Limited access to health care is the top issue facing Hawaii Island, particularly West Hawaii, a recently completed Community Health Needs Assessment found.
“On the neighbor islands, especially for the Big Island and West Hawaii, the No. 1 issue is access to health care,” said George Greene, president and chief executive officer of the Healthcare Association of Hawaii, which collaborated with the Healthy Communities Institute to conduct the statewide study on Hawaii’s health-care needs.
Because many health services are based on Oahu, Hawaii County suffers from limited access to various types of care, including primary, mental and specialized care, the State of Hawaii Community Health Needs Assessment reads. The assessment, released Wednesday, was compiled by the Healthcare Association of Hawaii and the Healthy Communities Institute.
The island’s geography exacerbates the issue by making transportation and the availability of care sometimes difficult to provide.
While data shows there is a lack of both primary care and specialty care available on the island; the shortage is especially severe in Puna, Ka’u and Waikoloa, according to the report. In the realm of mental health care, the island is facing a shortage in providers as well as a lack of substance abuse and mental health treatment options.
“Access to health care is not about having an insurance card and the availability of clinics,” said Greene. “It’s more than that. It’s looking at transportation and how we get people to community services, language issues and cultures. Those barriers to health.”
The report also pointed out several themes developed from the study of data: All groups experience adverse health outcomes due to chronic illness and health risk behaviors; greater socio-economic need and health impacts are found among certain groups and places in Hawaii; cultural and language barriers inhibit effective intervention for the most affected populations; and community health centers and schools are key community assets for effective interventions.
Individuals from all geographies, race, gender, and age groups experience poor health outcomes, according to the report.
High rates of chronic disease patterns, hospitalizations due to preventable causes and patterns of unhealthy behaviors are evidence.
In Hawaii County, many residents are affected by heart disease and stroke, cancer, diabetes and asthma, according to the report.
In 2011, the Big Island saw 421 hospitalizations due to heart failure and hypertension, 160 hospitalizations due diabetes, including long- and short-term complication and uncontrolled diabetes, and 18 hospitalizations for asthma for adults age 18 to 39 and 278 hospitalizations for asthma or COPD in older adults, those above age 40.
“Unmanaged heart disease has led to high rates of hospitalizations and deaths among residents of the Big Island. Hawaii County residents are at special risk for chronic respiratory problems, evidenced by unusually high asthma rates of COPD and asthma hospitalizations. Factors contributing to poor respirator health include high smoking rates, high particulate pollution, and exposure to volcanic gases,” the report reads.
Mental health and substance abuse are also key concerns identified in the report because such chronic health conditions significantly influence overall health. According to the report, Hawaii County recorded 1,036 hospitalizations for mental health issues in 2011 and statewide there were 5,180 hospitalizations.
“A societal shift toward healthier lifestyles that includes quality nutrition, daily physical activity, optimal weight control, social support and reduced substance abuse can have profound positive impacts on Hawaii’s health,” the report reads. “Special consideration for mental health, a chronic condition that significantly influences overall health, is critical for achieving population health goals.”
There are areas of high socio-economic need across all counties, especially on the Big Island, according to the report, which noted educational disparities are also found around the state with the greatest impact felt by Filipinos, Hawaiians and Pacific Islanders.
“These areas and groups with high socio-economic need are also the most affected by health problems, as evidenced by significantly worse health outcome measures, higher hospitalization rates, inadequate vaccination rates and myriad health challenges,” the report reads.
It also notes that while health insurance coverage is “good” in Hawaii, some essential health needs, like mental health care, long-term care for older adults and care for those with disabilities are not met.
“When planning for health improvement, careful consideration should be given to the highest need groups identified geographically by socio-economic measures,” the report reads.
Because of the strong correlation between poverty and race/ethnicity, some of the groups most affected by health issues often face cultural barriers to health improvement, according to the report.
Language differences, including limited English proficiency, and poor health behaviors that are common within a culture, are challenges that must be overcome in order to effectively prevent disease, according to the study. Improved translation services could help.
“Misinformation, mistrust, and a reluctance to seek care from providers of a different culture prevent many Micronesians in Hawaii County from accessing preventative care and treatment,” the report reads. “Differing views of pregnancy, birth control, and women’s health across the cultures represented on the Big Island also impact the rates of cancer screening, prenatal care, and teen births.”
While barriers like those above exist, the report found that community health centers and schools are key community assets for effective interventions.
“Locally based care has many advantages, including the ability to bring primary care services that are culturally appropriate to rural areas,” the report reads.
Health interventions at the school level can have a two-fold benefit of establishing healthy life-long behaviors among Hawaii’s youth as well as influencing the health of their families, according to the report. Schools can assist by addressing substance abuse, an increasing problem among teens, and childhood obesity by increasing physical activity time.
“Beginning health education early in life is now more important than ever, as more young people are developing diabetes or cancer and not seeking care until the disease is in a more advanced stage,” the report reads. “Preventative services and education on health risks can be effectively delivered in school environments.”
Affordable Care Act mandates asssessment
The goal of the report is to offer a meaningful understanding of the health needs in the community, as well as to help guide hospitals in their community-benefit planning efforts and development of an implementation strategy to address prioritized needs. It also serves as a foundation report for member hospitals to use in producing a completed CHNA report for their institutions.
The needs are based upon assessments of 26 of 28 hospitals in the state (excluding Tripler Army Medical Center and Hawaii State Hospital), key informant interviews, community resources listings and partner support, community survey, hospitalization rate data and hospital, 100 core indicators, and other community health stakeholders.
All charitable hospitals are mandated to complete a community health needs assessment in accordance with the Patient Protection and Affordable Care Act, passed in 2010. This is the first year that charitable hospitals nationwide must complete the assessment, which must be updated at least once every three years.
Hawaii Health Systems Corp.-affiliated hospitals, including Ka’u Hospital, Kona Community Hospital, Kohala Hospital, Hale Hoola Hamakua and Hilo Medical Center, do not have to complete the mandated assessment because they are public facilities, said Greene. North Hawaii Community Hospital is the lone nonprofit acute care facility on Hawaii Island.
Though not required to complete the assessment, all of the island’s HHSC-affiliated hospitals opted to take part in the statewide assessment, Greene said.
“The community hospitals didn’t have to do this but stepped up and said, ‘we want to be part of this’ because the end goal is to improve public health and they wanted to be part of improving health on the Big Island,” he said.
The statewide assessment was not mandated, but the association undertook the effort to “begin a dialogue” on the needs around Hawaii, both urban and rural, said Greene. Hawaii and Rhode Island were the only states that did statewide studies.
“All of our hospitals (26 of 28 in the state) really took a look at this mandate and asked ‘why just improve the communities that we individually serve?’ This is an opportunity to improve public health across the state,” he said. “It really falls in line with the collaborative spirit we have here in Hawaii.
The state plans to take the report’s findings to use while updating the State Health Plan, said Department of Health Director Loretta Fuddy. That plan, she said, hasn’t been updated in decades. Such a plan will likely take a couple of years to compile.
“The Department of Health is interested in this because we too, as part of accreditation, are going to be required to put together a health plan for the state,” she said. “We (currently) don’t have a clear strategic plan for health.”
To view the report in its entirety, including a separate 95-page assessment focusing on Hawaii County, visit hah.org.