Professional Documents
Culture Documents
Table of Contents
Introduction 5
Methodology 6
Part One: Historical Strengths 7
O Ka W Mamua (The Past) 7
Kne: Spirituality and Religion 7
Kne: The ina, Kai, and Resources 8
Kne: Family and Relationships 9
Kne: Education and Occupation 10
Kne: Leadership and Politics 11
Moohihia 12
Economic Transformations 12
Political Transformations 13
Social Transformations 14
Transformations in Hawaii during the Twentieth Century 15
Native Hawaiian Resiliency 16
Part Two: O Kia Au (The Present) 17
Demographics: The Kne Population in Hawaii 17
Social Determinants of Kne Health 18
Keiki 18
Ohana make-up 18
Education 20
Juvenile Crime 24
Mkua 24
Post-secondary Education 24
Economic Stability 26
Marital Status 28
Behavioral Risk Factors 28
Involvement with Criminal Justice System 31
Kpuna 31
Household Context 31
Preventive Services 32
Age and life expectancy 32
Health Outcomes 32
Mental Health 36
Morbidity 36
Further Conclusion and Recommendations 37
Discussion Questions 39
Works Cited 40
Part One: O Ka W Mamua 40
Part Two: O Kia Au 41
Acknowledgements 45
Copyright 2017. Office of Hawaiian Affairs. All Rights Reserved. No part of this report may be reproduced or
transmitted in whole or in part in any form without the express written permission of the Office of Hawaiian Affairs.
Suggested Citation: Office of Hawaiian Affairs. (2017). Knehlani Transforming the Health of Native Hawaiian Men. Honolulu, HI: Office of Hawaiian Affairs.
4 Knehlani Transforming the Health of Native Hawaiian Men
Knehlani Transforming the Health of Native Hawaiian Men 5
Introduction
This report aims to provide a picture of traditional and contemporary wellbeing of kne,
Native Hawaiian men. Based on these descriptions, the report will also offer recommendations
to support the strength of future generations of kne. The focus here is on kne, specifically,
as we apply Hawaiian framework and methodology that incorporates a gendered perspective
of both the social, spiritual, and physical word. Both the study and the recommendations are
intended as starting points for additional research, discussions, and programming.
Part 1: O Ka W Mamua (The Past) starts with a depiction of the placement of kne in Native
Hawaiian society. This section will explore traditional Native Hawaiian culture and historical past.
It highlights strengths that contributed to the vitality of a thriving knaka iwi (Native Hawaiian)
nation, and also examines historical challenges that have negatively affected Native Hawaiians.
It looks at the traditional kuleana (responsibilities) and contributions of kne in Hawaiian soci-
ety as a foundation for pono (proper) action. This section will also examine the moohihia, the
chronology of historical difficulties which altered the traditional roles and contributions of kne.
Finally, the section will include an examination of the continued resilience of Native Hawaiian
kne. What you will see is that Native Hawaiian men had a significant place across both the
breadth and depth of Hawaiian culture, and a healthily functioning society spoke to healthy kne,
and vice versa. The idea of an individuals well-being is directly reflected in a healthy society. That
Hawaiian culture was able to flourish for hundreds of years, prior to western contact, is a testa-
ment to the ways Hawaiian society kept Hawaiians healthy, and in turn healthy Hawaiians were
able to tend their families, gods, avocations, and the ina (land).
The second part of this overview, Part 2: O Kia Au (The Present), seeks to also create a
similar narrativebut this one is based on data collected from various contemporary sources
of the health of kne, in relation to his socio-economic and other disparities. Obviously, these
two sections cannot be compared directly, but it is hoped that, together, they create their own
narrativeone of how rapid change in so many facets of a society has had long-lasting and
far-reaching effects, in ways that are both clear and can only be fully understood in relation to
other, shifting forces.
Throughout, we pose questions for your consideration, about ways your organization and
policymaking can affect real change for kne. Although your organization may not work directly
with some topics, we hope that using the social determinants of health (SDH) as a framework
will create links between seemingly disconnected points. This report then become a jumping-
off point for reflection and discussion. We also seek to highlight pathways of Native Hawaiian
resiliency, even in the face of adversity that threatened and threatens to collapse the Hawaiian
culture, as well as recommendations for future waysin policy, practice, and data collectionto
direct our energies and resources, in order to monitor, support, and enhance kne health.
6 Knehlani Transforming the Health of Native Hawaiian Men
Methodology
This report makes significant usage of the Kkulu Hou Methodology, which was developed
by Dr. Kamanaopono Crabbe in 2009, and is rooted in the Native Hawaiian cultural practice of
umu hau phaku (rock-wall masonry). This practice was a fundamental aspect of constructing
ancient temples, shrines, fishponds, houses, and other structures. Umu hau phaku required
particular steps for gathering resources, site selection, construction planning, and skills train-
ing. The primary objective of the Kkulu Hou Methodology for research and reporting is fourfold:
It should be noted that first component of the report, O Ka W Mamua, is more narrative and
historically based, as opposed to data-driven. Thus, the sources of information include tradi-
tional oral accounts that were preserved as mookauhau (genealogies), moolelo (historical
narratives), and mele (songs and chants). Written historical accounts authored by foreigners at
contact were also analyzed for information relative to kne or societal well-being. These primary
sources record the long history of Native Hawaiians and were explored to affirm that Hawaiian
society consisted of thriving lands, resources, and peoples. Finally, the work of contemporary
scholars and academics were exhaustively researched and referenced where appropriate.
The second component of this report, O Kia Au, focuses on social determinates of health
which have been identified within current medical and social research literature. Data from nu-
merous sources were compiled to provide a context or overview of how social, economic, and
environment factors impact Native Hawaiian men in Hawaii. Major sources utilized include: the
U.S. Census Bureaus American Community Survey, the Hawaii State Department of Education,
State of Hawaii Department of Human Services Statistical Report on Child Abuse and Neglect,
the University of Hawaii Center on the Family Homelessness Services Utilization Report, and the
Hawaii State Department of Health Behavioral Risk Factor Survey System.
Finally, data on kne health outcomes are explored as the physical manifestations of the so-
cial determinates of health. Major sources of this information include Hawaii State Department
of Health Office of Health Status Monitory datasets and research from the University of Hawaii
Cancer Research Center. From all sources, the most recent data at the time of writing for Native
Hawaiian men was extracted and analyzed. In most cases, this selection includes data from
2014 or, where sample sizes were smaller, five-year estimates were used, which represents data
that was collected over a five-year period, as opposed to a point-in-time count. Other findings
reference data for the Native Hawaiian population at large. Unfortunately, in some cases data
specific to kne was not collected or was unable to be annualized due to small sample sizes. In
these instances, data for the larger Native Hawaiian population is referenced, along with data for
the total State male populationthe populations within which kne form a part. While specific
data for kne in regards to some topics are not available, these findings likely apply for kne also.
Knehlani Transforming the Health of Native Hawaiian Men 7
mano (4,000), kini (40,000), lau (400,000) and including genealogy and rank, participation
lehu (great multitude, infinite) akua (Kanahele, in religious ceremonies, place of residence, or
1986). Not only were there a multitude of gods, familial observation of an individual.
there were rituals, prayers, and beliefs that The application of kapu also differed accor-
were specific to every area of life for Native ding to an individuals gender. In particular,
Hawaiians. Hawaiian society was characterized by the
Despite the existence of countless akua, ritual separation of the sexes through kapu
there were four male gods who were believed and social norms, which protected the spiritual
to be primary gods and who were invoked differences in male and female mana. Because
almost universally in rituals and ceremonies of their more active role in formal religious
conducted by all Native Hawaiians. These ceremonies, it was necessary for kne to
gods included K, Kne, Lono, and Kanaloa. maintain their spiritual sacredness through
Many gods served as models for the behavior the observation of kapu in ways that were not
of kne. In moolelo, the akua Kne and usually required of whine.
Kanaloa travelled throughout Hawaii and There were also specific rituals that were
pierced the ground in places where there performed for and by kne, including those
was no water to form springs; they also built that marked significant milestones or events
a fishpond in Honuaula (Helu 2, Ka Nupepa in the lives of Native Hawaiian men. These
Kuokoa, January 12, 1865). These life-giving included birth, betrothal, marriage, and death.
activities were imitated by generations of alii, Although celebrations and ceremonies were
many of whom sought to develop irrigation held for all kne, their complexity varied
systems and build fishponds as part of their according to a number of factors, including
kuleana (responsibilities) as rulers to ensure rank and genealogy (Valeri, 1985).
the wellbeing of people and lands under their One of the most significant ceremonies in
care. the life of a kne was known as k i mua, which
Gods were often specific to certain acti- described the transition of a young boy from
vities, skills, knowledge sets, and occupations. taking his meals common eating house where
In a newspaper article published on March 30, women and young children ate to the mens
1865 in Ka Nupepa Kuokoa, S. Ekaula listed the eating house (Malo, 1951). K i mua can
various aumkua specific to kahuna anan be translated to thrust into the mens eating
(sorcerous priests), poe kanu ai (farmers), house, (Pukui, Haertig & Lee, 1972). As part
lau lapaau (medicinal healers), kahuna heiau of the k i mua ceremony, a boy was given his
(temple priests), poe lawaia (fishermen), and first malo (loincloth), which served both as a
n alii (the chiefs). In this way, a kne was mark of his entrance to the hale mua and his
believed to have divine mentors and spiritual growth into manhood (Pukui, Haertig, & Lee,
guidance in every part of his life. 1972). A boy was also taught to humehume,
to tie or gird himself with a malo by his close
Kapu and Aikapu male relatives. Another important ceremony in
Kapu were sacred restrictions that served the lives of kne was the incision of the penis
as guidelines for spiritual and moral behavior (kahe ule).
in traditional Native Hawaiian society. There
were many different types of kapu. Certain Kne: The ina, Kai, and Resources
kapu were meant to prevent overuse of The deep relationship between kne
resources; for example a konohiki (land and the ina (lands) and kai (sea) is well
manager) could place a kapu on a specific documented in traditional oral history and
type of plant or fish if they were not abundant literature. Moolelo, mele, and mookauhau
or out of season (Malo, 1951). A kapu could be were part of a large body of knowledge main-
specific to a place or a resource, but could also tained by the rigorous intellectual traditions of
be specific to classes of people. Kapu were Native Hawaiians, whose studied observation
also put in place to protect the sacredness of of their surroundings allowed for a deep
gods, people, places, and objects. understanding of the systemic physical and
The number and severity of kapu was spiritual interactions of people, resources, and
applied differently in traditional Hawaiian environments.
society depending on a number of factors, In mele koihonua the Hawaiian Islands
Knehlani Transforming the Health of Native Hawaiian Men 9
family who were blood relations. Native was also an important site of mentoring by
Hawaiians also recognized important social male family members. In this setting, male
relationships of varying degrees with other children were guided by their fathers, uncles,
non-related members of the community. grandparents, and even elder brothers and
The concept of ohana also encompassed cousins in all manners of life and living. The
deceased ancestors, who often remained hale mua allowed a boys learning, discipline,
active in family affairs as aumkua. and modeling to occur within a close-knit
It was also the sacred kuleana of kne to community; such activities were undertaken
see to the physical and spiritual care of his with the support of the extended network of
family. Scholar Ty Tengan (2008) notes, On all kne, rather than in isolated nuclear family
levels, the responsibility for feeding both the units. Thus, the hale mua was one of the most
family and the gods fell on the shoulders of important facets of the ohana system which
men (p. 35). This responsibility encompassed shaped the lives of kne (Tengan, 2008).
all the processes associated with being able The family was such an important part of
to provide nourishment, including farming social organization in traditional Hawaiian
and fishing, preparation of food (such as the society, that Native Hawaiians developed
building of imu) and learning and observing ways to maintain familial harmony and
the necessary prayers and rituals involved in minimize discord. Hooponopono was a
those activities. In the hale mua, kne were ceremonial familial mediation meant for
responsible for making daily offerings and conflict resolution. If hooponopono and other
prayers on behalf of the entire ohana (family), methods of mediation failed, a ceremony
ritually feeding the gods in order to care for known as m ka piko (cutting the navel cord)
the ancestors (Pukui, Haertig & Lee, 1972). In could occur; this involved cutting all ties
recognition of mens roles as providers, Pukui between an individual and the family. For
(1986) notes that the word kua, which has Native Hawaiians, m ka piko was a terrible
connotations of a backbone or a support, was thing, because it cut a person off from the
also used to refer to a husband. support, aloha, and mana of his family (Pukui,
Haertig & Lee, 1972).
The Ohana as a Network of a Support
One of the most important functions of Kne: Education and Occupation
the ohana was as a network of support, which From the time of his birth, a Native
was present throughout the life of a Native Hawaiian man was groomed for familial and
Hawaiian men. Networks of kinship and aloha societal roles. From the general knowledges
sustained the growth of young boys into and skills necessary to survive, to the more
men, perpetuating a cycle that fostered the specialized knowledges that were specific
passage of knowledge and promoted learning to the deft practice of elevated occupations,
throughout a lifetime. kne were part of a genealogy of knowledge
The ohana played a role in the life of a that spanned generations.
kne even before he was born; it was believed
that the actions, health, and even diet of a The Nature of Traditional Education
pregnant woman would affect the disposition Education was not only an important means
and attributes of a child. Therefore, a woman of passing on traditional knowledge, but also a
would carefully follow the strictures of kahuna highly spiritual process which allowed kne to
pale keiki (midwives), with the support and gradually acquire mana. For this reason, kapu
care of her family and the community (Pukui, reinforced structure and protocol in education
Haertig, & Lee, 1972). and training.
The ohana system provided a safe Several lelo noeau illustrate Native
environment for learning. As a young child who Hawaiian educational values and methods
ate in the hale noa, a boy was cared for by his of learning: The first, Paa ka waha, hana
mother, female relatives, and other women ka lima, The mouth is shut, the hands are
of the village. Once a boy had undergone the doing stresses the importance of observation
k i mua ceremony, the hale mua became an without question and the importance of
important place of instruction and learning actually working to learn.
within the community of men. However, it
Knehlani Transforming the Health of Native Hawaiian Men 11
to its members being representative of the would impact Native Hawaiian men within the
highest mana, the aha alii was also a council Islands are complex, this report will highlight a
of chiefs, which provided political advice in number of the economic, social, and political
matters of governance, war, and diplomacy. transformations of the nineteenth and twentieth
Pono leadership was tied to mana. An alii centuries that had a particularly deep effect.
inherited the right to rule through genealogy,
as well as a specific set of kapu, which Economic Transformations
sanctified him as a sacred and religious leader Some of the most visible transformations of
(Malo, 1952). However, his decisions and Hawaiian society are reflected in the changing
actions regarding the care of his people, the structures of the Hawaiian economy during
expansion of territory, the apportionment of the nineteenth century. Whereas ancient
resources, were all factors which affected his Native Hawaiians maintained highly productive
ability to continue ruling. Kameeleihiwa (1999) economies that were carefully regulated by
describes two paths to mana for alii. The path the alii, Euro-American commercial ideals and
through Lono was accomplished through activity would redirect the basis of the Hawaiian
diplomacy and marriage. The path through K economy to one of capitalism and place a new
was accomplished through warfare. emphasis on the accumulation of wealth and
As sacred religious and political leaders, personal property (Hitch, 1992). Indeed, the
Native Hawaiians believed that it was the kuleana early commerce and industry in the islands,
of the alii to intercede in heavenly matters on which consisted primarily of the trade of furs
behalf of the people, much as it was the kuleana and sandalwood, would shift to whaling, sugar
of the kne to petition the gods on behalf of a and pineapple production, and eventually
makainana family. Famines, epidemics, or tourism over the course of two hundred years.
other troubles could be understood as resulting The far-reaching effects of commerce
in the displeasure of the gods with the ritual in the Islands are especially apparent in the
observations of an alii. increasing urbanization that occurred during
Furthermore, a good chief would ensure the the 1800s: the concentration of new economic
care of his people by facilitating the building opportunities in commercial trading centers,
of infrastructure, including heiau, irrigation such as Honolulu and Lhaina, would prompt
systems, agricultural systems, and fishponds. many Native Hawaiians to leave rural areas of
Issues of taxation were important, and an alii the islands, a process that would ultimately
would know when and how much to tax in ways alter ties among families, communities, and
that would not overburden the people. It was places (McGregor, 2007). Such population
believed that a wise and good chief could make shifts are evident in demographic statistics of
the land and resources themselves flourish, the nineteenth century. In 1850, Hawaii Island
and that the mana of a good alii was essential was the most populated island. By 1872, Oahu
to maintaining the wellbeing of the people. had become the most populous island with an
There are many oral histories surrounding estimated population of 20,671, as compared
the pono actions of alii, who served as models to the estimated population of 16,001 for
for leadership for future generations. Hawaii Island (Schmitt, 1989).
As farmers and fishermen whose labor
Moohihia produced the basis of subsistence, kne had
Beginning in the late 1700s, a series of traditionally provided enough food for their
changes at all levels of society would both families, communities, and the alii. However,
hinder and alter the ability of Native Hawaiians Tengan (2008) notes that during the nineteenth
to practice their culture, and in the historically century, Native Hawaiian men moved to cities
short span of 100 years, Hawaiian society and were engaged in wage work away from
would be fundamentally transformed. These their traditional communities. In the growing
changes would disrupt the succession and capitalist systems introduced by Europeans
flow of knowledge and support within Hawaiian and Americans, men were seen as the primary
society, creating breakages in the systems economic and political actors, and were much
that had preserved and perpetuated Native more directly involved in powerful mediums of
Hawaiian culture. imperialism. For this reason, men were often
Although the processes and events that more disconnected from traditional culture,
Knehlani Transforming the Health of Native Hawaiian Men 13
whereas women were often the ones who access to the land and its resources.
preserved and reinforced it (Tengan, 2008). Political Transformations
Other economic activities would have large The political transformations in Hawaii
impacts on the lives of Native Hawaiian kne. during the nineteenth and twentieth century
The introduction of goods and materials (such were indeed revolutionary, particularly when
as flour, tinned foods, iron, glass, oil, and cloth) considering the scope of changes within
reduced the use of some traditional materials Native Hawaiian governance structures. For
and tools and increased mens integration in example, the transition from the traditional
the wage economy. The rise of sugar cultivation alii system of governance to a constitutional
in the islands would eliminate thousands of monarchy was astonishingly rapid. The
acres of forests and alter ecosystems. Sugar presence of a unified political entity that
plantations would affect the availability of spanned across the Islands was relatively new
agricultural land for kalo cultivation by diverting in the early nineteenth century. The formation
both land and resources, especially water of the monarchy within the Kamehameha
(Wilcox, 1997). Eventually the introduction lineage as a result of unification would lead
of pesticides, the switch in farming to cash to the development and strengthening of the
crops, the increasing use of monocropping, Hawaiian Kingdom government.
and the exhaustion of soil nutrients and would The 1819 breaking of the ai kapu (eating
devastate native agricultural practices. It would restrictions) and the subsequent ai noa
also foster immigration for sugar labor, and (free eating) by Liholiho, Kepolani, and
intermarriage with Native Hawaiians became Kaahumanu m (Kaahumanu and her
more common. The introduction of ranching supporters), transformed traditional sources
would have similarly devastating effects. of authority and shifted the traditional
During the reign of King Kamehameha III, relationships between the alii and the
a system was developed to mhele (divide makainana (members of the general
or portion) lands in the Islands that were populace) (Kameeleihiwa, 1992).
once held in common under alii and konohiki The 1820 arrival of the first company of
system. The land of Hawaii was divided into missionaries, who were sent by the American
individual parcels that could be held as fee Board of Commissioners for Foreign Missions
simple by private individuals. The body of (ABCFM), would also impact governance; a
legislation which are commonly known as number of Hawaiis most powerful alii nui
Mhele Acts were actually a series of laws that (high chiefs) embraced the religious doctrines
were enacted in stages, which were meant of the missionaries and moved to establish laws
to incorporate Western and Hawaiian legal based on Christianity, including edicts against
frameworks into the Kingdoms governance prostitution, polygamy, and adultery (Merry,
structures for the purpose of caring for the 2000). To some extent, the incorporation of
Native Hawaiian people. Although primarily Euro-American frameworks within Hawaiian
recognized as a system of land redistribution, laws (such as voting requirements), coupled
the Mhele also redistributed fishery rights. with other such factors (such as the increase
The Mhele process allowed for the in the number of non-Hawaiians in the Islands)
acquisition of private title to lands and would contribute to diminishing political
resources; although access and resource use participation among Native Hawaiians.
rights for Native Hawaiians were preserved in By the middle of the nineteenth century,
the laws surrounding the Mhele, these rights members of the Hawaiian government also
would be eroded by the practices of private began to consciously integrate Euro-American
landowners, through court cases and the secular legal frameworks within the Kingdoms
enforcement of laws in the judicial systems, governance structures (Osorio, 2002, p.
as well as in the transition of governance from 13). A Declaration of Rights was adopted by
the Kingdom of Hawaii to the Republic of Kamehameha III on June 7, 1839; it recognized
Hawaii, the Territory of Hawaii and the State a division and protection of rights between the
of Hawaii. In later years, particularly with the M (King) as sovereign, the chiefs, and the
erosion of many of the safeguards that were common people (McGregor, 2007).
in place within traditional Hawaiian society, The first Constitution of the Kingdom was
Native Hawaiians would increasingly lose adopted by Kamehameha III in 1840. The
14 Knehlani Transforming the Health of Native Hawaiian Men
creation and adoption of the Constitution United States, the Provisional Government
represented a voluntary shift from the formed the Republic of Hawaii in 1894
traditional alii system of governance towards (Coffman, 2009). Native Hawaiians would resist
a constitutional monarchy. The Constitution the Provisional Government and annexation
codified existing governmental structure by the United States during the mid-and
and practice, recognizing partially separated late 1890s through forming of political hui
executive, legislative and judicial branches, (groups), collecting Native petitions and
establishing a Supreme Court and a bicameral testimonies, and trying to encourage political
legislative body (Kingdom of Hawaii, 1840). advocacy among Native Hawaiians in Hawaii,
The Legislative Session of 1851 marked a the United States, and internationally. Despite
definitive shift in the governance structures the illegality of the overthrow, the lack of
of the Kingdom (Osorio, 1999). In particular, support for annexation from the majority of
non-Hawaiians were able to gain control of the Kingdoms population, and the presence
the authority of the House of Representatives of strong resistance movements, Hawaii was
in 1851, and although they remained annexed through a joint resolution of the U.S.
outnumbered by native representatives in Congress in 1898, during the administration
1851, their influence altered the form and of President William McKinley. By 1900, Hawaii
purpose of the legislature. It introduced new would become a U.S. territory without the
elements of governance to the Kingdom customary approval by a two-thirds majority
structure and drastically shifted the purpose of Congress (Coffman, 2009).
and form of Kingdom politics. For one thing,
the Constitution severely limited the authority Social Transformations
of the King and his ability to fulfill his traditional Many historians point to the breaking of
role as an alii. the 1819 ai kapu (eating restrictions) and the
In the transition of Hawaiian governance subsequent ai noa (free eating) by Liholiho,
to a constitutional monarchy during the Kepolani, and Kaahumanu m (Kaahumanu
nineteenth century, men became the primary and her supporters) as a seminal event in
political actors; although alii women had Hawaiian history that would greatly impact
served as kuhina nui (prime minister) and had the practice of the formal state religion.
been part of early House of nobles, they later However, despite the revolutionary nature of
would be excluded from political proceedings. the event, many Native Hawaiian makainana,
Additionally, only men were franchised under particularly in rural areas, maintained and
the constitutions. Over time, men who could perpetuated their practices and beliefs
not prove they owned land paid taxes, or (McGregor, 2007, p. 9).
were illiterate, were also excluded from voting Besides changing the demography of
(Lydecker, 1918). Hawaii, the influx of non-Hawaiians would
Agitation from sugar and commercial instigate a flood of ideas, beliefs, and practices
interests in the Kingdom, as well as those that would not only impact the traditional
with American nationalist proclivities, led practice of Native Hawaiian culture and
to increasing tensions within the Kingdom. history, but would also alter their value within
Eventually, this resulted in the 1887 Bayonet the Islands. The settlement of foreigners
Constitution, which would effectively strip in Hawaii began in the late 1700s; the
King Kalkaua of most of his executive powers escalation of travel and the establishment of
(Silva, 2004). In an effort to restore these regular trade routes within the Pacific Ocean
powers to the monarchy, Queen Liliuokalani led to the formation of small populations
attempted to promulgate a new constitution in of foreigners and beachcombers within the
January 1893, but was illegally overthrown in a Hawaiian Islands by the opening decades of
coup led by a group that included individuals the 1800s (Kamakau, 1992). This period also
heavily associated with American commercial marked the beginning of an extended period of
interests in the Islands. Stevens granted the Native Hawaiian diaspora, in which significant
so-called Provisional Government a measure portions of the Native Hawaiian population
of official U.S. recognition as the legitimate would move abroad (Chappell, 1997).
government of Hawaii (Silva, 2004). Following The growth of populations of foreign
a failed attempt to secure annexation by the nationals corresponded to the growing
Knehlani Transforming the Health of Native Hawaiian Men 15
Abuse/Neglect Education
Countless national and international There are many long-term health effects
studies confirm that sustained childhood of education that reach into adulthood,
experiences of abuse or neglect also including improved cognitive development,
have long-term consequences for mental improved social-emotional development, and
and physical health, as well as for social general health knowledge. Improved cognitive
adjustment, academic achievements, and development is associated with greater
subsequent employment histories. Adults academic achievement, which translates
with a history of childhood abuse have been into better employment opportunities and
found to suffer from significantly more health higher earning potential. Improved social-
conditions, and mental health effects include emotional development is associated with
depressive disorders, anxiety disorders, drug decreased propensity for risk-taking, stress,
abuse, and suicidal behavior (Moore, McDonald absenteeism from school, and self-regulation.
& McHugh-Dillon, 2015; Cashmore & Shakel, General health knowledge informs students
2013; McLeod et al., 2014; Macmillan, 2009; of health promoting and risky behaviors.
Norman et al., 2012; Reeve & van Gool, 2013; High educational attainment predisposes
Zielinski, 2009). the recipient to a higher health trajectory.
Limited research points to links between These individuals report lower chronic and
boys experience of abuse or neglect in child- acute disease burden, independent of basic
hood and increased rates of substance abuse, demographic and employment indicators
sexual transmitted diseases, and perpetration (Office of Hawaiian Affairs, 2015).
of domestic violence in adulthood. Far more
studies focused on the effects of child abuse School Enrollment in Kindergarten through
and neglect in women, making it difficult to Twelfth Grade
compare differences between men and women Historically, the State of Hawaii has one
as less is known on the effects of child abuse of the highest percent of students enrolled in
and neglect on men (Springer, 2007). private schools nationwide. Factors which may
Although Native Hawaiian keiki kne (boys) influence a students school enrollment may
experience increased protective factors due include family income, parent educational
to cultural values and traditional practices, attainment, race, ethnicity, religious affiliation,
Abuse/Neglect current social, economic, and political condi- and Hawaii State Department of Education
How can your tions (such as financial insecurity and unem- (DOE) School Quality rating. The long-term
organization address ployment) create disproportionately high levels impact of private education in comparison to
the need to reduce of child abuse and neglect within Native Hawaiian DOE education has not been determined.
the incidence and households (Kamehameha Schools, 2014).
prevalence of In 2015, Native Hawaiians constituted
childhood abuse and In 2014, 31% of all children in Hawaii 26.1% of male students in the DOE
neglect? were Native Hawaiian, yet Native system, including charter schools (24,659
Hawaiian keiki constituted 42.6% of all of 94,590 male students) (DOE, 2015).
confirmed victims of abuse and neglect Of these Native Hawaiian male
in Hawaii (State of Hawaii, Dept. of students, 70.2% were classified as
Human Services, 2014), a dramatic economically disadvantaged, as
over-representation (U.S. Census indicated through their eligibility
Bureau, 2014a). for the federal free/reduced lunch
Notably, though, confirmed cases of program (DOE, 2015).
Native Hawaiian child abuse and neglect Although not directly comparable
have decreased from 1,456 cases in with the information from 2015, data
2000 to 600 in 2014 (State of Hawaii, from the 2010 U.S. Census indicated
Dept. of Human Services, 2014). that 14.8% of Native Hawaiian male
Although data are not available specific students in kindergarten thorough
to Native Hawaiian boys, in the total twelfth grade were enrolled in private
State population boys constituted 46.8% school and 85.2% were enrolled in DOE
of confirmed victims (State of Hawaii, schools (calculated from U.S. Census
Dept. of Human Services, 2014). Bureau, 2010b).
10% 8% 6% 4% 2% 0% 0% 2% 4% 6% 8% 10%
100%
0%
Male Female Male Female Male Female
Native Hawaiian Non-Hawaiian All Students
In comparison,
Notes. Calculated from (DOE,18.1%
2015).of non-Hawaiian the new system reports results within four
male students in Hawaii were enrolled categories, including Exceeded Standard,
in private schools, and 81.9% were Met Standard, Nearly Met Standard, and
enrolled in DOE schools. Across the Did Not Meet Standard. As in any evaluation
nation, 10.3% of male students were based on standardized achievement tests,
enrolled in private schools, and 89.7% this discussion must consider the inherent
in DOE schools (calculated from U.S. limitations of this form of assessment. Many
Census Bureau, 2010). education scholars suggest that standardized
Math Proficiency by Gender and Native Hawaiian Status, SY2015
assessment methods are culturally bias and Standardized
Kamehameha Schools is thelargest Native Non-Proficient
Proficient skew results by actually measuring test-taking Educational
Hawaiian-serving private school in the State. skills rather than educational achievement. Achievement
100% Within a comparable time period, an annual The following data on Native Hawaiian student Tests
average of 5,369 Native Hawaiian students test results is presented within the larger How can your
were enrolled at Kamehameha Schools context of these debates. organization impact
campuses (calculated from Kamehameha kne youth within
Schools, 2011). If 50%
73.70 70.60of these students
56.10 52.10
Reading 60.80 57.10 Hawaiis educational
are assumed male, these averages equate In 2015, 27.5% of all Native Hawaiian system?
with 7.5% of Native Hawaiian male students male students tested were proficient
statewide and 50.9% of Native Hawaiian male in reading.
private school students. A higher percent of Native Hawaiian
50%
female students tested proficient
Standardized Educational Achievement Tests in reading than Native Hawaiian
In school year 2014 2015 the Hawaii male students, by 13.8 percentage
State DOE fully implemented a new standard- points.
ized achievement test system: The Smarter A higher percent of non-Hawaiian
26.30 29.40
Balanced Assessments. This system was 43.90 47.90 39.20 tested proficient
male students 42.90 in
designed to align the new Hawaii Common reading than Native Hawaiian male
Core Standards and measure whether students, by 19.7 percentage points.
0% students are on track for college and career (DOE, 2015)
Male Female
readiness. These tests are administered Male Female
Math Male Female
in grades three through eight and 11. Like In 2015, 26.3% of all Native Hawaiian
Native Hawaiian
previous standardized tests used in the Non-Hawaiian
DOE, All Students
male students tested were proficient
0%
0% Male Female Male Female Male Female
Male Female Male Female Male Female
Native Hawaiian Non-Hawaiian All Students
Native Hawaiian Non-Hawaiian All Students
Notes. Calculated from (DOE, 2015).
in math. (DOE, 2015).
Notes. Calculated from
A higher (DOE, of
percent 2015).
Native Hawaiian
female students tested proficient Science (The Hawaii State
in math than Native Hawaiian male Assessments are still used for science
students, by 3.1 percentage points. and are administered in grades 4 and 8)
A higher percent of non-Hawaiian In 2015, 34.2% of all Native Hawaiian
male students tested proficient in male students tested were proficient
Science Proficiency, by Gender
math than Native andmale
Hawaiian Native Hawaiian Status, SY2015
in science.
Science Proficiency, by Gender and Native
students, by 17.6 percentage points. Hawaiian Status,
A higher SY2015
percent of Native Hawaiian
Proficient Non-Proficient
Proficient Non-Proficient
100%
100%
Enrollment of Male Students, by School Type and Native Hawaiian Status, SY2015
Charter: Hawaiian-Focused Charter: Other DOE
100%
Enrollment of Male
Students, by School
Type and Native
Hawaiian Status,
50%
SY2015
Notes. Calculated from
(DOE, 2015).
Notes. Calculated
malefrom (DOE, 2015).
students tested proficient in
science than Native Hawaiian female Data on graduation rates are reported
male students, by 1.6 percentage by ethnicity or gender, not as a
points. combination. In 2014, Native Hawaiian
A higher percent of non-Hawaiian students in the Hawaii State DOE had a
male students tested proficient in graduation rate of 77.8%, in comparison
science than Native Hawaiian male to the total student rate of 82.1%. In
Population of Hawaii with a Bachelor's Degree or2014,
students, by 18.7 percentage points. male students in the Hawaii
Higher,
(DOE, 2015) State DOE had a graduation rate of
by Gender and Native Hawaiian Status, 2005-2014 79.1%, in comparison to the female
student rate of 85.2% (DOE, 2016).
Graduation from High Total Male Population
School Native Hawaiian Male considering
When Native Hawaiian Female
the total population
35% According to research from the U.S. of Hawaii of 25 years or older,
Centers for Disease Control, education is one however, an equal portion of Native
of the strongest predictors of health. There Hawaiian men have attained a high 30.0%
28.3%
30%are numerous ways completing a high school school diploma or higher. In 2014,
education can impact health outcomes. First, 92.9% of Native Hawaiian men had
it has a direct correlation of levels of future attained this level of education. This
25%income, as high school completion is also the rate is comparable to 92.2% of Native
gateway into college, which offers even greater Hawaiian women and 92.5% of the total
benefits than high school alone. Second, male 18.2%
population18.4%
(U.S. Census Bureau,
18.9% 17.8%
20%
high school education facilitates healthier
16.6% 2014a).
behavior
14.3% choices by 15.0% 15.6% access
offering learners 15.3% 16.0%
These results may suggest that Native
15%to health information and tools to acquire help Hawaiian male students are not
and resources, such as smoking cessation completing high school on time, 15.4%but15.0%
do
14.3%
14.6%
programs. Third, people are able to acquire
13.3% eventually gain their diploma
12.8% by age 25.
12.0% strengthen social networks, 12.5% 11.8%
10%social support,
and mitigate social stressors; simply 10.4% put, Connection to Native Hawaiian Epistemology
the more education people have, the more and Traditional Practices
5%social support they have. Finally, education Although by several measures of academic
helps2005
people to 2006
gain a 2007
sense of 2008 2009 achievement,
control over 2010 2011 2012
Native Hawaiian 2013 2014
male students
their lives, an outcome associated with better appear to be lagging behind their peers in
Notes. Adapted
health from (U.S.and
(Freudenberg Census Bureau,
Ruglis, 2007). 2014a) the Hawaii DOE system, alternative systems
24 Knehlani Transforming the Health of Native Hawaiian Men
provide educational opportunities which may offenses on the Crime Index (murder
address these disparities. Many Hawaiian- and non-negligent homicide, forcible
focus charter schools offer cultural-based rape, robbery, aggravated assault,
education, which can be defined as a holistic burglary, motor vehicle theft, larceny-
and comprehensive application of culturally theft, and arson). The majority of the
relevant education and referred to education arrests were for crimes related to
approaches that are ground in a particular larceny-thefts.
cultural worldview (Kanaiaupuni, 2010)in Between 2000 and 2014, however, there
this case, a Native Hawaiian worldview. was a 61% decrease of Native Hawaiian
Recent studies found that the use of cul- juveniles arrested for Part I offenses.
ture-based education strategies by teachers In 2014, 1,750 Native Hawaiian juveniles
and school systems is linked with education were arrested for Part II offenses,
outcomes of Native Hawaiian students. First, which represented 30% of total arrests.
strategies positively impact student socio- Crimes related to runaways accounted
emotional well-being, which are directly related for the highest number of these arrests
to current health outcomes, including identity, (34%).
self-efficacy, social relationships. Second, From 2003 - 2012, Native Hawaiian
enhanced socio-emotional well-being, in youth accounted for:
turn, positively affects math and reading test The highest number of individual
scores, which is a predictor of future health juvenile arrests (26,788 or 34% of all
outcome. juvenile arrests).
The highest number of total juvenile
8.5% of all Native Hawaiian male arrests (60,685 or 37% of 161,901
students (or one out of every 12 total juvenile arrests).
students) is enrolled in a charter The highest number of juveniles
school, in comparison to 4.2% of non- confined to the Hawaii Youth
Hawaiian male students. Correctional Facility (802 or 55% of
6.1% all Native Hawaiian male 1,470 total juveniles).
students are enrolled in a Hawaiian- (Hawaii State Department of the Attorney
focused charter school, over twice General, 2003 2014)
Juvenile Crime the percentage of non-Hawaiian male
In what ways can students (3.4%). Mkua
your organization The vast majority of Native Hawaiian Aging can also be viewed as two phases,
combat the male students, however, are enrolled adulthood and elderhood. Mkua (adults)
prevalence and in a mainstream DOE school (91.5%). and kpuna (older adults) are also vulnerable
incidence of keiki (DOE, 2015) to stressors and social conditionsin their
kne involvement in case, though, the concern becomes how the
the criminal justice Juvenile Crime accumulation of these circumstances over time
system? Juvenile crime can be seen as both an lead to chronic diseases, which then have to
outcome of early childhood social determinates be managed. Some stressors common among
of health, and a factor contributing to adult mkua include working long or irregular hours,
barriers to well-being. Recent research dealing with daily parental responsibilities, or
demonstrates the over-representation of caring for older family members. Long-term
Native Hawaiians in the criminal justice systems exposure to these stressors can put mkua
(Umemoto et al., 2012). These disparities are at higher risk for injuries, digestive problems,
reportedly the effect of the social, political, hypertension, obesity, or heart disease.
and economic conditions which increase the The social determinants of health impact
prevalence of antisocial and criminal behavior individuals in similar ways, but manifest
among Native Hawaiian youth, as well as the themselves differently at each stage of life.
results of institutional bias.
Post-secondary Education
In 2014, 391 Native Hawaiian One of the most significant factors in the
juvenilesrepresenting 31% of total future of a young adult is their level of educational
arrestswere arrested for Part I attainment. Research has shown that there are
Notes. Calculated from (DOE, 2015).
0.13 22 to 24 0.42
Notes. Adapted from (U.S. Census Bureau, 2014a)
0.05 20 and 0.39
0.21 16 to 19 0.76
1.00% 0.80% 0.60% 0.40% 0.20% 0.00% 0.00% 0.20% 0.40% 0.60% 0.80% 1.00%
Median Individual Earnings in Hawaii, by Gender and Hawaiian Status, 2005 - 2014
26 Knehlani Transforming the Health of Native Hawaiian Men
Median Individual Earnings in Hawaii, by Gender and Hawaiian Status, 2005 - 2014
Hawaii State: Native Hawaiian: Hawaii State: Native Hawaiian:
Male Male Female Female
$50K $48,440
$46,786
$45,577 $45,911 $45,443 $45,748
$45,494
$44,802
$45K
$41,821 $41,821 $41,811
$41,238 $44,194
$43,740 $42,826
$38,870 $42,832
$41,706
Median Individual $40K $40,618 $40,259 $38,040 $40,370 $40,162
$37,242
$36,242
Earnings in Hawaii, $35,471
by Gender and $33,780 $36,709 $35,977 $36,707
$35K $32,305
Hawaiian Status, $35,596 $35,725
$25K
$20K
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Notes. AdaptedStability
Economic from (U.S. Census Bureau, 2014a) Earnings
Because of its high cost of living, Hawaii poses
a great economic challenge for not only Native In 2014, the average annual earnings
Hawaiians, but all residents. With the nations of Native Hawaiian men was $41,811;
highest food and electricity costs, householders this figure is 89.4% of the average of all
must make difficult choices to select which men statewide ($46,786).
bills get paid every month. Parents working long From 2005 to 2014, Native Hawaiian
hours may be too exhausted from working a long male average annual earnings
Economic Male shift toOccupational
cook nutritiousRepresentation
meals, and instead in relyHawaii, by NativebyHawaiian
increased 2.9%, whileStatus,
the earnings of
Stability 2006 on cheap,-2010 high-calorie
as percentfood. of
Individuals
all menwithout
in occupationallinmen statewide increased 13.5% and
Hawaii)
In terms of economic health insurance cannot receive preventive the earnings of Native Hawaiian women
shifts over time, services or seek care when they fall ill. The closest Native Hawaiianincrease
Non18.3%. (U.S. Census Bureau,
Hawaiian
how can the State primary care physician may be an hour away by 2014a)
address the report bus, making the visit costly and time-consuming.
Material moving 33.43 66.57
findings that are Families unable to pay monthly mortgages or rent Occupation
linked to kne Laware enforcement
left to moveworkers
in withincluding supervisors 31.08 68.92
other family members or
health?
refighting and prevention and seek other
other protective shelter,
service creating
workers crowded
including living spaces.
supervisors 27.44 In the most72.56 recent data, from 2006
With barely enough financial resources for daily through 2010, Native Hawaiian men
Construction and extraction 27.22 72.82
living expenses, planning for the future becomes comprised 17.6% of the total male
nearly impossible,Transportation
leaving peopleoccupations 27.1
with the ability 72.9 but were over-represented
populations
to only respond to urgent
Farming, fishing,needs. Research
and forestry 22.61 in moving materials (33.4%), law
77.39
findings on unemployment rates, earning levels, enforcement (31.1%), firefighters
occupation, commuting Personal care
times, and service
poverty 20.86
rates, and (27.4), 79.13
construction and extraction
homelessness
Building and grounds indicate thatand
cleaning Native Hawaiian men
maintenance 20 (27.2%),80and transportation (27.1%)
are disparately affected by economic factors. occupations.
Community and social service 19.73 80.27
During this same time period,
Unemployment Production 18.95 Native 81.05
Hawaiian men had the lowest
In the most recent data, from 2006
Installation, maintenance, and repair through18.42 representation
81.58 in legal (5.5%), life/
2010, 3.8% of Native Hawaiian men were physical/ social service (6.8%),
unemployed, Office and administrative
compared with 2.1% ofsupport
all men 17.35
in health 82.65
technologists and technicians
Hawaii (U.S. Census Bureau, 2010c).
Healthcare support 16.57 (7.4%),83.43
health diagnosis and treating
practitioners (7.7%), and business and
Food preparation and serving related 14.72 85.28
Firefighting and prevention and other protective service workers including supervisors 27.44 72.56
Health diagnosis and treating practitioners and other technical 7.67 92.33
0 20 40 60 80 100
35%
30.10
30% 29.30 28.50
28.20 27.30
26.70
Average Travel Time
to Work in minutes, 25%
by Gender and Native
Hawaiian Status,
20%
2014
Notes. Adapted from (U.S.
Census Bureau, 2014b) 15%
10%
5%
0%
Native Hawaiian Non-Hawaiian Total
16000
4000
0
2001 2012 2013 2014 2015
35% 32.6
30 Knehlani Transforming the Health of Native Hawaiian Men
29.1
30%
Risk Behaviors by Race-Ethnicity in25.8
Hawaii Binge Drinking: 2013 26.6
24.8
25%
40%
20%
35% 32.6
15% 29.1 12.1
Risk Behaviors by 30%
25.8 26.6
Race-Ethnicity in 10% 24.8
Hawaii Binge 25%
Drinking: 2015 5%
Source. HHDW. 2016a 20%
0%
15% Native Hawaiian Caucasian Filipino Chinese
12.1 Japanese State of Hawaii
10%
Notes. Adapted from (Yuan, 2014)
5%
0%
Native Hawaiian Caucasian Filipino Chinese Japanese State of Hawaii
classification and 80% prison population, by custody classification and sex, 2012
state
sex, 2012 70%
Source. Ka Huakai: Native Native Hawaiian Non-Hawaiian
Hawaiian Educational
60%
100%
Assessment. 2012.
50%
90%
64.4 65.5 63.2 54.2 61.9 58.7 64.8 37.5 65.4 57.1 55.5 60.0 63.0 60.0
40%
80%
35.6 34.5 36.8 45.8 38.1 41.3 35.2 62.5 34.6 42.9 44.5 40.0 37.0 40.0
30%
70%
20%
60%
10%
50%
0%
40%
Male Female Male Female Male Female Male Female Male Female Male Female Male Female
35.6 34.5 36.8 45.8 38.1 41.3 35.2 62.5 34.6 42.9 44.5 40.0 37.0 40.0
30%
Community Minimum Medium Close Maximum Unclassified Total
20%The five custody levels shown are defined by the Hawaii Department of Public Safety (2012) as follows:
Note.
Notes. Adapted
Community: for inmatesfrom (Yuan,
who have 24 months2014)
or less to serve on their sentence and are eligible to participate [in] furlough programs, extended furlough, or residential
transitional living facilities. Minimum: for inmates with less than 48 months until their parole eligibility date; who have demonstrated through institutional conduct
10%
that they can function with minimal supervision in a correctional setting, or in the community under direct supervision. Medium: for inmates who have more than 48
months to their parole eligibility date; whose institutional conduct and adjustment require frequent supervision/intervention. Close: for those who have minimum
sentences of 21 years or more, who are serious escape risks or have chronic behavioral/management problems. Maximum: inmates who are chronically disruptive,
violent, predatory or are a threat to the safe operation of a facility.
0%
Native Hawaiians are over-represented in the Hawaii prison population. In 2012, Native Hawaiians constituted 17.7% of the total adult population in Hawaii,
Male Female Male Female Male Female Male Female Male Female Male Female Male Female
while in the male prison population Native Hawaiians accounted for 37.0% and in the female prison population 40.0%.
Even within more secure custody levels of close of maximum, Native Hawaiian men account for a lower percent of the population than Native Hawaiian women.
Community
These findings Minimum
are consistent with Medium
those of the 2006 Disparate Close
Treatment of Native Hawaiians inMaximum
the Criminal JusticeUnclassified Totalthat
System report, which concluded
while both Native Hawaiian men and women are disproportionately represented in the criminal justice system, the disparity was less for women. In these data,
44% of incarcerated women were Native Hawaiian, while 37% of incarcerated men were Native Hawaiian.
Notes. Adapted from (Yuan, 2014)
Knehlani Transforming the Health of Native Hawaiian Men 31
Hypertension
Compared to the rates from the State of Hawaii, kne had slightly higher rates of hypertension in
2011 and 2013. However, because the confidence intervals do overlap, it is difficult to ascertain
with absolute certainty that the kne rate for hypertension.
High Cholesterol
Compared to the rates from the State of Hawaii, kne had slightly lower rates of high cholesterol
for 2011 and 2013. The difference is marginal, and once again, the confidence intervals overlap.
Diabetes & Pre-Diabetes
2011 & 2013 Combined Data
Health Indicator Gender Race/Ethnicity Percent Lower CI (95%) Upper CI (95%)
Male Native Hawaiian 36.1% 30.5% 41.6%
High Cholesterol
Male State of Hawaii 37.7% 35.8% 39.6%
Both kne and whine diabetes and pre-diabetes rates are relatively comparable to one another
for both categories, for the aggregated years 2011 through 2014.
Heart Attack
2011-2014
Health Indicator Gender Race/Ethnicity Percent Lower CI (95%) Upper CI (95%)
Male Native Hawaiian 10.6% 8.3% 12.8%
Diabetes
Female Native Hawaiian 11.2% 9.4% 12.9%
2011-2014
Health Indicator Gender Race/Ethnicity Percent Lower CI (95%) Upper CI (95%)
Male Native Hawaiian 11.9% 9.7% 14.0%
Pre-Diabetes
Female Native Hawaiian 11.7% 9.8% 13.6%
Data from the aggregated years 2011-2014, show that kne are only slightly more likely to have
ever had a heart attack compared to whine. Differences may not be notable or significant, given
that the confidence intervals overlap.
Stroke
2011-2014
Health Indicator Gender Race/Ethnicity Percent Lower CI (95%) Upper CI (95%)
Data from the aggregated years 2011-2014, show that whine are only slightly more likely to
have ever had a stroke compared to kne. Differences may not be notable or significant, given
that the confidence intervals overlap.
Cancer
2011-2014
Health Indicator Gender Race/Ethnicity Percent Lower CI (95%) Upper CI (95%)
Although data exists for both incidenceany diagnosis of contracting cancerand for
mortalitya scenario where cancer leads to death, the data for cancer specific to kne are
available for the State of Hawaii, but have not been updated in nearly a decade.
The kne incidence rate becomes particularly troubling when the mortality rate for kne
Knehlani Transforming the Health of Native Hawaiian Men 35
Incidence
Race-Ethnicity Male Female
Incidence Count Incidence Rate Incidence Count Incidence Rate
Native Hawaiian 369 479.6 441 447.8
White 980 542.4 767 413.6
Table 7.122a Average
Chinese 186 423.5 166 317.3 Annual Incidence &
Filipino 403 466.8 336 341.4 Mortality Counts &
Japanese 842 476.3 776 363.9 Rates for All Cancer
Sites by Gender and
Total, All Races 2,967 485.7 2,684 382.2
Race-Ethnicity
Source: Hawaii State,
Mortality University of Hawaii,
Cancer Research Center
Race-Ethnicity Male Female of Hawaii , Hawaii Tumor
Mortality Count Mortality Rate Mortality Count Mortality Rate Registry, Hawaii Cancer
Facts & Figures 2010.
Native Hawaiian 173 231.7 162 171
White 336 198.2 252 133.6
Chinese 68 154.4 61 107.2
Filipino 158 178.7 95 98.3
Japanese 337 187.1 273 109.9
Total, All Races 1,158 192 912 124.7
Note: Invasive cases only, in-situ cases are excluded. Counts are 6 year average annual, rounded to the nearest whole.
All races include race/ethnic groups listed plus all other race/ethnic groups combined.
Rates are average annual and are per 100,000 population, age-adjusted to the 2000 U.S. standard population.
is also considered. Taken together, we get a clearer picture. For whatever reason, kne are
contracting cancer at the second highest rate, but dying from it with the highest mortality rate
of all groups broken down by race and sex (in 2010).
Perhaps shedding a little light on why incidence and mortality rates may be so high is one
statistic on prostate cancer. Compared to all other ethnic groups, kne have the lowest rate of
early stage prostate cancer, and the highest rate of late stage prostate cancer. One potential
reason for explaining this outcome lies in detection. If detection happens later for kne, then
cancer is likely more advanced. Admittedly, drawing broad conclusions on one outcome must be
done with caution. Nevertheless, this trend is particularly instructive. If this trend were reversed,
it could potentially lead to parity with other ethnicities regarding early, late, and un-staged
cancer rates. Understanding why kne are not as participatory in detection will be an important
component to determining and strategizing potential solutions.
Data from the aggregated years 2011-2014, show that whine are more likely to have ever
had cancer compared to kne. This is keeping with the general trend of men having lower
rates of ever having cancer compared to women, throughout the State of Hawaii overall.
The five leading cancer sites for mortality for kne from the most recently recorded years
of 2000-2005: Lung and Bronchus (31.3%), Colon and Rectum (10.1%), Prostate (6.1%),
Pancreas (5.6%), and Liver (5.3%).
36 Knehlani Transforming the Health of Native Hawaiian Men
Better policies
Basic public health research methodologies and indigenous ways of knowing should be
incorporated into State policy planning.
Policies that address children and adolescents should be improved to go upstream, to
consider causal and associated risk factors.
HRS 226-20 should be implemented in specific policies. The Hawaii State Planning Act
was amended to codify a commitment to addressing the health disparities and social
determinants of health (SDH) of Native Hawaiians, other Pacific islanders, and Filipinos.
Better programs
Public-private partnerships can be created, which convene to outline a master plan for
the well-being of kne. This plan will focus on reducing kne inequities through policies,
programs, and practice for the State of Hawaii.
Expand ohana-based programming that looks at prevention and interventions through a
family-based model, especially to address multigenerational patterns of SDH disparities.
Better collaboration
We can showcase how collaborations between OHA and Aha Kne show laulima and
collective effort to uplift the community needs. This report is an example of how a
collective effort can make important progress.
State agencies can improve data sharing and data disaggregation for advanced analysis,
to make data-informed decisions and deployment of resources.
Better practice
A statewide study could produce a complete, statewide data set (which included
information on cultural practices and values, etc.), which then would enable researchers to
start making correlations between various SDH. This study could include data collection by
age group and gender, as this report is outlined, and could be conducted cross-agency (for
example, by: OHA, DOH, DOE, DHS, DPS, UH, and DBEDT).
This report is somewhat unique as it begins to paint a more complete picture of the Native
Hawaiian male experience in Hawaii. If we were able to include indicators of cultural connection,
this picture would become even clearer. This report might be able to lend some insight into how
and why kne health needs more holistic interventions, departing from a more traditional, siloed
approach of education, early detection, and treatment. In fact, it goes back to the fact that we
need to support the whole person and positive experience throughout his entire life.
Knehlani Transforming the Health of Native Hawaiian Men 39
After reading this report, what ecological factor is the most important to
address about kne well-being?
How does having healthy kne positively affect the entire State?
How can your organization address kne well-being for kne of all ages?
In what ways can you work with outside organizations on Native Hawaiian
mens health?
In what ways can this report be used by your organization to achieve greater
health outcomes for Native Hawaiian males?
Who or what organizations need to be part of your planning for next steps
towards greater kne health?
What should be the next steps for the current administration to develop and
implement a shared outcomes framework for ohana-centered wellness?
40 Knehlani Transforming the Health of Native Hawaiian Men
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Knehlani Transforming the Health of Native Hawaiian Men 45
Acknowledgements
About this report
Knehlani Transforming the Health of Native Hawaiian Men is the first in a series of
reports by the Office of Hawaiian Affairs on the health of Native Hawaiians. According to scholar
Dr. Pua Kanahele, Knehlani literally means, The fire that ignites the sky, and is the name
of Peles father. In the context of this report, h is transformative energy, the heat that is
necessary to generate life on earth (water systems, food systems etc); lani is symbolic of the
ideal state of health; and Kne represents the connection of akua to kanaka.
Contributors
Part One: Historical Strengths is adopted from Mana K Kne: Native Hawaiian Mens
Wellbeing, a report written by Aha Kne, a non-profit organization whose mission is to
strengthen the Native Hawaiian community through nurturing and perpetuating the
traditional male roles and responsibilities that contribute to the physical, mental, spiritual, and
social well-being of Native Hawaiian males, their families, and communities.