Hawaii ranks first in health, last in economic well-being in COVID policy analysis


Nicole Pasia


Hawaii’s unique geography significantly impacted the economic and public health effects of COVID-related policies, a new report from the National Bureau of Economic Research found.  Hawaii had the lowest COVID-related deaths per capita and the lowest COVID mortality rate in the country. However, it also ranked last (51st) in economic performance and 46th in education attendance. Hawaii ranked 39th in overall pandemic response. 


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The report analyzed and compared varying COVID policies—such as lockdowns, masking, and vaccine mandates—across the 50 states and Washington, D.C. Results show that COVID policies that caused states to withdraw the most from economic activity “did not significantly improve health by doing so.” As an isolated island, however, Hawaii was an exception. 

“Understood in the context of island nations such as Australia and New Zealand, the experience of HI suggests that island locations can, by sustaining significant economic losses, reduce mortality for a year or more,” the report said.

The report measured the impact of state COVID policies in three areas: economic performance (unemployment and GDP), in-person and online school instruction, and mortality (COVID-related deaths and all-cause excess mortality).

Hawaii experienced a 5.3% rise in unemployment from April 2020 to December 2021. The state ranked at the bottom of this sub-measure along with Nevada due to the “overwhelming impact the global shutdown of tourism had on them,” according to the report. Hawaii also saw a 6.3% decrease in GDP during the pandemic, which was second worst in the nation even after industry adjustments. Early in the pandemic, Hawaii imposed strict travel restrictions, starting with a mandatory 14-day quarantine for incoming flight passengers in March 2020. From October 2020 through March 2022, the state operated the Safe Travels Hawaii program, which required travelers to present a negative COVID test to bypass quarantine. The state’s mask mandate also ended in late March—making Hawaii the last state to do so.

School closure policies also affected Hawaii’s ranking in the report. Using data from the school data aggregator Burbio, the report estimates 22.5% of school education occurred in person in Hawaii during the pandemic, putting the state near the bottom nationwide.

“School closures may ultimately prove to be the most costly policy decision of the pandemic era in both economic and mortality terms,” the report said. 

The question of how school closures will affect quality of life remains. According to University of Hawaii President David Lassner at the 2022 Hawaii State of Reform Health Policy Conference, student enrollment in higher education has dropped 4-5% during the pandemic, leading to lower income earnings over their lifetimes. Studies also show high school dropouts have a shorter life expectancy than graduates. Lassner said UH is working with community partners to strengthen the education pipeline as a result of the drop. 

Regarding mortality, Hawaii had the lowest age-adjusted COVID deaths relative to the state population—87.9 per 100,000. Hawaii also had the lowest percentage of all-cause mortality, which includes increases in drug and alcohol-related deaths or deaths from underlying conditions during the pandemic. However, the report cited other health conditions, such as obesity or old age, impacted pandemic mortality more than COVID policies. 

Although Hawaii is an outlier due to its geography and heavy economic reliance on the hospitality sector, the report found no apparent trend between locked-down economies and improved health during the pandemic, and that “much residual variation” remains due to states’ vastly different economic landscapes and imposed COVID policies. The study pointed towards developing data on quality of life that may show further effects of the pandemic at the state level.