Hawaii’s high rating in health is no excuse for complacency

THE ISSUE The United Health Foundation ranks Hawaii the third-healthiest state in the nation.

HAWAII is the nation's third-healthiest state, up from 14th place in 2002, according to indicators used in an annual report. Unfortunately, while some of the improvement is the result of advances in the social and medical arenas, part of it has to do with a change in measuring sticks. The report is no green light to bask in paradise.

The rankings are based on scores in 14 "determinants," areas that can affect future health, and health outcomes. Hawaii scores near the top in both of those broad categories in the report by the United Health Foundation.

It ranks first in per capita public health spending ($499), preventable hospitalizations (32.2 per 1,000 Medicare enrollees), heart-disease deaths (224.6) and cancer deaths (153.7) per 100,000 population. While public health support has greatly improved from 2002, a different method was used in the evaluation, preventable hospitalization was not rated in the 2002 comparisons and Hawaii's top place in cardiovascular and cancer deaths is unchanged.

The most significant improvement in a category measured similarly this year and five years ago was a decline of children in poverty from 15.5 percent (ranked 31st) to 10.5 percent (ranked fourth). The infant mortality ranking went up from 29th place to 21st as the rate improved to 6.3 from 7.2 deaths per live births per 100,000. Hawaii residents lacking health insurance declined to 8.8 percent from 11 percent, moving the state up the rankings from 11th to second place.

In the category of premature deaths, Hawaii dropped from third to eighth although the numbers are slightly better, now at 6,130 years lost per 100,000 population. While smokers declined to 17.5 percent from 20.5 percent of residents, Hawaii remains in sixth place, reflecting the national trend.

Infectious disease remains a problem in Hawaii. While the number of cases annually has declined to 21.5 percent from 24.7 percent since 2002, Hawaii's ranking went from 30th to 37th.

The thorn in Hawaii's health statistics remains the inadequacy of prenatal care. A measurement of access to and frequency of such care dropped from 24th to 46th in the rankings, with fewer than two-thirds of pregnant women receiving adequate care.

Chiyome Fukino, Hawaii's health director, has attributed the problem to doctors, nurses and other health-care workers leaving the profession. While the report indicates the number of Hawaii's primary-care physicians per capital has remained fairly steady -- seventh best in the nation -- Fukino has said high malpractice premiums have driven doctors from obstetrics work.

Hawaii's ranking gained from five years ago by the omission of motor vehicle deaths (27th highest) and the addition of obesity prevalence (third lowest) and primary care physicians per capita (seventh highest) as categories. It took a hit with the addition of binge drinking (39th) and immunization coverage of children less than 3 years old (29th).

In 2002, Hawaii residents said they reduced their activities by an average of 3.7 days in the previous month because of health problems, resulting in a national ranking of 22nd. This year, broken down to mental and physical health problems, they reported slowdowns of 2.6 and 2.9 days respectively, ranked fifth and third best.