The island of Guam lies between 13.2 and 137.7 N and 144.6 and 145.0 E. The island is 30 miles long and 4 to 9 miles wide, giving it an area of 212 square miles, making it the 32nd largest island of the United States. It is the southernmost and largest island in the Marianas as well as the largest in Micronesia.

POPULATION

Guam’s population was estimated at 167,358 in 2018[1], a growth of 8,000 persons from the official census figure of 159,358 in 2010. The estimated population represents a 5.4% increase from the census figure of individuals who call Guam home. Over half of the population (58%) is age 25 or older. The estimated median age is 30.4 years. Males slightly outnumber females, with an overall sex ratio of 1.03; however, for those age 25 years and older, the sex ratio is 1.0.

Guam’s population is multi-ethnic/multi-racial. Chamorros comprise the largest ethnic group, accounting for 37.2% of the total population. Filipinos make up 26.3%, Whites make up 6.8%, and Other Pacific Islanders comprise 11.5%. The ethnic/racial composition of Guam’s population has been shifting over time. The proportion of the population comprised of Chamorros declined from 44.6% in 1980, to 37.2% in 2018. On the other hand, Filipinos comprised only 21.2% of the population in 1980, but currently make up 26.3% of the island’s people. The ethnic group with the fastest rate of increase is the Chuukese population; from only 0.1% in 1980, Chuukese currently make up 7% of the population, a 7,000% increase. The ethnic diversity is reflected in the languages spoken at home. Twenty percent of the population (over 5 years) speaks another language as frequently as English at home; another 21% speak another language more frequently than English; and 0.5% speaks no English at all. This has a significant implication for effective service delivery, highlighting the need for culturally competent communication and services for close to half of the island’s population.

MCH Population

The MCH Program envisions a nation where all mothers, children, including children and youth with special health care needs, and their families are healthy and thriving. The mission of MCH is to improve the health and well-being of mothers, infants, children, and youth, including those with special health care needs, and their families.

LOCAL GOVERNMENT

Guam is an organized unincorporated territory of the United States, meaning that only select parts of the U.S. Constitution apply to its residents. Individuals born in Guam are considered citizens of the United States. Residents of Guam cannot vote in federal elections. Guam’s local government is organized into three branches: executive, legislative, and judicial. The legislative branch consists of a unicameral legislature with 15 members who are elected for two-year terms. The legislature is empowered and responsible for creating laws to protect the community, to ensure the health and welfare of the community, and to promote Guam’s development. Guam’s judicial branch decides issues of local laws and interprets how these laws should be applied. The judiciary consists of two bodies: the Superior Court of Guam and the Supreme Court of Guam. Finally, the island’s highest elected officials, the governor and lieutenant governor of Guam, manage the executive branch. These officials are tasked with the implementation of Guam’s laws through its departments, bureaus, and agencies and various committees that make up the Government of Guam.

Guam has a non-voting delegate in the U.S. House of Representatives. Non-voting delegates are able to perform many functions of a full representative, such as serve on committees, speak on the U.S. House Floor, introduce bills, and offer amendments. However, they are not able to vote while conducting business as the Committee as a whole or on final passage of legislation.

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; 48% are headed by a woman.

EMPLOYMENT/UNEMPLOYMENT

March 2019 results show total employment of 65,220 individuals, with 49,920 (76.5%) employed in the private sector; 11,520 (17.6%) employed in the Government of Guam; and 3,780 (5.7%) employed in the Federal Government. [2]

Looking at job growth, March 2019 data compared to one year earlier (March 2018) shows an increase of 0.52% in overall employment, with a decrease in employment in both Federal government (-2.07%) and Government of Guam (-2.54%) employment. Private sector employment, however, increased 1.46% from March 2018.

The March 2018 Guam Labor Force Participation Rate (LFPR) was 57.9% compared to the U.S. figure of 62.9%. This means that of the 122,720 individuals, who could work, 71,060 were employed and 3,100 were unemployed, but were willing and available to work. Guam’s Labor Force Non-Participation Report shows that 51,660 persons choose not to participate in the labor force. Of those 51,660 individuals, 2,530 indicated that they did not look for work and provided one of the following reasons –  1) Believe(d) no jobs were available; 2) could not find work; 3) School attendance; 4) Family responsibilities and 5) Could not arrange childcare.

The Unemployment rate in Guam for March 2019 [3]was 4.3 percent, an increase of 0.7 percentage points from the September 2018 figure of 3.6 percent and a decrease of 0.1 percentage points from the March 2018 figure one year earlier of 4.4 percent. The total number of persons unemployed in March 2019 was 3,120, which is virtually unchanged from one year ago.

 The number of persons Not in the Labor Force decreased by 1,760 from 51,460 in September 2018 to 49,700 in March 2018. For the March 2019 survey period, 2,380 persons, or five percent, in the Not in the Labor Force category indicated that they wanted a job but did not look for work for a variety of reasons. Whereas, 95 percent in the Not in the Labor Force category indicated that they did not want a job during the survey period.

CONSUMER PRICE INDEX

The latest Consumer Price Index (CPI) data was for the 4th quarter 2018, and it shows consumer prices on Guam have increased 2.3% when compared to the same period one year earlier. For those on a fixed income, a 2.3% increase translates to buying 2.3% fewer items than they did one year earlier. Consumer purchasing power dropped from .78 of a dollar in the fourth quarter of 2017 to .77 of a dollar in the fourth quarter 2018. This is a steady decline; Guam residents had .81 of a dollar in purchasing power at the beginning of 2017.

After climbing to a year high of $4.52 a gallon for regular grade gas, 2018 ended with a gas price of $4.00 a gallon of regular grade unleaded gasoline. [4]

HOUSEHOLD COMPOSITION

While Guam's overall population count has seen little change over the past few decades, the number of households has been fluctuating. Households, which are occupied housing units, grew 30.34% from 1990 to 2000, and then decreased 4.29% from 2000 to 2010. This is largely the result of change in household composition. [5]

The island's dominant household type in 2000 was married couples with children under 18 years of age, which represented 19,678 households on the island. In 2010, married couples with children younger than 18 accounted for 18,239 households, a decline of 7.3%. This dramatic transition was largely a result of the children of the baby-boom generation as they grew up and left behind a growing proportion of "empty nester" households

The most dramatic shift during the past years has been the explosion of non-family households[6] represented by 6,402 households. In 2010, non-family households grew to 7,827 or 22.3% of all households. Elderly people 65 and older make up 21.2% of all persons living alone[7]

In 2010, the median household income was $48,274; this is a decrease of 4.82% from 2000. The median family income for 2010 was $50,607 a change of 4.84% from the year 2000 median family income. [8]  

HOUSING

According to the 2010 Census of Guam's population, there were 50,567 housing units on Guam. Of the 50,567 units, 42,026 (83.11%) were occupied. Of the civilian population of 154,060 individuals, 73,094 (47.44%) were living in renter occupied units with an average of 3.50 people in the unit. The average rent in 2010 was $879.00 per month; this was a decrease of 12.68% from the median rent per month in 2000. [9]

In 2010, of the 50,567 housing units on Guam, 98.02% use the public water system as their source of water, 0.08% used a water well, and 0.29% had a water catchment system as the only source of water. Almost half of the housing units (54.89%) were constructed from concrete blocks, 38.98% were constructed from poured concrete, and 2.14% were built from wood. Ten percent of the 50,567 housing units lacked complete plumbing and 9.70% lacked complete kitchens. Three and a half percent of the units did not have telephone service. [10]

POVERTY

In examining the 2010 poverty status of residents on Guam, 22.50% of all individuals on Guam for whom poverty status was determined are considered to be in poverty; of these, 54% are individuals over 18 years of age; 4% are individuals over the age of 65 and 4% are children under the age of 18. [11]

When assessing the poverty status of families on Guam for the same period, 41% were married couple families. Forty four percent of families were a female-headed household and 15% of families with a male-headed household live in poverty. The use of government welfare and social service programs has been on the rise, indicating a growing problem of poverty on Guam. [12]

Medicaid

Medicaid in the United States is a federal and state program that helps with medical costs for some people with limited income and resources. The Health Insurance Association of America describes Medicaid as "a government insurance program for persons of all ages whose income and resources are insufficient to pay for health care."[13] Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States, providing free health insurance to 74 million low-income and disabled people (23% of Americans) as of 2017. [14],[15]

It is a means-tested program that is jointly funded by the state and federal governments and managed by the states, with each state currently having broad leeway to determine who is eligible for its implementation of the program. States are not required to participate in the program, although all have since 1982. Medicaid recipients must be U.S. citizens or qualified non-citizens, and may include low-income adults, their children, and people with certain disabilities 

The Federal Medical Assistance Percentage (FMAP), which is the share of a state’s Medicaid costs paid for by the federal government, ranges from 50% for the higher income states to 83% for the lower income states. The FMAP for the territories is 55%; an example is if Guam spends $10 million of its own money on Medicaid services, the federal government at 55% FMAP would put in $12.2 million.

The federal Medicaid funding for the territories comes from a few different sources. The permanent source of federal Medicaid funding for the territories is the annual federal capped funding, which has been supplemented by the Patient Protection and Affordable Care Act (ACA).

The chart below shows the proportion of annual federal capped funding and ACA Medicaid funding used by each territory in FY’17. The aggregate total of the annual federal capped funding for the territories was $400 million. Each territory spent through its capped funding, at which point, the territories used an aggregate of $1.2 billion in ACA funding.

Eligibility rules in Guam’s Medicaid program differ in some ways from those in the states. Guam is permitted to use a local poverty level to establish income-based eligibility for Medicaid, and is exempt statutorily from requirements to extend poverty-related eligibility to children and pregnant women, and Qualified Medicare Beneficiaries. Guam currently provides coverage to individuals, including children, with modified adjusted gross incomes up to 133% of the Guam poverty level (GPL). In 2016, this was $1,593 per month for a family of four or approximately 79% of the federal poverty level in 2016. Guam has expanded Medicaid eligibility to the New Adult Group under the Patient Protection and Affordable Care Act.

Guam uses CHIP funds as an additional source of funding for children in Medicaid after it has exhausted its CHIP allotment. It does not offer coverage to children whose incomes are above the threshold for Medicaid eligibility. Approximately 24% of Guam’s population was enrolled in Medicaid at the end of 2018.

Federal rules for Medicaid benefits generally apply to Guam, and its Medicaid program provides all mandatory benefits, including nursing facility services, and many optional benefits, including dental coverage and prescription drugs.

Guam has an insufficient number of specialists to provide needed services to beneficiaries, thus the Guam Medicaid program makes every effort to arrange for off-island care to ensure adequate access to quality care. These provider shortages and the remote island geography require beneficiaries to travel long distances to receive medical services that are not available on-island. For example, beneficiaries often travel thousands of miles to Hawaii, U.S. mainland or the Philippines for care.

Medically Indigent Program (MIP)

MIP is a 100% locally funded program established by P.L. 17-83 in October 1983, to provide financial assistance with health care costs to individuals who meet the necessary income, resource, and residency requirements. Public Law18-31 authorizes the Department of Public Health and Social Services, Division of Public Welfare (DPW), Bureau of Health Care Financing (BHCF) to administer the MIP.

COMPACTS OF FREE ASSOCIATION

The Compacts of Free Association are joint Congressional-Executive agreements between the United States and the Freely Associated States of Micronesia (FSM), the Republic of the Marshall Islands (RMI) and the Republic of Palau. Compact goals include achieving self-government, promoting economic advancement, and securing security and defense rights.

Under the compacts, the U.S. has a responsibility for defense of FSM, and the compacts provide the U.S. with exclusive military use rights in these countries. In addition, under the compacts, the U.S. provides economic assistance and access to certain federal services and programs. The U.S. funds the FSM, RMI, and Palau for a range of development programs, immigration privileges, U.S. transportation of mail, and other benefits. In exchange, each Pacific nation guarantees the U.S. exclusive use of its land for military purposes.

The compacts provide for citizens of these freely associated states to enter and reside indefinitely in the U.S. and citizens of the compact are exempt from meeting the Visa and labor certification requirements of the Immigration and Nationality Act. The migration provisions of the compacts allow compact migrants to enter the U.S. (which includes all states, territories, and possessions) and to lawfully work and establish residence indefinitely.

The Compact of Free Association Amendments Act of 2003 introduced the requirement for an enumeration of qualified nonimmigrants (for the purposes of this report they will be referred to as Compact of Free Association, or COFA, migrants) to be conducted no less frequently than every five years in the following jurisdictions: Hawaii, Guam, the Commonwealth of the Northern Mariana Islands (CNMI), and American Samoa. This enumeration would serve as the basis for apportioning $30 million in funding annually to these jurisdictions for a range of development programs and other benefits as a result of the in-migration of COFA migrants.

In accordance with the Compact of Free Association Amendments Act of 2003 (Public Law 108- 188), the U.S. Department of the Interior signed an Interagency Agreement (IAA) with the U.S.

Census Bureau to produce estimates of COFA migrants for 2018.

The Census Bureau estimates that there were 38,114 COFA migrants residing in the four

jurisdictions combined (Hawaii, Guam, CNMI, and American Samoa) in 2018. Guam had the highest number (18,874) of COFA migrants in 2018 with Hawaii having the next highest at 16,680. About 93 % of all COFA migrants in 2018 resided in Guam or Hawaii among these four jurisdictions.

NORTH KOREA

Guam made international headlines in 2017 when North Korea leader Kim Jung Un threatened to launch intermediate-range ballistic missiles toward the island of Guam. While Japan and South Korea were also mentioned in the threats, Guam had a particular ring to the global audience, in part because Guam is the closest American soil to North Korea. Somehow, Guam’s slogan “Where America’s Day Begins” had a more ominous ring to it.

International media outlets from Australia, London, and New York took notice, not just by calling in to get the voice of Guam, but also by dispatching some top field journalists to Guam. There was a “countdown” mood by the international press that came to the island only to find really nothing going on here of any international significance, except possibly the lack of tourists who come to enjoy our sparkling beaches.

Guam hotels, restaurants, and tourist shops began to notice thinning tourist crowds, so much so that some businesses were forced to reduce employee hours. As the North Korea threats continued, Guam’s Japan tourism market, once a staple of the island’s visitor industry for decades, started to plummet. The Guam Visitors Bureau confirmed 7,556 total cancellations in plans to visit Guam since August 2017, although the decline was slightly cushioned by South Korean tourists, who took the threats in stride, and were encouraged to travel through strong competition by low-cost airlines. As analysts acknowledged that North Korean attempts to develop missiles had advanced to a surprising degree, the threat carried a grave tone. 38 North, a website for analysts dedicated to North Korea issues, described tensions between North Korea and the United States as “extremely high, antagonized further by exchanges” between U.S. President Trump and North Korean leader Kim Jung Un. As the leaders continued to exchange words, the Guam Office of Homeland Security/Civil Defense issued an information sheet of what to do in case of nuclear attack and the island’s warning sirens were tested.

In August 2017, President Trump called Governor Eddie Calvo to reassure the island that the U.S. military would protect Guam from North Korea. There was no sense of panic across Guam, even though Guam’s Homeland Security acknowledged it would take only 14 to 18 minutes for a North Korean missile to reach the island. Whether that would be enough time for the U.S. to react without resulting in destruction, on Guam or elsewhere, remains a question. Should note that the threat dissipated within a month or so and is not ongoing.

GUAM AND NATURAL DISASTERS

Guam’s strength is in its resourcefulness. The people of Guam have learned to withstand and recover quickly from natural disasters and are known for developing a resiliency necessitated by their isolation and great geographical distance from the rest of the United States.

Guam is also located within the “Ring of Fire.” The Ring of Fire is an area in the Pacific Ocean where the movement of the earth’s plates causes frequent earthquakes and volcanic activity. The ring extends along the edges of the large Pacific plate, from New Zealand, through Indonesia, past the Mariana Islands and Japan, and along the Aleutian Islands in Alaska. The ring continues further along the whole west coast of the North American continent, Central America and South America to the southernmost point in Chile. These coastal areas are particularly vulnerable to the effects of tsunamis even if the epicenter of an earthquake is located thousands of miles away.

The Northwestern Pacific Ocean region is made up of a succession of three tectonic plates. From the most western, moderately sized Philippine Sea plate, to the small crescent-shaped Marianas Plate and lastly, to the east, the Pacific plate.

Due to its location on the Marianas plate, Guam occasionally experiences earthquakes. In recent years, earthquakes with epicenters near Guam have had magnitudes ranging from 5.0 to 8.2 (1993). The 1993 earthquake injured 48 people and caused more than $100 million in damages.

Lying so close to the Equator means that Guam’s climate is tropical, with temperatures ranging from a mean high temperature of 86F and a mean low of 76F. The dry season runs from December to June. The remaining months (July to November) constitute the rainy season with an average annual rainfall of around 98 inches.

Guam is located in “Typhoon Alley,” the busiest location for tropical cyclones, and it is common for the island to be threatened by tropical storms and possible typhoons during the wet season. The highest risk of a typhoon is during August through December; they can, however, occur year-round.

Super Typhoon Pongsona (2002) was one of the worst typhoons to ever strike the island of Guam. It was Guam’s third most intense storm, with sustained winds of 144 miles per hour (mph), gusts to 173 mph. Only two storms exceeded Super Typhoon Pongsona—Karen in 1962, with 155 mph sustained winds; and the Typhoon of 1900, wind speed unknown. Super Typhoon Paka in 1997 equaled Pongsona in intensity while it passed over Guam. Preliminary damage estimates for Guam totaled more than $700 million, which placed Pongsona in the top five typhoons for damage.

On Sept. 7, 2018 when Typhoon Mangkhut (Thailand for kind of fruit) formed as a tropical depression, it was known as Tropical Depression 26W. On the day it formed, a tropical storm watch was posted for Enewetak. 26W then moved west toward Micronesia and strengthened into a typhoon. Three days later, Typhoon Mangkhut hit Guam. At 5 a.m. on Sept. 10 the NWS in Guam noted that "Damaging or destructive winds are now occurring. Damaging south winds of up to 105 mph with gusts to 120 mph will continue for the next few hours. Winds will gradually decrease to between 55 and 65 mph around midnight.” 

Typhoon Mangkhut, which was the planet’s most intense storm of 2018, this year (that was in 2018, not “this” year), rammed into Hong Kong, causing significant damage. The storm, which had battered the northern Philippines with the strength of a Category 5 hurricane, weakened slightly while crossing the South China Sea but was still a force to be reckoned with in Hong Kong

HEALTH CARE DELIVERY SYSTEM

Guam’s health care delivery system is pluralistic and distinguished by a 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, as well as the military retirees and veterans on Guam.

All the 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 specialized and tertiary medical services are thousands of miles away, necessitating medical referrals to Japan, the Philippines, Hawaii, or the United States 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’ flight time.

Guam has been designated a Health Professional Shortage Area (HPSA) and a Medically Underserved Area (MUA). Health Professional Shortage Areas (HPSA) are federal designations that apply to areas, population groups or facilities in which there are unmet health care needs. Designations help prioritize limited federal resources to the areas that need them most. The federal Medically Underserved Area/Population (MUA/P) designation identifies areas or populations as having a need for medical services based on demographic data.

Guam’s health care system consists of hospitals, outpatient clinics, and home health care services. As a public health department, the goal is to improve the health status of every Guam resident and to ensure access to quality health care. This includes helping each person live a life free from the threat of communicable disease, tainted food, and dangerous products. To assist in this mission, activities include regulation of health care providers and facilities when appropriate.

[1] US Census Projections, US Census Bureau

[2] Guam Department of Labor

[3] Guam Department of Labor

[4] Consumer Price Index, Governor of Guam Office

[5] Demographic Profile Data Comparative, Prepared by Guam State Data Center, Bureau of Statistics and Plans, December 2012

[6] A nonfamily householder is a householder living alone or with nonrelatives only.

[7] Demographic Profile Data Comparative, Prepared by Guam State Data Center, Bureau of Statistics and Plans, December 2012

[8] Demographic Profile Data Comparative, Prepared by Guam State Data Center, Bureau of Statistics and Plans, December 2012

[9] Demographic Profile Data Comparative, Prepared by Guam State Data Center, Bureau of Statistics and Plans, December 2012

[10] Demographic Profile Data Comparative, Prepared by Guam State Data Center, Bureau of Statistics and Plans, December 2012

[11]  Demographic Profile Data Comparative, Prepared by Guam State Data Center, Bureau of Statistics and Plans, December 2012

[12] Demographic Profile Data Comparative, Prepared by Guam State Data Center, Bureau of Statistics and Plans, December 2012

[13] America's Health Insurance Plans (HIAA), p. 232

[14] Terhune, Chad (October 18, 2018). "Private Medicaid Plans Receive Billions In Tax Dollars, With Little Oversight". Health Shots. .

[15] Medicaid, the nation's public insurance program that assists 75 million low-income Americans.