The challenge of being at the top? It’s difficult staying there — and, in all likelihood, there’s nowhere to go but down.

The good-news highlight is that Hawaii ranked No. 1 in the U.S. for overall health care, again, in the 2019 Commonwealth Fund Scorecard on State Health System Performance — thanks largely to the state’s visionary 1974 Prepaid Health Care Act, which mandates health insurance for all employees who work at least 20 hours weekly. Residents here enjoy high levels of health-care access, with only 5% of adults and 2% of children uninsured.

But peeling away at the Scorecard’s metrics reveals bad-news stats that represent real lives lost in Hawaii: Suicide deaths rose to the second-highest rate in the U.S., at 15.2 per 100,000 in 2017, up from 8.2 per 100,000 in 2005; while the alcohol death rate rose to 5.8 from 3.5, and drug poisonings climbed to 13.8 from 9.4.

Such dire trendlines among these so-called “deaths of despair” should concern all of us in high-priced Hawaii. Stressors abound every day, from time wasted in traffic — Honolulu had rated the nation’s worst traffic several years ago — to the high cost of living and especially of housing, among the highest in the U.S. with an $810,000 median price for an Oahu single- family home.

The perception of a widening chasm between haves and have-nots is fueled by Census figures, such as from 2016, showing 1 in 6 residents here living in poverty, and Hawaii having the nation’s ninth-highest poverty rate when factoring in cost of living. And Hawaii’s households are among, or top, states hardest hit by hunger and food insecurity.

Given such difficulties, Hawaii is relatively fortunate to, so far, have prevented an opioid-abuse epidemic, as seen in worst-off West Virginia. Proactive measures here, such as opioid-prescription curbs, seem effective, but such vigilance must remain to fend off addiction and its downward spiral.

Any rising rate in self-harm is concerning, but it’s Hawaii’s suicide rate — rising to the second-highest in the U.S. — that is most alarming. Whether it’s mental hurt caused by bullying, illness or cost-of-living stresses, help in coping is critical. Early intervention is crucial to bolster mental health — so it’s heartening to hear public-service spots by local role models destigmatizing and encouraging calls for help, and to see $100,000 in public funds recently approved for suicide prevention programs.

“Hawaii isn’t as burdened as a lot of other states by these so-called deaths of despair,” noted David Radley, a senior scientist at the Commonwealth Fund. “But that doesn’t diminish the real impact these are having in Hawaii.”

The ongoing challenge is to not backslide from achievements: Hawaii’s No. 1 rankings for overall health care, for lack of disparity, and for avoidable hospital use and cost; No. 2 for access and affordability; No. 3 for healthy lives; No. 5 for prevention and treatment.

Even as health cost burdens grow nationwide, Hawaii is underpinned by robustness in both health coverage and access — largely due, again, to the Prepaid Health Care Act as well as to the state’s policy of Medicaid expansion, which realizes the importance of this safety net for disabled and indigent residents. It is starkly telling that several states that most recently expanded eligibility for their Medicaid programs saw meaningful gains in access to healthy outcomes.

This new Scorecard is useful for the wealth of interactive, state-specific health-care data it provides (see bit.ly/2Zfn1BW). It’s up to each state, working with the federal government, to mine the data to improve the health of its citizens. And it tells Hawaii, rated No. 1 overall, that there are still many more ways to go up, not down.

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Getting help

>> Crisis Line of Hawaii: Oahu, 832-3100; neighbor islands, 800-753-6879

>> National Suicide Prevention Lifeline: 800-273-TALK (8255)