Video: How social determinants impact our ohana


Nicole Pasia


One of the key discussions at the 2022 Hawaii State of Reform Virtual Health Policy Conference earlier this month revolved around the complex social and economic factors that impact the health of our communities, and how Hawaii’s health care system can better address them. 

Bringing perspectives from health plans, policy advocates, and community health centers, this panel discussion featured Francoise Culley-Trotman, AlohaCare CEO, Beth Giesting, retired director of the Hawaii Budget and Policy Center, and Helen Kekalia, Moloka’i Health Center CEO. Kealoha Fox, AlohaCare senior manager of social health integration, moderated the panel.


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As part of a six-year social determinants of health (SDOH) transformation plan that launched in 2021, AlohaCare initiated an assessment to better understand their members’ needs, which include Medicaid and Medicare beneficiaries. 

Culley-Trotman identified three common trends that impact members’ health: 1) a high prevalence of potentially preventable chronic medical conditions (diabetes, heart failure, etc.), 2) behavioral health conditions such as depression, anxiety, and substance misuse), and 3) SDOH such as housing, food, and financial insecurity. 

One way AlohaCare is working to address the SDOH needs of their members is through Unite Hawaii, a cross-silo system that allows providers to easily refer patients to community-based organizations (CBOs), depending on their specific needs.

Culley-Trotman also highlighted the importance of data collection when addressing SDOH.

“We’ve already seen that the data allows us to really focus in on those areas that there’s a true need. We’ve been able to confirm that the things we know—like housing, shelter, employment, and individual and family support—really make a critical difference.”

One SDOH of particular concern to Giesting was the lack of affordable housing in Hawaii, and its health impacts. People experiencing homelessness are even more at risk because they cannot regularly access preventative health care services.

“Our health care system is not organized to take care of people who are experiencing homelessness,” she said. 

Leading up to the conference, the Hawaii Budget and Policy Center published a three-part series on the links between health and housing in Hawaii. The report included several policy recommendations that would increase access to affordable housing, including increasing rent vouchers and low-income tax credits.

Kekalia rounded out the discussion with a boots-on-the-ground perspective from her federally-qualified health center, which operates the largest on-site food pantry in Moloka’i, along with other resources, such as family counseling. 

The ultimate goal for community-based care is to lift vulnerable communities out of poverty, she said. That means addressing SDOH, which accounts for 40% of a person’s health, according to the County Health Rankings Model. Kekalia also supported the need for a coordinated health care system to address the complex needs of Hawaii’s communities. 

“People do not live in individualized vacuums. Although the health sector is built that way and we tend to operate that way, our ohana units are not. They’re multi-layered individuals with multi-level complexities.”

What the full discussion here: