Ka Wai Ola - Office of Hawaiian Affairs, Volume 8, Number 5, 1 May 1991 — Hawaiian Health Horizons [ARTICLE]

Hawaiian Health Horizons

Health is only one aspect of well-being

This is the fourth article in a five-part series summarizing the findings of the E Ola Mau Native Hawaiian Health Needs Study conducted in 1985. It findings and recommendations led, in part, to the passage of the Native Hawaiian Health Care Act of 1988 whieh established the Papa Ola Lokahi Hawaiian health consortium. The consortium's five members agencies — the state Department of Health, E Ola Mau, the University of Hawai'i, Alu Like and Office of Hawaiian Affairs — are working with island communities to develop a comprehensive health care master plan for Native Hawaiians and a network of Native Hawaiian health care systems statewide.

Report of the E Ola Mau Native Hawaiian Health Needs Study Part 4 of a series: Historical/CulturaI Task Force The purpose of this report was to provide a historical and cultural context to the E Ola Mau Hawaiian Health Needs Study Report with appropriate conclusions and recommendations. Available historical information reveals that for more than 1,500 years prior to 1778, there flourished a generally robust native po'e (people) adapting well over the centuries to their island ecosystems in a cluster of mid-Pacific islands later to be called Hawai'i. Cultural values and practices stemmed from basic concepts of lokahi (unity) with a living, conscious and communicating cosmos; harmony with self — na'au (mind), kino (body), 'uhane (spirit), wailua (dream soul), and others — 'ohana (family), kupuna (ancestors), 'aumakua (ancestral gods), and nature; observance of kapu (sacred law) and communication with the spiritual realm to maintain mana (special energy). These beliefs and practices were generally effective in promoting wellness and preventing and controlling illness. Western impact, beginning in 1778, resulted in spiritual devastation and almost complete eradication of the Native Hawaiians. The main factors for this were introduced infections, native laek of immunity, and haole (white) eeonomie, political, social, cultural and military control, with resulting Native Hawaiian despair and, for many, loss of will to live in a world that had become hostile and no longer meaningful. The illegal overthrow of the Hawaiian kingdom by a haole oligarchy, aided by U.S. armed forces in 1893, and subsequent annexation by the U.S. in 1898, without consent of, or compensation to, ka po'e Hawai'i, continued the abuse and humiliation of Native Hawaiians with further loss of our culture, religion, language, lands, status and power. In spite of the rise in the Part-Hawaiian populahon our adverse health profile persisted as just one dimension of a conquered, indigenous people alienated from a non-indigenous government. Most po'e Hawai'i have not adapted to the dominant haole eeonomie, social, political and educational system, unlike many Asian immigrants. Yet too many Native Hawaiians have embraced some harmful western ways, such as ingestion of excessive malnutrients (fatand sugar) and inadequate dietary fiber; tobacco, aleohol and drug dependence; laek of physical fitness; and ko'iko'i (stress). The current health care system has failed to address and improve the health status of ka po'e Hawai'i. In spite of the grim health profile of our po'e, some traditional Hawaiian cultural strengths persist and are even admired by some nonHawaiians, e.g., reverence for nature, expressed aloha 'aina (love of the land), communication with

the spiritual realm, group affiliation over individual assertion, sensitivity to others' moods, avoidance of confrontation, minimization of risk ("ain't no big thing"); child-rearing; desire to eonhnue a basic lifestyle close to the land and sea within an extended 'ohana; and pride of heritage, such as in revitalization of mele (song), hula (dance), other arts and crafts, lawai'a (fishing), mahi'ai (farming), and lapa'au (Hawaiian medicine). The report said if Hawai'i society continues to ignore Native Hawaiian health problems as has been usual in the past, two trends will emerge: • Native Hawaiians will undergo further de — Hawaiianization and become assimilated as nonHawaiians, even though they may occasionally be identified as Native Hawaiians. By comparison, the report says most of the relatively small number of affluent Native Hawaiians already belong to this class. By assimilating and attaining personal achievement in and on haole terms, most have rejected traditional Hawaiian cultural group affiliation. Health problems and other social ills, as "Hawaiian," cease to exist for them. This goal of assimilation was the official mission of the missionaries; was, and still may be, the goal of the Kamehameha Schools; and is still advocated by some Native Hawaiians and many non-Hawaiians for Native Hawaiians. However if steps are taken to kako'o (support) Native Hawaiians in furthering their spiritual and cultural identity, self-esteem will improve. Support for political self-determination and eeonomie selfsufficiency, to regain a land base will allow pursuit of more meaningful lives and thus, improved wellbeing, including health. How ean Native Hawaiians recover and maintain their ethnic identity? One way is via resistance to the dominant haōle society, through passive resistance (while quietly maintaining aspects of our culture) and through active resistance, through confrontation and control. These strategies though may spell loss of some traditional ways. Another approach is through practicing biculturalism (Native Hawaiian and haole ways). This requires tolerance, respect, understanding and kako'o by non-Native Hawaiians. It also means po'e Hawai'i would adopt some non-Hawaiian modern technological advances, especially in urban centers, and meanwhile revitalize use of traditional cultural concepts and practices, where applieahle, especially in rural areas.

Recommendations of the HistoricaI/Cultural Task Force The report calls for a "holistic awareness" that health is only one aspect of well-being, and for Native Hawaiians as Native Hawaiians, pride of heritage is paramount. Thus, it says, the historical and cultural basis for the Hawaiian health plight must be the major consideration. It warns against looking only at superficial apparent causes, such as lifestyles, environment, health care and biological factors; or providing programs only in terms of physical health promotion, disease-prevention and intervention. The report calls for Hawaiian involvement in plans for change by means of: • Input by ka po'e Hawai'i in all stages of planning and implementation, with the goal of control by Native Hawaiians of programs for ourselves. • Building upon current Native Hawaiian cultural strengths by incorporation of appropriate Native Hawaiian values and practices.

• Monitoring to assure that programs are for definite benefit of ka po'e Hawai'i, and not merely for promoting non-Native Hawaiian researchers and sustaining administrative bureaucracies. • Systematic and continuous collection, tabulation, and analysis of critical health data by Native Hawaiians on Native Hawaiians for health needs assessments and specific health programs for Native Hawaiians. The recommendations eall for emphasis on health-promotion in the holistic sense and diseaseprevention and control within appropriate cultural contexts, rather than exclusive end-stage intervention in hospitals. The report warns that mere improvement of Hawāiian health statistics, or prolonging life expectancy of ka po'e Hawai'i by imitating modern haole lifestyles may not be necessarily ideal or appropriate for ka po'e Hawai'i and rather contribute to ill health of Hawaiians. Recommendations also eall for health education for Native Hawaiians by trained po'e Hawai'i, in the 'ohana, in loeal Native Hawaiian communities, and among Native Hawaiian health professionals, using Native Hawaiian cultural concepts, language and practices, and using modern communication methods, such as sophisticated television programs.

hducation should target specihc groups with specific hea!th problems, such as: pregnant teenagers, preschool youngsters with dental caries, youths with cigarette, aleohol and drugabuse; patients with diabetes, high blood pressure, obesity, and those at high risk for coronary heart disease and cancer. Other recommendations are far more sweeping, and include: • Appointment of a Native Hawaiian health administrator in Hawai'i at the state level and for eaeh county, to coordinate government health programs for Native Hawaiians with nongovernment programs. • Native Hawaiian community (loeal family) health centers. • Investigation of reinstituting free medical care for needy po'e Hawai'i at the Queen's Hospital, Kapi'olani Hospital, and Lunalilo Home. And integration of health programs with others concerned with: • Land — return of the Native Hawaiian land base through return of federal ceded lands, state ceded lands, Hawaiian Home lands, and proper protection of private Native Hawaiian lands, such as the Bishop Estate, Lili'uokalani Trust, Queen Emma lands, and threatened private Native Hawaiian family lands. • Population control of further in-migration to prevent further unhealthful crowding, enme and destruction of natural resources. • Law — State civil rights law to assure representative health care for po'e Hawai'i. Education of more Native Hawaiian culturallysensitive attorneys, legal aides and mediators. • Political self-determination: Locally-elected Native Hawaiian councils and governing boards. Representation of po'e Hawai'i on all government bodies. Workshops on political organization and effective action on Native Hawaiian issues. Register every eligible Native Hawaiian to vote; provide transportation to voting booths. • Eeonomie self-sufficiency: Job-training, especially for self-sufficiency in living from the land and the sea. Restraints on foreign multi-national control of Hawai'i economy and especially for Native Hawaiian lands. • Environmental protection against pollution and destruction of our natural resources by continued page 18

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/rom page 16 government, developers, tourism, other commercial interests and the military. • Education: Hawaiian language and culture in all public and private schools, with instruction on Native Hawaiian rights and history of exploitation of Native Hawaiians, coordinated with health instruction at all levels. • Housing: Preference for needs of loeal Native Hawaiians over desires of malihini (newcomer) and greed of developers. • Transportation: Limitation on automobiles and roads to reduce accidents and fatalities, and restrictions on destructive air and sea transportation facilities and practices. • Energy: More use of natural energy sources; less dependence on foreign oil. • Historic sites: Protection, restoration, maintenance and proper cultural use of Hawaiian historic sites in regular celebrations, ceremonies, cultural 'aha (gathering), and historical dramas. • Communication: Appropriate representation (about 20 percent) of Native Hawaiian culture, language and personne! in all major media (TV, radio, newspapers). Restriction of commercial advertising of healthharmful marketed products. Lawai'a (fishing); Restoration of na loko (fishponds) to be maintained by po'e Hawai'i;

subsidized cooperative lawai'a until such programs become self-sustaining. Appropriate nurturing and protection of Native Hawaiian marine food sources. • Mahi'ai (farming): Subsidized cooperative, diversified mahi'ai for loeal needs, engaging Native Hawaiians, until farming programs become selfsustaining; promotion of individual home gardens, and smal!-scale farming for family subsistence of Native Hawaiian food sources, such as, taro, 'uala

(sweet potato), uhi (yam), 'ulu (bread-fruit), mai'a (banana). • Language and culture: 'Aha Punana Leo (language nest) for preschool, child-care Native Hawaiian culture-language centers, conducted by trained Hawaiian language speakers and incorporating traditional Native Hawaiian cultural concepts, literature, and practices. Thus, a new generation of Native Hawaiian language speakers will succeed the few remaining elderly ones.