Drinking Smoke: The Tobacco Syndemic in Oceania

9. U.S. Associated Micronesia: Pacific Smoke Inhalation Case Study Number 2

164 Chapter 9 U.S. Associated Micronesia Pacific Smoke Inhalation Case Study Number 2 Most of what is imported here in cans and in cigarette packets is slowly, and in many cases not so slowly, poisoning the population to death. —Rodney Jackson, Dietary Genocide This second case study is of a different sort than the preceding one. In the former instance our attention was focused on two so-called minority ethnic groups1 in a dominant settler society that is a developed and relatively wealthy country. In U.S. Associated Micronesia—henceforth for ease of reference to be called Micronesia2 —we encounter a mix of political entities and a range of linguistically and culturally distinct peoples. What binds them together at this moment in history is their present or former colonial connection to the United States. The specific polities to be included here are the Commonwealth of the Northern Mariana Islands (CNMI), the Federated States of Micronesia (FSM), the U.S. Territory of Guam (Guam), the Republic of the Marshall Islands (RMI), and the Republic of Palau (ROP). All of them except Guam formerly were a part of the U.S. Trust Territory of the Pacific Islands set up under the aegis of the United Nations following World War II after the islands were taken from Japan. CNMI and Guam are directly connected to the U.S. as a commonwealth and a territory respectively. CNMI became a commonwealth in 1978; Guam became a U.S. territory in 1899 when the United States seized it from Spain during the Spanish-American War, and it has remained so except for a short interlude during World War II when Japan U.S. Associated Micronesia 165 occupied the island. FSM, RMI, and ROP are now independent nations, but all three remain tied to the United States via Compacts of Free Association. These compacts assure them of economic assistance, provide for the right of their citizens to immigrate and work in the U.S. without the restrictions that face most non-nationals, and give the U.S. an exclusive strategic military presence in the region. Although they are all linked to the United States in one way or another, these islands have “little capacity for the routine collection, analysis, and reporting of health and related data” (Anderson et al. 2006, 1775–1776). Consequently, the material examined and reviewed below is lacking in many respects and has some notable gaps, especially when compared with the richness of material available for Aotearoa. Nonetheless, taken collectively, enough data exist to provide at least a partial portrait of the health circumstances that surround tobacco use in Micronesia. As much as possible the material will be presented along lines similar to chapter 8, but the distinct locations to which the data refer will be kept clear at all times.3 Ethnicity in Micronesia is complex, multilayered, and arguably problematic (Poyer 1999). In what follows, “ethnic” labels will be used that in most cases mirror the political entities discussed in the introduction. The main reason for handling ethnicity in this way is that the data have been gathered and published along these lines. Thus we will encounter Chamorros and Carolinians from the CNMI; Chamorros from Guam; Palauans from the ROP; Yapese and Outer Islanders from Yap State; FSM, Chuukese, and Mortlockese from Chuuk State, FSM; Pohnpeians from Pohnpei State; FSM, Kosraens from Kosrae State, FSM; and Marshallese from the RMI. In at least two of these instances—RMI and ROP—“ethnicity” is equal to nationality. Ethnicity and Health Inequalities Whereas there are abundant data for ethnic health inequalities in New Zealand , the situation in Micronesia is more one of assumptions based on a limited amount of actual information. Palafox and Ka‘ano‘i (2000) offered a very brief discussion of health disparities that included Micronesia plus American Samoa. They commented that The health systems...instituted in these jurisdictions were modeled after the United States health system. These systems tended to be hospital based with little emphasis on prevention or public health. Presently , a large disparity in health status exists between these six jurisdic- 166 Chapter 9 tions and the United States as a whole. There are also large disparities between jurisdictions. (ibid., 5)4 They went on to discuss the paucity of accurate health data, using tobacco as an example of why it is difficult and frustrating to establish appropriate prevention programs in the islands. One of their statements in...