No ethnic group has been hit harder by the coronavirus pandemic than Native Hawaiians and Pacific Islanders. That became clear in Hawaii this summer when the state Department of Health began separating out ethnic COVID-19 data.
But it was not a surprise to some.
“We know that there are disparities in Native Hawaiian health across the board. Based on reports that were coming out from the CDC, we knew those who were vulnerable were populations like Native Hawaiians and Pacific Islanders,” said Kuhio Lewis, president and CEO of the Council for Native Hawaiian Advancement. “So we knew we had to do something.”
What emerged was a group of 10 ethnic and cultural organizations that galvanized to try to stop the spread of the virus in the Native Hawaiian and Pacific Islander communities.
Called the NHPI Collective COVID-19 Awareness and Prevention Campaign, the hui led by Kamehameha Schools, the Council for Native Hawaiian Advancement and the Office of Hawaiian Affairs began to take a cultural approach to its mission of promoting safety and wellness amid the pandemic.
Members of the collective also include The Queen’s Health Systems, Papa Ola Lokahi, Queen Lili‘uokalani Trust, King Lunalilo Trust and Home, Partners in Development Foundation, Kawaiaha‘o Church and We Are Oceania.
But even with their efforts, the NHPI community continues to be disproportionately affected by the disease. Recent Health Department data show that Pacific Islanders still account for the majority of COVID-19 cases, with nearly 30% of the cases, even though they make up only 4% of the population. Native Hawaiians represent the third-highest pool of COVID-19 positive patients with 17% of the cases to date.
The problem isn’t confined to Hawaii. According to the Native Hawaiian and Pacific Islander COVID-19 Data Policy Lab at the UCLA Center for Health Policy Research, the ethnic group is experiencing some of the highest coronavirus rates of any racial and ethnic group across the nation.
The problem itself is largely hidden from view, according to the UCLA lab, because fewer than 20 states separate out COVID-19 data for NHPIs.
What is known is that the NHPI community ranks first among ethnic groups most affected in 70% of those states, including Hawaii, California, Arkansas, Washington, Oregon and Utah. In Los Angeles County alone, Native Hawaiians and Pacific Islanders are seeing rates of infection up to five times that of white people, according to the UCLA lab.
The problem, experts say, is driven in part because the NHPI community generally experiences high rates of chronic diseases, including diabetes, certain cancers, heart disease, obesity and asthma.
In addition, many in this diverse group have fewer financial resources, live in large, multigenerational households in densely populated neighborhoods and work in essential jobs, placing them at significantly higher risk for COVID-19.
In Hawaii the Micronesian community has been hit especially hard.
“We have seen many deaths in our families,” said Jocelyn Howard, a Chuukese who is program director of We Are Oceania.
But she can also see behavior and attitudes beginning to change, with some in the Micronesian community avoiding funerals and other culturally significant gatherings that are usually well attended.
“When you talk about it, it’s easy,” Howard said of the social distancing required to stay safe. “But when you practice it, it’s hard — when you show up at the home and you cannot hug your auntie and you cannot stay in the way it’s supposed to be done. You leave your family feeling empty.”
In August, when virus numbers were spiking in Hawaii, representatives of the NHPI cultural groups came together to work toward a cohesive voice.
“We realized we need to do this through a cultural lens,” said Kau‘i Burgess, director of community and government relations at Kamehameha Schools. “As island communities, our people and our cultures share similar values and practices, so we are working together to effect change throughout Hawaii — for our keiki, for our kupuna and for all the people of Hawaii.”
So far, the collective, among other things, has worked to stop the spread of the virus in the NHPI population by:
>> Launching a campaign aimed at encouraging a focus on health and well- being, through the leadership of dozens of kumu hula.
>> Creating public service announcements featuring key community leaders.
>> Providing and directing people to resources like free COVID-19 testing, food distributions and financial support.
While the virus in Hawaii has subsided from the levels seen this summer, the group is not letting its guard down.
“That’s been our biggest fear, that people are going to relax, think the battle is over and then start going back to normal, which would be a dangerous thing at this point,” said Mehana Hind, OHA community engagement director.
Hind said inspiration for the effort comes from their Hawaiian ancestors who survived a period in the late 1700s and during the 1800s when diseases were rampant in the islands.
The population of Native Hawaiians declined from 200,000 (or as many as 1 million by some estimates) down to 40,000 at the time of the overthrow of Queen Lili‘uokalani in 1893.
“Those 40,000, we are their descendents,” Hind said.
“We can speak to the smart choices that Lili‘u made — for instance, to shut the harbors down when there was an outbreak of smallpox in Honolulu to make sure it didn’t get to the neighbor islands,” she said.
But they can also learn from mistakes, Hind said, including that of a woman with smallpox who knew she was dying and gathered her family around her one last time — only to pass the fatal disease to her family members.
“The overarching message is, Native Hawaiians and Pacific Islanders have been dealing with pandemics for generations,” Lewis said. “And so as we look forward in this pandemic upon us now, we lean on the ike, or knowledge, of our kupuna to tell us we can’t take anything for granted. We have to come together and do our part as leaders in the community to protect our people.”
With COVID-19 raging on the mainland and tourism opening in Hawaii, the threat of the virus remains very real. The coalition is now urging the NHPI community to get a flu shot and observe Thanksgiving without gathering in the usual way.
Dr. Gerard Akaka, vice president of Native Hawaiian affairs and clinical support at The Queen’s Health Systems, said that if the virus and the flu take hold at the same time, Hawaii’s hospitals could be overwhelmed.
“We are at war and COVID-19 is the enemy. We have to change the way we do things and share aloha in a different way,” he said.