Hawaii: The Health State
Public officials in Hawaii believe that their state has entered into a "new era of health care." This view is based on a series of recent innovations that are intended to reduce the proportion of the population without health insurance and create a health care environment that is conducive to and supportive of health promotion and disease prevention. This chapter chronicles these efforts and seeks to relate them to two critical political variables: the emergence of a "health culture" in the state and a new political leadership that is committed to pursuing an innovative health policy agenda. 1
The chapter is organized in three parts. In the first I will briefly describe the setting of Hawaii, the health state. This idea emerges out of a political-economic context that is different from that of Hawaii's sister states and that owes much to the historical nexus in the state of agriculture and tourism. Hawaii has also produced a distinctive political culture in which the dynamics of politics in a small island state are readily identifiable. Central to these dynamics has been the development of the Democratic Party as the dominant political force during the statehood era. Imbued with a spirit of political liberalism, Democratic dominance has worked both to limit the effect of Reaganism on state policy and to provide a niche within which new political leaders have emerged. Health issues have proved a valuable currency in this emergence.