Hawaii is at a crossroads. Most of the efforts to plan for its future have positioned Oahu as the population center of the state. And while that surely will remain true, there will be enough of a shift that residents of the neighbor islands will need to take a firmer grasp of the reins to have any kind of preferred future.

This week the Star-Advertiser began a series that will take a closer look at the state’s changing growth trends and highlighting the needs that are coming to the fore beyond the City and County of Honolulu.

The first focal point, taken on by Star-Advertiser writer Mary Vorsino, is Hawaii island. Despite the geographic dimensions that give it the "Big Island" nickname, this part of the state has a character that’s still largely rural.

That is the way many county residents want to keep things, but mounting pressures for development demand that they make their voices heard in debates about how that growth plays out.

The population of Hawaii County has grown by nearly one-quarter over the past 10 years, the most recent Census figures from 2010 putting it just over the 185,000 line. That’s the highest growth rate in the state, but the island doesn’t get nearly the attention in policy-making discussions that it deserves.

This is nothing that Hawaii County itself hasn’t grasped. The island’s most current general plan was approved in 2005 by the County Council, spawning the creation of community development plans for six districts: North and South Kona, Puna, North Kohala, South Kohala, Ka‘u and Hamakua. To its credit, the county has placed its documents online (www.hawaiicountycdp.info), and are available for public viewing at various stages of completion.

The state’s political leadership from all islands should take an interest in this, too, because decisions on state resources and policies must be made in the context of what each island needs.

Among the island’s bright spots is the depth of its energy resources. The mix of solar, geothermal and other technologies puts energy self-sufficiency within the grasp of Hawaii island residents, a prize that should be aggressively pursued.

But there are shortcomings, too, and one of the most acute is the inadequacy of medical services. According to a 2011 report that the Hawaii Physician Workforce Assessment Project issued to the Legislature, the Big Island needs 174 more doctors to serve even its current population.

Demographic and socioeconomic conditions there also translate into illnesses that go untreated longer before the overcommitted physicians take on the cases.

State officials have tried to respond to this health-care crisis in all the state’s remote districts by encouraging doctors to practice in underserved areas as part of the Hawaii Health Corps, in exchange getting repayment of medical-school loans. But this problem will need continued attention in the coming years, especially as the rollout of the federal Patient Protection and Affordable Care Act yields some growing pains in the nation’s medical delivery system.

However, the Big Island jobs picture has been less than rosy. A recent Hawaii Economic Issues report shows the county lagging in job creation in contrast to its population growth.

Hawaii County’s sheer size produces other community needs. The long commutes some residents endure for work suggests that improvements in the island’s transportation infrastructure — everything from highway safety upgrades to a more accommodating bus schedule — will be essential in the coming years.

In recent years, state and county planners have published the Hawaii 2050 Plan, a long-overdue update to the Hawaii State Plan of some four decades earlier. Sustainability is the watchword throughout the document, its overarching goals ranging from diversifying the economy to management of the environment and natural resources.

Finding balance amid the push and pull of those goals is not going to be easy, especially for Hawaii island, where the demand for jobs and affordable housing, and the desire for preservation of a "country" lifestyle, are equally potent. The pace of the county’s growth further underscores how short the time is for getting the balance right.