Where Candidates Stand on Hawai‘i Public Health Issues in 2026

Every election cycle, Hawai‘i Public Health Institute invites candidates running for office to complete a survey and publishes their responses to provide voters with information about the candidates’ positions on public health issues that impact Hawai‘i residents and families.

Across these areas, survey results show broad support among participating candidates for proposals designed to expand access to care, reduce health and economic barriers, strengthen prevention, and address the social and environmental conditions that shape health outcomes.

The following analysis is based on candidates who have advanced to the general election or have won the seat outright (77 responses). Not all candidates responded to every question; percentages reflect only those who answered the specific question. For this analysis, “support” refers to the combined share of “Strongly Support” and “Somewhat Support” responses.

Note: The Voter Guide is for informational purposes only. HIPHI is a nonpartisan nonprofit and does not support or oppose any candidate for elected office. The survey was sent to 312 candidates, with 174 respondents (55.7% response rate), where they indicated their position on a four-point scale: strongly support, somewhat support, somewhat oppose, and strongly oppose. Responses were collected between June 5 and September 4, 2026. See the “Compare Issues” tab to compare where surveyed candidates stand on each issue.

Prevention

Survey results indicate strong support for several preventative health measures in Hawai‘i, with candidates expressing support for expanding immunization coverage, implementing a 2-cent-per-ounce fee on sugary beverages, and strengthening the state’s Food is Medicine infrastructure.

Access to immunization is crucial for the security of disease control and the well-being of Hawai‘i residents. While the Centers for Disease Control and Prevention (CDC) has changed childhood vaccination protocols against the advice of medical professionals, proposals have been offered to require health insurers to provide no-cost coverage for immunizations. The policy has received support from 90% of surveyed candidates, demonstrating broad bipartisan interest in maintaining affordable access to preventative care.
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Candidates also expressed support for a 2-cent-per-ounce fee on sugary beverages, with 76% favoring the policy and more than half indicating strong support. The fee is intended to reduce consumption of sugar-sweetened beverages while improving long-term health outcomes among Hawai‘i residents. The fee is estimated to generate at least $60 million in revenue for the state and could be used to strengthen critical health initiatives, such as prevention programs, food access expansion, and health care access.
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Additionally, 95% of surveyed candidates favor increasing infrastructure and state support for Food is Medicine (FIM) programs, including medically tailored meals, produce prescription programs, and nutrition services integrated with healthcare. The program demonstrates the value of nutrition as an integral component of health care.
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Oral Health​

Candidates also expressed interest in the oral care space, including preserving the current level of funding for dental services subsidized through Medicaid, allowing dental hygienists to practice a full scope of services in limited public health settings, and investing in dental workforce education programs.
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The call to preserve the current level of funding for Medicaid dental benefits for adults received strong support, with 98% of surveyed candidates indicating they support continued coverage. Maintaining coverage preserves oral health care for adults who rely on Medicaid coverage. Moreover, allowing dental hygienists to practice the full scope of their licensure and training in limited public health settings could be particularly impactful for Hawai‘i’s keiki, who experience some of the highest rates of dental decay in the nation. The proposal received 96% support from surveyed candidates, with more than two-thirds strongly supporting it.
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Further emphasizing the importance of expanding access, 95% of responding candidates support investing in dental workforce education programs in Hawai‘i, Maui, and Kauaʻi counties.

Affordability

Key affordability issues include establishing a Paid Family and Medical Leave program, providing free school meals, raising the minimum wage, implementing free public transit statewide, and expanding access to Supplemental Nutrition Assistance Program (SNAP) benefits.

Currently, Hawai‘i residents lack access to Paid Family and Medical Leave (PFML). A PFML program would provide up to 12 weeks of paid leave for employees to care for a newborn, bond with a new child, or care for a family member with a serious health condition. The proposal received 88% support among surveyed candidates.

Expanding access to free school meals received 95% support among surveyed candidates. With approximately one in three Hawai‘i households experiencing food insecurity, providing free school meals could reduce the financial burden on families while ensuring children have consistent access to nutritious food. Currently, eight states have expanded free school meals to all students.
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Raising Hawai‘i’s minimum wage to a livable wage received 77% support among surveyed candidates, highlighting broad recognition that wages must better reflect the rising cost of living. Income is an important component of public health and affordability, particularly as approximately 45% of Hawai‘i households are considered Asset Limited, Income Constrained, Employed (ALICE). In 2026, a family of four needs to earn more than $110,000 annually to meet basic needs in Hawai‘i, equivalent to a full-time wage of more than $26 per hour. Yet Hawai‘i’s minimum wage is scheduled to reach only $18 per hour in 2028. This leaves a significant gap between minimum-wage earnings and what families need to survive.
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The push to implement free public transit statewide in Hawai‘i received 80% support from responding candidates. Hawai‘i residents face some of the highest transportation costs in the nation, and many communities lack affordable, reliable transportation options to access work, school, healthcare, and essential services. The initiatives would reduce financial burdens on families, improve mobility for youth, kūpuna, and low-income residents, and help decrease traffic congestion and greenhouse gas emissions.
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Finally, 87% of responding candidates support expanding SNAP eligibility to individuals and families earning below 300% of the Federal Poverty Level (FPL). Currently, SNAP benefits in Hawai‘i end when household income reaches approximately 200% of the FPL. For a family of four, this threshold is around $74,000 per year, even though the same family may need more than $110,000 annually to meet basic living expenses. The push to expand SNAP benefits beyond 200% FPL would allow benefits to gradually decline to $0 as a family’s income rises. Presently, families receiving SNAP are faced with an immediate loss of over $10,000 in benefits annually for earning just $1 over the 200% FPL.
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General Health

Hawai‘i has not yet established a statewide pathway for Medicaid reimbursement for services provided by Community Health Workers (CHWs). Creating such a pathway would help integrate CHWs into the healthcare system while improving access to culturally responsive and community-based care. The proposal received 88% support among surveyed candidates.

In addition to Medicaid reimbursement, investing in CHW training, certification, and career pathways could strengthen the workforce and increase the availability of community-based health services. This proposal received 98% support among surveyed candidates.

In Hawai‘i, more than 25% of the population is over the age of 60. While the number is projected to grow, dignified care for kūpuna is a growing concern statewide. Tax credits for out-of-pocket care costs for unpaid family caregivers of kūpuna or those with disabilities were supported by 96% of surveyed candidates.

Stable public investment is particularly important as programs such as Medicaid and the Supplemental Nutrition Assistance Program (SNAP) face ongoing funding and policy challenges. Of surveyed candidates, 82% support identifying additional revenue sources from those who can afford it most to ensure funding is available to sustain existing and implement new necessary social programs.

Alcohol

According to public health research, increasing alcohol taxes can help prevent underage drinking and reduce excessive consumption. Adjusting and indexing the state alcohol excise tax to current inflationary standards could help fund vital community services, such as substance use prevention and treatment services, affordable housing and houseless services, or physical education (PE) and health teachers in all schools. The proposal received 82% support from responding candidates.

Sweetened, high-alcohol beverages such as BuzzBallz and Four Loko, are often associated with binge drinking among underage and young adult consumers. These beverages can contain significantly more alcohol than a standard beer and may be marketed in ways that appeal to youth. The proposal to impose higher taxes on sugary, high-alcohol beverages received 83% support among surveyed candidates.

The National Transportation Safety Board has recommended lowering the blood alcohol concentration (BAC) limit for alcohol-impaired driving from 0.08 to 0.05 as a strategy for reducing alcohol-related crashes and fatalities. Alcohol-impaired driving is a significant road-safety concern in Hawai‘i, with alcohol linked to a substantial share of motor vehicle deaths on the state’s roads. Lowering Hawai‘i’s legal BAC limit from 0.08 to 0.05 could help prevent crashes and save lives and received 78% support among surveyed candidates.

Finally, a proposal to require cancer warning labels on alcohol advertising and promotional materials, received 90% support among surveyed candidates. The 2025 U.S. Surgeon General’s Advisory on Alcohol and Cancer Risk identifies alcohol consumption as a risk factor for several types of cancer. Warning labels and other public education efforts could help consumers make more informed decisions about alcohol use.
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Tobacco & Nicotine

Tobacco use remains a significant public health concern in Hawai‘i. Each year, approximately 1,400 Hawai‘i adults lose their lives due to tobacco use. Youth use of e-cigarettes is also an ongoing concern. Among youth who use tobacco products, approximately 8 in 10 began with a flavored product, highlighting the role that flavors may play in initiating tobacco and nicotine use.

Flavors such as menthol, fruit, candy, and other sweet or appealing varieties can make tobacco and nicotine products more attractive to young people. Ending the sale of all flavored tobacco and nicotine products in Hawai‘i, including cigarettes, small cigars, e-cigarettes, and nicotine pouches, received 81% support among surveyed candidates.

In 2018, the Hawai‘i Legislature declared the sale of tobacco products a matter of statewide concern, which nullified existing local laws and prevented counties from adopting new restrictions on the sale of tobacco products, including e-cigarettes. Authorizing the counties to regulate the sale and access of tobacco products would allow individual counties to respond to local public health needs, particularly as youth tobacco and e-cigarette use remains a growing concern on the neighbor islands. The proposal received 87% support among surveyed candidates.

Nicotine pouches are quickly becoming a rising threat to our health, as usage rates have increased 250% from January 2023 to August 2025. These products are extremely potent, flavorful, and addictive. The FDA has a limited list of less harmful products that are authorized for sale in the U.S., but most nicotine pouch products sold in Hawai‘i are not on this list, and thus are federally illegal. Limiting nicotine products, including nicotine pouches, available for sale in Hawai‘i to those that are federally legal and authorized for sale by the Food and Drug Administration (FDA) is favored by 89% of candidates who responded to the survey. ​

Hawai‘i currently allocates approximately 12.5% of its annual Tobacco Settlement payments toward tobacco prevention and cessation services. In 2025, the state spent approximately $7.5 million on prevention, while healthcare costs directly attributable to smoking were estimated at $600 million annually. The ongoing allocation of Tobacco Settlement funds toward tobacco prevention and cessation services is supported by 95% of surveyed candidates, including 66% who strongly support it. ​

Climate Health

Hawai‘i is particularly vulnerable to the health effects of climate change because of its geographic location and exposure to a range of climate-related hazards. Some geographical health impacts include extreme heat, wildfire smoke, vector-borne diseases, flooding, water insecurity, disruptions to the food system, and mental health challenges following disasters.
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The Hawai‘i Department of Health currently has only one epidemiologist focused on environmental health statewide. The lack of professionals makes it difficult to monitor the growing range of health threats associated with climate change. Allocating additional funding to the Department of Health to expand environmental health and climate-related epidemiology capacity would strengthen statewide surveillance, allowing the state to identify emerging risks and respond more effectively. The proposal received 82% support among surveyed candidates.
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Hawai‘i is experiencing rising temperatures and more frequent days with elevated heat risk. Extreme heat is among the leading weather-related causes of illness and death worldwide, and its effects are not distributed equally. Children, kūpuna, outdoor workers, athletes, and people with limited access to air conditioning or other cooling resources can face particularly high risks. Improving statewide heat-resilience efforts, including heat-health monitoring, shade and cooling infrastructure, heat-safety protections in schools and workplaces, and community-based preparedness and response efforts, received 93% support among surveyed candidates.
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Conclusion

Hawai‘i’s surveyed candidates show high levels of support for policies that expand access to care and address the root causes of adverse health outcomes. Many of these proposals are also deeply interconnected. For example, affordability measures like a livable minimum wage, free school meals, and expanded SNAP access directly shape residents’ ability to access preventive care, oral health services, and community-based support systems. With nearly half of Hawai‘i households not earning enough to cover basic living expenses, and wages projected to fall further behind the cost of living, these policies represent a necessary step to close an accessibility gap.

For more information about the voter guide, please contact the HIPHI Policy Team at policy@hiphi.org.