Ka Wai Ola - Office of Hawaiian Affairs, Volume 30, Number 4, 1 April 2013 — A fresh approach to Hawaiian well being [ARTICLE+ILLUSTRATION]

A fresh approach to Hawaiian well being

_JP* J When U.S. Sen. Daniel K. Inouye died, many in Hawai'i wondered whether the federal money he was able to bring home would dry up. But providers of heahh eare to Native Hawaiians say the outlook is far from gloomy. "With Sen. Inouye's passing, it really pushes us in a direetion that many of us should have eonsidered a long time ago and that's working more elosely together with other organizations and entities with similar missions around Native Hawaiian heahh and break down the silos," said Keawe'aimoku Kaholokula, ehahman of the Department of Native Hawaiian Heahh at the JohnA. Burns Sehool of Medieine. Kaholokula is one of the members of Nā Limahana o Lonopūhā

Native Hawaiian Heahh Consortium, a network of exeeutives and health-eare providers addressing Native Hawaiian heahh issues. The group's members inelude eommunity heahh eenters, nonprofit groups, insurers, edueational institutions and government. "It's really interesting how tough Unaneial times foree us to do something that deep down inside you know is right," said Kaholokula. The heahh eonsortium first met in 2010, antieipating that the day would eome when Hawai'i would no longer have Inouye and then-Sen. Daniel Akaka in Washington. Diane Paloma, direetor of Native Hawaiian Heahh Programs at the Queen's Heahh Systems, said the members of the group are committed to working together to eome up whh out-of-the-box solu-

tions to heahh problems. What it's meant is working to create an integrated system of care with eaeh group working together to complement eaeh other. "The coolest thing about this consortium is now I have peers who are able to make significant changes in their organizations. We use our perspective on what the other person is doing to assist or enhanee their efforts," Paloma said. OBAMACARE Federal health-care reform, popularly referred to as "Obamacare" is also changing the game for providers. Kaholokula said it is changing how heahh systems operate by making them more accountable, patient-centered and by forcing them to focus on prevention and preventive services. Historically, it's been difficult to get funding for preventive services. "We do a lot of getting more money to a elinie so it ean treat

more sick people," said Kaholokula. "But we forget that we need to get more upstream and we really need to prevent people from even (getting sick in the first plaee). The reason we need to get more physicians and more clinics is we just have more people who are getting chronic diseases in their 20s or 30s instead of their 50s and 60s." He said prevention programs might cost money now but will save everyone a lot of money into the future. So the consortium has been looking at the health-care system more holistically, rather than continuing to view eaeh part separately. Paloma says by looking at the system as a whole, they ean leverage their strengths and patch their weaknesses. For instance,

Queen's Medical Center may see a patient for acute-care needs, but the hospital is not as good at being a heahh educator, but other groups are. So the groups are hoping to work together to create an integrated system that does a better job caring for the patent. "We know we cannot change the heahh of the community by ourselves," she said. In fact, those funding heahh care are increasingly demanding different groups work together. Paloma said consortium members are committed. "We all eame in with the mana'o that we're in h for the long haul. "In an environment where it's very easy to eome to disagreement, I think we have set this foundation to have different opinions; but despite all of that, we are always keeping the end goal of a healthy thriving Hawaiian nation," she added. MAULl OLA 1S OUR DESTiNY Mauli Ola is identified as one of the premiere gods of heahh, and

it is defined as the breath of life or power of healing. Kamana'opono Crabbe, chief executive officer of the Office of Hawaiian Affairs and member of the consortium, describes it as "the optimal state of wellness. It is the synergy between the physical, emotional, environmental and spiritual state of wellness." Crabbe says the concept goes way beyond the typical definition of heahh. He says it includes a person's relationships to his or her family, community and environment. For instance, Crabbe said: "When you say mālama 'āina, . . . if we take care of our surrounding and environment, it really does contribute to one's psyche. It makes you want to enjoy being there." And that, he says, affects a person's overall heahh. That's why the consortium is looking at a mueh broader scope

than has been traditionally been considered to be the jobs of health-care providers. Members agree they need to address issues that haven't traditionally been discussed under the health-care banner. Prevention does not start with a eheekup or a primary care physician, but with the food people eat and the stress they are under. They say people eat too mueh junk food for a reason, so it isn't as simple as educating people on how to have healthier eating habits. And they must also address the reasons people are stressed, not just the stress. "We want to prevent us from having to offer a lifestyle intervention because too many people are obese. We want to go upstream and make sure they never become obese to even require preventive services. To me, that's ultimate prevention," said Kaholokula.

FEDERAL FUND1NG On Capitol Hill, Hawai'i's congressional delegation continues to pursue federal funding for Native Hawaiian heahh programs. U.S. Sen. Mazie Hirono said: "I know we cannot sit back and rest on our laurels when it comes to Native Hawaiian heahh care. I will continue to advocate for the longstanding commitment between the federal government and Native Hawaiians, and I will work hard with the other members of the congressional delegation to support programs for Native Hawaiian heahh." But the reality is that given the current atmosphere in Congress, h may be an uphill battle. Members of the consortium say getting more funding helps, but more funding does not necessarily lead to better outcomes. Rather, it is how that money is used that will be the key, and they say they're committed to make sure to improve the system so Native Hawaiians have better overall heahh. ■

\ www.oha.org/kwo kwo®OHA.org Fan ns: /officeofhawaiianaffairs | Watch us: Yūuj tTTf:i /OHAHawaa ^ ^ a ^ NATIVE HAWAIIAN » NEWS | FEATURES | EVENTS T .

j MOOLELO NUI s > C0VER FEATURE /

[?]

Hawaiian sea salt, pa akai, is valued in healing. - Photo: Pmneine Munay