Drivers of Health Care in HawaiiHawaii Economic Association

Virginia Pressler, MD, MBA, FACS

Director, Hawaii Department of Health

June 4, 2015

OECD, World Bank

About 3 years

Life Expectancy: A Basic Health Outcome

OECD, Commonwealth Fund, World Health Organization

The US Health Care Return on Investment

Austria

Belgium

CanadaChile

Czech

Republic

Denmark

Estonia

Finland

France

Germany

Greece

Hungary

Iceland

Ireland

Israel

Italy

Korea

Luxe

mbourg

Mexico

Norway

Poland

Slovak R

epublic

Slovenia

Spain

Sweden

Switzerla

nd

Turkey

United Kingdom

United States

OECD0

5

10

15

20

25

30

35

40

45

50

Health and Social Spending, Total, % of GDP (2012)

Health Social

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

www.americashealthrankings.org

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

www.countyhealthrankings.org

Rank County

1 Honolulu (HO)

2 Maui (MA)

3 Kauai (KU)

4 Hawaii (HA)

But Disparities Persist…

www.healthtrends.org

Based On Where You Live in Hawaii…

Hawaii Primary Care Data Book, 2012

Your Access to Health Care…

Other Social Determinants of Health…County / Uninsured Rate

(Clinical Care)Adult Smoking(Health Behaviors)

Unemployment(Social & Economic)

Housing Shortage(Physical Environment)

Honolulu 7% 15% 4.3% 27%

Maui 9% 15% 5.1% 32%

Kauai 8% 16% 5.7% 28%

Hawaii 10% 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 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

World Health Organization

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

Healthcare Association of Hawaii

Word Cloud from Hawaii’s 2013 Assessment

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

D R A F T

Public Health Milestones in Hawaii

www.healthtrends.org

Outbreaks of plague, small pox, tuberculosis, etc.

Public health nursing established,

TB sanitoriums, plantation health.

Plantation housing and sanitation

standardsStatehood

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

Resources

• http://www.hawaiihealthmatters.org/• http://www.healthyhawaii.com/• http://www.hhdw.org/• http://health.hawaii.gov/physical-activity-nutrition/choose-healthy-n

ow/• http://hah.org/reports-data/hah-reports/

Mahalo for Contributing to Our Community’s

Health