Ka Wai Ola - Office of Hawaiian Affairs, Volume 8, Number 2, 1 February 1991 — Hawaiians at greater medical risk [ARTICLE]

Hawaiians at greater medical risk

Hawaiian Heali li Horizons

To provide a necessary background for understanding of the challenges faced in addressing Hawaiian health concerns, a series of artiples on Hawaiian health needs follows, based on the E Ola Mau Native Hawaiian Health Needs Study.

Published in Dec. 1985, the study was developed by the Native Hawaiian Health Research Consortium, conducted by the Waianae Coast Comprehensive Health Center and administered by Alu Like, ine. The study was funded by an appropriation to the U.S. Department of Health and Human Services. Its findings and recommendations led, in part, to the passage of the Native Hawaiian Health Care Act of 1988 (Public Law 100-579) whieh established the Papa Ola Lokahi Hawaiian health consortium. The consortium's five member agencies — the state Department of Health, E Ola Mau, the University of Hawai'i, Alu Like and OHA — are working cooperatively with island communities to develop a comprehensive health care master plan for Native Hawaiians and a network of Native Hawaiian health care systems statewide.

More recent data on Hawaiian health conditions is contained in a Native Hawaiian Health data book compiled by Papa Ola Lokahi that was published in August 1990 by the Office of Hawaiian Affairs. The E Ola Mau Native Hawaiian Health Need Study is divided into five task force reports whieh cover separately: medical health, mental health, nutrition and dental care, historical and cultural aspects, and strategies for health planning. The following series in Ka Wai Ola O OHA will excerpt and summarize the findings of eaeh task force's report. Future articles will examine the work of Papa Ola Lokahi and island planning committees to address Hawaiian health care needs via a health care master plan and statewide health care systems.

Report of the Medical Task Force Part I of a series In general, Native Hawaiiansexperiencea lower life expectancy than other ethnic groups in Hawai'i. This higher mortality is due both to a higher rate of accidental deaths as well as a greater risk of significant illnesses. Infant>mortality rates of Native Hawaiians are higher than other groups, as are congenital abnormalities and underweight infants.

Native Hawaiians, furthermore, suffer disproportionately from the most significant chronic diseases whieh underlie disability and mortality in later life such as diabetes, heart disease, hypertension, and cancer. Native Hawaiians have higher cancer rates than other groups for cancers of stomach, lung, and female breast and cervix. Furthermore, Native Hawaiians have a poorer sur 'ival rate from cancer compared with persons from other ethnic group diaghosed at the same stage of disease. Based on age-standarized rates, the report concludes that Hawaiians have the greatest risk of diabetes, heart disease, and some forms of cancer,

while part-Hawaiians are somewhat more likely to suffer from hypertension. The evidence suggests that Native Hawaiians, furthermore, experience heart disease and hypertension at earlier ages than other groups, having higher rates even in the young adult population.

hvidence suggests that Native Hawanans rank high on risk factors for many diseases. Native Hawaiians have higher rates of teen pregnancy and illegitimate births than other groups. Furthermore, pregnant Native Hawaiian women rank highest in having late or no prenatal care, in smoking and aleohol consumption during pregnancy, in toxemia and urinary tract infections during pregnancy, and in complications of pregnancy among the over-35 age group.

Surveys of health awareness about cancer show that Native Hawaiians are less knowledgeable about symptoms and risk factors for cancer. What evidence is available also suggests that Native Hawaiians engage in behaviors whieh are high risk for developing diabetes, heart disease, hypertension, and cancer. For these diseases, high fat and salt consumption in the diet, being overweight, smoking, and heavy aleohol consumption, and for some diseases, a laek of sufficient exercise, create a greater risk of developing the disease. In all of these respects, Native Hawaiians tend to be at higher risk than other ethnic groups in Hawai'i. Although systematic evidence about the utilization of health services is sparse, the limited evidence reviewed in this report also suggests that Native Hawaiians receive fewer health services.

Native Hawaiians appear to participate less than other groups in health education, health promotion, and screening and referral programs, even when these programs have been intentionally made available to communities where a high proportion of Native Hawaiians live and are offered free of charge. Furthermore, Native Hawaiians are reported to enter medical treatment at the late stages of disease, only when self-care and traditional practices have not brought sufficient relief.

The major problem does not seem to be the laek of available health services resources, since nearly all areas of the state are now served by some form of health services. Therefore, the reasons for under-utilization probably rest on laek of accessiblity due to financial barriers, and even more importantly, on the laek of acceptability of services to Native Hawaiians due to cultural differences. The pnneiple recommendations of this report, therefore, are aimed at addressing the need to alter the manner in whieh health services are delivered.

Effective health service delivery Recommendations of the report are based on five principles for promoting more effective health service delivery in the community: 1. The under-utilization of health education, health promotion, health screening, and medical treatment services by Native Hawaiians must be addressed by developing a suitable mode of health service delivery. 2. Native Hawaiians should participate in the creation, direction and implementation of more

effective health services, and be in the health care professions whieh deliver the services. 3. Native Hawaiians have a special status in the population of Hawai'i as Native Americans, whieh should be recognized in programs targeted to address their needs. The federal government and state governments have special obligations to provide financial resources and programs to the Native Hawaiian community as Native Americans. 4. Health services and their delivery need to be made compatible with cultural and interpersonal styles of Native Hawaiians. For example, the following are three important components of Hawaiian culture whieh have direct implications for health services:

• Spiritual values — The traditional culture of Native Hawaiians emphasizes the spiritual unity of the individual with the environment and the spiritual significance of events such as illness. Moreover, there is a rich tradition of health practices and rituals and respect for traditional healers among Native Hawaiians. Health services will be more effective if they respect these traditional values and concerns of Native Hawaiians.

• Minimization of risk — The Hawaiian culture emphasizes the preservation of harmony. Individuals tend to minimize the importance of experiences whieh set them apart from others or whieh threaten to disrupt the group. The "ain't no big thing" coping strategy ean result in efforts to play down symptoms of illness and delay in seeking health care. For this reason, a system of active outreach is needed rather than reliance upon individual initiative to seek out services, particularly for prevention and early care.

• Interpersonal style — Hawanan culture focuses on affiliation, the development of close bonds between peers and the reliance upon personal networks in coping with problems. Native Hawaiians are uncomfortable with impersonal, bureaucratically organized services and with reliance upon expert authorities. Therefore, health services will be most effective if they utilize the natural social relationships existing among the Native Hawaiians. 5. Native Hawaiians experience a disproportionate risk of many serious health problems, and the current mode of health service delivery is inadequately serving this population. In order to address the health needs of Native Hawaiians, a number of general structural changes and innovations are needed. General recommendations A number of key recommendations based on the above principles were developed. (Many are being fulfilled in the work of Papa Ola Lokahi and E Ola Mau.)

• Funds should be made available from the U.S. Public Health Service and other agencies of the federal government to develop and implement needed changes in the health delivery system, including modifying or developing programs targeted for the Native Hawaiian population. • The State of Hawai'i, and specifically the branches of the Department of Health should reallocate resources to give priority to Native continued page 22