Strategies to address the COVID-19 disparities among Pacific Islander communities

A report by the Hawaii Advisory Committee to the U.S. Civil Rights Commission outlined ways the Biden administration and local leaders can help address the disparities felt by Pacific Islander communities during the COVID-19 pandemic.


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In a report released in March by the Hawaii Department of Health, Pacific Islanders accounted for 24% of the state’s diagnosed COVID-19 cases through the end of January, despite only making up four percent of the state’s population. They also had the highest age-adjusted mortality rate in the state at 319.6 deaths per 100,000.

The report identifies several factors that caused Pacific Islander communities’ vulnerability to contracting the virus. Members of the advisory group noted that of the minority groups encompassed in the Pacific Islander communities, Micronesians are one of the most vulnerable due to their special immigration status that had previously prohibited them from accessing Medicaid. 

According to researchers at the University of Hawai‘i, the 2015 decision by Gov. David Ige’s to cut Micronesian migrants’ access to state-funded Medicaid affected their health by, among other things, increasing their mortality rate by over 40% higher in 2018 compared to the period prior to 2015 when they were eligible for Medicaid. This outcome is despite the availability of state-funded premium coverage for private insurance and significant outreach efforts to reduce the impact of this coverage change. The report said:

“Testimony also noted that Micronesians are under enrolled in health insurance, have higher cases of hospitalizations, and an increased risk of developing preventable health issues since they are less likely to visit the doctor.”

Micronesians are legally present in the U.S. through the treaties known as the Compacts of Free Association (COFA). But while they work and pay taxes, they are excluded from many social supports like food stamps and the Biden administration’s funeral reimbursements for families who lost a loved one to COVID-19.

In December 2020, former President Trump restored Medicaid eligibility for members of COFA nations. But the civil rights advisory group now wants the U.S. Department of Health and Human Services (DHHS) to actively reach out to states with large Pacific Islander communities to ensure that people from COFA nations are aware they are now eligible for Medicaid.

Dr. David Derauf, executive director and physician for Kokua Kalihi Valley Comprehensive Family Services, highlighted the relationship between employment and health care access. He testified that segments of Pacific Islander communities either work in low paying hourly jobs or are unemployed, which forces them to either go without health care or to rely on an overburdened community health system. 

Derauf added that because of the high rents in Hawai‘i, Pacific Islander communities tend to live in crowded living quarters. He stated among his patients, the highest record of adults living in one household is 21 adults sharing a one bedroom apartment. At the same time, many Pacific Islander communities are likely to be essential workers employed in jobs that are public facing and therefore at a higher risk of contracting the virus and bringing it home.

He also said the prevention guidance provided by the Centers for Disease Control and Prevention (CDC) regarding social distancing are disconnected from the realities of the culture of Pacific Islander communities.

“The pressures of American assimilation have already challenged cultural patterns of connectedness amongst our Pacific Island communities. The additional separation that COVID-19 prevention requires can trigger historical traumas related to colonization and discrimination.”

According to the advisory group, federal agencies should actively reach out to the communities who have been disproportionately impacted by the pandemic.

The advisory group asks DHHS to require standardized, detailed data collection about Pacific Islander communities. They also want the U.S. Department of the Interior and Office of Insular Affairs to engage with the COFA migrant community to address the current inadequacies affecting their health, safety and welfare relative to the pandemic. 

In the recommendations made to state and county leaders, the group said the Ige administration should provide better education about the needs of vulnerable communities, including Pacific Islander communities, to the health care system. The report noted one specific case:

“In one case, a nine months pregnant mother contracted COVID-19 and was isolating at home when she developed complications and needed emergency medical help. Ms. Howard said that the pregnant woman’s family contacted 911 for an ambulance but were refused service and the family was told to contact We Are Oceania. When the family called We Are Oceania staff, the staff advised the family to call her primary care provider, only then, after her doctor ordered the ambulance to take the pregnant mother to the hospital, did this person receive required medical aid.”

The report says health access is challenging in Hawaii for many groups for reasons such as eligibility, proximity to health centers and knowledge of services.

As part of his efforts to coordinate a comprehensive federal response to the issues faced by Asian American, Native Hawaiian and Pacific Islander communities, President Joe Biden signed an executive order Friday to address the systemic issues.

“Asian American, Native Hawaiian, and Pacific Islander (AA and NHPI) communities together constitute the fastest growing ethnic group in the United States and make invaluable contributions to our society, our economy, and our culture. Yet for far too long, systemic barriers to equity, justice, and opportunity have put the American dream out of reach for many AA and NHPI communities, and racism, nativism, and xenophobia against AA and NHPI communities continues to threaten safety and dignity of AA and NHPI families. The new Initiative is charged with driving an ambitious, whole-of-government agenda to advance equity, justice, and opportunity for AA and NHPI communities.”