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Region IX

RegionIX consists of:

• Arizona
• California
• Hawaii
• Nevada
• United States Pacific Island Jurisdictions:
  • American Samoa
  • Commonwealth of the Northern Mariana Islands
  • Federated States of Micronesia
  • Guam
  • Republic of the Marshall Islands
  • Republic of Palau

Region IX overview

It is the most populous as well as racially, ethnically, and culturally diverse region in the U.S. Of the total regional population of 40,174,513 over 40 percent are people of color. This is more than twice the national average. And, in major urban cities such as San Francisco it is not unusual for more than 100 different languages to be spoken. It is a region of sharp contrasts. For example, California is one of the largest and most heavily populated states in the U.S., with more than 32 million residents while the Republic of Palau only has about 18,000 residents. Moreover, 7 of the 10 entities which form Region IX are island nations located in the Pacific Ocean. They occupy a total geographic area comparable to the size of the continental U.S. Since Region IX spans several time zones including the international dateline, communication is a particular challenge in the region.

There are about 19.8 million women in Region IX. Like the U.S., there is similarity among states and Pacific jurisdictions with regard to prevalent women's health problems, e.g., cardiovascular disease, cancer, pneumonia and influenza, accidents and unintentional injuries, etc. Yet, the level of importance of each health problem varies geographically and culturally. The disparate configuration of needs, problems, and means across the region require the development and implementation of health promotion and disease prevention programs which are culturally responsive to women's health care issues. In addition to access to care, key regional women's health issues include HIV/AIDS, cancer and breast cancer awareness, violence prevention , and minority women's health.

The region is home to 3 National Centers of Excellence in Women's Health: University of California at San Francisco, University of California at Los Angeles, and University of Arizona Health Sciences Center at Tucson. Also, located in the region are 2 National Community Centers of Excellence in Women's Health: Mariposa Community Health Center in Nogales, Arizona and Kokua Kalihi Valley Comprehensive Family Services in Honolulu, Hawaii. Finally, 2 Rural/Frontier Coordination Centers for Women's Health contracts have been awarded to the Arizona Association of Community Health Centers in Phoenix and the Southern Nevada Area Health Education Center in Las Vegas.

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State of Arizona

Arizona has a total population of about 4.6 million (1997); 50.5 percent are females. The racial/ethnic distribution of the population is as follows: White (68.7 percent), Black (3.4 percent), American Indian/Alaska Native (5.9 percent), and Asian/Pacific Islander (1.8 percent); Hispanic (20.2 percent); White-Hispanic (18.9 percent); and Non-white Hispanic (1.3 percent). Arizona has a median income of $30,863 with 20.5 percent of residents living below the poverty level. The state has 15 large counties. "Migrant streams", the agricultural routes which Mexican migrant workers follow to earn a living, result in key state health issues. The results are difficulties in follow-up care, lack of preventive health care, etc. especially for women. The Office of Women's and Children's Health, within the Arizona Department of Health Services, has primary responsibility for the health of women and children in the state. With a staff of about 75 members, the office administers the Title V - A & B Block Grants, Perinatal, Children, and Adolescent programs, and state-funded activities, e.g., Newborn Intensive Care, Healthy Start, Newborn Screening, and Teen Prenatal Express. Also, it administers programs such as community health nursing, injury prevention, perinatal substance abuse, etc. Other divisions within the department focus on breast and cervical cancer screening, older adults, nutrition, etc. The Office of Women's and Children's Health recently developed the KareBook, a hand-held medical record for pregnant migrant women.

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State of California

California has a total population of about 32.3 million (1997); 49.9 percent are females. The racial/ethnic distribution of the population is as follows: White (52 percent), Hispanic (28 percent), Black (8 percent), American Indian/Alaska Native (1 percent), and Asian/Pacific Islander (11 percent). California has a median income of $40,237 with 16.9 percent of residents living below the poverty level. The leading causes of death for the state of California are cardiovascular disease and cancer. The major health concerns are HIV/AIDS, teen pregnancy, breast cancer, cardiovascular disease, and infant mortality.

The Office of Women's Health within the California Department of Health Services was authorized in August 1993 by Executive Order W-57-93. The office serves as the focal point within the department for setting and monitoring women's public health policies; promoting more comprehensive and effective approaches to improve women's health, and including better coordination of existing programs and resources; and enhancing the visibility, prominence of women's health problems as well as innovative solutions. In addition, the Office of Women's Health conducts annual telephone surveys on the health status of women within the state and publishes reports on the survey results. May 7th is California Women's Health Day.

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State of Hawaii

Hawaii has a total population of about 1.2 million (1997) with 49.5 percent females. The racial/ethnic distribution of the population is as follows: White (33.5 percent), Hispanic (8.3 percent), Black (2.4 percent), American Indian/Alaska Native (0.6 percent), and Asian/Pacific Islander (63.5 percent). Hawaii has a median income of $42,851 with 12.1 percent of residents living below the poverty level. A reorganization of the Hawaii Department of Health is ongoing. The departmental unit which has the lead responsibility for women's health issues is the Family Health Services Division. One is the maternal mortality death rate which is higher than the rest of the U.S. Also, there is a departmental focus on reducing the pregnancy rate in the late teens (17-19 years old) and promoting violence prevention activities. A series of "resource cards" have been developed to provide women with contact information for various kinds of health care services. Women's health activities are growing within the state. Hawaii is the only state in the U.S. which devotes an entire month to promoting women's health prevention and education. The Hawaii State Commission on the Status of Women in collaboration with the Department of Health and other agencies and organizations throughout the state launches a "Women's Health Month" each September. The Governor signs an annual proclamation and each island holds health fairs, lectures, and special activities which address the health concerns of women and promote healthy lifestyles. Over 400 activities focused on women's health are held throughout the state each September.

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State of Nevada

Nevada has a total population of about 1.6 million (1997) with 49.0 percent females. The racial/ethnic distribution of the population is as follows: White (87.4 percent), Hispanic (12.1 percent), Black (7.1 percent), American Indian/Alaska Native (1.8 percent), and Asian/Pacific Islander (3.8 percent). Nevada has a median income of $36,084 with 8.1 percent of residents living below the poverty level. The Bureau of Family Health Services is the focal point within the Nevada State Health Division for women's health issues. The Bureau has 110 employees and 12 different programs. It administers all of the Title V programs, e.g., WIC, Newborn Screening, etc. With the second highest teen pregnancy rate in the U.S., a major focus of women's health activities has rested with Title V initiatives and pregnancy. The Bureau is involved in prevention activities i.e., media campaigns such as "Baby Your Baby?", teen leader programs, the Youth Advisory Council, etc. The result has been a recent 6.3 percent decrease in the teen pregnancy rate. Moreover, the Health Division has received a Breast and Cervical Cancer Early Detection Program grant. The state holds a "First Lady's Conference on Women's Health Issues" a collaborative biennial effort between the Southern Nevada AHEC, the State Health Division and the Governors' Spouse.

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United States Pacific Island Jurisdictions:

American Samoa

American Samoa is a Pacific basin territory with a population of 54,089 (1995 est.), with females numbering 30,641. The racial/ ethnic distribution is as follows: Samoan (89 percent), White (2 percent), Tongan (4 percent), and Other (5 percent). Women have a life expectancy rate of 78.85 years. As an incorporated territory of the U.S., American Samoa is located in the mid South Pacific about 2,600 miles from Hawaii and totals 76 square miles. About 50 percent of the population is under the age of 20 and about 59 percent of the population are below the poverty level. The infant mortality rate has decreased from 8.0 in 1988-89 to 6.1 in 1991-92. Their adolescent pregnancy rate is 40.0 with only 19.0 percent of women ages 15-44 using any method of birth control in 1993. Clinical and self breast examinations are the focus of many of their women's health activities. Other initiatives are being developed.

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Commonwealth of the Northern Mariana Islands

Commonwealth of the Northern Mariana Islands (CNMI) is a Pacific basin commonwealth with a total population of 78,753 (1995 est.) with females numbering 34,0861. The racial/ethnic population includes Chamorros, Carolinians and other Micronesians, Whites, Japanese, Chinese and Koreans. Women have a life expectancy rate of 69.48 years. CNMI is a chain of 17 volcanic islands stretching over 375 miles from north to south and 181 square miles in land mass. While there are 6 inhabited islands, most of the residents live on Saipan. The CNMI was formerly a part of the Trust Territory of the Pacific Islands. In the 1970s, the residents chose to form a closer tie with the U.S. and became a commonwealth. Almost 54 percentof the total population is under the age of 20 years old. About 71 percent of the total population are below the poverty level. The general fertility rate in 1993 was 105.4 while their adolescent pregnancy rate was 92.9. In the same year, only 18.5 percent of the women ages 15-44 used any method of birth control. The infant mortality rate has decreased from 17.9 in 1988-89 to 9.3 in 1991-92. The U.S. rate in this latter period was 9.9. Currently, the Commonwealth of the Northern Mariana Islands are prioritizing women's health issues and developing initiatives.

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Federated States of Micronesia

Federated States of Micronesia is a Pacific basin freely associated state of 103,938 (1995 est.) people, with females numbering 50,245. Women have a life expectancy rate of 69.99 years. Nine ethnic Micronesian and Polynesian groups comprise the total population. The Federated States of Micronesia consists of 4 islands states: Kosrae, Yap, Chuuk, and Pohnpei. Kosrae State is 1 volcanic island of 43 square miles with 7,435 people. It has a wet tropical climate and many rivers and waterfalls. Kosrae is almost exclusively rural with a subsistence economy. Yap State consists of 1 volcanic complex of 4 islands plus 11 inhabited outer islands and atolls. Yap has a total land area of 46 square miles and 2/3 of its 10,886 population live on Yap proper. It is one of the most traditional island groups of the Pacific. Residents speak Yapese, Ulithian, and Woleaian. Chuuk State comprises the volcanic islands in the Chuuk Lagoon and some 24 outer-island atolls; this totals about 290 islands. Chuuk is the most populous of the FSM states with 48,853 residents and a land area of 49 square miles. It is world famous for divers interested in exploring sunken WWII Japanese fleets. Pohnpei State consists of 1 large volcanic island and 6 inhabited atolls with most of its 133 square miles on Pohnpei Island. The population totals 33,346. Pohnpei is the national capital of the FSM and site of the Community College of Micronesia. It is a fertile island with much local agriculture and a growing tourism industry. It is gaining a reputation for its gourmet pepper. About 57 percent of the total FSM population are under the age of 20 years and 95 percent of the total population are below the poverty level. The general fertility rate in 1993 was 107.2 while the adolescent pregnancy rate was 54.8. In that year, 28.5 percent of the women ages 15-44 used any method of birth control. Their infant mortality rate decreased from 22.0 in 1988-89 to 16.1 in 1991-92. The Pohnpei Community Health Center serves approximately 30,000 persons through the provision of additional primary care capacity at the main center facility in Kolonia as well as improving access to care by supporting staff at the outlying remote dispensaries located throughout the islands. Innovative plans are being considered to address women's health care needs.

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Guam

Guam has a total population of 144,694 (1995 est.) with females numbering 70,4871. The racial/ethnic distribution is as follows: Chamorro (47 percent), White (10 percent), Filipino (25 percent), Chinese, Japanese, Korean and Other (18 percent). Women have a life expectancy rate of 76.13 years. Guam is the largest Micronesian island with a land area of 212 square miles. Formed by the union of 2 volcanoes, northern Guam is a flat limestone plateau while the southern part is mountainous. Guam's population is highly diverse, with residents from throughout Asia and the Pacific as well as a substantial number of U.S. military and their dependents. About 31 percent of the residents are under the age of 20 years. The general fertility rate in 1992 was 124.9 while the adolescent pregnancy rate was 105.9. In that year, only 5.3 percent of the women ages 15-44 used any method of birth control. The infant mortality rate has decreased slightly from 9.9 in 1988-89 to 9.8 in 1991-92. The Southern Region Health Center provides primary care to approximately 30,000 persons who reside in the more isolated southern rural area of Guam. As a result, the Guam Department of Health offers prenatal care, dental, nutrition and health education services to the most underserved area. Health care professionals are developing activities which focus on the unique health care needs of their female population.

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Republic of the Marshall Islands

Republic of the Marshall Islands has a total population of 53,635 (1995 est.) with females numbering 30,881. The racial/ethnic distribution is as follows: Micronesian (98 percent) and Other (2 percent). Women have a life expectancy rate of 65.45 years. It consists of 2 chains of 29 coral atolls and 5 low islands stretching several hundred miles from north to south with a total land area of 70 square miles. The Republic, formerly a Trust Territory, entered into a compact of free association with the U.S. in 1986. About 54 percent of the population are under the age of 20 years. About 95 percent of the total population are below the poverty level. The general fertility rate is 112.6 while the adolescent pregnancy rate is 96.7. Of the women ages 15-44, 62.5 percent used birth control. Their infant mortality rate is very high, 63.0 in 1988-89, and decreased only slightly in 1991-92 to 60.0+. The Ebeye Community Health Center serves an estimated 10,000 persons living in a 90 acre island in the Kwajalein Atoll. The Ministry of Health has initiated health education programs in the community, increased outreach and follow-up services, and addressed the problems associated with high rates of alcohol abuse, teenage pregnancy, and infant mortality.

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Republic of Palau

Republic of Palau has a total population of 16,304 (1995 est.) with females numbering 8,412. The racial/ethnic composition is primarily Micronesian. Women have a life expectancy rate of 73.02 years. It is the westernmost jurisdiction in Micronesia; it is less than 500 miles from the Philippines. Palau consists of several hundred volcanic islands and a few coral atolls. Only 8 islands are inhabited. The land area is 77 square miles. About 40 percent of the residents are under the age of 20 years and 73 percent of the total population are below the poverty level. The infant mortality rate increased from 26.6 in 1988-89 to 26.8 in 1991-92. The Palau Community Health Center serves an estimated 20,000 residents. The general fertility rate is 107.0 and adolescent pregnancy rate is 76.2. About 29 percent of all women ages 15-44 used any method of birth control in 1993. An estimated 974 persons actually used family planning services.

Content last updated July 1, 2005.

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