Sorry - premature send. Here's what I meant to say: Yes - and Hawaii is a distinct outlier in Kawachi / Kennedy / Subramanian publications related to several ways of looking at socioeconomic position (e.g., income) inequality and health related outcomes (mortality, self-rated health, etc.) in multi-level analyses of US states. Yet, if one breaks that down to subgroups in the population, race & ethnicity still do matter. Here is where Hawaii's specific context and social history of Hawaiian dispossession and sovereignty loss, successive waves of immigrant labor recruitment (which group came when to do what), etc. become important. (see later works, e.g., Subramanian SV, Kawachi I. <http://www.ncbi.nlm.nih.gov/pubmed/16338630?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum>Whose health is affected by income inequality? A multilevel interaction analysis of contemporaneous and lagged effects of state income inequality on individual self-rated health in the United States. Health Place. 2006 Jun;12(2):141-56. Epub 2005 Jan 18. PMID: 16338630 <http://sfx.hul.harvard.edu/sfx_local?__char_set=utf8&id=pmid:16338630&sid=libx:hul.harvard&genre=article> Also, besides a somewhat better public policy on health insurance coverage and access to health care (more inclusive), Hawaii is also distinct in having a public education system founded by the sovereign nation of Hawaii (when it was a democratic, representative parlimentary government with a popularly elected lower House). It has always been funded not from local property taxes, but from the central government. In US state public education system rankings Hawaii gets an "A" for equality of public education support/funding across the state. -- Alice Furumoto-Dawson PS: disclosure - I'm originally from Hawaii, so I'm not a disinterested party. -------- Original Message -------- Subject: Re: [SDOH] Fwd:Re: [SDOH] -Any articles/infor will help Date: Thu, 03 Jul 2008 15:54:56 -0500 From: Alice Furumoto-Dawson <[log in to unmask]> Reply-To: [log in to unmask] Organization: University of Chicago - CIHDR To: Social Determinants of Health <[log in to unmask]> References: <[log in to unmask]> <[log in to unmask]> <[log in to unmask]> Yes - and Hawaii is a distinct outlier in Kawachi / Kennedy / *Subramanian SV* <http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Subramanian%20SV%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus>, Ann Pobutsky wrote: > Diana: > > Hawaii did pass the Prepaid HealthCare Act (1980's) which required > employers to provide health insurance to employed people working more > than 20 hours per week...so Hawaii does have higher health insurance > coverage compared to many other states. > > But this all depends on the economy and when we have setbacks (like > right now and in the 1990's), you find the uninsured rate going up > (employers hire more part-timers etc). > > The kids in Hawaii are all basically covered in the CHIP-Children's > Health Insurance Program (Medicaid). > > But having health insurance doesn't stop the disparities....we have > on-going and persistent disparities (premature mortality) among > (espeically) Native Hawaiians and other Pacific Islanders, Filipinos, > low SES folks and rural areas...biggest mediating factor is > socio-economic circumstances. > > Our state chronic disease rates are low when comparing nationally > (.e.g. we are in the top 5 states along with Colorado etc. for lowest > obesity rates) but once you start to get in to the details, the > disparities start to emerge Big Time. > > So mandating employers to pay doesn't cover everyone because of the > loopholes and having insurance and 'access to care' doesn't eliminate > disparities. > > Ann P. > > ----- Original Message ----- > From: Diana Liu <[log in to unmask]> > Date: Tuesday, July 1, 2008 4:31 pm > Subject: Re: Fwd:Re: [SDOH] -Any articles/infor will help > To: [log in to unmask] > > > My understanding is that Hawaii has Statewide Universal Health > Care. Do you see a decreased health disparities compared with other > States? It would be very interesting to hear your experience. > > > > > Date: Tue, 1 Jul 2008 14:43:22 -1000 > > From: Ann Pobutsky <[log in to unmask]> > > Subject: Re: [SDOH] -Any articles/infor will help > > To: [log in to unmask] > > > HELP-does anyone have any articles/information I can use to > combat the idea that access to care will eliminate health disparities. > > > Is there some peculiar focus in the U.S. on 'access to care' as > the 'solution'? > > > Ann M. Pobutsky, PhD > > Chronic Disease Epidemiologist > > Community Health Division > > Hawaii State Department of Health > > 1250 Punchbowl St., Rm. 218 > > Honolulu, HI 96813 > > email: [log in to unmask] > > phone: (808) 586-4485 > -- Alice Furumoto-Dawson, Ph.D. Sr. Research Associate Center for Interdisciplinary Health Disparities Research Institute for Mind & Biology University of Chicago Chicago, IL - USA Email: [log in to unmask] http://cihdr.uchicago.edu/ -- Alice Furumoto-Dawson, Ph.D. Sr. Research Associate Center for Interdisciplinary Health Disparities Research Institute for Mind & Biology University of Chicago Chicago, IL - USA Email: [log in to unmask] http://cihdr.uchicago.edu/ ------------------- Problems/Questions? Send it to Listserv owner: [log in to unmask] To unsubscribe, send the following message in the text section -- NOT the subject header -- to [log in to unmask] SIGNOFF SDOH DO NOT SEND IT BY HITTING THE REPLY BUTTON. 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