During a discussion about healthcare in a Hawaii Public Radio debate with Ed Case last Wednesday, U.S. Senate candidate Mazie Hirono suggested that Hawaii is the nation’s healthiest state. Hirono attributed that status to Hawaii’s Prepaid Health Care Act — a program she defended while representing the state’s 2nd Congressional District in the U.S. House.

“I pushed very hard to make sure that Hawaii’s Prepaid Health Care Act, which has enabled the people of Hawaii to be probably the healthiest people in the entire nation … was exempted from the Affordable Care Act,” she said.

Originally enacted in 1974, the state’s healthcare act was the first law in the country to require that private-sector employers provide healthcare benefits for workers. Guaranteeing similar benefits, the federal government’s Affordable Care Act of 2010 would’ve superseded the Prepaid Health Care Act.

Hirono included her own amendment in the federal legislation back when it passed through the House. The amendment protects Hawaii’s act from being modified or limited, as long as it ensures at least as much healthcare coverage as does the Affordable Care Act.

Proving a direct relationship between Hawaii’s healthcare act and the health of the state’s people is beyond the scope of a simple fact check. Instead, we’ll look at whether Hawaii is in fact the healthiest state in the U.S.

What The Studies Say

Civil Beat first consulted Hirono spokeswoman Carolyn Tanaka.

“Hawaii has repeatedly been ranked as one of the healthiest states in the country by the United Health Foundation,” Tanaka said in an email.

The foundation gathers data from the U.S. Departments of Health & Human Services, Commerce, Education and Labor; the Environmental Protection Agency; the American Medical Association; the Dartmouth Atlas Project and the Trust for America’s Health to evaluate each state’s relative health in its America’s Health Rankings report. States’ rankings are based on four components: behaviors, community and environment, public policies and clinical care.

What Tanaka said is true — the United Health Foundation in 2011 ranked Hawaii the country’s fourth-healthiest state. In 2009 and 2010, it ranked Hawaii America’s fifth-healthiest state.

“Let me point out that she said ‘probably’ the healthiest state,” Tanaka added. “Not that we are ‘the healthiest state.'”

Tanaka then directed us to a report from the Gallup-Healthways Well-Being Index. The 2011 report ranked Hawaii number one for overall well-being.

Gallup’s well-being surveys are based on the World Health Organization’s definition of health, which takes into account physical, mental and social well-being — not just the absence of sickness. According to the organization’s website, Gallup compiles data gathered from interviews taken with 1,000 American adults across the country everyday to build its well-being index.

The overall well-being ranking is a composite of scores given in six categories: life evaluation, emotional health, physical health, healthy behavior, work environment and basic access. Hawaii ranked first in the emotional health and healthy behaviors categories and placed in the top five for the life evaluation, physical health and basic access categories. The state’s weakest well-being score was for work environment.

Still Healthy, But More Obese

The state may rank highly for overall health and well-being, but Hirono’s statement glosses over the particular health issues that affect Hawaii’s people.

Back in 1995, the Trust for America’s Health ranked Hawaii the nation’s least-obese state. But since then, the state’s obesity rate more than doubled, reaching 23 percent in 2011, when it ranked fifth least-obese state.

To put that into context, the United Health Foundation in 2011 reported that 28 percent of the nation’s population was obese, up from less than 15 percent in 1995. Colorado came in first at 21 percent, Mississippi was last at 35 percent.

The Trust’s report also shows that diabetes rates in Hawaii have nearly doubled since 1995, with more than 8 percent of the population suffering from the disease in 2011. The state’s diabetes rate is about the same as that for the whole nation, which is 8.7 percent.

What’s more, the United Health Foundation’s report shows that health disparities weaken Hawaii’s health profile. Obesity is a problem for about 57 percent of the state’s Hawaiian and Pacific Islander population — compared with less than 20 percent of whites. Diabetes afflicts about 10 percent of both the Hawaiian and Pacific Islander and Asian populations — versus less than 5 percent of whites.

Lastly, we asked Hirono’s campaign why she credited Hawaii’s healthcare act with the state’s high health marks.

Tanaka pointed to the 2011 United Health Foundation report, which highlights a “Low rate of uninsured population” and “High per capita public health funding” as two of the state’s three strengths. (The other is a “Low rate of preventable hospitalizations.”)

And while there’s no direct correlation between these strengths and the state’s health ranking, Gallup does consider “Basic Access” one of the sub-indices for its well-being composite score.

Hawaii ranked fourth in Gallup’s Basic Access sub-index with 85.6 points — only one point below the highest-ranking state in that category, which was Minnesota.

BOTTOM LINE: According to the United Health Foundation, Hawaii is home to some of the healthiest — but not the healthiest — people in the nation. The Gallup-Healthways’ 2011 “State of Well-Being” report ranked Hawaii number one in the country for overall well-being. Tanaka emphasizes that Hirono qualified her claim with the word “probably.” Hirono’s statement doesn’t take into account the fact that Hawaii still suffers from distinct health issues. However, both reports suggest that relatively widespread access to basic healthcare helps Hawaii health rank highly. Civil Beat judges Hirono’s statement to be MOSTLY TRUE.