In July 2025, Hawaiʻi’s Governor signed into law House Bill 1300. This bill appropriates $500,000 for the University of Hawaiʻi Cancer Center, University of Hawai'i at Mānoa to conduct a multiethnic cohort study focusing on the social determinants of health, lifestyles, environmental exposures, and resilience factors of Native Hawai’ians, Pacific Islanders, and Filipinos. The goal of the study is to understand the differences in health outcomes for the residents of the islands. This study is particularly significant as Hawaiʻi is home to some of the most diverse racial and ethnic groups in the country, and some of those groups disproportionately face worse health outcomes. Of all the racial and ethnic groups in Hawaiʻi, Native Hawai’ians have both the highest incidence of cancer and the highest mortality in both men and women. Filipino women face the highest incidence of thyroid and ovarian cancer. The study aims to catch as many factors as possible that lead to these disparities, including:
Social determinants of health are of growing interest in relation to cancer control. Despite cancer death rates declining over the last 20 years, there are increasing gaps in mortality among population groups. Hawaiʻi highlights the importance of specialized initiatives designed around helping specific groups. Often, Native Hawai’ians are aggregated with Asian Americans which can be troublesome when attempting to address specific disparities that only Native Hawai’ians may face. For example, breast cancer incidence and death rates are 30-50% lower when aggregating Asian Americans, Native Hawaiʻians and Pacific Islanders, but Native Hawai’ians and Pacific Islanders actually face much higher disparities.
Social determinants of health impact the entire cancer care process from access to preventative measures like screening, the affordability of certain treatments and general knowledge about risk factors. Targeted examination of disparities for specific populations helps to improve understanding of how disparities emerge and what steps work best to mitigate them. Due to its wide array of ethnic groups and unique environments, Hawaiʻi is a prime test case for how to study health disparities.