Wednesday, 22 May 2019

Health in Hawaii: Good News, But Not for Everyone – Hawaii Business Magazine

Overall, the Islands are often ranked as the healthiest state in America.

But diabetes, excessive drinking, vaping and other problems are on the rise and health outcomes are worse than average for some local groups, including Native Hawaiians, other Pacific Islanders, the mentally ill and the poor.

Table of Contents

Part 1: The Challenge
Part 2: We’re No. 1
Part 3A: Diabetes Epidemic Keeps Spreading
Part 3B: How to Beat Diabetes Before it Starts
Part 4: Helping Children with Mental Illness
Part 5: The Micronesian Struggle for Health Care
Part 6: Employee Wellness

Like the other CHANGE Reports, this one on health does not try to be comprehensive. Senior Writer Beverly Creamer writes about major problems and the ways local leaders, government agencies, nonprofits and companies  are trying to deal with them. We welcome your feedback and suggestions on this and all the CHANGE Reports on Facebook, Twitter, LinkedIn and Instagram using the tag #HawaiiforChange.

The six CHANGE Reports from Hawaii Business Magazine are based on a framework created by the Hawaii Community Foundation. “The CHANGE framework acknowledges the interconnected nature of community issues and zeroes in on six essential areas that constitute the overall well-being of these islands and people,” HCF says.

“By examining critical community indicators by sector, we can identify gaps where help is specifically needed and opportunities where help will do the most good.”

CHANGE stands for:

  • Community & Economy (report published in the February issue)
  • Health & Wellness (this report)
  • Arts & Culture (scheduled for June)
  • Natural Environment (scheduled for May)
  • Government & Civic Engagement (scheduled for July)
  • Education (report published in the March issue)

Disclosure: Hawaii Business got support from the aio Foundation, HCF and other organizations, and input from many people, but no one outside the Hawaii Business editorial team had any control over the content of these reports. —Steve Petranik


Part 1: The Challenge

Taking a Good Health Care System and Making it Better

Hawaii is often called one of the healthiest states in the nation and that’s partly the result of Hawaii’s Prepaid Health Care Act.

The 1974 law was the first in the country to mandate all full-time workers be covered by health insurance; the employer must pay at least 50 percent of the premium, with employee contributions not exceeding 1.5 percent of monthly wages. Many businesses also voluntarily cover at least part of the premium for dependents.

Before the law was passed, only 70 percent of local residents had health insurance; afterward, with the help of federal and state government programs for gap groups like the poor and children, coverage peaked at 98 percent.

The percentage of uninsured increased over time but the federal Affordable Care Act, nicknamed Obamacare, reduced the rate again and the latest data show only 3.7 percent of the local residents lack health insurance.

Robert Harrison, chairman and CEO of First Hawaiian Bank and chair of the Hawaii CHANGE Project’s Health Committee, says Hawaii has been fortunate. “We have very high-quality health care, and the cost has been reasonable. Certainly we can always do better on both quality and cost, but overall Hawaii is in a good place now,” Harrison says.

Nonetheless, he says, the state “has the opportunity to take a very good system and make it better. Some of the issues we need to address are how to better care for our homeless population, as well as continuing to deliver quality care at an affordable price.”

Here are some other challenges:

  • About 15 percent of Native Hawaiians lack health insurance – three times the average rate of uninsured statewide.
  • As many as half of Hawaii’s residents are either at a higher risk of developing diabetes or already have it.
  • Youth and children with mental illnesses often fail to get the help they need.

Dr. Virginia Pressler, former state health director, believes the biggest factors harming the health of Hawaii’s people are inadequate access to mental health services, tobacco and vaping, too little physical activity, and fast foods and sugary beverages.

“These lead to substance abuse, kidney failure, dialysis, cancer and heart disease,” Pressler says.

Bruce Anderson, who succeeded Pressler as state health director in May, provides a similar list. “Currently, some of my highest concerns are the increases in e-cigarette use by our youth, climate change and its impacts on public health, and the need for more mental health services in our communities,” Anderson says.

A report last year from the Pew Charitable Trusts provided fodder for critics of the state government. The Pew report ranked states on the percentage of the state revenue that came from federal funds; Hawaii ranked second last among the states, with only 22.7 percent of state revenue coming from the federal government. Much of that revenue funds health programs.

Six states got more than 40 percent of their revenue from the federal government, the Pew report said. Even some states which have relatively high state taxes like Hawaii do much better on that measure: For instance, California and New York each got more than 32 percent of state revenue from the federal government, the Pew report said.

Pressler acknowledges the state government’s problems in that area but says the situation is complex. State programs work hard to apply for those federal funds “only to be frustrated by administrative and legislative policies restricting their expenditure. And then they expire and cannot be used,” she says

Anderson actually disputes the report’s claims. “Over the decades that I have worked in the Department of Health, we have been very aggressive in applying for and receiving federal grant awards to support the health and environmental management programs. During the current fiscal year, the department received $141,369,958 in federal funds, which support health and environmental management programs statewide.”     

Another Hawaii health issue centers on Hawaii’s Micronesian community – citizens from the Republic of Palau, the Federated States of Micronesia and the Republic of the Marshall Islands. Most adults in that community don’t have health insurance. U.S. agreements with the Micronesian states once included access to Medicaid or other health care benefits but Congress ended that in 1996. In 2013, the latest year for which data are available, nearly 25 percent of non-Hawaiian Pacific Islanders did not have health insurance.

Harrison says he and a group of state health care leaders that includes Dave Underriner from Kaiser Permanente, Ray Vara from Hawaii Pacific Health,  Art Ushijima from The Queen’s Health Systems, and Mike Stollar and Dr. Mark Mugiishi from HMSA, will address key health issues and work with the Legislature and Gov. David Ige’s administration to look for solutions.

Pressler sees the Honolulu rail system as a bright light on the horizon.

“Transit-oriented development allows people to live without cars and consequently walk and bike more, as well as the ability to have easier access to healthy food and employment,” she says.

What Determines How Healthy You Are?

The single largest set of influences on a person’s health are social and economic factors. That means you can tell more about a person’s health by knowing their ZIP code than by knowing their genetics.

An analysis from the federal Centers for Disease Control and Prevention found a more than 10-year difference in average life span in Hawaii, based on what ZIP code people live in. The longest average life spans are usually found in high-income ZIP codes and the shortest in low-income ZIP codes.

A map showing all Hawaii ZIP codes can be found here.
View the report.

Source: “Public policy frameworks for improving population health,” a 1999 report in the Annals of the New York Academy of Sciences.

of Hawaii residents who get health insurance coverage through employers. Average annual employee premium after employer contribution: $703.

$2,349 a day: Average cost for an inpatient day in a Hawaii hospital before insurance payment.

Source: eHealth, a national online marketplace for health insurance.

More People Get Food Stamps in Hawaii

Hawaii has increased access to the Supplemental Nutrition Assistance Program, SNAP, the program still widely called food stamps, according to the national Food Research and Action Center. SNAP is designed to give low-income people money to buy food.

Hawaii earned a $724,000 performance bonus from the federal Food and Nutrition Service in 2013 because of major improvements in processing food stamp applications faster. In 2011, 61 percent of eligible local households participated, placing Hawaii 49th in the nation for participation. The latest available data shows 84 percent of eligible households participated in 2015, 26th in the nation.

Some Ethnic Groups Live Longer

A study of life expectancy among five ethnic groups in Hawaii found that Chinese live the longest on average and Native Hawaiians the shortest. And women in Hawaii, on average, live 6.1 years longer than men.

The 2017 study from a research team at UH also found that in 2010 the average life span for Hawaii residents was 82.4 years, 3.7 years longer than the national average.

This graphic from the study sh