Health Promotion in Minority Populations: Hawaii

The US healthcare system slightly differs when compared to other industrialized countries. In many developed states, medical services are widely accessible for residents, while the US imposes strict insurance programs which are sometimes not available for the low-income, unemployed, and elderly population. Even with the implementation of such programs as Medicare and Medicaid, not everyone obtains equal access to the healthcare services.

The American nation comprises several ethnic groups, including black, Hispanic, Asian, American Indian, and Native Hawaiian e minorities, most of which are deprived of the quality healthcare facilities the whites have. For instance, many Native Hawaiians suffer from poor health outcomes, so a deliberate promotion plan should be created based on their cultural values and practices.

Native Hawaiians is the minority which was previously included into the Asian ethnic group. However, the health outcomes were significantly different between these two parties, so they were divided into two separate cohorts. Currently, Native Hawaiians and Pacific Islanders belong to the group, but the results of each are usually reviewed and analyzed separately. The current health status of Native Hawaiians is characterized by a number of poor health outcomes: overweight and obesity, hypertension, diabetes, and high rates of asthma and cancer mortality (Morisako, Taualiʻi, Ambrose, & Withy, 2017).

Thus the percentage of those who ever had asthma is 19.6 percent, which is much high than the national average of 12.9 percent (NCHS, 2017). More than eleven percent of adults aged sixty-five and over need help with personal care, which is almost twice higher than the percentage among all the US adults (NCHS, 2017). Despite these facts, the Native Hawaiian ethnic group representatives were previously characterized as healthy, strong, and hardy people (Brown, Kim, Ka’opua, Mokuau, & Browne, 2015). However, the major reasons for poor health outcomes of this minority result from either genetic dispositions or the intervention of Western nations.

In the United States, the health disparities evolved among Native Hawaiians because of discrimination and inappropriate access to healthcare services. For instance, the high prevalence of cardiometabolic disorders has been attributed to psychosocial stressors, socioeconomic deprivation, and sociocultural challenges (Kaholokula, Ing, Look, Delafield, & Sinclair, 2018). Among the adults of this ethnic minority, about four percent of them experienced psychological distress, while the national average index is only three percent (NCHS, 2017).

Furthermore, after the advent of Western civilizations, there were dramatic changes in the land tenure and social structures followed by suppression of the local culture and language (Brown et al., 2015). Colonization had resulted in historical trauma and loss of traditional lifestyles, where “fishing and agriculture were replaced by large-scale industrial rural economy” (Brown et al., p. 916). As a result, some nutritional challenges arose because Native Hawaiians could no longer consume natural foods grown on the island.

Based on the historical premises, Native Hawaiians faced a number of barriers to health. Moreover, the expansion and evolvement of traditional healthcare services sponsored by the US official institutions were not satisfactory. Native Hawaiians still experience a cost barrier, could not obtain full insurance coverage, and receive a routine annual checkup (Morisako et al., 2017). Currently, elders of this minority have “the lowest per capita incomes and highest poverty rates of all American ethnic groups” (Brown et al., 2015, p. 913).

Native Hawaiians have been continuously facing economic and acculturation-related challenges that negatively influence their physical and mental health status (Kaholokula et al., 2018). In search of better employment and health care access opportunities, the representatives of this minority are often forced to migrate to other states in the US, Australia, or New Zealand.

Those who obtained an opportunity to receive the appropriate healthcare services also encountered misunderstandings with practitioners. Deficiencies in cultural competency, local language skills, and conflicting perceptions and attitudes toward healthcare created a barrier on the way to the quality healthcare services for Native Hawaiians (Morisako et al., 2017). Meanwhile, many community members stick to their traditional practices and beliefs in health promotion activities. Native Hawaiians have the values similar to those of pagan people who believed that a man is a part of nature, mutually influencing each other. When one breaks the laws of nature, he or she may receive a punishment in the form of the disease.

Furthermore, their main beliefs constituted that a man is a holistic organism in which body and spirit should be cooperating in harmony. Hula practices are traditional among Native Hawaiians as they help a person to become complete. A decade ago, “scientists from the University of Hawaii and the cultural practitioners of hula formed a partnership to develop and evaluate a cardiac rehabilitation program based on hula” (Kaholokula et al., 2018, p. 261). Currently, herbal healing practices, acupuncture, and tai chi, brought by Japanese and Chinese migrants to the island, are also prevailing among the local people.

Creation of the appealing care plan for Native Hawaiian ethnic group should be based on the health belief model and consider sociocultural and socioeconomic realities of the group. As many representatives of this minority already suffer from diabetes, obesity, and hypertension, tertiary prevention is the most appropriate of the health promotion strategies. Its main principle constitutes softening the impact of present illness by helping people to cope with the long-term problems and improve their quality of life.

Those interventions are supposed to incorporate the principles of health belief model that helps people to realize the existing health problems, recognize barriers and beliefs, and promote engagement in health improvement behavior. Furthermore, these preventive measures are expected to be the most effective with the incorporation of basic local health belief and traditions. When traditional and alternative healthcare practices are combined, this is called integrative medicine (Ali & Katz, 2015).

Tertiary prevention based on such an integrative approach for chronic disease is expected to reduce morbidity levels. For instance, nutritional supplements such as fish oil, herbal pills, and mind-body techniques are used to treat type 2 diabetes, while therapeutic diets combined with herbal tinctures can cure hyperlipidemia (Ali & Katz, 2015). If Native Hawaiians recognize and implement such integrative medical practices, the overall health status of the minority could be improved.

Native Hawaiians is the ethnic minority experiencing numerous health disparities emerged as a result of Western colonization. When Hawaii was acquired by the US, traditional agricultural practices were substituted by the industrial ones. Thus the local people experienced shifted lifestyles, discrimination in educational, employment, and healthcare spheres. Many Native Hawaiians left the island, but those who stayed did not receive the appropriate medical treatment as practitioners do not possess sufficient cultural competencies and languages skills. To improve the health status of Native Hawaiians, a proper care plan should be created basing on the health belief model principles and considering the healing practices of local people.


Ali, A., & Katz, D. L. (2015). Disease prevention and health promotion: How integrative medicine fits. American Journal of Preventive Medicine, 49(5), 230-240.

Brown, K. L., Kim, B. J., Ka’opua, L. S., Mokuau, N., & Browne, C. V. (2015). Native Hawaiian and Pacific Islander elders: What gerontologists should know. The Gerontologist, 55(6), 912-919.

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

Morisako, A. K., Taualiʻi, M., Ambrose, A. J., & Withy, K. (2017). Beyond the ability to pay: The health status of Native Hawaiians and Other Pacific Islanders in relationship to health insurance. Hawaii Journal of Medicine and Public Health, 76(3), 36-41.

National Centre for Health Statistics (NCHS) (2017). Health conditions and behaviors of Native Hawaiian and Pacific Islander persons in the United States, 2014. Vital and Health Statistics, 3(40). Web.