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
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
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
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
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