Joseph Keawe‘aimoku Kaholokula, Ph.D.
Professor and Chair
Department of Native Hawaiian Health
John A. Burns School of Medicine
University of Hawai‘i at Mānoa
The coronavirus disease 2019 (COVID-19) pandemic has spotlighted the health inequities of Native Hawaiians and Pacific Islanders (NHPI) and provided the podium from which to amplify their voices.
Historically, the voices of NHPI were drowned out by other numerically larger health-disparate racial/ethnic groups in the U.S. Their unique health concerns are often overlooked because their data has been aggregated—grouped together—with those of Asian Americans, an arbitrary practice that has done a disservice to both groups.1 NHPI know that resources follow the data, which is why they have been voicing their support for disaggregating—separating out—the data for NHPI and Asian Americans for decades, but to little avail.
Along comes COVID-19 to amplify their voices as to why data disaggregation is important.
NHPI have the highest number of COVID-19 confirmed cases of any racial/ethnic group in 14 of the 21 states that report disaggregated data, which include Arkansas, Colorado, Hawai‘i, Illinois, Oregon, Utah, and Washington.2 In the other 7 states, including California and North Carolina, NHPI are among the groups with the highest case rates. In 11 of the 16 states reporting disaggregated death data, which include Alaska, Arkansas, Iowa, Louisiana, and Tennessee, NHPI have the highest COVID-19-related death rates of any racial/ethnic group. These inequities would have been concealed from the public had NHPI data been aggregated with other racial/ethnic groups.
Pre-existing health disparities and inequities in the social determinants of health are driving the COVID-19 risk among NHPI.3 They make up a large number of the essential workforce, such as in the tourism and food industries.4 In the military, NHPI representation is 6 times higher than in the general U.S. population.5 NHPI are more likely to live in large multi-generational households and denser communities, which further increases their exposure risk. The high rates of asthma, obesity, diabetes, heart disease, smoking, and vaping among NHPI increase the risk for severe COVID-19 symptoms.6 COVID-19 containment and mitigation measures have led to an increase in economic hardships, behavioral health issues, and difficulties in managing chronic disease for many NHPI.
NHPI leaders and advocates have sprung into action to protect their communities.6 A National NHPI COVID-19 Response Team was formed, comprised of NHPI members from various states, each with county and state-specific groups. In Hawai‘i, the NHPI COVID-19 Response, Recovery, and Resilience Team was formed to join the national team’s efforts. These efforts have changed the policies and practices of county and state public health departments in the collection and reporting of NHPI-specific data. They have secured much-needed resources to ensure NHPI communities have personal protective equipment and food security; access to COVID-19 educational materials, testing, and places to self-quarantine; culturally-informed contact tracing; and financial assistance. NHPI communities took to social media and videoconferencing to stay connected with family and friends and to remain socially and culturally engaged during the COVID-19 containment and mitigation measures. These efforts have been independent of local, state, and federal governments.
NHPI are resilient and thriving communities in the U.S. Although they make up only 0.4% of the entire U.S. population, they are among the fastest-growing racial/ethnic groups.7 The Native Hawaiian population alone, for example, is expected to almost double in population size from 530,000 to nearly a million by 2040.8 As their population and dispersion across the U.S. grow, so does their influence.
The COVID-19 crisis has paved a path to health equity for NHPI. It has led to an unprecedented mobilization and the establishment of a strong national coalition. It has shown the efficacy of NHPI communities in responding to a public health crisis. NHPI communities are well organized and prepared to engage directly with county, state, and federal public health agencies to provide NHPI leadership, perspectives, and cultural assets in combating health inequities in NHPI communities.
As an ancient Hawaiian proverb proclaims, “Pūpūkahi i holomua!” (Unite to progress.) NHPI are doing just that.
- Panapasa SV, Crabbe KM, Kaholokula JK. Efficacy of Federal Data: Revised Office of Management and Budget Standard for Native Hawaiian and Other Pacific Islanders Examined. AAPI Nexus. 2011;9(1-2):212-220.
- NHPI COVID-19 Data Policy Lab Dashboard. UCLA Fielding School of Public Health; 2020. https://healthpolicy.ucla.edu/health-profiles/Pages/NHPI-COVID-19-Dashboard.aspx. Accessed November 16, 2020.
- Kaholokula JK, Samoa RA, Miyamoto RES, Palafox N, Daniels SA. COVID-19 Special Column: COVID-19 Hits Native Hawaiian and Pacific Islander Communities the Hardest. Hawaii J Health Soc Welf. 2020;79(5):144-146.
- Morey BN, Tulua A, Tanjasiri SP, et al. Structural Racism and Its Effects on Native Hawaiians and Pacific Islanders in the United States: Issues of Health Equity, Census Undercounting, and Voter Disenfranchisement. AAPI Nexus Journal: Asian Americans and Pacific Islanders Policy, Practice. 2020;17(1 & 2).
- 2018 Demographics Report. U.S. Department of Defense;2018. https://download.militaryonesource.mil/12038/MOS/Reports/2018-demographics-report. Accessed November 16, 2020.
- Samoa R, J.K. K, Penaia C, et al. COVID-19 and the State of Health of Pacific Islanders in the United States. AAPI Nexus: Policy, Practice and Community. 2020;17(1 & 2).
- Hixson L, Hepler BB, Kim MO. The Native Hawaiian and Other Pacific Islander Population: 2010. U.S. Census Bureau;2012.
- Goo S. After 200 Years, Native Hawaiians Make a Come Back. Pew Research Center. http://www.pewresearch.org/fact-tank/2015/04/06/native-hawaiian-population/. Published 2015. Accessed November 17, 2020, 2020.