August 2014

Perspective on Hawaiian Health

Perspective on Hawaiian Health


The issue of health care for Native Hawaiians is complex. In a sense there is no true native Hawaiian, but rather individuals of Native Hawaiian ancestry. For more than a thousand years Native Hawaiians were among the healthiest people in the world. Living in a paradise where food was abundant, weather was mild and diet, lifestyle, stress and social order were all more or less conducive to physical, mental, emotional and spiritual health and well-being.

At some point all of this changed. Invaders entered and divided and conquered. The result was a breakdown in order, culture, healthy lifestyles, diet and finally, the combined physical mental, emotional and spiritual well-being.

After more than thirty years in the practice of medicine it has become clear that the greatest majority of what we think of as illness comes from three main causes. Dietary deficiencies and excesses, stress and toxic chemicals. The lifestyle we chose either brings us toward illness or takes us away from illness. It determines what we eat, the amount of stress in our life and our degree of exposure to toxic chemicals. All of these factors are greatly influenced by our self-image, who and what we see our self being.

For example, and individual who at some level feels hopeless (whether this is caused by what he thinks, the conditions he was born into or the conditions he has created in his life or lack of opportunity) will more than likely eat foods that are less than healthy, he will experience greater stress in his life and he will be more likely to expose himself to toxic substances including smoking cigarettes, increased alcohol consumption or possibly drug use.

Consequently, if he has a genetic tendency toward diabetes or heart disease, his less than healthy diet will likely crystalize the situation and his diabetes will manifest itself. Because of underlying negative attitudes and beliefs systems, he may make poor choices. He may choose not to perfect his diet, not to exercise regularly, not to solve problems completely and possibly not to be consistent in his Western medical or native Hawaiian healing programs.

Western medicine is a system based on dispassionate science. It can be thought of as an Interventive Medical System. That is, one first has to get sick before they go to their physician for medical treatment. It is based on process which treat the individual after he is already sick. Often after he has already been sick for many years. Since Western Interventive medicine is not designed to deal with the causes of illness, but rather the secondary affects of these causes, few people are really healed. In fact, clearly the concepts of "cure," "healing" and "prevention" are almost entirely nonexistent in Western Medicine. When used are usually applied to "curing an infection" "healing a wound" or "instruction on diet or prophylactic antibiotics."

Hawaiian medicine, on the other hand, is at its root a true mind, body, spirit healing system. In ancient times it was implicit in the community and was directed as much at nourishing the understanding of the people as it was in subtly controlling their diet, mental, emotional and spiritual beliefs and lifestyle.

Concepts such as pono (setting right), lokai (balance and unity-harmony), 'ola'l'o (sincerity, and truthfulness), imi'ike and a'o (seeking after knowledge, learning) clearly set Hawaiian Native healing systems and healers way ahead of Western medicine. The concept that intangible and nonquantifiable, non scientifically reproducible ideas and constructs as forgiveness, humility, working together, sharing, caring for each other, can heal the body, the mind and the spirit are not yet part of Western Interventive medicine.

We can think of the Native Hawaiian Traditional Healing system as an Integrated Health Care System. It integrates wellness into lifestyle and it integrates mind, body and spirit into wellness. It deals with prevention as an underlying basic fundamental integral part of working with people and the community. An excellent example of this is ho'oponopono which brings together all parties involved in a conflict. The process looks at the causes and the underlying problems which precipitated the "condition" and then creates a solution that works for all. The process does this by using intangible, nonscientific methods such as understanding the reason things happen, their effect on all involved, forgiveness, restitution, cleansing of guilt and sin, rehabilitation. Those that used ho'oponopono clearly understood that there can be no healing if the cause is not found and caring solution is not created.

Modern Hawaiians' face a number of health problems their ancestors never had to deal with. These health problems are not caused by their poor genetics, nor by their inferior tissues for their great-grandparents were healthy and experienced health and longevity.

Their present day illnesses are caused by what they eat, that is, eating Western processed, denatured foods, nutrient deficient foods. Foods which are high in refined sugars, fats, cholesterol, salt as well as toxic chemicals and additives and low in essential nutrients and fiber. They are caused by stress (the difference between the way we want or life (and the day to day events of our life) to be and the way they really are. They are caused by smoking, alcohol, air pollution, pollution of the water and what whole foods they do eat.

They are caused by lack of information, confusion, guilt, fear, frustration and loss of roots with tradition and the best aspects of the past.

To change this requires a multi prong approach. Fortunately, because of the insight of those who have come before us much of the ground work has already been laid. Programs are in place, systems are operable whether optimally or not and yet there is much work to do.

What Is Needed to Accomplish the Goal of a Healthy Hawaiian People?

To ensure a strong and health native Hawaiian people, the individuals, their families and the communities must become involved. Healthy lifestyles and accessibility to integrated health care must be available.

To improve the health conditions of Native Hawaiians there must be an assurance of primary Interventive health care for those who are presently chronically ill or suddenly suffer from an acute life-threatening illness. There must be a process of education not simply directed at early intervention but directly at preventing the physical, mental, emotional and spiritual causes of illness, the role of diet, cleanliness and hygiene, how to avoid exposure to toxic chemicals in food, water and air. This program must be directed at parenting skills and the problems of the young Hawaiian children, boys and girls, to deal with unwanted, pregnancy, early pregnancy, prenatal care and embracing the positive cultural wisdom of traditional Hawaiian values.

Concepts such as "health promotion" and "disease prevention" must be understood not wholly as a function of the Interventive Health Care construct, but in a new context which embraces and encompasses Native Hawaiian Healing Traditions and values.

While accessibility and availability of health care is of vital importance, belief in, trust and acceptance are also important. Those Native Hawaiians who come to believe that Western medicine is best should be respected. Those who would rather work with Native Hawaiian Traditional healers la'au lapa'au, lomi lomi, spiritual healers or even alternative medicine naturopathy, chiropractic, energetics should also have their wishes respected.

Ultimately crucial to the health and well-being of the Hawaiian people is not which practitioner they see or chose to use, but that the practitioners are all dedicated to helping them to overcome existing illness and prevention of future illness.

While proper identification of health problems, case management, outreach, enrollment are essential, cooperation and coordination of efforts between traditional Native Hawaiian healers and the Western medical system and alternative practitioners is even more essential. Recognizing illness and getting the sick person to a care system is only the first step. The individual must not only get the very best care available but the health care system must work as a team dedicated to the sick or injured persons overall well-being. It is not unusual today to find a person seeing several practitioners (medical, traditional and alternative) and yet there is no coordination between the practitioners, they may not even know that other practitioners are involved, treatment programs may be in conflict, different diagnoses are made, and not infrequently medications, herbs or other treatments are in direct conflict undoing the benefits of the other and even poisoning or undermining the well-being and longevity of the patient.

A system which considers physical, mental emotional and spiritual causes of illness must ultimately be set in place so that proper assessment, intake and recognition of the factors involved in creation of illness can be identified. Without this there can really be no true promotion of health and well-being.

Relevant to all of this are the many social, financial and cultural needs and factors of the individual Hawaiian person, his or her support systems and the willingness of the community to support and help those that cannot fully help themselves (laulima, lokomaika'i, malama, ho'omana'o.)


Three Main Goals

  1. Earliest identification and treatment of acute and chronically ill Native Hawaiians through the most acceptable and culturally responsive methods possible.

  2. Identification of groups and individuals at risk for health problems in the near future and the development of resources to prevent and intervene at the earliest possible point.

  3. Long range programs to solve problems that can potentially lead to illness and disease through education and environmental solutions.


Three Main Problems

  1. Lack of understanding by the Western Interventive medical system of the specific problems and solutions necessary to maintain and support the culture and traditions of the Hawaiian people.

  2. Too few Native Hawaiian healers and lack of adequately trained support people.

  3. Inadequate coordination and structure for Western physicians and alternative practitioners to meet, understand and work together with Native Hawaiian healers for the overall good of the Hawaiian people. No referral system between the two groups. Lack of understanding of the roles, needs and values of the other.


The Medical and Health Problems the Hawaiian People Face*

  • Heart Disease and atherosclerosis Cancer

  • Stroke (Cerebrovascular disease)

  • Hypertension

  • Diabetes

  • Obesity

  • Respiratory Disease (Infectious and secondary to smoking, asthma, bronchitis)

  • Aging (Increasing chronic diseases which are not part of the aging process)

  • Substance abuse, including alcoholism, smoking, illicit and prescriptive drug abuse

  • HIV

  • Suicide

  • Premature birth, infant mortality, fetal death, fetal alcohol, drug and chemical abuse, low-birthweight babies

  • Chronic liver and kidney disease

  • Infectious disease (Otitis Media)

  • Injury

  • Adolescent criminal and non-criminal destructive behavior, teenage pregnancy

  • Chronic diseases within the elderly


    *Not in order of effect on society and individual.  

    Who is Most Affected?

    The Piha Kanaka Maoli and the very young suffer the most. The Hapa Kanaka Maoli are next and all other races in Hawaii have lower rates of virtually all illnesses.

    This suggests that the Piha and Hapa Kanaka Maoli are eating the worst diet, have the most stress, and are subjected to the most effects of toxic chemicals.

    The Hawaiian people in a sense are the most vulnerable for they have lost their traditions, lost attachment to their natural diet, lost their attachment to the land, the physicalness of their life, many rights and powers in their own lands. Because of all of these factors (and others not mentioned) they are more depressed, and more susceptible to illness.

    To reverse these negative influences the health care system must work hand in hand with rebirthing the traditional culture, giving clear alternatives, creating hope and opportunity for each and every Native Hawaiian whether living in Hawaii or not.


    The Solutions

    In the above perspective I have very briefly laid out what I believe are the main elements of the health problems of the modern Native Hawaiian male and female. What their children will have to face and what I believe are the main causes of these health problems.

    The solution lies not in getting grants, not in enrolling people into programs, not in statistics nor in supporting one group or another, Western Physicians or Native Traditional Healers, but rather creating a process of clear thinking, partnerships, associations, networking that bring an integrated program of health care services, prevention, problem identification, and community involvement to the Native Hawaiian people.

    The role of the Executive Director of Hui No Keola Pono could be to assemble a team of the very best available people on Maui and in all of Hawaii. Then to join together with the Native Hawaiian Health Care resource organizations, Papa Ola Lokahi and the four other island-based organizations Ke Ola Mamo on Oahu, Na Puu Wai on Moloka'i and Lana'i, Hoola Lahui on Kaua'i and Hui Malama Ola Na Oiwi on the Big Island. Identify young Native Hawaiians who are interested in careers in the health field and help them to obtain scholarships from the Native Hawaiian Health Scholarship program.

    The intention of this is to network and share information and resources, programs and learn from each other and from each others experiences. With one goal, to help the Hawaiian people, reduce suffering, eliminate illness and increase longevity. This is a Hawaiian goal, one which requires the support the greater community of Hawaiian people (native and non-native) to maximize results.