Ua mau ke ea o ka aina i ka pono: Self-determination as a social determinant of health

Background: The Kingdom of Hawai‘i was independent in 1795 until 1893, when it was overthrown. Since 1898, Hawai‘i has been a part of the United States. Despite measures such as the Hawaiian Homes Commission Act, the Admissions Act, and the Native Hawaiian Health Care Improvement Act , Native Hawaiians continue to have large disparities in health outcomes and socioeconomic measures. Traditional biophysical models struggle to explain these differences.

Purpose: To determine if actualizing self-determination may impact health disparities.

Methods: After examining data from the Hawai‘i Department of Health Vital Statistics database to determine disparities between different ethnic groups, a literature search was performed to identify research among other indigenous groups which has analyzed self-determination as a social determinant of health.

Results: Native Hawaiians have significant disparities in health outcomes. Self-determination has been shown, in other indigenous groups, to be a social determinant of health.

Discussion/conclusion: A theoretical construct which includes the social determinants of health, and particularly self-determination in addressing health disparities between Native Hawaiians and other ethnic groups in Hawai‘i may have greater impact than current theories which focus on genetics, and individual and family choice. Events and processes which have and continue to impact on the health of Native Hawaiians may be contextualized within the concept of intergenerational trauma, which may be addressed through actualizing self-determination for Native Hawaiians as a group. Actualizing self-determination, if it results in improvements in lower levels of stress, improved access to healthcare, housing, education, and employment, may reduce disparities in health outcomes.