ASSESSMENT AND PRIORITIES FOR HEALTH & WELL-BEING IN NATIVE HAWAIIAN & OTHER PACIFIC PEOPLES

DEPARTMENT OF NATIVE HAWAIIAN HEALTH CENTER FOR NATIVE AND PACIFIC HEALTH DISPARITIES RESEARCH

JOHN A. BURNS SCHOOL OF MEDICINE UNIVERSITY OF HAWAIʻI AT MĀNOA

Mele Look Hawai’i Rural Health Conference Kaua‘i Sheraton Resort October 23, 2014

WHO IS INCLUDED?

Native Hawaiian,

527

Samoan, 184

Guam/Chamorro, 148

Tongan, 57 Fijian, 32 Marshallese,

22

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

Filipino All NHPI NativeHawaiian

Samoan Tongan Guamanian& Chamorro

2000 2010 % change

Hawaii’s Native Hawaiian, Pacific Islander & Filipino Populations are Growing

USA: Native Hawaiians & Pacific Islander Populations in 2010, (thousands)

USA: 1.2 million NHPI Comprise ~.4% of USA population

WHERE DO WE LIVE?

Top 5 Counties - Highest % NHPI

1. Honolulu, HI 2. Hawai‘i, HI 3. Los Angeles, CA 4. Maui, HI 5. San Diego, CA

USA 30% NHPI in Hawai‘i 23% NHPI in California.

Census 2010

HOW IS OUR HEALTH?

62.5 69.1 69.5 67.6

72.6 74.2 74.3 80.9 80.5

0

10

20

30

40

50

60

70

80

90

Hawaiian Filipino State Total

Age

In Y

ears

1950 1960 1970 1980 1990 2000

Native Hawaiian life expectancy improved … But lags 6 years behind of total State

Native Hawaiian Mortality Rates for Top Causes of Death, 2000

Native Hawaiians die from the same TOP Causes of Death … Just at earlier age and with earlier onset

HEALTH BEHAVIORS NEED TO IMPROVE

0

10

20

30

40

50

60

70

0

10

20

30

40

50

60

70

Nat

ive

Haw

aiia

n (%

)

Cum

ulat

ive

Heal

th D

ispa

rity

(%)

Smoke Heavy Drinkers No Physical Activity Native Hawaiian

SMOKING & ETHNICITY

Native Hawaiians and Filipino men have significantly higher rates of smoking

8.8

10.8

13.4

15.3

15.4

16.8

19.6

20.6

22.7

25.3

5 10 15 20 25 30

Japanese (F)

Filipino (F)

Caucasian (F)

Caucasian (M)

Hawai‘i State Average

Japanese (M)

Native Hawaiian (M)

United States Average

Native Hawaiian (F)

Filipino (M)

Percentage

COMMUNITY HEALTH CENTERS Key Health Service Providers

44%

25%

18%

13%

NHPI

Caucasian

Asian

Others

2013 PILI ‘Ohana Project – 5 Co-PIs

PILI ‘Ohana Project is EFFECTIVE in reducing weight & … Prevent diabetes & metabolic syndrome

• Randomized Control Trial • Strong CBPR Guidance • 25+ community sites • 5 Major Studies • 9 Years

R21 MD 001660

Scientific Knowledge + Community Wisdom = HEALTH

Hula is now PROVEN to improve hypertension management

Hula & Health Research Studies

• Randomized Control Trial • CBPR guided • 12 weeks • Hula 2x week + 3 hr heart health ed

Health is Impacted by Many Factors

Where we live, learn, work, and play impacts our health

• Economic

• Education

• Social & Cultural

• Emotional & Spiritual

0

10

20

30

40

50

60

70

0

20

40

60

80

100

120

140

160

Stat

e of

Haw

ai‘i

Hono

lulu

Cou

nty

East

Hon

olul

u

Wes

t Hon

olul

u

‘Ew

a

Wah

iaw

a

Wai

‘ana

e

Wai

alua

Ko‘o

laul

oa

Ko‘o

laup

oko

Haw

aii C

ount

y

Hilo

Puna

Ka‘u

Sout

h Ko

na

Nor

th K

ona

Sout

h Ko

hala

Nor

th K

ohal

a

Ham

akua

Mau

i Cou

nty

Hana

Mak

awao

Wai

luku

Laha

ina

Lana

‘i

Mol

oka‘

i

Kaua

i Cou

nty

Hana

lei

Kapa

‘a

Lihu

‘e

Kolo

a

Wai

mea

Nat

ive

Haw

aiia

n (%

)

Cum

ulat

ive

Econ

ocm

ic D

ispa

rity

(%)

Native Hawaiian and Economic Disparity

Adults w/o High School Diploma (2000) Unemployed (2008) Financial Aid (2008)

Food Stamps (2008) Below 200% Poverty (2000) Native Hawaiian (2000)

Economic Well-being is Critical • Poverty contributes to inequitable health outcomes • NHPP labor force needs more people with college

degrees in higher wage fields such as technology, science & business

10.0

15.0

20.0

25.0

30.0

35.0

40.0

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

Food

Pre

p & S

ervin

g Rela

ted

Perso

nal C

are &

Ser

vice

Sales

& R

elated

Build

ing/G

roun

ds C

leanin

g & M

ainten

ance

Healt

hcar

e Sup

port

Tran

spor

tation

& M

ateria

l Mov

ing

Farm

ing, F

ishing

, & F

ores

try

Prod

uctio

n

Offic

e & A

dmini

strati

ve S

uppo

rt

Arts,

Ente

rtainm

ent, S

ports

, & M

edia

Prote

ctive

Ser

vice

Educ

ation

, Tra

ining

, & Li

brar

y

Comm

unity

& S

ocial

Ser

vice

Instal

lation

, Main

tenan

ce, &

Rep

air

Busin

ess &

Fina

ncial

Ope

ratio

ns

Life &

Phy

sical

Scien

ce

Cons

tructi

on &

Extr

actio

n

Comp

uter &

Math

emati

cal

Lega

l

Arch

itectu

re &

Eng

ineer

ing

Healt

hcar

e Pra

ctitio

ners

& Te

chnic

al

Mana

geme

nt

Male Female Median Hourly Rate

Jobs held by NHPI in Hawai‘i, Hourly Rates

Better Education = Better Health • Numerous studies have shown a college degree

will lead to better health status • Hawai‘i Community Colleges have been very

successful in enrolling Native Hawaiians

13.6 12.1

15.9 14.1

17.0

14.9

22.4

14.5

23.5

14.7

0.0

5.0

10.0

15.0

20.0

25.0

UH Community Colleges UH Undergraduate

Perc

enta

ge

1992 1996 2000 2006 2007

Native Hawaiian Student Enrollment

PROMISING TREND Community College Innovation

Native Hawaiian Health Professional Development

Health School or Department University of

Hawai‘i at Mānoa (N)

NH Majored in College/School

(N)

NH Majored in College/School

(%) School of Medicine 497 39 8.0 Psychology Department 294 25 8.5 School of Human Nutrition, Food & Animal Sciences 185 23

12.0 School of Nursing & Dental Hygiene 665 96 14.0 School of Social Work 301 63 21.0

Cultural Values & Social Support Impacts Well-being

• Traditions & cultural values help families to overcome social challenges

• Cultural re-awakening strengthens identity and well-being

• Interconnections of spiritual and physical health

COMMUNITY SPEAKS OF HEALTH NEEDS

Ulu Network Organizations

93% said Priority Health Areas are:

Diabetes

Heart Disease

Obesity

Neighbor Island Health Service Needs

Nutrition expertise & education

Specialists in diabetes & heart

disease

Behavioral & mental health

Nutrition Education in Hilo

Oahu Health Service Needs

• Lifestyle Changes • Diet, Exercise, Healthy

Habits Prevention

• Disease management • High blood pressure,

diabetes, heart disease Prevention

Native Hawaiian Traditional Healing

• 28% offer traditional healing services • Most others are very interested but need

assistance – Financial support – Educating staff – Administrative issues

Hui No Ke Ola Pono, Maui

Traditional Healing Center

Support for Prevention

PILI Program, Papakolea

Health insurance usually doesn’t cover prevention programs

Hilo Food Garden & Diabetes Hui Mālama Ola nā ‘Ōiwi

Promising Practices

Programs That Work • PILI ‘Ohana • Land Food &

Health

Lifestyle Changes • Food Gardens

• Schools • Communities • Homes

Outstanding Models • Wai‘anae Coast

Comp Hlth Center

• Kokua Kalihi Valley Hlth Ctr

Hawai`i Island

Maui

Kaho`olawe

Lāna`i

Molokai` Ni`ihau

PILI Program Locations

Waianae Hawaiian Homestead Assoc

Kaua`i

O`ahu

Ke Ola Mamo

Kōkua Kalihi Valley

Queen Medical Center

Waimānalo Health Ctr.

Ho`ola Lāhui Hawai`i

Nā Pu`uwai

Keaukaha Hawn Homestead

Lāna`i Community Health Ctr.

Papakolea -Kula Na Po`e Hawai`i

Moloka`i Community Health Ctr

Hawai`i Maoli

JABSOM

Keiki o ka ‘Aina

Queen Liliu‘okalani Children’s Center

Panewa Hawn Homestead

Food Gardens Returning to ‘Āina

• Kalihi Kokua Kalihi Valley

• Wai‘anae Wai‘anae Coast Comp Hlth

• Wai‘anae, Honolulu, Koolaupoko, Koolauloa Ke Ola Mamo

• Hilo Hui Malama Ola na ‘Oiwi

• Waimanalo Waimanalo Hlth Ctr

• Hana & Wailuku Hui no ke Ola Pono

Hilo, Hui Malama Ola na ‘Oiwi

Kalihi, KKV

Role Models & Innovators

• Tight relationship with Wai‘anae community • Focus on enabling services • Incorporation of Hawaiian culture

WCCHC, Staff training

Role Models & Innovators

Recolonizing Kalihi

Pacific isle women get a workout and healthy harvests through an innovative agricultural initiative

By Katherine Nichols

knichols@starbulletin.com

May 16, 2006

Kokua Kalihi Valley • Focus on Social Determinants like community

empowerment • Native Hawaiian beliefs & practices in programs • Returning to ‘āina seen as a bold health strategy

“neighbors being neighborly”

What’s Working? • Integrating cultural values & practices with established

health promotion strategies • Addressing the social determinants of health • Community-placed approaches • Culturally-competent integrated primary care • Collaborations & partnerships with innovation &

sustainability • Growing our own health care workforce • Community resources to promote healthy behaviors

Tui Family, Papakolea

Ulu Hina, Kū Papa -Thriving & Enduring

Mahalo This presentation was made possible with

awards from… • National Institutes of Health, National

Institute of Minority Health & Health Disparities (P20MD00173;U54MD007584)

• Health Resources & Srv Admin (2D34HP16044 )

• The Queen’s Health Systems