Hawaii is the healthiest state in the nation for the third year in a row — at least if you believe the United Health Foundation, the group that released its annual nationwide survey.
On paper, Hawaii looks great — low rates of obesity, fewer cancer deaths, preventable hospital admissions; it seems like a health insurer’s dream.
But wait. How can America’s healthiest state have the highest rates of diabetes, kidney failure and tuberculosis?
For the past 25 years, public health officials and the foundation have collaborated on this study partly to evaluate the rates of death, smoking, suicide, strokes, heart attacks, heart disease and other notable health measures.
Where the data comes from exactly is hard to know, but much of the material is based on people self-reporting about their behaviors, such as how often they go to the dentist or have their cholesterol checked.
In many cases self-reporting isn’t very reliable, and that’s problematic.
Take diabetes. Results show that we have the ninth lowest rate of diabetes in the nation, which sounds promising.
However, the University of Hawaii recently published results of a 16-year long study on diabetes prevention in conjunction with 26 other health centers nationwide. UH was chosen because Hawaii has one of the highest rates of diabetes in the US.
In certain ethnic populations, the rate is almost double the double the national average of 8 percent.
How could one of the cornerstones of the health ranking be so wrong?
The Centers for Disease Control says that nearly 30 percent of people who have diabetes don’t know it, so if they are asked about having the condition, their answer is truthfully no. And they are wrong. United Health Foundation based their data on asking people if a doctor has ever told them they have diabetes, which doesn’t reflect reality.
Another dangerously misleading ranking is the availability of primary care doctors in communities nationwide. Hawaii looks really good in this area. The data suggests that everyone should be able to find a primary care doctor because there are more than enough to go around.
In the end, how much can we count on Hawaii’s number one ranking by the United Health Foundation? Not enough to bet our health on it.
But many residents of neighbor islands will vehemently disagree, as is clear from the extensive media coverage of the statewide doctor shortage. It is well documented annually by the University of Hawaii, which publishes a report on the availability of doctors in Hawaii. UH counts a shortage of almost 700 doctors, particularly in primary care, throughout the islands.
And the situation is likely to get worse. Federal funding has capped the number of residency training programs for new doctors, which will further worsen the shortage as older doctors retire and demand for their services increases.
This will make it even harder for people to find a doctor when they are sick, and need immediate care, not to mention for preventative testing to stay well. The health rankings report missed this entirely.
Without a clear understanding in Washington, D.C., that Hawaii is in desperate need of doctors — and where — federal programs for under-served areas won’t be available in the islands.
Clearing the Air
Hawaii has consistently ranked high on health largely because of low rates of smoking and obesity in the state because health officials know tobacco use is the leading cause of preventable disease and death in the US.
So, where does Hawaii rank in terms of the number of smokers? The most at-risk group are teenagers; 90 percent of all adult smokers started before they turned 18.
The health report says fewer than 10 percent of our high school students smoked an old-fashioned cigarette in the last 30 days.
That may be true, but electronic cigarettes were not included in the survey.
This study showed that 32 percent of teens are smoking tobacco, mostly in the form of e-cigs. The long-term effects of “vaping” are not known yet, but there is emerging concern that e-cigs are becoming a gateway toward traditional cigarette smoking.
So a survey that looks only at traditional cigarettes is not providing the whole picture, and it misleads parents and educators about other forms of tobacco that are increasingly popular among the likely next generation of smokers.
Don’t Forget About the Kidneys
The incidence of kidney failure in Hawaii is 30 percent higher than in any other state. It predominately affects Asians and Pacific Islanders, according to the National Kidney Foundation.
The survey didn’t look at kidney function at all, but it has a huge impact on health, as well as on many of the other measures that were evaluated, including heart disease and strokes.
Our statewide shortage of board certified nephrologists, or kidney specialists, points to another serious risk to the health of people with kidney problems.
Hawaii also holds the unique distinction of having the highest rates of tuberculosis in the nation, with increasing numbers of multi-drug resistant cases. These rates have been declining over the past few years, but they remain a big problem — and are not addressed in the rankings at all.
The Global Perspective
Now, even if you believe the rosy United Health Foundation picture for Hawaii, sometimes being the best in the nation just isn’t good enough.
Compared to other countries worldwide the U.S. spends more money on health care with lesser results.
Basically, we don’t spend well, with 18 percent of gross domestic product going toward health costs; the highest percentage for a nation on earth. Yet we come in at thirty-fourth when it comes to our 79-year life expectancy; the same as countries like Columbia, Costa Rica, Qatar and Cuba.
In terms of infant mortality, we are forty-second, alongside Bosnia and Herzegovina, Serbia, Macedonia and Slovakia.
Every other high-income country does better than us on mortality, survival, and longevity.
So we fork out a lot of money, and don’t seem to be any healthier than our counterparts. In many ways, we may be worse off.
In the end, how much can we count on Hawaii’s number one ranking by the United Health Foundation?
Not enough to bet our health on it.