By Nina Wu Honolulu Star-Advertiser
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Three years since surveys began, the University of Hawaii has found that the state’s numerous health care challenges continue to grow, especially for those living in poverty.

The latest University of Hawaii Economic Research Organization Public Health Report found there to still be a high mental health burden, particularly among young adults, continued barriers to health care, and persistent struggles obtaining food.

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While each category result tells its own story, according to UHERO research economist Daniela Bond-Smith, the findings together “show a system under pressure.”

Some key findings from the report:

— Overall health status: A lower number of adults, 40%, rated their health as excellent or very good in December, down from 44% in June 2023. Among Native Hawaiian/Pacific Islanders, excellent/good ratings dropped to 23%, compared with 40%, in just 18 months.

— Mental health burden: Among those surveyed, 31% reported symptoms of depression, and 4% reported symptoms of severe depression. Rates were highest among those ages 18 to 34, and NHPI, Filipino and low-income groups. Of low-income respondents, 10% reported severe depressive symptoms.

— Barriers to mental health care: A higher proportion of adults reported missing needed mental health care — 22% in 2024 compared with 5% in 2023. The rising trend was consistent across all racial and income groups.

— Food insecurity continued: Nearly 30% of adults reported low or very low food security, or having enough food to meet basic nutritional needs. Rates are higher among NHPI, Filipino and low-income groups.

— Barriers to health care: Many reported barriers to physical health care, with 79% citing the lack of providers available and 49% citing the cost. For mental health care, 69% reported being unable to get therapy or counseling, 50% were unable to access psychiatrists and 31% were unable to get urgent mental care services.

The UHERO Rapid Survey is a comprehensive, statewide health data monitoring project that follows a cohort of more than 2,000 adult residents over time to help inform public policy.

It was initially launched in 2022 to provide data during the COVID-19 public health emergency, and has since evolved into one of Hawaii’s largest surveys tracking health equity.

The first report, published in June 2022, focused on the health effects and views of COVID-19 in Hawaii, while the second one, in January 2023, focused on long COVID and its impacts on employment and economic security.

A third report in July 2023 examined access to food and stable housing as core determinants of health.

The fourth report, “Hawaii’s Health and Wellbeing Journey Over Time — Monitoring Equity and Access,” examines mental health, access to health care and food security among various age and ethnic groups.

There is some lag time, as the fourth report, published May 21, reflects data collected between March and December 2024.

For self-reported health status, UHERO found significant disparities across ethnic groups, with NHPIs and Filipinos reporting higher rates of poor and fair health compared with their white and other Asian counterparts.

Primary barriers to getting physical health care include the unavailability or limited hours of appointments, high out-of-pocket costs and insurance coverage. Those below the poverty line had a harder time getting dental care due to out-of-pocket costs without insurance.

For some the barriers were transportation-related — the provider was either too far away or there were not enough suitable ways to travel to the appointment.

Difficulty accessing specialist services, in particular, were reported by 61% of respondents, up from 37% in 2023.

“The UHERO Rapid Health Survey reveals widening disparities in health, access to care, and basic needs like food and housing — particularly among Native Hawaiian, Pacific Islander, Filipino, Hispanic, and low-income communities,” said the authors in the report. “These inequities are not isolated; they stem from systemic barriers that demand coordinated, equity-driven action.”

They continued, “Addressing them requires targeted investments in community-based mental health services, culturally competent healthcare providers, and expanded access to both primary and dental care — especially in underserved rural and outer islands.”

But the state must also tackle the structural roots of health disparities by investing in affordable housing, strengthening local food systems and creating pathways to stable employment

UHERO’s findings are available online via an interactive dashboard.

Health declines and disparities

— There was a decline in those rating their overall health as excellent/very good (40% in December versus 44% in June 2023).

— Participants across all racial groups reported an increase in delayed or forgone physical health care in the past year and a half, but substantially higher rates were reported among poverty/ALICE status respondents. Hispanics, Blacks and Native Americans reported the highest level and largest increase in health care access issues.

— Access to specialists generally worsened over the past 1-1/2 years for all age groups, ranging between 60% for people age 18-34 and 69% for people ages 65 and over.

— Over the past 2-1/2 years, nearly 1 in 3 adults in Hawaii have reported symptoms of depression. In December, 27% of respondents reported depressive symptoms, while 4% reported highly depressive symptoms. Rates were highest among ages 18-34, Native Hawaiian/Pacific Islander, Filipino and low-­income groups.

— Nearly 30% of adults reported low/very low food security in 2024. NHPI, Filipino, Hispanic, Black and Native American respondents reported higher-­than-average rates of food insecurity.

Source: University of Hawaii Economic Research Organization