Kalaheo community is situated in Kauai County, Hawaii (HI). The first settlers in the area were early Polynesians − “they left behind evidence of their existence dating from as early as 200 A.D. to 600 A.D.” (Kaua’i Historical Society [KHS], n.d., par. 2). Later, under the outside influence, i.e., missionary activities and industrialization, the population on the island became highly diversified and many cultural and religious (animistic) practices of indigenous people were either replaced or forbidden.
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Throughout the time, agroforestry was the major type of occupation on Kauai Island. Before the immigration wave, Hawaiians adhered to sustainable agricultural practices, but the first immigrants established a commercial monocropping industry (e.g., coffee bean and sugar cane industry) that attracted labor force from around the world (KHS, n.d.).
Kalaheo is an urban cluster with the population density of 1.872 per square mile (in 2010) and 1.560 per square mile (in 2017) (Hawaii State Data Center, 2013; Kalaheo, n.d.). In 2010, the total population accounted for 4.840 people (Kalaheo, n.d.).
The total land area of Kalaheo community is 2.95 square miles. The elevation above sea level is 700 feet. It is located in the southern territory of Kauai Island, in the northern area of the Pacific Ocean.
Like on all Hawaiian islands, the climate in Kalaheo is tropical. The territory is rich in rainfalls − Kauai Island receives nearly 12.344 mm of precipitation per year. The temperature may range from 32°C in summers to 26°C in winters. The territory is prone to the appearance of occasional storms. However, the number of natural disasters in Kauai region is smaller than the US average, whereas earthquake activity in Kalaheo is below HI average (Kalaheo, n.d.).
The total volume of fresh water supplied in Kauai County to the public is 14.94 millions of gallons a day. According to 2006 Air Quality Index, air pollution in the community is much lower than the US average (18.8 compared to 74.7). Moreover, the average indoor radon level in the county is less than 2 picocuries per liter which indicate low potential of threat to health (Kalaheo, n.d.).
There are about 3.5 grocery stores, 2.5 convenience stores, and 13.8 full-service restaurants per 10.000 of people in Kauai County. The low-income child obesity rate in Kalaheo population is below the state average − 7.6% compared to 9.2%. Nevertheless, adult diabetes rate is higher than Hawaii average (9.2% compared to 8.1%), while obesity rate in this community is similar to the state average − 20% (Kalaheo, n.d.).
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Although disasters are less frequent in Kalaheo than in the mainland United States, due to the isolated location of the island, the authorities encourage inhabitants to prepare for natural calamities beforehand. During emergencies, Civil Defense information is broadcasted through different media. Kalaheo Elementary School serves as the major shelter for the general population, as well as residents with special needs and pets (Hawaii State Department of Health [HSDH], 2010).
In 2015, the median house value in Kalaheo accounted for US $566,581, and median gross rent price − $1,488. The ratio of owner and renter occupied units was 61 to 24. In 2013, only 29 households had an income of more than $200.000, 188 households received $60.000-$75.000, and 55 − less than $10.000 (Kalaheo, n.d.).
The state-wide number of homeless people in 2015 was 7.921, and the rate has an upward tendency (“Report,” 2016). With a relatively high number of low-income households in Kalaheo, the community is at risk as well.
People of Kalaheo Community
Demographic and Biological Characteristics
The total number of males in Kalaheo is 2.367 (51%) and females − 2.228 (49%). Since 2000, the population has grown by over 17%. The average age of residents is 42, while the state-wide median age is 37. The racial composition of Kalaheo population is whites (40%), Asians (25%), mixed (20%), Hispanic (11%), Native Hawaiian (4%), etc. Only 48% of individuals are currently married, 14% − divorced, and 31% − never married. About 0.6% of households are gay and lesbian (Kalaheo, n.d.).
Throughout several years, life expectancy has increased in Hawaii. However, life expectancy for the Native Hawaiian residents remains 12 years lower than for other ethnicities (74.3 compared to 86.1 years in Asian population in 2000). During a few decades, the major causes of mortality in Kauai County include coronary heart disease and cancer (HSDH, 2011).
During 2000 and 2006, the index of suicides in Kauai County was 113.8 − higher than the state average. Also, about 17% of the population has low self-esteem and feel bad about themselves. The primary sources of stress include the high cost of living, lacking insurance coverage, and so on.
The crime level in the community is below the country average, yet it remains relatively high. Property crime is the most common type of the offense in Kalaheo. In 2017, there are also 10 registered sex offenders living in the town (Kalaheo, n.d.).
For individuals of 25 years old and older, the unemployment rate is 4.7%. Since 2009, the index demonstrates a downward tendency with almost a twofold decrease. However, it remains higher than the statewide unemployment rate (Kalaheo, n.d.).
In the total Kalaheo population, 95% of adults have high school education, 37.5% − bachelor’s degree, and 16% − graduate or professional degrees. Males mostly choose such types of occupation as food services, waste management, administration, technical services, etc., while females often engage in retail, education, and transportation (Kalaheo, n.d.).
Only 15% of Kalaheo residents avoid alcohol and other substances. A significant part of the population is insufficiently health-conscious (about 47%). Those individuals neglect the principles of healthy diet and do not engage in physical activities. As a result, the median BMI in the community is slightly higher than the state average – 27.6 compared to 26. Additionally, the average sleeping time is below the norm – 6.8. Moreover, a relatively low level of teeth and gum health may indicate that residents do not visit the dentist regularly (Kalaheo, n.d.).
The nearest healthcare facilities provide such services as palliate care, nursing service for elderly residents, home care, family medicine, dental care, and so on. Despite a great variety of available services, high rates of mortality due to chronic conditions may indicate a low quality of life-long health condition management. In Hawaii, over 80% of adults have at least one of such chronic conditions as heart disease, stroke, diabetes, cancer, high blood pressure, obesity, and so on. Additionally, it is identified the low-income residents usually report their health status and refer for professional assistance less frequently than the higher-income ones (HSDH, 2011).
Kalaheo community is characterized by a significant level of economic inequality associated with such issues as inequitable access to health care and environmental injustice. Nearly one-fourth of the population in Kalaheo is below 200% of the federal poverty level (HSDH, 2011).
Low income is directly correlated with individuals’ education level that, in its turn, may interfere with the development of awareness of existing disease identification and self-assessment measures, contribute to excess psychological stress, and lead to harmful behaviors, e.g., smoking, drinking, substance abuse, etc. Moreover, the level of income defines the ability to obtain health coverage. Thus, the level of income may be considered one of the major causes of health disparities in the selected population group.
Advocacy and Research
Political context and governance are regarded as the root causes of multiple healthcare-related problems (HSDH, 2011). It is apparent that the identified health disparities refer to broader social issues which cannot be resolved without significant governmental and institutional support. Therefore, healthcare practitioners should strive to contribute to change through advocacy, staff and stakeholder education, and evidence-based practice aimed to investigate health outcomes in disadvantaged social-economic groups. To achieve better results, nurses should collaborate with Hawaii Public Health Association, as well as other non-governmental, educational, and healthcare organizations.
The development of public awareness is the crucial factor that may influence the policymakers’ decision. Thus, to increase the effectiveness of the lobbying process, it is important to raise awareness of the issue by publishing relevant research findings because the more resounding the problem is, the more effect on the legislation transformation it may have. High-quality evidence can largely support the policy change initiatives that would lead to the decrease in healthcare disparity rates.
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The identified mortality and morbidity rates (i.e., obesity, heart disease, and diabetes, etc.) indicate the prevalent risk factors in Kalaheo − poor nutrition and low level of health consciousness. For this reason, it may be recommended to design a community education program aimed to encourage individuals to engage in healthier lifestyles and use various disease-specific protection activities. Such a program may foster favorable behavioral changes in the target population.
It is suggested that the lack of the understanding of health risks can be correlated with inadequate attitudes to healthcare and beliefs about diseases among Kalaheo residents. Therefore, education about the risk factors is essential. Community-based education administered at local schools, healthcare centers with the participation of leaders and medical specialists from minority and majority ethnic groups may help to motivate individuals at risk to modify their behaviors.
The education approach should be based on Social Learning Theory that emphasizes both individual psychological aspects of behavior and their interrelations with wider social systems, such as family and community. The program will help program participants to comprehend the positive effects of healthy dietary habits and physical activities on their personal development and the development of the society as a whole because through healthier practices and behaviors they may contribute to the improvement of social health indicators.
Moreover, the education program should be developed with the consideration of low-income residents’ needs and interests. Appropriate marketing tools for the effective communication of campaign messages should be implemented to reduce negative perceptions and increase emotional readiness among learners.
The measurable outcomes of the given health promotion program may include the increased knowledge of specific disease terminology, prevention methods, risk factors, and symptoms of various health conditions, as well as proximate sources of social and financial support in the region. The development of awareness and right attitude in the members of Kalaheo community may result in the more frequent practice of protection activities such as self-reports and regular referrals to professional settings. In the long run, the program may contribute to the reduction of morbidity and mortality in the community.
Hawaii State Data Center. (2013). Urban and rural areas in the state of Hawaii, by county: 2010. Web.
Hawaii State Department of Health. (2010). A natural disasters safety and readiness guide for seniors in Hawaii. Web.
Hawaii State Department of Health. (2011). Chronic disease disparities report 2011: Social determinants. Web.
Kalaheo, Hawaii. (n.d.). Web.
Kaua’i Historical Society. (n.d.). Story of Kaua’i. Web.
Report: Hawaii homeless population continues to grow. (2016). Web.