VisionAdults have meaningful work, family–sustaining incomes and healthy lifestyles

Socioeconomic Factors

Factors such as educational attainment, income, employment, social support and a sense of control all impact health.  Improvement in these areas for a population is associated with improved health status and lower death rates.

The negative impact of poverty on health is well documented.  Unfortunately, Hawaii County has a higher proportion of people in poverty than the other counties in Hawaii (chart).

Unemployment is also linked with poverty and a negative impact on health.  Hawaii County and Maui County have a higher unemployment rate than the other counties. The recent ACS 2010 data release shows Hawaii County unemployment was 8.0%, which is substantially higher than the State rate of 5.1% (chart).

Multiple Job Holder
Because the cost of living in Hawaii is relatively high, a higher proportion of people in Hawaii State work multiple jobs compared to the national average (Chart).  Data by county was not available at this time

Sense of Control at Work
It is important to note that for adults, a sense of “control” at work can be a protective factor for health and a sense of “lack of control” at work can be an additional risk factor for mortality, as shown by the Whitehall Study.  This study tracked (for 25 years) death rates of 17,530 male British civil service workers who all had access to free health care.  The study found (both at 10 and 25 years) that the highest death rates were in the lowest civil service rankings,  which had the lowest “sense of control” and which had a death rate three times greater than the highest civil service classification.  See The Whitehall Study.

Lifestyle Factors


Though our hopes are for adults to have healthy lifestyles, the reality is that 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.

Adult Physical Activity
Since regular physical activity is clearly linked with better health, tracking improvements in this indicator over time is important.  BRFSS data showed that Hawaii County had slightly more adults (56.0%) that are getting moderate physical activity, (30 minutes per day, five times a week) however, 45% of the population is getting less than the recommended amount of physical activity (chart).

Implication: Interventions to promote regular physical activity for adults will need to address the barriers of multiple jobs, high cost of housing, long travel times to work, access to walking trails and employer policies.

Eating Fruits and Vegetables
In addition to physical activity, another protective factor is adequate consumption of fruits and vegetables.  In 2009, BFRSS survey results showed Hawaii County slightly better than the State, however, only approximately 25% of Hawaii County residents and 24% of Hawaii State residents reported consuming the recommended five a day servings of fruits and vegetables (chart).

Alcohol Consumption (Binge Drinking)
Problem alcohol use is a risk factor for high blood pressure, stroke and trauma.  Rates of binge drinking have doubled from about 10% to 20% over the past decade in both Hawaii County and Hawaii State and are similar to State rates (chart).

Implication: Screening for problem alcohol use in they emergency department has been shown to be effective in reducing alcohol-related trauma and could be an effective strategy in Hawaii County.

Adult Smoking
Smoking increases the risk of lung cancer, bladder cancer, heart attack and stroke. Hawaii County has consistently higher smoking rates than the State (chart).  Although there was substantial improvement between 2009-2011, Hawaii County still has an opportunity for improvement  to reach the Healthy People 2020 goal of 12%. There are many new resources in Hawaii County to support smoking cessation.

Implication: Connecting businesses, schools and health care providers with these resources is an important strategy.  For recommendations to providers on smoking cessation, see “What works in Smoking Cessation.” For free publications of resources for quitting call 1-800-358-9295 and see Tobacco Free Hawaii at

Adult Body Mass Index – Overweight
Hawaii County has about the same proportion of the population who are overweight compared to the State (34%) in  2011 (chart).  Both rates have remained relatively constant over the past decade.

Adult Body Mass Index – Obese
Unfortunately, over the past decade,  Hawaii County  and the State had a gradual increase in the percent of people defined as obese, by a body mass index (BMI)>30 (chart).  In 2011,  About 23% of Hawaii County residents reported a BMI more than 30 compared to the 21% for the State. Obesity is associated with many health risks including increased risk of diabetes, high blood pressure, heart attack, stroke, cancer and decreased quality of life.

Implication: Addressing the obesity epidemic will require individual change and environmental change. Policy changes in the community, the work place and at schools could set the stage for reducing the obesity epidemic by designing safe walking areas to encourage walking, and offering healthier food choices.  See the U.S. Prevention Services Task Force recommendations:  screening for obesity in adults at , BMI calculator from National Heart, Blood, and Blood Institute.


Disease, Hospitalization and Death Rates



Adult High Blood Pressure (Hypertension)
Hawaii County residents reported an increasing proportion of people who were told they had high blood pressure from about 25% in 2001 to about 30% in 2009 (chart).  The proportion of people in Hawaii County reporting high blood pressure is about the same as the State.

In 2009 fewer Hawaii County residents  with high blood pressure reported  taking medication, 72.9% compared to the State, 78.7% (chart).


High blood pressure is a major risk factor for stroke, heart attack and cardiovascular disease.  The first line of treatment is lifestyle modification, including increasing exercise, weight loss, increasing fruits and vegetables, and decreasing salt and alcohol consumption. When lifestyle management alone is not effective and when blood pressure is greater than 140/90, medication is recommended.  Lowering high blood pressure prevents stroke, cardiovascular disease and kidney failure (chart). See Prevention, Dectection, Evaulation and Treatment of High Blood Pressure.

Adult Diabetes
Obesity and lack of regular exercise are major risk factors for adult onset of diabetes.  In 2010, Hawaii County had the same proportion of residents surveyed who indicated they had been told by a doctor that they have diabetes according to the BRFSS survey between 2006-2010 (chart).

Implication: Optimal patient management of diabetes helps to prevent complications and hospital admissions.  Hawaii County has a relatively higher rate of hospitalizations per 100,000 population, 7.38 compared to the City and County of Honolulu,3.88 (chart).

Decreasing hospital utilization for diabetes will require improving identification and management of diabetes through patient support and education, and reducing risk factors including inactivity, obesity, high blood pressure and smoking, as well as improving systems of care.



Coronary Heart Disease
The age-adjusted coronary heart disease (heart attack) death rates for both the State and County have improved over the past six years (chart). However, the Hawaii County death rate is consistently higher than the State rate. This may be due to higher rates of modifiable risks including smoking, and obesity, as well as Hawaii County’s challenges with access to primary healthcare.

Implication: Reducing Hawaii County coronary artery disease death rates will require addressing both life-style and access to care issues.









Stroke Death Rates
Hawaii County  stroke death rate has also improved over the past decade however, it is consistently higher compared to the State over the past decade except in 2004 (chart).  Causes for this higher death rate are likely multiple. The higher rate may in part be due to higher risk factors including:  smoking and obesity, which is higher in Hawaii County. In addition, lower access to primary care is known to be associated with higher stroke death rates and access to medical care is lower in Hawaii County.  Also a smaller proportion of Hawaii County people with high blood pressure are taking medication.

Implication: Reducing high blood pressure through prevention, early identification and effective management is the most effective population strategy for reducing strokes and stroke deaths. A leadership “think tank” meeting was held in Hawaii County in 2003 to begin to answer the questions “Why?” and “What can be done to improve?”  Conference proceedingsclick here...





Overall Cancer Rates
The overall age-adjusted death rate for cancer in Hawaii County is consistently higher than the death rate for the State (chart).    The reasons for the differences are likely complex and may include inadequate access to care, which would provide timely screening, diagnosis and appropriate treatment, as well as life-style risk factors such as smoking, obesity and alcohol consumption.  The possibility of other environmental factors should be considered and investigated.





Breast Cancer Rates
Hawaii County breast cancer death rates are difficult to assess because of the relatively small population in which a very small change in the number of deaths can translate to an apparently large change in the rate. Also in small populations the rate is not reported for years with less than 25 deaths.  For the years reported, Hawaii County has a higher breast cancer death rate than the state (chart).Protective factors include breast feeding and consumption of broccoli and cauliflower type vegetables.  Early detection through effective screening with mammograms and self-exams helps detect breast cancer at earlier stages which are more treatable.





Lung Cancer Rates
Hawaii County (chart) lung cancer death rates have varied substantially over the past 10 years, most likely because of the relatively small population. However, Hawaii County rates were more often higher than the State rates.  In 2009 the Hawaii County lung cancer death rate was 38.4 per 100,000 age-adjusted population compared to 34.7 for the State.





Colon Rates
Because of small numbers, colon cancer death rates for Hawaii County  were not calculated in 2001(chart).  However, the general trend shows that Hawaii County has a decreasing death rate for colon cancer and was actually lower than the State rate in 2009.  This improvement may be related to increased screening.





Screening Recommendations
Implication: Lowering population death rates from cancer will require improving access to screening, decreasing modifiable risk factors and using evidence-based care.

•U.S. Preventive Services Task Force recommendations are available at
•American Academy of Family Physicians comparison of different recommendations for cancer screening is  available at





Cancer Resources
For state-of-the-art recommendations for cancer care, the federal government provides up-to-date information for patients and physicians at 1-800-4CANCER.  Additional cancer resources are listed below:

•UCSF Cancer Resource Center –
•National Cancer Institute – or  1-800-4-CANCER
•American Cancer Society-
•American Cancer Society West Hawaii Office (808) 334-0442
•NCCN/ACS Treatment Guidelines for Patients

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