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  • Kevin Hara

Beyond Our Walls

Updated: May 8, 2022

Kevin Hara

Healthcare in our society today is dominated by acute disease. This is where the bulk of our resources are expended. Heart attack, heart failure, stroke, sepsis, diabetes mellitus, and COPD consumes our hospital beds and healthcare resources.

Preventive medicine can reduce the occurrence of acute disease. Just as regular oil change extends the performance and longevity of car engines, proper diet extends the performance and longevity of our bodies. There is value in risk factor modification with attention to smoking, substance abuse, obesity and physical inactivity.

We can go further upstream to identify the roots of these unhealthy lifestyles. These roots are classified as the social determinants of health. These are the community conditions in which people are born, work, play, and live.

Life expectancy varies widely based on where we live. In Hawaiʻi, there is more than a twelve-year difference in life expectancy between east and west Oʻahu. The social determinants of health are believed to form the basis for these differences.

To achieve a healthier society, healthcare needs to go beyond the walls of our clinics and hospitals. Healthcare needs to get into our communities and address the social determinants of health. Healthcare providers address the individual social issues of patients. We can also address the community social situations.

Education is one of the social determinations of health. Literacy has been associated with life expectancy.

Reading is important, “Simply because if you do not learn to read and you live in America, you do not make it in life” (G. Reid Lyon, Chief, Child Development and Behavior Branch of the National Institute of Child Health and Human Development, 1997.) In Hawai’i, 16% of adults are illiterate (National Center for Education Statistics, 2003.) Dyslexia is a specific learning disability that is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. Dyslexia in the general population is estimated at up to 20%. Illiteracy in the prison population has been reported at 80%; 48% of whom have dyslexia. High school students with dyslexia have a 35% dropout rate. Dyslexic students are often labelled as being lazy and stupid, but dyslexia is not about intelligence. People with dyslexia just think and process differently. In fact, they have been found to have the gifts of creativity and innovation.

Investment in school development to improve literacy will produce an improvement in a key social determination of health. Improving reading literacy in our communities can create a healthier Hawai’i. Reading literacy in our children is of paramount importance. We can help achieve this but we need to go beyond the walls of our clinics and hospitals and get out into our communities.


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