When the pandemic hit in 2020, Hawaii’s then-director of the health department wasn’t expecting the coronavirus to impact marginalized communities more than others.

Within months, the data proved him wrong — by August, Pacific Islanders made up nearly a third of Covid cases but just 4% of the state’s population. Filipinos and later Native Hawaiians also experienced disparities.

Now, Hawaii health organizations and advocacy groups want to make the state’s approach to inequity more proactive, and community advocates are looking to the Department of Health’s plan to create an Office of Health Equity as a potential solution.

The state agency received about $2.5 million to establish the office last June and hire eight people, part of a $24.5 million federal grant to address disparities through various programs.

Months later, the office still hasn’t started operations.

The idea was that the office would build relationships with marginalized communities, conduct and report on data analysis regarding health disparities, collaborate with various health department divisions and push for policies that would address health inequities.

It was a recognition that even though Hawaii often ranks well as a healthy state, conditions often vary according to neighborhoods and racial and ethnic background.

Previous versions of the office didn’t stick. Before the pandemic, Gov. David Ige and the Legislature cut funding for the already tiny office, in part because some questioned whether it was necessary.

Advocates for communities of color who face health disparities in Hawaii praised the move to revive the office as a step in the right direction, but now some are wondering what happened.

Lola Irvin, who leads the health department’s chronic disease division, said the establishment of the office takes time. Her division is in the process of recruiting for two positions and just got approval this month to start filling six more.

She noted her division hasn’t been given extra resources in order to get the new office up and running.

“It’s a lot of uncompensated hours here of getting this set up,” she said.

State Sen. Jarrett Keohokalole was more blunt.

“What’s taking so long is that they’re overwhelmed in there,” he said of the Department of Health, stressing the challenges of the recent omicron-driven Covid-19 surge. He thinks state funding would help address the problem.

“Unless the state government takes some action to address it permanently, systemically, then I think we should continue to expect what we’ve been seeing,” he said.

Potential State Funding

Keohokalole introduced Senate Bill 2031, which would provide state funding for the establishment of the office and codify some of its responsibilities.

The measure passed the health committee, which Keohokalole chairs, on Wednesday. It had the backing of the Healthcare Association of Hawaii, which represents Hawaii hospitals; the nonprofit health insurance company AlohaCare; the American Heart Association and the Hawaii Public Health Institute.

Keohokalole said he introduced the measure because he knows the health department is swamped and that communities are anxious to see this office get off the ground.

“We have to do a better job of standing up that internal department infrastructure so that they can get this work done,” he said. “It’s one thing to get the money, it’s another way to use it in the interest of these communities.”

The $24.5 million in federal funding goes to a lot besides the new equity office — it’s also supposed to help the state pay for vaccination and telehealth services among other priorities. The money expires on May 31, 2023.

Irvin from the health department said that means the slow hiring hasn’t put federal funding in jeopardy since the grant doesn’t expire for more than a year.

She told House lawmakers in a hearing this month that the agency supports the intent of the bill but doesn’t want extra funding for the office to sacrifice Gov. David Ige’s other financial requests and priorities.

She said if any state funding is appropriated, it should be used to bridge the gap between May 31 and June 31 to ensure that salaries can continue to be paid for the final month of the fiscal year.

Making the office permanent requires a lot of steps, she explained in an interview Friday.

The federal funding only supports temporary positions. Civil service positions require legislative support and funding. Even if money is appropriated for the 2022-2023 budget year, the agency would have to come back next year to ensure it continues.

By then, Hawaii will have a new governor and it’s unclear what the political support for the initiative might look like given that it would entail a recurring cost.

“It’s not easy,” she said. “There are a lot of constraints legally. We can’t just do it.”

After hearing Irvin’s testimony, the House health committee decided to defer the House version of Keohokalole’s bill.

Potential Inspiration

The Senate measure goes next to the Ways and Means Committee, where some community organizations are hoping it survives.

Liza Gill is co-chair of the Hawaii Coalition for Immigrant Rights, which represents 25 immigrant-serving organizations in the state.

“We think it’s really important that this office exist, that it be fully staffed, that it be given the authority and capacity to develop the trust that is very much needed and in some cases where it’s never existed and in other cases where it’s been broken in the last several years,” she said.

Sheri Daniels, executive director of Papa Ola Lokahi, a nonprofit dedicated to advocating for better health for the Native Hawaiian community, said health disparities aren’t just about race and ethnicity but also geography, sexual orientation, disability and other factors.

She hopes that the health department’s Office of Health Equity could eventually inspire similar equity-focused positions in other state agencies.

Gill agreed, noting Hawaii experiences clear inequities in other areas like housing and education.

“I think the Department of Health over the last couple of years has really ramped up (its equity work) and probably done the most out of any state agency to try to address that and get out information in multiple languages and go to people where they are, but that needs to happen across the board for there to be the kinds of shifts that are needed,” she said.

Daniels wishes there were more conversations between the health department and communities like her own. She’s seen different versions of this office get established and get defunded over the years and wonders whether this time will be different.

“Where is the commitment?” she asked.

Irvin said it takes time. Once the Office of Health Equity gets off the ground, employees do plan to hold community listening sessions.

“Even if we haven’t added positions yet, the rest of us are taking this on to create these positions and to set up the Office of Health Equity to be an effective organization that can serve our communities because we all live here and we all want the best present and future for our children and families,” she said.

Civil Beat’s health coverage is supported by the Atherton Family Foundation, Swayne Family Fund of Hawaii Community Foundation, Cooke Foundation and Papa Ola Lokahi.