Native Hawaiian Community Leads Way to Improve Oral Health Statewide
By Tercia Ku, Papa Ola Lokahi, and Nancy Partika, Oral Health For All Hawaii-HCAN
We do have those who fall through the cracks and those are the ones we care about; those are the ones we want to help.
Available data specifically on Native Hawaiian oral health needs is limited, but a growing number of sources indicate clear disparities for Native Hawaiians in both oral health outcomes and access to care statewide, from ages 0-5 and older. When you consider those native communities, or visit them in person, you can see just how widespread poor oral health has become for the roughly 311,000 Native Hawaiians living in Hawai’i – that is more than half the total Native Hawaiian population nationwide. Those numbers demonstrate just how much impact poor oral health can have on a single ethnic minority, making improvement all the more necessary.
First, some history
Prior to 1778, tooth decay among Native Hawaiians was non-existent. With the introduction of other diverse people, foods and changes in diet, oral health and tooth decay for the indigenous population became endemic by 1930. Today, oral health in Hawai‘i has become a serious and problematic public health issue, with Hawaii receiving a failing grade of “F” in three oral health “report cards” published by the Pew Center of the States since 2010.
In 1985, a core group of Native Hawaiian professionals led by Dr. Kekuni Blaisdell completed a Native Hawaiian health needs assessment. The E Ola Mau Report findings became the foundation for the1988 Native Hawaiian Health Care Act passed by Congress – a significant step to support improved overall health among indigenous communities.
A generation later, the Native Hawaiian Health Care Systems, Papa Ola Lōkahi, community partners, and other Native Hawaiian service organizations convened to assess progress made in improving Native Hawaiian health across several key areas, including oral health. This recently-released report, The E Ola Mau a Mau – the next generation of Native Hawaiian health, involved community-based task group efforts on 7 key areas: historical and cultural perspectives, mental and behavioral health and wellness, medicine, nutrition, data governance, workforce development, and oral health.
Major findings and recommendations from that most recent report align with and further support the Hawai‘i Oral Health Coalition’s recommendations for action, including the need to:
- address oral health in connection with overall health;
- increase oral health literacy and awareness;
- develop a diversified oral health workforce, including in rural areas;
- invest in prevention;
- increase access to care (and decrease oral health care disparities);
- implement culturally-adapted programs and practices; and
- systematically improve data collection relevant to Native Hawaiian oral health.
One significant recommendation is to develop policies aligned with and reflective of Native Hawaiian culture. Like many other indigenous cultures, Native Hawaiians are highly connected with ‘ohana (family, community), ‘āina (land, environment) and akua (spirituality). They also value relationships and view health holistically.
In addition, the state’s Health Caucus recently identified dental benefits for adult Medicaid beneficiaries as their health priority for the 2020 legislative session. Given approximately 68,000 Native Hawaiian adults in the state have Medicaid (according to MedQuest), an adult dental benefit would create access to oral health care and address oral health disparities for many families and communities in Hawai‘i.
Knowing what we now know about the disparities in oral health for the Native Hawaiian population, it is our collective duty and responsibility to ensure that we all work with the Papa Ola Lokahi, the Native Hawaiian Health Care Systems, its partners and our affected communities to ensure Oral Health Equity — PONO (Do the right thing).
‘A‘ohe mea nana e ho‘opuhili, he moho no ka lā makani.
There is no one to interfere, for he is a messenger of a windy day.
Said in admiration of a person who lets nothing stop him
from carrying out the task entrusted to him.
‘Ōlelo No‘eau #189 (Pukui, 1983, p. 23)
The full E Ola Mau a Mau Report and the oral health report are available online at http://www.papaolalokahi.org/native-hawaiian-programs/native-hawaiian-health-needs-assessment.html.