Background: The health challenges of Micronesians are generally well known. However, most of the health-related data collection
occurs in the population centers and relatively little is known about the health of the residents of Micronesia’s rural outer islands.
This is of particular concern in the Federated States of Micronesia (FSM) where a large portion of the population lives on the outer
islands. To gain a better understanding of the health issues facing the isolated outer islands of Micronesia, a health survey was
performed on Ulithi Atoll in Yap, FSM. Methods: A survey was created by the Yap State Department of Health Sevices and members
of the Ulithian community. The survey was carried out on two of the four inhabited islands of Ulithi Atoll in July 2004. Both island
communities actively participated in the survey providing translation and data gathering assistance. Results: It was estimated that a
>90% response rate for both islands was achieved. Analysis demonstrated that relative to the U.S., the Atoll’s population experienced
high rates of obesity (45%), hypertension (29%), and smoking (55%). Sixty-six percent of men surveyed reported alcohol use versus
16% of women. Use of alcohol was markedly lower on Fatharai Island where a Chief had mandated abstinence. Preventative health
screening was limited with over 80% of women having pap smear in the past 2 years. In addition, the community identified finances
and transportation as the main difficulties in accessing healthcare. Conclusion: Overall, the research identified a number of health
issues that require closer attention, in particular hypertension, overweight, obesity, alcohol misuse, smoking prevalence, betel nut/
tobacco chewing, and domestic violence. There is indication that the community may be ready to address some of these issues. The
value of community action within cultural frameworks is apparent, and there may be potential to extend culturally-based approaches
to address a broader range of issues.