Table 2.

Examples of Essential Public Health Services Used in the US Associated Pacific Islands (USAPI) Diabetes Prevention and Control Programs

Essential Public Health Servicea	Examples of Pacific Island DPCP Approaches
Monitor health status to identify community health problems	American Samoa, FSM, and RMI monitor health status via the WHO-STEPwise approach to chronic disease surveillance.
	Guam monitors health status by administering the CDC BRFSS every 3 years.
	Diabetes registries are developed (at various levels of operation) across the islands through the DHHS Diabetes Health Disparities Collaborative.
Diagnose and investigate health problems and health hazards in the community	Multiple challenges face USAPI DPCPs regarding monitoring diabetes and supporting the health care delivery system, for example, shortages or inadequacy of medicine and laboratory supplies, and shortages of health care professionals.
	All DPCPs are strategically engaging partners in primary and secondary prevention efforts to help decrease strain on scarce system resources.
	All DPCPs partner with their local health care systems (hospitals, clinics, and dispensaries).
	All DPCPs, in partnership with the Papa Ola Lökahi Pacific Diabetes Education Program, conducted community discussion groups to investigate diabetes problems, barriers, strengths, and community resources.
Inform, educate, and empower people about health issues	DPCPs and the Pacific Diabetes Education Program work collaboratively to increase diabetes awareness across communities.
	All DPCPs have developed or adapted national diabetes education materials to reflect local language and culture.
	DPCPs have spearheaded the following campaigns to inform the public using cultural connections: RMI's Father's Day health screening events addressed increasing men's participation in screening and diabetes education. Guam produced a diabetes management video in collaboration with local health care professionals. CNMI hosts Cooking with Color, a weekly television nutrition program, and recently started a Water is Cool campaign to help decrease soda pop use and an Off the TV campaign to help increase physical activity among youth.
	Palau works with traditional leaders to develop and distribute the publication Control Your Diabetes in Palauan.
Mobilize community partnerships to identify and solve health problems	CNMI DPCP partners with Commonwealth Diabetes Coalition, Rota, and Tinian Diabetes associations to provide nutrition counseling and blood glucose monitors to women with diabetes during pregnancy.
	FSM has developed strong links with the Development and Sustainability Agricultural Program working to develop school and community gardens to improve community access and behaviors around healthy food choices.
	Palau has developed a partnership with Ulkerreuil a Klenger, a nonprofit group supporting diabetes education and outreach through media, health fairs, schools, and religious programs.
	RMI created links with Women United Together for Marshall Islands to increase outreach efforts to outer atolls (islands).
Develop policies and plans that support individual and community health efforts	FSM DPCP working with UNICEF has created policy to promote breast-feeding.
	Palau DPCP partnered with the Department of Education to increase the number of sports offered after school and is working on a project to merge physical education and science.
	RMI DPCP facilitated the passage of a smoke-free workplace in government buildings and nutritional changes in schools and hospitals.
	DPCPs are working to integrate diabetes prevention into the CDC and WHO noncommunicable disease strategic plans within their jurisdictions.
Enforce laws and regulations that protect health and ensure safety	CNMI diabetes risk prevalence study in youth enabled a review of regulations affecting school environments and championed change.
	All DPCPs advocate for increased compliance with tobacco laws and regulations throughout the island communities.
Link people to personal health services and assure the provision of health care when otherwise unavailable	American Samoa integrates diabetes outreach with breast and cervical cancer programs.
	CNMI provides a weekly Walk on Wednesday outreach program targeted to uninsured or underinsured people living with or at risk for diabetes.
	Guam works with local clinics to promote free foot examinations and lipid screenings.
	FSM has translated diabetes resource and self-care manuals into 4 local languages.
	Palau created cultural programming that allows people with diabetes to base their behavioral choices on diabetes education networks.
	RMI created Power to the People diabetes messages to empower people with diabetes to ask for screening examinations for diabetes complications.
Assure a competent public health and personal health care workforce	Every DPCP is challenged to provide this Essential Public Health Service.
	Each DPCP attempts to work with partners (eg, hospital and dispensary systems, land grant colleges, nonprofits) to provide continuing education programs for health professionals on current evidence-based standards for diabetes care and management.
Evaluate effectiveness, accessibility, and quality of personal and population-based health services	The DHHS Diabetes Health Disparities Collaborative has been introduced within each Pacific island hospital/clinic system and is operating at various levels.
	American Samoa, FSM, and RMI are working to develop an effective interface with the WHO STEPwise approach to chronic disease surveillance.
Research for new insights and innovative solutions to health problems	American Samoa participates with Brown University in a research project on empowering community health workers to deliver diabetes education.
	CNMI conducted a cross-sectional diabetes risk prevalence study among high school sophomores, which formed the foundation for youth-oriented diabetes prevention efforts.
	FSM's Let's Go Local food campaign researched the nutritional values of locally grown fruits and vegetables and promotes local healthy food choices to the community.

Abbreviations: DPCP, diabetes prevention and control program; FSM, Federated States of Micronesia; RMI, Republic of the Marshall Islands; WHO, World Health Organization; CDC, Centers for Disease Control and Prevention; BRFSS, Behavioral Risk Factor Surveillance System; DHHS, Department of Health and Human Services; CNMI, Commonwealth of the Northern Mariana Islands; UNICEF, United Nations Children's Fund; PAHO, Pan American Health Organization.

^a From the 10 Essential Public Health Services (13).