KAILUA-KONA — For the fourth straight year Hawaii took the title as the healthiest state in the nation.
The state’s low prevalence of obesity and low rate of preventable hospitalizations were among the strengths noted in the United Health Foundation’s America’s Health Rankings report released this week. Hawaii has consistently been in the top six states since the report launched in 1990. However, the report did point out areas where the Aloha State can improve, as well.
Closing out the top five states in the nation, according to the report, were Vermont, Massachusetts, Minnesota and New Hampshire. The worst state in the nation in terms of the health rankings was identified as Louisiana.
“I’m very proud we can continue to be at the top for health measures as both a doctor and legislator in health matters, but I do think when you are the top and you see deficiency it’s a great opportunity because we don’t have to do so much cleanup — we can be forward thinking and we have an opportunity to be cutting edge on behavioral health, addiction and new systems for immunization,” said Josh Green, an ER physician who represents Kona and Ka‘u in the state Senate. “Once you’re toward the top, you have an incredible latitude to set yourself apart.”
Second-lowest obesity rate
Hawaii ranked No. 2 in the nation for the fewest number of adults who are obese for the second year in a row at 22.1 percent of adults being obese, just behind Colorado’s 21.3 percent clip.
Katie Moore, a fitness and Zumba instructor in Kona, said Hawaii’s low obesity rate might be because of the support people have for another, particularly on the Big Island when it comes to weight loss and fitness, she surmised.
“There really is a community effort. Families, couples and friends are working out together. I think I really see the community effort on it, including caring for each other and sharing (information) with each other,” she said. “We really generally care about each other as a community and we come together on those health issues, be it obesity or dengue fever. We only have each other and we are on an island so we need to work together and we do. It’s very unique to our state.”
Room for improvement
Though the state ranked high nationally, obesity remains a big issue for the state, officials with the state Department of Health said Friday.
“In general, we are facing a nationwide epidemic of obesity and it just happens we are the lower end but it doesn’t mean we don’t have an obesity crisis we are facing in Hawaii,” said Ranjani Starr, an epidemiologist with the Chronic Disease Prevention and Health Promotion Division.
Obesity in Hawaii increased from 10 percent of the population in 1995 to 22.1 percent in 2014, she said. The state estimates that, based on its current trajectory, more than one-half of adults will be obese by 2030.
“We’ve more than doubled – in fact, nearly three in five adults in Hawaii are overweight or obese — when you combine (the two) that rate is 55 percent,” she said. “Among our children, one in three, or 28.6 percent, of kids entering kindergarten are overweight or obese.”
In 2013, the state determined that 39 percent of Native Hawaiian adults and 57.4 percent of Pacific Islanders were obese.
“It’s the same trend among our youth as well, one in five Native Hawaiian youths are obese and one in three Pacific Islander youths are obese,” Starr said. “In general, children who are overweight or obese are likely to be heavy as an adult.”
However, there is no one solution to address obesity, said Bronwyn Sinclair-White, communications coordinator for the DOH division. The state is working to address the problem in the community, schools, work sites and health care system through such programs as the Rethink Your Drink campaign, requiring more healthy food and drinks be served in schools, and ensuring that communities have safe areas for people to recreate or commute without using a car, among others.
“We are seeing a bunch of things happening in all of our communities geared toward better health and giving people the opportunity to live healthier lives, but it’s really putting it all together for a comprehensive approach to obesity,” she said.
Green believes there is a chance Hawaii could move to No. 1 in the coming years thanks to recent public health initiatives such as the Rethink Your Drink campaign to raise awareness of empty calories and Choose Healthy Now, a new initiative to color-code food items based on nutrition, among others. However, it could take several years for it to show in the report’s ranking.
First for preventing hospitalization
Hawaii also received accolades for its ability to prevent hospitalization for many preventable diseases, asthma attacks, diabetes and hypertension, with just 24.4 discharges for ambulatory care-sensitive conditions per 1,000 Medicare beneficiaries.
High rates of preventable hospital admissions can indicate problems with access to primary health care, the report also found. Hawaii ranked ninth in the nation with 140.9 primary care physicians per 100,000 population, better than the national average of 127 per 100,000 people.
According to a report prepared by the John A. Burns School of Medicine for the state Legislature earlier this year, Hawaii faced a shortage of over 890 full-time physicians. The combined effects of general population growth and the aging of both the population and the physician workforce will push the shortfall to a projected 1,500 physicians within five years. The report also noted the greatest shortage was seen in primary care physicians, particularly on the neighbor islands.
“That’s a big challenge and we haven’t been able to crack that. We’ve just been treading water with providers here and that could get worse as we have more people getting older,” Green said. “Over time this could become more worrisome.”
The challenges: excessive drinking and vaccinating keiki
Despite the overall high ranking, Hawaii still faces challenges when it comes to a excessive drinking and immunizing adolescents for Tdap, a combination vaccine that protects against three potentially life-threatening bacterial diseases: tetanus, diphtheria, and pertussis (whooping cough).
Hawaii ranks 40th in the nation for Tdap vaccinations among adolescents with 82.3 percent of teens aged 13 to 17 having received one dose of the vaccine since age 10. That’s below the national average of 87.6 percent.
For excessive alcohol use, which includes binge and chronic drinking that can lead to fetal damage, liver diseases, hypertension and cardiovascular diseases, among other major health problems, Hawaii ranked 43rd, well behind West Virginia at No. 1. According to the report, 21.1 percent of Hawaii’s adults reported either binge or chronically consume alcohol.
Green called the ranking “bad,” but noted it’s “not uncommon for states that are very isolated to have high rates of alcohol and drug addition.”
“It doesn’t mean it can’t be dealt with,” he said. “That’s an area that, I really think, in the next decade we are going to have to totally commit ourselves to helping people.”
Info/read the full report: www.americashealthrankings.org