Hawaiʻi’s health perceptions declining: New survey reveals widening disparities

Hawaiʻi residents are reporting a decline in their own health outlook and face escalating barriers to care, according to a new statewide survey released Wednesday. The University of Hawaiʻi Economic Research Organization’s Rapid Health Survey reveals widening healthcare disparities are disproportionately affecting Native Hawaiian, Pacific Islander, and low-income communities across the islands.

Launched in 2022, the study tracks over time more than 2,000 adults in Hawai‘i. It completed its fourth major study of this same group of individuals in December 2024. The latest findings show a decline in self-reported physical health, persistent mental health challenges, and escalating barriers to healthcare access.

Falling rates of those reporting “excellent or very good” health

Only 40% of Hawaiʻi adults rated their health as “excellent or very good” at the end of last year. This is a 4 percentage point drop from 44% in mid-2023. This also marks a stark 43 percentage point decline from a year prior, when 83% of adults reported “good or better health.”

The decline was even more dramatic among Native Hawaiian and Pacific Islander respondents and those below the poverty line. Their “excellent/very good” health ratings fell from 40% to just 23% in 18 months.

Mental healthcare needs persistent and rising

Mental health challenges continue to be a significant concern across Hawai‘i. The UHERO Rapid Health Survey found 31% of all respondents reported symptoms of depression, with 4% experiencing severe symptoms. These rates were highest among young adults aged 18–34, as well as Native Hawaiian, Pacific Islander, Filipino, and low-income groups, with a notable 10% of low-income individuals reporting severe depressive symptoms.

Maui Wildfire Exposure Study

Adding to these statewide findings, a separate UHERO study specific to Maui highlights the mental health impact of the August 2023 wildfires. The UHERO Maui Wildfire Exposure Study, completed May 15, 2024, found a “notable increase in depression” among Maui residents compared to before the disaster.

More than half of those surveyed reported symptoms of depression — significantly higher than state and local averages. The study also revealed about 30% of Maui participants experienced symptoms of moderate or severe anxiety, along with elevated levels of low self-esteem (35%) and suicidal thoughts (4.4%), underscoring severe mental health challenges for wildfire survivors. It found that “exposure to smoke, ash and debris is not associated with mental health outcomes, suggesting that mental health effects are affecting a broader population of survivors beyond people who have been physically exposed.”

Access to mental healthcare

Access to mental healthcare has become increasingly difficult, with the proportion of adults missing needed mental health care growing from 5% in mid-2023 to 22% by late 2024. This trend was consistent across all ethnic and income groups, with young adults aged 18–34 experiencing the most significant jump to 39%.

Beyond mental health, the survey found widespread barriers to healthcare access. Provider availability (79%) and cost (49%) were the most frequently cited obstacles to physical healthcare. For mental health care, 68% of respondents said they experienced barriers to therapy, 50% to psychiatrists, and 31% to urgent care services.

Food insecurity highest among most needy

Food insecurity remains a persistent challenge for a substantial portion of the population, with nearly 30% of adults reporting low or very low food security. This burden disproportionately affects Native Hawaiian, Pacific Islander, Filipino, and low-income groups. For those living near or below the poverty line, only 33% reported being food secure.

Widening disparities reflect systemic problems

The UHERO Rapid Health Survey’s executive summary concludes that these widening disparities in health, access to care, and basic needs like food and housing, particularly among Native Hawaiian, Pacific Islander, Filipino, Hispanic, and low-income communities, are systemic problems.

“These inequities are not isolated; they stem from systemic barriers that demand coordinated, equity-driven action,” the executive summary says. “Addressing them requires targeted investments in community-based mental health services, culturally competent healthcare providers, and expanded access to both primary and dental care — especially in underserved rural and outer islands.”

To build a more resilient and equitable Hawai‘i, the summary emphasizes the need to tackle the structural roots of health disparities. The report recommends investing in affordable housing, strengthening local food systems, creating pathways to stable employment, and sustaining real-time data systems like the UHERO Rapid Health Survey to guide public policy.

“Above all, we must ensure that solutions are developed and implemented in partnership with communities most affected,” the summary says. “Building a healthier Hawai‘i is not only a policy imperative — it is a shared responsibility.”

UHERO’s interactive dashboard, accompanying the report, provides a platform for policymakers and stakeholders to take a deeper dive into survey trends across various demographic subgroups.