After graduating from the University of North Carolina in May, we recently spent five weeks traveling between the Hawaiian Islands, speaking with primary care physicians, public health officials, community organizations and patients to learn about the policies and culture. that impact the health of people in Hawaii. Our research took us from the state Department of Health in Honolulu to Ka’u County on Hawaii Island, the west side of Kauai, and Kaunakakai on Molokai.
Through conversations with people from different backgrounds and experiences, we understood the unique importance placed on community, the “ohana” and the “aina”. These strengths make Hawaii amazingly resilient, but resilience should not be confused with a lack of hardship.
Behind Hawaii’s beauty lurks a hidden crisis. The shortage of health care providers across the state has created significant barriers to accessing mental health treatment. These access difficulties have led to high suicide rates, particularly on neighboring islands where provider shortages are most acute. From 2019 to 2021, the island of Hawaii had a suicide rate of 21 deaths per 100,000 residents, nearly double that of Honolulu and nearly 1.5 times the national average.
The recent disaster on Maui is likely to result in significant psychological distress for those affected and the broader community. While immediate action is needed to meet the acute needs on Maui, a longer-term strategy is needed to improve access for all who call Hawaii home.
Beyond mental health, the lack of providers makes it difficult for residents of Hawaii Island and other neighboring islands to access needed medical care. According to the 2022 Hawaii Physician Workforce Assessment, 58% of the state’s residents report experiencing delays in their health care in the previous year.
In Ka’u, we met with the only family doctor in the entire county and saw how drastic this shortage can be. Unfortunately, this shortage is only expected to worsen, with more than half of providers reporting that they are considering either reducing their hours, foregoing medication, or relocating to the mainland due to the challenges here in Hawaii.
On Molokai we met with Dr. Dang-Akiona, who splits her time between Kohala and a clinic in Kaunakakai to make up for the recent loss of two family doctors on Molokai. As the number of providers becomes increasingly scarce due to worsening shortages, delays in care and other barriers to access for patients are likely to become more common.
The unpleasant reality is that complex problems like this often require complex solutions. Unfortunately, having worked in youth mental health and suicide prevention advocacy for a combined 16 years, we are no strangers to these challenges. Many of the challenges observed in Hawaii can be attributed to the undervaluation of primary care and mental health providers.
Adjusted for cost of living, doctors in Hawaii face the lowest Medicare reimbursement rates in the United States. As MedQuest and private insurance companies follow Medicare’s lead, it is no longer possible for many doctors to practice in Hawaii.
As aspiring physicians, we hope to one day be part of the solution by providing care to families in underserved parts of the state. However, as individuals we can only do so much. The path to greater access to mental health requires community-focused, system-level change through coalition building and policy reform.
Ethan Phillips, BSPH, is a master’s candidate at the University of Oxford studying health systems modeling. He is a recent graduate of the University of North Carolina at Gillings School of Global Public Health in Chapel Hill, where he received his bachelor’s degree in public health 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 organization that acts as a convener and catalyst for solutions to improve health and access to health care. For more information, visit our website at www.communityfirsthawaii.org or our Facebook and Instagram pages at @communityfirsthawaii.
