More than two months into the COVID-19 crisis, there’s still no official public data on how many Native Hawaiians have been infected, even in Hawaii.
State epidemiologist Sarah Park says that the state is working on collecting the data and hopes to share it soon. But some Native Hawaiian advocates say the delay highlights a broader problem with the state’s data collection: state agencies don’t consistently collect data on Native Hawaiians.
“The fact that they don’t disaggregate Native Hawaiians, in every possible office, department, data gathering effort that the state undergoes is astounding,” says Kim Birnie, communications director at the Hawaiian health care nonprofit Papa Ola Lokahi.
“It’s 40 plus years later after the constitutional convention when that became a thing,” Birnie continued, referring to the 1978 Hawaii constitutional convention when the state approved several constitutional mandates involving the Native Hawaiian community. “The state has an obligation to identify so that it can divert its resources to Native Hawaiian issues.”
When it comes to COVID-19, the state has been following federal guidelines that combine Native Hawaiians and other Pacific Islanders into a single category. As a whole, that group is experiencing a disproportionately high rate of infections in Hawaii.
According to state data, Native Hawaiian and Pacific Islanders make up 18% of those who’ve tested positive for the virus — even though they only comprise about 10% of Hawaii’s population.
But it’s impossible to tell from the state’s publicly available data whether the Native Hawaiian community itself is being hit hard, or what Pacific Islander communities may be affected. It’s possible Native Hawaiians could make up all of those cases, or none of them, but there’s no way to know as long as the data is presented that way.
That’s a common problem statewide, according to Beth Giesting, director of the Hawaii Budget and Policy Center. She oversaw a project last summer sponsored by Papa Ola Lokahi that aimed to analyze how the state was spending money on Native Hawaiian-related programs.
But the project quickly morphed when the center realized that state agencies weren’t consistently keeping data on the community.
Giesting said some programs like the Department of Health’s alcohol and drug abuse division do an excellent job tracking data on Native Hawaiians, but the mental health division combines Native Hawaiians with other Pacific Islanders and has a mixed race category that could be masking more data. She was taken aback when she found out that the Judiciary doesn’t track any racial or ethnic data at all.
“How can you design programs and evaluate programs if you don’t have any data about who you’re serving?” she said.
Birnie, from Papa Ola Lokahi, says that on a national level, she understands why some states may not disaggregate Native Hawaiians. But she doesn’t think that makes sense here.
“In Hawaii, should not Hawaii be counting the residents of its indigenous people?” she asks.
But collecting and parsing race and ethnicity data isn’t easy in health care, especially in the midst of a global pandemic.
“It’s not as simple as, ‘Just pull it out,’ otherwise we would have just pulled it out a long time ago quite frankly,” Park said.
The Department of Health is typically informed about confirmed coronavirus cases from lab reports, Park says, which don’t include race and ethnicity data.
When a positive COVID-19 lab result comes in, state workers take that information and track down the health care providers who submitted the data. If the state is lucky, Park says, the patient’s physicians will have filled out a Center for Disease Control form about the case.
“But if that form isn’t filled out, then we have to start at square one,” Park said.
The initial goal is to find the patient and begin investigating with whom they had contact. There’s a lot of data that investigators need to collect about each case, and “something like race is not going to be as important at the start of the outbreak,” Park says.
As the number of new cases each day has fallen, state investigators have been calling up patients to fill in data gaps, including asking questions about race. Park says her staff is working on disaggregating the data but didn’t give a timeline for when it would be completed.
“How can you design programs and evaluate programs if you don’t have any data about who you’re serving?” — Beth Giesting, Hawaii Budget and Policy Center
Currently, Hawaii race data on coronavirus infections is updated every Friday on the state’s website. There is no race or ethnicity data yet available about Hawaii COVID-19 hospitalizations, deaths or testing, and the state hasn’t provided any data on Hispanic or Latino communities.
Joseph Keawe‘aimoku Kaholokula, chairman of the Native Hawaiian Health program at the University of Hawaii medical school, noted that there are some drawbacks to disaggregating Native Hawaiians from the broader Pacific Islander category depending on the numbers involved.
His bigger priority is making sure that Native Hawaiians aren’t hidden in the “mixed race” category in the state’s COVID-19 data.
So many Native Hawaiians are mixed race that such a categorization could be hiding numerous cases, he said. He noted that if you count people who are at least part-Hawaiian, the Native Hawaiian community makes up about 22% of the state population, far more than the 10% on the Department of Health’s website.
“Obviously they’re doing a disservice to Native Hawaiians and Pacific Islanders,” he said. “They are also disrespecting us by them choosing how they want to categorize us culturally. They need to fix that.”
Back in 2012, the Office of Hawaiian Affairs lobbied to pass a law that would have created a uniform policy regarding race and ethnicity data collection for all state agencies.
State departments pushed back and the House and Senate versions of the bills both died before their respective money committees. Gov. David Ige, then head of the Ways and Means Committee, never called a hearing for the Senate version.
Sterling Wong, spokesman for OHA, was then the public policy manager. At the time, he says, some state agencies opposed the bill, which was based on a similar law in California.
“Better data, better information just leads to better decision-making,” he said. “We want better data on Native Hawaiians specifically to understand what our community’s needs are. How we can best use our limited resources to help our community?”
Since the proposal failed, OHA has focused on working with departments to encourage and facilitate data collection. OHA has a memorandum of agreement with the Department of Education, he says, and has also been happy with race and ethnicity data provided by the University of Hawaii.
Still, he says, the pandemic has underscored the gaps in race and ethnicity data collection and he plans to revisit the discussion within OHA.
Sheri Daniels, executive director of Papa Ola Lokahi who is also co-leading a local Native Hawaiian COVID-19 task force with Kaholokula, said the COVID-19 crisis has highlighted a longtime issue of data collection and “made it into a glaring problem.”
For her part, Giesting at the Budget and Policy Center says the nonprofit hopes to finish its analysis of statewide data collection this summer and release a report by the end of the year.
“It really is ludicrous that in a place that is as diverse as Hawaii that they would not be collecting disaggregated data,” she said.
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