Culture, work experience, socio-economic status, and education are among some of the factors that contribute to the diversity of racial and ethnic group associated with the Hawaiians (Chung-Do et al., 2016). The geriatric population for instance, still considers the traditional native practices, customs, and beliefs as relevant in regards to other Hawaiians who value the western culture way of life. Often, it may include various practices such as speaking the Hawaiian language, singing traditional music as well as practicing traditional means of dieting. The health beliefs and knowledge may require an individual assessment of native Hawaiians, especially when conducting an interview. The reason for this is because the recognized diversity plays an important role in determining the cultural perspective of the patient. In most cases, grouping or labeling the patient is avoided to retain the individuality of the person and enhance an ideal patient-physician relationship.
The concept of self in native Hawaiians is based on social relationships. The individual, society and nature share common characteristics making them inseparable which in turn relates to their psychological health (McCubbin & Marsella, 2009). As a result, these types of bonds, from a relational and emotional perspective, guarantees that each receives enough protection as well as support for purposes of enhancing psychological well-being. On the contrary, the imbalance of these bonds may affect the individual, society, and nature thus causing harm. Furthermore, it can also lead to maladaptive behaviors or even psychopathology.
In most cases, Hawaiians often tend to live with their families. According to the studies that have been carried out, most of the Hawaiian families were found to be poor with an increased unemployment rate (McCubbin & Marsella, 2009). Also, most of them live in rented houses and have minimal opportunities of owning their home. In comparison to the national average, many show promising results of graduating from high school. However, despite the specified results, about half of them can go further and be presented with a bachelor's degree.
In the Hawaiian religious belief context, Chiefs were believed to possess a sacred power which linked them to the gods. Normally, they had established a system called the kapu system where women were limited to make choices regarding foods and also they were not allowed to eat at the same table with men (Religion and expressive culture , 2018). They connected their deities with particular crafts and activities and sacrifices were made to them at domestic shrines. Tattoos and also carved wooden idols of the gods were often common especially among the Chiefly men. Indigenous dance forms such as the hula were performed at major festivals including the celebrations of fertility usually being accompanied by drums, sticks, bamboo pipes, rattles and other percussion instruments.
Native Hawaiians secreted and buried their dead in caves. They believed that the deceased personal power or mana dwelled in the bones. This taboo was particularly important in their death rituals and people who broke it was sentenced to death and were presented as offerings to the gods. Also, despite many Hawaiians today using the western medicine, some still prefer consulting healers and spiritual specialists. They also consider themselves as more likely to suffer from spiritual possession and in most cases, many relate to the idea that people with evil thoughts on others are more likely to suffer material consequences.
Health Disparities of Hawaiian Cultural Population
Behaviors such as tobacco use, alcohol use, physical inactivity, and violence as well as victimization are commonly experienced among the Native Hawaiians. For instance, excessive smoking can lead to high risk of lung cancer thus increasing mortality rate. On the other hand, excessive consumption of alcohol is associated with high risk of several cancers including oral cavity, pharyngeal, laryngeal and liver among others. Physical inactivity often is experienced by the population as a result of unhealthy diet which in turn can lead to obesity. Also, violence and victimization are also common among the Native Hawaiians due to the kind of environment that most have been raised which in overall, consists of poor neighborhoods.
Traditional Vs. Complementary/Alternative Medicine
Native Hawaiians contribute to a significant number of populations of Hawaii's poor and unemployed. Most of them have higher chances of serious health problems including cancer, diabetes, and hypertension among others. Hawaiian tradition regards to nature and health as entwined and they also believe that when one suffers from an illness is as a result of punishment for disobeying the rules or committing an evil act. Hawaiians practice a variety of healing practices such as acupuncture, tai chi and intake of herbal medicines which was commonly derived from the Japanese and Chinese (Bach, 2015). Furthermore, after the healing modality process was completed, a person is often assigned spiritual blessings. Healing modalities such as massages are also commonly practiced among the population. Additionally, various herbs including ginger root are used for stomach upset, and plantain leaves are also used for people with a diabetic condition which in turn helps in regulating their blood sugar levels. Most Hawaiians associate themselves with traditional healing practices compared to complementary medicine. The reason for this is because they believe that such practices play a vital role in preserving their culture as well as helping them to plan their treatment and prevention methods.
Health Disparities and Nutrition
Some of the most commonly experienced health disparities among the Native Hawaiians include cardiovascular disease, hypertension, diabetes, obesity, and cancer. Cardiovascular disease is known to be among the leading causes of death in all racial and ethnic groups across the United States. Recent studies have shown that Native Hawaiians possess a higher risk of having this kind of disease compared to other groups due to various factors such as unhealthy consumption of food and beverages, excessive use of tobacco and alcohol and lack of physical activity. On the other hand, hypertension is considered as a risk factor for coronary heart disease and stroke. In most cases, the increased rate of hypertension is as a result of obesity, high blood pressure as well as other psychological factors such as work strain, social status, and emotional stress.
Native Hawaiians are more likely to have diabetes due to the high prevalence of obesity and physical inactivity. Diabetic people possess a higher risk of mortality from diseases such as cardiovascular and renal and also are more likely to suffer from lower health-related quality of life. Moreover, several chronic diseases such as hypertension, cancer, Type-II diabetes are commonly linked to obesity. An unhealthy diet is the main risk factor that causes diabetes together with psychological problems including depression. Also, some of the health behaviors associated with Native Hawaiians such as excessive smoking are potential risk factors linked to cancer especially lung cancer, which also contributes to high mortality rates.
Cultural Barriers and Perception of Health Care Providers
In most cases, Native Hawaiians and other Pacific Islanders are often assessed individually regarding their health beliefs and knowledge (Wergowske & Lanoie Blanchette, 2018). Health care providers need to consider specific factors when establishing a health care system for such a population such as heterogeneity which involves individual assessment and culturally related health beliefs. Grouping them will cover their individuality and increase the potential risk of building a relationship which can be considered as effective. Thus, it is important specifically for health care providers to identify the patient's background and have comprehensive knowledge regarding the specified population. Also, it is important for them to differentiate the Native Hawaiians beliefs and practices from that of western culture to avoid any misinterpretations.
Over the recent years, the western culture influence has shaped the health beliefs and knowledge of Native Hawaiians regarding how they perceive the design, delivery, and treatment of health services. Health problems such as cardiovascular disease, obesity, hypertension, and diabetes are associated with the Native Hawaiians, and as a result, high mortality rates are commonly experienced among the population. When establishing a health care assessment in the population, grouping or labeling in most cases is avoided for purposes of preserving the patient's individuality as well as establishing a significant relationship between the patient and healthcare provider. The reason for this is because of the wide variation that exists among the population due to various factors such as ethnicity, culture, religion, work experience and education.
Bach, D. (2015). What matters to the heart: Hawaiian belief and value systems relating to disease and spirituality (Doctoral dissertation, Saybrook University)
Chung-Do, J. J., Look, M. A., Mabellos, T., Trask-Batti, M., Burke, K., & Mau, M. K. M. (2016). Engaging Pacific Islanders in research: community recommendations. Progress in community health partnerships: research, education, and action, 10(1), 63-71.
McCubbin, L. D., & Marsella, A. (2009). Native Hawaiians and psychology: The cultural and historical context of indigenous ways of knowing. Cultural Diversity and Ethnic Minority Psychology, 15(4), 374.
Religion and expressive culture - Hawaiians. (2018). Everyculture.com. Retrieved 8 March 2018, from http://www.everyculture.com/Oceania/Hawaiians-Religion-and-Expressive-Culture.html
Wergowske, G., & Lanoie Blanchette, P. (2018). Health and Health care of Native Hawaiian and Pacific Islander American. Web.stanford.edu. Retrieved 8 March 2018, from https://web.stanford.edu/group/ethnoger/nativehawaiian.html
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