II.A. OVERVIEW OF THE STATE
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Geography
The Federated States of Micronesia (FSM) is made of four group of island states: Pohnpei (the Capital state), Chuuk (the largest in population), Yap, and Kosrae (the smallest, one-island state). Altogether, the FSM has 607 small islands located in the Western Pacific, about 2,500 miles southwest of Hawaii. Some of the islands are volcanic and others are small atolls. Except the state of Kosrae doesn’t have any other smaller atolls. The four FSM states are widely spread apart by the ocean, hundreds of miles from east to west. From farthest east is the state of Kosrae, which is more closer to the islands of the Republic of the Marshalls than to the islands of Yap, then going Westward to the states of Pohnpei, Chuuk, and farthest west is the state of Yap, which is more closer to the islands of the Republic of Palau than the rest of the FSM. The four states are united and regulated under the FSM National Constitution.
https://en.wikipedia.org/wiki/Federated_States_of_Micronesia
Demographics
Below Table depicted the results from the 2010 Census which estimated 102, 843 persons residing in 16, 767 households in the FSM.
As mentioned in the Summary Analysis of Key Indicators from the FSM 2010 Census of Population and Housing, "While FSM population declined between 2000 and 2010, it is interesting to note that the number of households had increased from 15,723 to 16,767, an increase of 1,044 households. The average household size declined from 7 persons in 2000 to 6 person in 2010. Similarly, average family size declined from 7 in 2000 to 4 in 2010, indicating a preference for smaller families by couples in FSM".
Population by State (2010) |
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State Total |
Male |
Female |
FSM Total |
102,843 |
52,193 |
50,650 |
Chuuk Total |
48,654 |
24,835 |
23,819 |
Kosrae Total |
6,616 |
3,352 |
3,264 |
Pohnpei Total |
36,196 |
18,371 |
17,825 |
Yap Total |
11,377 |
5,635 |
5,742 |
According to the FSM Statistics 2010 Census Summary Report, it was stated that changes in the age and sex structure of a population are most effectively illustrated via what is called a population pyramid, but the overlaying population pyramid helps to identify unique population developments or demographic change by Comparing the 2010 0‐4 year age group with the 10‐14 year age cohort of 2000, for example, indicates fertility has been declining; The higher proportion of 10‐14 and 15‐19 year olds in 2000 compared to 2010, points to high level of family migration out of FSM, and/or greater proportions of these age groups migrated outside for education or to seek work opportunities; and The change in population composition is most pronounced in relative terms amongst those in the older ages with 2010 numbers in the age‐groups more than what they were in 2000.
According to World Bank, the FSM's demographic in 2016 and 2017 is depicted below:
Life expectancy: 69.20 years (2016) World Bank
Fertility rate: 3.14 births per woman (2016) World Bank
GNI per capita: 4,210 PPP dollars (2017) World Bank
Population growth rate: 0.6% annual change (2017) World Bank
The 2000 FSM Census of Population and Housing published in December 2002 for each FSM state provides evidence of the differences and similarities across the FSM states that had an impact on the implemented activities at the state and national MCH programs: At least 85% of citizens are native to the state in which they reside; more than 90% of citizens of each state prefer communicating in their state’s native language (one of eight major languages in FSM); While English is the official language and is used in schools and government, the percentage of people who speak English averages 57%, with a low of 40% on Chuuk and a high of 75% on Kosrae; A high percent (averaging 49% across the FSM states) of citizens over 25 years of age do not have a high school diploma; The unemployment rates are high, ranging from 9% on Kosrae to almost 48% on Pohnpei. Concurrently, an average of 56.75% reported no income on the 2000 Census questionnaire; and the previously substantial job market for agriculture, forestry, fishing and quarrying have been replaced by Public Administration; Education; and Wholesale/ Retail Trades now employing the most workers.
Although there is the FSM National Constitution that holds the four FSM states together, each of the four states has its own state Constitution. Each of them replicates that of the national government with three branches of separate powers. Each of the FSM states has considerable autonomy and each one of them is equally unique in its own geography, ecology, language and cultures. Each state has unique cultural characteristics which are as important as the others. The cultural diversity is challenging and typified by the existence of eight major indigenous languages. However, with the existence of English language as the official language throughout the islands in the governments, schools, and commercial businesses, it lessens the burden of not understanding one another when languages become the barrier.
System of Care Population Served
The 2018 FSM population projection estimates showed that there were 31,564 women of reproductive age (defined as women 15-44 years old). It was reported that about one fourth of the women of reproductive age had received direct services from the MCH programs in 2018.
2018 FSM POPULATION ESTIMATES |
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Sex/Age |
Total |
Male |
Female |
Total |
102,797 |
52,153 |
50,644 |
0 to 4 |
10,863 |
5,623 |
5,240 |
5 to 9 |
11,459 |
5,875 |
5,584 |
10 to 14 |
11,341 |
5,793 |
5,548 |
15 to 19 |
11,540 |
5,936 |
5,604 |
20 to 24 |
10,820 |
5,601 |
5,219 |
25 to 29 |
8,303 |
4,384 |
3,918 |
30 to 34 |
5,935 |
3,071 |
2,865 |
35 to 39 |
5,162 |
2,580 |
2,583 |
40 to 44 |
4,873 |
2,453 |
2,421 |
45 to 49 |
4,777 |
2,270 |
2,507 |
50 to 54 |
4,675 |
2,275 |
2,401 |
55 to 59 |
4,351 |
2,163 |
2,188 |
60 to 64 |
3,654 |
1,796 |
1857 |
65+ |
5,042 |
2,335 |
2,708 |
Sources: FSM Census Population Projection |
The number of infants (less than one year old) in the 2018 FSM population projection was 2,172. The 2018 population estimates shows that there were 22,322 children 1- 9 years of age. There were 22,881 children 10-19 years of age in the FSM. The MCH programs served 45,203 of these groups (0-19 years old) including the CSHCN population.
Government
The 21st Congress of the Federated States of Micronesia (FSM) began its first regular session on May 11, 2019 and on the same day elected the new president and vice president of the FSM. The new president is David W. Panuelo from the state of Pohnpei and also the 9th president of the Federated States of Micronesia. Yosiwo P. George from the island of Kosrae is re-elected as the vice-president for the nation.
The President and the Vice President of the Federated States of Micronesia are the highest Chief Executives of the FSM. They are elected from among fourteen members of the National Legislative branch, which is the national Congress. Four of them represent each of the four states for four-year terms, and the other ten members apportioned based on the population. They only serve their terms for two years. Currently, Chuuk has six seats in the Congress, Pohnpei has four, and the remaining four are two seats for Yap and two seats for Kosrae. All members of the Congress get elected by their respective state eligible, registered voters. Although there is the FSM National Constitution that holds the four FSM states together, each of the four states has its own state Constitution. Each of them replicates that of the national government with three branches of separate powers. Each of the FSM states has considerable autonomy and each one of them is equally unique in its own geography, ecology, language and cultures. Each state has unique cultural characteristics which are as important as the others.
The four states are united and regulated under the FSM National Constitution. The Constitution provides separation of power of the three branches of government, the Executive, Legislative and Judiciary. Unlike the USA, most of the government functions are carried out at the state levels, except foreign policy and national defense are carried out at the national level.
People, Cultures, and Religion
People from the FSM are classified as people from Micronesia (The Micronesia region encompasses five sovereign, independent nations—the Federated States of Micronesia, Palau, Kiribati, the Marshall Islands and Nauru—as well as three U.S. territories in the northern part: Northern Mariana Islands, Guam and Wake Island) according to Wikepedia.org. Traditionally, like the rest of the Micronesians the FSM people rely on fishing and farming for subsistence. Skills such as
Woodcarving, traditional canoe and cottage constructions, fine weaving from hibiscus and coconut palms are regularly practiced and carried on as part of their traditional culture. The older people teach and pass them down to the younger generation.
The people of the FSM are generally known as friendly people. They have a relaxed island lifestyle which very common among the island people. They have their own culture for particular ethnic group, and religion plays a major role in the culture. For example, Sundays in Kosrae, is a day of worship and for rest. Almost all stores and shops are closed on Sundays. Drinking alcohol on a Sunday is prohibited.
Culturally, there are important aspects to FSM culture that give context to the development of an effective FSM prevention infrastructure. Islanders have not completely understood the concept of medical confidentiality and many people are reluctant to be seen and examined by the physician, nurse or health aide. Because of this reluctance and lack of understanding of preventive measures, people seek medical care only when conditions are too serious to be ignored any longer, and sometimes that is too late. Micronesians often believe that illnesses and other diseases are brought upon a person by gods and/or ancestors for various reasons (such as punishment for certain members of the family or clan who have offended the gods or ancestors), and illnesses are thought to be remedied only by reconciliation of the gods, families or individuals.
Lanugage
The cultural diversity is challenging and typified by the existence of eight major indigenous languages in the FSM. However, with the existence of English language as the official language throughout the islands, in the governments, schools, and commercial businesses, it lessens the burden of not understanding one another when languages become the barrier. English is taught in the schools throughout the Islands in the FSM. Several older people speak Japanese, the language they learned during the Japanese Administration before the World War II.
Economy
Since the inception of the FSM independent government, the government has become the main employer of the Island. Like today, the public sector continues to depend greatly upon the assistance provided to FSM under the Compact of Free Association Agreement, other federal grants and foreign grants. Majority of the people in the FSM earning an income are employed by either the State government or the FSM National government. The private sector relies on the moms and pops retail stores, restaurants, and hotels, and farming and fishing.
Transportation
Nowadays people on the islands rely on vehicle transportation to go from one village to another and the only 2 national ships that provide services among the main islands and the outer islands. Shipping services to and from the four FSM States are provided by outside shipping companies like Kyowa Line from Japan, Mariana Express Lines Pte. Ltd. from Singapore and etc. The United Airline is
the only commercial airline that provides flight services to and from United States of America to the four islands States via island hopper en route Guam five times a week.
Healthcare System
The FSM National Government Department of Health and Social Affairs only provides advice and support to the FSM states. Each state has its own health services department. There is only one hospital in each state. They also have a few community health centers that are serving the community people in the villages. The health centers are more accessible to the community people than the hospital. The hospital in each state serves more as a last resort for the sick people to seek for health care if the community centers do not have what they need. Very recently, the community health centers have one or two doctors available to assist the regular or daily health assistant. Not all the centers have adequate medical supplies and equipment. However, most people on the islands prefer to visit the health centers because they are closer to their homes, and they have affordable medicines.
There are 5 Department of Health Services in the FSM; one national and four for the primary health agency for the four the States. The Health services are provided by the State Department of Health Services and other health programs; both primary and secondary health system of cares are made available through the State hospital only. Patients with complications or those requiring tertiary cares are referrd off-island to Guam, Phillipines or Honolulu, depending on availability of funds provided by either the State governments or Micare Health Insurance.
General Health
According to the 2018 FSM BRFSS findings, more than 90% of the survey population reported that they have fair to excellent health. One out of ten individual respondents mentioned that they had 14 or more mentally unhealthy days during the previous 30 days.
The most-common chronic disease in the FSM was high cholesterol, hypertension, arthritis, asthma and diabetes. Those who reported ever having high cholesterol was among female respondents (45.7%); males reported ever had high cholesterol (37.1%). The highest prevalence of high cholesterol was shown among FSM respondents aged 55 to-64 years old (61.2%). Overall, (37.8%) in the survey population are obese. There was a significant gender difference in obesity. A higher percentage of females (44.5%) reported being obese than males (32.9%). About one-third of the study population (32.2%) was overweight. The percentage of overweight in males (33%) is slightly higher than overweight in females (31.1%).
The prevalence of current daily tobacco smokers was 13.3 % and less than daily tobacco smokers was 8.6%, significantly higher in the male survey population. The highest percentage of current daily smokers was in the age groups 45-54 years old, while current less than daily smokers was in the earliest age groups 18-24 years old.
Youth Suicide and Youth Mental Health in the FSM
Tragically, many youths struggling with mental health issues often turn to suicide; a trend Micronesian at-risk youth coped with. Suicide is a sensitive subject in most Micronesian communities. Since the 1970’s, Micronesia has had the highest suicide rates in the world as mentioned during the Youth International Day in 2014.
A large number of previous suicide studies incorporated the populations of the Micronesian community into very broad categories namely Asian Americans & Pacific Islanders. As a result of this ill defined categorization, we have unfortunately lost the capability of making importation differentiations between others & Micronesians as well as their various sub-groups within those populations. This has actually overlooked the diverse make up of the category of Pacific Islanders.
According to previous research, the incidence rates of completed suicide among the Pacific islanders including the Micronesian populations are some of the highest worldwide.
For the Micronesian populations specifically there is rather limited information on suicide data.
There have been some assumptions that culture may contribute to suicidal behaviors but there is a lack of research in terms of suicide across the different cultures. The development of necessary evidence based interventions for the prevention of suicide has been affected due to this lack of research.
According to current FSM Behavioral Health & Wellness program Psychiatrist, Dr. Victor Wasson, he said "I feel that more of this much needed research is to be done in order to ensure that we establish prevention/intervention strategies that are culturally orientated/sensitive". He has stated that mental illness may have not been an important factor in Micronesian suicides but this can be debated (due to the lack of expertise for identification/diagnosis during that time, lack of awareness/under-reporting along with the stigma that accompanies them and the cultural explanations of certain symptomatology with traditional management if any). Among the victims who were actually diagnosed with a mental illness (10%), the common illness was schizophrenia. Alcohol was blamed as a contributing factor towards suicide method motivation or method. It was stated that 41%- 68% were intoxicated/drinking at the time of completed or attempted suicide.
The most common methods used in Micronesia among men (86%) and women (69%) is by self strangulation/asphyxiation or in other words hanging. There may have been a cultural patterning of this particular method having not been influenced by models of a foreign kind.
According to Dr. Wasson, the reasons for committing suicide are in the following:
- Alterations in the family relationships and structures following the colonization periods and moving on into a new era where change is inevitable.
- A reduction in dependence on subsistence production and more reliance on cash economy may have affected the importance of clan activities and lineage.
- Undermining of the social supports structures for adolescents caused by unaccustomed reliance on the nuclear family leading to a rise in parent-adolescent conflicts
- Suicide has somewhat been accepted/expected (to some extent) and become more familiar among youths in the resolution of conflicts/social problems faced in society.
- The Micronesian belief system that pertains to communication in spirit may also be another factor for influence from one suicide to another.
- Despite the findings that suicides were a result of impulsive behavior, there is a trend involving long term intolerable situations and the preference to withdraw and handle matters indirectly rather than confrontation.
According to the 2018 FSM BRFSS National Report, more than 10% individuals reported that they had more than 14 mentally unhealthy days. There was gender similarity when reported ever had more than 14 mentally unhealthy days each month.
Emergency Preparedness
FSM has been the recipient of two cooperative agreements since 2004.
Public Health Emergency Preparedness (PHEP) and Hospital Preparedness Program (HPP)
The main functions of these cooperative agreements are preparedness and response planning.
When Zika virus was reported in the state of Kosrae, one of four states within the Federated States of Micronesia (FSM), the territory responded with a PHEP-funded mosquito control and elimination campaign. Campaign activities included an island-wide mosquito survey, communication efforts such as travel advisory brochures, radio programs, and posters, and mosquito spraying at the homes of all reported cases.
PHEP has the following capabilities:
HPP Capabilites are:
The Four Capabilities The four Health Care Preparedness and Response Capabilities are:
Capability 1: Foundation for Health Care and Medical Readiness
Capability 2: Health Care and Medical Response Coordination
Capability 3: Continuity of Health Care Service Delivery Goal of Capability
Capability 4: Medical Surge
Other Issues
FSM is tremendously experiencing adverse effects of climate change, very highly vulnerable to nature disaster, and that is another area that the nation is now focusing on to work with other governments and entities in strengthening resilience through disaster management.
Other barriers that all the MCH programs in the four States do encountered:
- Demographic Setting of the islands
- Transportation issues
- Need to improve on Public Education and Awareness
- Data collection from Outer Islands
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