ESPHL PROJECT HIGHLIGHTS

HAWAII
July 2014

Team Members **:

David Sakamoto *
Rosalyn Baker
Della Belatti
Lorrin Kim
Jean Luka
Kendra Oishi
Debbie Shimizu
Danette Tomiyasu
Lori Wada
* Team Leader
** We remember Loretta Fuddy, the late Director of the Hawaii State Department of Health, for her
vision and leadership.
For additional information, contact:
Lorrin Kim
Chief, Office of Planning, Policy, and Program Development
Hawaii Department of Health
Phone: 808-586-4188 Email: lorrin.kim@doh.hawaii.gov

States policies shape where we live, learn, work, and play, and impact the publics health. While there is evidence
for what works to improve populations health outcomes, many states lack robust partnerships capable of
mobilizing stakeholders, re-examining existing legal models, and innovating through statue and regulation. The
Excellence in State Public Health Law (ESPHL) program sought to strengthen the relationships among health
policy decision-makers in and among selected states and to increase the ability of these states to understand how
policy could improve the publics health. States determined their own priorities, and ESPHL did not predetermine states outcomes.

The unifying concept that motivated Hawaiis Excellence in State Public Health Law (ESPHL)* team was
health equity: oral health is a conspicuous outlier, particularly for children of low socio-economic status,
despite Hawaii's wealth of dental resources. Hawaii's geographical isolation and island-culture foster a
natural community orientation supportive of concepts like health equity. However, geographical
isolation within the states islands can also drive unequal and disproportionate distribution of resources,
particularly when it comes to the needs and resources of Oahu, the main island, and the rest of the
state.

We witnessed a shift in the

model as we worked with
legislators, from oversight to
partnership and participation.
It is a different way of
engaging relationships.
-

Dr. David Sakamoto,

Deputy Director,
Hawaii Department
of Health

A second unifying concept was sustainability. Financial and

operational sustainability is a key outcome and only models
demonstrating such promise were considered. Hawaiis
Department of Health (DOH) previously provided substantial
direct dental services in schools and through department clinics,
but funding for those services have eroded over the decades to
the point where the entire client base for direct oral services is
several thousand captive or special populations. Public health
continues to move from the provision of direct services to a
greater emphasis on oversight and coordination with the private
sector, primarily due to shrinking budgets.

A monthly Dental Initiatives Meeting was convened to

coordinate this project with an existing general dental health
planning project funded by a U.S. Center for Disease Prevention and Control (CDC) grant. This resulted
in bringing in additional team members, including the Chief of the Hospital and Community Based
Dental Services Branch (HCBDSB), a DDS by training; a HCBDSB Hygienist supervisor; the Chief of the
Developmental Disabilities Division (also a DDS by training); a Developmental Disabilities Division
Planner; a Family Health Services Division Planner; and a Policy and Planning Office Planner.
External partners included:

Collaborators from the Hawaii Primary Care Association, a Federally Qualified Health Center
(FQHC) association
Hawaii Dental Service (Delta Dental)
Hawaii Dental Association
Hawaii Department of Human Services (Medicaid agency)
Representatives from the University of Hawaii, School of Public Health
University of Hawaii, John A. Burns School of Medicine
University of Hawaii, Kapiolani Community College, School of Nursing and Dental Hygiene
Papa Ola Lokahi/Native Hawaiian Health System
Office of Hawaiian Affairs
Private dental professionals, collaborators, advisors

ESPHL, a program of the Aspen Institute Justice & Society Program, was made possible by a grant from the Robert
Wood Johnson Foundation.

The emerging data linking oral health to academic performance was important in helping to engage the
Department of Education. Although it is very likely that the health sector collaborators would have
participated anyway, exposing the participating legislators (and their staff) to the planning and
execution of public health programs would not have been possible under ordinary circumstances.
The Hawaii team developed solutions through technical assistance funds provided by the ESPHL
program, which were used to facilitate in-state meetings, though only with external stakeholders such
as subject-matter experts (e.g. dentists, hygienists). That appeared to have the effect of improving
morale and cohesion.
Working across branches of government was the most valuable skill learned as a result of ESPHL
participation. In the future, the Hawaii team will apply these lessons to other high profile projects.