De-Occupation as a Determinant of Health: A Genealogy of Public Health Sovereignty

Within the context of the U.S. occupation of Hawai'i, State-sponsored and Hawaiian-led health initiatives cannot be reduced to a binary of "colonial/unhealthy" versus "Hawaiian/healthy." Instead, they operate within overlapping and often conflicting paradigms structured by what we term the Ideology of Occupation. This ideology obscures a central reality: kaumaha-the deep, collective malaise affecting the Hawaiian psyche ( Rezentes, 1996)-is the result of a disruption in the kū'auhau (genealogy) of Hawaiian public health, in which sovereign systems of care were replaced by a bureaucratic apparatus detached from Hawaiian life. Although culturally grounded interventions provide meaningful therapeutic value, the prevailing culture-as-health paradigm remains embedded within the status quo of occupation. As such, it functions as a co-opted form of palliative care that manages the symptoms of a political source of suffering. Drawing on Laenui's phases of Decolonization and grounded in Sai's legal framework of Belligerent Occupation, we reframe healing through the conceptual paradigm of health sovereignty, defined as the authority of a people to determine the knowledge systems, institutions, and political conditions that shape health and well-being. We argue that the health of the Hawaiian nation cannot be realized within an occupied system of care. Meaningful healing requires the restoration of the Hawaiian Kingdom's lawful authority and the reestablishment of self-determined health systems rooted in Hawaiian knowledge, institutions, and jurisdiction.