The University of Hawaii began surveying Hawaii residents on aspects of their health and access to health care three years ago, following the same group of more than 2,000 adults throughout. Alarmingly, the most recent surveys appear to indicate that problems have magnified — especially for young adults and Native Hawaiians.
This year’s report, “Hawaii’s Health and Wellbeing Journey Over Time — Monitoring Equity and Access,” focused on mental health, access to health care and food security, and found that the levels of each were troublingly low. For just one example, adults between the ages of 35 and 64 reported the lowest rates of excellent or very good health, with about 2 in 3 responding that they were experiencing only middling levels of healthiness.
The highest barriers to obtaining health care reported were lack of insurance coverage, limited availability and high out-of-pocket costs — indicating that even in our highly insured state, too many are falling through the cracks. In response, the state must do better at identifying communities suffering from lack of access, and align services to match.
These responses create a to-do list for community service providers, public health officials and our elected leaders. Potential solutions have already been considered; action is now required.
Those who’ve been following the news may recognize the solutions UHERO recommends to improve health and mental health for Hawaii’s people, as they have also been publicly recommended to divert people from the “prison pipeline” and prevent domestic violence, which also disproportionately affect Native Hawaiian, Pacific Islander, Filipino, Hispanic and low-income households.
To remedy these daunting problems, the state must direct health and mental health services to communities in need. That means expanding programs, especially in underserved and rural areas. More attention must be paid to aligning care with community characteristics, and identifying competent providers who can connect with those needing care. To get there, focused investment will be required.
Boosting the availability of telemedicine — consultation with health care providers by phone or online — can be one facet of a solution. It’s an effective option for less serious or ongoing health issues that don’t require a full physical examination, increasing access exponentially, and potentially saving patients time and money.
Publicly supported clinics, which by design provide a major share of health care services for immigrant, low-income and uninsured households, also have a role to play here — one which their dedicated staffers are eager to fill, given sufficient resources and funding. And so, funding must be provided.
The unprecedented economic challenges and societal changes created by the COVID-19 pandemic have been pivotal in leading Hawaii voters and governments to tackle these issues. During the pandemic, as the backdrop of business-as-usual went dormant and needs soared, it became clear to a majority of Hawaii’s people that public policy on housing, education, health and mental health care, and even minimum wage had gone stagnant to the point of malfunction, and demands rose for change.
It’s now incumbent on state and county governments to continue this transformation for the good of residents here: building affordable housing and discouraging real estate profiteering; shifting educational practice to ensure underserved and low-income communities can find employment or receive necessary job training; ensuring that wages are adequate to address the cost of living.
Strengthening local food networks is also recommended. This creates employment and increased community stability.
And finally, UHERO is correct in noting that continued, well-managed data collection is necessary to ensure that action creates positive results.
“Building a healthier Hawaii is not only a policy imperative — it is a shared responsibility,” the report states. Recognizing this responsibility is job one.
The four UHERO surveys so far have all been centered on health-related issues, with tailored questions to address different frameworks: COVID-19 (June 2022); long COVID and its economic effects (January 2023); access to food and stable housing, also known as “core determinants of health” (July 2023). Results haven’t been reassuring in any of these surveys, but between 2023 and 2024, they fell dramatically, indicating that respondents are struggling more, and feeling worse.
It could be possible that changes in the surveys’ focus influenced responses, and magnified the drastic shifts in self-reported health status — but even leaving that aside, the surveys indicate growing, unmet needs that cannot be ignored. By tackling these issues now, it’s still possible to sidestep deeper developments — increased crime, homelessness, insecurity — that could be far more damaging and expensive to fix.
