Hawaii Brings Back Health Equity Office As Pandemic Highlights Disparities

The pandemic has highlighted long-standing health inequalities in Hawaii, as COVID-19 has disproportionately affected Filipinos and non-Hawaiian Pacific Islanders. The Department of Health hopes to reduce them by reinstating the former Office of Health Equity with the help of an injection of nearly $ 25 million in federal funds.

The change comes as racial and ethnic disparities in the pandemic persist between coronavirus cases, hospitalizations, deaths and vaccination rates on the islands.

Lola Irvin, who heads the health department’s chronic disease division, said the reform of the equity office and increasing its staff to seven are in response to these disparities.

“We are taking the lessons learned and we will continue to work with community leaders,” Irvin said. The office is designed “as a way to keep our focus on how to continue what we are doing and learn from what has happened”.

Currently, the population of Hawaii’s Pacific Islands – excluding Hawaiians – accounts for 20% of coronavirus cases statewide, although they only represent 4% of the population. At times during the past 15 months, the community accounted for over 30% of infections statewide.

The state’s Filipino community has also experienced disproportionate virus rates: 20% versus 16% of the population. The high rates of coronavirus in both communities are due to many factors including, but not limited to, high rates of frontline workers, overcrowded living conditions, barriers to accessing healthcare health and pre-existing health problems.

Long-standing inequities

The pandemic has highlighted not only Hawaii’s health, social and economic disparities, but also how the state has failed to address them.

Just six years before the pandemic, the Ige administration got rid of the Office of Health Equity, whose mission was “to increase the capacity of government, private providers, communities and individuals to eliminate disparities. in health and improve the quality of life. of the diverse populations of Hawaii.

In the same year, the Ige administration reimbursed public health insurance for thousands of low-income Pacific migrants, switching them to more expensive subsidized private health insurance. Studies from the University of Hawaii found that the policy change correlated with a drop in hospital visits, an increase in uninsured emergency room visits and a sharp increase in mortality for the community.

When the pandemic struck, Pacific Islanders were, as might be expected, the hardest hit. But the racial breakdowns detailed in Hawaii’s coronavirus data have been relatively slow to emerge. In April 2020, Bruce Anderson, then director of the Hawaii Department of Health, said he did not expect racial disparities to emerge in the Hawaii pandemic and downplayed socioeconomic disparities in the State.

Native leaders of Hawaii and other Pacific Islanders have felt left out of the pandemic response and frustrated by the initial lack of disaggregated case data. As the virus spread through communities in the Pacific Islands, many families were unable to get state help in part because of language and cultural barriers. It took more than six months for the state to put together a dedicated contact tracing team, made up of people speaking a wide range of Pacific Islander and Filipino languages.

Other states and cities had more infrastructure than Hawaii to address pandemic disparities. In Louisville, Kentucky, staff from the city’s Center for Health Equity have been formally integrated into the city’s response to the pandemic. Seattle and Portland had also established health equity officers who helped facilitate communication with marginalized communities.

What the office will do

Over the past year, the Ministry of Health has improved its data collection and reporting, as well as communication and outreach to marginalized communities.

The agency also recently released a health equity report analyzing how the pandemic has disproportionately affected Pacific Islanders and non-Hawaiian Filipinos.

Kim Birnie of the nonprofit Papa Ola Lokahi, which is dedicated to improving the health of native Hawaiians, said improving communication and data disaggregation in the state is a huge success that has helped to better target resources to tackle disparities.

Birnie noted that Hawaii is the only state that separates Filipinos from other Asians and native Hawaiians from other Pacific Islanders in COVID-19 data.

“Personally, I’ve been talking about data disaggregation for 30 years,” she said. “Data disaggregation is so important, otherwise the real picture of health is obscured when we are grouped together with everyone. “

She is excited about the new Health Equity Office, which she says was previously dedicated to the health of native Hawaiians.

“I think it is important to recognize the disparities and to recognize the main reasons why some communities continue to experience an unequal burden on health,” she said.

About $ 2.5 million will be used for two years of office funding, with an option to renew for a third year, Irvin said, adding that the organization will initially be placed in its chronic disease division and the first year, she will be in charge. to hire staff.

The relaunched Health Equity Office will include a project manager, three epidemiologists and three program specialists. Irvin said she was also starting to recruit an advisory group.

“That way we will have internal and external accountability,” she said.

Much of the office’s work will involve better data collection and better reporting. She noted that the office will play a key role in updating data standards on race and ethnicity.

The office will also have a role to play in influencing both internal policies, such as hiring and retention practices, and external policies, such as bills in the Legislative Assembly that may have an impact. on health equity.

More federal funds

The Office of Health Equity is expected to take roughly a tenth of the $ 24,512,230 grant from the Centers of Disease Control and Prevention. The bulk of the funding – around $ 10.5 million – will go towards COVID-19 prevention, including testing, vaccinations and data collection, Irvin said.

People who identify as native Hawaiian, Pacific Islander, or black are under-represented in Hawaii’s vaccination rates, while people of white and Asian descent are currently over-represented. Irvin said the funding would help ensure the state can fund targeted vaccination efforts, such as in a specific church.

The state has yet to release disaggregated data on immunization rates for Filipinos separately from other Asians.

An additional $ 9.4 million will go to partner engagement efforts, including community outreach and public education. Over the past year, the state health department has hired more people who carry out community outreach activities with communities in the Pacific Islands and the Philippines and funding is expected to expand their positions.

Almost $ 2.4 million more will go towards data collection and reporting.

Approximately $ 7 million of the money targeted for the above goals will go specifically to the Hawaii State Board of Primary and Rural Health Care, which plans to implement a partnership telehealth program. with state libraries and state university. The money is also provided to pay for six medical transport vans across Oahu, Maui, Kauai, Hilo, Kona and Lanai, Irvin said.