Ka Wai Ola - Office of Hawaiian Affairs, Volume 00, Number 1, 1 Iune 1982 — HE MAU NINAU OLA [ARTICLE+ILLUSTRATION]

HE MAU NINAU OLA

by Kekuni Blaisdell, M.D. Burns Medical School, UH

When asked to write this eolumn, I readily accepted because I was eager to follow-through on proposals I had made in October 1980 at the OHA in the 80s Conference at Leeward Community College. One of my recommendations was more 'imi and kukakuka on specific medical problems, needs and programs of our po'e Hawai'i. Basic information is inadequate and we need more airing of views throughout the Hawaiian community on health matters. According, this initial eolumn will be an overview of the subject with an invitation to you readers to submit your questions and comments. Subsequent columns will focus on specific topics suggested by your responses. As reported in the December 1980 issue of Alu Like's The Native Hawaiian, health is essential if we Hawaiians are to regain our cultural identity, acquire eeonomie selfsufficiency and assert political self-determination. To know what to do about our health, we need to know where we are, decide where we want to go, and then eollectively design workable means to get there. Where are we? The available data on the heahh status of us Hawaiians are meager and disheartening. As of 1970, life expectancy at birth was shortest for us Hawaiians — an average of 67.5 years, compared to the 74-year mean for the total state population, whieh includes all races, according to a 1980 East-West Center report. In 1975, mortality for all major causes of death was highest among us Hawaiians, according to Alu Like figures. We natives comprised only 13% of the adult population, yet we accounted for 28% of the heart disease deaths, 22% of total cancer deaths, 35% of lung cancer fatalities, 23% of strokes and 24% of auto deaths. Our Hawaiian youth, who comprised 20% of the population in their age group, were responsible for 27% of the suicides that year. Hawaiian newborn and infant deaths were 30% vs the 17% expected. If we look at the leading chronic illnesses for 1976, we see that 23% of Hawaiians had high blood pressure, but only 12% of the total state population was so affected. Similarly, we Hawaiians had greater prevalences of asthma, diabetes, arthritis and heart diseases than the other ethnic groups in Hawai'i. We do not as yet have useful statistics on birth defects and mental illnesses. Health Care What of the extend and quality of medical care for our Hawaiian people? Again, we have only incomplete data, and then only for the elderly, collected by Alu Like for 1976. More medicare-eligible Hawaiians did not take advantage of this assistance than non-Hawaiians. Elderly

Hawaiians were more often hospitalized than senior nonHawaiians. Our health-care system, like other aspects of our island society, is haole-dominated, generally lacking in Hawaiian cultural concepts and practices, and with serious under-representation of Hawaiians among health professionals. Of the 2000 of so licensed and active MDs in our state, less than 50% (about 2%) are Hawaiians, and (continued on Page 8)

He Mau-Ninua Ola (continued from Page 7) many predominantly Hawaiian communities have no physician. What are the reasons? Why are we po'e Hawai'i comparatively less healthy than our fellow non-Hawaiians in our native land? The reasons fall into three main categories: (1) the genes we have inherited from our kupuna; (2) our individual lifestyles with respect to what we choose to eat, our consumption of cigarettes, aleohol and drugs, our personal hygiene and our mental coping with stress; and (3) our environment, such as crowding, public sanitation, automobiling, noise, exposure to harmful chemicals, and catastrophies that may be beyond our individual control, but may be amenable to group action. Thus, modern medical science tells us that: — Most cases of hypertension are related to a combination of heredity, excessive sodium salt ingestion and stress. — The most eommon form of heart disease, coronary atherosclerosis, is chiefly related to heredity, dietary fat, cigarette-smoking, high blood pressure, inadequate physical activity and stress. — Most strokes are linked to hypertension and or atherosclerosis. — In diabetes, casual factors are mainly heredity, obesity and overindulgence in dietary fat and sugar. — Cigarette-smoking accounts for most cases of lung cancer and bronchitis, and enhances atherosclerosis. — Aleohol, drug abuse and the stress of crowded living, with anti-social and self-destructive attitudes contribute to the rising rates of auto injuries, child abuse, suicides, homicides and venereal infections. — Despoiling of the natural resources and beauty of our 'aina by pollution and careless "development" result in insanitation, crowding, crime, stress and dependence on imports that have made us strangers in our own homeland. While our ancestral genes may render us more susceptible to some illnesses, certainly we cannot, and should not, blame them for our self-abuses. Like our fellow island residents, too many of us consume "junk foods," puhi paka, inu loa, misuse drugs, hold distressing tensions, laek physical fitness and adequate sleep, and we thoughtlessly disrupt our delicate island ecosystems. These unwholesome behavioral traits were not characteristic of our noble kupuna. They are not traditionally Hawaiian, indeed, they are un-Hawaiian and even antiHawaiian. In Hawai'i of old, care of the body, the mind and the spirit were necessary to preserve eaeh individual's mana. This also entailed harmonious relationships with others and respect for one's ancestors and for nature — the land, the sea, the water, the air wind — for were they not all manifestations of the gods? How tragically far we have strayed from these precious cultural values of our kupuna whieh promoted their wellness. Where do we want to go? With this basis as to where we are and why, what, then, are appropriate heakh goals for us Hawaiians? Clearly we need to improve the heakh indices as previously enumerated so that we Hawaiians do not consistently compare unfavorably with our fellow nonHawaiians. However, I would also suggest that improving statistics is not enough, for there is mueh unhealthiness even within the racial groups with the "best" statistics. We Hawaiians and non-Hawaiians alike need also to consider the goal of living more meaningful lives, regardless of whether they are longer or shorter, or whether or not we have physical disabilities. How meaningful is it to live beyond 80, abandoned by one's 'ohana in a put-away nursing home? Ideal health cannot be freedom from illness and living forever, but, more realistically, the ability to deal effectively with life's recurring challenges, including the inevitability of death. How do we get there? How we pursue this ideal requires group as well as individual decisions and actions whieh we will consider with your ninau, suggestions, criticisms and requests in future columns.