Culture and Cancer in Kanaka Maoli (Native Hawaiians) Abstract

PURPOSE: To consider the role of culture in the persistently high cancer rates of Kanaka Maoli (Native Hawaiians) in their homeland. METHODS: Historical and recent cancer and other health and socio­economic data and not readily accessible information on Kanaka Maoli and other major ethnicities were analyzed. FINDINGS: In the 1990s, the 205,078 Kanaka Maoli, who comprise 18.8% of the total Ka Pae'aina (Hawaiian Archipelago) population of 1,108,229, continue to have the highest and still rising cancer mortality rates compared to other ethnicities. Rates are higher for piha (pure) Kanaka Maoli than for hapa (mixed) and greater for Kanaka Maoli men over women. The leading cancer sites are lung, breast, stomach, uterus, liver and rectum. Overall five year cancer survival rates for Kanaka Maoli remain shorter than for the other ethnic groups. Kanaka Maoli rank highest for cancer risk factors, such as tobacco use, alcohol use, and obesity; diets high in calories, total fat, saturated fat, cholesterol, processed foods, foods low in fiber, vitamin C, calcium, and folate. Kanaka Maoli continue to have the most unfavorable rates for other leading causes of death, chronic morbidity, suicide, accidents, and other social and economic indicators such as family income, home ownership, schooling, crime and imprisonment. Kanaka Maoli tend to live in rural communities where they comprise 40­90% of the population and where Western health care services are meager and distant. Kanaka Maoli under­utilize Western health care, health promotion and disease prevention services. Kanaka Maoli score poorly in cancer knowledge and tend to have a fatalistic attitude toward cancer. CONCLUSIONS: An interplay of underlying historical, societal and cultural factors, not specific for cancer, nor for ill health, appear to account for the worsening broad plight of Kanaka Maoli. These include: (1) Kanaka Maoli depopulation in earlier years since initial foreign contact, 1778­1989; (2) Worsening minority status for Kanaka Maoli (18%) with accelerated non­Kanaka Maoli settler immigration, domination, exploitation and subjugation of Kanaka Maoli; (3) Continuing dis­possession of Kanaka Maoli lands and other natural resources to which Kanaka Maoli remain spiritually, culturally, and biologically attached; (4) Cultural assimilation of Kanaka Maoli by the dominant Western society ; (5) Cultural conflict, despair and too eager acquisition of harmful foreign ways, such as consumption of processed foods, tobacco, alcohol, other inimical chemicals, reckless automobiling, consumerism, economic dependency, crowding and stress ; (6) Cultural revitalization and the five community-based Native Hawaiian Health Care Systems initiated in 1990 have not yet had a measurable effect of Kanaka Maoli health and other indicators. RECOMMENDATIONS: (1) Kanaka Maoli return to strong self­identity with traditional, spiritual, and cultural attachment to their sacred environment, self­empowerment and self­sufficiency, resisting coercive assimilation, cultural conflict, despair and destructive foreign dependency and lifestyle ways. (2) Support for Kanaka Maoli culturally competent health research, education, training, disease prevention and primary health care at individual, family, and community levels.