Study: Despite Progress, Hawaiians, Other Islanders Still Die Younger
Life expectancy for Native Hawaiians is 6.2 years lower than the state average, though life expectancy has increased by nearly 12 years since 1950.
Therein lies the “good news, bad news” of a new study published Tuesday.
While much progress has been made to improve the health and quality of life of Native Hawaiians and other Pacific Islanders living in Hawaii, their lives are still shorter than whites and Asians. The “big three” killers are diabetes, obesity and heart disease.
The reasons are multiple, including lower income levels and lack of access to services.
But there’s more good news in the study, published by the John A. Burns School of Medicine: The cultural values and practices that sustained Hawaiians for centuries are key to their continued recovery, including the “healing power” of hula, as one health expert put it, cultural education through charter schools and growing food in a back yard or school garden.
“We are returning to the things we know work well, things our ancestors knew but we have lost,” said Dr. Joseph Keaweaimoku Kaholokula, chairman of the Department of Native Hawaiian Health at the UH medical school.
Lawmakers convened Tuesday at the Capitol to hear about the health report.
Kaholokula and other health officials presented the study to the Health and Hawaiian Affairs committees in the state Legislature.
The study’s many authors want to capitalize on what they say has been tremendous progress in treating Hawaiians, Samoans, Tongans, Chamorro, Micronesians and Filipinos. Yes, Filipinos — though usually categorized with other Asians, Hawaii health officials stress that they, too, represent a Pacific Island group with similar health problems.
A top priority for the health officials is to have the Legislature create a task force to establish a Native Hawaiian health-improvement plan. Other goals are to improve access to data from state agencies, to increase preventive services in Hawaiian communities and to promote legislation to address “social determinations” that contribute to health.
Dr. Marjorie K. Mau, director of the Center for Native and Pacific Health Disparities Research, which also contributed to the report, says differences in the health status of disadvantaged populations must be corrected.
“This is not just a racial and ethnic problem,” she told lawmakers. “It goes way beyond race.”
Other factors include gender, income and geography. As was pointed out at the study’s presentation, if a neighborhood like Waianae doesn’t have sidewalks, it’s no coincidence that residents may be less physically active.
That made for another request of lawmakers, from Dr. Mele Look, who works with Mau at the Disparity Research Center: more parks and public recreational facilities to encourage healthy lifestyles.
And more organized physical activity in public schools, urged the med school’s dean, Jerris Hedges.
Josh Green, a medical doctor who chairs the Senate Health Committee, nodded affirmatively at the suggestions.
“Health care transformation is the buzz right now,” he said.
Landmark Study
The new study — Assessment and Priorities for Health & Well-Being in Native Hawaiians & Other Pacific People, reproduced below — is described as a landmark publication by its authors.
Maenette Ah Nee-Benham, dean of the Hawaiinuiakea School of Hawaiian Knowledge at UH Manoa and a trustee with Queen’s Health Systems (which helped fund the study) called the study unique in that it sought to include the voices of community members.
She said “the manao” of the study incorporates both scientific knowledge but also the world view of Hawaiians “to inform and guide our practice and policies.”
The study, advocates said, also demonstrates tremendous progress made in increasing research conducted by “homegrown” researchers. Mau observed that, just 20 years ago, there existed a mere five papers on Native Hawaiians and diabetes. She tied that growth in information to the Hokulea’s worldwide voyage, set to depart Hawaii in 2014, “to prepare the next generation” for a healthier, holistic existence.
The existence described for Hawaiians and Pacific Islanders is anything but healthy. To select just a few sobering statistics:
• Native Hawaiians have higher rates of death in comparison to all other ethnicities in the state.
• More than half of Hawaiians earning under $15,000 annually are smokers.
• Hawaiians and Pacific Islanders live in environments more prone to violence.
• Throughout Micronesia, the Marshallese have the highest prevalence of breast, cervical and thyroid cancers.
Yet, there are also promising signs of change. Here’s a few:
• The infant mortality rate for Hawaiians and Filipinos have shown “clear improvement” over the past 25 years.
• Over the past decade, Hawaiians have reported greater participation in diabetes self-management activities.
• The number of Hawaiians enrolled in community colleges jumped 53 percent between 1992 and 2010.
• Traditional values have helped many in the Hawaiian community cope with and overcome health challenges.
A last point is a key finding of the study: that the integration of cultural practices into health intervention “is innovative and an important promising practice.” Traditional values like ohana, lokahi and aloha “strengthen the resilience, identity and social connectedness of Native Hawaiians and Pacific Islanders and contribute to their physical, mental and spiritual health.”
Experts agree that an “integrated and multi-systemic approach” is necessary to establish “health equity,” the study concludes.
It won’t be easy, especially for people holding several jobs to get by and eating at McDonald’s because there isn’t time for something better.
As Kaholokula pointed out, it will take a “redesign of our society” — to have people become passionate about health and cultural values and turn it back to the communities where they live, work and play.
