The Healthcare Legacy of the Mission Civilisatrice in Unincorporated U.S. Territories

Halabi, Sam F. | March 30, 2022

Individual and population health in unincorporated U.S. territories – American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands – lag terribly behind those in the 50 U.S. states and D.C. The populations in the territories – with drastically higher rates of poverty – suffer and die from chronic conditions like cancer, diabetes, and heart disease at far higher rates; must find facilities and doctors thousands of miles away for even moderately complex cases; and perpetually struggle to make access to basic services available. While scholars have long pointed to the disparate treatment of these populations by Congress – especially with respect to Medicaid reimbursement – this Essay argues that the disadvantages and health disparities experienced by territorial populations run far deeper. In fact, the entire structure of healthcare access and financing in unincorporated U.S. territories is fundamentally shaped by how the U.S. federal government occupied those territories, restructured healthcare practice and facilities to sustain the U.S. presence, and as those territories were transferred to the Department of the Interior, imposed financing and programming constraints that made dependency perpetual. This Essay argues for two immediate measures: parity in Congressional commitment to healthcare financing as between U.S. states and U.S. territories, and establishment of investigatory committees to identify and restore indigenous health practices destroyed by U.S. occupation modeled on the Native Hawaiian Healthcare Improvement Act.