Cancer Disparities among Pacific Islanders: A Review of Sociocultural Determinants of Health in the Micronesian Region

Abstract

It is well appreciated that the social determinants of health are intimately related with health outcomes. However, there is a paucity of literature that explores these themes comprehensively for the indigenous people within Micronesia. Certain Micronesia-specific factors, such as transitions from traditional diets, the consumption of betel nut, and exposure to radiation from the nuclear bomb testing in the Marshall Islands, have predisposed certain Micronesian populations to an increased risk of developing a variety of malignancies. Furthermore, severe weather events and rising sea levels attributed to climate change threaten to compromise cancer care resources and displace entire Micronesian populations. The consequences of these risks are expected to increase the strain on the already challenged, disjointed, and burdened healthcare infrastructure in Micronesia, likely leading to more expenses in off-island referrals. A general shortage of Pacific Islander physicians within the workforce reduces the number of patients that can be seen, as well as the quality of culturally competent care that is delivered. In this narrative review, we comprehensively underscore the health disparities and cancer inequities faced by the underserved communities within Micronesia.

The US Economic Burden of Health Inequities

“…We anticipate that this study underestimated the economic burden among the Native Hawaiian or Other Pacific Islander population given that it only included the 50 states and Washington, DC, and did not consider the Native Hawaiian or Other Pacific Islander populations in the US-Affiliated Pacific Islands (USAPI), including US territories (eg, Guam and the Commonwealth of the Northern Mariana Islands) colonized for land and military gain . The hundreds of thousands of Indigenous people in the USAPI are medically underresourced and typically excluded from research . The USAPI also face significant educational disparities, a variable accounting for greater economic burden than racial inequity …”

“…The hundreds of thousands of Indigenous people in the USAPI are medically underresourced and typically excluded from research . The USAPI also face significant educational disparities, a variable accounting for greater economic burden than racial inequity …”

“…People in the USAPI face an extensive noncommunicable disease burden exacerbated by economic disruption, poverty, and poor medical infrastructure . Expensive off-island medical evacuations are increasing across the USAPI, which places greater financial pressure on already resource-strained islands . Climate change is increasing tropical infectious diseases, disaster-related injury, and displacement .…”

“…Expensive off-island medical evacuations are increasing across the USAPI, which places greater financial pressure on already resource-strained islands . Climate change is increasing tropical infectious diseases, disaster-related injury, and displacement . Given stagnant USAPI health care spending budgets over decades, catastrophic disasters such as the 2023 Typhoon Mawar perpetuate a vicious cycle of financial disempowerment and economic burden inequities …”

“…Climate change is increasing tropical infectious diseases, disaster-related injury, and displacement . Given stagnant USAPI health care spending budgets over decades, catastrophic disasters such as the 2023 Typhoon Mawar perpetuate a vicious cycle of financial disempowerment and economic burden inequities …”