The Health of Native Hawaiian and Other Pacific Islanders
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Grand Canyon University: NRS-429VN
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Native Hawaiian and Other Pacific Islanders (NHPI) Population In 1997, the Office of Management and Budget revised Statistical Policy Directive No. 15, Race and Ethnic Standards for Federal Statistics and Administrative Reporting and separated the 1976 racial category of “Asian and Pacific Islander” into two groups: “Asian” and “Native Hawaiian or Other Pacific Islanderi Native Hawaiians, Samoans and Chamorros are indigenous peoples to the State of Hawaii, the U.S.Territory of American Samoa and the U.S. Territory of Guam respectively. 8 out of 10 Pacific Islanders in the U.S. are native to the United Statesiv. Pacific Islanders include diverse populations who differ in language and culture. They are of
Polynesian, Micronesian and Melanesian backgroundsv. The Polynesian group is the largest and includes Native Hawaiians, Samoans, Tongans and Tahitiansvi. The Micronesian group, which is the second largest, includes primarily Chamorros from Guam but also includes other Chamorro and Carolinian from the Mariana Islands, Marshallese, Palauans and various others which include but is not limited to Pohnpeian, Chuukese, Kosraen, and Yapese from the Federated States of Micronesiavii. Of the Melanesian group, which would include Papua New Guinea, the Solomon Islands and Fiji, Fijian‐Americans are the largest in this groupviii. According to the 2000 U.S. Census, there are 874,000 reported Native Hawaiian and Pacific Islanders (NHPI), which account for 0.3% of the entire U.S. populationx.
Health Status of NHPI Based on CDC's Summary Health Statistics: National Health Interview Survey of 2014, the health status for NHPI population with percent of persons all ages in fair or poor health is 7.0% (CDC, 2014). In general, the health status of NHPI tend to be better than that of non-Hispanic Whites and members of other racial and ethnic groups. NHPI have lower death rates from heart disease, HIV/AIDS and cancer compared to members of other racial and ethnic groups,2 but they have higher mortality rates for certain types of cancer such as stomach and liver. 3 NHPI adults are less likely than non-Hispanic Whites to have a chronic condition (29% vs. 45%), and prevalence rates for any chronic condition are lower in all groups (less than 29%). Across the U.S., the health insurance coverage rate for NHIP is lower than most other racial groups however. One in four NHPI under 65 years old do not have health insurance. Educational attainment is related to socio-economic conditions, and the link between personal income and health status has been well established. Within Hawaii alone, the earnings benefit of a college education is higher among NHPI than it is among other major ethnic groups. In the U.S. 15.9% of Native Hawaiians and other Pacific Islanders hold at least a bachelor’s degree and 4.6% have obtained a graduate or professional degree.
Health Promotion by NHIP "Health promotion is the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behavior towards a wide range of social and environmental interventions" (World Health Organization, 2016). Health promotion defined by NHPI is by understanding their history, values, beliefs, practices, and aspirations. Core cultural values shared by NHPI include family, community, spirituality, and a holistic view of life and health, which strongly influence health behaviors. The holistic worldview of NHPI emphasize the interconnectedness of all things, including the belief that spiritual health contributes to physical health (Pukui et al., 1972). Kinship and the extended family, for example, are central to many social and economic aspects of life for Micronesians and Samoans (Palafox & Warren, 1980). Social isolation has been one of the primary causes of psychological problems and mental illness, such as depression. Generally, families who are unhappy are more susceptible to diseases, hypertension, and suicidal ideations and attempts. There is a strong need to build healthy communities that can engage people of all ages to combat social isolation (Kaiser Foundation, 2010).
Health Disparities in NHPI In general, Native Hawaiians and Pacific Islanders (NHPI) bear a disproportionately higher prevalence of many chronic medical conditions, such as cardiovascular disease, diabetes, and obesity, collectively known as cardiometabolic disorders (Mau et al., 2009). Native Cardiovascular disease (CVD), which includes coronary heart disease (CHD) and stroke, is the leading cause of death and disability in the world (WHO, 2012). This is consistent with Native Hawaiians having a higher prevalence in different types of CVD and its various risk factors. Among CVD risk factors, hypertension is the most common (Kaplan & Opie, 2006; Pieske & Wachter, 2008). The high rate of hypertension among NHPP may be explained in part by the high rate of obesity and other factors that affect blood pressure. An association has been found between hypertension and psychosocial stressors, such as work strain, social status, and emotional stress, for which many NHPP of lower incomes and in certain occupations may experience more persistently (Kulkarni et al., 1998). Recent studies have found that 1 in 3 Native Hawaiian adults have or are at-risk for diabetes or pre-diabetes (Aluli et al., 2009; Grandinetti et al., 1998). Diabetes is rising among Polynesians, Micronesians, and Melanesians who have prolonged exposure to more Westernized lifestyles (e.g. access to calorie dense, high fat foods and less physical activity) compared to more traditional subsistence-based lifestyles (Okihiro & Harrigan, 2005; Papoz et al.,1996). The prevalence of having two or more chronic conditions increases with obesity (Must et al., 1999). In the U.S., more than half of NHPI are either overweight (31.7%) or obese (31.0%) (Asian and Pacific Islander American Health Forum, 2010). Hawaiians not only have higher rates of death for diabetes and heart disease but also for cancer and other leading causes of death. Cancer is the second leading cause of death in the state of Hawai‘i and while rates vary by ethnic groups, the four most common types of cancer in Hawai‘i are: breast (female), colorectal, lung and prostate cancers (Green, 2010). For the NHPI population, numerous reports identify the following health risks: low levels of physical activity, poor diets, high tobacco use, high rates of overweight and obesity (Moy et al., 2009). From 2005 to 2007, the percentage of alcohol use for NHPIs (46.4%) was lower than for Whites (64.2%) and similar to other racial groups. Smoking and tobacco use are the leading cause of preventable illness and death in Hawai‘i and the nation. Two in five NHPI adults (42%) in the U.S. were physically inactive, with others getting at least some exercise or regular exercise.
Health Promotion Prevention in NHIP Using tertiary prevention health promotion prevention appears to be more effective for NHPI especially in focusing on chronic disease management such as obesity, diabetes and cardiovascular disease. With increased attention to diabetes management efforts on the part of community health clinics (CHC), the Native Hawaiian Health Care Systems (NHHCS), and private physicians, a growing number of Native Hawaiians are reporting increased diabetes awareness and access to diabetes management education. Between 2000 and 2010, the number of Native Hawaiians who reported receiving diabetes management education increased from 47% to 57%. Burden of chronic diseases already present in many NHPIs, interventions to increase physical activity would prove to be especially beneficial to NHPIs due to the health benefits of physical activity, such as lowering blood pressure and blood glucose and improving insulin-sensitivity (Cook et al., 2010). A range of innovative practices continue to be developed to help NHPI adopt healthier lifestyles and to better manage their chronic medical conditions. A number of these initiatives focus on community-based and culturally-relevant interventions. Implemented these culturally adapted interventions via peer educators in various community settings. Found significant improvements in weight loss maintenance, physical functioning, and blood pressure for the lifestyle intervention and glycemic control for the diabetes intervention (Mau et al., 2010; Kaholokula et al., 2012; Sinclair et al., 2012). The integration of NHPP cultural practices into health interventions is innovative and an important promising practice. Another promising effort is the growing school and community garden movement in Hawai‘i. These gardens are not only a new source of fresh vegetables, fruits, and herbs, but also provide a means to reconnect individuals to the practice of growing and eating healthy foods. At the root of many of these efforts is a cultural and spiritual grounding in the deep relationship that Pacific Peoples have with ‘aina (land) – that which feeds.