Chronic Disease

Vision – Adults have meaningful work, family–sustaining incomes and healthy lifestyles

Desired OutcomeReduce the impact of chronic disease and support achievement of vision for adults

Though our hopes are for adults to have healthy lifestyles, the reality is that there are many barriers to healthy lifestyles and there is room for improvement in several categories. Improvement will likely require interventions at multiple levels, including systems and policy levels as well as at the individual level.

Primary Indicators

Hawaii County has higher diabetes hospitalization and higher death rates for heart attacks and stroke.

  • Hospital utilization rate for diabetes (chart)
  • Death rate for coronary heart disease (chart)
  • Death rate for stroke ( chart)

Related Indicators

Hawaii County has higher unemployment, higher levels of population in poverty and the state has high rates of adults working multiple jobs.


  • Percent unemployed (chart)
  • Percent population below 200% poverty (chart)
  • Percent population working more than one job ( chart)

Access to Healthcare

Hawaii County has a relatively high uninsured population like the neighbor islands compared to the City and County of Honolulu and fewer physicians per population.

  • Percent uninsured (chart)
  • Licensed physicians with a Hawaii Primary address per 1,000 population(chart)

Lifestyle Factors

Hawaii County has higher smoking rates than the state and residents who are of Hawaiian ethnicity have much higher smoking rates.  Hawaii County has relatively high rates of alcohol consumption, which exceeds recommendations compared to the state.  Hawaii County population meeting recommendations for physical activity and nutrition are actually slightly better than the state.

  • Percent smoking, Hawaii compared to state (chart)
  • Percent smoking by ethnicity (chart)
  • Percent exceeding recommendations for alcohol consumption ( chart)
  • Percent meeting exercise recommendations (chart)
  • Percent meeting nutrition recommendations (chart)

Modifiable Risk Factors for Chronic Disease

Hawaii County has higher rates of overweight and obesity compared to the state and similar rates of high blood pressure.

  • Percent overweight (chart)
  • Percent at risk or told have high blood pressure (chart)
  • Percent obesity (chart)

Death Rates from Chronic Disease

Hawaii County has higher death rates from heart attacks and stroke.

  • Death rate from coronary heart disease (chart)
  • Death rate for stroke (chart)

Partners with a Role to Play


Schools, Employers, Hamakua Health Center, Tutu’s House, and Five Mountains Hawaii-Live Well Project


Hawaii Island Beacon Community, Department of Health, American Heart Association, American Cancer Society, Hawaii County Office of Aging, Senior Centers, Kona-Kohala Chamber of Commerce


Department of Health-Chronic Disease Prevention, Department of Health-Healthy Hawaii Initiative and Diabetes Network, Office of the Governor, HMSA, Kaiser Permanente, and American Heart Association


Health and Human Services, Healthy Communities Programs, Association of Community Health Improvement


JABSOM – UH School of Medicine, UC Berkley School of Nutrition

What Works Best

Patient and Community Engagement

  • School-based health education integrated into curriculum, practices and polices such as requiring physical eduction.
  • Business-based support for workforce wellness and healthy behaviors including nutrition, physical activity and smoking cessation support.
  • Business development of healthy lifestyle support businesses (i.e, Gyms, healthy restaurants)
  • Multiple interventions including policy change such as smoke free workplace, incentives to exercise and quit smoking.
  • Culturally relevant lifestyle change programs.
  • Increasing access to affordable fruits and vegetables
  • Chronic disease self management curriculum.

Transforming Health Care

  • Shift from acute care model to chronic disease model of medical care.
  • Physician reimbursement for smoking cessation counseling and lifestyle modification counseling.

What is Being Done

Patient and Community Engagement

Transforming Health Care

Suggested Strategies

Increase Awareness:

  • Increase employers awareness of the cost of employee chronic disease.
  • Increase awareness of impact of lifestyle on chronic disease.
  • Increase awareness of local resources to support healthy lifestyles.  Develop resource inventory.
  • Increase awareness of patient activation as a predictor of chronic disease outcomes.  See Health Services Research.

Obtain Additional Data:

  • Increase awareness of Hawaii County relatively high annual hospital utilization rates.

Inventory and Build Existing Resources:

  • Develop and share resource inventory of patient education, support and lifestyle change programs, in each region of Hawaii County.

Increase Organizational Links:

Promote Effective Programs:

Promote Effective Practices:

Promote Effective Policies:

  • Systems approach to increase safe walking and biking trails and professional education about lifestyle management, and patient activities.
  • Provide healthy food options for school lunches, vending machines and employee meals.

Improve Health Systems:

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