Accurate representation of Native Hawaiians and Pacific Islanders (NHPI) is sorely needed in the health care system, especially as the long-term impacts of the COVID pandemic continue to arise, according to Native Hawaiian oncologist Kekoa Taparra, MD, PhD.
Paka Ola Lokahi, a non-profit focused on improving Native Hawaiian health, recently hosted a webinar where Taparra spoke on the historical context that has led to present-day health disparities in Pacific Islander communities, and ways to address the disparities going forward.
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Prior to contact with Western societies, Pacific Islander communities had a wide variety of health practices in place, including a focus on connecting with nature and a holistic medicine framework. Eventual contact with Western society brought diseases such as gonorrhea, syphilis, and tuberculosis that decimated the population. By 1900, Taparra said over 95% of the Native Hawaiian population had been wiped out, leading to a genetic bottleneck that continues to influence present-day health issues.
Colonization and war across the Pacific not only led to racial discrimination and loss of land and culture for Pacific Islanders, Taparra said, but directly impacted their health as well.
“The physical consequences of radioiodine fallout that occurred from nuclear bomb testing is associated with increased risks of certain cancers,” he said. “This also leads to generations of people who are very adverse to radiation [treatment] … because of perceptions of radiation as only things that can be harmful. As a physician, it can be very hard to talk people down from that.”
Aside from an increased risk of certain cancers, Taparra noted Pacific Islanders also have higher rates of obesity, infant mortality, and shorter lifespans.
These disparities are notable in relation to COVID as well. Citing a March 2021 study from the UCLA Center for Health Policy of Research, 18 of 20 reporting states identified Native Hawaiians and Pacific islanders as the ethnic group with the highest per capita death rate.
However, Taparra said little attention is being paid to this issue, due to the tendency for data to lump NHPI with Asians, which can mask the disparity.
“When we don’t have representation in clinical trials, it really calls into question whether or not the data applies to the patients that we are trying to treat,” he said.
In terms of what health leaders can do to address these disparities, Taparra recommends more culturally-aware trials that disaggregate NHPI data as its own unique group. He also advocated for more NHPI representation in the health workforce, specifically by strengthening federal funding or scholarship programs for those looking to enter the workforce.
Taparra also noted the ongoing shift in the Native Hawaiian diaspora across the US. He said the 2020 Census marked the first time more Native Hawaiians indicated they are living on the mainland than in Hawaii, due to the rising cost of living and stalemate wages. To support those living on the continent, Taparra encouraged local support groups to consider how they might reallocate their resources to better reach those living on the mainland.