Adversity and resiliency in the lives of Native Hawaiian elders.(Report)

The Hawaiian stands firmly in the present, with his back to the future and his eyes fixed upon the past, seeking historical answers to present-day dilemmas. Such an orientation is to the Hawaiian an eminently practical one, for the future is always unknown whereas the past is rich in glory and knowledge. (Kame'eleihiwa, 1986, pp. 28-29).

Regardless of their racial or ethnic origins or the state in which they live, disenfranchised and oppressed cultural populations across the United States have alarmingly similar social, health, and economic profiles. People indigenous to the lands that currently constitute the United States--Native Hawaiians, American Indians, and Alaska Natives--share a history of forced incorporation into the dominion and the trauma of colonized peoples. This history has contributed to shorter life expectancies and higher prevalence of a number of chronic diseases--diabetes, heart disease, and cancer--when comparing indigenous groups with majority populations in the United States (U.S. Department of Health and Human Services, 2000).

Native Hawaiians constituted less than 1 percent of the total U.S. population, about 401, 162 people, in 2000; approximately 60 percent resided in the state of Hawai'i. Of Native Hawaiians age 60 and older, about 20,994 live in Hawai'i, and 10,951 live in other U.S. states (U.S. Census Bureau, 2007). Nationally, Native Hawaiians as a group have higher mortality rates for cardiovascular disease and cancer than most other ethnic groups in the United States, and they rank second in prevalence of obesity (Fong, Braun, & Tsark, 2003). Rates for other social ills--substance abuse and child abuse--are highest among Native Hawaiians of all ethnic groups in Hawai'i (Mokuau, 2002). Specific to Native Hawaiian elders (na kapuna), data from Hawai'i suggest a number of serious social and health disparities--for example, poorer health, greater rates of disability, more problems with self-care, and an underutilization of services when compared with non-Hawaiian elders (Alu Like, 2005; Braun, Yang, Onaka, & Horiuchi, 1996; Mokuau, Browne, & Braun, 1998). About the same percentages (9 percent to 10 percent) of Native Hawaiian and U.S. elders live in poverty, but the per capita incomes for Native Hawaiians are significantly lower (Braun, Yee, Browne, & Mokuau, 2004). Scholars have offered a number of explanations: the historical impact of cultural trauma, poverty, inadequate access to health care (especially culturally responsive care), institutional and internalized racism, discrimination, and poor health practices (Mokuau, in press; Tsark, Blaisdell, & Aluli, 1998). Data about na kapuna who reside in the continental United States are nearly nonexistent (Braun et al., 2004). But there is another side to the lives of na kapuna, one that speaks to a resilient culture with enduring cultural values and traditions that promote health and family care (Braun et al., 2004; Mokuau, in press).

Building on the life course literature and resiliency theories, we propose a model that provides a context from which to analyze and understand the serious social and health disparities found in na kapuna. A number of culturally based solutions have been developed and implemented to address some of these well-documented social and health concerns, with positive results (Mokuau, in press; Mokuau, Browne, Choy, & Braun, 2008). Nonetheless, and although some progress has been made, the attainment of good health and well-being for all Native Hawaiians and specifically na kapuna has yet to be achieved.

Gerontology research has identified the biological, psychological, social, and other changes that occur with aging. We add to this discussion and argue that improving the health and well-being of Native Hawaiian elders requires that social workers take into account those cultural and historical markers and resiliency factors (for example, cultural values and traditions) that ultimately shape health and life trajectories. We introduce ola pono na kapuna, which is a practice model that incorporates cultural and historical markers and resiliency factors to explain the present and future health and social profiles of na kapuna. In the Hawaiian language, ola is defined as life, health, and well-being and pono is defined as perfect order (Pukui & Elbert, 1981). Thus, ola pono na kapuna aims to promote the life, health, and well-being of Native Hawaiian elders. In line with Hawaiian cosmography (Mokuau, in press), we define health broadly to include social and health issues rather than a sole focus on the absence of disease. We end with a discussion about implications for the profession, including a description of Ha Kapuna, National Resource Center for Native Hawaiian Elders, whose goal is the improvement of health and well-being for na kapuna.

THEORETICAL PERSPECTIVES

Life Course Perspective