Ka Wai Ola - Office of Hawaiian Affairs, Volume 31, Number 1, 1 January 2014 — Authors of health report call for broader approach to well-being By Lisa Asato [ARTICLE+ILLUSTRATION]

Authors of health report call for broader approach to well-being By Lisa Asato

Atask force should be created to establish a Native Hawaiian health improvement plan that would address heahh disparities within that populahon, the chairman of the University of Hawai'i Native Hawaiian Heahh Department told state lawmakers. The task force would examine data collection methods, prevention programs and ways to leverage resources, among other aspects. Chairman Keawe Kaholokula presented the recommendation at a state legislative informational briefing on the department's recently released report, Assessment anel Priorities for Health anel Well-Being in Native Hawaiians anel Other Pacific Peoples. The 90-minute briefing highlighted "priority areas" and potential strategies sought by communities, said Kaholokula, a co-author of the report. "Now we need a plan to take that information and tum it into effective programs (and) health-care services across the state," he told lawmakers. The joint briefing was before the heahh and Hawaiian affairs eommittees from both the House and Senate. Senate Heahh Chairman Josh Green, a Hawai'i County physician, called the task force an "excellent" idea. He cited the report's findings on morbidity and mortality risks, behavioral risks such as smoking and drinking, and eeonomie issues

including unemployment and poverty, saying he could see "over and over again" that disparities spiked in communities with high concentrations of Native Hawaiians, namely

Wai'anae, O'ahu; Ka'ū, , Hawai'i; Hāna, Maui; and Moloka'i. "I think we could quickly convey to our colleagues the

return on investment in human terms," he said. "When I read this that's the first thing I see." Dr. Marjorie Mau, a report eo-au-thor and director of the department's Center for Native and Paeihe Health Disparities Research, whieh took the lead on the report, said Native Hawaiians improved in life expectancy and infant death rates, but still lag behind the state in general in those categories. "In fact Native Hawaiians die from the same top causes of death, just at an earlier age" compared to other ethnicities, she said, referring to 2000 data that show heart disease, cancer, stroke and diabetes as the leading causes of death in the state. The report - and the Sept. 24 presentation to lawmakers - also focused on promising programs and so-called "social determinants," or factors like education, and eeonomie, cultural and emotional well-being. "Like genetics and like biology, (heahh is) influenced by the enviSEE REP0RT ON PAGE 12

The report showed: • Life expectancy for Native Hawaiians, Filipinos anel the state has improved to 74.3, 80.9 and 80.5, respectively; however, Hawaiians still lag behind, and the lag grewto sixyears from four between 1990 and 2000. • Native Hawaiian infant death rates per 1,000 has improved to 7.1 in 2000 from 11.1 in 1981, but still surpasses the state's 5.9 rate from 9.5 overthe same period. • In 2005, Wai'anae had the highest rates in the state for smoking, heavy drinking and low physical activity. High rates were also seen in othercommunities with high proportions of Hawaiians: Ka'ū, North Kohala, Moloka'i, Hāna and Kapa'a. • The percentage of Native Hawaiians meeting recommended levels of physical activity increased to 54.5 from 46.6, almost 8 percent, between 2001 and 2005, the highest increase among all groups studied in the state. • Native Hawaiian enrollment at University of Hawai'i community colleges rose 53 percent - from 13.6 percent to 28.8 percent of total students enrolled between 1992 and 2010. • In 2010, Hawaiians comprised 21 percent of students in the UH School of Social Work, 14 percent in the School of Nursing and Dental Hygiene, and 8 percent in the School of Medicine. • Nationally, Native Hawaiians' and Pacific lslanders' unemployment rate increased 60 percent from 2007 to 2010, from 4.8 percent to 12 percent. NHPI's 2010 rate was higherthan that of whites and Asians but lowerthan that of Hispanics and blacks. To download a copy of the report, visit www3.jabsom.hawaii.edu/native and eliek on "Native Hawaiians & other Pacific Peoples Health Status Report" underPublications. To watch the informational briefing on demand, visit http://bit. ly/ljtEJLb.

HEALĪH

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REPORT Continued from page 6

ronment," said Kaholokula, a report co-author. "Our behaviors are influenced by what we have, the resources we have or don't have and the opportunities we see and don't see." He said everyone wants to be healthy, but "in Hawai'i, where you have to work two jobs to make ends meet, it's very difficult for people to avoid McDonald's when they got half an hour to get from Job A to Job B and that drive-through, that's the only dinner you're going to get. By design we're forced into the lifestyle that promotes obesity." Emphasis should be placed on "upstream factors" that cause diabetes, heart disease and early death, he said. In other words, "our poMeal, socioeconomic situation," whiehpolicymakers have direct control over. Innovations, he said, will eome through partnerships as a way of leveraging resources and diverse areas of expertise. He cited the

relatively young Nā Limahana o Lonopūhā Native Hawaiian Heahh Consortium as an example that unites groups like Queen's Medieal Center, OHA, the UH School of Social Work and Native Hawaiian Heahh Department, and Wai'anae Coast Comprehensive Heahh Center, among others, to address Hawaiian heahh issues. Government data collection also could be improved. Lor example, current data are not disaggregated by ethnicity orNative Hawaiians are lumped in whh Asians, he said. "It's very challenging for us to really make any kind of good decisions about research or medical care services when we can't get good access to the data in a timely fashion." The report, meanwhile, highlighted needs identified by the Ulu Network, a coalition of 30 organizations in Hawai'i and California working to improve the heahh and well-being of Native Hawaiians and Pacific Peoples. As it did 10 years ago at its

inception, the department surveyed members on the biggest problems they face, said Mele Look, the department's community engagement director. She said 93 percent identified diabetes, heart disease and obesity as the top three. "They said, 'When you eame 10 years ago, it's the same problem, it's just gotten bigger,'" she said. Look said the network members pointed to "promising practices," such as food gardens and programs where "scientific practices and community wisdomcame together." That includes the OHA-funded Partnerships to Improve Lifestyle Interventions (PILI) 'Ohana Project, a community-based intervention program to prevent diabetes and address obesity. Mau said PILI is effective in eombatting "metabolic syndrome" - a clustering of diabetes, heart disease, hypertension and obesity, whieh disproportionately affects Native Hawaiians and Pacific Islanders. Other effective culture-based and community-focused programs

include the Hula Empowering Lifestyle Adaptation study, or HELA, a program that promotes heart heahh through hula; andMālama Pu'uwai programs to ease the transition from hospital to home for Native Hawaiians and Pacific Islanders with heart conditions, she said. After the briefing, Look said society is "slowly recognizing the broader influences on health, but it is not a widely accepted perspective." "Talking about these other determinants of health is not typical of medical school departments," she said. But after 30 years in Native Hawaiian heahh, she recognizes

"solutions are not going to eome by just looking at the medical approach." She noted it took 25 years for American society's view of smoking to change. "So we need those kinds of broad policy solutions ... if inequity is going to change," Look said. "We're going to find justice in heahh for Hawaiians and Pacific Islanders that have these huge gaps. "The solution is definitely not going to be a pill and it's not going to happen in a doctor's office. It's got to happen across communities and across all society." ■

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