It may seem obvious that Hawaii’s households residing farthest away from a doctor’s or dentist’s office are less able, and therefore less likely, to receive adequate health care than those in more densely populated areas, and that the burden worsens for those with low incomes. Certainly, Hawaii’s rural residents themselves know this. However, there’s a silver lining involved in documenting the facts for Hawaii: It can lead to more availability of federal money and support to help improve the situation.
Until now, the state has not conducted a closely tracked study documenting the difference in health and wellness between rural and urban or suburban residents. That has changed with a first-of-its kind study by the University of Hawaii Economic Research Organization (UHERO), detailing the “significant” health disparities faced by Hawaii residents in rural areas compared to urban areas.
State and federal agencies must quickly incorporate this data to initiate improvements in health care planning and funding for rural communities on Oahu and throughout Hawaii.
It’s significant for Oahu that better health care access and higher levels of good health are experienced by those who live in the Honolulu metro area, as compared to residents of West Oahu, the North Shore and other more isolated areas. While state and federal agencies have typically classified all of Oahu as “urban,” this study defines urban areas as confined to metro Honolulu, East Oahu and a slice of Central Oahu from Kaneohe in the east to Kapolei in the west.
UHERO researchers documented that rural residents reported having more health challenges and health-related limitations than their urban counterparts. Having to scramble for access to health care amid an ongoing doctor shortage, and logistical and expense-related difficulties in using air transportation to access care for neighbor island residents are among the factors.
This matters because the data provides evidence that public policy and programs need refinement to address the disparities. Programs that focus on mobilizing health care to specific areas are needed, as is outreach to vulnerable population groups.
The findings also justify advocacy for higher Medicare reimbursements in rural areas — which must be a key priority, as should be prioritizing investments in areas such as Lahaina, where accessing health care is a struggle.
Enhanced Medicare reimbursements and other federal support are needed to address the ongoing financial struggles of Hawaii’s health care centers and hospitals. And while Hawaii’s recent foray into loan forgiveness to attract medical practitioners is a step in the right direction, the new findings can help tailor efforts where gaps exist.
The study can also support seeking more federal funding for other smart solutions, including remote telehealth. It’s now incumbent on the state Department of Health, administrators of Hawaii’s state-funded hospitals and federally funded clinics, the University of Hawaii’s medical school and other eligible health providers to search out opportunities.
Researchers used data gathered from the UHERO Rapid Healthy Survey, an ongoing health survey of Hawaii adults conducted twice yearly; data came from a June 2023 survey of 1,571 residents, more than 20% of whom identified themselves as living in rural areas.
Disparities exist between rural and nonrural residents across the board, regardless of gender, age or ethnicity. Rural residents with disabilities and living below the poverty line reported they struggled the most with their physical health. And nearly 22% of rural residents rated their health as “fair” or “poor,” compared to fewer than 14% of nonrural residents.
Living in an island state, Hawaii’s residents can face a plethora of logistical challenges. But living in less-populated rural areas shouldn’t equate to being chronically medically underserved. Strides must be made to have good health care as accessible to those living in the country as it is to those in the city.
