The Healthy Hawai‘i Initiative: insights from two decades of building a culture of health in a multicultural state

Abstract

Background: The Healthy Hawai'i Initiative was created in 2000 with tobacco settlement funds as a theory-based statewide effort to promote health-supporting environments through systems and policy change. Still active today, it is imbedded explicitly in a multi-sectoral, social ecological approach, effectively striving to build a culture of health before this was the name for such an ambitious effort. Methods: From interviews with key informants, we analyze two decades of the Healthy Hawai'i Initiative (HHI) in the context of the Robert Wood Johnson Foundation (RWJF) Culture of Health Action Framework (CHAF). We list HHI accomplishments and examine how the Initiative achieved notable policy and environmental changes supportive of population health. Results: The Healthy Hawai'i Initiative started with an elaborate concept-mapping process that resulted in a common vision about making "the healthy choice the easiest choice." Early on, the Initiative recognized that making health a shared value beyond the initial stakeholders required coalition and capacity building across a broad range of governmental and nonprofit actors. HHI coalitions were designed to promote grassroots mobilization and to link community leaders across sectors, and at their height, included over 500 members across all main islands of the state. Coalitions were particularly important for mobilizing rural communities. Additionally, the Initiative emphasized accessibility to public health data, published research, and evaluation reports, which strengthened the engagement to meet the shared vision and goals between diverse sector partners and HHI. Over the past two decades, HHI has capitalized on relationship building, data sharing, and storytelling to encourage a shared value of health among lawmakers, efforts which are believed to have led to the development of health policy champions. All of these factors combined, which centered on developing health as a shared value, have been fundamental to the success of the other three action areas of the CHAF over time. Conclusions: This evidence can provide critical insights for other communities at earlier stages of implementing broad, diverse, multifaceted system change and fills a key evidence gap around building a culture of health from a mature program in a notably multicultural state.

Partnerships and Community Engagement Key to Policy, Systems, and Environmental Achievements for Healthy Eating and Active Living: a Systematic Mapping Review

“…Only 11 of the 52 initiatives reported using a planning or evaluation framework, 3 of which used Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) ( 19 , 32 , 46 ). All other frameworks mentioned were used for a single initiative ( 20 , 29 , 31 , 36 , 38 , 39 , 62 , 72 ).…”

“…We organized HEAL interventions’ implementation and evaluation activities by the 7 I+PSE components ( Figure 2 ). Healthy eating (n = 24) ( 19 , 22 , 28 – 30 , 32 , 34 , 35 , 38 , 39 , 43 , 44 , 46 – 48 , 52 , 53 , 56 , 59 – 62 , 64 , 66 , 68 , 71 ) and HEAL (n = 23) ( 1 , 20 , 21 , 24 , 26 , 27 , 33 , 36 , 37 , 40 – 42 , 45 , 49 – 51 , 54 , 57 , 58 , 63 , 65 , 67 , 69 , 72 ) initiatives included many intervention and evaluation activities across the 7 I+PSE components, with an emphasis on activities addressing organizational policy (I+PSE component 5) and environmental changes (I+PSE component 6) as anticipated because of the nature of this review. Those that only focused on active living (n = 5) ( 23 , 25 , 31 , 55 , 70 ) also emphasized activities addressing organizational policy (I+PSE component 5) and environmental changes (I+PSE component 6), to the near exclusion of all other components.…”

“…Those that only focused on active living (n = 5) ( 23 , 25 , 31 , 55 , 70 ) also emphasized activities addressing organizational policy (I+PSE component 5) and environmental changes (I+PSE component 6), to the near exclusion of all other components. Only 12 interventions of any kind reported attempting to advance public policies and legislative activities (I+PSE component 7) ( 20 , 26 – 28 , 31 , 32 , 49 , 50 , 54 , 56 , 59 , 65 , 71 ). Interestingly for PSE-focused initiatives, 20 included activities directed at the individual behavior change level (I+PSE component 1) ( 24 , 26 , 27 , 34 , 35 , 38 , 39 , 41 – 44 , 46 , 47 , 53 , 56 , 58 , 59 , 61 , 62 , 68 , 69 , 71 , 72 ).…”

Osteoporosis treatment rates after hip fracture 2011–2019 in Hawaii: Undertreatment of men after hip fractures

“…According to 2018 census data, 25.6% of the individuals living in Hawaii identified themselves as being white, while 37.6%, 10.2%, 10.7% identified themselves as Asian, Native Hawaiian/Pacific Islander or Hispanic/Latino, respectively [ 15 ]. The health care system in Hawaii is uniquely characterized by strong health outcomes as compared to the rest of the United States, associated with relative longevity, low rates of uninsured patients, and good access to healthcare [ 4 , 16 ].…”

Anti‐racist approaches to increase access to general and oral health care during a pandemic in the Pacific Islander community

“…Due to the significant lack of state‐level prevention and public health infrastructure in Hawaiʻi to address health disparities that disproportionately affect PIs, the initiatives developed thus far have been led by community organizations such as non‐profits, churches, and social service providers 16,17 . In a summary report 18 that outlines 20 years of work by the Healthy Hawaiʻi Initiative, a multi‐sector, state‐wide public health collaborative, the following strategies were identified as integral in the successful targeting of health disparities among Native Hawaiian, Pacific Islander (PI), and Asian American populations: population‐based prevention focus, culturally based approaches, community‐clinical linkages, and the integration of prevention and treatment. The many barriers these patients face in accessing health care extends to dental care and there is a significant lack in prevention and public health infrastructure in Hawaiʻi to address oral health disparities that disproportionately affect PIs 16,19 …”