Native Hawaiian men in poor health, OHA report finds

The health of Native Hawaiian men is considerably worse than their counterparts in Hawaii’s general population, according to a new report that found higher rates of obesity, asthma, deaths from cancer, mental health problems and the shortest life expectancy, among other disparities.

The report, issued Friday by the state Office of Hawaiian Affairs, links many of the health problems to the changes that transformed life in the islands following Western contact in the late 1700s and the subsequent influx of immigrants that dramatically changed the cultural landscape for Native Hawaiians.

The 45-page report, titled “Kaneho‘alani: Transforming the Health of Native Hawaiian Men,” calls for better policies and programs to provide “holistic interventions” rather than “a more traditional, siloed approach of education, early detection, and treatment.”

Several years in the making, the report is said to build upon the E Ola Mau study, which was written in the 1980s and led to the passage of the federal Native Hawaiian Health Act.

Kamana‘opono Crabbe, OHA’s chief executive officer, said the report is the first to compile data on a range of medical issues, chronic diseases, behavioral health problems and socioeconomic challenges while looking through a “cultural lens.”

Much of the data came from annual state Department of Health surveys.

“But they don’t disaggregate it, they don’t break it down by ethnic group or gender, so we had to do that,” Crabbe said. “It was a multiyear process to get that information, and once we were able to obtain the data files, we were able to distill it down into our own analysis.”

The report offers a historical perspective at the top, declaring that an individual’s well-being is directly reflected in a healthy society.

“That Hawaiian culture was able to flourish for hundreds of years, prior to western contact, is a testament to the ways Hawaiian society kept Hawaiians healthy, and in turn healthy Hawaiians were able to tend their families, gods, avocations, and the aina (land),” the report said.

While ancient Native Hawaiians maintained productive economies regulated by the alii (royals), Euro-American commercial ideals and activity would divert the basis of the Hawaiian economy to one of capitalism, placing a new emphasis on the accumulation of wealth and personal property, the report states.

The far-reaching effects of commerce, according to the report, were especially apparent in the increasing urbanization that occurred during the 1800s. New economic opportunities prompted many Native Hawaiians to leave rural areas, “a process that would ultimately alter ties among families, communities, and places.” In 1850, Hawaii island was the most populated island. By 1872, Oahu was the most populous.

“In the growing capitalist systems introduced by Europeans and Americans, men were seen as the primary economic and political actors, and were much more directly involved in powerful mediums of imperialism. For this reason, men were often more disconnected from traditional culture.”

The transformation of life in the islands would lead to many health disparities among Hawaiian men, a function of the resulting social, economic and political conditions such as financial insecurity, unemployment and poverty, the report said.

According to the document, Hawaiian children are more likely to come from single-parent households than other children in Hawaii. They also experience disproportionately high levels of child abuse and neglect.

With a higher proportion of economically disadvantaged Native Hawaiians in public school, Hawaiian students are generally less proficient in reading, math and science than non-native students. They generally have a lower graduation rate, as well.

The report says, however, that some education scholars suggest that standardized assessment methods are culturally biased.

Between 2003 and 2012 Native Hawaiian youths accounted for the highest number of juvenile arrests and the highest number of juveniles confined to the Hawaii Youth Correctional Facility.

In general, Native Hawaiians have lower educational attainment, higher unemployment and lower earnings than others in Hawaii. They have a low representation in white-collar professions, are overrepresented in the homeless population and have a greater number in the state’s prisons, the report says.

As for health outcomes, Native Hawaiian men live shorter lives than non-natives in general and suffer higher rates of smoking, soda drinking, binge drinking, obesity, asthma and cancer, among other issues.

Older Hawaiian men suffer disproportionately from higher poverty rates, high health care costs, low retirement rates and increased dietary complications due to health conditions requiring nutritional support or multiple medications, according to the report.

The document recommends a further statewide study to produce a complete data set, including information on cultural practices and values to enable researchers to begin to make correlations between various social causes of poor health of Native Hawaiian men.

OHA is developing a report on the health of Native Hawaiian women, scheduled for release in May.

About 50 community leaders attended a meeting at OHA on Friday to introduce the men’s report.

One of them, Molokai physician Dr. Noa Emmet Aluli, praised the effort, saying it will help motivate the community to improve the health conditions of the next generation.

“This report is encouraging,” Aluli said, “because it gives us the power to make change, or to bring improvements, in a collective way with our alii, our professionals, with our educators, with our politicians.”

Former Family Court Judge Michael Broderick said the report is likely to attract the attention of the criminal justice system.

“I think there are a lot of people in Hawaii who are in denial about the numbers and about the data and about the disproportionate impact that the justice system has on Native Hawaiians,” Broderick said.

“This report verifies what a number of people thought for many years, but now we know for sure. For example, Native Hawaiians are disproportionately represented in prison. And I think from a judge’s perspective, judges often have unconscious biases. And it’s unconscious, so that means they’re not aware of it, which I think contributes to the disproportionate number of Hawaiians in prison,” he said.

Kānehōʻālani: Transforming the Health of Native Hawaiian Men by Honolulu Star-Advertiser on Scribd