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Health Promotion in Native Hawaiian Population

Health promotion is an approach that aims to enable people to control their health and its social determinants. Often, gender, race or ethnicity, education, income, disability, geographic location, and sexual orientation factors have a decisive influence on the level of health care accessibility. The nurse’s task is to identify and level out the impact of these factors while ensuring equal access of the population to health services. This paper aims to compare the health status of the Native Hawaiian minority group to the national average and develop a care plan applying a cultural-based approach.

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Native Hawaiians and Other Pacific Islanders (NH, NHPI, or NHOPI) are Americans who have ancestors among the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands. 1.5 million Native Hawaiians live in the US, which is 0.4% of the overall population (Office of Minority Health, 2017). States with the most significant Native Hawaiian population are Hawaii, California, Washington, Texas, Utah, Nevada, Arizona, Florida, Oregon, and New York. Notably, the life expectancies of this group are 80.1 years, which is slightly higher than the life expectancies for non-Hispanic whites (OMH, 2017). It is a high index, which reveals the good health potential of these people.

Higher rates of obesity characterize the health status of Native Hawaiians compared to the national average. The obesity trend is disturbing, as 38.7% of NH adults are obese, and 37% are overweight, although these numbers have a declining tendency (Office of Hawaiian Affairs, 2017). Besides, OMH (2017) reported that “risk factors that are prevalent among Native Hawaiians are hepatitis B, HIV/AIDS, and tuberculosis” (para. 4).

According to OHA (2017) statistics, 69.1% of infants in Hawaii State were immunized against Diphtheria, Measles, Haemophilus influenza type b, Hepatitis B, and other viruses. But there is no specific data on NH infant immunization. Also, 6.7% of NH adults were diagnosed with some cancer, 21.1% – with some form of arthritis, 32.3% have high cholesterol, 29.7% – high blood pressure, and 28.4% have asthma (OHA, 2017). Additionally, 23.7% of NH adults live with at least one disability, and 15.8% were diagnosed with a depressive disorder (OHA, 2017). These statistics put overweight, arthritis, high cholesterol, and high blood pressure problems in the first place.

In the chosen minority group, health disparities are partially presented. Scientists mention that Native Hawaiian men have higher death rates from colon cancer comparing to other groups (Cassel et al., 2017). Scientists also note that Native Hawaiians “have a high prevalence of diabetes compared to the general US population” (McElfish et al., 2019, p. 19). According to OHA (2017) statistics, 12.8% of NH had diabetes diagnosis compared to 9.7% in other Hawaii State population. Diabetes is considered to be a nutritional problem; therefore, it is essential to address the nutrition issues in the frameworks of a healthcare intervention.

Nutritional problems among Native Hawaiian older children and adolescents include poor nutrition. Only 27.4% of NH high school students have breakfast every day, and 15.7% of middle school students do not have breakfast meals any day (OHA, 2017). Also, 61% of Native Hawaiian women receive medical insurance for delivery and prenatal care through Medicaid/QUEST, and 58% benefit from the WIC program that aims to provide supplemental foods and nutrition education. Hence, the government solves the nutritional problems effectively but incompletely.

Social determinants relevant to the Native Hawaiian minority include cultural, socioeconomic, sociopolitical, and educational factors. According to OHA (2017), 92.6% of NH is a high school graduate or higher, compared to 90.9% in other groups, and 16.4% have a Bachelor’s degree or higher, compared to 31.4% in other groups. Notably, 92.0% of NH adults have health care coverage, compared to 90.2% non-NH, and 62.3% visit a dentist once a year, compared to 71.6% of non-NH (OHA, 2017). Finally, 81.2% participate in leisure-time physical exercises, compared to 80.4% of non-NH, and 20.2% consume fruits and vegetables five or more times a day, compared to 18.1% in other groups (OHA, 2017). Thus, social determinants of the NH group do not differ much from other groups except for the access to higher education.

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Besides, Native Hawaiians are highly likely to be discriminated by the police. Significantly, 31.1% of adults arrested for Index Offenses were NH comparing to 68.9% of non-NH (OHA, 2017). According to scientists (Kaholokula, Ing, Look, Delafield, & Sinclair, 2018), discrimination causes stress and contribute to cardiometabolic-related disorders. The unemployment rate in the civilian labor force is 6.9%, compared to 4.9% in other groups (OHA, 2017).

At the same time, 13.3% live in poverty, compared to 10.1% in other groups, which may indicate inadequate salaries in both groups (OHA, 2017). Suchwise, there are education, employment, and police discrimination barriers for NH compared to other groups.

The most popular health promotion activity among Native Hawaiians is hula dance, an Indigenous dance of Hawaii people. Nowadays, it is widely applied by western scientists to combat cardiovascular diseases among NH (Walters et al., 2020). Hula dance is a part of the traditional cultural approach, OI. OI includes Indigenous practices displayed through story-telling, songs, dances, and celebrations and has calendrical, educational, class, and governance aspects. Kumu hula, the hula masters, are still teaching hula dance. They named the newest anti-CVD hula Ola Houika Hula or Ola Hu, which means “renewed health through hula” (Walters et al., 2020).

This dance meets the spiritual, physical, and emotional needs of an individual, as it signifies the connection with nature and its forces, improve health through physical activity, and gives a strong feeling of community. Unfortunately, in modern Western society, tribal dance traditions have not been preserved. The only analog is music festivals, although such open-air celebrations may lack spirituality.

The following care plan will help Native Hawaiians to combat obesity with healthy nutrition and physical activities. A healthy diet among NH of all ages will help reduce diabetes, while physical activity will reduce depression and stress. Three levels of health promotion prevention will include primary, secondary, and tertiary prevention. The implementation of the care plan with a community-based approach is recommended, as it proved to be highly beneficial (Kaholokula et al., 2018). Notably, the community-based approach will allow for building a trusting relationship with group members.

On the primary level, cooperation with the WIC program will be crucial, as it has shown significant involvement among young mothers. As to other groups, the construction of small backyard aquaponics in cooperation with the MALAMA program will show great results. This concept of a small ecosystem where fresh fish and vegetables are grown has much in common with the ahupua‘a traditional land cultivation approach (Ho-Lastimosa et al., 2019).

Secondary prevention will focus on maintaining local physical activity to reduce the impact of overweight and obesity through hula dance practicing. Collaboration with WIC is recommended for further healthy diet and eating habits promotion. Tertiary prevention will target older people who have been obese for a long time – their participation in group activities, particularly in the aquaponics construction, should be ensured.

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Thus health status of the Native Hawaiian minority group was compared to the national average. A care plan was proposed to combat obesity by providing the local population with healthy food through the construction of backyard aquaponics. The need to apply a community-based approach and draw on local traditions was discussed. The Indigenous hula dance was described in detail as it helps to increase the physical activity level, relieve stress, and cope with depression.


Cassel, K., Hughes, C., Higuchi, P., Fagan, P., Lee, P., & Brady, S. K. (2017). Abstract A24: Pilot study to improve colon cancer screening for Native Hawaiian men. American Association for Cancer Research, 26(2_suppl), A24.

Ho-Lastimosa, I., Chung-Do, J. J., Hwang, P. W., Radovich, T., Rogerson, I., Ho, K.,… & Spencer, M. S. (2019). Integrating Native Hawaiian tradition with the modern technology of aquaponics. Global health promotion, 26(3_suppl), 87-92.

Kaholokula, J. K. A., Ing, C. T., Look, M. A., Delafield, R., & Sinclair, K. I. (2018). Culturally responsive approaches to health promotion for Native Hawaiians and Pacific Islanders. Annals of human biology, 45(3), 249-263.

McElfish, P. A., Purvis, R. S., Esquivel, M. K., Ka‘imi, A. S., Townsend, C., Hawley, N. L.,… & Kaholokula, J. K. A. (2019). Diabetes disparities and promising interventions to address diabetes in native Hawaiian and Pacific Islander populations. Current diabetes reports, 19(5), 19.

Office of Hawaiian Affairs, Research, Demography. (2017). Native Hawaiian Health Fact Sheet 2017. Volume IV: Native Hawaiian Health Status. Honolulu, HI.

Office of Minority Health. (2017). Profile: Native Hawaiians/Pacific Islanders

Walters, K. L., Johnson-Jennings, M., Stroud, S., Rasmus, S., Charles, B., John, S.,… & Lowe, J. (2020). Growing from our roots: Strategies for developing culturally grounded health promotion interventions in American Indian, Alaska Native, and Native Hawaiian Communities. Prevention Science, 21(1), 54-64.

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