INSIGHTS ON PBS HAWAIʻI: What’s it Going to Take? The Health of Hawaiʻi’s People | Program


HAWAIʻI IS CONSISTENTLY
LABELED AS THE HEALTHIEST PLACE TO LIVE. BUT THAT’S NOT THE WHOLE
PICTURE. ALMOST A THIRD OF HAWAIʻI
RESIDENTS HAVE HIGH BLOOD PRESSURE RESIDENTS OF LOW
INCOME AREAS ON ALL ISLANDS LIVE SHORTER LIVES. INCOME, LOCATION AND
ETHNICITY ALL HAVE A DRAMATIC IMPACT ON HEALTH. WHAT CAN BE DONE TO BUILD A
HEALTHIER HAWAIʻI? JOIN US AS WE ASK WHAT’S IT GOING TO TAKE? TONIGHT’S LIVE BROADCAST AND LIVESTREAM OF WHAT’S GOING TO TAKE ON INSIGHTS ON PBS HAWAIʻI START NOW. [INTRO MUSIC] ALOHA AND WELCOME TO
INSIGHTS ON PBS HAWAIʻI…I’M DARYL HUFF. HAWAIʻI’S REPUTATION AS ONE
OF THE HEALTHIEST STATES MASKS SOME SERIOUS
PROBLEMS. IT’S A GOOD‑NEWS
STORY THAT DOESN’T APPLY TO EVERYONE. THERE ARE
DRAMATIC DIFFERENCES IN LIFE EXPECTANCY, BASED ON YOUR
ECONOMIC STATUS, YOUR ETHNICITY, AND WHERE YOU
LIVE. WE HAVE HIGH RATES OF
DIABETES AND HIGH BLOOD PRESSURE. THERE’S A SUICIDE,
ON AVERAGE, EVERY OTHER DAY. MANY OF THE THREATS TO
GOOD HEALTH ARE PREVENTABLE, AND MANY MORE
ARE CURABLE. DATA
GATHERED BY THE HAWAIʻI COMMUNITY FOUNDATION’S
CHANGE FRAMEWORK GIVE US THE FACTS AND FIGURES WE
NEED TO MOVE FORWARD. SO
WE ASK, WHAT’S IT GOING TO TAKE FOR HAWAIʻI TO TRULY BE
THE HEALTHIEST PLACE IN THE WORLD FOR ALL WHO LIVE
HERE? WE LOOK FORWARD TO YOUR
PARTICIPATION IN TONIGHT’S SHOW. YOU CAN EMAIL, CALL OR
TWEET YOUR QUESTIONS. AND
YOU’LL FIND A LIVE STREAM OF THIS PROGRAM AT
PBSHAWAII.ORG AND THE PBS HAWAIʻI FACEBOOK PAGE. NOW, TO OUR GUESTS. MADELEINE HIRAGA‑NUCCIO
CHAIRS THE PREVENT SUICIDE KAUAI TASK FORCE. SHE HAS
BEEN WITH THE CHILD AND ADOLESCENT MENTAL HEALTH
DIVISION ON KAUAI FOR THE PAST 20 YEARS. FOR 20 YEARS
BEFORE THAT SHE WORKED WITH NONPROFITS IN
CALIFORNIA AND HAWAIʻI IN THE AREAS OF MENTAL HEALTH,
FOSTER CARE, CRIMINAL JUSTICE AND COMMUNITY
HEALTH CARE. ERIC PAI IS HEART TRANSPLANT
RECIPIENT WHO RECEIVED HIS NEW HEART ABOUT TWO YEARS
AGO. HE IS A LONG‑TIME
HAIRDRESSER WHO HAS HELPED WITH MANY OF HAWAIʻI’S
BIGGEST HULA EVENTS INCLUDING THE MERRIE
MONARCH FESTIVAL. HE GREW
UP IN HAWAII KAI AND IS A GRADUATE OF KAISER HIGH
SCHOOL. RICHARD BETTINI HAS BEEN THE
PRESIDENT AND CEO OF THE WAIANAE COAST
COMPREHENSIVE HEALTH CENTER FOR 25 YEARS. HE IS A
GRADUATE OF THE U‑C BERKELEY SCHOOL OF PUBLIC
HEALTH AND EARNED A MASTER OF SCIENCE FROM SAN JOSE
STATE. HE IS A MEMBER OF
NUMEROUS HEALTH‑RELATED BOARDS AND PAST BOARD
CHAIR FOR MEDICAID INSURER ALOHA CARE. DR. ANDREA HERMOSURA
RECEIVED HER PHD IN CLINICAL PSYCHOLOGY FROM THE
UNIVERSITY OF HAWAIʻI AT MANOA. SHE WAS BORN IN
HONOLULU, RAISED IN KANEOHE AND IS A GRADUATE OF
KAMEHAMEHA SCHOOLS. A
LICENSED PSYCHOLOGIST…SHE IS AN ASSISTANT PROFESSOR IN
THE DEPARTMENT OF NATIVE HAWAIIAN HEALTH AT THE UH
MED SCHOOL. MAHALO TO ALL OF YOU FOR
LET ME START WITH YOU. IF YOU LOOK AT THE HEALTH
CARE SYSTEM, WHAT IS IT THE THING YOU’RE MOST
CONCERNED ABOUT, IF YOU COULD SAY ONE THING YOU’RE
MOST CONCERNED ABOUT, ABOUT THE FUTURE OF OUR
HEALTH CARE SYSTEM?>>I THINK THE THING THAT,
AREA OF RESEARCH THAT I LOOK AT IS IN HEALTH
DISPARITIES. LOOKING AT CERTAIN
CONDITIONS THAT AFFECT NATIVE HAWAIIANS
DISPROPORTIONATELY COMPARED TO OTHER RACIAL
AND ETHNIC GROUPS. AREA INTEREST IS BIAS AND
RACISM AND HOW THAT CAN PLAY A ROLE IN THE HEALTH OF
OUR PEOPLE.>>Daryl: IF YOU WERE GOING TO
ADDRESS THAT, HOWTHAT AFFECT THE OUTCOMES PEOPLE
HAVE?>>SO A LOT OF THE BIAS HE’S
WE HAVE CERTAIN POPULATION IS SYSTEMIC. LEARNED THROUGH
NARRATIVES FROM SCHOOLS, PARENTS, HAD HISTORY BOOKS,
MEDIA, THAT CAN CREATE MORE OPPORTUNITIES FOR SOME,
WHILE DISADVANTAGING OTHER PEOPLE. I THINK THAT THAT SOMETIMES
TRANSLATES INTO HEALTH CARE SYSTEMS, AND WHO GETS ACT
IS HE IS TO WHAT KIND OF CARE AND WHETHER OR NOT THEY
GET QUALITY CARE WHEN THEY DO GET THE CARE THEY NEED.>>Daryl: THE MISSION OF YOUR
ORGANIZATION OF THE WAIANAE COAST IS ESSENTIALLY TO
EQUAL OUT THESE DISPARITIES FOR YOUR POPULATION OUT
THERE. DO YOU FOLD THAT THAT IS A
HUGE ISSUE FOR OUR HEALTH CARE SYSTEM IN HAWAIʻI?>>MY BOARD OF DIRECTORS,
FEW THINGS ABOUT THE WAIANAE HEALTH CENTER. IT’S A NONPROFIT. OWNED BY THE COMMUNITY. SO OUR BOARD, PATIENTS
REALLY OWN THE HEALTH CENTER. THEY PROVIDE OUR STAFF WITH
TRY DIRECTIVES. MAKE PRIMARY CARE
ACCESSIBLE, HELP BECOME ECONOMIC ENGINE IN THE
COMMUNITY TO CREATE JOBS, AND RESPECTED AND ENGAGE
THE CULTURE IN EVERYTHING WE DO. GIVE THEM THAT AND GIVEN
WHERE WE ARE IN HAWAIʻI, THINK THERE ARE MANY, MANY
MORE THINGS TO BE OPTIMISTIC ABOUT AND OPPORTUNITIES
THAT ARE THERE AND THREATS. THE FIRST THREAT THAT COMES
TO MIND IS WORKFORCE SHORTAGES. NOT ENOUGH PRIMARY CARE
DOCTORS THAT ARE TRAINED OR WANT TO WORK IN LOW
INCOME COMMUNITIES. YOU SEE, A NUMBER OF HEALTH
CENTERS AROUND THE STATE STRUGGLING WITH THAT RIGHT
NOW. I SAY THAT’S ONE OF THE BIG
THREATS THAT COMES TO MIND. MANY MORE OPPORTUNITIES
THAN THREATS.>>Daryl: WE’RE GOING TO CIRCLE
BACK ON THE ISSUE OF HEALTH CARE WORK FORCE. YOUR SPECIALTY IS SUICIDE. HOW DO YOU THINK THAT THE
SUICIDE RATE IS REFLECTIVE OF THE GENERAL CONDITIONS OF
OUR MEDICAL SYSTEM?>>WELL, LET ME JUST SAY I AM
VERY ACTIVE IN SUICIDE PREVENTION AND AWARENESS. MY MAIN DAYTIME JOB
REQUIRES ME TO BE INVOLVED WITH A BROAD CROSS SECTION
OF CHILD AND ADOLESCENT MENTAL HEALTH. NONETHELESS, IT IS
SIGNIFICANTLY IMPACTED BY ISSUES AROUND DEPRESSION
AND LOW MOOD AND SITUATIONAL ISSUES THAT
BRING PEOPLE TO THE BRINK OF MAKING A VERY DRASTIC
DECISION. IT IS, I WOULD SAY THAT’S THE
PERHAPS THE TIP OF THE ICEBERG OR THE FLAG THAT IS
TELLING US THAT WE HAVE TO BEGIN TO LOOK AT A PERSON
WITH A HEAD CONNECTED TO THE BODY. THAT IS WHAT IS GOING ON FOR
US MENTALLY, EMOTIONALLY, ABSOLUTELY EFFECTS OUR
PHYSICAL HEALTH. AND OUR LONGTERM OUTCOME
AS WELL.>>Daryl: GOOD POINT. SO YOU HEAR THESE EXPERTS
TALKING ABOUT HEALTH CARE SYSTEM, WHAT GOES THROUGH
YARD MIND GIVEN YOUR EXPERIENCE AS A HEART
TRANSPLANT RECIPIENT?>>MY EXPERIENCE IS, ALL
REALLY GOOD. I WAS SO LUCKY TO EXPERIENCE
REALLY GOOD HEALTH CARE. I GOING TO SENT TO STANFORD
FOR MY SURGERY. ALWAYS FELT I LIKE I WAS
AMONG THE GREATEST MINDS IN THE MEDICAL FIELD. NOW I’M BACK HERE AT QUEEN’S. I’VE BEEN VERY LUCKY. HEALTH CARE SYSTEM IS
REALLY, REALLY HELPED ME OUT A LOT.>>Daryl: TELL US A LITTLE BIT
ABOUT YOUR LIFE DAY‑TO‑DAY NOW. HOW IS THAT? WE WERE TALKING EARLIER
ABOUT ALL THE MEDICATIONS YOU HAVE TO TAKE. A LOT OF MEDICATIONS. MORNING AND NIGHT. NOW PLANNING BACK TO DOING
MORE AND MORE HAIR AND MAKE UP JOBS. REALLY BACK TO NORMAL. NOW I’M ABLE TO DO IT WITHOUT
HUFFING AND PUFFING. I HAVE MORE ENDURANCE NOW.>>Steve: WE OFTEN HEAR ABOUT
HOW PEOPLE HAVE TO WAIT A LONG TIME FOR A TRANSPLANT.>>RIGHT.>>Daryl: WHAT WAS THAT LIKE
FOR YOU?>>AT THE TIME I WAS VERY OF A
FOG ABOUT IT ALL. GOING THROUGH IT, YOU LEARN
ABOUT IT. I WAS LUCKY, I WAS TURNED
SEPTIC BEFORE THEY DECIDED THAT IT WAS JUST NOT GOOD
ENOUGH. MOVED ME TO THE FRONT OF
LINE OF THE LIST. BEFORE YOU KNEW IT, I GOT
THREE OFFERS ON THREE DIFFERENT HEARTS. AND.>>Daryl: YOU GET TO CHOOSE?>>YOU GET TO ‑‑ THEY OFFER
YOU A HEART. MY FIRST HEART WAS, THEY
SAID IT WAS A GOOD MATCH. IT’S NOT PERFECT ONE. I WENT, OH, IT’S NOT? THEY SAID, CAN YOU PASS. YOU DON’T HAVE TO TAKE THE
HEART. I GO, WHAT’S THE MATTER WITH
THE HEART? HE SAID, WELL, IT HAS HEPATITIS
B. BUT WE CAN CURE IT IN ‑‑ THAT’S
GOING TO BE A HARD PASS. SO YOU KNOW, IF YOU’RE GOING
TO DO TAKE MY HEART, I WANT THE BEST HEART GOING BACK
IN. IT WAS LIKE TWO DAYS LATER,
SECOND CALL, AND I DO THE OPERATING TABLE AND I’M ON
THE TABLE. AND THERE IS NO DOCTOR. DECIDES THAT HE COMES IN, HE
GOES, WE’RE NOT GOING TO DO IT. I DON’T LIKE THIS HEART. GET ME OFF AT THAT TABLE. I’M THINKING, WHERE WAS IT
THAT YOU HAVE TO WAIT A LONG TIME FOR ORGANS? TWO DAYS LATER WE HAVE THE
HEART. THEY SAID IT’S PERFECT. WENT IN, GOT THE HEART. THREE TIME IS A CHARM. NEVER HAPPENS WHAT I WAS
TOLD. NOT EVER. HEALTH CARE HAS BEEN SO
GOOD FOR ME. I’VE BEEN VERY, VERY
FORTUNATE.>>Daryl: WE’RE TALKING ABOUT
THIS. WONDERFULLY POWERFUL
STORY.>>I DON’T KNOW, WHAT MAKES
MY NEW HEART IS I CAN’T IMAGINE PEOPLE NOT BEING
ABLE TO GET THE KIND OF HEALTH CARE THAT I GOT. I DON’T KNOW HOW IT THAT
THAT THEY DON’T HAVE IT. VERY
INTERESTING.>>Daryl: LET’S TALK ABOUT THAT. ONE OF THE OTHER REAL RED
FLAGS OUT THERE IN HAWAIʻI, PARTICULARLY, IS LIFE
EXPECTANCY. COUPLE OF GRAPHICS ABOUT
THIS, LOOK AT LIFE EXPECTANCY IN A COUPLE OF
COUNTIES. IF THEY CAN BRING THAT UP,
WHICHEVER COUNTY THEY SHOW ME. WAIANAE COAST, 74.9 YEARS. EAST HONOLULU, 87.3 YEARS. ALMOST 13 YEARS
DISCREPANCY BETWEEN WAIANAE AND HAWAIʻI KAI OR
EAST HONOLULU. HOW IS THAT POSSIBLE? LET’S TALK ABOUT THAT. ASK THE EXPERTS HERE. MAUI COUNTY, ABOUT A TEN
YEAR DIFFERENCE. LITTLE BIT LESS THAN TEN YEAR
DIFFERENCE BETWEEN BASICALLY MOLOKAI AND
KAHULUI. CENTRAL MAUI. LET ME TRY THIS. IS THIS BECAUSE OF
GEOGRAPHY? WHAT THE HECK IS GOING ON
THERE?>>I BELIEVE THERE’S A
CORRELATION WITH POVERTY. LOOK AT SOCIAL CONDITIONS,
WE’RE BEGINNING TO LEARN MORE AND MORE HOW
IMPACTFUL THEY ARE ON OUTCOMES. WHEN I SAID IT WAS OPTIMISTIC,
COUPLE OF THINGS LEAD ME TO BE OPTIMISTIC. I DIDN’T KNOW MUCH ABOUT THE
SHOW. DIDN’T KNOW IF I WANTED TO
COME ON THE SHOW. SOMEONE SENT ME A LINK OF
ONE OF YOUR PRIOR SHOWS. HAD A BUNCH OF BUSINESS
LEADERS SAYING WE NEED TO CHANGE CERTAIN THINGS
ABOUT HAWAIʻI. WE HAVE A LOT OF YOUNG
PEOPLE LEAVING, LACK OF OPPORTUNITY. WHAT ABOUT THE HOMELESS? ALMOST EVERYBODY IS
IMPACTED BY HOMELESS. I SAW A COMMITMENT FROM THE
BUSINESS COMMUNITY DO PARTNERSHIPS AT THE
COMMUNITY LEVEL TO ADDRESS THE SOCIAL DETERMINANCE OF
HEALTH. THAT GAVE ME HOPE. I REALLY BELIEVE IN THAT, THE
PUBLIC/PRIVATE PARTNERSHIPS. SO HOW DOES THAT REALTY
BACK TO WAIANAE? WE DID 210,000 CLINICAL VISITS
LAST YEAR. 80% OF THOSE WERE TO
PEOPLE THAT, 200% OF POVERTY OR LESS. MANY OF THEM ARE IMPACTED
BY FOOD AND SECURITY, HOUSING AND SECURITY, BUT I
SEE A LOT OF POTENTIAL AND I CAN TALK MORE ABOUT THAT
LATER.>>Daryl: I WOULD LIKE TO ASK
ANDREA. THIS IS KIND OF YOUR
SPECIALTY, RIGHT? DISPARITY. WHAT DO YOU SEE THE ROOT OF
IT? WE TALKED LITTLE BIT ABOUT
ETHNICITY. THERE ARE CONDITIONS THAT
SEEM TO FOLLOW ETHNICITIES AS WELL AS ATTITUDES YOU
DESCRIBED. POVERTY TENDS TO FOLLOW
ETHNICITIES WHAT DO YOU THINK IS HAPPENING WHEN YOU
LOOK AT THOSE NUMBERS?>>I THINK IT’S VERY
CORRELATED. LARGE NATIVE HAWAIIAN
POPULATION IN WAIANAE, FOR EXAMPLE. IF I GO BACK TO HISTORICALLY,
NATIVE HAWAIIANS WEREN’T ALLOWED TO SPEAK HAWAIIAN
LANGUAGE IN SCHOOLS, WEREN’T ALLOWED TO
PRACTICE CULTURAL PRACTICES AND BELIEVES. SO SOMETIMES, THEY NEVER
OWNED LAND. SO WHEN WE WERE COLONIZED,
THE IDEA OF OWNING LAND DIDN’T MAKE SENSE AND DIDN’T
CREATE OPPORTUNITIES FOR THEM TO DO THAT. AND TO BE IN HIGHER
SOCIOECONOMIC STATUS. SO THEY COULD ACCESS
BETTER CARE AND ACCESS MORE HEALTH, I THINK THEY’VE
DONE RESEARCH WHERE THERE’S MORE FAST FOOD
RESTAURANTS PER BLOCK IN WAIANAE COMPARED TO HAWAIʻI
KAI.>>I WISH THERE WAS MORE IN
HAWAII KAI. THERE’S EVEN IF YOU LOOK AT
THE MEDIAN STRIP IN HAWAII KAI, YOU CAN PLAY FOOTBALL
ON THE MEDIAN STRIP. IF YOU GO TO WAIANAE, THERE’S
NO MEDIAN STRIP. A LOT OF ACCIDENTS. YOU COULD HAVE NONHEALTH
CARE RELATED DEATHS OF SOME OF THESE AREAS.>>ABSOLUTELY.>>Daryl: PACE THAT COULD FACE
US. TALK ABOUT KAUAI AND WHAT
DO YOU THINK ABOUT THE DISPARITIES?>>I THINK ONE OF THE TERMS
THAT RICH MENTIONED IS GOING TO BE BECOME COMMONPLACE. MORE AND MORE
COMMONPLACE. SOCIAL DETERMINANCE OF
HEALTH. WHAT WE’RE TALKING ABOUT,
IT’S THE SAME FOR KAUAI AND NEIGHBOR ISLANDS AS IT IS FOR
OAHU, THAT THE CONDITIONS UNDER WHICH WE LIVE, KINDS
OF ACCESS WE HAVE, EDUCATION AND HOUSING AND
ALL OF THOSE OTHER THINGS THAT MAKE UP OUR LIVES,
THOSE ARE THE THINGS THAT REALLY CREATE OUR HEALTH
STATUS. AND WHERE WE SAW IT BEFORE,
THAT IT’S PRIMARILY WHETHER WE GO TO THE DOCTOR OR
WHETHER WE TAKE THE RIGHT MEDICATION, I THINK THE
EVIDENCE IS GROWING VERY QUICKLY THAT THOSE AREN’T
THE PRIMARY, FUNDAMENTAL ISSUES THAT IMPACTED OUR
QUALITY OF HEALTH. IT HAPPENS IN THE AREA OF
BEHAVIORAL HEALTH, ANOTHER COMMON TERM THAT’S
GROWING IF USAGE IS ADVERSE CHILDHOOD EXPERIENCES. WHAT WE CALL ACES IN THE
BUSINESS. THOSE ADVERSE CHILDHOOD
EXPERIENCES WHICH INCLUDE THINGS LIKE BEING IN A
HOUSEHOLD THAT EXPERIENCES FROM TIME TO
TIME DOMESTIC VIOLENCE, OR HAVING A PARENT WHO DIES, OR
PARENT WHO GOES AWAY TO PRISON, OR HAS A SUBSTANCE
ABUSE PROBLEM, THOSE KINDS OF THINGS ARE IMPACTING OUR
LIVES IN VERY REAL WAYS. THEY’RE LIMITING OUR, THE
LENGTHS THAT WE LIVE.>>WHEN YOU HEAR WHAT
THEY’RE SAYING, AS A NATIVE HAWAIIAN AS WELL AS, YOU’RE
BASICALLY RAISED MIDDLE CLASS?>>I WOULD SAY YES.>>WHEN YOU HEAR THIS, WHAT
DOES IT MAKE YOU THINK ABOUT?>>REALLY LUCKY, I’M REALLY
LUCKY. I WAS BORN AND RAISED IN THE
SAME HOUSE THAT I’M LIVING IN NOW. IT SADDENS ME THAT NOT
EVERYONE HAS THE SAME ACCESSIBILITY TO THINGS LIKE
DOCTORS OR JUST MEDICAL CARE, JUST.>>OR FOOD. OR FOOD. GOOD CLEAN AIR. WATER. EDUCATION. CRAZY.>>Daryl: ARE WE SAYING NOW,
TALKING ABOUT, THIS IS FOR HAWAIʻI, PRIMARILY, A NATIVE
HAWAIIAN ISSUE? IS THAT FAIR? I HAVE A QUESTION, REASON I’M
ASKING. WE HAVE A QUESTION. WHY ARE SO MANY NATIVE
HAWAIIANS AND LOCALS SO HEALTH COMPROMISED? IS IT THEIR CULTURE?>>I’M NOT SURE IF IT’S THEIR
CULTURE. GOES BACK TO SOCIAL
DETERMINANCE OF THE HEALTH. WHERE THEY PRIMARILY WORK,
LIVE, PLAY. ALL OF THOSE THINGS. ENVIRONMENTS THAT WE ARE
LIVE IN. CAN AFFECT OUR HEALTH.>>Daryl: THEY SAY THE
PRECONTACT HAWAIIANS WERE PROBABLY THE HEALTHEST
PEOPLE ON EARTH. WHAT I’VE HEARD MANY TIMES. HOW DO YOU THINK THAT PLAYS
OUT IN TERMS OF ETHNICITY IN PARTICULAR FROM THE
EXPERIENCE YOU’VE?>>I THINK THE CORRELATION IS
POVERTY. OTHERS UNIQUE TO NATIVE
HAWAIIANS IS LOSS OF LAND. A LOT OF PEOPLE ARE HURTING. A LOT OF PEOPLE FEEL THEY
CAN’T LIVE IN HAWAIʻI. AFFORD HEALTHY FOOD AND
HAVE THE KIND OF JOB IT TAKES TO PAY FOR RENT OR TO BUY A
HOME. YOU HAVE THOUSANDS OF
HAWAIIANS ON THE WAIT LIST TO GET HOUSING. THAT’S HURTFUL TO PEOPLE.>>HOUSING BEING
COMPROMISED IS A BIG FACTOR TO HEALTH. IF YOU DIDN’T HAVE A ROOF
OVERHEAD, WOULDN’T LET HAVE YOU A HEART. YOU WERE TALKING BEFORE,
YOU NEED ELECTRICITY ALL THE TIME.>>RIGHT. CRAZY.>>Daryl: BRING UP THIS
QUESTION OF WHAT’S IT GOING TO TAKE, WE’RE TALKING ABOUT
THESE BIG MACRO FACTORS, POVERTY, YOU KNOW, TRAUMA,
HOUSING, ECONOMY, EDUCATION, DO WE HAVE TO FIX
ALL OF THOSE THINGS TO MAKE OUR HEALTH CARE SYSTEM
BETTER? OR HOW DOES THE HEALTH
CARE SYSTEM ADJUST TO THAT?>>I THINK WE DO.
AND I THINK WE CAN. ONE SHOW I WATCHED,
CREATED VILLAGE PROJECT, AROUND A KITCHEN, VERY
SUCCESSFUL. SOMEBODY ASKED ON THE
SHOW, WHY WASN’T IT REPLICATED. BECAUSE PEOPLE DIDN’T KNOW
HOW TO WORK WITH COMMUNITY. THERE’S A DYNAMIC IN WORKING
WITH A LOW INCOME COMMUNITY OR HAWAIIAN
COMMUNITY. IN WHICH IT’S A LOT OF
DECISION‑MAKING ABOUT WHAT SHOULD HAPPEN, NEEDS TO BE
TURNED OVER TO THAT COMMUNITY. EMPOWERMENT ISSUE. AND I THINK THAT IS VERY
IMPORTANT LESSON WE NEED TO LEARN. WE TALKED ABOUT HIGH BLOOD
PRESSURE. YOU WORK WITH DIABETES. MANY OF YOUR CLIENTSS ARE
DIABETIC. REAL STRUGGLE. WHEN IT COMES TO
HYPERTENSION, HIGH BLOOD PRESSURE, HAWAIʻI HAS A RATE
OF ABOUT 32%. U.S. AVERAGE IS 31%. YOU LOOK AT THE SMALL PRINT
THERE, 60% OF PATIENTS HAVE IT UNDER CONTROL. IS THAT SOMETHING THAT THE
HEALTH CARE SYSTEM COULD DO BETTER? GETTING PEOPLE TO TAKE THEIR
MEDS?>>OF COURSE. WELLNESS,PREVENTION,
MAINTENANCE IS ALL THERE. BUT SOMETHING ABOUT WHEN
PEOPLE DON’T HAVE HOPE, AND SOMETHING WE NEED TO DEAL
WITH. NOW, ONE OF THE THINGS
THAT’S VERY INTERESTING, QUEST MEDICAID PROGRAM,
WHICH MOST OF OUR PATIENTS BEING ABOUT BELOW POVERTY,
THEY’RE ENROLLED IN QUEST. THAT PROGRAM IS ABOVE A
BILLION A YEAR. THINK ABOUT THAT. I THINK WE HAVE ENOUGH
RESOURCES TO REALLY ADDRESS THESE SOCIAL
CONDITIONS. AND WE HAVE SOME
LEADERSHIP, I THINK, IN MEDICAID RIGHT NOW, THAT
GETS IT. I THINK THERE IS BIDS OUT NOW
UNDER THE QUEST PROGRAM. I THINK IT’S CALLED THE HOPE
PROGRAM. WHERE HEALTH PLANS NOW ARE
GOING TO BE RESPONSIBLE FOR ADDRESSING SOCIAL
CONDITIONS. HOUSING, FOOD, ALL OF THESE
THINGS. THAT’S GOING TO CREATE A
REALLY INTERESTING DYNAMIC AS LONG AS HEAT PLANS
EMPOWER COMMUNITIES TO SOLVE THEIR OWN PROBLEM
AND TRUST THE JUDGMENT THAT COMES OUT OF
COMMUNITIES.>>Daryl: IT IN TERMS DIABETES. HIGH BLOOD PRESSURE,
KEEPING THEM UNDER CONTROL. WHAT ARE THE BARRIERS TO
PEOPLE WHO NEED REGULAR MEDICATION. CHANGE THEIR DIET, MAKE ALL
OF THESE LIFESTYLE CHANGES. IS THAT DIFFERENT FROM ONE
COMMUNITY TO THE NEXT?>>I THINK SO. HE SAID SOMETHING
INTERESTING. I THINK ‑‑
>>Daryl: RICH? NO.>>GOT LUCKY. COMMUNITIES NEED TO FIGURE
OUT HOW TO EMPOWER THEIR OWN COMMUNITIES BECAUSE I
THINK THEY’RE FAMILIAR WITH THE CHALLENGES THAT HAPPEN
IN THEIR COMMUNITIES. EVEN LIKE IN TERMS OF SOCIAL
DETERMINANCE OF HEALTH, FINDING THAT THE HEALTH CARE
SYSTEM CAN ONLY DO SO MUCH BECAUSE A LOT OF THE
PERSON’S HEALTH STARTS DECLINING OR IS GOOD WAY
BEFORE THEY EVEN STEP INTO THE DOORS OF THE HEALTH
CARE SYSTEM. SO I THINK.>>Daryl: LET ME ASK ERICK. IS THAT YOU?>>I’M ALSO DIABETIC AND I TAKE
BLOOD PRESSURE MEDICATION. AND MY BLOOD PRESSURE IS
REALLY GOOD. I THINK YOU HAVE TO DECIDE
YOU WANT TO DO IT. YOU HAVE TO COMMIT TO DOING
IT. I KNOW I HAVEN’T.
KIND OF GOT THAT AHA MOMENT. DOESN’T WORK UNLESS YOU
PUT THE PILL IN YOUR MOUTH. OR DOESN’T WORK IF YOU
DON’T, NOT A LITTLE BIT MORE CONSCIOUS OF WHAT GOES IN
YOUR MOUTH WITH FOOD. A LOT OF TIMES, THEY DON’T
HAVE BEING ASSESS TO RIGHT FOOD AND STUFF LIKE THAT.>>Daryl: DID IT TAKE A CRISIS
FOR YOU HAVE HAVE THAT AHA MOMENT WERE YOU ALSO QUITE
SICK BY THE TIME YOU GOT THERE? DO YOU THINK YOUR OWN
LIFESTYLE CONTRIBUTED?>>WASN’T THAT BAD. I JUST THINK, ONCE MY HEART
WAS BAD, THEN EVERYTHING ELSE BECAME VERY IMPORTANT. AGAIN, YOU HAVE TO DECIDE
YOU WANT TO DO IT.>>I THINK THAT’S TRUE. I ALSO THINK THAT IF YOU’RE
WORRYING ABOUT PUTTING FOOD ON THE TABLE, FEEDING
YOUR KIDS, GOING FROM JOB TO JOB, WE KNOW THAT PEOPLE IN
HAWAIʻI WORK MULTIPLE JOBS, IT’S REALLY HARD THEN TO
EXERCISE OR COOK, HOME‑COOKED MEALS. MORE VEGETABLES. JUST KIND OF SURVIVING. WHETHER YOU’RE JUST TRYING
TO SURVIVE.>>I WILL NO IDEA THE LEVEL OF
HUNGER IN OUR COMMUNITY. UNTIL WE STARTED DOING FOOD
DISTRIBUTION AND CONNECTING WITH THE COMMUNITY, HOW
KIDS RUSHED TO GET OFF THE SCHOOL BUS, BEFORE THE FREE
BREAKFAST ENDS. OR THEY’RE GOING TO GO
HUNGRY. AND SO ONE. THAT’S ONE OF
THE THINGS WE’VE BEEN WORKING ON, SURVEY
THOUSANDS OF OUR PATIENTS AND WE USE A SOCIAL
DETERMINE AND TOOL WHERE WE ASK THEM WHAT ARE YOUR
BIGGEST SOCIAL CONCERNS. I WAS SO SURPRISED THAT
FOOD AND HUNGER AND HEALTHY FOOD CAME IN AHEAD
OF HOUSING. HOUSING IS REALLY IMPORTANT.>>Daryl: GOT A QUESTION FROM
A VIEWER. PLEASE DISCUSS THE DIET,
CHEAP JUNK FOOD, HEALTH. FAMILY DOESN’T HAVE ENOUGH
MONEY TO DO AS ANDREA WAS SAYING, WHAT DO THEY DO?>>EAT SPAM MUSUBI. WHICH IS REALLY YUMMY BUT
REALLY NOT GOOD. A LOT OF KIDS ARE VERY
FAMILIAR WITH ALL OF THAT KIND OF STUFF. HAWAIʻI IS BIGGEST CONSUMER
OF SPAM. IT’S EASY FOOD. IT’S EASY FOOD TO HAVE.>>Daryl: RELATIVELY CHEAP.>>VERY SALTY. CHEAP. SO KIND OF DAMNED IF YOU DO
AND DAMNED IF YOU DON’T.>>Daryl: IS THERE ‑‑ GO AHEAD.>>I WAS THINKING THAT ONE OF
THE THINGS, SOUNDS LIKE YOU’RE ASKING AND THE
VIEWER IS ASKING, SO THERE ARE ALL OF THESE GREAT
GRAND IDEAS ABOUT ADDRESSING SOCIAL
DETERMINANCE OF CHANGE. THOSE DETERMINANCE OF
HEALTH. THOSE ARE GOING TO TAKE A
LONG TIME TO ACTUALLY SHOW SIGNIFICANT IMPACT. BUT AT THE SAME TIME, THE
ADVANCES I BELIEVE IN HEALTH CARE, TECHNOLOGY OF IT, AND
THEN THE CHANGE OF THINKING THAT WE’RE HAVING ABOUT
HOW THE PATIENT, HOW THE CLIENT IS SUPPOSED TO BE
ENGAGED IN HIS OR HER OWN WELFARE AND HEALTH, I THINK
THOSE THREE THINGS TOGETHER ARE GOING TO MAKE
THE CHANGE HAPPEN FASTER THAN WAITING FOR ALL OF THE
UPSTREAM THINGS TO OCCUR.>>Daryl: COUPLE OF QUESTIONS. OUR VIEWERS TOTALLY GET
WHAT YOU’RE SAYING. CALLER HAS CELIAC DISEASE. HOW YOU PRONOUNCE IT. ABLE TO MAINTAIN HEALTH BY
EATING HAWAIIAN FOODS IN A PLANT‑BASED DIET. HOW CAN WE MAKE THIS
LIFESTYLE MORE MAINSTREAMED? OTHER QUESTION IS ABOUT
SCHOOLS, EDUCATING YOUNG PEOPLE, AND ASK WHETHER THE
CUTS TO PE AND HEALTH CLASSES BEEN CONTRIBUTING. BACK TO THE DIET ISSUE,
MENTIONED NATIVE HAWAIIANS WERE THE HEALTHIEST PEOPLE
ON THE PLANET. WHEN YOU TOOK THE WATER,
TOOK THE LAND, DESTROYED EXISTING AGRICULTURAL,
THERE ARE EFFORTS IN THE ISLANDS TO RE‑ESTABLISH
SOME OF THOSE THINGS. ESPECIALLY ON WAIANAE. ARE YOU AFFILIATED WITH MA’O
FARM?>>SURE. WITH VERY A NETWORK IN OUR
COMMUNITY. I WANT TO TALK I DON’T KNOW IF
I CAN DO THIS JUSTICE, I WANT TO TALK ABOUT A REMARKABLE
MEETING HELD LAST TUESDAY NIGHT. IN OUR COMMUNITY. WE WERE APPROACHED, JOSH
GREEN AND LIEUTENANT GOVERNOR, AND WILLIAM AILA,
WITH HAWAIIAN HOMES, APPROACHED US AND SAID,
WHAT IF YOU HAD 25 ACRES OF LAND AND YOUR MISSION WAS
TO ADDRESS THE SOCIAL DETERMINANCE OF HEALTH.>>Daryl: CAN YOU MAKE IT
250 ACRES?>>WELL, THAT’S ONE OF THE
THINGS I THINK THE COMMUNITY CAME BACK AND SAID. YOU CAN’T BUILD A THE LOT OF
HOMES ON THAT BUT WHAT WOULD YOU DO? I WOULD LIKE ABOUT THAT WAS
NOT THIS IS WHAT YOU’RE GOING TO DO. WE WANT TO LISTEN THE
COMMUNITY. WE WANT YOUR IDEAS. IT STARTS WITH THAT. VERY POWERFUL. YOU COULD IMAGINE THAT
THERE’S A LOT OF PERCEPTIONS IN THE COMMUNITY ABOUT HOW
ONE WOULD DO THAT. NOT EVERYBODY MIGHT HAVE
THE SAME OPINION. SO THIS MEETING, THERE WERE
PEOPLE THERE, I THINK, THAT WERE READY TO SAY, HERE YOU
GO. TAKING HAWAIIAN LANDS AWAY. AND OUR THOUGHT WAS, NO. WE WERE APPROACHED, SO WE
WANT TO FACILITATE A PROCESS WHERE PEOPLE IN
THE COMMUNITY COLUMN WITH THEIR IDEAS. WHAT WAS REMARKABLE BY THE
END THAT HAVE 2, 3 HOUR MEETING, THERE WAS
COMPLETE UNITY. AND THERE WAS A PROCESS TO
FIND ON HOW WE WOULD WORK WITH HAWAIIAN LEADERSHIP
AND HOW WE WOULD DESIGN THAT PROPERTY TO ADDRESS
SMALL HOMES WOULD BE PART OF IT, FOOD, FOOD SECURITY
WOULD BE PART OF IT, WE WOULD ACTUALLY CREATE
WAREHOUSES TO DISTRIBUTE FOOD. BUT ALSO, TO LEARN ABOUT
HOW WE CAN DO SUSTAINABLE AGRICULTURE, PART OF IT AND
ONE OF THE BIGGEST THINGS WE COULD DO, IS GETTING
PEOPLE JOBS. I HONESTLY THINK THAT PART
OF THE ALIENATION AND ROOT CAUSES OF DISEASE IS PEOPLE
NOT HAVING MEANINGFUL WORK. AND THE WAIANAE HEALTH
CENTER EMPLOYS 800 PEOPLE. MAJORITY OF OUR EMPLOYEES
ARE LIVE IN OUR COMMUNITY. THIS IS A LOT OF GROCERIES. IF WE CAN GET MORE
HAWAIIANS TRAINED IN THE PROFESSIONS WE CAN RECRUIT
HER TO WAIANAE. AND BUT WE CAN GET A LOT OF
OUR PEOPLE IN REALLY HIGH PAYING JOBS AND RAISE
STANDARD OF LIVING . I DON’T KNOW IF THERE’S A BETTER
THING WE CAN DO THAN TO CONTRIBUTE WELLNESS THAT
WAY. ECONOMIC DEVELOPMENT.>>Daryl: I WANT TO MOVE ON, I
THINK THAT WE’VE DONE A GOOD JOB. COVERING THAT ISSUE. I THINK THAT THERE’S ALSO,
YOU KNOW, NUTS AND BOLTS PROBLEMS IF OUR SYSTEM. PROBLEMS RIGHT NOW. YOU’RE TALKING ABOUT HEALTH
PLANS BEING EMPOWERED. THAT’S QUEST. THAT’S A LOT OF PEOPLE. THAT’S LIKE A THIRD OF
POPULATION. BUT THAT’S QUEST. OTHERWISE, WE’VE GOT
BASICALLY TWO OR THREE INSURANCE COMPANIES IN THIS
STATE THAT REALLY DRIVE WHAT OUR SYSTEM LOOKS LIKE. EDITORIAL. I WOULD LIKE TO TALK A LITTLE
BIT ABOUT THINGS WE’RE SHORT OF, WHICH ARE MEDICAL
PRIMARY CARE PHYSICIANS. HUGE SHORAGE. ANYBODY KNOW HOW SHORT
WE ARE OF PRIMARY CARE DOCTORS? I DIDN’T EVEN KNOW WE WERE
SHORT.>>Daryl: SO THERE’S A STUDY
THAT IS PUT OUT BY THE HEALTH SERVICES RESOURCE
ADMINISTRATION THAT SAYS, HAWAIʻI IS NOT SHORT OF
PRIMARY CARE. SO INVALID. SOMETHING WE’RE GOING TO
GO AFTER BECAUSE YOU KNOW, IT’S ABOUT ‑‑
>>Daryl: YOU THINK THEY’RE WRONG?>>OH, YEAH. ABSOLUTELY THEY’RE WRONG. I THINK THERE IS A SHORTAGE
OF PRIMARY CARE DOCTORS WILLING TO WORK IN AN
ENVIRONMENT IN WHICH THEY’RE SEEING PATIENTS LIKE
OURS. IT COULD BE ON MOLOKAI.>>Daryl: DOES THAT KIND OF
EXPLAIN THE GEOGRAPHIC DISTRICT?>>I THINK DOCTORS ARE BEING
TRAINED.>>Daryl: ON KAUAI, WHAT KIND
OF SHORTAGE ‑‑ I ALWAYS HEAR THAT BIG ISLAND, MAYBE MAUI,
NOT SO MUCH, BUT SOME OF THESE ISLANDS, ARE NOT THAT
UNUSUAL CONDITIONS WILL STILL FORCE YOU TO HAVE TO
FLY TO OAHU.>>CORRECT. YEAH. PRIMARY CARE ON KAUAI,
PROBABLY 3 TO 4 MONTH WAIT FOR A NEW PATIENT TO GET IN
TO A PRIMARY CARE PROVIDER. I THINK SPECIALISTS ARE EVEN
WORST. PSYCHIATRIST. TELEHEALTH THINGS ARE
BECOMING MORE.>>Daryl: LIST OF SPECIALIST
THAT WE ARE MORE THAN 25% SHORT IN. I’M NOT SURE WHERE THE
STATISTICS COME FROM. SMALL. SOURCES HAWAIʻI COMMUNITY
FOUNDATION. INFECTIOUS DISEASE, GENERAL
SURGERY, ORTHOPEDIC SURGERY, COLORECTAL AN
OTHERS. I REMEMBER BEING IN THE
HEALTH CARE FIELD MYSELF. MAKE SURE YOU GET
EVERYBODY TESTED, EVERYBODY HAS TO HAVE TEST
FOR POTENTIAL COLON CANCER. WHEN THEY DID THAT, THEY HAD
WAY TOO MANY PATIENTS WHO NEEDED ATTENTION. NOT ENOUGH DOCTORS, NOT
ENOUGH SPECIALISTS TO TREAT THEM. WHAT ARE WE GOING TO DO
ABOUT THAT? WHAT CAN BE DONE ABOUT
THAT?>>A LOT OF INITIATIVES JOHN A.
BURNS OF MEDICINE. PIPELINE PROGRAMS,
INTERVENE IN MIDDLE SCHOOLS, NANAKULI. TO GET THEM STUDENTS
INTERESTED EARLY IN SCIENCE. AND MATH. SO THEY CAN COMPETITIVE AND
GO INTO HEALTH CARE. A LOT OF LOCAL INITIATIVES
HAPPENING TO TRY TO RECRUIT AND HELP PEOPLE
SUCCESSFULLY GET INTO MEDICAL SCHOOL. BUT THEN TO GRADUATE AND TO
STAY HOME. PEOPLE WHO ARE FROM HERE,
ARE MORE LIKELY TO STAY HERE. ABOUT YOU THEN IF THEY
RECRUIT FROM ELSEWHERE, THEY WANT PEOPLE WHO ARE
GOING TO STAY HERE FOR A LONGTERM. NOT PEOPLE COME AND GET
SHORT PERIOD OF TIME, AND THEN LEAVE THEN. IMPORTANT TO RECOGNIZE
THAT DOCTORS AND NURSES ARE A COMPONENT OF OUR
HEALTH CARE SYSTEM. BUT THERE IS A LIST OF OTHER
PROFESSIONS ALSO SHORT STAFFED. AND THE WHOLE IDEA OF
BUILDING UP FROM THE BOTTOM WITH THE COMMUNITY HEALTH
WORKERS AND PEOPLE WHO CAN GO INTO THE RURAL AREAS
AND CONNECT WITH FOLKS WHO MAY NOT HAVE ENGLISH AS A
FIRST LANGUAGE, AND HAVE DIFFERENT CULTURES, THAT IS,
THAT ALSO CREATES A LARGE BASE FOR CHANGING THE WAY
HEALTH IS.>>Daryl: ANSWER TO GET MORE
MONEY INTO THE COMMUNITY TO PAY MORE DOCTORS SO
MORE DOCTORS COME? OR MORE ABOUT, AS YOU’RE
DESCRIBING, TAKE THE CEILING OFF WHAT SOME OF THOSE
LOWER LEVEL HEALTH CARE, I HATE TO SAY LOWER LEVEL,
CAN’T THINK OF ANOTHER WORD. WHY DO YOU HAVE TO SEE MD? CAN YOU SEE A NURSE
PRACTITIONER? AS I UNDERSTAND IT, IN THIS
STATE, BEEN PRETTY SLOW TO ADOPT ALTERNATIVES TO MDS.>>GOING TO TAKE A
COMBINATION OF THINGS. REAL GAPS WHAT WITH WE
NEED. TODAY, I WAS WALKING ACROSS
OUR CAMPUS WITH SOME VISITORS FROM NEW ZEALAND. RAN INTO 25 OF OUR MEDICAL
STUDENTS. WAIANAE HEALTH CENTER IN
PARTNERSHIP WITH UNIVERSITY OSTEOPATHIC MEDICINE. WE TRAIN FOR 3 YEARS
DOCTORS. FOR RESIDENCY PROGRAM TO
PLACE THEM. SO WHEN I SAID TO THEM, HOW
DO YOU FEEL ABOUT THAT? YOU COME HERE. LEARN FOR 3 YEARS. DO YOU LIKE WORKING IN THE
COMMUNITY LIKE WAIANAE? WE LOVE IT. WE LOVE TO STAY. WE WOULD WORK NEIGHBOR
ISLANDS, HEALTH CENTERS. BUT BECAUSE WE CAN’T GET A
SINGLE SLOT OR VERY FEW, HAVE WORKED WITH HILO TO
GET A COUPLE. THEY ALL GO BACK TO THE
MAINLAND. THEY DO RESIDENCY FOR A
COUPLE OF YEARS, BOND BACK THERE, AND WE LOSE THEM. AND SO WE ARE GOING TO DO
WHATEVER IT TAKES TO GET MORE RESIDENCY SLOTS. SO WE CAN REALLY EXTEND
THAT PROGRAM WHERE WE’RE GETTING THE RIGHT KIND OF
STUDENTS THAT WANT TO WORK IN A COMMUNITY LIKE OURS. OTHER THING IS NURSE
PRACTITIONERS WHERE WE HIRE PRACTITIONERS RIGHT OUT
OF SCHOOL. THEY COULDN’T REALLY
SUSTAIN WHAT THEY WERE DOING IN WAIANAE. VERY DIFFICULT. SO WE WORK WITH A GROUP
OUT OF CONNECTICUT STARTED NURSE PRACTITIONER
RESIDENCY PROGRAM. HAD BETWEEN 3 AND 8 NURSE
PRACTITIONERS TRAINING FOR A YEAR AFTER THEY’RE
CREDENTIALED.>>Daryl: WHAT DO YOU THINK IS
THE PROBLEM, WHY DO YOU THINK WE’RE SO SHORT OF
DOCTORS? OR MEDICAL PROFESSIONAL?>>I THINK COST OF LIVING HERE
IS HIGHER. MOST PHYSICIANS AND HEALTH
CARE PROVIDERS GET PAID LESS THAN THEY WOULD IN THE
CONTINENT. SO THE QUALITY OF LIFE SOME
OF THEM ARE LOWER. I THINK WHAT WE’RE TRYING TO
DO A LOT OF, LIKE INTEGRATED HEALTH CARE, TRYING TO TREAT
THE PATIENT, WITH BELIEVING THAT THE THE HEAD IS
CONNECTED TO BODY. HAVING PSYCHOLOGIST OR
COMMUNITY HEALTH NAVIGATOR AND PHARMACIST IN THE CLINIC
TO HELP PEOPLE WITH DIABETES, MANAGE MEDICATION
TO TALK ABOUT DEPRESSION, AND COMMUNITY HEALTH
NAVIGATOR TO GET THEM CONNECTED TO COMMUNITY
RESOURCES THAT THEY NEED TO IMPROVE THEIR HEALTH.>>Daryl: IN THIS STATE, ONE
REASON WE HAVE THIS REPUTATION AS HEALTHIER
STATE PREPAID HEALTH CARE ACT, EMPLOYER MANDATE FOR
HEALTH CARE. ONLY HAVE LIKE I WAS SAYING
EARLIER, COUPLE OF MAIN PRIVATE INSURANCE
COMPANIES IN THIS STATE. HOW MUCH HAS THAT
INFLUENCED INNOVATION, CHANGE, ABILITY TO ADJUST TO
THE KEEP OF THINGS YOU FOLKS ARE TALKING ABOUT?>>SO I LIKE ‑‑ SORRY. GOING TO DEFER. IT BAFFLES ME THE SORT OF, I
DON’T KNOW, OBSTACLES TO GETTING ENGAGEMENT OF THE
ENTIRE SYSTEM. INCLUDING THE PAYOR. I’M HOPING SOMEONE HERE HAS
THE ANSWER.>>Daryl: I DO WANT TO‑I’LL GET
TO YOU. I PROMISE. WHAT KIND OF INSURANCE DID
YOU HAVE WHEN YOU FIRST GOT ILL AND WHAT PROGRESSION
DID YOU MAKE IN TERMS OF BEING ABLE TO PAY FOR THIS
INCREDIBLY EXPENSIVE PROCESS?>>YOU WERE ON PRIVATE
INSURANCE?>>I DIDN’T HAVE PRIVATE
INSURANCE. I DIDN’T HAVE ANY INSURANCE. MY SOCIAL WORKER AT QUEEN’S
SAID, LET’S HOOK YOU UP WITH QUEST. THEN IT JUST WAS, HEAVEN
AFTER THAT. SO I DON’T THINK I’VE EVER
HEARD SAY QUEST IS HEAVEN. MEDICAID.>>WITHOUT IT, NOT HAVE DONE
ANY OF WHAT I’VE BEEN THROUGH. MY DIABETIC, DOCTOR, PRIMARY
CARE DOCTOR, CARDIOLOGIST.>>Daryl: DID YOU HAVE GETTING
ACCESS TO THOSE SPECIALISTS.>>WHEN YOU HAVE A HEART
TRANSPLANT. YOU’RE KIND OF AT THE FRONT
LINE. I CAN ALSO MENTION TOO, FOR
KIDS HAVE MENTAL HEALTH ISSUES, BEHAVIORAL HEALTH
ISSUES, QUEST ACTUALLY IS, LASS A BROADER ARRAY OF
SERVICES FOR THOSE KIDS. CONTRACTING WITH A VARIETY
OF AGENCIES INCLUDING STATE DEPARTMENT OF HEALTH.>>Daryl: IN A LOT OF WAYS
QUEST IS BETTER SYSTEM THAN PRIVATE HEALTH CARE SYSTEM.>>I THINK THERE’S ENOUGH
MONEY IN QUEST DO A LOT OF GOOD. I THINK THERE NEEDS TO BE ‑‑
WHEN WE WORKED WITH WELL THE HEALTH PLAN. AND CHANGES TENDS TO
CHANGE, WHEN THERE’S A HIGH DEGREE OF TRUST IN WORKING
TOGETHER. REALLY GOOD DATA I THINK
HEALTH CARE NEEDS TO BORROW FROM THE BUSINESS
COMMUNITY AROUND PERFORMANCE METRICS. AND ALSO, ALIGNED INCENTIVES. WE’RE NOT INCENTIVIZING
CORRECTLY. ONE OF THE THINGS WE’RE
DONE, LOOK AT WHERE ARE THE AVOIDABLE COSTS? WHERE CAN YOU SQUEEZED
OUT OF THE HEALTH SYSTEM THAT WON’T HURT PEOPLE BUT
HELP PEOPLE AND REPROGRAM THAT TO ADDRESS SOCIAL
CONDITIONS? THAT’S WHAT IS GOING TO
HAPPEN. AND I HAVE NEVER ‑‑ IT’S
AMAZING, ONE OF THE HEALTH PLANS THAT I WON’T MENTION. USED TO FIGHT WITH ALL THE
TIME, BUT THAT HEALTH PLAN I GET TOGETHER WITH THEIR
LEADERSHIP ONCE A MONTH. OVER AT MY CONDO. WE TALK ABOUT HOW WE CAN
ADDRESS THE SOCIAL THIS DETERMINANCE OF HEALTH
USING THIS POT OF MONEY. WE ALSO HAVE TO PROVE THE
VALUE OF WHAT WE DO. SETTING UP SYSTEMS BETTER
TRACK VALUE AND RETURN ONINVESTMENT TO THE HEALTH
CARE DOLLARS THAT TO BE PART OF THIS
TRANSFORMATION.>>Daryl: DO YOU FEEL
GOVERNMENT HEALTH CARE SYSTEM WOULD BE BETTER?>>I THINK THAT HEALTH PLANS
PROVIDE UTILITY. TO THE DEGREE THAT THEY
PROVIDE UTILITY, WHICH MEANS TO GET MORE VALUE OUT OF
THE DOLLAR, THEY’RE WORTH WHILE. IF THEY STOP PROVIDING THAT
VALUE, MORE AND MORE PEOPLE ARE GOING TO LOOK AT
SINGLE PAYOR SOLUTIONS.>>Daryl: IN TERMS OF, MENTAL
HEALTH FOR TEENS ESPECIALLY, AN TALKED A
LITTLE BIT ABOUT SUICIDE. ARE THERE RESOURCES IN THE
COMMUNITY FOR KIDS WHEN THEY ARE IN A CRISIS?>>THERE ARE. THEY’RE UNEVENLY SPACED. I HAVE TO SAY NEIGHBOR
ISLANDS STRUGGLE MORE WITH HAVING THE FUN COMPLEMENT
OF RESOURCES. WE KNOW THAT THOSE KINDS OF
THINGS ARE FREQUENTLY POPULATION BASED. THAT IS, THEY SURVIVE IN THE
FISCALLY VIABLE BECAUSE THERE’S A LARGE POPULATION. AND DON’T EXIST ON THE
NEIGHBOR ISLANDS. ANY CHANCE THAT’S
REFLECTIVE OF ‑‑ HOW DOES KAUAI COMPARE WITH OTHER
ISLANDS WHETHER IT COMES TO SUICIDE?>>SO CLEARLY, ACROSS THE
BOARD, AND THE WAY WE MEASURE DEATH BY SUICIDE,
FREQUENTLY OVER A PERIOD OF TIME, BECAUSE THEY CAN
FLUCTUATE SO MUCH, IN A YEAR, IT’S HARD TO DO ANY KIND
OF REAL ANALYSIS, IF YOU DON’T TAKE THREE TO FIVE
YEAR PERIOD. WE EVALUATE BASED ON THAT. THEN WE DETERMINE RATES BY
100,000 POPULATION.>>Daryl: GRAPHIC THAT SAYS, ON
AVERAGE, ONE PERSON DIES EVERY 2 DAYS IN HAWAIʻI. HOW DOES THAT PARSONS OUT
ACROSS THE ISLANDS?>>SO THE RATE OF DEATH BY
SUICIDE IS HIGHEST CURRENTLY OVER THE MOST RECENT
STATISTICS FROM 2012 TO 2017. SO IT’S THAT KAUAI ISLAND AND
HAWAIʻI HAS THE HIGHEST RATES OF SUICIDE PER 100,000. MAUI IS NEXT. OAHU IS ALMOST HALF OF THE
RATE OF KAUAI.>>Daryl: THAT’S CRAZY. REALLY CRAZY. SO TALKING ABOUT SUICIDE CAN
BE TRIGGERING FOR SOME PEOPLE. SO WE DO HAVE A COUPLE OF
PHONE NUMBERS WE WOULD LIKE TO PUT UP IF ANYONE
NEEDS HELP. CAN PUT THAT GRAPHIC UP. OAHU, NUMBER IS 832‑3100. NEIGHBOR ISLANDS, 18753‑68
8753‑6879 ON NEIGHBOR ISLANDS. GOOD QUESTION FROM A
VIEWER. WILL TECHNOLOGY MAKE A BIG
IMPACT ON A PRODUCTIVITY OF PRIMARY CARE PHYSICIANS,
TELEMEDICINE, ARTIFICIAL INTELLIGENCE?>>I WAS AT A MEETING
NATIONALLY RECENTLY, WAS AROUND THE TABLE WITH
MEDICAL DIRECTORS FROM DIFFERENT ‑‑ I ASKED THEM THE
QUESTION. WHAT PERCENTAGE OF MEDICAL
VISIT ALSO BE DONE THROUGH CELL PHONE WITHIN FIVE
YEARS? THE LOWEST NUMBER WAS 30%. SO THE IDEA OF INTERACTING
WITH YOUR PRIMARY CARE PROVIDER REMOTELY, TODAY, I
HAD A MEETING WITH OUR TEAM THAT DOES PAIN MANAGEMENT. PRIMARILY LOOKING AT FOLKS
THAT ARE TRYING TO GET OFF OF OPIOID ADDICTION. I SAID, WHERE ARE THE
PATIENTS COMING FROM.>>THEY’RE COMING FROM ALL
OVER THE STATE. FROM THE NEIGHBOR ISLANDS. AND WHY? WELL, THERE’S NOT ANY
SERVICES. WE WERE MEETING WITH IT
PEOPLE. COULD WE, WITHIN A YEAR,
DESIGN A SYSTEM AROUND PAIN MANAGEMENT THAT CAN BE
DONE TRY TELEMEDICINE. THE ANSWER WAS YES. WHAT WAS GOOD ABOUT IT IS
THE CONFIDENTIAL. PEOPLE, I FOUND WHY ARE
PEOPLE COMING FROM THE NEIGHBOR ISLANDS, THEY DON’T
WANT TO BE SEEN GOING INTO A PAIN MANAGEMENT COMPANY. ADDITIONAL ADVANTAGE OF
BEING ABLE TO DO FACE‑TO‑FACE, WAY WE CAN DO
IT WITH PRESCRIPTIVE AUTHORITY, AND THEN TREAT
PEOPLE AND GIVE THEM THE SUPPORT THEY NEED AND
REFERRAL REMODELY.>>Daryl: WHEN YOU TALK ABOUT
YOUNG PEOPLE, DO YOU THINK THAT MIGHT BE REALLY IF YOU
THINK ABOUT IT, REVOLUTIONARY THING?>>INITIATIVES GOING ON RIGHT
NOW TO TRY TO START TO INTERVENE MORE PREVENTIVE,
IN A PREVENTIVE. TEXT MESSAGES, USING APPS
TO HELP THEM TRACK THINGS EARLY. PHYSICAL ACTIVITY CALORIE
INTAKE. SPEAKING THEIR LANGUAGE
REALLY. MONITORING YOUR HEART ON
YOUR WATCH.>>Daryl: WOW. RIGHT THERE. DO YOU END UP TACK TO GO
SOME OF YOUR SPECS‑TALKING TO SOME OF YOUR SPECIALISTS
ON THE MAINLAND OR SKYPE OR ANYTHING LIKE THAT? NO. I HAVE ALL OF MY DOCTORS
HERE. ONCE A YEAR, THEY WOULD LIKE
ME TO GO AND MAKE SURE EVERYTHING IS COOL. NEIGHBOR ISLANDS IN
PARTICULAR, DOES THAT GIVE YOU LITTLE BIT OF HOPE, ABOUT
MANAGING TO CONNECT PEOPLE? IS IT STILL TOO ELECTRONIC?>>NO. I THINK I HEARTLY AGREE THAT
TECHNOLOGY HAS THE POTENTIAL TO CHANGE THE
TRAJECTORY OF OUR COMMUNITY’S ACCESS TO
HEALTH CARE. AND IN FACT, IT’S ALREADY
BEING ROLLED OUT OR CHILD AND ADOLESCENTS MENTAL
HEALTH BEHAVIORAL HEALTH AREA. WE ALREADY HAVE CLINICS ON
HAWAIʻI ISLAND, BOTH SIDES OF KONA, HILO, MAUI,
PSYCHOLOGISTS ON OAHU, SEE KIDS AND FAMILIES BY ZOOM. AND THEY’RE BEING TREATED AT
A HIGHER RATE, WITH HIGHER EFFICIENCY, HIGHER NUMBERS.>>Daryl: BETTER ABLE TO DEAL
WITH A CRISIS?>>WE ACTUALLY, THAT IS ALSO
BEING TRIED OUT. RIGHT NOW, AT THE HOSPITAL
ON KAUAI, WILCOX, THERE IS A NEW ENDEAVOR TO BRING A
PSYCHIATRIST BECAUSE THERE’S SUCH A DERTH OF
PSYCHIATRISTS ON KAUAI. TO HAVE A PSYCHIATRIST
AVAILABLE DURING THE DAY. FOR EMERGENCY SITUATIONS.>>Daryl: ACTUALLY JUST
OCCURRED TO ME. SOME OF THE HEALTH PLANS,
QUEST HEALTH PLAN, OFFER FREE CELLPHONES. SMART PHONES. IT BE RETURN ON INVESTMENT
THAT PAYS OFF IF YOU KEEP PEOPLE OUT OF ER. I’LL SHUT UP. YOU’RE TRIGGERING SOME
THOUGHTS THAT I WANT TO MAKE SURE WE PUT ON THE
TABLE. RELATED TO SUICIDE, RELATED
TO EARLY INTERVENTION. ANOTHER SHOOTING ON THE
MAINLAND TODAY. IT’S HAPPENING MORE AND
MORE. AND ONE OF THE THINGS THAT
WE’VE TRIED, THAT SEEMS TO BE REALLY WORKING VERY
WELL, IS WE STARTED WITH WAIANAE HIGH SCHOOL. WE PUT A NURSE PRACTITIONER
AND A PSYCHOLOGIST. IN THE SCHOOL. WE ACTUALLY HELPED THEM,
BUILT OUT A SPACE. CALLED SCHOOL BASE CLINIC. GOT A GRANT FROM THE
WEINBERG FOUNDATION. SUSTAIN THIS. HEALTH PLANS HAVE STEPPED
UP. SUPPORTED IT. THE FINDINGS ARE AMAZING. THERE’S NOT REALLY TIME TO
GET INTO ALL OF IT. BUT WE TURNED OUT A LOT OF
ABSENTEEISM AND THAT HELPS THE SCHOOLS A NUMBER OF
WAYS. HELPS THE KIDS. UNCOVERED SO MUCH IN THE
IMPACT OF BULLYING, ALIENATION, ABUSE IN THE
HOME, GOES ON AND ON. AT SOME POINT, WE NEED TO
PUBLISH A STUDY. RETURN ON INVESTMENT PAID
OFF IN DECADES BETTER OUTCOMES. WHO WOULD HAVE THOUGHT
THAT TREATING SOMEONE’S HEALTH ISSUE EARLY ON,
ATTENDANCE AT SCHOOL.>>ABSOLUTELY. WE STARTED WAIANAE HIGH
SCHOOL BECAUSE THEY ASKED US TO AND WE HAD A CLOSE
CONNECTION THERE. IT WAS SO SUCCESSFUL,
NANAKULI HIGH SCHOOL. NOW WE’RE IN WAIANAE
INTERMEDIATE. OTHER SCHOOLS ARE SAY CAN
GO YOU DO THIS FOR US? IT’S NOT A DOCTOR WELL
TRAINED WITH THE PH.D. PSYCHOLOGIST. COMMUNITY WORKER.>>Daryl: I HAVE TO HONOR OUR
VIEWERS GETTING SOME OF QUESTIONS. ONLY ABOUT SIX OR SEVEN
MINUTES LEFT. WHEN YOU TALK ABOUT
COMMUNITY, DOES IT ONLY PERTAIN TO NATIVE HAWAIIANS? I KNOW THE ANSWER IS NO. BUT WHAT OTHER GROUPS IN
THIS COMMUNITY NEED THE KIND OF ATTENTION?>>FILIPINO HAVE PRETTY BAD
HEALTH STATUS. MICRONESIANS. PACIFIC ISLANDERS.>>Daryl: IS IT SIMILAR
PROBLEMS?>>SIMILAR PROBLEMSES. FILIPINOS ARE USUALLY
GROUPED UNDER ASIAN POPULATIONS BUT HEALTH
STATUS IS MORE SIMILAR TO PACIFIC ISLANDERS THAN THERE
ARE TO ASIANS.>>Daryl: ANOTHER QUESTION. A LOT OF QUESTIONS ABOUT
DIET. SOME OF THE OVERSEAS
COUNTRIES GOVERNMENT TAKES MORE PROACTIVE ROLE
SEEING HEALTHY, NONGMO, NONSTEROID, NONANTIBIOTICS
FOOD ARE READILY AVAILABLE. WHAT WOULD IT TAKE TO GET
GOVERNMENT HERE MORE INVOLVED? GREAT QUESTION.>>SOUNDS LIKE A MONEY
QUESTION.>>Daryl: MONEY OR LAND. WHO WANTS TO GROW
SOMETHING THAT IS GOING TO COST THREE TIMES IF YOU
GROW IT HERE THEY CAN BUY IT IN THE SUPERMARKET.>>WHOLE QUESTION OF
SELF‑DETERMINATION.>>Daryl: ANOTHER GREAT
QUESTION. CALLER SEE ACE CONNECTION
BETWEEN OVERTHROWN MONARCHY AND CHANGES IN
VALUES PRACTICE OF HAWAIIAN PEOPLE TO MORE WESTERN
INFLUENCES. WHAT DOES THE PANEL THINK. REMIND OF DANIEL ANTHONY
AND THE PAIA GRASSROOTS MOVEMENT. PRIMARY DOCTOR IS NOT
TRAINED IN NUTRITION. STARTED GRASSROOTS WITH
REGISTERED DIETICIANS IN THE SCHOOLS. HOW BIG IS DIET IN ALL OF THIS? HOW MUCH SHOULD WE FOCUS
ON?>>HUGE. I THINK IT’S HUGE. I THINK IT’S HUGE TOO. BUT I THINK THERE ARE
ECONOMIC DECISIONS. MOTIVATIONAL DECISIONS. IF YOU WANT TO CHANGE
WHAT’S IN THE MARKET, I THINK WE NEED TO EDUCATE PEOPLE
AROUND ALTERNATIVES HEALTHY FOODS AND ALL OF
THAT. FEW YEARS AGO, DID A THING
CALLED WAIANAE DIET. PUT PEOPLE BACK ON THE
TRADITIONAL DIET. BUT THEN, WAY WE DO IT IS,
WONDERFUL DOCTOR TERRY SHINTANI, WOULD BE TO GET
PEOPLE TO DINE TOGETHER. WHEN THE PROGRAM WAS
OVER, PEOPLE GO BACK TO THE OHANA AND PARTY UNDER THE
TENT. MIX OF ETHNICITIES IS WHAT
GIVES US GREAT CHOICES OF FOOD. I MEAN, IT’S LIKE SO WHAT’S IT
GOING TO TAKE TO GET PEOPLE TO CHANGE? THAT WAS A VERY DIRECTED
PROGRAM.>>IT HAS TO BE AFFORDABLE. INITIATIVES NOW TO DO LIKE
AQUAPONICS, RAISING YOUR OWN PLANTS. AND FISH. TEACHING PEOPLE TO GARDEN. WHAT PLANTS WOULD GROW
WELL IN THE COMMUNITY THESE LIVE IN SO YOU CAN MAKE,
GROW YOUR OWN FOOD FOR YOUR HEALTH.>>Daryl: HAVE YOU CHANGED
YOUR DIET?>>I SHOULD CHANGE IT A LOT
MORE. I HAVE TO BE VERY CONSCIOUS
ABOUT CARBS AND STUFF LIKE THAT. SALT IS THE ENEMY FOR ME. SALT RETAINS WATER. IT MAKES MY HEART WORK
HARDER AND SO SALT IS NUMBER ONE. BUT SALT IS EVERYWHERE. SALT IS EVERYWHERE. THAT’S THE PROBLEM.>>Daryl: DO YOU THINK KNOWING
THE PEOPLE THAT YOU KNOW AND PEOPLE IN YOUR
COMMUNITY, DO YOU THINK PEOPLE, WHAT’S IS TAKE TO GET
PEOPLE TO CHANGE THEIR DIETS WHEN THEY ARE HEALTHY
INSTEAD OF WHEN THEY GET TAUGHT BY DIETICIAN.>>I THINK PEOPLE ARE OPEN TO
GO HAVE A BETTER DOSTOEVSKY. STRANGE THING TO HAVE
HEALTH FOOD OR FOOD GOOD FOR YOU. NOW IT’S MORE COMMON PLACE. I THINK IT’S JUST TAKING
LONGER THAN IT SHOULD. THE CHANGE OVER. I THINK IT WILL HAPPEN. I DON’T THINK IT’S SO FOREIGN
ANY MORE.>>WHAT ARE YOUR THOUGHTS
ABOUT THAT? DIETICIAN IS NOT YOUR
SPECIALITY.>>NO. WE MADE SOME MAJOR
CHANGES ACROSS THE NATION IN TERM OF TOBACCO USE. AN THERE WERE A NUMBER OF
COMPONENTS TO THAT EFFORT. ALMOST VIEWER ASKING WHAT
TO WOULD TAKE FOR A GOVERNMENT TO CHANGE. THERE WOULD HAVE TO BE A
ENTIRE COMMUNITY, EDUCATIONAL PROCESS AND
CHANGING THE FINANCIAL ASPECTS OF WHAT KIND OF
THINGS WERE EASY TO GET AND WHAT KINDS OF THINGS WERE
TAXED.>>Daryl: WHERE DOES THE
PRESSURE COME FROM?>>PEOPLE HAVE TO WANT TO
BE WELL. I WANT TO MENTION SUCCESS
OF FARMER’S MARKET. WE OPERATE SEVERAL. ONE IN NANAKULI IS REALLY
CAUGHT ON. MAKING HEALTHY FOODS FRESH
FRUITS AND VEGETABLESES EASILY AVAILABLE AT A FAIR
PRICE. WE FOUND A WAY TO LINK THAT
IN WITH SOME OF THE FOOD PROGRAMS. THAT PEOPLE GET COUPONS TO
BE ACQUIRE. IF WE CAN DOUBLE DOWN AND
MAYBE THEY GET TWICE VALUE, IF THEY GET VEGETABLES AND
FRUITS AND THEY’RE THERE, ACCESSIBLE EASY TO GET TO, I
THINK WE CAN HAVE AN IMPACT.>>Daryl: YOUR THOUGHTS ABOUT
THAT?>>I THINK WE SHOULD START
WITH THE YOUNGER KIDS. WE’RE TRYING TO CHANGE OUR
PREFERENCES FOR HEALTHY FOOD WHEN WE’RE OLDER. IT’S A LOT HARDER.>>I’LL VOUCH FOR THAT. INTO THAT’S REALLY GOOD
POINT. IF THE PARENTS DO MANAGE TO
CHANGE, THAT WILL TEACH THE KIDS OF COURSE.>>YEAH. GOES HAND IN HAND.>>Daryl: EVERYTHING GOES
HAND IN HAND. THAT’S THE MESSAGE OF
TODAY’S SHOW. NOW PRETTY MUCH DONE. BEFORE WE SAY GOOD‑BYE. WE WANT TOLD YOU THAT IF
YOU WOULD LIKE TO SEE THE DATA COMPILED BY THE
CHANGE FRAMEWORK, GO TO HAWAIʻI FOR CHANGE.ORG. MAHALO TO ALL OF YOU AT
HOME FOR JOINING US TONIGHT. AND WE THANK OUR GUESTS ‑
MADELEINE HIRAGA‑NUCCIO‑SUICIDE
PREVENTION SPECIALIST WITH THE HEALTH DEPARTMENT ON
KAUAI RICHARD BETTINI, PRESIDENT
AND CEO OF THE WAI’ANAE COAST COMPREHENSIVE
HEALTH CENTER ERIC PAI, HEART TRANSPLANT
PATIENT AND LONGTIME HAIRDRESSER. AND DR. ANDREA HERMOSURA,
CLINICAL PSYCHOLOGIST AND ASSISTANT PROFESSOR AT THE
JOHN A. BURNS SCHOOL OF MEDICINE
NEXT WEEK ON ANOTHER SPECIAL EDITION OF INSIGHTS. WE CONTINUE OUR SERIES
“WHAT’S IT GOING TO TAKE?” BY
ASKING THIS QUESTION. DOES
HAWAIʻI HAVE THE WILL AND THE RESILIENCY TO BUILD A BETTER
FUTURE. WE HOPE YOU JOIN US
THEN. I’M DARYL HUFF FOR INSIGHTS
ON PBS HAWAIʻI ‑ A HUI HOU!