COVID-19 has exposed the health disparities in Hawaiian populations - one of the most underserved populations in health care. According to a recent report, Hawaiian populations in Los Angeles County, California, had five times the infection rate of white people. While the data reveals the stark contrast between the impact of COVID-19 on Hawaiian populations versus others, it also shines light on Hawaiian health disparities that existed before the pandemic.
Health disparities describe differences in health care access and outcomes between groups. For example, an individual’s race, ethnicity, age, gender, or physical disability can prevent them from receiving optimal care relative to individuals in other groups. Other barriers can include socioeconomic and educational status, as well as geographic location.
A way to eliminate Hawaiian health disparities is to improve health equity, which means that a patient receives the same quality care as another patient, regardless of race and ethnicity, cultural background, educational level, or other factors. Nurses and health care providers, policymakers, community groups, and others can help achieve fairness in access to health care by providing better health care resources, launching community outreach efforts, creating chronic disease management programs, and more.
Data About Hawaiian Health Disparities
Statistics from the Office of Minority Health (OMH), an agency of the U.S. Department of Health and Human Services (HHS), illuminate the health care needs of Native Hawaiians and Pacific Islanders, who make up about 0.4% of the U.S. population (roughly 1.4 million people). According to 2019 data from the U.S. Census Bureau, the health care needs of Hawaiians have historically gone unmet compared with non-Hispanic white populations.
It’s important to note that data isn’t collected and published in ways that specifically target the Hawaiian populations, but rather is typically included in a larger group known as Asian American and Native Hawaiian and Other Pacific Islander (AANHOPI).
By disaggregating data about Hawaiian populations, researchers can improve data accuracy about Hawaiian health inequities, potentially helping them find ways to eliminate Hawaiian health disparities. According to the Journal of Racial and Ethnic Health Disparities, health data about AANHOPI subgroups is combined under the assumption that these groups are similar. Therefore, the small size of health data samples for each of the AANHOPI subgroups is aggregated.
Unfortunately, the practice of combining data for these groups obscures key differences among them, such as "historical narratives, cultural values, and socioeconomic status," according to the Journal of Racial and Ethnic Health Disparities study. Studying and collecting health data about Hawaiian populations can reveal a clearer picture of the health disparities unique to this group and serve as a foundation for finding solutions.
Examples of Hawaiian Health Disparities
Health care professionals, educators, legislators, and others can take various steps to uncover ways to eliminate Hawaiian health disparities. The first critical step to help advance health equity is to examine the data to better understand health disparities in Hawaiian populations.
OMH reports that leading causes of death for Hawaiian populations include cancer, heart disease, injuries, stroke, and diabetes. The data also reveals higher rates of smoking, alcohol consumption, and obesity compared with other groups. At the same time, Hawaiian populations lack proper access to cancer prevention and control programs.
Diabetes is a major cause of death in Hawaiian populations. The data reveals that Hawaiians are 2.5 times more likely to receive a diabetes diagnosis or die from the disease than white populations. Moreover, the data shows that 39% of Hawaiians have uncontrolled diabetes, far exceeding the Healthy People 2020 goal of 16.1%.
The most recent data about Hawaiian health disparities helps to illuminate the health disparities in Hawaiian populations compared with white populations:
- 37 times higher rate of tuberculosis
- Nearly twice the infant mortality rate
- 80% higher obesity rate
- Three times more likely to be obese compared with the overall Asian American population
- Four times more likely to suffer a stroke; 30% more likely to die from a stroke
The data also reveals some areas of opportunity. As regards hypertension, 59% of Hawaiians have controlled hypertension, a percentage that’s within reach of the Healthy People 2020 goal of 61.2%.
Resources: Hawaiian Health Disparities
The following resources provide additional information and data about health disparities and diseases that impact Hawaiian populations the most:
- Centers for Disease Control and Prevention, Native Hawaiians and Other Pacific Islanders: This resource provides information about various diseases that impact Hawaiian populations.
- Office of Minority Health, Diabetes and Native Hawaiians/Pacific Islanders: This offers data and statistics on diabetes among Hawaiian populations.
- Office of Minority Health, Immunizations and Asian Americans: This resource provides information about immunizations for hepatitis, influenza, and pneumonia among Hawaiian populations.
Factors Driving Hawaiian Health Disparities
In addition to providing an understanding of Hawaiian health disparities and who’s most affected, the data reveals factors that can cause the disparities.
According to 2019 data from OMH, the following disparities exist between Hawaiian populations and white populations:
- About 88% of Native Hawaiians and Pacific Islanders had completed a high school education vs. more than 93% of whites.
- About 24% of Native Hawaiians and Pacific Islanders had completed a bachelor’s degree or higher vs. about 37% of whites.
- More than 7% of Native Hawaiians and Pacific Islanders had completed a graduate or professional degree vs. more than 14% of whites.
While education level doesn’t predict an individual’s health, it can be a key differentiator that determines lifespan. According to research published in the Proceedings of the National Academy of Sciences, Americans between the ages of 25 and 75 with a college degree live longer.
Education helps to prolong lifespans by providing opportunities to earn higher incomes, opening the door for social and psychological benefits, healthier lifestyles, and improved access to health care.
According to census data, 38.1 million Americans (about 11%) lived in poverty in 2018. This figure is important to note in a conversation about ways to eliminate Hawaiian health disparities because economic stability is a primary determinant of health.
According to Healthy People 2030, many people experiencing economic instability lack the financial resources to afford healthy foods, health care, and housing.
As regards Hawaiian populations, OMH reports that the median household income for Hawaiians was $66,695 in 2019, lower than that of white households ($71,664). More Hawaiians also lived at or below the poverty level compared with white populations: about 15% vs. about 9%, respectively. Unemployment rates were higher for Hawaiian people as well: about 6% vs. about 3.7%.
Employment programs and policies aimed at helping people pay for necessities such as healthy food and health care can help reduce poverty rates and establish economic stability so individuals can improve their health and well-being.
According to a Kaiser Family Foundation health and health care infographic, 23% of individuals in Hawaiian populations have problems paying medical bills as opposed to whites (16%) and other Asian groups (9%). The inability to access medical care can lead to poor health outcomes, lower quality of life, and inappropriate use of health services, such as emergency department services that could’ve been provided in outpatient settings, according to BMC Health Services Research.
Health insurance can help mitigate health care costs. However, among Hawaiian populations, insurance coverage disparities also exist. The lack of or limited access to health insurance can dramatically impact an individual’s ability to receive health services. For example, someone without health insurance is highly likely to delay medical treatment due to high costs.
OMH reports the following 2019 data that indicates insurance coverage disparities between Hawaiian and white populations:
- Private health insurance: 65.8% vs. 74.7%
- Reliance on Medicaid or public health insurance: 34% vs. 34.3%
- Uninsured: 9.1% vs. 6.3%
Strategies for Addressing Hawaiian Health Disparities
Together, nurses and health care providers, policymakers, community groups, and others play a vital role in finding ways to eliminate Hawaiian health disparities. For example, nurses and health care providers can advance health equity and improve patient access to care. Nurses are regularly in contact with patients in health care settings. As the patient-facing representatives of health care organizations, nurses can leverage their understanding of the benefits of health promotion and disease prevention to educate patients and their families whenever possible.
In addition, nurses play a critical role in advocating for patients, helping to bring awareness of health issues and disparities in underserved populations, and influencing policies and procedures to optimize health outcomes.
Through their patient interactions, nurses can also learn more about the disparities that Hawaiian populations face and serve as informative resources to their health care organizations. In response, health care organizations can partner with community groups to launch community outreach efforts, develop chronic disease management programs, or introduce initiatives that help overcome cross-cultural barriers in healthcare.
Another vital strategy is education. For example, a study the journal Ethnicity & Disease conducted during 2017-2018 highly recommended cancer prevention programs for Hawaiians to address cancer risk behaviors. In another example, education can help close the uninsured gap. A brief on health insurance coverage from the HHS indicates that the uninsured rate among Hawaiians and Pacific Islanders was 12.3% as of 2019 — higher than that for other Asian American and Pacific Islander groups. Education programs can help inform people in this group of the benefits that the Affordable Care Act (ACA) has made available.
Health Care Resources for Hawaiians
The following links include organizations that help provide information about improving health care access and resources for Hawaiians:
- AcademyHealth, "Connecting Cultural Values to Social Determinants of Health in Hawai‘i": This resource summarizes a 10-year community planning effort to shape legislation focused on addressing Hawaiian health disparities.
- gov, Native Hawaiian Health Systems: This resource includes information about eligibility and application for Native Hawaiian health systems.
- State of Hawai‘i Department of Human Services, Community Resources: This resource provides various links for Hawaiian communities, from information on long-term care and children’s health and development to links to palliative and hospice care resources.
Tackling Health Problems Facing Hawaiians
Hawaiian populations have been plagued with disproportionately higher rates of health problems compared with other population groups in Hawaii and throughout the U.S. For example, Hawaiian populations exhibit higher mortality rates due to chronic diseases, such as diabetes.
When programs, such as the Native Hawaiian Health Care Systems Program and Papa Ola Lokahi centers, focus on improving education, economic stability, and insurance coverage, Hawaiian health disparities can be lowered. However, before health care professionals, educators, legislators, and others can begin to eliminate Hawaiian health disparities, they must first understand them.