Lt. Gov. Josh Green discussed health care in Hawaii during the 2019 Hawaii Comprehensive Cancer Coalition Summit on Wednesday at the Grand Naniloa Hotel in Hilo.
Green was one of several speakers during the summit, the purpose of which was to bring together stakeholders to discuss issues related to cancer prevention, early detection, treatment and survivorship in Hawaii and highlight state and cancer control priorities.
“First of all, in Hawaii, the state of health care is exceptional in many ways and challenging in many ways,” Green, a Big Island physician, told the crowd. “Year after year, we are now the healthiest state in America, which is a testament to the hard work that our public health care workers do, our health care system, our doctors and nurses and so many people who believe in access. So we’re No. 1, and we sometimes wonder to ourselves, ‘how can that be?’ because we also have so many needs at the same time.”
According to Green, Hawaii often tops health rankings because the state does better than others in terms of covering people.
“Almost everyone has health care coverage and that’s a blessing,” he said. “So we can prevent certain things, and we can help people with their blood pressure issues and diabetes and many issues, and we cover people for their cancer treatment. However, the other side of the coin, of course, is do we have enough health care providers, and that is an incredible challenge for us.”
Green spoke about arriving on the Big Island in 2000 and the need he saw as a rural health care provider in Ka‘u.
One individual was diagnosed with lung cancer based just on a physical exam, he said. Further care was also a challenge because of the limited number of oncologists and the patient didn’t have the resources to get to Hilo for further exams.
“So we have challenges,” Green said. “So, though we have about 7,000 individuals who will be diagnosed each year with cancer, and about 2,200 will die, we have so many other people” who might not be able to be diagnosed.
Hawaii’s health disparities are well documented, he said.
“Health disparities usually result from poverty. Sometimes they result from ethnicity also and that is a challenge for us here in Hawaii … ,” Green said.
Green said Hawaii has a 20% shortage in all health care disciplines throughout the state, but the farther away from Honolulu that number doubles, which means the Big Island, Kauai or Maui tend to have a 40% shortage of health care professionals.
“So that makes it essentially twice as difficult to find a provider — nurse practitioner or (physician assistant) or doctor — at any given time,” he said. “Combine that with the fact that some disciplines just don’t exist at all, or they can’t sustain them, like neurosurgery, on the Big Island.”
Some cases have a full team, Green said, “so we have to transport ourselves over to Oahu or other islands. So these challenges are magnified, and that means that there are times when we aren’t able to diagnose people.”
In addition to shortages of providers and economic and ethnic disparities, “we also know that … ZIP code is more telling than your genetic code now, in many places in the country,” he said. “So if you are a child that lives in the ZIP code where Waianae is or Ka‘u is, the likelihood is you will have a much greater difficulty living a healthy, long life than if you live in say the ZIP code of Kailua or Kohala, where you have a lot more affluence and there’ll be a lot more physicians per square mile.”
Green said new initiatives are needed to address poverty and ethnic disparities.
“We need a mission where we can constantly bring oncologists and fellows and screening to our community, and we know this because we’ve been dealing with this problem for a very long time,” he said.
Green also spoke about a recent two-day medical mission to Samoa that took a team of health care workers — including Green, who coordinated the effort — to administer measles vaccinations to thousands of Samoan residents.
“We knew that aloha was strong, we just didn’t know it would be fast,” he said about the quickly organized mission, garnering laughs from the audience. “… And so I guess I’ll just wrap up by saying our commitment to solving our cancer crises in Hawaii will be strong, and we will also try to make it as fast as we can, for all those we love who want to get care, who want to get screened …”
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