 Welcome to Hola Iloha. We're the voice for the Hispanic Chamber of Commerce at Hawaii, where we work hard to be a resource for the Latino business community. My name is Barbara Salazar-Deluca, President of the Hispanic Chamber of Commerce here in Hawaii, and today we're going to be discussing health disparities in Hawaii with a very special guest, Dr. Ruben Juarez. So let me tell you a little bit about Ruben. He is an HMSA Distinguished Professor at UHero and the Economics Department at UH Manoa. He's also the CEO of Hawaii Integrated Analytics. He was granted the PhD in Economics from Rice University in Houston, Texas in 2008 and has been a Professor of Economics and UHero member since 2018. And he's also the Treasurer of the Hispanic Chamber of Commerce, so that's our connection there. He's going to be here to discuss some of his latest projects. He has been leading with a variety of partners across the state of Hawaii. Welcome, Dr. Juarez. Why don't you tell us a little bit about your history? Yeah, so I moved to Hawaii about 15 years ago from Texas, as you were saying. Although I'm originally from Mexico, growing up actually in the border in San Diego, Tijuana, we've been working in health economics, looking at social networks, behavior, in order to address diabetes disparities in Hawaii for the last several years. During the pandemic, we co-founded and currently serve as a co-director of the Pacific Alliance against COVID-19 or PAC, where we were looking to increase testing capacity and education in underserved communities in Hawaii along with many of our health partners. So yeah, that's basically it. Well, I'm sure some of our viewers have a question about what are health disparities and who is most affected in Hawaii? Yeah, so health disparities actually refers to differences in health outcomes, like diabetes, obesity, access to healthcare services, experienced by different groups. So for instance, you can think of different races or ethnicities, socioeconomic status, gender, sexual orientation, geographic location, or any other characteristics that you can think of. These disparities result in unequal health outcomes, such as higher rates of diseases or disabilities, or even mortality in some cases. So health disparities are often associated with social and economic outcomes, and that's where economies basically come in. So your health is influenced by factors such as discrimination, lack of access to healthcare, the environment, cultural beliefs, and that's what we are trying to measure basically as an economist. Interesting. I'm surprised to hear sexual orientation is a factor. No, and actually, Hawaii has actually many health disparities. So I'll give you some examples. Okay. So Native Hawaiians and Pacific Islanders have higher rates of obesity, diabetes, heart disease, and cancer compared to other racial groups in the state. So for instance, for diabetes alone, which is one of the things that I've been focusing for the last few years, Native Hawaiian and Pacific Islanders are 2.5 times higher rates than the general population in the state. And they are also diagnosed on average 10 years earlier than other groups. So they start experiencing diabetes or diabetes symptoms 10 years before other people in the state. Is that mental health? Is that due to childhood obesity? Because they're diagnosed again? Could be. Yeah. So that's one of the things that we're trying to explore. So like, what are the reasons why some of the individuals become diabetic early on? And that's actually one of the exciting projects that I'm going to be telling you about. And there is an opportunity later on to discuss about it. So I'm hoping that participants who are interested can join the studies so they can help us understand why diabetes happens early in some people, but not in others. So but diabetes is one of them, right? But there is also mental health disparities, so like Native Hawaiians and Filipinos have higher rates of depression and suicide than other people in the state. Access to healthcare, of course, is a significant issue in Hawaii, especially in rural areas and among low income people. And you can think about Hispanics, you know, like some Hispanics and not only Hispanics, but like there is people who are undocumented in Hawaii and they may not have access to healthcare and that causes a disparity. So stop some abuse and addiction. And we have a large homeless population, which would have lack of healthcare. Absolutely. So homelessness is another major health disparity in Hawaii with higher rates of homelessness in Honolulu and other areas, especially like urban areas, leading to increased risk of infectious diseases and mental health problems. So that's basically some, you know, overview of some of the disparities that we see in Hawaii. But yeah. I'm curious real quick about the homelessness population. Is it higher on Oahu or neighboring islands? Typically Oahu, yeah. So we have a significantly higher rate in Oahu. Yeah. Well, probably because we have a higher population, maybe. It's higher population. I mean, so, you know, the reasons why people become homeless, I mean, are still not totally clear. I mean, there is obviously mental health problems, but there is people who like just cannot afford to live in inexpensive housing like in Hawaii, right? And Honolulu is one of the most expensive cities, of course. That's true. So even housing is not affordable. I know exactly, right? That's what they call it affordable, but, you know, you have to pay a million dollars, you know, for a house or an apartment. I mean, it's crazy. You mentioned social networks. So I mean, what are social networks and how have social networks been found to influence health outcomes in the context of Hawaii's population and health disparities? Yeah. So when people think about social networks, they often think about online networks like Facebook or Instagram. But, you know, more generally, social networks refer to like this web of connections that everyone is interconnected to between individuals, including family, friends, community members, to provide, you know, what does my friend and family provide? Well, social support, information, and resources. And these connections have significant impacts on your health, especially in the context of health disparities. So as Hispanics, you know, we know that, you know, we rely on our family to get information to make decisions, right? I mean, you know, we talk to our abuelitos or abuelitos or my parents, you know, about our health. And these things are, these people are very influential in our lives, of course. And this is this is this health information transmit across social networks and influence at the end your health. So more importantly, so in Hawaii, I mean, social networks have been found to play a significant role in promoting health and reducing health disparities. For example, that is have shown that social support from families and friends can contribute to better mental health, especially, especially among native Hawaiian Pacific calendars, who have higher rates of depression and suicide. In addition, social networks also contribute to health disparities in a negative way. So like there are positive ways and negative ways. So one of the negative ways is, you know, population with like small percentages like say Pacific Islanders of Hispanics may have a smaller social networks due to cultural factors, maybe immigration and acculturation, which can potentially limit access to like say resources like act like hospitals or social support. And, and you know, this actually contributes at the end of your health. So and even even I'll be mentioning a little bit about the pandemic and some of the effects that we saw, and we've seen how social networks positively influence vaccination outcomes, but also negatively influenced vaccination outcomes. So it's like both sides. So, you know, overall, I mean, social networks are important factors to consider in addressing health, especially health disparities in Hawaii. And efforts to strengthen and expand social networks can have positive impacts on health outcomes, especially for underserved populations that if Hawaiian Pacific calendars Hispanics are in the state. Right, right. Well, you mentioned our families are very influential on us, right. So, and that's our social network. And it could be, they could be given as positive and negative advice of their disparities, you know, and their experience, you know, that the advice might not be as well received, I guess, as we had a bigger network. So we've seen that you worked on many issues of health disparities from COVID-19 to cardio metabolic diseases to mental health. What have been some of the main findings? Yeah, so we actually initiated many, many studies in Hawaii, looking at diabetes, COVID-19, mental health. So I'll give you one example, like it's one of the oldest ones that we've been working on. So we have this ongoing project with Mao organic farms. If you don't know about Mao, it's located in Waianae, a beautiful farm, a community based program that takes basically high school students at risk of not going to college and provide them with a scholarship to go to college in exchange of 20 hours of work at the farm. I've heard of that. And, you know, this is this, yeah, and, you know, this is a project that, you know, it's basically created to help support education, right, of these students. But then what we are seeing is that not only it's an educational program, but it's actually a health intervention, something that, you know, they didn't create or create it to be. So we've been working with them to evaluate, you know, the impact that this program has on the health of the interns going through the farm. And what we found is that this farm is an effective pre-diabetes intervention. So what does that mean? Well, basically individuals like, you know, these are 18 to or 16 to 22 years old individuals are already experiencing pre-diabetes at a higher rate than the general population when they come into the farm. And what we see is that after a year in the farm, they actually decrease their level of risk for diabetes. And this is because, you know, they are doing a lot of exercise, they are potentially eating healthier in the farm. But even more, we also see that, you know, it's not only them that are being affected, but actually their families. So like this impact, these healthy behaviors are transferred into their family, potentially, you know, by eating healthier foods, maybe even bringing food from the farm, you know, more veggies, right? So yeah, so that's one example of some of the projects we have. So like evaluating this impact. During the pandemic, we had a large project as well, where we had basically looking at several studies to increase vaccination uptake. And really understand how can we effectively mitigate the negative outcomes of the pandemic So as part of PAC, as I was mentioning, we actually provided over 50,000 COVID-19 tests in partnerships with, you know, the health centers at the AHARO network of health centers that include the Wai'anae Cost Comprehensive Health Center, Kamakua Kohala Health Center. What am I missing? I mean, why about a local center? Yeah. And Molokai Health Center. And then so what we saw is that what we saw is that a large proportion of individuals who got vaccinated either had higher trust in government and health care providers. And those who did not get vaccinated, trusted and consuming more unofficial information sources like social media, or you know, you get information about the vaccine from your friends and family. TikTok. Yeah, TikTok, exactly. Hello. Oh my gosh. And you know, this, as you can see, right, social networks can be good, right? But they can also be bad for vaccination, right? If you start hearing misinformation from social networks, then you are less likely to be vaccinated. If you trust these sources, then you are less likely. So basically, what we learned right from this large project, and we continue getting data obviously, because every test for us was an opportunity to get information from participants, is that it's really the power of social networks, that if we want to have an effective intervention, we need to target not only individuals, but actually their friends and family. And then we have a large cohort as well of like 2000 individuals in the state as part of the New Hero Rapid Survey. And we've been following these individuals for many months already. And we just have to make assessments on the impact of the pandemic, where we found that two in three individuals in the state were negatively affected by the pandemic. And this has persisted over time, like two out of three. That's like 66% of individuals in the state. So we're using this to look at, how can we effectively come up with policies to effectively resolve some of those issues that the pandemic caused? And then we're moving forward to look at partnerships with the Department of Health, the state government, Hawaii Community Foundation, to look at other aspects. What is the impact of mental health for instance? So that's actually one of the projects that we're hoping to use this cohort to like provide us some answers. Well, I love how the Mayo Farms project has caused a positive impact on families and eating healthier and lowering the diabetes. What strategies or interventions have you identified that effectively leverage social networks to mitigate health disparities in Hawaii? So I think in general, what we found is that trust is a very important component of health. That's something that people never thought possible, but like our community-based organizations that we work with, they knew that. So they knew that that in order to like effectively engage populations, you need to like develop this trust. And I can give you some example of where Oceania, I mean, there was an amazing community-based organizations targeting Pacific Islanders, and they've been super effective at increasing their vaccination update. And this type of, so basically, this is just giving us like an example, right? Of like, how can we effectively target like working with community organizations, working with our kupuna, and looking at like, who are social media influencers, who could potentially send this targeted messaging that we want our populations to hear. In addition, you know, for our project on diabetes and obesity, we are seeing that family interventions should focus on family interventions, not only like individual intervention. So, for instance, we work with the food basket in the Big Island, and we found that having the employees committing to a diet, like collectively, like everyone, was more effective than doing it by yourself. And then why? Well, because, you know, your co-workers are supporting you in the challenges, right? Of eating healthier. So, yes, accountability. Absolutely. Yes, and I love the fact that, I mean, it makes sense to establish trust in the community. Just there's other issues like the census, for example, right? Some communities don't trust the census, but the more we educate, you know, and the sources where the education is coming from establishes that trust. Yeah. There's a lot to talk about how disparities in native Hawaiian Pacific Islanders, Filipino populations, how do health disparities affect the Hispanic population in Hawaii? There are health disparities in Hawaii for Hispanics. So, we've been seeing those. You know, Hispanics and Latinos are a small percentage of the Hawaii population, of course, but they experience, you know, larger rates of like, you know, limited access to healthcare. Okay. So, that would be like an obvious example. So, Hispanics and Latinos have been found to have limited access to healthcare due to language barriers, lack of insurance, even limited availability of cultural and linguistically appropriate healthcare services, right? Like people don't speak Spanish, right? At health centers here in Hawaii. Higher rates of chronic diseases. Diabetes is a typical one that Hispanics experience, like native Hawaiian Pacific Islanders. They have higher rates, hypertension, obesity, and this obviously lead to other complications beyond this cardiometabolic diseases. Higher rates of infectious diseases, such as tuberculosis and hepatitis B, related to other groups. And honestly, like it's just a limited representation of healthcare services. So, like, healthcare providers, right? So, like, we don't have enough doctors. We don't have enough nurses who are Hispanics here in Hawaii who would potentially speak the language. So, that's more or less like an overview, like some of that. I have a question. So, the Hispanic population and the Hawaiian population, so we experience some of the same things like obesity, diabetes. Is this because we show our love through food? I mean, if I go to a family function and I don't serve myself, if there's something wrong, like, oh, what's wrong with you? I know, right? There are these cultural things that you have to do, right? You cannot say no, right? Like, to eating, and you have to initiate everything that is on your plate and all. That's potentially a cause. I mean, it's not the only one, but, you know, for sure, culture is very important when it comes to, like, obesity and diabetes. And I believe you had Lisa Sanchez at the last podcast. And she was mentioning about some of these cultural aspects, right? Of health in Hispanics. And I listened to it, and it was very nice, actually, because it really tells you, I mean, some of the things that we are finding in our studies with larger populations. You know, Ruben, since you're the Treasurer of the Hispanic Chamber of Commerce, and you've been working with hundreds of businesses in the state during COVID to obtain information from them, what are activities that a business can do to improve their health of their employees? So, yeah. So, I think, I think in general, like, there are, you know, things that every business has to do, like, wellness programs, you know, like, how can you promote effectively healthy eating, exercise, stress management within your employees? And I can give you some examples, but we don't have time today of, like, some effective interventions. Health screenings and enable prevention at the workplace. We've seen that that's successful. And during the pandemic, we work on, like, even vaccination, vaccination at the workplace was effective. Work, like, work life balance, okay, foster a supportive work environment within work. I mean, it's obviously good for work, but also for the mental health of employees. Education and training, provide resources, and, you know, healthy food options at work. Finally, I think that health insurance coverage, you know, could be another way, like offer comprehensive health plans that cover preventive service, mental health services, and access to a network of healthcare providers. And I know, you know, it's important for, from a business perspective, to tailor this initiative to your population, but also to the cost, you know, to your budget. So, how to do that, how to find a right compromise, obviously. Right. That's a lot of options. So, yeah, prioritized, right? What's important for your staff? Yeah. Well, how can the Hispanic Chamber of Commerce, Hawaii, support health and well-being in our communities? Yeah. So, the Hispanic Chamber of Commerce has already been supporting some aspects. I mean, we continue trying to find avenues to do this, improving the well-being of employees from our different members. We're working on assessing the needs, actually, of Hispanic-owned businesses or part of our Chamber to develop this initiative. So, in our last podcast, as you mentioned, I mean, we had Lisa who was working on cultural aspects of health and equity. And we've been working together on some of these initiatives, like developing wellness programs tailored to the needs of Hispanic employees and their families. And then networking and support so that Chamber can facilitate networking opportunities for Hispanic professionals, creating the supportive community that you need to thrive. And we do this through many events already. Advocacy and education so that Chamber is advocating for policies to support the well-being of Hispanic employees and not only Hispanics, but like in general employees in the state, you know, equitable access to healthcare, affordable housing, education opportunities. And more importantly, I think it's like cultural integration is something that is missing. So, like, how do you promote the Chamber? How do you promote basically this culture at the workplace, you know, like Hispanic culture in particular? Well, I think one of the things that you can do is, like you said, tailoring programs for wellness, incorporating Zumba or Pachata or Salsa, which we see happening all over the island. Absolutely. That's a great one, right? I mean, so, like, you want to have like, you know, like the night Hispanic, you know, music. What about community engagement? Yeah, community engagement is also something that the Chamber can organize, basically community service projects and volunteering opportunities for employees to give them, you know, like a flavor of the local community and engaging in philanthropic activities that can foster the sense of purpose and well-being among employees. Yeah. Are there any ongoing studies where people can participate in helping reduce health disparities? Yes. So, we have actually a large study going on where participants can join the study. So it's open. So we're hoping to recruit 2,100 individuals in the state. It's a diabetes study where we are trying to look at, like, how does the social environment during early adulthood basically underlie diabetes progression in Hawaii? So, like I was mentioning that Native Hawaiian Pacific Islanders show that their diabetes is expressed 10 years earlier than the average in the state, right? So we're trying to understand why that happens. So, if you guys enroll, if anyone who enrolls actually and completes all the activities of the study, receive $100 and basically to sign up, you can come to our website, the study website, which is highseed.org. That's H-I-S-E-E-D.org. Or you can visit my website, which is R-U-B-N-J.net, that's RU-N-J.net. And we have a few more studies going on. Like, we have this hero cohort that we're trying to increase from 2,000 to 5,000 participants. We're looking for funding, so we're hoping to, you know, finding sponsorships. So if you're interested in sponsoring the project, you're always welcome to that and you can contact me directly. Well, I'm sure you'll be successful at it. Is there anything else you wanted to cover before we wrap it up? No, I think that's it. Thank you so much for having me and, you know, I'm always, you know, happy to talk to people. Of course. Thank you for being a guest, Ruben. So with that, I just wanted to close and mention that we have an upcoming Buenos Dias breakfast, which is going to be next Tuesday, June 13th at Chacarilla Ranchero in Capolei. And we're going to be discussing AI, artificial intelligence, and how to use it to streamline your business. Our member, Edwin Rogers, is going to be presenting that. So it's going to be great. You can find that online on Venprite. $10 includes breakfast. And then our upcoming show on Think Tech Hawaii is going to be June 21st with our new member, Alex. He's the owner of the Mercado de la Raza. So it's a Latino grocery store located on Baritania. So that's going to be exciting to have him on. So this has been Hola y Aloha on Think Tech Hawaii. We've been talking with Dr. Ruben Juarez, also our board member, Treasurer and a new hero and professor does it all. Thank you, Ruben, for educating us today on health disparities in Hawaii. And you're welcome. Thanks, viewers, for joining us on Think Tech Hawaii. And we'll be back in two weeks. So please tune in and tell your friends. This is Barbara DeLuca signing up. Adios y Aloha, everyone.