Each year, Hawai‘i receives top marks among various state health rankings. We should be proud of that recognition, and of the policies that helped put us there, including the Prepaid Health Care Act, Medicaid expansion, and support for organized labor. But good health isn’t just a result of having health insurance. The status of our health is determined largely by socioeconomic factors (40 percent) and healthy behaviors related to these factors (30 percent), such as access to nutritious, affordable food, and having the time and a safe place to exercise. The remaining factors are housing and transportation (10 percent), genetics (10 percent) and clinical care (10 percent).

Research has shown that “health” is correlated with income and wealth equity, decent housing, and education, from preschool through college. With those factors in mind, Hawai‘i’s current economic trends may not keep our residents in the best of health.

Hawai‘i’s cost of living is the highest in the nation with a “regional price parity” of 118.4 percent of the national average. Hawai‘i is tied for second in the nation in the percentage of cost-burdened renters: 46.4 percent of renters here pay 35 percent or more of their income toward rent.




Income growth in Hawai‘i over the past 25 years has failed to touch lower-income workers. Only the top 20% of earners have gotten ahead.














The amount of money required to cover a bare-bones “survival budget” for a family of four has increased by 20 percent.














The gap between wages and costs has widened because the jobs created in Hawai‘i are disproportionately low-wage jobs. Hawai‘i wages, on average, are 10% lower than the national average.


















People with more education earn more money.












But only 33% of jobs projected for 2020 will require a bachelor’s degree or higher.















And there are big differences in who has college degrees. In part, it’s because a college education is expensive. 47% of Hawai‘i college graduates in 2015 left school $24,554 in debt. Lower-income students may not be able to stay in school and earn a degree, and this helps perpetuate the income gaps between groups. As for getting an educational head start, average preschool costs in Hawai‘i are the highest in the nation as percent of median income for couples. This is, in part, because Hawai‘i is last in nation in access to public preschool (only 2% of 4 year-olds in 2015-16).















Good policies can help reverse these trends

Here are six well-researched programs and policies proven to strengthen family economic security and, with it, better health outcomes. Some are in place here, others could be improved upon, and several need significant work here in Hawai‘i.

  • Earned Income Tax Credit (EITC) – A $1,000 increase in EITC benefits results in better test scores, better likelihood of high school graduation and college enrollment, reduced stress and sick leave, and fewer low-birth weight babies. Hawai‘i’s state EITC went into effect in 2018. This good start needs to be turned into a refundable tax credit, as it is on the federal level and in many other states.
  • Supplemental Nutrition Assistance Program (SNAP) – Participation decreases metabolic syndrome and results in better educational outcomes and less dependency on public benefits. Hawai‘i has done a good job of increasing participation in this important food program in recent years.
  • Quality preschools – Attending quality preschool results in better lifelong educational and economic prospects. Hawai‘i has a long way to go to ensure access to good quality preschools that are available and affordable to all families. It is important for us to greatly expand and fund public preschools across the state.
  • Paid sick leave – Ensuring that all workers can take time off when ill increases economic security, reduces ER use for primary care, and helps contain the spread of communicable diseases.  Hawai‘i does not require employers to provide paid sick leave but we should. The people who are not currently protected with paid sick leave are usually those least able to make ends meet without a full paycheck.
  • Housing First – This program helps get people into housing, reduces hospital admissions, improves physical and mental health, and increases access to treatment for substance use. Housing First has been successfully linking homeless people in Hawai‘i to housing since 2014 through public-private partnerships.
  • Transitional Jobs – Access to work improves physical and mental health, better birth outcomes and child health, and reduces domestic violence. The Transitional Jobs program in Hawai‘i is a successful program that could be expanded to meet more local employers’ needs. It is coordinated by the state Workforce Development Council.