Better health is about more than just diet

In Hawaiian, the words for life (ola) and for health (olakino) are closely related, which makes sense. Anything that improves overall living conditions for a target population — including economic, educational and other factors — produces better health for them and benefits for the broader society as well.

In the past week that relationship has been manifest in the statistics on the health outcomes of Native Hawaiians. Those statistics, released in the report "Assessment and Priorities for Health and Well-being in Native Hawaiians and Other Pacific Peoples," can be read both as a glass half-full or half-empty.

The good news in the study, produced by the University of Hawaii’s John A. Burns School of Medicine, is that various social innovations have bettered health for the Native Hawaiian community in recent decades.

The bad news? The Hawaii population that’s the worst off is still the group that’s lived here the longest. And to a similar extent, the other groups in the study — Pacific Islanders and Filipinos — also suffered poor health.

The takeaway message was that Native Hawaiians still have average life spans about six years shorter than other isle residents, with a heightened risk of developing diabetes, heart disease and obesity. Although the life-expectancy gap was about two years wider in 1960, the fact that the indigenous population isn’t thriving rightfully draws the attention of the medical school. Ignoring this tragedy would be folly.

Fortunately, it isn’t being ignored. The positive development, according to the investigators of the study, is that there are strategies that have been effective at reversing the health trends, although too gradually.

That process needs to accelerate, with the participation of policymakers, educational leaders and the broad business community, because plainly good health is keyed to other aspects of life, starting with basic economic sustainability.

For all the struggling Pacific groups, the basic problem is poverty, and enhanc- ing health requires that this barrier be overcome. Families trying, and often failing, to keep a roof over their heads also are overwhelmed by the strains of earning survival wages at multiple low-paying jobs, and too overwhelmed to attend to healthy living habits.

Native Hawaiians and Pacific Islanders comprise the state’s most economically disadvantaged ethnic category, with almost one-fifth living in poverty. Education provides the most reliable route away from a multigenerational poverty cycle.

For Native Hawaiians specifically, the difference a college education makes for earning power is greater than for other major ethnic groups, according to the study. And this is why the University of Hawaii’s policy goal of increasing college graduation among Native Hawaiians can help provide the foundation for a more secure economic future.

One promising trend cited is the 53 percent jump in this group’s enrollment in community colleges between 1992 and 2010. And this is buttressed by the growth of educational strategies that reach out to younger students who otherwise might not see school as relevant. These include the Hawaiian language immersion movement and the Hawaiian-focused charter schools.

Additionally, entities such as Kamehameha Schools have turned their attention to the needs of young families, with infancy and early-childhood programs that provide a healthy start for the next generation. Some of these programs extend into public schools, and that boosts prospects for all students, regardless of ethnicity.

But all of this is with an eye to the future. What would help the health of the current population would be economic development and job-training programs within the community. In Waianae, which has the single largest concentration of Native Hawaiians in the state, some of this is already happening in venues such as the Waianae Coast Comprehensive Health Center, which has on-site career development for much of its staff; its leadership considers job training part of its health program for its patients.

That’s the sort of thinking that should be part of policymaking at every level. Simply put, if Hawaii is to improve the health profile for its poorer residents, patients must be considered in all aspects. Health encompasses all facets of life. It can’t be improved in isolation from how people earn a living or raise their children to hope for the future.