Hawaii's 65-and-over share rose from 19.3 to 21.5 percent from 2020 to 2024, against 18.0 percent nationally (DBEDT). In ISPI's analysis, island healthcare systems should plan for single-provider roles, supply disruption, and dependence on interisland transfer.
Abstract
Examines security and preparedness issues for Hawaii's healthcare systems as the population ages, including insider risk in single-provider roles, supply reserves, and neighbor island acute care. All ISPI research is free under Creative Commons Attribution 4.0.
Key Findings
Residents 65 and older rose from 19.3 to 21.5 percent of Hawaii's population from 2020 to 2024; the U.S. figure was 18.0 percent (DBEDT 2025)
In ISPI's analysis, single-provider roles call for graduated insider threat responses rather than immediate suspension
In ISPI's analysis, hospital supply reserves should be sized to each facility's isolation and resupply options
Summary of the paper
"Hawaii's Aging Population, Healthcare Infrastructure, and Island Security" examines security and preparedness issues for island healthcare systems serving an aging population.
It draws on state population data, harbor data, and federal insider threat and HIPAA security guidance.
What the paper finds
- Aging. Residents 65 and older rose from 19.3 to 21.5 percent of Hawaii's population from 2020 to 2024, against 18.0 percent nationally.
- Single-provider roles, in ISPI's analysis, call for graduated insider threat responses rather than immediate suspension.
- Supply reserves, in ISPI's analysis, should be sized to each facility's isolation and resupply options.
What it recommends
- HHSC: graduated insider threat responses for single-provider roles.
- Hospitals: written reserve targets based on isolation.
- Legislature: neighbor island stabilization and telemedicine.
- Governor's Office: link health and housing strategy with outcome tracking.
Who it's for
Hospital and clinic leaders, HHSC, health security officers, and legislators.
Small island health systems across the Pacific also depend on few staff and on imported supplies, so the same planning approach applies, in ISPI's analysis.
Cite as
Pulley, Warren (2026). Hawaii's Aging Population, Healthcare Infrastructure, and Island Security: Workforce Constraints, Insider Risk, and Emergency Supply (ISPI HI-09). Island Security Policy Institute, Honolulu. https://ispiglobal.com/papers-landing/hi09-aging-population https://doi.org/10.5281/zenodo.23449789
BibTeX
@techreport{ispihi092026,
author = {Pulley, Warren},
title = {Hawaii's Aging Population, Healthcare Infrastructure, and Island Security: Workforce Constraints, Insider Risk, and Emergency Supply},
institution = {Island Security Policy Institute},
address = {Honolulu, HI},
number = {ISPI HI-09},
year = {2026},
url = {https://ispiglobal.com/papers-landing/hi09-aging-population},
doi = {10.5281/zenodo.23449789}
}Related Research
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