G UAM
1.
CONTEXT
1.1
Demographics
The population of Guam was estimated at 180 692 in 2010, with 103 males for every 100 females. Population
density is 335 per square kilometre. Total life expectancy for both sexes is 79.4 years; men are expected to live to
77 years of age and women to 82.1 years. The crude birth rate decreased slightly from 20.6 in 2004 to 19.7 in 2008.
The crude death rate in 2008 was 4.4 per 1000 population, a slight increase from 4.2 in 2004.
1.2
Political situation
The political situation on Guam remains stable, with elections for the mayors of municipal civil districts (villages)
and the unicameral legislature last held in 2004. Cooperation between the Executive Branch and the Legislative
Branch is growing.
1.3
Socioeconomic situation
The economy of Guam is largely dependent on the tourism industry. In the late 1990s, the Asian and global
economic downturn and other unforeseen events, such as super typhoons, greatly affected tourist arrivals, causing
a financial crisis that lasted more than a decade. In 2005, however, tourism started to stabilize and Guam's
economy started to recover. Economic growth was due to an increase in construction projects. From 2006 to
2009, construction of military infrastructure and private housing projects increased. The number of tourist visitors
remained constant, however. Thus, hotel construction was limited to expansion, renovation and upgrading of
existing facilities as there was still substantial vacant capacity. Despite this, rising hotel expenditures have
contributed to the country's economic growth and recovery. In 2005, the reported per capita gross island product
was US$ 22 661.
1.4
Risks, vulnerabilities and hazards
No available information.
2.
HEALTH SITUATION AND TREND
2.1
Communicable and noncommunicable diseases, health risk factors
and transition
No available information.
2.2
Outbreaks of communicable diseases
There were two food poisoning outbreaks in 2006. The first occurred in September 2006 among over 100
students and four adults at Chief Brodie Elementary School. Victims complained of abdominal cramps, diarrhoea
and vomiting, but none required hospitalization. The definite cause of the outbreak was not determined.
However, the rapid onset and recovery from symptoms experienced by those affected suggests that it may have
been due to Bacillus cereus or Staphylococcus aureaus intoxication, problems that may be facilitated when transporting
food.
The Department of Public Health and Social Services was notified of another food poisoning outbreak in October
2006 among 49 tourists staying in a local hotel. Investigation revealed that tourists complained of nausea,
vomiting, diarrhoea and headache, but no hospitalization was required. The affected persons had eaten at a
number of regulated establishments prior to their illnesses; no significant food establishment violations that might
have contributed to the outbreak were identified.
2.3
Leading causes of mortality and morbidity
Based on inpatient data, the leading causes of morbidity in 2007 were diseases of pregnancy, childbirth and the
puerperium; other forms of heart disease; diabetes mellitus; ischaemic heart disease; influenza and pneumonia;
114 | COUNTRY HEALTH INFORMATION PROFILES
certain infectious and parasitic diseases; malignant neoplasms; cerebrovascular diseases; asthma; and other chronic
obstructive pulmonary diseases.
The leading causes of death in 2003 were: cardiovascular diseases (119.4 per 100 000 population), malignant
neoplasms (68.4), cerebrovascular diseases (31.2), accidents (17.4) and bacterial diseases, such as septicaemia
(16.2).
2.4
Maternal, child and infant diseases
In 2003, there was no maternal death. About 87% of total deliveries in 2004 occurred in health facilities. The
infant mortality rate declined from 12.3 per 1000 live births in 2004 to 11.7 in 2005-2007. In 2006, the coverage
rate for poliomyelitis and measles immunization was 85%, while it was 89% for DTP3 and 91% for hepatitis B3.
2.5
Burden of disease
No available information.
3.
HEALTH SYSTEM
3.1
Ministry of Health's mission, vision and objectives
Guam is dedicated to the attainment of health for all by 2010. In 1992, the Guam Health Planning and
Development Agency identified 13 health service priority areas to be strengthened:
•
•
•
•
•
•
•
•
•
•
•
•
•
human resource development;
health planning;
wellness promotion;
health information systems;
communicable disease control;
disposal of hazardous and toxic materials;
availability and accessibility of health services;
environmental protection;
drug and alcohol abuse;
chronic disease prevention and control;
injury prevention;
maternal and child health; and
vector control.
Although some improvement has been seen in the area of health information systems, wellness promotion and
communicable disease control, the remaining areas continue to be top priorities.
3.2
Organization of health services and delivery systems
No available information.
3.3
Health policy, planning and regulatory framework
See Section 3.1.
3.4
Health care financing
Total health expenditure amounted to US$ 159.8 million in 2000, with per capita total expenditure on health of
US$ 1032.4. As of 30 September, government expenditure on public health for 2005 was US$ 64 million, about
9% of total government expenditure.
3.5
Human resources for health
Guam is experiencing health workforce shortages due to the early retirement of its most experienced
professionals. Human resources for health are still lacking in critical areas and must be developed locally to the
greatest extent possible. The following training needs are priorities: environmental studies, with an emphasis on
COUNTRY HEALTH INFORMATION PROFILES
| 115
GUAM
environmental law, policy, management, and planning and analysis; and short-term training on retail hazard
analysis critical control point (HACCP), as well as on drugs, medical devices and controlled substances.
The Guam Environmental Protection Agency (GEPA) relies heavily on its professional staff to provide technical
expertise at all areas of environmental resource protection, management and policy. At the same time, this
technical expertise is needed for the young professionals within GEPA, as the fields of environmental protection
and science are constantly changing. However, due to early retirement and voluntary separation, all personnel with
over 10 years of professional and technical experience have left GEPA, leaving half (two out of four) of the
remaining personnel with less than four years of professional GEPA experience. Combined with the local hiring
freeze, it is anticipated that no new professionals will be hired within the next two to three years. The lack of well
educated and technically trained personnel is severely undermining the professional credibility of GEPA. To
further complicate matters, GEPA also serves as the primary regulatory agency for all environmental issues and
policies on Guam, and takes the lead for most other islands in Micronesia.
The Division of Environmental Health of the Department of Public Health and Social Services is also greatly
understaffed. Over half the Division's staff have fewer than five years experience, and staff generally lack
specialized training. Training in retail HACCP is lacking. The United States Federal Drug Administration is urging
all locales, states and territories to explore HACCP as a requirement in retail and food service establishments, and
to develop a model food code that incorporates HACCP principles.
All health care products, from toothbrushes to prescription medications, are regulated and monitored by the Drug
and Medical Device Programme. Due to Guam's geographical location and the ethnic diversity of its people,
various drugs and medical devices of foreign origin are imported, distributed and marketed. These include many
poorly labelled, misbranded and adulterated drugs, as well as hazardous medical devices. Training in the area of
drug and medical devices is therefore necessary for staff of the Division of Environmental Health. Forged
prescriptions, lack of accountability of controlled substances by businesses, and illegal dispensing of controlled
substances are estimated to be significant problems. However, because of the lack of human resources, only
urgent cases are pursued and investigated.
3.6
Partnerships
No available information.
3.7
Challenges to health system strengthening
Guam is faced with the challenge of maintaining a health care system that will adequately meet the needs of a
predominantly young and growing population. At the same time, it is also facing the added challenge of
addressing the problems of the rapidly increasing number of older people, estimated to have increased from 3.9%
of the total population in 1990 to 7.5% in 2010.
A reduction in human and financial resources has severely impacted the health system. An early retirement
programme, instituted at the end of 1999, led many experienced health workers to retire. While the vacated
positions have continued to be funded, there is not a large enough resource pool to fill all of them. Tightening
government budgets have left some less critical positions vacant, and these vacancies have reduced the overall
amount of services available to the uninsured and underinsured population. The vacancies have also affected
progress in strengthening other health service priority areas, such as disposal of hazardous and toxic materials,
environmental protection, vector control, and drug and alcohol abuse services.
4.
LISTING OF MAJOR INFORMATION SOURCES AND
DATABASES
Title 1
:
Operator
Web address
:
:
Guam statistical yearbook 2006 and 2008
Guam cancer facts and figures 2003-2007
Bureau of Statistics and Plans, Office of the Governor
http://bsp.guam.gov/
116 | COUNTRY HEALTH INFORMATION PROFILES
Title 2
:
Web address
:
Office of Vital Statistics,
Guam Department of Health and Social Services
http://dphss.guam.gov/
Title 3
Web address
:
:
United States of America Bureau of the Census
http://www.census.gov/
Title 4
Web address
:
:
Secretariat of the Pacific Community
http://www.spc.int/prism/
5.
ADDRESSES
DEPARTMENT OF PUBLIC HEALTH AND SOCIAL SERVICES
Postal Address
:
Website
:
123 Chalan Kareta
Mangilao, Guam 96913-6304
http://dphss.guam.gov/
WHO REPRESENTATIVE
There is no WHO Representative in Guam. Queries about WHO’s programme of collaboration with Guam should be directed to the
Director (Programme Management):
Office Address
:
World Health Organization
Regional Office for the Western Pacific,
United Nations Avenue, Manila, Philippines 1000
Postal Address
:
P.O. Box 2932, Manila, Philippines 1000
Telephone
:
(632) 528-8001 (trunk line)
Office Hours
:
0700H-1530H
Website
:
http://www.wpro.who.int
6.
ORGANIZATIONAL CHART: Ministry of Health
COUNTRY HEALTH INFORMATION PROFILES
| 117