Why are COVID-19 infections so high among Pacific Island (PI) communities relative to their population numbers?

That is the million-dollar question with a multifaceted answer that we can actually find in the PI community itself. However, allow me to share a few thoughts.

1. Tread carefully so that we never blame the victim.

2. The headlines have compartmentalized and, perhaps, simplified our experiences with COVID-19, but core to Pacific cultures is that all things and people are connected; with COVID-19 we are forced to disconnect. There’s a need to navigate the disconnect.

3. COVID-19 spotlighted and exacerbated the health struggles of PI communities; it did not start it. It awoke experiences of historical trauma and consequences that accumulate into cumulative trauma. History plays an important role in our response to COVID-19 in PI communities.

4. Our PI communities and scholars have provided wisdom on contributing factors to the high COVID-19 numbers and social determinants of health in PI communities. It all points toward systemic and structural barriers to access and availability of resources as well as inequity and exclusion.

The list of contributing factors includes inaccurate data as a starting point and lack of access to quality health care in general. Health disparities and socio-economic stressors, including housing inequities and lower-paying jobs that coincide with lower educational achievements, also are important to consider. We must not forget the consequences of prejudice, differential treatment and unequal opportunities and how the lack of financial resources can be a barrier to the prevention of COVID-19 given the costs of masks, cleaning, isolation, social distancing, etc.

How can government agencies and private groups work together to address the health concerns in PI communities?

Start with the broader context of leveling the playing field for PI communities, especially in how we’re perceived and treated and, consequently, given opportunities for advancement.

Partnership: Come to the source. PI people must be at the table as equal partners for decision-making and policies that affect us. Engage us in navigating preventative and interventive responses to health challenges. Contact tracing should utilize trusted, connected and in-language community health workers. Engage our PI faith-based community.

Approach: Create a comprehensive and sustainable approach that respects PI culture and engages the PI community. As a foundation, collect accurate and disaggregated data to inform the approach. Use PI cultural strengths such as communal responsibility and intergenerational connection to create culturally and linguistically responsible solutions. Provide funds and resources for masks, cleaning supplies, testing, interpretation, isolation and social distancing and education on protocols for testing and what to do with a positive test result.

Future direction: This is an opportunity to increase representation in the health care workforce as NHPI (Native Hawaiian and Pacific Islander) professionals and leaders, by investing resources to increase capacity and create pipelines and pathways for education and career advancement.

Should the public be concerned about racial hostility directed at these communities?

Absolutely. History and current lived experiences, daily in some cases, with -isms of all kinds, including structural racism, should inspire us to stand up and speak out for equity and inclusion. This is an opportunity to leverage NHPI talents, skills and indigenous knowledge in dismantling structural racism in a pandemic that exacerbated health disparities in our communities.

Is it important that Native Hawaiians be distinguished from other Pacific Islanders in tracking COVID-19 by race?

Yes, that proves to be best practice. We are already disproportionately represented as a collective NHPI. Now, we need group-specific, accurate and disaggregated data. We need to accurately identify needs unique, and specific to, the group and acquire resources that match these needs. At the same time, the NHPI community has looked out and cared for each other continuously and more so with COVID-19. … Perhaps we need to focus on both distinguished needs and collective efforts, especially knowing that we are already invisible now in the midst of the pandemic, and we may be invisible when a vaccine is available.

How would you rate the threat level posed by COVID-19 compared to the general health risks facing PI communities?

As indicated earlier, existing health disparities in PI communities and social determinants of health were documented prior to COVID-19, but they have contributed significantly to the risks. Because the PI cultural perspective on health is holistic and connected, so are the threats to health connected to a PI person’s holistic self in terms of physical, mental, spiritual and social dimensions. So, it behooves all of us to engage the strengths of the PI culture. The PI community can navigate this pandemic with the proper modern tools and resources to reconnect and reconcile mechanisms that may put us at risk not only for COVID-19 but other health challenges.

BIO FILE

Professional background: Member, Native Hawaiian & Pacific Islander Hawai‘i COVID-19 Response, Recovery & Resiliency Team. Professor and dean of the College of Health & Society, Hawaii Pacific University.

Personal background: I am an immigrant Pacific Islander woman of Tongan heritage from the Ofahengaue family, born in Tonga and groomed in Hauula by some of the finest women on the planet. I attended Laie Elementary School and Kahuku High School. Outside of work, I try to enjoy what I missed most while being away from Hawaii —talking story with mom and dad who still live in Hauula, having a Zippy’s meal with my son, enjoying a drive around the island, laughing for no particular reason with the mana wahine in my NHPI communities and, perhaps, most rewarding for the future: real-time mentoring and nurturing of NHPI young women towards achievements in higher education.