Ethnic Makeup in Hawai‘i 

Total population of Hawai‘i was 1,248,807 in 1998. 

Hawai‘i’s Department of Health break down its population in 1998 is: 

Ethnicity Number of People Percent 

Unmixed (except Hawaiian) 688,747 60% 

Caucasian 252,320 22% 

Black 17,433 1.5% 

Japanese 208,653 18% 

Chinese 41,843 4.0% 

Filipino 146,380 12.7% 

Korean 13,728 1.2% 

Samoan/Tongan 8,390 >1.0% 

Mixed (except Hawaiian) 223,595 18% 

Hawaiian/Part Hawaiian 236,465 19% 

Correcting the Visions of Paradise 

By Stephen P. Jiang, ACSW


Closing the Gap, Pacific Islander Health • June/July 2000


Hawai‘i. The word alone conjures 

thoughts of beautiful beaches, 

aqua blue waters, and warm sunny 

days. The nation’s only island state, 2500 

miles southwest of California, is the most remote land mass in the world. Typically, visitors vacationing in Hawai‘i take home memories of resort locales such as Waikiki, Lahaina, 

or Kona. Visions of Hawai‘i created by media images and television shows such as 

Baywatch Hawai‘i perpetuate these stereotypes. 

What most visitors do not realize is that 

Hawai‘i is a rural state. Nearly 90 percent of 

the state’s land mass with 20 percent of the 

state’s population is federally designated as 

rural. The remaining 80 percent of the state’s 

population reside on the island of O‘ahu, 

where Honolulu, the state’s only urban center, is located. 

All seven of Hawai‘i’s other islands are 

rural. These communities face many problems common to all rural areas, with the additional challenges of allocating resources to 

distinct island populations. 

Misconceptions about Hawai‘i tend to 

blind policymakers to the state’s health issues, especially challenges faced by Hawai‘i’s 

rural residents. “We have to get policymakers 

to realize that they cannot think of Hawai‘i 

based on their last vacation. The state’s rural 

health issues are real and unique,” said Kirk 

Lange, health planner in the Hawai‘i State 

Office of Rural Health (SORH). 

Health care resource allocation represents 

one such problem. While a significant number of residents live in rural Hawai‘i, the state’s 

health care resources are concentrated primarily in Honolulu. As a result of the imbalance 

of resource allocation, six of the of the state’s 

eight primary care health professions shortage areas (HPSA), all seven of its dental 

HPSAs, and all of its four mental health 

HPSAs are on neighbor islands. 

Access to adequate care is made more 

difficult on the neighbor islands because the 

only means of transportation between islands 

is by plane. “Neighbor island 

residents traveling to Honolulu 

pillars of Hawai‘i’s economy, were all negatively impacted by downturns in the American and Asian economies. Hawai‘i’s rural hospitals have been hurt financially by the state’s 

economic downturn, as well as by cuts in 

federal reimbursements mandated by the Balanced Budget Act of 1997. Heightened unemployment and underemployment have reduced coverage by Hawaii’s much touted employer mandate for health insurance coverage. 

SORH is meeting these unique rural island needs through a number of efforts. 

SORH is implementing the Critical Access 

Hospital program to help maintain access to 

hospital care in rural areas. To build community-based economic development capacity, 

SORH is undertaking efforts to replicate the 

federal Office of Rural Health Policy/ USDA 

Operation Rural Health Works project. All 

of these efforts are being directed by a statewide comprehensive rural health plan, currently being developed in partnership with 

the state’s dynamic rural health association. 

SORH is also working with the Hawai‘i 

State Primary Care Association, the State Primary Care Office, and Hawai‘i’s Area Health 

Education Centers to remedy health professional shortage problems through various recruitment and retention efforts. 

Key programs include the Native 

continued on page 2>>>> 

in search of care typically spend $100 for 

round trip airfare, ground transportation and 

maybe lodging,” according to Valerie Yin, 

director of the SORH. Furthermore, there 

are no reliable means of public transportation on neighbor islands, so even access to 

local care is difficult. 

Transportation issues and isolation also 

make it hard to attract and retain health professionals in rural Hawai‘i. As in other rural 

states, most health professionals choose to live 

and practice in urban areas rather than in 

rural communities. 

While Hawai‘i has long enjoyed a reputation as a state with many positive health 

status indicators, the state still faces a number of health issues. The rates of suicide, hepatitis A and C, measles, mumps, rubella, 

chronic and binge drinking, cancer, diabetes, and obesity are examples of key health 

status indicators that are worse in Hawai‘i 

than the U.S. average. In most cases, Native 

Hawaiians and other Pacific Islanders have 

the worst health indicators in the state. Of 

special concern, Hawai‘i has the worst tuberculosis indicators in the nation. 

Hawai‘i’s poor economic health has exacerbated its health needs. While the 

economy has been surging in the continental U.S., Hawai‘i is still struggling. During 

the 1990s, agriculture, tourism, and military support, the three 

Office of Minority Health Resource Center 1 U.S. Department of Health and Human Services 
Correcting the Visions of Paradise 

By Stephen P. Jiang, ACSW


Closing the Gap, Pacific Islander Health • June/July 2000


Hawaiian Health Scholarship Program (NHHSP), the J–1 visa waiver 

program, and the National Health Service Corps. The NHHSP is 

designed to recruit Native Hawaiian students who are required to 

serve in predominantly Native Hawaiian communities. 

Yin concludes that raising education and awareness about rural 

health issues is also a critical part of her office’s plans. “People whose 

perception of Hawai‘i is based on media mistakenly assume all is well 

in Hawai‘i. A great deal of education has to be conducted to eliminate 

the stereotypes that divert attention from the health care needs in 

Hawai‘i in general, and rural Hawai‘i in particular,” she said. 

For more information, contact SORH at 808-586-4188. 

Mr. Jiang is a Planner for the State Office of Rural Health, Hawai‘i 

State Department of Health.

Office of Minority Health Resource Center 2 U.S. Department of Health and Human Services