One Size Doesn’t Fit All Medicine

Are Native Hawaiian health issues properly addressed? The University of Hawaii medical school’s new Hawaiian Health Department aims to find out

January, 2003

The health statistics for Native Hawaiians are grim. According to medical research, the ethnic group is more prone to complications due to asthma, diabetes and heart disease. Native Hawaiians also are 60 percent more likely to die from cardiovascular diseases, 50 percent more likely to die from cancer and 50 percent more likely to die from diabetes, compared with the rest of the state. The 2000 U.S. Census reports that Native Hawaiians comprise 6.6 percent of Hawaii’s population and part-Hawaiians comprise 23 percent. They also lead the state in obesity, AIDS, alcoholism, the shortest life expectancy, the highest infant mortality and the highest teen pregnancy, among other health risks.

To address the health care needs of Native Hawaiians, the University of Hawaii John A. Burns School of Medicine in August 2002, established the Department of Hawaiian Health. It is the first academic department in the nation devoted to Native Hawaiians. Dr. Marjorie Mau is the chairwoman of the department. A part-Hawaiian, she is a Creighton University-trained endocrinologist, specializing in internal medicine, diabetes and metabolism. She has a master’s degree in epidemiology (the study of population) from Harvard University.

Why was this academic department of Hawaiian health established and for what purpose?
This department embodies Dean Edwin Cadman’s vision of the school better serving Native Hawaiians. We are responding to the health needs of this region, to understand the cultural factors, but also the biological health risks. We are unique and are beginning to understand our unique health issues. We are starting with Native Hawaiians, whose needs are so great. We hope to expand to other Pacific island populations, most notably Filipinos, and envision our department to be the center for Pacific health research and practice.

What are the department’s goals, and how are you funded?
Our mission is to be an academic center of excellence committed to optimal health and wellness of all Native Hawaiian people through research, education and health care practices.

We differ from other departments in that we will have a community advisory board. We were created with broad-based community support. This includes Papa Ola Lokahi, Native Hawaiian health care systems administrator, and each of the five island-based health care centers established by Congress; the community health centers (Kalihi Palama, Waikiki, Waianae Comprehensive, Hana, Molokai, etc.); and Queen’s Health Systems, both a partner in building capacity and a major funder, providing $1 million annually for five years. Our funding, a third of which comes from grants, includes federal, state and private funds. We received the medical school’s first grant to create an endowed chair for research.

What impact will this new department have on the community?
Although Hawaii has more doctors per capita than the national average, we just don’t have them in the right places. Among rural Native Hawaiian populations, there is a shortage of medical care professionals. Our Imi Hoola program provides an extra year of pre-med studies as an incentive for promising students in economically disadvantaged areas to enter medical school, with hopes of them returning to serve their communities.

We have ineffective models of health care, largely based on treatment guidelines using Caucasian standards for what’s “safe” cholesterol, blood pressure or body-mass index (BMI) for weight levels. More of our Asian and Pacific island residents, because of smaller body size, should probably weigh less. We don’t know yet how important even the subtle differences are and how we develop new health care models to address the important differences.

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