Drivers of Health Care in Hawaii Hawaii Economic Association Virginia Pressler, MD, MBA, FACS Director, Hawaii Department of Health June 4, 2015

About 3 years Life Expectancy: A Basic Health Outcome OECD, World Bank

The US Health Care Return on Investment OECD, Commonwealth Fund, World Health Organization

For each $1 in health care, about $1 is spent on social services in the US. For each $1 in health care, over $2 is spent on social services, on average in OECD countries. OECD

Hawaii is the Healthiest State in the Country Strengths Relatively low prevalence of obesity Relatively low rate of preventable hospitalizations Relatively low rate of cancer deaths Challenges High prevalence of binge drinking High incidence of infectious disease Low immunization coverage among children

RankCounty 1Honolulu (HO) 2Maui (MA) 3Kauai (KU) 4Hawaii (HA) But Disparities Persist…

Based On Where You Live in Hawaii…

Your Access to Health Care… Hawaii Primary Care Data Book, 2012

Other Social Determinants of Health… County /Uninsured Rate (Clinical Care) Adult Smoking (Health Behaviors) Unemployment (Social & Economic) Housing Shortage (Physical Environment) Honolulu7%15%4.3%27% Maui9%15%5.1%32% Kauai8%16%5.7%28% Hawaii10%19%6.8%28%

Especially NH/PI… Hawaii’s better- than-average health status is not shared by Native Hawaiian and Pacific Islander populations. 5x 3x 2x 4x 3x The breast cancer death rate is five times higher The colon cancer death rate is three times higher The obesity rate is twice as high The heart disease death rate is four times higher The stroke death rate is three times higher The suicide death rate is at least three times higher

Most chronic diseases are strongly associated and causally linked with four particular risk factors World Health Organization

Word Cloud from Hawaii’s 2013 Assessment Healthcare Association of Hawaii

Health Outcomes Health Factors Policies and Programs Social & Economic Factors (40%) Health Behaviors (30%) Clinical Care (15%) Physical Environment (5%) Tobacco use Diet & exercise Substance use Sexual activity Uninsured rate Quality of care Unemployment Education Income Family & social support Community safety Housing & transit Built environment Air & water quality Access to care Length of Life Quality of Life The “social determinants of health” Genetic Predisposition (10%)

A Hawaii Model for Social Determinants Upstream “root causes” are socio-economic, political and other factors that influence living conditions and social circumstances that support or impede health Downstream results are effects or outcomes of the root causes.

Food Desert distribution and retail reform A New State Health Improvement Plan Community Health Needs Assessment (2013) Chronic disease and health risk behavior drive poor outcomes Certain groups and places are impacted disproportionately Cultural and language barriers inhibit interventions Limited access to care or healthy alternatives Community-based solutions are key assets Public Health, and Human Services Behavioral health and chronic disease integration Implement SNAP bonus for fruits and vegetables Certify medical interpreters Expand telehealth infrastructure School health integration Private Sector Establish corporate culture of health and wellness Corporate diversity education programs Healthy workplace eating and vending policies Participate in Blue Zone initiatives Health in All Policies Sugar Sweetened Beverage tax Safe Routes to School policies Adopt and enforce CLAS standards Worksite Wellness program incentives Reintroduce nutritional education and physical education Private Health Care System Pay-for-Quality Hospital Community Benefit Planning Reimburse Community Health Workers Health information exchange FQHC/DOE school- based sealants project Individuals and Families Improved family health literacy Improved family planning behaviors Healthy ethnic recipes and substitutes Chronic disease self- management program participation Establish ethnic community gardens Root Causes Public Policy Collaboration Improved Outcomes

Public Health Milestones in Hawaii Outbreaks of plague, small pox, tuberculosis, etc. Public health nursing established, TB sanitoriums, plantation health. Plantation housing and sanitation standards Statehood Pre-Paid Health Care Act

The Department At A Glance Four Administrations General Administration, Behavioral Health, Environmental Health, Health Resources Attached Agencies Aging, Health Planning, Disabilities Advocacy, Environmental Quality, Language Access, Hawaii Health Systems Corporation Approximately 2,500 employees and $890,000,000 budget

General Powers and Duties Section 321-1, Hawaii Revised Statutes: (a) The department of health shall have general charge, oversight, and care of the health and lives of the people of the State, and shall pursue as a goal, the achievement of health equity. The department shall consider social determinants of health in the assessment of state needs for health. The mission of the Department of Health is to protect and improve the health and environment for all people in Hawai‘i. Over 2,500 employees, 75 programs, and $890M budget

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Mahalo for Contributing to Our Community’s Health