The service area for MOHC is the island of Molokai (261 square miles) — the fifth largest of Hawaii’s six inhabited islands, with a total population of approximately 7,200 residents. The island of Molokai has been designated a Medically Underserved Area and a Health Professional Shortage Area for Primary Care, Dental Care and Mental Health, by the U.S. Public Health Service. The primary ethnic groups [some residents are represented more than once due to mixed ethnicities] on the island are Native Hawaiian/Part Hawaiian (62%), Asians/Part Asian (42%), and Caucasian/Part Caucasian (29%). A majority of the Asian population is ethnic Filipino. The target population consists of the individuals on Molokai who live below 200% of the federal poverty guidelines. According to the 2002 & 2003 Hawaii Health Surveys 56% of the population of Molokai or approximately 4,000 residents live below the 200% federal poverty guidelines.
The major health care needs of the target population include maternal and child health risks, baby bottle tooth decay, childhood asthma and obesity, teen pregnancies and teen substance abuse. Chronic health conditions in adults include diabetes, asthma, heart disease, high blood pressure, obesity, mental health illnesses and substance abuse. Out of 27 communities throughout the state, Molokai ranks fourth worst for combined socio-economic and maternal and child health risk.
Molokai’s unique health needs stem from the island’s geographic isolation and limited resources. The island of Molokai has one of the lowest overall rankings in the state in measurements of economic health, socio-economic stability and food security. Molokai has an unemployment rate of 15%, more than two times higher than the State average. The “not employed” rate which includes those who are unemployed but not receiving unemployment benefits is estimated to exceed 19.5%. A reported 38% live outside the usual social service network and rely on subsistence farming, hunting, and fishing. Historically many of the large businesses, such as Kaluakoi Resort, Del Monte and Dole, closed their doors, leaving many residents to take multiple part time or seasonal jobs, often without health benefits. The number of uninsured people in Hawaii is estimated to be between 110,000 and 136,000 people (9-11%). While the statistics of uninsured individuals on Molokai are unavailable at this time, we can reasonably assume that the percentage of uninsured individuals will exceed state levels due to the higher poverty and unemployment rates on this island. Poverty, language, geographical isolation, lack of health insurance and the high cost for off-island travel are the primary access barriers to comprehensive health care on Molokai.