Say Ahhh …

Director Chiyome Fukino gives the state Department of Health an overdue checkup

April, 2003

Spring has officially arrived, and for the state’s new health director, Dr. Chiyome Fukino, that means spring-cleaning. “In a housekeeping sense, I think anybody that comes into a new corporation needs to understand the functions of that business,” Fukino says. “To a certain extent, the Department of Health needs to clean up its act, so that the Legislature, the governor and the community feel comfortable that what we’re doing is appropriate, cost-effective and that we’re, at all times, trying to act in the best interest of the public.”

Fukino says her strategy will be to start from the inside out, by familiarizing herself with every division, branch and attached agency within the department, then using the sum of all the parts to define goals for the department. She likens her strategy to a Hindu fable about a group of blind men and an elephant. In it, the men are each instructed to feel, and then describe the elephant, based on their individual experiences.

“One man felt the ear and said, ‘An elephant is flat like a fan,’ and another felt its trunk and said, ‘No, it’s long like a snake,’” says Fukino, reciting the tale. “They were all trying to describe the elephant, but they only knew their individual parts. Our department is similar, where people are dedicated to their parts, and are going to advocate from their point of view. My job is to consider all parts individually, but also to be able to look at the whole elephant.”

“Prevention” is a big health care buzzword these days. How much of an emphasis will the department place on encouraging healthy living?
Prevention is a big thing. When you do public-health initiatives, it’s first. So we’ll focus on helping people learn how to stay healthy and what to do about dieting and exercising and following up with their doctors. Taking it even further, we need to teach people that the government is there to help, but we need them to think in terms of self-sufficiency. Do all that you can to take care of yourself and your family. There is no free lunch. We’re seeing the result of people thinking that it is a free lunch, because the cost of health care has gone up. So if we can prevent people from living unhealthy lives, we can help lower health care costs.

You’ve mentioned long-term care among your top three priorities. What solutions do you suggest?
There are two bills in the Legislature. One looks to give a tax credit for purchases of long-term-care insurance. That’s a difficult thing. The other seeks to set up a fund that people contribute to for long-term-care insurance. But I think the benefit you receive for what you’re putting in is relatively low. The answer is really going to be found in encouraging people to live healthier lives. And also to prepare, through savings and whatever means they can, to reduce the number that are going to be dependent on the state or institutional care. In the old days, there was an expectation that someone in the family would take care of the kupuna or the elderly. But because of the economy now and the need to often times have two-worker households, there isn’t a free person to stay home with them. So we’re going to have to develop better day programs or services for the elderly, so they can remain in their homes. I think that’s preferable to institutional care. And if we’re going to set up sites where people move to, then we have to look at the best setting to do that in, because it changes the way you plan to enlarge your city and how you build it.

What do you hope to accomplish by the end of your first year?
I think that, if, by the end of the first year, we are able to give a factual, accurate accounting to the Legislature and administration about what is actually going on in this department, I think that will greatly assist them in understanding where funding needs to be placed. Because it’s a resource that we’re accountable to the public for. And if we could even just get a handle on that, that would be a major accomplishment. I’m also anticipating that in a year, I’ll have a really good handle on how the department interacts with Native Hawaiians.

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