LEADERSHIP CORNER
Health director tackles elder care, substance abuse, mental health
Interviewed by David Butts
Advertiser Staff Writer
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Title: Deputy Director of Health, appointed by Gov. Linda Lingle in December 2002
Organization: State Department of Health, which has about 3,800 employees and an annual budget of about $690 million
Age: 56
High school: Maine Endwell, in upstate New York
College: Five degrees from the University of Hawai'i, including a doctorate in public health. Kadohiro came to Hawai'i in 1968 to attend summer school at UH, met her future husband, Howard Kadohiro, on the day she arrived and decided to stay.
Life-changing event: Her family hosted an exchange student from Sweden when Kadohiro was a senior in high school. "It opened my eyes to the importance of ... looking beyond your front door, and that probably is what got me to Hawai'i."
Little-known fact: She helped prepare mochi for New Year's celebration with her husband's family in Kona.
Major challenge: "Trying to streamline processes in state government to see where we can shave off some time to get things done — filling positions, paying bills, all of the different processes. I'm determined to make that happen where we can.
"That's my mandate. Nobody told us we had to do that, but I just started getting extremely frustrated. 'Why isn't that position established yet? We got funding for it.' "
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Q. When you try to streamline processes at a big bureaucracy, do a lot of people respond with, "But this is the way we have always done it"?
A. "Maybe a little bit of that. I worked here for 13 years before I left to go to the university for 12 (years). We have some really, really, super-good people here. Sometimes people just didn't think about the big picture. In their shop it may not be so bad, but maybe all along the way there is a day delay here and a day delay there. I definitely don't think it is intentional, but it's time to take a big-picture look at things and see where we can trim the system."
Q. What damage does that slowness do to the department?
A. "You have to turn back (federal) monies because you couldn't get positions filled and then you couldn't get the work done. It's not that it's horrible, horrible, but I'm sure there are ways to streamline it and push it along a little faster."
Q. How has it been getting the cooperation of bureaucrats who worked so long with Democrats?
A. "I don't necessarily think it's a partisan issue. I really think it's just a change in the leadership and it's a new government and, yeah, some of it might be a little bit because of the party thing. It's just another way of doing things, improving. We certainly didn't walk in to pull the rug out from under everything that's going on and start all over again. We definitely didn't come in with, 'We got to slash and burn. ... ' We just want to continue to improve things."
Q. What is the state of health in Hawai'i now?
A. "In the 1980s we were known as the health state. Over the last four or five years, we started slipping in our ranking, down to as low as 13 (among the 50 states). Now we are up to No. 9 in terms of health status.
"We certainly have some huge concerns. One is we've got a growing elderly population. We've got the longest longevity in the nation, and with that comes the health problems of the elderly.
"It's very hard. People want to age in their homes, yet their family members are working and they can't give up their jobs, and a lot of elderly feel reluctant — they don't want to demand that of their children. How can we get services to them rather than having to place them in a structure, in a building? So we are taking a long look at that together with the Department of Human Services.
"Another huge issue is substance abuse. We are way over the top. ... A lot of our social problems are very much related to our substance use. ...
"Our other huge issue is mental health. A lot has been done, improving how things are done, not only at the state hospital, but in the community, with mental health services.
"Those are our top three big health concerns as the Health Department. The other is looking at health disparities and improving the health of those populations in our state that have the worst statistics. Certainly Native Hawaiian health is one area of that."
Q. Last year the state budget crunch meant funding was cut, and you had to adapt. How did you do it?
A. "We had to cut back some on preventive programs. It's really, really sad that that's usually the first to go. We have not had to let staff go. We have been able to meet some of the cuts through attrition."
Q. Diabetes is a growing problem in Hawai'i. You've spent most of your career helping to educate people about diabetes and treat those with it. Until recently you were president of the American Association of Diabetes Educators. What's Hawai'i's situation now?
A. "It's a huge problem. Approximately 7 (percent) to 8 percent of our population has diabetes, or between 80,000 to 90,000 people. We are among the highest-occurring states for Type 2 diabetes.
"Type 2 diabetes is more likely to occur in nonwhites, and we know that obesity and poor physical activity are huge risk factors, and it's also very genetic. As long as we continue as a society eating super-size meals and fast foods and not getting exercise, (and) we are busy sitting at our desks and at our computers and watching the tube to unwind at the end of the day, (the problem will grow)."
Q. Why is it so prevalent in Hawai'i?
A. "A lot of it is because most of our ethnic groups here are not Caucasian, and Type 2 is a non-Caucasian disease, but it also has to do with our love of food."
Q. You were diagnosed with diabetes when you were 6 or 7 years old. How difficult has it been living with the disease?
A. "I was actually advised that I probably wouldn't live very long. My first year at college (on the Mainland), I went to the health center to establish a relationship with a physician there, and they asked me what was I doing at college, why wasn't I home, implying why wasn't I home waiting to die. ... I was also told I wouldn't be able to have children, and I have two wonderful children.
"Somewhere along the line I decided if I was going to live a short life, that was OK but I was going to pack everything in. I was going to do the most I could do to be a productive, contributing member of society. When I turned 35 or so, all of a sudden I thought ... I guess I'm maybe not going to die as young as I thought I would. I had never thought about retirement or (the) long-term future. And I thought, every day from today is a gift, because it is a day that I didn't think I was going to have."
