After graduating from the University of North Carolina in May, we recently spent five weeks travelling between the Hawaiian Islands and speaking with primary care clinicians, public health officials, community organizations and patients to learn about the policies and culture which affect people’s health in Hawaii. Our research took us from the state Department of Health in Honolulu to the Ka‘u district of Hawaii Island, the west side of Kauai, and Kaunakakai on Molokai.
Through talking story with people from all different backgrounds and experiences, we have come to understand the unique importance placed on community, ‘ohana, and the ‘aina. These strengths make Hawaii amazingly resilient, yet resilience should not be mistaken for lack of need.
Behind the beauty of Hawaii lurks a hidden crisis. A shortage of health care providers across the state has created significant barriers to accessing mental health treatment. These access challenges have led to high rates of suicide, particularly on neighbor islands where the provider shortage is most pronounced. From 2019-2021, Hawaii Island experienced a suicide rate of 21 deaths per 100,000 people, almost two times the rate for Honolulu and almost 1.5 times the national average.
The recent disaster on Maui is likely to produce significant mental health burdens for those affected and the broader community. While immediate action is needed to address the acute needs on Maui, a more long-term strategy is needed to increase access for all those who call Hawaii home.
Beyond mental health, provider shortages make it more difficult for residents of Hawaii Island and other neighbor islands to access needed medical care. According to the 2022 Hawaii Physician Workforce Assessment, 58% of state residents report experiencing delays in their health care in the prior year.
In Ka‘u, we met with the only primary care physician in the entire district and saw just how drastic this shortage can be. Unfortunately, this shortage is only expected to worsen, as more than half of providers report considering either reducing their hours, leaving medicine, or moving to mainland due to the challenges faced here in Hawaii.
On Molokai, we met with Dr. Dang-Akiona, who splits her time between Kohala and a clinic in Kaunakakai to help make up for the recent loss of two primary care physicians on Molokai. As providers are stretched thinner due to the worsening shortage, delays in care and other access barriers are likely to become more common for patients.
The uncomfortable reality is that complex problems, such as this one, often require complex solutions. Having worked in adolescent mental health advocacy and suicide prevention for a combined 16 years, we are unfortunately not strangers to these challenges. Many challenges seen in Hawaii can be tied back to the undervaluing of primary care and mental health providers.
Physicians in Hawaii face the lowest Medicare reimbursement rates anywhere in the U.S. when adjusted for cost of living. With MedQuest and private insurance following Medicare’s lead, it has become unsustainable for many clinicians to practice in Hawaii.
As aspiring physicians, we hope to one day be part of the solution by delivering care to families in under-resourced parts of the state. However, we can only do so much as individuals. The path to greater mental health access will require community-oriented, systems-level change through coalition building and policy reform.
Ethan Phillips, BSPH, is a master’s candidate at the University of Oxford studying health system modeling. He is a recent graduate of the University of North Carolina at Chapel Hill’s Gillings School of Global Public Health, where he received his undergraduate public health degree in health policy and management.
Julia Morneau, BS, is a recent graduate of the University of North Carolina at Chapel Hill, where she received her bachelor’s degree in psychology.
This editorial is brought to you by Community First Hawaii a nonprofit serving as a convener and catalyst for solutions to improve health and access to health care. For more information, please visit our website at www.communityfirsthawaii.org or Facebook and Instagram pages at @communityfirsthawaii.
