Ka Wai Ola - Office of Hawaiian Affairs, Volume 8, Number 11, 1 November 1991 — Island health groups awarded $2.3 million [ARTICLE+ILLUSTRATION]

Island health groups awarded $2.3 million

by Deborah Lee Ward Editor The next step toward improved health for Native Hawaiians statewide is underway, with a $2.3 million grantfrom the U.S. Department of Health and Human Services to establish Native Hawaiian health centers.

The centers will be located on Kaua'i, O'ahu, Maui, Moloka'i, and in Waimea and Hilo on the island of Hawai'i. They will emphasize preventive health care services such as nutrition, hygiene promotion and disease prevention. The grants however, are for core support money. Eaeh center will have to seek additional funding sources for programs. Establishment of the island centers is the next

phase in the development of a statewide Native Hawaiian health care system by the Papa Ola Lokahi (POL) planning organization. Papa Ola Lokahi was established through the federal Native Hawaiian Health Care Act of 1988

The act (PL 100-579) was a landmark pieee of legislation. This three-year act (its implementation began in 1989) authorized the formation of POL to help develop a master plan for improving health services to Native Hawaiians and establish Native Hawaiian organizations to provide services and management of a Hawaiian health care system. Papa Ola Lokahi is a coalition made up of the

state Department of Health Office of Hawaiian Health, University of Hawai'i, Office of Hawaiian Affairs, Alu Like, ine. and the E Ola Mau organization of Native Hawaiian health professionals.

As part of its work to create a master plan for Hawaiian health, Papa Ola Lokahi encouraged and fostered the establishment of communitybased groups on eaeh island to develop their own health needs plan for Native Hawaiian island residents. Executive director Dr. Larry Miike and groups to organize, provided them with planning

money, helped them develop successful applications for federal funding, and certified the groups as eapahle of administering the funding and system plans.

Now, Papa Ola Lokahi will continue to work with the five island groups to provide further technical assistance and to build them into a statewide network where eaeh is responsible for their own island services and yet work collectively for the eommon good of all Hawaiians. The five centers are Hawaiian-run organizations that will eventually begin to provide health continued page 12

Larry Miike

Health groups awarded $2.3 million

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promotion and disease prevention services, and to extend primary medical care. At present, none of the centers is ready to begin providing health care services to Hawaiian beneficiaries, because they are just getting started.

On the nahonal level, Papa Ola Lokahi will need help to support continuation of the Native Hawaiian Health Care Act whieh expires in Sept.

1992. Miike %aid Congress to date has been supportive and has so far agreed to a 10-year extension of the act. In Feb., hearings on reauthorization with veto-proof legislation he said.: Honolulu office of Sen. Dan Inouye, who was instrumental in the act's passage. Miike said one challenge that may be faced for reauthorization of the act is how to protect it from a presidential veto, because the current administration sees the act as a "pork barrel" for Hawaiians. It will be the job of Hawaii's congressional delegation to find a way to tie in the reauthorization with veto-proof legislation. Miike said the administration sees Hawaiians as a special interest group and that it is trying to eliminate special programs for targeted minorities. This view does not recognize a trust relationship ketween *Hawaiians as native people and the :eaerai government.

A long-range goal of Papa Ola Lokahi would be to aDDlv for grants to fund research on how to reduce the high incidence in Native Hawaiians with breast cancer, diabetes, heart disease and other health conditions. POL will also be responsible to evaluate the effectiveness of the health care centers and the Native Hawaiian Health Care Act in meeting health needs of Hawaiians. Now that the foundation has been laid for the Native Hawaiian health care system and the island health centers are on their way, Miike is making way for a new executive director to carry out the next phase. Papa Ola Lokahi is presently recruiting for this position.

Miike will stay on to phase in the new director but is looking forward to his future work as professor of medical policy at the UH John A. Burns School of Medicine where he will be putting together a Kellogg Foundation Grant at the Native Hawaiian Center of Excellence. The program is designed to increase the number of Native Hawaiian students and graduates, and increase the Hawaiian medical facility. He said at present the UH has from 6 to 9 percent Native Hawaiian students enrolled, and 14

percent Hawaiian enrollment in the medical school, due in part to the 'Imi Ho'ola recruitment program for minority medical students. The most challenging thing for Miike about launching the Native Hawaiian health care system, he said, was to convince people they were serious about giving power to the loeal community. Miike is very familiar with the goals and terms of the act and was an ideal person to see to its implementation in Hawai'i. He prepared all the statistics for the act when he worked for the Office of Technology Assessment in the U.S. Congress.

The goal of the health care act is to reach all Hawaiians in Hawai'i. The centers will provide services to help eligible Hawaiians get quality care and access to services. Centers will try to provide medical insurance coverage for all clients — either through Medicare or the State Health Insurance Program (SHIP) or via other providers. This is the first step to access to medical services. The island centers will also stress an outreach approach to case management, for example nurse teams going into the community. They will also try to incorporate traditional Hawaiian healing practices (for example, herbal medicine, la'au lapa'au, or ho'oponopono) as acceptable options in treatment.

Centers have the initial job of making the current system more accessible to Hawaiians; helping Hawaiians personalize their health care programs; planning health fairs; planning programs; planning health fairs and programs for diabetics; setting up kupuna meal risks through education and behavior change; increasing regular health checkups, immunization shots; and finding any means to help improve the number of health services to Hawaiians. In a number of years there may be actual health center locations. The long-term aim is to provide the Hawaiian community with a health care system and insurance and benefits package. Miike noted that it is more difficult to set up a system than just clinics. "The challenge will be for the community to leam to run it," he said.