Public Health Hotline

The Hawai‘i State Department of Health (DOH) is a large and multifaceted agency with a broad mandate to monitor, protect, and enhance the health and environment of our state. Our areas of responsibility include behavioral health, environmental health, health promotion and wellness, disease outbreak and control, oral health, infectious disease management, and primary prevention for people of all ages, ethnicities, and communities on every island. At the start of a new administration, the most common questions asked are: What is your vision? What are your priorities for the Department of Health? How do you leverage your resources to improve health status? I am pleased to announce our departmental strategic plan, Foundations for Healthy Generations, which will align our efforts to address five priority areas: health equity, disease prevention and health promotion, public health emergency preparedness, clean and sustainable environments, and quality and service excellence. Initiatives and objectives outlined in the plan serve as the platform to measure progress and improvements in the health status of the people of Hawai‘i. The priorities are responsive to the current health challenges of our state and nation, based upon a public health theory of change, and grounded in evidenced-based practice.

Health Equity

Health Equity is central to a quality and high performing health care system. Vulnerable populations, such as those lacking in health care coverage, low-income families, racial and ethnic minorities, and rural and isolated communities are at an ever increasing risk for poorer health outcomes than the rest of society.¹ The World Health Organization states the aim of establishing health equity is to reduce or eliminate health disparities that result from “factors which are considered to be avoidable or unfair.”² Inequities are often systematic in the health care system or predicated upon the social determinants of health.³ The distribution of disease can often be traced backed to injustices based on race, class, gender, religion, immigration, sexual orientation, and stigma.⁴ Nationally, and in Hawai‘i, there are significant disparities in key health indicators: infant mortality, life expectancy, and rates of preventable disease. For example, Hawaiian mothers have higher rates of unintended pregnancies, late prenatal care, and poor birth outcomes.⁵ Native Hawaiians are five times more likely to experience diabetes between the ages of 19–35, and have the highest cancer mortality rates.⁶ The Department of Health will provide the leadership at the governmental level to ensure that health equity and the social determinants of health are addressed at policy and programmatic levels.

Disease Prevention and Health Promotion

Hawai‘i and the nation have seen health care costs increase dramatically over time. The United States spends more on healthcare than any other country, mostly to treat preventable and non-communicable diseases such as cardiovascular disease, hypertension, and diabetes. Despite this enormous expenditure, we continue to see unprecedented rates of chronic disease in children and adults. For the first time in over 200 years, today's children may expect a shorter life span than their parents.⁷

Current societal norms and practices encourage lifestyle and behavioral choices that often result in preventable conditions such as obesity and cancer.

Financial, housing, and interpersonal stress often influence unhealthy habits like smoking, alcohol and substance abuse, and passive forms of entertainment. Our environment, both natural and built, affects our choices for physical activity and can worsen rates of diseases such as asthma and cancer. Unless significant societal changes are made, chronic disease will become an unsustainable burden for future generations. To assure the health of future generations we must take a concerted and systemic approach to address the myriad factors which influence health behaviors at a societal level.

Public Health Emergency Preparedness

Events like Hurricane Katrina, September 11th and the H1N1 influenza outbreak have redefined public health and the need to improve departmental response to natural and man-made disasters. While we have made significant investments to upgrade our capacity to prevent disease and respond to public health emergencies, resources are lower than the projected need.⁸ With Hawai‘i being one of the most isolated places in the world, it is especially critical that our department forge collaborative relationships with the state's health care system and community volunteers to assure timely response at the county and state levels. We need to continue to increase our departmental capacity to prepare for all-hazards emergencies and ensure that tools are in place for a robust public health response across the state, especially as new threats emerge. Critical to this effort is a well-trained workforce, biosurveillance infrastructure, epidemiological expertise, improved public health laboratory capacity, and maintaining a volunteer Medical Reserve Corps. We will continue to enhance our technology to improve emergency communication between our department, hospitals, the State Civil Defense, county level response teams, and other responders. Being prepared saves lives and protects the health of our community as well as that of the emergency responders. With a focus on emergency preparedness, response, and recovery, the department is committed to increase our capacity to address a wide spectrum of threats and to preserve and protect our families and our environment.

Clean and Sustainable Environments

Clean air, soil, water, and a safe source of food are fundamental to assuring the health of communities. In addition, Hawai‘i is renowned for our pristine environment, clean air and clear waters. Our way of life, economic sustainability and public health all depend on preserving these gifts of nature. Foundations for Healthy Generations will emphasize the issues of environmental justice; no community because of its social, cultural, or economic status should bear a greater burden of impacts from regulated industries or facilities. While protecting our air, land, and water from harmful pollutants, we will also focus on improving our business processes by implementing electronic permitting to promote both environmental and economic sustainability. If harmful oil or chemicals are spilled or discovered, we will be ready to immediately respond and oversee their appropriate and immediate clean up. Consolidation of the vector control and food safety programs will increase our ability to prevent food-borne and vector-borne illness. In light of global threats ranging from a tsunami's destruction of nuclear facilities to international terrorism, our radiological response team will remain on alert for any harmful contamination. Among all the complex public health challenges that our department faces, assuring a clean and sustainable environment remains an important pillar built on a solid foundation of service and the sacred trust of our people.

Quality and Service Excellence

Government is often viewed as inefficient, unresponsive, and costly. Foundations for Healthy Generations answers Governor Abercrombie's call to transform government with strategies that maximize tax payer return on investment, customer satisfaction, and public health impact.

Our Performance Improvement Initiative will identify and integrate the best practices of management science into public administration, and establish a business culture committed to the principles of Continuous Quality Improvement and customer service. We will improve government transparency and public confidence by implementing online performance report cards on our public health activities and business operations. This initiative will culminate with our application for full national accreditation by the Public Health Accreditation Board, a credential that will distinguish the Hawai‘i Department of Health as a center of public health excellence and leadership.

Foundations for Healthy Generations will drive the public health system to achieve fundamental, cost-effective, and sustainable improvements in health status that will improve outcomes and reduce long-term cost. Our strategic plan harnesses the department's expertise in behavioral health, environmental health, and public health to advance proven and promising practices such as promotion of healthy life choices, family and care-giver support, strengthening the safety net, and assisting individual and family decision-making. Through this initiative we aspire to influence key drivers of social determinants of health such as tax policy, built and natural environments, economic development, education and human services, housing and transportation, and natural resources.

Foundations for Healthy Generations connects with people across the lifespan, starting with preconception and perinatal health, through childhood and adolescence, and on to adulthood and the senior years with approaches appropriate to the unique and rich diversity of populations in Hawai‘i.

Over the next few months you will learn more about each of the five pillars of the department's Foundations for Healthy Generations. The strategic plan is available online at http://hawaii.gov/doh/strategicplan. We will seek your guidance and expertise as we implement the plan, because reaching the department's vision of “Healthy People, Healthy Communities and Healthy Islands” can only be achieved through strategic partnerships and leveraging our resources. Our future descendants deserve nothing less.

Together with deliberate thought and action, let us create a legacy of sustainable islands, with lifelong health and wellness for generations to come. ‘A‘ohe hana nui ka alu‘ia, no task is too big when done together by all.⁹

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