Helping The Health Of Hawaiians

Health Issues Intrinsic to Hawaiian Population

Bringing Alternative Heath and awareness to local-area residents is one of the principal goals of the Positive Energetics Foundation. We started “dabbling” in this venture approximately a year ago – just helping out local folks. The response and results have been overwhelming. The problem is that while we have identified the need, we have also found it to be so considerable that we cannot afford to help everyone. This is why we made the decision to form a legal organization and provide services with the assistance of corporate sponsorships and grant funding.

STATEMENT OF NEED

Health Issues Intrinsic to Hawaiian Population

In the 2000 U.S. census, Native Hawaiians and other Pacific Islanders (NHOPIs) were recognized as a distinct racial minority group, with unique histories, values, and traditions. This recognition caused local social workers to realize the need for identification of intrinsic needs that may be inherent to the Hawaiian population. Subsequently, with its historical commitment to social and cultural diversity, local social workers have begun to establish a knowledge base on this population in periodical literature. This has been most helpful in identifying potential heath issues and to suggest corrective measures for such issues.

For example, in their report entitled Has social work met its commitment to Native Hawaiians and other Pacific Islanders? A review of the periodical literature, the authors found during a review of literature published from 1995 to 2004, that 32 articles were found in 23 journals, representing 0.64 percent of the more than 5,000 articles published in these journals. Unfortunately, however, much of this literature combined information on this population with that of Asian Americans, thereby masking the distinctiveness of Pacific Islanders. “These results suggest that although social work has demonstrated a commitment to NHOPIs by beginning to establish a knowledge base, refinement and expansion of knowledge is still needed. The authors recommend three steps to refine this knowledge base: (1) increase the number of publications, (2) disaggregate data so that Asian Americans will be considered separately from NHOPIs, and (3) ensure that information on this population be anchored in cultural values and culturally based models of practice.” (School of Social Work, University of Hawaii, Honolulu, HI 96822, USA; 2008 Apr;53 (2):115-21.)

Heart Disease among Hawaiian Population

The incidence of heart disease is disproportionately large among the Hawaiian population. They suffer a higher prevalence of heart disease and associated risk factors than do other Americans, as well as serious barriers to health care, including accessibility and the acceptability of services to this population. (School of Social Work, University of Hawaii, Honolulu 96822, USA; 1995 Feb;20(1):46-51.)

According to a Journal article by Noreen Mokuau, Claire K. Hughes, Joann U. Tsark, Heart Disease and Associated Risk Factors among Hawaiians: Culturally Responsive Strategies, “The leading cause of death of adults in the United States is heart disease. The death rate for Hawaiians from heart disease is 44 percent higher than that for the total U.S. population (U.S. Congress, Office of Technology Assessment, 1987). The age-adjusted mortality rate (computations that reflect risk as if all groups being compared have the same age distribution) of heart disease for Hawaiians is 273 per 100,000 persons; for the total U.S. population it is 190 per 100,000 persons. (Health and Social Work, Vol. 20, 1995; 1:46-51)

“The heart disease mortality rate for Hawaiian men (344 per 100,000) is disproportionately higher than the rate for all men of other ethnic groups (212 per 100,000), and the rate for Hawaiian women (244 per 100,000) is higher than that for all women of other ethnic groups (109 per 100,000).” (Wegner, 1989a)

Poor Quality of Life among Hawaiians

This research further found that Native Hawaiians, that is the people indigenous to the Hawaiian Islands, are impoverished in quality of life. “Only recently has the myth that native Hawaiians are a carefree people living in a tropical paradise been dispelled. The number of health and mental health problems confronting native Hawaiians is alarming; their general health status is far below that of other U.S. population groups.” The researchers suggest a level of urgency in examining the unique circumstances of native Hawaiians and subsequently encouraging professional support for the planning of culturally appropriate services for this population.

Supports and obstacles to cancer survival for Hawaii's native people

According to University of Hawaii John A. Burns School of Medicine, “investigators have suggested that high cancer mortality rates among Native Hawaiians are due to fatalistic attitudes toward the disease, poor access to care, and lack of consideration of Native Hawaiian cultural values in Western approaches to healthcare.” In a study conducted by the University, “eight focus groups were held on five islands, attracting 45 Native Hawaiian cancer survivors from both rural and urban locales. The focus groups explored survivors’ experiences with cancer diagnosis, treatment, and recovery. Participatory research methods were used, with researchers gaining community input on study design, incorporating appropriate Native Hawaiian cultural protocols into the focus groups, and engaging participants in the interpretation of the data.” The results indicated that similar to cancer survivors of other ethnicities, “these individuals demonstrated the following: success in accessing healthcare information, professionals, facilities, and insurance; the ability to overcome the barriers confronted; and proactive health behaviors regarding screening, diagnosis, and treatment. They also demonstrated ways in which they were sustained through the cancer experience by Native Hawaiian traditions, such as helping others, gaining strength from Hawaiian spiritual beliefs, and relying on family for personal support. Participants did not respond passively to their cancer diagnoses, and they expressed few fatalistic attitudes. Participants did give numerous examples of other Native Hawaiians who did not seek screening or treatment for cancer because they lacked insurance, had poor access to care, or felt alienated by Western healthcare.” (Emphasis added)

According to researchers, these findings indicate that it is imperative we improve access to care, incorporate cultural values in health education and services, in order to enhance survivorship and quality of life for Native Hawaiians with cancer. (University of Hawaii John A. Burns School of Medicine, and Research Co-Director, 'Imi Hale, Honolulu, Hawaii 96813, USA; 2002 Jul-Aug;10(4):192-200.)

Importance of Culture and Honoring Diversity in Community Practice

According to Brandon University in Canada, nurses work daily with individuals, families, groups, and communities where lives are enriched and challenged by cultural diversity. Many indigenous people living in a community are often suspicious of outsiders and especially those who are highly educated. In treating such indigenous individuals, it is important to realize and deal with the challenges and strategies for respecting culture and honoring diversity. Instead of using the more “traditional” nursing practice of working with individuals, it is often times more beneficial to work with collectives, i.e. to community practice beyond individuals and families, beyond community as context, to community as client. Recommendations for effective community practice in working with groups and organizations must be heeded when working in a community containing an indigenous population. (School of Health Studies, Brandon University, Brandon, Manitoba, Canada; 2007; 21 (4):255-70.)

Diet-related cancer in Native Hawaiians

As with many native cultures, ever since they were exposed to Westerners in 1778, the native people of the Hawaiian Islands have experienced multiple health and social problems, including such problems as cancer and mortality.

In research conducted by the Hawaii State Department of Health, they found sufficient evidence to indicate there is a disproportionate rate of cancer among the native population.

An important result of the research was the prescription regarding the incorporation of cultural practices and beliefs into health care services. In particular, “incorporating the traditional Hawaiian diet into nutrition programs aimed at health education and promotion may have long-term consequences for cancer prevention. Preliminary data on dietary intervention for Native Hawaiians reveal success on several health indices.” and “Intervention programs that use elements of a culture, such as the traditional Hawaiian diet, reflect the inherent strengths of that culture.” (Hawaii State Department of Health, Honolulu 96813, USA; 1996 Oct 1;78(7 Suppl):1558-63.) There is no doubt an organization that works towards improving the health status of Native Hawaiians in the 21st century will, in part, require a respect and systematic inclusion of such traditional elements into health care services.

Native Hawaiian Traditional Healing

The development of teaching healthy life-style interventions that are acceptable to specific cultural groups is a great challenge. Per the School of Social Work, Arizona State University, “Interventions that are based on the traditional healing practices of a particular culture ensure cultural relevance and consistency with its values and worldview.” (School of Social Work, Arizona State University, Tempe 85287-1802, USA; 2002 Apr; 47 (2):183-92.) The importance of culturally-based interventions when providing health services is imperative, as culturally-based interventions may be most appropriate for client systems within a particular culture – in essence the patient will be more willing to work with a provider, if that provider of health care/maintenance knows something of their culture and does not just use “Western” medicine.

For example, when using medical therapies for native Hawaiians, the inclusion of ho'oponopono, for example, would make the therapy more acceptable. According to http://www.ancienthuna.com, “Ho'oponopono means to make right. Essentially, it means to make it right with the ancestors, or to make right with the people with whom you have relationships. We believe that the original purpose of Ho'oponopono was to correct the wrongs that had occurred in someone's life including Hala (to miss the thing aimed for, or to err, to disobey) and Hewa (to go overboard or to do something to excess) which were illusions, and even 'Ino (to do harm, implying to do harm to someone with hate in mind), even if accidental.” When you combine “making it right” with ancestors or in other relationships with other medical therapies, a native Hawaiian is more likely to accept that therapy – and improve their heath.

Need to Improve the Health of the Hawaiian Population

To put it simply: Hawaiian’s are not healthy. Poor nutrition and little to no education on proper eating and exercise have helped to exacerbate this situation. Add to this issue are the numbers of individuals who are un- or underinsured who are ineligible for health-related services and assistance. Where are these individuals supposed to obtain assistance or education on their health and the options for improvement that may save their lives?