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Director's Comments Transcript: Native Hawaiian Health 04/21/2009

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Greetings from the National Library of Medicine and

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I'm Rob Logan, Ph.D. senior staff National Library of Medicine substituting this week for Donald Lindberg, M.D, the Director of the U.S. National of Medicine.

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The health status of Native Hawaiians and Pacific Islanders is a major challenge for the physicians and traditional healers who serve the indigenous peoples of Hawaii, Guam, Samoa, and other Pacific Islands. However, the efforts to improve health care are fostering some imaginative, culturally appropriate approaches in Hawaii, including a network of clinics that combine western medicine with native healing, plus an interest in community outreach within the state's medical school and other health care organizations.

First, Native Hawaiian/Pacific Islanders' health statistics are sobering. According to the U.S. Office of Minority Health, Native Hawaiians/Pacific Islanders have higher rates of smoking, alcohol consumption, and obesity than other U.S. ethnic groups.

The U.S Office of Minority Health reports in Hawaii, Native Hawaiians have more than double the rate of diabetes as white residents. Native Hawaiians are almost six times more likely to die from diabetes as white residents. The incidence of tuberculosis is 21 times higher for Native Hawaiians than for white residents.

Also, the infant mortality rate (or deaths per 1,000 births) for Native Hawaiians is almost three percent higher than all other populations. The U.S. Office of Minority Health reports other unusually prevalent risk factors among Native Hawaiians and Pacific Islanders include: hepatitis B, and HIV/AIDS.

A 2007 U.S. Census estimate reports there are a little more than one million Native Hawaiians/Pacific Islanders in the U.S., or about 0.1 percent of the nation's population. About one-half of this population lives in Hawaii; while others tend to live in: California, Washington, Texas, New York, Florida, and Utah.

The U.S. Office of Minority Health reports about 30 percent of the Native Hawaiian/Pacific Islander population is under 30 years old. The skew towards youth in the Native Hawaiian/Pacific Islander population may explain high HIV/AIDS risk factors, among others. But the website of the U.S. Centers for Disease Controls and Prevention's Office of Minority Health & Health Disparities succinctly summarizes the broader challenges.

They write and we quote: Native Hawaiian and Other Pacific Islanders ... 'generally experience poorer health than the American population as a whole. They are more at risk for developing and dying from cancer, heart disease, diabetes, and other diseases' (end of quote). Some of the factors that may contribute to these poor health outcomes include: low socioeconomic status, cultural disruption, limited access to health care, nutritional habits, and a sedentary lifestyle.

These challenges are not news to public health officials in Hawaii, area health professionals, and the faculty of the John A. Burns School of Medicine at the University of Hawaii-Manoa (which is the state's comprehensive, physician training institution). During a recent visit an NLM team (led by Dr. Lindberg) heard some innovative ideas grounded in traditional beliefs that inform culturally tailored efforts to improve the health of Native Hawaiians.

First, the John A. Burns School of Medicine has a department of Native Hawaiian Health that provides clinical care and adds significant research about efforts to improve the individual and public health of Native Hawaiians and other Pacific Island Peoples.

Among the faculty's initiatives, one of the most interesting infuses all medical students with the importance of community service as well as commitment to patients and the public - plus community - health. A series of posters within the medical school consistently remind everyone of the importance of community outreach, improving the health of all Hawaiians, and other ethnic populations in Hawaii that experience health disparities.

Several faculty members and the School's dean explained the posters are part of an intensive effort to foster culturally sensitive caring -- accompanied by a responsibility and responsiveness to public health challenges.

The Hawaiian Health Board, Papa Ola Lokahi, which has national responsibilities for educating, training, and planning Native Hawaiian health programs also assists a network of Native Hawaiian health centers and community health clinics that provide preventive services and primary care throughout the islands. Among the clinics' innovations include efforts to integrate Western medicine with traditional healing and encourage Native Hawaiians to take advantage of both types of services.

One especially interesting clinic in Waianae (a rural, ocean front setting about 50 minutes from downtown Honolulu), blends traditional and western medicine with a respect for the environment. Officials at the clinic explain that traditional Hawaiian medicine is based on principles that dovetail the health and welfare of the community, the health and welfare of the land that persons live on, with the health of the individual. So, as part of patient care and community outreach, the clinic encourages community outreach, the use of local plants as medicinal remedies (when appropriate with western care), as well as teaching patients and visitors an appreciation for the surrounding ecosystem.

Besides a comprehensive, modern medical clinic that could be a hypothetical base to conduct clinical trials, Waianae offers a homemade trail that helps patients, their families, and visitors understand the integrated vision of health and illness among Native Hawaiians. On the trail one sees displays of growing, indigenous medicinal plants, how they are used, plus a description of the Hawaiian historic vision of health, and the fragility of the ecosystem of the soaring cliffs that meet the sea on Oahu's western shore.

The combination of ecological appreciation, a community and public health orientation, up-to-date clinical and dental care, and the unselfish time and assistance of traditional healers and elder-Kapuna (especially to help persons cope with the emotional side of health and illness) all create Waianae's relaxed, healing ambience. During our visit, the providers and atmosphere exuded a point: this is a place to get well, enhance the welfare of others, and care for nature. It's an impressive blend that could be embraced in settings far from Hawaii's borders.

You can learn more about Native Hawaiian and Pacific Islander health by typing 'Native Hawaii health' in the search box on's home page. Among the list of websites that pop up are links to the aforementioned websites from the U.S. Office of Minority Health, and the Centers for Disease Controls and Prevention.

Links to the websites to the Department of Native Hawaiian Health at the John A. Burns School of Medicine and Papa Ola Lokahi can be found by typing 'Native Hawaiian health' in Google or similar search engines.

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