Editor's note: Our September/October issue includes a profile of Penn State Hershey alum and Hawaii Gov. Josh Green; shortly after the magazine went to press, unprecedented and deadly wildfires devastated the town of Lahaina on the island of Maui. “This is the largest natural disaster in our history,” Green said in a video update posted online Aug. 13. “There is very little left” of Lahaina, he said, estimating the value of the loss at $5.6 billion. “But most of all, people are suffering.” The Hawaii Chapter of the Penn State Alumni Association is collecting donations to assist with the recovery effort. You can contribute through Venmo to @PSUHawaii.
A few months before clinching a landslide election victory in August of last year to become Hawaii’s ninth governor, Josh Green reluctantly hung up his stethoscope and stopped covering emergency room shifts on the weekends at the rural Hawaii hospital where he’d worked for nearly two decades. It was a difficult decision, he says, but it didn’t change things on a fundamental level. Because even while serving in Hawaii’s highest office, Green remains a doctor first.
That was clear on a weekday morning in May, when Green ’97 MD Hershey and his security motorcade, on their way to a local groundbreaking ceremony on the Big Island, came across an SUV overturned onto the hard volcanic rock of an inactive lava field. Green jumped out of his official state vehicle, took off his sports coat, and made his way to the SUV to help the trapped driver. “We had to move quite a lot of rock to get him out,” Green says. “I was able to assess him, so I knew his neck was stable and he didn’t have a brain injury.”
The driver was fine save for a few bumps and bruises, but photos of the scene, snapped by Green’s communications team, went viral in the islands and made national headlines. One showed the governor, on his hands and knees on the unforgiving rock, speaking to the driver—suspended upside down by his seatbelt—through the window of the vehicle as it rested on its roof. Another showed him alongside firefighters, walking the injured man to a waiting ambulance.
A few weeks later Green provided first aid at another accident, this time to a man who was thrown from the open bed of a pickup truck. For the governor, it was in keeping with the balance he’s maintained since entering Hawaii politics 20 years ago—first in the state house and senate, then as lieutenant governor, and now as the state’s top elected official. Until last year, he also worked as an ER physician. And he has never stopped thinking, and acting, like a doctor.
His medical training and experience give Green a keen insight into the state’s chronic problems. He has seen first-hand the impacts of a lack of affordable housing and a shortage of health care workers, issues he was already working to address as lieutenant governor. And he says his approach is seeing results. Since taking office last December, Green has continued working with the state legislature to expand on his “tiny homes” village initiative, aimed at addressing the state’s homelessness crisis. In May, he unveiled the state’s first medical respite kauhale, a community housing project installed near the grounds of the governor’s residence in Honolulu and designed for people discharged from hospitals who would otherwise return to homelessness.
Green, who inherited a $2.6 billion budget surplus, has also helped set aside $30 million to keep young doctors in Hawaii, pledging to erase their student loans in exchange for working in underserved communities. Laura Thielen, executive director of Partners in Care, a consortium of service providers to the homeless, says the tiny homes model generally and the kauhale in particular are great examples of Green’s approach. At their core, the initiatives are about a network of support. “It’s about community,” she says.
Thielen says the governor recognizes homelessness as a problem that demands resources—that to solve it, she says, “we have to put our money where our mouth is.” Green won more than 63% of the vote in the general election last fall—about the same percentage he won in the Democratic primary—and his ability to continue to address the homelessness crisis and other challenges on his to-do list figures to be a test of his mandate. He’s pledged to bring new urgency to the state’s transition to green energy and to addressing the impacts of climate change, especially on coastal communities and infrastructure. He’s trying to find a new balance for the state’s economic engine—tourism—that scales back the negative impacts visitors have on island communities, while still welcoming tourism dollars. Perhaps most urgently, Green is trying to wrestle with Hawaii’s skyrocketing cost of living, made worse by record-high inflation, that is driving many young professionals to seek opportunities on the continent.
Speaking in his office in May, Green highlighted those projects and others as he sought to underscore how he’ll tackle them—with aloha. Far more than just another way of saying “hello,” aloha speaks to a welcoming, positive vibe with deep roots in Hawaiian culture that pervades most corners of civil society. Leading with aloha, Green says, is about championing respect and diversity while diagnosing what ails communities on the islands—and prescribing solutions. “They say the best job in politics [if you want] to help people is governor. And I think it’s true,” he says. “You can make really local change, but also make systemic change.”
Green’s stature and popularity grew during the early days of the COVID-19 pandemic, when the then–lieutenant governor won praise for his clear communication style and the near-daily “whiteboard briefings” on social media that he used to convey the latest pandemic statistics, trends, and warnings. Gino Amar is an administrator at Kohala Hospital, the 28-bed community hospital on the northern tip of the Big Island where Green has seen patients since 2004. He says Green’s bedside manner is a lot like his approach to constituents: warm, thoughtful, and clear. “He’s still one of us even though he’s governor,” says Amar. “He’s stopping at accidents. It’s in him to help.”
Yet Green says he didn’t always know he was going to be a doctor, let alone a politician. Born and raised in Pittsburgh, he talks often about his close-knit Jewish family and his parents’ humanitarian work, but he admits he wasn’t sure what he wanted to do with his life after graduating from high school and heading to Swarthmore College. Majoring in biology and anthropology, he struggled at first, getting a D in a much-feared organic chemistry class and, he says, never taking a political science course—“not one.”
After that difficult first year, Green applied for a grant to spend a semester abroad and ended up in India, where he recounts an impromptu train trip traveling in a third-class compartment from southern India to the capital, New Delhi. Spending three days on the train, Green says, he saw people struggling with extreme disabilities and realized that quality medical care could have eased their suffering. Then and there, he decided to return to Swarthmore, work on improving his grades, and go to medical school.
After graduating from Swarthmore in 1992, Green headed to the Penn State College of Medicine, and then to a three-year residency in family practice in Pittsburgh. Along the way, he also signed up for medical missions in rural South Africa and Swaziland (now Eswatini), where he treated patients for HIV/AIDS and malaria in hospitals that, he says, also served as makeshift orphanages for the children of patients who died. Following his residency, in 2000, he was awarded a National Health Service Corps scholarship, allowing him the opportunity to pay off his medical school loans in exchange for serving in a rural community. The health corps gave him three options for his duty station: northern Maine, a federal penitentiary in Oklahoma, and Hawaii—a small place called Ka‘u at the southernmost tip of the Big Island. He chose Hawaii.
Arriving in the islands as a fresh-faced doctor, Green served in the rural clinic and four-bed emergency room at Ka‘u Hospital, established in 1971 to replace medical facilities managed by sugar plantations. He wanted to make a difference for patients but knew he had a lot to learn about the people and culture of his new home. The region of Ka‘u has about 6,000 residents scattered across an area larger than the island of Oahu (home to the state capital, Honolulu). Many are working-class or living in poverty; workers displaced by shuttered sugar mills now find jobs in tourism centers or on coffee farms.
Green soon realized that the patients coming to his ER and clinic were sicker than they should have been. They weren’t getting the preventive care they needed, nor the mental health services. “We had no access to drug treatment, no access to trauma services, no access to mental health care,” he says.
Frustrated, Green started searching for solutions. He spoke to local policymakers and legislators. He talked to hospital administrators and public health experts. He got nowhere. He decided to run for state office, he says, to make a point. “I never had any political aspiration at all. I wanted to be a physician, and I am a physician,” he says. “I just really wanted to explain that we had these issues.”
In his first run for state house in 2004, Green challenged an incumbent. He didn’t think he was going to win, but he threw himself into the race, going door to door to speak to constituents and showing up at public meetings to share his concerns. What happened next, he says, was “dumb luck.” “The person I ran against ended up having some legal problems, and I ended up winning,” Green says. “The next thing I knew I was in the house of representatives and in the ER.”
Green would go on to serve four years in the state house before running for state senate, where he spent a decade. “I worked every weekend pretty much covering the hospital,” he says. “I was able to keep both careers going, but I figured sooner or later I would lose an election. The universe seemed to conspire to keep me in.”
Along the way, he met his future wife, Jaime Kanani Ushiroda, a family law expert who was working in a state senator’s office. (When Green became governor last year, she became Hawaii’s first Native Hawaiian first lady.) Their children, Maia and Sam, spent their early years joining Green on weekends for the 50-minute flight to the Big Island, where their dad worked in the hospital, and then returning to Oahu for his day job at the state capitol.
The well-being of children has long been one of Green’s priorities. Geri Pinnow first met Green in 2014, when he was chairing the state senate’s Health and Human Services Committee. She’d come to him with a problem: Kids with autism weren’t getting the care they needed. As a public school teacher, she knew the lack of services and support was a statewide concern. As a mom of a son with autism, it was personal. Together, she and Green crafted what would be known as “Luke’s Law” to provide universal insurance coverage for kids with autism.
“He was the champion of the bill,” Pinnow recalls. “He was very passionate—saw it through from beginning to end.” She says Green’s background made him uniquely qualified to talk about the importance of comprehensive health care coverage for kids with autism, ensuring they received services as early as possible, when that help would have the biggest impact. But Pinnow says Green won her over by doing more than introducing the measure. He wasn’t deterred, she says, after the bill failed to pass when it was first brought before lawmakers, and he worked even harder in 2015, to ensure the votes were secured for passage and the bill signed into law. “I wanted to give up that first year, and we didn’t,” she says.
Pinnow says Green was also happy to offer his time to her and to Luke, welcoming them to his office and explaining the legislative process. He held a news conference to garner support for the measure and invited them to that, too. What Pinnow remembers most is how Green gave Luke special attention. “I didn’t have to explain Luke to him. He got him,” he says. “That was the whole doctor thing coming through.”
Luke, now 23, was able to get the services he needed thanks to the law that Green helped pass. He works at a local grocery store—a job he never could have gotten, his mother says, without the new fully covered supportive services. And in 2022, Luke cast a ballot for the first time in the general election. He wanted to vote for his friend—Josh Green. “Luke wanted to tell others how great he was,” Pinnow says.
During his time in the legislature, Green was also instrumental in the creation of Hawaii’s Cancer Research Center; helping shepherd in a new law that increased the legal age for buying tobacco and e-cigarettes to 21; and creating a statewide trauma system aimed at streamlining crisis care. “Most of the legislation I worked on was health-based,” Green says. “I would see a problem in society or in communities where I was working as a doctor, and we translated that to policy.”
It’s an approach he continued to embrace after getting elected in 2018 as lieutenant governor, a role often dismissed as having little power or influence. Green was determined to do more with the office and found his chance in 2019, when he learned of a deadly measles outbreak in Samoa, the island nation located about 2,600 miles southwest of Hawaii. Green worked with health care providers to put together a mass vaccination mission designed to save lives. He reached out to the World Health Organization for vaccines. He worked with Hawaiian Airlines to donate the travel. He connected with the Samoan government to cut through red tape.
That December, Green and dozens of other Hawaii doctors and nurses landed in Samoa for a two-day blitz. In just 48 hours, they administered some 37,000 measles vaccines to help tamp down an outbreak that killed more than 60 people. “It was a pretty extraordinary experience,” Green says.
At the time, he had no idea that trip would help prepare him for an unprecedented global crisis that was just months away. COVID-19 was a public health and economic disaster for Hawaii, all but shutting down tourism on the islands and triggering tens of thousands of layoffs. “As the only physician in higher office, I became the COVID liaison,” Green recalls. “We decided to tackle this with analytics.”
Shortly after the state instituted a quarantine for incoming travelers and issued stay-at-home orders for nonessential workers, Green started conducting daily COVID updates on his social media accounts. He’d share what he knew and what residents needed to do to stay safe, all delivered in diagrams and graphs scribbled on a whiteboard with a marker. The no-nonsense presentation, delivered with the care of a doctor, endeared Green to many. Residents came to rely on his updates. They trusted him on when to stay home, when to wear a mask and, eventually, when to get vaccinated. The briefings also made him a household name on the islands.
Green credits Hawaii’s strong community ties and cultural sense of societal care, embodied by the word kuleana, or responsibility, for helping to bring the virus under control. He worked with hospitals and emergency management officials to ensure that the health care system wasn’t overtaxed, and to set up a vaccination program. “We checked every last detail to make sure we had enough hospital and infectious disease care, enough vaccinations available in every corner of the state,” he says. It paid off: Throughout the pandemic, Hawaii had the nation’s lowest COVID mortality rate.
Green credits his Penn State mentors, including then-head of the family practice training program Dennis Gingrich, for helping him “learn how to communicate. … The years where we focused on communication and harm reduction and decreasing people’s anxieties served me well in the pandemic.”
Green says he’s still stopped by people who want to thank him for those whiteboard briefings. He also believes his direct and analytical style won him points with those on the other side of the aisle. “It’s the opportunity I have, to communicate with people,” he says. “I’m doing that same thing on poverty, on homelessness, on gun violence, on economic questions—using a whiteboard, using basic communication skills so that everybody feels engaged.” He believes Hawaii’s diversity and aloha spirit help move conversations along: “I don’t know if it’s unique to Hawaii, but if everybody did a little more of that, I think there would be less animosity toward politicians.”
As governor, and with the pandemic having receded as a public health emergency, Green has sought to expand his focus. On tourism and environmental management, he’s pushed for a so-called “green fee” that would charge tourists for visiting Hawaii’s most popular outdoor landmarks and beaches. The proposal didn’t make it through the last legislative session, but he intends to reintroduce it next year. He also saw mixed success on his economic proposals, securing a tax break for working families while failing to get support for broader tax relief to ease Hawaii’s cost of living.
Back at his office the day after responding to that highway accident, Green was energized discussing how the kauhale project embodies old Hawaiian notions of caring for one another. He paused for a moment and smiled. “The most extraordinary thing that happened yesterday was not the accident,” he said. Rather, it was a phone call Green got on his cell—a number he gives out “a lot”—from an unhoused man who said he’d had nine strokes and was regularly going to the hospital. He wanted to know if he could move into one of Green’s tiny houses set up adjacent to the governor’s residence.
“He’s one of those people that’s not only struggling and suffering on the street, but probably consumes a half a million dollars or more a year in health care,” Green says. “The moment he’s sheltered, the cost will drop to nothing. He will need far fewer medical interventions.”
After the call, Green recalled meeting the man years ago when he was running in a park and the man’s dog tried to bite him. Green says he’d given the man his phone number and encouraged him to reach out when he was ready to get off the streets. “I get a lot of interesting calls,” he said, “but that was something else.”
Mary Vorsino is the digital managing editor at Hawaii News Now. She lives in Honolulu.
