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Hawaii residents living in rural areas experience significantly more health problems than their urban counterparts, according to a first-of-its-kind report from the University of Hawaii Economic Research Organization (UHERO). The report, released on August 25, also found that the problems are even greater for rural residents with disabilities and those who live in poverty.
The data was collected through a survey of 1,571 residents, more than 20% of whom reported living in rural areas, in June 2023. The evaluation used data from the UHERO Rapid Survey, a twice-yearly health survey of Hawaii's general population cohort that has been conducted since 2022.
This is the first rural health report specific to Hawaii that measures data at the individual level.
Compared with those living in urban areas, rural residents reported poorer overall health and more days per week when their activity was limited by physical or mental health conditions.
The report was produced by UHERO and funded by UH's Rural Health Research and Policy Center (RHRPC) through a grant from the U.S. Department of Health and Human Services, Health Resources and Services Administration.
Key findings:
Rural residents reported being 43% less likely to perceive their overall health as very good or good compared to non-rural residents. Approximately 22% of rural respondents rated their health as fair or poor (21.7%, n=70), and less than 14% of non-rural respondents (14%, n=169) rated their health at this level. Rural residents reported that their physical health limited their activities an average of 3.8 days per week compared to 2.5 days in non-rural areas. Additionally, rural residents reported that their mental health limited their activities an average of 3.1 days per week compared to 2 days in non-rural areas. Having a disability and living in a rural area was associated with 2 more days per week of their physical health limited their activities compared to non-rural people with disabilities. Among Asians, good overall health (those who report their general health as very good, very good, or good) is higher than 70% of rural residents compared to over 80% of nonrural residents. Fewer than 40% of people living in rural households below the poverty line report good overall health compared to over 50% of nonrural residents. Native Hawaiians and Pacific Islanders (NHPIs) were more likely to be in the rural sample (23.1%) compared to 14.7% of those surveyed in nonrural areas, and NHPIs reported 1.1 more days per week affected by physical health problems compared to non-NHPIs.
This report examines several definitions of rural. The results above are based on the report's primary definition of rural, which includes all ZIP codes in the state except East Oahu, Kaneohe in the east to Kapolei in the west, Lihue on Kauai, Kahului-Wailuku on Maui, and Hilo and Kailua-Kona on the Big Island of Hawaii.
The University of Hawaii researchers noted that the report's findings suggest that policy responses aimed at improving health outcomes and access to preventive care should include efforts to reduce disparities between rural and non-rural populations. The findings also suggest that rural health policies should prioritize outreach to marginalized groups, particularly those with disabilities and low-income rural residents.
“This report helps explain how health outcomes differ between rural and urban areas and provides evidence upon which potential policy solutions can be based to address these challenges,” said Amy Grace, principal investigator at the Center for Rural Health Research and Policy and director of the University of Hawaii System Office of Strategic Health Initiatives.
UHERO is housed within the College of Social Sciences at the University of Hawai‘i at Manoa, and RHRPC is housed within the University of Hawai‘i System’s Office of Strategic Health Initiatives.
