Health and Health Care in the U.S. Virgin Islands: Challenges and Perceptions

Article excerpt

Abstract: This research was designed to discover how residents of the United States Virgin Islands think about their health, health status, health problems, and the quality of the health care delivery system. Six focus groups were organized - one for males and one for females on each of the largest islands (St. Thomas, St. Croix, and St. John). Results indicated that Virgin Islanders see a large role for personal responsibility in achieving and maintaining good health, although there are cultural and economic barriers that prevent taking full advantage of available health services. Residents are especially concerned about privacy and threats to confidentiality of patient information that could occur among professionals.

Key Words: Health Disparities, Confidentiality, Virgin Islands

While some scholars have examined health disparities in the Caribbean (Pan American Health Organization 1997; Quinlan 2004, Mahoney 2005), to date there has been limited published scholarly research that addresses health issues and health disparities in the U.S. Virgin Islands (USVI). The available studies are primarily national surveys such as the Behavioral Risk Factor Surveillance System (BRFSS) that included participants from the USVI (Neyer et al. 2007; Casper, Croft, Hong, Fang, & Greer, 2010). What is known is that on at least some important health measures, the USVI compares poorly to the health status of Americans living on the mainland. For example, whereas the estimated 2010 infant mortality rate for mainland Americans was 6.14 deaths per 1,000 live births, in the USVI it was 7.4 (Central Intelligence Agency 2010). How do residents of the USVI view health, their health status, health problems, and the quality of their health care delivery system? In response to an application submitted by the Division of Nursing, University of the Virgin Islands (UVI), in 2004 the National Institutes of Health, National Center on Minority Health and Health Disparities (NIH/NCMHD) awarded a threeyear grant to establish "The Caribbean EXPORT1 Center for Research and Education in Health Disparities." The Export Center provided support for UVI faculty to develop the capacity and infrastructure to begin to investigate and address health issues and disparities in the USVI. Later, in October 2007, a five-year NCMHD grant was awarded to establish the "Caribbean Exploratory Research Center" (CERC) and continue and expand this work.

The research reported in this paper is a product of that grant. It reports on one method the authors used to gain a preliminary understanding of how Virgin Islanders view health problems, how they define "good" health, what they do to protect and improve their health, and how they view the health care delivery system. We wanted to learn how effective they see mainstream and alternative health care delivery systems in achieving better health. And, as an exploratory study, we also wanted to pinpoint issues that need further study.

The USVI covers 346 square miles, about twice the area of Washington, D.C., with an estimated population in mid-2010 of 1 10,000 residents, who live primarily on three islands: St. Croix, St. Thomas, and St. John. The 2000 U.S. Census classified 78 percent of the residents as Black (AfricanCaribbean), 10 percent White, and 12 percent "other." Just under half (49 percent) of the population was born in the Virgin Islands. Native born or naturalized Virgin Islanders are U.S. citizens. Thirty two percent were born elsewhere in the Caribbean. About 13 percent of the population is originally from the 50 states in the U.S., 4 percent hail from Puerto Rico, and 2 percent from elsewhere. Fourteen percent of the population identifies as Hispanic, primarily from Puerto Rico, the Dominican Republic and other Caribbean Islands. In 2002, some 28.9 percent of the population lived below the poverty line (Central Intelligence Agency 2010; Virgin Islands Now 2010). With this rich heterogeneity, any study of health in the Territory, particularly in differences with the 50 American states, is closely interrelated with race and ethnicity. …