9/23/2013 1 ASSESSMENT AND PRIORITIES FOR HEALTH & WELL-BEING IN NATIVE HAWAIIAN & OTHER PACIFIC PEOPLES Hawai‘i State Capitol Rm 329 September 24, 2013 DEPARTMENT OF NATIVE HAWAIIAN HEALTH CENTER FOR NATIVE AND PACIFIC HEALTH DISPARITIES RESEARCH JOHN A. BURNS SCHOOL OF MEDICINE UNIVERSITY OF HAWAIʻI AT MĀNOA Health Equity Health Equity for for Native Hawaiians Native Hawaiians Maenette Benham, PhD The Queen’s Health Systems Board of Trustees Chair, Native Hawaiian Health Committee Dean, Hawaiinuiakea- School of Hawaiian Knowledge University of Hawai‘i
Transcript
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ASSESSMENT AND PRIORITIES FOR HEALTH & WELL-BEING IN NATIVE HAWAIIAN & OTHER PACIFIC PEOPLESHawai‘i State Capitol Rm 329September 24, 2013
DEPARTMENT OF NATIVE HAWAIIAN HEALTHCENTER FOR NATIVE AND PACIFIC HEALTH DISPARITIES RESEARCH
JOHN A. BURNS SCHOOL OF MEDICINEUNIVERSITY OF HAWAIʻI AT MĀNOA
Health Equity Health Equity forfor
Native HawaiiansNative Hawaiians
Maenette Benham, PhDThe Queen’s Health Systems Board of Trustees Chair, Native Hawaiian Health CommitteeDean, Hawaiinuiakea- School of Hawaiian KnowledgeUniversity of Hawai‘i
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Significance of FindingsSignificance of FindingsFor Hawai‘i & JABSOMFor Hawai‘i & JABSOM
Jerris Hedges, MS, MDDean, John A. Burns School of MedicineUniversity of Hawai‘i
• Challengeso Diabetes Heart Disease Obesityo Diabetes, Heart Disease, Obesityo Health Behaviors are hard to changeo Health is impacted by many factors, from genetics to
jobs
• Solutionso Innovation through community – universityo Innovation through community university
collaborationso Building science and research infrastructureo Preparing health professionals to service communities
throughout Hawai’i
DEMOGRAPHIC & HEALTH DEMOGRAPHIC & HEALTH DISPARITIES HIGHLIGHTSDISPARITIES HIGHLIGHTS
Marjorie Leimomi Mala Mau, MS, MD, FACPProfessor, Department of Native Hawaiian Health Director & Principal InvestigatorCenter for Native & Pacific Health Disparities ResearchUniversity of Hawai‘i, John A. Burns School Medicine
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A A Conceptual Conceptual Model of Health Model of Health DisparitiesDisparities
What do you mean “Health Disparities”?
“Unjust”Differences in
Health(Disadvantaged
Populations)Health Policy
Health Disparities Research
“Unjust”Differences in
Health(Disadvantaged
Populations)
Biological (unavoidable) differencesIn Health
POPULATION HEALTH STATUS
“Unjust”Differences in
Health(Disadvantaged
Populations)
Mau M, 2008, 2011, 2013
Research &
Science
The “Black Box”
Healthy People 2020Healthy People 2020• Defines a health disparity as “a particular
type of health difference that is closely linked with i l i d/ i t l social, economic, and/or environmental
disadvantage. • Health disparities adversely affect groups of people
who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical g y p ydisability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.”
U.S. DHHS. The Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020. Phase I report: Recommendations for the framework and format of Healthy People 2020. http://www.healthypeople.gov/hp2020/advisory/PhaseI/sec4.htm#_Toc211942917.
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DEMOGRAPHIC & HEALTH DEMOGRAPHIC & HEALTH DISPARITIES HIGHLIGHTSDISPARITIES HIGHLIGHTS
What every policymaker needs to What every policymaker needs to know about these DATA … know about these DATA …
But But iis afraid to ASK!s afraid to ASK!
WHO is included?WHO is included?USA: Native Hawaiians & Pacific Islander
Populations in 2010, (thousands)FACT: 1.2 million NHPIs live in U.S. … Increase of 40% since 2000.Comprise ~.4% of US.
Native Hawaiian,
527
Guam/Chamorro, 148
Tongan, 57Fijian, 32 Marshallese,
22
40.0%
50.0%
60.0%
70.0%
250,000
300,000
350,000
400,000
Hawaii’s Native Hawaiian, Pacific Islander & Filipino Populations are Growing
527
Samoan, 184
0.0%
10.0%
20.0%
30.0%
40.0%
0
50,000
100,000
150,000
200,000
Filipino All NHPI Native Hawaiian
Samoan Tongan Guamanian &
Chamorro
2000 2010 % change
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WHERE do WE LIVE?WHERE do WE LIVE?FACT: 350K (~30%) NHPIs live in Hawai‘i and
FACT: Top 5 Counties -
286K (~23%) NHPIs live in California.
Highest Percentage of NHPIs1. Hawai‘i County2. Maui County3. Kauai County4. Honolulu, County5. Anchorage, AK Census 2010
HOW is our HEALTH?HOW is our HEALTH?
72.6 74.274.380.9 80.5
70
80
90
NH Life Expectancy Improved … But lags 6 years behind of Total State
FACT: NH die from the same TOP62.5
69.1 69.567.672.6
0
10
20
30
40
50
60
Hawaiian Filipino State Total
Age In Years
1950 1960 1970 1980 1990 2000 11.1
9.2 9.59.28 0
10.0
12.0
00
NH Infant Death Improved … But remains higher than State
FACT: NH die from the same TOPCauses of Death … Just at Earlier Age
6.17.27.0
7.66.87.1
5.8 5.9
0.0
2.0
4.0
6.0
8.0
Native Hawaiian Filipino State Total
Rate per 1,00
1981 1990 2000 2009
FACT: Worldwide the 4 leading NC Diseases: cardiovascular disease, diabetes, cancer and chronic respiratory diseases … 3 of 4 same in NHPIs
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WHAT have we LEARNED?WHAT have we LEARNED?
We Already KNEW that … Diabetes, Heart Disease, Hypertension, Obesity
FACT: Diabetes is the STRONGEST Risk Factor for Heart Disease & Kidney Failure in NHPIs!
HIGHER in NHPIs To Prevent HD and KF … Stop Diabetes and Improve Diabetes Care!!
40
60
34.7 39.3 41.9
Percent of Adults with Metabolic Syndrome
“Clustering”of Risk Factors= Metabolic Syndrome
0
2013.9
Whites (n=295) Japanese (n=190)Filipino (n=186) N Hawn (n=510)
Grandinetti, Kaholokula, Theriault, Mau. 2010
FACT: REDUCING Metabolic Syndrome Risk Factors … can REVERSE TRENDS of ALL Diseases
Education & Learning Education & Learning WHEREWHERE it’s NEEDED is KEYit’s NEEDED is KEY
FACT: The PILI ‘Ohana Project is Effective in Reducing Weight & … Prevent Diabetes & Metabolic Syndrome in NHPIs +
2013 PILI ‘Ohana Project – 5 Co‐PIs
FACT: Kulia Ola Kino Maika’i was 1st
Diabetes Education Program (1993) designed & implemented by NH
Communities (N Kohala, W Kaua’i)
R01 DK 48136, R21 MD 001660
Heart Care Programs for NHPIs: Heart Care Programs for NHPIs: Hospital Hospital >> Home>> Home
Malama Pu’uwai Programs:
U01 HL 079163, P20 MD 000173‐S1
FACT: Malama Pu’uwai (151 enrolled) & Ho’omau Ka Pu’uwai (500+) have reached more than 650 NHPIs with CVD
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Hula Empowering Lifestyle
Heart Programs Incorporate the Healing Effect of Hula
Hula Empowering Lifestyle Adaptation Study (HELA)
FACT: Hula is now PROVEN to be FACT: Hula is now PROVEN to be rigorous exercise … and safe for People with Heart Disease!
Diabetes Programs WHERE its NeededDiabetes Programs WHERE its Needed
FACT: Few PC Providers have Enough Time or Training to Advise Patients on
Molokai Site
gLifestyle Behavior Changes
Lana`i Site
Hanapu Study Staff - Hilo Site
FACT: There is a Shortage of Specialty Care Access in Rural Areas (Diabetes, Kidney, Heart, etc.)
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Promising Programs by NHPIsPromising Programs by NHPIsKokua Kalihi Valley’s Ho‘oulu ‘Āina Community Park
FACT: For many NHPIs, seeking care from Traditional Healers is “1st line treatment”.
Community-based gardensHui Malama Ola Na O’iwi- Land & Health Prg.
Native Hawaiian Traditional Healing Center
What’s on the Horizon?
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• To prepare the NEXT GENERATIONo Leading Experts in NHPI health & health care
FACT: Most (if not all) of the “expert” leadership in NHPI health disparities are HOMEGROWN!
• Health care professionals of tomorrowo Will need a “new” SKILL SET to be successful
FACT: UH health profession schools have a plan: “Hui of Deans”
• The “near” HORIZON needs enabling Policy Makers
FACT: We need YOU!
Standing on the Foundation of My Ancestors, Mentors & Teachers
He Huliau – Obesity 2005
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OTHER OTHER DETERMINANTS OF HEALTHDETERMINANTS OF HEALTHHIGHLIGHTSHIGHLIGHTS
Brent Kakesako, JDExecutive Director, Hawai‘i Alliance for Community Based Economic Development
Health is Health is Impacted by Impacted by Many FactorsMany Factors
Where we live, learn, work, and play impacts our health• Economic Well-being• Education• Social & Cultural Well-
being• Emotional & Spiritual
Well-being
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Economic WellEconomic Well--being is Criticalbeing is Critical• Poverty can contribute to inequitable health outcomes• Native Hawaiian labor force need more people with
college degrees in higher wage fields such as technology science & businesstechnology, science & business
15.0
20.0
25.0
30.0
35.0
40.0
5 0
10.0
15.0
20.0
25.0
30.0
35.0
40.0Jobs held by NHPI in Hawai‘i, Hourly Rates
10.00.0
5.0
Food
Pre
p & S
ervin
g Rela
ted
Perso
nal C
are &
Ser
vice
Sales
& R
elated
Build
ing/G
roun
ds C
leanin
g & M
ainten
ance
Healt
hcar
e Sup
port
Tran
spor
tation
& M
ateria
l Mov
ing
Farm
ing, F
ishing
, & F
ores
try
Prod
uctio
n
Offic
e & A
dmini
strati
ve S
uppo
rt
Arts,
Ente
rtainm
ent, S
ports
, & M
edia
Prote
ctive
Ser
vice
Educ
ation
, Tra
ining
, & Li
brar
y
Comm
unity
& S
ocial
Ser
vice
Instal
lation
, Main
tenan
ce, &
Rep
air
Busin
ess &
Fina
ncial
Ope
ratio
ns
Life &
Phy
sical
Scien
ce
Cons
tructi
on &
Extr
actio
n
Comp
uter &
Math
emati
cal
Lega
l
Arch
itectu
re &
Eng
ineer
ing
Healt
hcar
e Pra
ctitio
ners
& Te
chnic
al
Mana
geme
nt
Male Female Median Hourly Rate
Better Education = Better HealthBetter Education = Better Health• Many scientific studies have shown having a college
degree will lead to better health• Community Colleges have been very successful in y g y
enrolling Native Hawaiians
15.914 1
17.0
14.9
22.4
14.5
23.5
14.715.0
20.0
25.0
ntage
Native Hawaiian Student Enrollment
13.612.1
14.1 14.5
0.0
5.0
10.0
UH Community Colleges UH Undergraduate
Percen
1992 1996 2000 2006 2007
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Cultural Values & Social Support Cultural Values & Social Support Impacts WellImpacts Well--beingbeing
• Traditions & cultural values help families to overcome social challengesovercome social challenges
• Cultural re-awakening strengthened cultural identity and boosted social-well being
• Core cultural values emphasize interconnection between spiritual health and physical health
Finding SolutionsFinding Solutions• Native Hawaiian Job Pathways are needed into science,
technology, business S h l hio Scholarships
o Internshipso Educational Enrichment Opportunities
• Native Hawaiian Educational Pathways have been successful in Community Collegeso Cultural practices
N ti l Hi t B li fo Native values, History, Beliefs
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Promising TrendPromising TrendCommunity College InnovationCommunity College Innovation
COMMUNITY COMMUNITY SPEAKSSPEAKSOF HEALTH NEEDS OF HEALTH NEEDS
HIGHLIGHTSHIGHLIGHTS
Mele Look, MBADirector, Community EngagementDepartment of Native Hawaiian HealthJohn A. Burns School of MedicineUniversity of Hawai‘i
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Molokai`
Ulu Network Ulu Network Organizations in HawaiOrganizations in Hawai‘‘ii
Kaua`i
O`ahu
Waimānalo Health Ctr.Ho`ola Lāhui
Hawai`i
Kaua`i Community Health Ctr.
Ko`olauloa Community Health Ctr.DPCP Hawaii
Moloka`i Community Health Ctr
Maui
Kaho`olawe
Lāna`i
MolokaiNi`ihau
Hāna Health
Waianae Coast Comp. Health Ctr.
Ke Ola MamoKalihi-Pālama Health Ctr.
Kōkua Kalihi Valley Comp. Family ServicesHawaii Primary Care Assoc.
KS-Kapālama Campus
Papa Ola LokahiWaikīkī Health Ctr.
Nā Pu`uwai
Moloka`i General Hospital
Community Clinic of MauiMālama I Ke Ola Health Ctr.
Hui No Ke Ola Pono
Hāmākua Health Ctr.
Hui Mālama Ola Nā `Ōiwi
Lāna`i Community Health Ctr.
Kula Na Po`e Hawai`i
y
Hawai`i Maoli
Hawai`i(Big Island)
Queen Emma Clinic Bay Clinic
LEGEND:Ulu Network Organization Main Site
Ulu Network Organization Satellite
West Hawaii Community Health Ctr
Hawai i Maoli
Hilo Medical Center
93% said 93% said Priority Priority Health Health Areas are:Areas are:
Diabetes
Heart Disease
Obesity
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Oahu Health Service NeedsOahu Health Service Needs
Scientific Knowledge + Scientific Knowledge + Community Wisdom = HEALTHCommunity Wisdom = HEALTH
• PILI ‘Ohana Lifestyle Programo UH-JABSOM, Dept Native Hawaiian Health, po Kula no na Po‘e Hawai‘i – PAPAKOLEAo Kokua Kalihi Valley Hlth Center – KALIHIo Ke Ola Mamo – WAI’ANAE, HONOLULU, KO‘OLAULOA,
KO‘OLAUPOKOo Hawai‘i Maoli – Hawaiian Civic Clubs
Tui Family, Papakolea
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Molokai`
PILI Program LocationsPILI Program LocationsKaua`i
O`ahu
Waimānalo Health Ctr.
Ho`ola Lāhui Hawai`i
Moloka`i Community Health Ctr
Maui
Kaho`olawe
Lāna`i
MolokaiNi`ihau Waianae Hawaiian Homestead Assoc
Ke Ola Mamo
Kōkua Kalihi Valley
Queen Medical Center
Nā Pu`uwai
K k h H H t d
Lāna`i Community Health Ctr.
Papakolea -Kula Na Po`e Hawai`i
o o a Co u y ea C
Hawai`i Maoli
JABSOM
Keiki o ka ‘Aina
Queen Liliu‘okalani Children’s Center
Hawai`i Island
Keaukaha Hawn Homestead
Panewa Hawn Homestead
Food GardensFood GardensReturning Returning to ‘to ‘ĀinaĀina
• Wai‘anae, Honolulu, Koolaupoko, Koolauloa Ke Ola Mamo
• Hilo Hui Malama Ola na ‘Oiwi
• Waimanalo Waimanalo Hlth Ctr
• Hana & Wailuku Hui no ke Ola Pono
Hilo, Hui Malama Ola na ‘Oiwi
Kalihi, KKV
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Role Models & InnovatorsRole Models & Innovators• Tight relationship with Wai‘anae community• Focus on enabling services• Incorporation of Hawaiian culture
WCCHC, Staff training
Role Models & InnovatorsRole Models & InnovatorsKokua Kalihi Valley • Focus on Social Determinants like community empowerment
May 16, 2006
• Native Hawaiian beliefs & practices in programs• Returning to ‘āina seen as a bold health strategy
Recolonizing KalihiPacific isle women get a workout and healthy harvests
through an innovative agricultural initiativeBy Katherine Nichols
What help is needed?What help is needed?Prevention Program support• Create reimbursement or way to have low cost programs• PILI ‘Ohana, gardening, heart health education, pre‐diabetes education
Support for more new models• Culturally‐aligned health services & programs• Traditional Native Hawaiian Healing
Replication of Best Innovation• Bring the best of KKV & WCCHC to other places
NEXT STEPS & CLOSINGNEXT STEPS & CLOSING
J. Keaweʻaimoku Kaholokula PhDChair, Department of Native Hawaiian HealthJohn A. Burns School of MedicineUniversity of Hawai‘i
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What’s WorkingWhat’s Working• Programs that integrate cultural values & practices with
t bli h d h lth ti t t iestablished health promotion strategies• Programs that address the social determinants of health• Community-placed approaches to health promotion• Culturally-competent,
integrated primary care services
• Collaborations & partnerships that lead to innovation & sustainability
• “Growing our own” health care workforce
• Investments in community resources to promote healthy behaviors
The PILI ‘Ohana Community‐Academic Partnership
Next StepsNext Steps• Establish a State Task Force to establish a Native
Hawaiian Health Improvement Plan• Improve access to Native Hawaiian specific data from State
agencies• Utilize existing collaborations, systems, and partnerships to
leverage resources and maximize outcomes • Promote legislation to address social determinants of health• Support community-organizations in promoting their own health• Increase preventive services available in Native HawaiianIncrease preventive services available in Native Hawaiian
communities
MōhalaMōhala ii kaka waiwai, , kaka makamaka o o kaka puapuaFlowers thrive where there is water,
as thriving people are found where living conditions are good.
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MahaloMahaloThis presentation was made possible with awards
from…from…• The National Institute of Minority Health & Health
Disparities of the National Institutes of Health (P20MD00173;U54MD007584)
• The Queen’s Health Systems, Native Hawaiian Health Program
Molokai`
Ulu Network Ulu Network Organizations in HawaiOrganizations in Hawai‘‘ii
Kaua`i
O`ahu
Waimānalo Health Ctr.Ho`ola Lāhui
Hawai`i
Kaua`i Community Health Ctr.
Ko`olauloa Community Health Ctr.DPCP Hawaii
Moloka`i Community Health Ctr
Maui
Kaho`olawe
Lāna`i
MolokaiNi`ihau
Hāna Health
Waianae Coast Comp. Health Ctr.
Ke Ola MamoKalihi-Pālama Health Ctr.
Kōkua Kalihi Valley Comp. Family ServicesHawaii Primary Care Assoc.
KS-Kapālama Campus
Papa Ola LokahiWaikīkī Health Ctr.
Nā Pu`uwai
Moloka`i General Hospital
Community Clinic of MauiMālama I Ke Ola Health Ctr.
