Overview -

   

As the westernmost territory of the United States, Guam is the largest and southernmost island in the Mariana Archipelago. The island is 30 miles long, ranges from 5 to 9 miles in width, and has 209 square miles. Guam is in the Western Pacific Ocean, 3,700 miles southwest of Honolulu, 1,500 miles east of Manila, 1,500 miles southeast of Tokyo, and 3,100 miles northeast of Sydney.

 

Based on the Guam Statistical Yearbook, the North region had slightly more than half of Guam’s population (53.4%) in 2019. That was equivalent to 89,069 persons. The Central region had about 30.6% (50,990 persons), and the South region had 16% (26,602 persons) of Guam’s population.

 

Within the North region, Dededo municipality had more than double the population (47,002, 53%) than that of Yigo (21,480, 24.1%) and Tamuning (20,587, 23.1%) in 2019. It was also the most populous municipality among all 19 municipalities on Guam. The Naval Communications and Telecommunications (NCTS) Finegayan, part of Navy Base Guam and Andersen Air Force Base, are located in the North region.

 

Mangilao municipality had the most population followed by Barrigada municipality within the Central region. In 2019, about 15,887 people (31.2%) and 9,282 people (18.2%) resided in Mangilao and Barrigada municipality. Mongmong-Toto-Maite (7,138, 14%) and Chalan Pago-Ordot (7,135, 14%) municipality, on the other hand, had about similar population sizes.

 

The South region is the most rural and suburban area on Guam. It had the lowest population density among all three regions. In 2019, the most populous municipalities in the South region were Yona (6,777, 25.5%) and Santa Rita (6363, 23.9%) municipality. The least populous municipality was Umatac, it was home to about 818 people (3.1%) in 2019.

Ethnic Profile –

 

While population growth has been minimal, the racial and ethnic diversity of Guam continues to increase. Of the total population, 90% of the residents reported belonging to one ethnicity, and 9.4% reported belonging to one or more ethnicities.

 

Projected trends in the ethnic composition of the island population through 2020 show a 56% increase in the top four racial groups – Chamorro, Chuukese, Filipino and Other. The proportion of the other ethnic groups remains relatively stable through 2020.

 

Local Government

 

Guam is an organized, unincorporated territory of the U.S., which means that, in some cases, federal laws do not automatically apply to the island. For example, U.S. import tariff laws do not apply, and Guam is considered a duty-free port. On the other hand, federal banking and transportation laws and regulations apply to Guam, with some exemptions, to address the island's unique political, geographical, and social circumstances. Guam has only one level of government. The Organic Act of Guam provides for three branches of government: executive, legislative, and judicial.

 

The Governor heads the Executive Branch. Until 1970, the Governor of Guam was appointed by the President of the United States. Since the November 1970 election and the January 1971 inauguration, the Governor and the Lieutenant Governor have been elected for four-year terms. In 2010 and 2014, the Honorable Eddie Baza Calvo and the Honorable Ray Tenorio were elected and re-elected, respectively Governor and Lieutenant Governor. Guam’s 2018 general election was historic for the island. Guam elected its first female Governor, gained a female super-majority, with ten females in the Legislature. There are 33 agencies, commissions, and boards within the Government of Guam; a woman heads 48%. The Governor is responsible for implementing all local and federal laws pertaining to Guam. She oversees the functions of the departments and agencies within the Executive Branch.[1]

 

Guam's judiciary system consists of the Federal District Court of Guam and the Unified Judiciary of Guam, which consists of the Superior Court of Guam and the Supreme Court of Guam. Prior to the Supreme Court's creation, local appellate cases were heard by the Appellate Division of the Federal District Court before going to the Federal Ninth Circuit Court of Appeals. Since July 26, 2000, the Supreme Court of Guam has assumed appellate jurisdiction over lower local courts. With the Senate's consent, the President of the United States appoints the presiding judge of the Federal District Court to an eight-year term. This Court has jurisdiction over cases involving federal law. The Superior Court of Guam has authority over all matters arising under the laws of Guam. This includes family, small claim, traffic, probate, civil, and land registration issues. The Supreme Court of Guam hears all appeals.[2]

 

Guam has a unicameral legislature. As a result of a plebiscite vote in 1998, the number of senators was reduced from 21 to 15. In addition to making laws for the island, senators are responsible for appropriating funds using the General Fund for government operations and other public purposes. Guam also has a non-voting delegate in the U.S. House of Representatives. Although precluded from voting on the floor of Congress, Guam’s delegate does serve and vote in those House committees and subcommittees of which the delegate is a member. Guam elected its first Public Auditor in November 2000 as a result of P.L. 25-42. The Public Auditor serves a four-year term and is responsible for auditing all transactions and accounts of all departments, offices, corporations, authorities, and agencies of the Government of Guam. As a result of P.L. 25-44, Guam also elected its first Attorney General in November 2002.[3]

 

Languages –

 

The ethnic composition of the population, for the most part, determines the languages Spoken at home, and these languages are English 43.9%, Chamorro 17.8%, Philippine languages 21.2%, Other Pacific languages 10%, Asian languages 6.3% and other languages. Presently, 39.6% of Guam's households speak English exclusively, 18.2% speak other languages either as frequently or more frequently, while 0.4% speak no English. 

 

Education

 

The educational needs of Guam are provided by an island-wide public-school system (the Department of Education) comprised of five high schools (grades nine to twelve); eight middle schools (grades six to eight); and 27 elementary schools (grades one to five) operated by the Government of Guam.

 

The Catholic Archdiocese of Agana also operates a substantial school system with ten schools with three high schools, six elementary/middle schools, and one elementary school. Several other religious denominations also operate schools on Guam. These include Saint John's Episcopal School, Harvest Christian Academy, Guam Adventist Academy, Temple Baptist School, and Trinity Christian School. The Department of Defense Education Activity (DoDEA) also provides education for military dependents on the island with four schools; one high school, one middle school, one elementary school, and one joint elementary/middle school. Additionally, there are two Japanese schools, one Chinese school, and one Korean school operating on-island. In addition, Asmuyao Community School has been established to offer alternative education and independent study programs. The Guam Trades Academy is a training center geared to support construction and related industries on Guam.

 

During School Year ("S.Y.") 2018-2019, there were thirty-nine (39) public schools that provided educational services for 28,954 students. Further breakdown by levels showed twenty-six (26) elementary schools totaling 12,960 students in Grades K-5 and 534 students in Head Start, eight (8) middle schools totaling 6,458 students in Grades 6-8, and five (5) high schools totaling 9,536 students in Grades 9-12.

 

A “dropout” as defined by the Guam Education Board Policy #375 is a student who was enrolled in a department of education high school sometime during the given school year and after enrollment stopped attending high school without having been:

• transferred to another school or a high school equivalency educational program recognized by the Department; or
• incapacitated to the extent that enrollment in school or participation in an alternative high school program was not possible; or
• graduated from high school, or completed an alter recognized by the Department, within six (6) years of the first day of enrollment in ninth grade;
• expelled; or removed by law enforcement authorities and confined, thereby prohibiting the continuation of schooling.

The table below shows that JFK High School had the greatest increase in the school dropout rate from school year 16-17 to school year 17-18 (1.6% to 5.8%). Simon Sanchez High School had the lowest dropout rate at 0.2%.

 

Guam High School Drop Out Total
High School	SY 11-12	SY 12-13	SY 13-14	SY 14-15	SY 15-16	SY 16-17	SY 17-18	SY 18-19
GWHS	497	482	451	377	355	323	334	324
JFKHS	372	396	481	484	365	368	387	353
SSHS	356	338	376	353	352	371	352	344
OHS	269	308	300	304	346	322	351	332
SHS	274	246	257	302	346	395	318	274
THS	N/A	N/A	N/A	144	181	220	262	244
JP Torres	N/A	N/A	N/A	N/A	N/A	55	N/A	N/A
Total	1768	1770	1873	1964	1945	2054	2004	1871

Source: Guam DOE

 

The Guam Community College (GCC) provides vocational and technical education for high school students through college. GCC collaborates with local high schools and the University of Guam and is fully accredited by the Western Association of Schools and Colleges (WASC).

 

Guam Community College conferred 430 degrees, certificates, and/or diplomas upon 353 graduates May 19, 2019. This year's graduating class includes a record number of post-secondary credentials and journey worker certificates conferred, as well as many individual stories of perseverance and triumph. The enrollment number in Fall 2019 was 2,131 students.

 

GCC launched our Associate of Science (AS) in Practical Nursing in Fall 2019. The new degree program replaced our practical nursing certificate that was withdrawn in Fall 2018. The (AS) program was approved by both the Accrediting Commission for Community and Junior Colleges (ACCJC) and the Guam Board of Nursing Examiners, which means students can obtain an associate degree and become licensed as Practical Nurses on the island following successful passing of the NLCEX-PN exam

 

The University of Guam (UOG) offers post-secondary degree programs through five different colleges and schools, namely: College of Liberal Arts and Sciences (CLASS), College of Natural and Applied Sciences (CNAS), School of Business and Public Administration (SBPA); School of Education (SOE); and School of Nursing and Health Sciences (SNHS). The University provides six Baccalaureate (B.A., BBA, B.A. Ed., BS, and BSW) and six Masters (Professional MBA, MED, MAT, MPA, MS, and M.A.) degree programs.

 

The University of Guam conferred degrees to 253 students today at its Fanuchånan 2019 Commencement Ceremony held at the UOG Calvo Field House. Crossing the stage were 176 undergraduate and 77 graduate students. The number of master’s degrees conferred is 30% higher than last year.

The largest number of graduates came from the School of Business and Public Administration, which conferred 102 undergraduate and graduate degrees. The business school and the School of Education graduated the most master's students, conferring 33 degrees each.

Employment/Unemployment -

 

Civilian employment on Guam in 2018 was 65,110. Employment has been hovering between 62,2000 and 65,500 since 2012. Three-quarters of the jobs (74 to 77%) are in the private sector. Roughly two-tenths (17 to 20%) are GovGuam jobs, and the remainder (6 to 7%) are federal. Private sector employment slowly but steadily increased between 2012 and 2017 and then fell to zero in 2018.

 

On the other hand, the unemployment rate has improved over the last seven years of available data. The recovery began after 2010, and the unemployment dropped every year until 2018. The gain may not be statistically significant, but with other economic indicators slowing down, it could cause concern.              

Source: Guam Department of Labor

 

Interpretation of the data suggests that unemployment will remain relatively low, with the significant employment growth occurring in the private sector. Many of the new jobs would be in the retail trade and service industries.

 

Between 2012 and 2018, employment in the construction industry has fluctuated between a high in 2013 of 7,120 and a low in 2014 of 6,070 paid employees. In 2018 construction employment was at 6,500.

 

The average hourly earnings for non-salary private-sector workers was $12.37 in 2010 and grew to $ 14.08 in 2018, an increase of 14%. The growth has been more significant for construction workers, earning $14.18 an hour on average in 2010, increasing 19% to $16.80 in 2018. This is likely an indicator of a tight labor market for construction due to H2B Visa restrictions.

 

Population Characteristics –

 

As of the most recent U.S. Census of 2010, Guam’s population was 159,356. From 1950 to 2010, Guam’s population grew at an average of 21% per decade (about 2.1% annually). However, as shown in the table below, the Census Bureau projects that this growth will taper off.

 

Annual Rate of Increase of Guam’s Population
	1950-1960	1960-1970	1970– 1980	1980– 1990	1990-2000	2000-2010	2010-2020	2020-2030
Annual population increase	1.2%	2.4%	2.2%	2.3%	1.5%	1.6%	1.2%	0.9%

Source: Guam Demographic Profile

 

Over half of the population (58%) is age 25 or older. The median age is 29.1 years (males: 28.4; females 29.9 years). Males slightly outnumber females, with an overall sex ratio of 1:3; for those 25 years and older, the sex ratio was 1:0.

Although there are no concrete numbers of children and youth with special health care needs (CYSHCN) on Guam, it is estimated that one out of every ten families had at least one child with a special health care need.

 

Children and youth with special health care needs are those who have (or who are at increased risk for a chronic, physical, developmental, behavioral, or emotional condition). Children with a disability face a lifetime of physical and social challenges, including discrimination. The challenges of parenting a special needs child can stress a family, increasing financial burdens and difficulties accessing adequate

physical and mental health care and special support.

 

Population-based data on persons who identify as lesbian, gay, bisexual, transgender, and questioning (LGBTQ) on Guam is becoming more available. While the U.S. Census does not ask sexual orientation or gender identity, the Guam Behavioral Risk Factor Surveillance System (BRFSS) and the Guam Youth Risk Behavior Surveillance System (YRBSS) now include questions on both.

 

• The 2018 BRFSS found that 3.3% of Guam's population identify as LGBTQ; this was 69.3% higher than what was reported in 2017.
• In the 2018 Guam YRBSS, 1% of ninth and 11th-grade students identify as gay or lesbian. However, 2 to 8% identify as bisexual, and another 3 to 6% identify as not sure (questioning). In each grade, a range of 2 to 4% of students identify as transgender, genderqueer, gender fluid, or unsure if their gender identity.

 

Data from the BRFSS, YRBSS, and a survey conducted by Guam's Alternative Lifestyle Association (GALA) shows significant concerns for LGBTQ youth and adults on Guam. The LGBTQ community disproportionately experiences exclusion, poverty, homelessness, and barriers to health care.

 

The Guam Demographic Profile expected the number of persons aged 65 and older to double between 2010 and 2020 until more than one in five persons would be older adults. Aging presents new challenges to health, including increasing levels of disability. For example, older adults are at increased risk of injuries from falls, over half, which occur at home.

The age dependency ratio expresses the relationship between the "dependent population' (ages 0-15 and 65 plus, referred to as "youth" and "elderly" and the "working-age population (ages 16-64). Higher values indicate a greater level of dependency.

 

Household Income –

 

The median household income on Guam was about $63,000 in late 2019. That was up from about $50,000 in 2010 and $39,000 in 2000. Those figures are anchored in U.S. Census data. It is more challenging to estimate household income in intercensal years because the series available does not match Census data.

 

In 2000, about 26% of Guam households had incomes below the poverty guideline. That numbered decreased to 22.5% in 2010. There is not enough data to estimate what poverty rates may be for 2019, but if household income figures continue to climb at rates above inflation, perhaps the poverty rate will be lower than 22% at the next census.

 

Poverty –

 

Poverty refers to a condition in which one is unable to afford fundamental building blocks such as clean water, nutrition, health care, education, clothing, and shelter. Poverty rates vary significantly according to geography, age, race, and household types. The population groups with the highest poverty rates often have the poorest health status. (Marmont 2005)

 

The 2019 Federal Poverty Guidelines designates that a family of four with a gross yearly income of $25,750 as living in poverty. The annual income median salary for a family working at the minimum wage level is $19,572. Thus, a family with the head-of-household working full-time earning the minimum wage has an income significantly less than the federal poverty level.

 

In examining the 2010 poverty status of residents on Guam, 22.5% of all individuals on Guam for whom poverty status was determined were considered to be in poverty; of these, 54% were individuals over 18 years of age; 4% were individuals over the age of 65, and 4% were children under the age of 18.

 

When assessing families' poverty status on Guam for the same time period, 41% were married-couple families. Forty-four percent (44%) of families were female-headed households, and 15% were male-headed households living in poverty.

 

For some of the most impoverished families, Guam offers cash assistance to low-income persons/families based on rules and standards set by the Division of Public Welfare, Guam Department of Public Health and Social Services (DPHSS). There are two major programs for cash assistance, the Cash Assistance Program (CAP) and Temporary Assistance for Needy Families (TANF).

 

Source: DPHSS, Division of Public Welfare

 

Recipients of CAP are individuals or couples with no dependent children, whose temporary or permanent circumstances prevent their employment. CAP is 100% locally funded. The total number of persons who were eligible for CAP in FY2019 was 4,486. This was a decrease of 6.4% from F.Y. 2018. When comparing the total number of households eligible in 2019, there was a decrease of 3.6%. The reduction of people who are found eligible and the number of households under the CAP program may be attributed to the time limit of five years to be under the program.

 

TANF provides cash assistance to families for dependent children with whom they live, and for pregnant women. TANF is a federal/state program with the federal government setting basic rules for administering the program allowing states to develop their programs, and as a result, eligibility limits and benefit levels vary widely across the states.  

 

Food Security –

 

Food security is defined as access by all people to enough food for an active, healthy life and is necessary for a family to be healthy and care for its members. Food insecurity occurs whenever the availability of nutritionally adequate and safe foods or acquiring acceptable food is limited or uncertain. Hunger is an unpleasant or painful sensation caused by a recurrent lack of food.

 

Food insecurity contributes to overweight and obesity, as well as undernutrition. The higher cost of nutritious foods, the stress of living with food insecurity, and physiological adaptations to food restriction help explain why food-insecure families may have a higher risk of overweight and obesity.

The Supplemental Nutrition Assistance Program (SNAP) (aka Food Stamps) is a federally funded program intended to provide a basic safety net to alleviate hunger and malnutrition by permitting low-income households to obtain a more nutritious diet. The amount of SNAP benefits provided are based upon monthly income.

 

The Guam SNAP income guidelines require that most households must meet both gross and net income tests. However, if a household has an elderly person or a person receiving certain disability payments, they only need to meet the net income test. Laws have been passed to determine the income eligibility standards for SNAP benefits. Gross monthly income limits are set at 130% of the poverty level for the household size. Net monthly income limits are set at 100% of poverty.

 

Source: Division of Public Welfare, DPHSS

 

The University of Guam Cooperative Extension and Outreach Services, through a Memorandum of Understanding (MOU) with DPHSS, conducts the SNAP-Ed program. SNAP-Ed benefits persons eligible for SNAP by making healthy choices within a limited budget and encouraging them to live active lifestyles. The program regularly offers free workshops on topics such as food planning, shopping, and cooking.

 

Researchers and leaders have long used eligibility for free or reduced-price lunch under the National School Lunch Program (NSLP) as a proxy for measuring the level of poverty. Created under the National School Lunch Act of 1948, the program's goal is to provide students nutritionally balanced meals. The scale of the NSLP is massive; close to 100,000 institutions provide lunch to nearly 30 million students each day. More than 20 million lunches are free, while 1.8 million cost students about 40 cents each. That tallies up to 3.6 billion free or reduced-prices lunches serve annually.

 

One of the more impactful programs on Guam fighting the hunger situation is that all public schools on Guam serve meals for free. This free meal plan is provided through the federally funded Community Eligibility Provision grant that is provided by the U.S. Department of Agriculture. The program feeds students, so they are focused and ready to participate in classes by giving them the nutrition they need.

 

Housing –

 

The federal government's standard for housing affordability is that households should pay no more than 30% of income to meet their housing cost. Households that pay more than 30% of their housing income are considered "housing cost-burdened," and those that pay more than 50% are considered "severely cost-burdened."  The federal guidelines for housing programs generally use the Median Family Income estimates as the basis for eligibility.

 

For F.Y. 2019, Guam had the 11th highest rent out of 56 states and territories. The rent for a studio or efficiency apartment was an average of $728 per month and $1,846 for a 4-bedroom house or apartment. The average Fair Market rent for a 2-bedroom home is $1,051 per month.

 

The Section 8 Housing Choice Voucher (HCV) program provides housing assistance to very low-income families. The program's objective is to help eligible families afford a decent, safe, and sanitary home in the private rental market. While under the program, Section 8 participants are responsible for finding a suitable unit anywhere, as long as they meet the Housing Quality Standards. The level of assistance depends on the family’s annual income. However, in most cases, the Guam Housing and Urban Renewal Authority (GHURA) subsidizes 70% of the rent, and the family pays the remaining 30%.

 

Homeless –

 

A safe home and stable housing are essential for everyone. Without a home, it is difficult to apply for a job or build long-term relationships, which reduces social support. Without a home, youth and children suffer from hunger, have reduced mental and physical health, often experience physical and sexual violence, and are more likely to miss school.

 

Two trends are largely responsible for the rise in homelessness over the past 20-25 years, and there is a growing shortage of affordable rental housing and a simultaneous increase in poverty. Problems of definitions and methodology often complicate studies of homelessness. Homelessness may be a transitory situation, and many homeless people are simply hard to find.

Therefore, it is difficult to determine just how many individuals or families are, in fact, homeless.

 

The Guam Homeless Coalition (CHC) conducts a Point in Time (PIT) Homeless count, an unduplicated count of homeless (sheltered and unsheltered) individuals and families. The count is an annual project of the CHC and is mandated by the U.S. Department of Housing and Urban Development. The count offers a snapshot of homelessness on Guam and provides the minimum number of people experiencing homelessness in the community. 

 

The 2018 PIT count found 265 households with a combined total of 854 adults and children. Of the 265 households, 143 households, or 54%, were adults-only totaling 2017 individuals. Families consisting of adults and children numbered 120 with 645 individuals and accounted for 45% of the total homeless households. The remaining 1% were 2 households with only children comprised of 2 individuals below the age of 17.

 

Of the total number of unsheltered homeless households, 89 of the 221 or 40% lived in structures that were defined as "not adequate" due to missing walls, roof, floor, door, and/or windows. The remaining 132 households lived in areas not meant for human habitation and those who were street homeless.

Source: Guam PIT

 

Some of the sub-groups of those experiencing homelessness include veterans and those dealing with mental health issues, substance abuse challenges, HIV or AIDS, and those fleeing domestic violence. As shown in substance abuse and veterans are the largest subgroups requiring supportive services.

 

The 2019 PIT homeless population increased with a substantial increase in the number of homeless families. There were 873 homeless individuals and 300 households counted, compared to 854 individuals and 265 households recorded in 2018.

 

The number of homeless people not staying in a homeless shelter increased from 727 in 2018 to 765 in 2019. They have "a primary nighttime residence" that is a public or private place not designed for a or ordinarily used as regular sleeping accommodation for human beings. There were 108 people in shelters, based on the 2019 preliminary data, a decrease of 127 in shelters in 2018. Nearly half, 425, of the homeless population on Guam is under the age of 18. Sixteen percent of those are under the age of 5. In 2019, 242 children were under the age of ten.

 

Increasing numbers of households with disabled persons from 2009 to 2019 indicate an increased need for accessible housing units with supportive care services and facilities.  This population has

 

Housing Accommodations Needed
Need bathroom grab bars	16.9
Need shower seat	15.0
Need ramps	9.0
Need emergency call device	7.1
Need wheelchair modifications	6.8
Need roll-in shower	6.6
Need textured walls for the blind	5.9
Need railings	5.2
Need alerting device for the deaf	7.4

a high rate of unemployment and poverty (39%), and of those who are disabled but not in the labor force, 64% live below the poverty level. [4]

 

Households with at least one disabled member is a growing subsection of the Guam population. Based on the Housing Demand Survey[5]The proportion of households affected by disability grew by about 4 percentage points in the last ten years.

 

Households Reporting Someone with a Disability
Disabled Households	2009		2019
Yes	5,479	12.3%	7,648	16.8%
No	38,980	87.5%	37,649	82.5%
Don’t Know/Refused	92	0.2%	348	0.8%
Total	44,551	100.0%	45,645	100.0%

Source: Guam Housing Demand Survey, 2019

 

Health Services –

 

Health services involve the preservation of health and prevention, treatment, and management of illness through the profession of medicine, dentistry, nursing, and allied health. Guam's health care delivery system is pluralistic and distinguished by the public and private sector for the local civilian population and a military system for the delivery of medical services to the active military members and their dependents and the military retirees and veterans on Guam.

 

All health services customarily found in a community of similar size in the U.S. mainland are available to the island population. One unique problem setting Guam apart from mainland communities is that many specialized and tertiary services are thousands of miles away, necessitating medical referral to Japan, the Philippines, Hawaii, or the U.S. mainland. Guam lies about 5,800 miles (12 flight hours) from the U.S. mainland and 3,800 miles (7 flight hours) southwest of its closest U.S. neighbor, Hawaii. Guam, while being remote from the U.S., is closer to the Asian rim. Tokyo, Taipei, Manila, and Hong Kong are all within three hours of flight time.

 

Guam has been designated a Health Professional Shortage Area (HPSA) and a Medically Underserved Area (MUA). HPSA's are federal designation that applies to areas, population groups, or facilities with unmet needs. Designations help prioritize limited federal resources to the areas that need them most. The MUA designation identifies areas or populations as having a need for medical services based on demographic data.

 

In 2019, Guam had 609 physicians licensed to serve its population; this includes physicians at the Guam Regional Medical City (GRMC), licensed military physicians working on a part-time basis. Other data shows a ratio of 24 active physicians per 10,000 residents, compared to the national average of 14 per 10,000 residents. Some off-island physician specialists visit Guam on a quarterly and semi-annual basis to provide services not typically available on Guam.

 

Also affecting Guam's ability to meet its population's health care needs is that a large percentage of the island's population does not have adequate health insurance to cover medical costs. It is estimated that 23% of Guam's population is uninsured or underinsured if they possess private health insurance but does not adequately cover necessary treatments. Furthermore, many individuals who have health insurance cannot afford the co-pays for treatments or medications and will turn to government health services for free services. Government health agencies mandates are to serve all those that come in through the door. Although they do have processes to verify whether an individual is insured or not, private insurance companies are unwilling to release their clients' names due to confidentiality issues. Often if an individual states he/she does not have health insurance, agency staff must take their word for it.

 

Medical tourism is a way that insurance providers and people outside the healthcare system attempt to deal with the high cost of specific procedures. Many Guamanians go and have gone to St. Luke's Hospital in the Philippines to seek expertise or treatment for their ailments. For the uninsured that need major operations done, places like Thailand, Singapore, and India are gaining attention as medical tourism destinations.

 

Private Sector

 

The private sector caters more to the community's individual needs, providing on a one-to-one basis, out-patient medical and dental care, laboratory, radiological and optometric services, and pharmaceuticals. There are several multi-specialty medical/dental groups. In addition, there are specialty medical group practices and individual physicians and dentists: Independent laboratories, pharmacies, and optical retailers within the community that provides auxiliary services.

 

Private Hospital –

 

Guam Regional Medical City (GRMC) is the only private hospital on Guam and is in one of Guam's most populated areas. The Medical City (TMC), a Joint-Commission Accredited Philippine health care organization, operates GRMC. GRMC offers health services aligned with TMC's Centers of Excellence, which features wellness, cardiology, oncology, endocrinology, pulmonology, neurology, and other medical and surgical subspecialties.

 

GRMC has a cardiac center and a cancer center of excellence. The cardiac center offers a cardio-catheterization lab, a cardiothoracic surgeon, and a cardiovascular specialist. The open-heart surgery program was revived after having to shut down temporarily as GRMC could not secure specialized cardiac nurses from the Philippines because of diminished access to workers with H-2B visas.

 

The hospital has 130 staffed beds with the capacity to expand to 250. Some hospital employees are an ear, nose, and throat physician; an endocrinologist; a gastroenterologist; a dermatologist; a neurosurgeon; an orthopedic surgeon for joint replacements; a breast imaging specialist; and a rheumatologist. Although Guam has hematologists and oncologists, GRMC has pediatric hematology and oncology for the treatment of children.  

 

Private Clinics –

 

Guam has ten specialty and primary care clinics and about 30 pharmacies for prescription drug needs. Specialized healthcare facilities are Guam Radiology Consultants, five renal care facilities; Guam’s first privately owned and operated birthing center with all the comforts of home; a surgicenter for out-patient surgical procedures, and the Heart & Vascular Institute of Guam.

 

There has been a recent increase in private mental health providers on Guam. Private providers are mostly psychiatrists, clinical psychologists, and individual, marriage, and family therapists. Private clinics also provide some mental health services. Only a limited number of private providers and pharmacies accept government insurance, such as Medicaid and the Medically Indigent Program (MIP), due to factors such as slow reimbursement.

 

Home Health Care -  

 

This type of care is given in the home under physician’s orders. It includes care similar to what one would receive in a hospital or skilled nursing facility but is less expensive and much more convenient for the patient and caretaker(s). Home health care covers a wide range of skilled healthcare services given at the time of illness or injury. For hospice, home health care is typically for a patient facing a life-limited illness.

 

Nurses and other home health assistance, such as physical therapists or licensed vocational nurses, provide certified home health care for skilled care patients. Home health care is typically covered by Medicare and consists of caregivers coming to a patient's residence over 30 to 60 days. Guam has about four home health care agencies.

 

Military -

 

The U.S. Naval Hospital offers medical care to military personnel, military dependents, veterans, and emergency cases, civilians. The military also runs small out-patient clinics at Andersen Air Force Base and on the Naval Base, as well as a dental clinic.

 

The hospital provides family practice, Ob-GYN services, pediatrics, general surgery, internal medicine, acute care, and emergency medicine. The hospital is staffed by active duty, civilian, and volunteer personnel.

 

Although the primary population treated at the Naval Hospital is military personnel and dependents, civilians may be treated in emergencies. Through a Mutual Aide Agreement, seriously ill or injured persons are taken to the closest emergency room facility if judged time-critical.

 

Collaboration between the military and the public health system includes limited consultation and treatment services by specialized military medical officers, assistance when GMHA or DPHSS encounter supply or pharmaceutical shortages, and a source of back-up during times of human or natural disaster.

Guam Veterans Clinic –

 

The U.S. Department of Veterans Affairs (V.A.) is responsible for providing benefits for qualified veterans. The VA office assists veterans with information and applications for their benefits and claims.

 

The Guam Community-Based VA Clinic provides primary health care to eligible veterans. The clinics also handle referrals to specialists at the Naval hospital or private clinics in the community. If this fails, referrals may be sent to Tripler Army Medical Center in Hawaii.

 

A Memorandum of Understanding (MOU) was signed with DPHSS Community Health Centers to help bridge the gap in providing primary and mental health services to veterans by providing services at the health centers.

 

Public Sector

 

Guam Memorial Hospital Authority (GMHA)

 

Guam Memorial Hospital Authority (GMHA) is Guam's civilian hospital. The 220,000 square foot hospital has 161 acute beds and 40 beds at its off-site long-term skilled nursing unit (SNU). Eighty-seven full and part-time physicians staff GMHA. Guam Memorial Hospital Authority (GMHA) is a primary source for Guam's healthcare services and is also utilized by some of the neighboring islands in the Western Pacific.

 

The hospital offers comprehensive adult and pediatric medical services. These include but are not limited to 24-hour emergency services; medical telemetry and progressive care; obstetrics; labor and delivery; nursery; in-patient and out-patient surgery; intensive care (neonatal, pediatric, and adult); laboratory and blood bank services. 

 

GMHA earned full Joint Commission Accreditation after losing it in 1983. Accreditation by the Joint Commission, which evaluates hospitals based on national patient safety goals, medical staffing, healthcare quality, and other categories, symbolizes that a hospital meets or exceeds national performance standards and is committed to meeting safe, high-quality value health care.

 

Before 2004, GMHA had a licensed bed capacity of 192 acute care beds, translating to a ratio of 1:2 beds per 1,000 population. The number of beds was reduced in 2004, following the conversion of several four-bed wards into semi-private rooms. The reduction in beds resulted in a new total of 172 licensed acute beds, thus reducing acute care beds. In 2008, during a Centers for Medicare & Medicaid Services (CMS) inspection, GMHA was informed that the four beds in the Neonatal Intensive Care Unit (NICU) and the Intermediate Newborn Unit were not considered acute care units; therefore, those beds no longer counted towards the total. Thus, the total number of beds was reduced to 161, bringing acute care beds to the population higher. This ratio is representative of the ability and capacity of acute care medical services available on Guam. This is of concern due to Guam's status as a regional hub for treating patients in the region.

 

In December 2014, GMH opened its newly expanded hospital emergency room and intensive care unit. The renovated ER-ICU went from eight to 14 beds and increased in size from 120 square feet to 200 square feet.

In addition, GMH welcomed a donation of medical equipment from Naval Hospital Guam in May 2014 as the Naval Hospital completed its move to its replacement facility. An estimated value of $2 million worth of medical equipment was given to the hospital, including an X-ray, CT scan, and fluoroscopy equipment, to name a few.

In 2015, the GMHA opened an Urgent Care Center. The urgent care center, which is about 1,000 square feet, will treat patients who may not need emergency room services. It's located in the hospital's former emergency room, at the rear of the hospital building. The hospital built a new emergency room last year. The center will be open on weekdays from 3 p.m. to midnight; however, patients won't be accepted after 11 p.m.

Guam Behavioral Health and Wellness Center (GBHWC)

Guam Behavioral Health and Wellness Center (GBHWC) is the single step agency offering comprehensive behavioral health services to adults and children on Guam and private providers. All individuals are eligible for services at GBHWC, although the agency prioritizes the most indigent clients.

GBHWC has a wide range of different facilities around the island, including a medication clinic that caters to less severe mentally ill individuals who are unable to care for their mental condition due to a lack of resources, and individuals experiencing acute emergencies and/or crisis.

Guam Behavioral Health and Wellness Center (GBHWC) is responsible for addressing Guam's behavioral health services, including child and mental healthcare for adults, drug and alcohol abuse, and treatment and rehabilitation of these issues. GBHWC has a wide range of different facilities around the island dedicated to certain assistance or treatment. There is a medication clinic that caters to less severe mentally ill individuals who are unable to care for their mental condition due to a lack of resources, and individuals experiencing acute emergencies and/or crisis.

The Healing Hearts Crisis Center (HHCC) is Guam's Rape Crisis Center. As a division of GBHWC, HHCC exists with the intent to provide survivors of sexual assault with "discrete, immediate, and full medical attention."

HHCC incorporates a holistic approach for the survivor of sexual assault or abuse. HHCC services include intake assessment and crisis intervention, forensic and multi-disciplinary team interviews, short-term case management, and linkage to other needed services such as individual and family therapy. HHCC also provides medical services, including forensic examinations and collection of forensic evidence, and outreach and training to schools, service providers, and the community-at-large.

Department of Public Health and Social Services (DPHSS)

The Department of Public Health and Social Services (DPHSS) is Guam's designated governmental agency responsible for providing healthcare services. DPHSS is one of the major providers of social services to the island's residents. The mission of DPHSS is "to assist the people of Guam in achieving and maintaining the highest level of independence and self-sufficiency in health and social welfare." The DPHSS comprises five divisions: Division of General Administration; Division of Public Health; Division of Public Welfare; Division of Senior Citizens; and the Division of Environmental Health.

• The Division of General Administration (G.A.) provides department-wide administrative support functions.
• The Division of Public Health (DPH) is DPHSS's largest division, and its mission is to ensure the provision of direct and indirect healthcare services for individuals, families, high-risk groups, and the community at the three public health facilities, in addition to schools, home settings, and other community locations and accordance with legal mandates and identified collective health needs of the population.
• Community Health Centers – DPHSS operates two community health centers (Northern and Southern). The centers are federally qualified health centers and are multi-specialty primary care clinics. There are three primary types of services that are provided: 1) Primary care and preventive services; 2) Support services, and 3) Social services.
• The Division of Public Welfare's (DPW) mission is to promote positive social conditions that contribute to attaining the highest health and social well-being for the economically and socially disadvantaged populations. The division also administers payments and various social services to remove social barriers that prevent a person from obtaining/maintaining life's basic necessities.
• The Division of Environmental Health (DEH) is the branch of DPHSS responsible for ensuring public and consumer health and protection through preventive measures against unsanitary conditions. DEH’s major functions include sanitation inspections of regulated facilities, plans and specifications of regulated facilities, processing center operations, consumer commodities regulation, and vector control.

[1] Guampedia, Politics and Government, Guam’s Political Status, accessed Feb. 18, 2013

[2] Guampedia, Politics and Government, Guam’s Political Status, accessed Feb. 18, 2013

[3] Guampedia, Politics and Government, Guam’s Political Status, accessed Feb. 18, 2013

[4] Guam Consolidated Plan

[5], Guam housing, and Urban Development Needs Assessment.