Hula and other culturally based programs should be used to address longstanding health inequities affecting Native Hawaiians and other Pacific Islanders in Hawaii, according to a new report from researchers at the University of Hawaii John A. Burns School of Medicine.

The report calls for systemic change and is the culmination of a year of research, said lead author Mele Look from the UH Department of Native Hawaiian Health. It builds upon a similar report published in 2013, but unlike the previous version, includes a chapter on the historical drivers of current health inequities among Native Hawaiians.

“Because culture is such a significant part of what distinguishes a population, especially Indigenous communities, disease prevention, treatment, and management programs must be culturally responsive at their core and the cornerstone of health promotion,” the report says.

A group of women dance hula together under the direction of Kumu hula Mahealani Kalikolau 'olenakalani at the Magic Island Park in Honolulu, Thursday, July 9, 2020. (Ronen Zilberman photo Civil Beat)
Women dance hula together under the direction of Kumu hula Mahealani Kalikolau ‘olenakalani at the Magic Island Park in Honolulu. Hula is one way for Hawaiians to manage hypertension and other diseases. Ronen Zilberman/Civil Beat

Foreign diseases and the dispossession of lands and kingdom lay the foundation for current health problems, according to the report, which was released Monday and intended to inform public policies and funding regarding Native Hawaiian health. Pacific Islanders more broadly also have been harmed by colonization and military environmental waste, most notably nuclear testing in the Marshall Islands.

Apart from the new history section, many of the findings about the state of health inequities are similar, Look said. More than half of non-Hawaiian Pacific Islanders — 54% — suffer from obesity, along with 43% of Native Hawaiians, more than twice as high as white, Chinese, Filipino and Japanese communities in Hawaii.

The obesity rate among non-Hawaiian Pacific Islander teens is 44%. The rate among Native Hawaiian teens is less than half of that at 19%. But the rate among white and Japanese teens are far less, at 7% and 5%, respectively, according to the report.

Look said she relied upon data that lumped Native Hawaiians and other Pacific Islanders together when disaggregated data wasn’t available. The community as a whole has high rates of coronary heart disease, cancer and diabetes.

It was unclear whether those disparities would remain if the communities were disaggregated. When Hawaii separated COVID-19 data for Native Hawaiians from other Pacific Islanders, the state found the coronavirus rate for Hawaiians was relatively low and extremely high for other Pacific Islanders, such as Chuukese, Marshallese and Samoan residents.

Prioritizing Indigenous Health

Look said one key takeaway from the report is that effective culturally based solutions exist to address health inequities.

“There are more promising practices both that are supported by scientific research and others that are driven by the community that seem to be very innovative and very promising,” Look said.

One recommended practice is using hula to help manage high blood pressure. More than a dozen organizations including community health centers offer hula classes to help address hypertension and prevent heart disease.

Look said she is hoping that the Legislature will help hypertension management using hula become reimbursable under insurance.

“We need to rededicate ourselves to make health for our community a priority and make health for all our community members matter,” she said.

Sheri-Ann Daniels, executive director of the nonprofit Papa Ola Lokahi, said she appreciates the report’s emphasis on the need for systemic change and believes better data disaggregation would help.

“As much as we want to think about culture and about Indigenous frameworks and thinking, at the end of the day we have to access resources from non-Native policymakers,” she said.

Click here to read the report.

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