Although the COVID-19 pandemic emergency has ended, many Hawaii residents continue to struggle with housing and access to health care.

Results from the University of Hawaii Economic Research Organization’s third public-health report, released today, reflect a more positive outlook on the pandemic.

Of the 1,575 Hawaii adults surveyed in the spring, the majority said the worst of the pandemic is already behind us. Only 6% said the worst is yet to come, down from 9.1% in November and 14.5% in May 2022.

Most respondents also reported their health to be in good shape, but disparities exist.

“We found that about 70% of respondents felt their health was good or excellent, but there are significant differences across various categories,” said author Ruben Juarez, UHERO’s HMSA-­endowed professor of health economics. “We are seeing that basically those experiencing housing insecurity, those experiencing food insecurity, and those experiencing poverty were more likely to be negatively impacted by the pandemic and to be in worse physical and mental health.”

One-third of participants reported symptoms of depression, which was more likely if they were dealing with unemployment, a recent COVID-19 infection or housing instability or costs.

Youth were more likely to report depression than older adults, the survey found. Native Hawaiians and Filipinos tended to report lower health ratings, as did those still struggling with the long-term effects of COVID-19 or access to health care, particularly mental health services.

“In terms of mental health, what we’re seeing is housing is a really important determinant, and the amount of money you are paying for housing,” said Juarez.

Those paying more than 30% of their income on housing, for instance, tend to have lower self-esteem and significantly worse mental health.

The combination of high cost of living and below-­average wages likely exacerbates food insecurity and stress, contributing to poor mental health, according to the report.

“Our findings reveal that these layered social determinants notably affect Hawaii’s marginalized communities,” the report said, “who disproportionately grapple with mental health issues, prohibitive housing costs, and food insecurity.”

These findings do not necessarily mean one directly causes the other, he said, but should spur conversations on how to address social determinants related to health outcomes in Hawaii.

Additionally, more than 10% reported barriers to health care — including delays to their general practitioners, dental care, specialty services and mental health care.

These were most often due to the unavailability of appointments, work schedule conflicts and excessive costs.

Approximately 5% reported having to delay mental health care for the same reasons, including insurance incompatibility.

And despite the increased optimism, COVID-19 is still present in Hawaii.

The positivity rate among respondents — or those that reported testing positive for COVID-19 at least once since the start of the pandemic — increased to 53% in June, up from about 45% in November.

“It is still out there,” said Juarez. “It hasn’t gone away.”

The rate is likely higher when untested, asymptomatic individuals with COVID-19 are accounted for, he said.

Higher rates continue to be reported among younger adults, Native Hawaiian, Pacific Islander and Filipino populations.

This increase, however, was much lower than in the previous report, when the positivity rate jumped from 25% in May 2022 to 45% in November.

Also, a growing number are suffering from long COVID.

More than 35% reported experiencing long-term effects of COVID-19 lasting more than a month, up 5% from the previous report, with the most common symptoms being cough, shortness of breath, mental fog, headaches and extreme fatigue.

Of those who are unemployed, nearly half (49%) reported suffering from long COVID.

The issues associated with long COVID, such as unemployment, housing, mental illness and access to treatment, will need to be addressed for years to come, said Juarez.

“Unfortunately, this is telling us long COVID is here to stay,” he said, “and it’s continuing to affect our economy, so we need to find solutions.”

UHERO conducted the surveys in partnership with the Pacific Alliance Against COVID-19, following the same cohort of more than 2,000 adults in Hawaii.

The first report was published in June 2022, followed by a second one in January that found COVID-19 fatigue was setting in among residents.

The next one, said Juarez, will take a deeper dive into the social determinants of health.