Here’s Why Hawaii Is A Model For Identifying Pandemic Racial Disparities
Asian Americans and Pacific Islanders are often lumped together, which makes it impossible to see how distinct communities are experiencing the pandemic.
Hawaii鈥檚 Covid-19 data stands out nationally for how much detail is available about specific race groups under the Asian American and Pacific Islander umbrella.
The Centers for Disease Control and Prevention , scholars from the University of Hawaii and others that gives the most detailed look yet at how the pandemic has disparately affected communities in Hawaii.
Researchers and community advocates say that disaggregated data is necessary to ensure those most affected by the pandemic are getting resources they need. Detailed race data also helps people responding to the pandemic better understand what’s driving disparities and design culturally and linguistically appropriate interventions.
Brittany Morey is an assistant public health professor at the University of California at Irvine and a faculty advisor of the Native Hawaiian Pacific Islander Data Policy Lab at the University of California at Los Angeles.
She said one of her fellow members of the data lab helped persuade the health department in Riverside, California to disaggregate Pacific Islanders in its Covid data. Sure enough, Riverside found Covid disparities affecting that community and that knowledge helped secure funding to address the problem.
鈥淒isaggregated data is powerful at the local and the state level in order to garner resources for those who need it the most,鈥 said Morey, on data reporting gaps among Pacific communities.
The CDC analysis compared Covid-19 case and death rates in Hawaii for 20 different races, including five under the Asian umbrella and 11 categories of Pacific Islanders.
The study found Marshallese, other Micronesians and Samoans had the highest rates of Covid-19 between March 1, 2020 and Feb. 28, 2021. The death rate was highest among people categorized as 鈥淥ther Micronesians,鈥 more than seven times the state average. Samoans had the second-highest Covid death rate, about twice the state average.
The study didn鈥檛 include data from the most recent delta surge that has disproportionately infected the Native Hawaiian community.
But it did include new data on Hawaii鈥檚 Korean and Vietnamese communities, as well as previously unreleased details about Pacific communities such as Tongans and Fijians. Among the Asian communities studied, Covid cases were most common among Hawaii鈥檚 Filipino and Vietnamese residents.
The study showed Covid case rates among Hawaii鈥檚 Black community were higher than all the Asian communities, but still below the statewide average. For the time period studied, cases among Native Hawaiians were also below average.
Data released by the state Department of Health shows that Covid cases among Native Hawaiians shot up in July 2021, although so far they remain underrepresented in Covid deaths.
Morey said she doesn鈥檛 know of any other states that break out Asian Americans and other Pacific Islanders to the degree that Hawaii does. Even California, which has a large Filipino community, doesn鈥檛 disaggregate Filipinos in its Covid data online, something Hawaii has been doing for more than a year.
Dearth Of Data Nationally
Part of what makes Hawaii鈥檚 data stand out is how little is available nationally. Morey鈥檚 study found that more than half of U.S. states don鈥檛 report Covid-19 case or death rates for the category of Native Hawaiian and other Pacific Islanders, despite 1997 federal guidance recommending that the community be separated from Asians and other communities.
Daniel Wang, an internal medicine resident at the University of California at Los Angeles about Covid-19 rates among Asian Americans and Pacific Islanders in the U.S., said race data can be tricky because it鈥檚 personal and subjective, and isn鈥檛 always recorded accurately. Still, he believes disaggregation of Pacific Islanders from Asian American communities provides the best glimpse into what鈥檚 happening during the pandemic.
Unfortunately, that’s uncommon given how relatively small the communities are.
鈥淭hat鈥檚 a pity because that doesn鈥檛 mean that they don鈥檛 exist. But on paper they don鈥檛, which then makes them an exquisitely vulnerable group,鈥 he said. 鈥淭hese are lives that if we don鈥檛 count, they get forgotten.鈥
That鈥檚 a concern for Tina Tauasosi-Posiulai, a community partnership and research specialist at the University of Hawaii, who said Samoans are often overlooked when they鈥檙e lumped into other groups.
鈥淚f you look at AAPI, it鈥檚 like a silent PI,鈥 she said. 鈥淭hey only put us there so that the number can be increased or higher but when it comes to distribution of resources, we don鈥檛 normally get anything.鈥
That can also happen when money goes to the broad category of 鈥淣ative Hawaiian or Other Pacific Islanders,鈥 Tauasosi-Posiulai said.
“When funding comes to Native Hawaiians, most of the time Samoans don鈥檛 get anything,” she said, adding that last year some Native Hawaiian-focused organizations generously shared funding during the pandemic.
Morey from UC Irvine said she likes how the authors of the CDC study chose to present population data based on people who identified at least partially with each race, instead of lumping multi-racial people into a separate category.
That鈥檚 particularly important for Pacific communities where so many are multi-racial, she said, adding failing to count people who are partially one race can make communities appear smaller than they really are.
Hawaii 鈥渃an be an example for the rest of the country in how to handle race and ethnic classifications,鈥 she said.
Sheri Daniels, who leads the nonprofit Papa Ola Lokahi that’s dedicated to Native Hawaiian health, said she鈥檚 proud of how the state heeded calls to disaggregate Covid data on Native Hawaiians and hopes it can be extended to other types of data.
鈥淭his is our homeland,鈥 she said. 鈥淭his is our right as K膩naka here in Hawaii to have that.鈥
The ability to see how the delta variant is driving up cases among Native Hawaiians specifically has galvanized the community into action.
鈥淲hat is just amazing and what I鈥檓 not surprised by is the rallying of community leaders and organizations,鈥 she said.
Wang said the way that Hawaii has been working with community groups to guide the data collection and trying to implement community-specific Covid responses is another best practice.
鈥淭hat is more than most places are able to do but that really is what we should be doing everywhere,鈥 he said.
Data That’s Still Missing
Joshua Quint, an epidemiologist at the Hawaii health department and lead author of the CDC study, said the data comes with several limitations. In the study, the data isn’t age-adjusted and 18% of the race data is missing.
Disparities are also subjective depending on what the reference points are. For example, Quint said he and other study participants made a conscious decision not to use how white people are experiencing the pandemic as a baseline, even though that鈥檚 common in other racial inequity analyses.
Doing so 鈥渄efines everyone else in relation to the white experience and it sort of gives whiteness a prime position,鈥 he said, adding that it can be beneficial sometimes to make that comparison.
Quint said listening to community calls to disaggregate the Covid data allowed the state to identify disparities they wouldn鈥檛 have otherwise known about.
If that hadn鈥檛 happened, he said, 鈥淭he Pacific Islander experience would鈥檝e been totally washed out by the Native Hawaiian group because the Native Hawaiian group is so much bigger.鈥
But there鈥檚 still more specificity that Hawaii could provide. Wang from UCLA said he would have liked to see Covid case data on the Hispanic or Latino community. Tauasosi-Posiulai from the University of Hawaii questioned why the 鈥淥ther Micronesian鈥 category wasn鈥檛 broken down further, given how large it was.
Quint says that the state has Covid case count data for Micronesian communities such as Chuukese, Kosraeans and Pohnpeians but couldn鈥檛 include them in the study because researchers couldn鈥檛 find reliable population counts.
Hawaii hasn鈥檛 published data on Hispanic or Latino Covid rates because that ethnicity data is missing at a much higher rate than race data.
鈥淚t鈥檚 an indication that we need to do either more training or update our processes to make it easier to get that data element completed,鈥 Quint said.
Agnes Malate is one of many Filipino advocates in Hawaii who have been working to get her community vaccinated. But one problem is that she doesn鈥檛 know how many Filipinos have gotten their shots.
The state health department planned to roll out data on Filipinos鈥 vaccination rates by April but that didn鈥檛 happen. Quint said it鈥檚 because there was and continues to be too much missing data to determine what percentage of Hawaii鈥檚 Filipino community is vaccinated.
鈥淲e can鈥檛 really draw conclusions from such a small subsample,鈥 Quint said, explaining the vaccination data system nationally didn鈥檛 include detailed race data for Filipinos until April. 鈥淚t just goes to show these systems and standards really need to be in place in advance.鈥
Malate said the lack of data makes it hard to figure out if her community鈥檚 vaccination efforts are working.
鈥淲e understand that they鈥檙e working on it but the urgency is now,鈥 she said. 鈥淲e really need that data.鈥
Vaccination data that does exist shows Native Hawaiians have below average vaccination rates whereas other Pacific Islanders have vaccination rates that are on par with the state average.
The latter is good news for Josie Howard’s Chuukese community, who have been among the hardest hit racial groups throughout the pandemic.
“Definitely it鈥檚 a success. We mobilized our community,” she said. But Howard still worries that the state’s Covid data may be an undercount since there’s relatively less contact tracing during the delta surge.
What the data doesn’t capture is the emotional cost of the pandemic, which weighs heavily on her and others working on the front lines.
“The experience with Covid in our community, it does make me feel very exhausted because I feel like it never ends for us,” she said.聽“I see more death this time around than before.”
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About the Author
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Anita Hofschneider is a reporter for Civil Beat. You can reach her by email at anita@civilbeat.org or follow her on Twitter at .