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 lNative Hawaiiansr 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 18.8p of the total Ka Pae'aina lHawaiian Archipelagor 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 lpurer Kanaka Maoli than for hapa lmixedr 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 obesitys 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 40­90p 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 includec l1r Kanaka Maoli depopulation in earlier years since initial foreign contact, 1778­1989s l2r Worsening minority status for Kanaka Maoli l18pr with accelerated non­Kanaka Maoli settler immigration, domination, exploitation and subjugation of Kanaka Maolis l3r Continuing dis­possession of Kanaka Maoli lands and other natural resources to which Kanaka Maoli remain spiritually, culturally, and biologically attacheds l4r Cultural assimilation of Kanaka Maoli by the dominant Western society s l5r 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 s l6r 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: l1r 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. l2r Support for Kanaka Maoli culturally competent health research, education, training, disease prevention and primary health care at individual, family, and community levels.