prevent chronic diseases, and reduce health disparities among peoples of the US Affiliated Pacific Islands (USAPI) . ASPIRE coalitions and strategies will be based in 8 USAPI communities: American Samoa, Commonwealth of the Northern Mariana Islands, Guam, Republic of the Marshall Islands and Republic of Palau, and each of the 4 States of the Federated States of Micronesia (Chuuk, Yap, Kosrae, Pohnpei). In 2010 the Pacific Island Health Officer’s Association (PIHOA), the association of USAPI medical directors, declared a state of emergency against NCD’s because of the disparate and heavy burden of diabetes, hypertension, strokes, cancer in their respective Pacific jurisdictions. The USAPI jurisdictions have small populations, their island economies are struggling, the communities are geographically distant and rural, and access to adequate health care is lacking. Whereas the United States is classified as a High Income country by the World Bank, the 8 of 9 ASPIRE USAPI communities are classified as Low Middle Income countries. The poor economic, isolated rural geographic environments, poor health care access, and lack of a trained health workforce are associated with health disparities, and increase NCD rates and portend of poor health outcomes. ASPIRE will support culturally tailored strategies to address the preventable health behaviors of tobacco use, poor nutrition and physical inactivity that ultimately lead to reduced health disparities in chronic conditions of hypertension, heart disease, Type 2 diabetes, and obesity . The ASPIRE organization consists of the University of Hawaii, John A. Burns School of Medicine Pacific Cancer Programs in partnership with 8 established multi-sector non-communicable disease coalitions based in their respective USAPI jurisdictions. The ASPIRE collaborative will continue to harmonize and develop the REACH work with other established cancer and NCD partners. The expected outcomes through the REACH ASPIRE program will include long term health outcomes such as a decrease in obesity, cardiovascular disease, diabetes, strokes and hypertension. Other important outcomes include increasing the local human resource capacity, through training, and developing sustainable jurisdiction and regional organizations / collaborative that prevents and controls NCDs in the USAPI.
