Low income again tied to lack of medical care

Low-income residents in Hawaii are less likely to get cancer screening and lack access to mental health care, according to a community health report this month by the Healthcare Association of Hawaii.

They are also less likely to afford effective contraceptives, said the report, released July 3.

Researchers assessed community health for the state as a whole, as well as for racial groups and geographic areas, to help Hawaii’s hospitals and heath care facilities better understand health disparities, the needs of vulnerable populations and unmet health needs or gaps in services.

The association joined with the Healthy Communities Institute last year to compile the report, the State of Hawaii Community Health Needs Assessment, which features data and personal interviews.

The assessment says that there are areas of high socioeconomic need on all counties — but especially on Hawaii island.

While parts of Oahu are designated as medically underserved, that designation applies to the entirety of the other islands, the report said. Also:

» Parts of Maui and Hawaii counties have a shortage of primary care doctors.

» Parts of Maui County don’t have enough dentists.

» No county has enough psychiatrists or mental health counselors.

The document focuses on how poverty, race and location affect health in Hawaii.

"The economic disparity in Hawaii drives many of the health disparities discussed throughout this report," it says. "It is widely understood to be one of the determinants of health, along with education and the social environment."

The report found low-income residents to be disproportionately affected by heart-related illnesses and concluded that socioeconomically disadvantaged residents who are limited to affordable-housing options face an increased risk for asthma and lack access to safe environments for physical activity.

"The number of Hawaii residents living in poverty and facing greater health challenges is likely underestimated because federal definitions of poverty do not adjust for the high cost of living in the state," it said.

The report also found that people with disabilities in Hawaii are more likely to live in poverty than the general population, "which puts them at further disadvantage to accessing needed care and services."

Native Hawaiian or Pacific Islanders were found to have the state’s highest:

» Teen birthrate.

» Proportion of infants born to mothers with less than 12 years of education.

» Death rates for breast cancer and colorectal cancer.

"Cancer screening for women has not met national targets, and colon cancer screening has decreased in recent years," the report said. "Additionally, the concentration of cancer treatment centers on Oahu makes it costly for cancer patients on neighboring islands to access care."

Diabetes is highest among Native Hawaiians, at 11.4 percent, followed by Filipinos at 10.1 percent.

"While health insurance coverage in Hawaii is better than the U.S. in general, there are many other barriers to care that make access to health services a complex issue," the report says.

Mental health was the most frequent cause for hospitalization among 15 preventable causes studied for the report. Among the others were heart failure, bacterial pneumonia, asthma and urinary tract infections.

Hawaiians, Filipinos and Japa­nese exhibit a disproportionately low incidence of mental health hospitalizations, while Caucasians and all other races have higher mental health hospitalizations than their population makeup would suggest, the report said. Low-income families, rural residents, veterans and native Hawaiians all face difficulty in obtaining mental health care.

The Healthcare Association of Hawaii is a 125-member nonprofit organization that has represented many of Hawaii’s health care providers — such as acute-care hospitals, long-term care facilities and hospice programs — for more than 70 years.