The Healthy Hawai‘i Strategic Plan 2030: A Roadmap for Preventing and Managing Chronic Disease and Envisioning a Healthy and Equitable Future

Abstract

In June 2021, over 200 stakeholders, advocates, and visionaries gathered to launch the Healthy Hawai‘i Strategic Plan 2030 (HHSP), a 10-year strategic plan for improving the health of Hawai‘i residents by preventing and reducing chronic disease and advancing health equity. The HHSP is a guide to enable coordination across common risk factors, program areas, interventions, and strategies for chronic disease prevention and control. Developed during the COVID-19 pandemic, which revealed major areas of susceptibility in our health system infrastructure and magnified existing disparities, the HHSP prioritizes health equity and strives to create sustainable change to transform communities, schools, health care and worksites to support the health of the people of Hawai‘i. The HHSP is a living document and partners – present and future – are invited to work together to achieve a healthier future for the people of Hawai‘i.

The HHSP is available in an interactive format and can be downloaded at: www.HHSP.hawaii.gov

Chronic Disease and Obesity in Hawai‘i

In Hawai‘i, chronic diseases are among the most prevalent, costly, and preventable of all health problems. The past two decades have seen unprecedented increases in chronic disease and obesity due to pronounced changes in the environment, behavior, and lifestyle. Almost two- thirds of Hawai‘i residents are living with at least 1 chronic condition such as diabetes or heart disease, which diminishes their overall health and puts them at risk for severe illness from COVID-19.¹

The annual costs of chronic diseases in Hawai‘i are projected to be $9 billion in direct medical costs and an additional $3.2 billion in indirect costs due to lost employee productivity (average per year 2016-2030).² If the current trend continues, by 2030 the projected cost per Hawai‘i resident would be $8300 per year.³ The COVID-19 pandemic underscores the need for investing in chronic disease prevention, and innovative policy, systems, and environmental change that will impact health and health equity in Hawai‘i. People of any age with chronic diseases, underlying medical conditions, and those who smoke are at increased risk for severe illness from COVID-19. A 2021 study in the Journal of the American Heart Association attributes two-thirds of U.S. COVID-19 hospitalizations to obesity, diabetes, hypertension, and heart failure.⁴

Most chronic diseases can be prevented by eating well, being physically active, avoiding tobacco, and getting regular health screenings.⁵ Tobacco use is the single most preventable cause of death and disease, followed by physical inactivity and poor nutrition.⁶_⁷ These 3 risk factors are major contributors to the development of chronic diseases such as asthma, diabetes, many types of cancer, and heart disease and stroke.⁸

A Coordinated Plan to Address Chronic Disease and Obesity

From May 2019 – May 2021, partners across the state came together to develop the HHSP. Prior to the HHSP, individual program area plans outlined objectives and strategies for each risk factor and chronic disease. Recognizing the opportunity to improve collaboration and better leverage resources and efforts, leaders and stakeholders decided that a single, coordinated plan to prevent and reduce chronic disease would be developed and encompass the following program areas: Asthma, Cancer, Diabetes, Heart Disease and Stroke, Physical Activity and Nutrition, and Tobacco. The HHSP belongs to all the existing partners that developed the coordinated plan and those who join in achieving the objectives.

Community engagement and ownership begins at the formative stage. The HHSP Advisory Group with representation from across program areas and societal sectors provided recommendations on the vision, structure, and process for developing and introducing the plan. Stakeholder working groups were convened by program areas and labored over the course of 2 years to develop objectives and strategies.

Moving to a harmonized planning approach and consistently embedding the social determinants of health in the plan enables coordination of multiple programs across common risk factors, interventions, and strategies. It also facilitates the expansion of evidence-based policies, programs, and services, and keeps Hawai‘i in step with national funding requirements, recommended strategies, and best practices that combine multiple health areas and address the spectrum of chronic disease.

The HHSP also supports and reinforces the following comprehensive, chronic disease prevention and management strategic plans for the state:

• Hawai‘i Asthma Plan 2030

• Hawai‘i Cancer Plan 2030

• Hawai‘i Diabetes Plan 2030

• Hawai‘i Heart Disease and Stroke Plan 2030

• Hawai‘i Physical Activity and Nutrition Plan 2030

• Hawai‘i Tobacco Prevention and Control Plan 2030

Overview of the Healthy Hawai‘i Strategic Plan

The HHSP contains 58 objectives that strive to create sustainable change across our communities, schools, health care systems, and worksites to support the health of the people of Hawai‘i. The HHSP Advisory Committee, along with a wide range of stakeholders from across the state developed the HHSP objectives utilizing a common framework. All objectives incorporate principles of the Social Ecological Model and are organized into four sector areas representing the social determinants of health: Community Design and Access, Education, Health Care, and Worksite. The plan prioritizes goals, objectives, and strategies that lead to policy, systems, and environmental change. Objectives were developed using current data, best practices, and evidence-based science, and reflect one or more cross-cutting themes. The HHSP is meant to be a living document that is reviewed and updated throughout the plan’s timeframe.

Sector-based objectives of the HHSP include:

• Communities with wider sidewalks and bike lanes that make walking and rolling to work easier and safer;

• Parks and beaches that are smoke-free and well-maintained;

• Chronic disease self-management classes conveniently located at worksites, schools, pharmacies or through telehealth;

• Safeguards that keep vaping products out of the hands of youth; and

• Sun protection guidelines in schools to lower the risk of skin cancers as keiki grow up.

The HHSP objectives and strategies can be found at: www.HHSP.hawaii.gov

Focus on Priority Populations and Achieving Health Equity

Hawai‘i is one of the most diverse states in the nation. The state’s main population groups are Native Hawaiians, Japanese, Chinese, Filipinos, Other Pacific Islanders, and Caucasians. Hawai‘i has a larger percentage of Native Hawaiians, Other Pacific Islanders, and multiracial subgroups than the rest of the country. Non-Caucasian minorities, including large immigrant populations from Asian and Pacific Islander nations, comprise 74% of the population.⁹ Although Hawai‘i has consistently placed a high value on providing accessible, top quality health care for all, health disparities between population groups exist.

Numerous social, economic, and environmental factors influence the health of individuals and populations. For example, people with a quality education, stable employment, safe homes and neighborhoods, and access to high-quality, preventive health services tend to be healthier throughout their lives and live longer. Conversely, people with behavioral health disorders, those identifying as a sexual and gender minority including lesbian, gay, bisexual, transgender, queer and/or questioning (LGBTQ), or persons of low socioeconomic status, often face inequitable health outcomes. Where you live directly affects your health in a number of ways, from the accessibility of healthy food, to the availability of green space to be physically active, to access to primary health care. In Hawai‘i, life expectancy ranges by zip code from 73 years to 87 years, a 14 year difference.¹⁰ Inequity is also found across ethnic and non-English speaking communities. Native Hawaiians, Pacific Islanders, and Filipino population groups concomitantly face the greatest disparities in health outcomes from chronic disease. The COVID-19 pandemic and climate change are bearing out the disparate vulnerabilities across communities in Hawai‘i.

The HHSP recognizes and prioritizes the importance of addressing health equity and priority population groups that are more likely to experience poor health outcomes. Research suggests social determinants of health may be the most important factors in health outcomes and health equity. To ensure that individuals and communities across the state achieve their full health potential, the HHSP addresses social determinants of health domains such as education; health care and quality; and neighborhood and built environments. The plan also provides insights on population characteristics, disease data and trends, and existing health inequities. Communities that are most vulnerable or more likely to experience disparities have been identified and prioritized. Work will continue with organizations representing priority populations to identify objectives and develop action plans specific to priority communities.

Implementation and Next Steps

The HHSP Advisory Group and program area stakeholder groups are meeting regularly to ensure implementation of the plan’s objectives and strategies, and to monitor and evaluate progress. Data trackers are currently being developed to monitor performance and progress of the HHSP and program areas. The HHSP was launched online and designed to be a dynamic public-facing document that is assessed and updated throughout the plan’s timeframe. HHSP partners will be invited to meet every other year to assess and monitor progress and make any needed adjustments to objectives and the plan. Stakeholder group membership is expected to expand to assure an inclusive, community-based participatory approach to realize the plan’s goals.

Partners

The work of the HHSP is led by the Hawai‘i State Department of Health, Chronic Disease Prevention and Health Promotion Division (CDPHPD). CDPHPD promotes health and reduces the burden of chronic disease by empowering communities, influencing social norms, and supporting and encouraging individuals to make healthy lifestyle choices. CDPHPD utilizes an integrative and coordinated approach to assemble and unite partner agencies statewide to build a shared vision, implement strategies, and secure resources that will improve the health of the people of Hawai‘i. Contributions of time, energy, resources, and expertise are provided by the following:

Advisory Group Members

The HHSP Advisory Group members are partners from across the state who provide input on the vision, purpose, and development process of the plan. Thank you to these respected leaders who offer valuable advice and expertise. A list of the Advisory Group member can be found on the HHSP website.

Program Area Partners

Thank you to the numerous individuals and organizations who contributed to the development of this plan. These diverse and esteemed partners are listed in the program area chronic disease prevention and management plans for the state.

Figure 1.

HHSP Vision, Mission, and Goals