Ke ola o Ka Lâhui: Towards a theory of Native Hawaiian health

As with other indigenous populations, Native Hawaiian (Kânaka Maoli) face significant inequities in health compared to other groups in Hawai‘i, their ancestral homeland. The etiology for these inequities have been located in genetic variants, lifestyle choices, history, and the larger political economy. This study surveys the literature for theories on the etiology of Native Hawaiian, then presents a synthesis of these theories, locating the roots of health and non-health in the shifting nexus of genetics, behavior, history and the political economy. Evaluating health in this model is not simply mainstream outcomes such as general health status, prevalence of diabetes and cardiovascular disease, or even poverty, but also includes indigenously relevant variables such as access to traditional resources, area in indigenous and endemic biota, and numbers of traditional cultural practitioners. Actualizing these measures may lead to the formulation of alternative policies which address the determinants of both mainstream and Native Hawaiian relevant outcomes.