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The food system can create or destroy health

Organic fruit in Hawaiʻi Farmers Market
Organic fruit in Hawaiʻi Farmers Market

What we eat has a huge impact on our health. What kind of food is available and affordable? Why is locally produced food more expensive and less accessible than imported food?  How can we eat better?

Food systems are complex. Multiple social and economic factors affect the availability and access to food. At the household level, food access is related to income, health literacy and culture. At the level of society, food access is related to economic and environmental policy as well as the commercial drivers of food culture. The food system can create or destroy health.

Poor diets have been a key risk factor for premature death and diminished quality of life from obesity, diabetes, hypertension and cancer in Hawaiʻi for many years. Unhealthy diets are cheaper and more accessible. Typically these diets have high caloric content but low nutritive value – characterized by processed food that has excessive sugar, salt and trans-fatty acids.

Access to healthier food choices that are locally produced addresses food insecurity as well as nutrition needs of the people in ways that are culturally appropriate and sustainable. Food system-related diseases can only be prevented through transformation of the food system.

Food security as a social determinant of health

Ripening green apple bananas on Hawaiʻi Island
Ripening green apple bananas on Hawaiʻi Island.

The Hawaiian Islands are home to one of the most geographically isolated and food-import dependent populations in the world. It is estimated that Hawaiʻi imports close to 90% of its food. At any given time, Hawaiʻi has a 5-7 day food supply.

The COVID-19 pandemic brought Hawaiʻi close to a food crisis, when the shipment of food tethered as supplier ports in the continental United States closed down. This sparked unprecedented concern, interest and action to do something about the vulnerability of our food system. Learning from the COVID-19 pandemic and mindful of future pandemics, as well as the threat of climate change, the food system must be protected in order to prevent a complete disruption of the food chain – that would have severe consequences on health and well-being.

There is a disproportionate burden of food insecurity among Native Hawaiian and Pacific Islanders, Asian-Americans and low-income groups. Economic and social disparities are significant drivers of food insecurity. Vulnerable groups are at greater risk for hunger, malnutrition, obesity and poor health. There is a disproportionate burden of food insecurity on low income groups, Native Hawaiians, Pacific islanders and Filipinos.

Food security for a household means access by all members at all times to enough food for an active, healthy life. (USDA, 2021). Food security includes at a minimum:

  • The ready availability of nutritionally adequate and safe foods.
  • Assured ability to acquire acceptable foods in socially acceptable ways (that is, without resorting to emergency food supplies, scavenging, stealing, or other coping strategies).

Food Access: What we eat, versus what we grow

Coffee plant in central Oʻahu
Coffee plant in central Oʻahu

HIPHI has led improvement in health outcomes in Hawaiʻi through policy, advocacy, community partnerships and action on a number of fronts, since 1996. We are a “hub for health” – bringing together multiple stakeholders to work together toward improved health outcomes, particularly for the most vulnerable.

The COVID-19 pandemic unmasked huge disparities in food access and called for immediate action to mitigate hunger and worsening of chronic disease, rendering visibility to the underlying reasons behind food insecurity in the state.

Through the Food Systems and Resiliency Program of HIPHI, we confront the challenge of food insecurity as a public health concern requiring urgent action. The program zeroes in on the issue of food access at the intersection of what we grow and what we eat.

As in many parts of the country, in Hawaiʻi, what we grow is not what we eat, and what we eat is not what we grow. A dependence on imported food has distorted the nutritional balance of our diets.

Our program focuses on universal food access as a public health goal, at the same time we work closely with sectors that are engaged in food availability and food safety.


Food and nutrition security for everyone, at all times in Hawaiʻi.


Increase food access, particularly for vulnerable/underserved/marginalized groups of Hawaiʻi.

Support and enable sustainable  food production in the places where people live, learn, work and play that have the highest rates of food insecurity.

Promote local sources for healthier diets to reduce food system-related diseases and conditions like obesity and overweight as well as diabetes, heart disease and cancer and their risk factors.

Public health: a powerful argument for food systems transformation

HIPHI is part of Transforming Hawaii’s Food System Together, a collaborative and multi-sectoral food system change initiative. We believe that the health of the people and the health of āina are one. The increase in premature deaths from chronic and non-communicable diseases in Hawai’i in recent history, is a compelling reason for food systems transformation that is bold and immediate. Making healthier food choices available throughout the life cycle requires action from multiple sectors in a range of settings, as the pathways to poor health outcomes are complex and highly contextual. Clarity on the inextricable interconnections between our islands, our food systems, our health and our people require engagement with all of government and all of society. Policies on economic development as well as equitable and sustainable use of natural resources: land and water, as part of the Sustainable Development Goals for Hawai’i, are at the heart of the changes that are necessary. Food is a human right, in the same way that health is a human right. Food systems transformation and food sovereignty is about social justice.

We are a part of Transforming Hawaii’s Food System Together, a collaborative and multi-sectoral food system change initiative.

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