Deconstructing the sick Hawaiian: Genes, epigenetics and decolonization

Introduction: Native Hawaiians have some of the poorest health indicators in their own lands. Oftentimes, these data are characterized as the result of poor lifestyle choices, or genetic vulnerabilities. History, the political economy and the genealogy of the sick Hawaiian are erased by locating illness as a fundamental defect (genetic vulnerability) or product of “choice”. Methods: Literature review on PubMed using terms “Hawaii,” “Hawaiian,” “health,” “diabetes,” “cancer,” “heart,” “hypertension,” and “obesity.” Findings: A majority of articles reviewed emphasized the high prevalence or incidence of illness in Native Hawaiians, either compared locally to Hawai'i or to national data. Discussion/Conclusion: The genealogy of the sick Hawaiian is thus inextricably intertwined with the political, social, economic and cultural history of Hawai'i, and retrieving this history problematizes the “sick Hawaiian.” This identity becomes problematized, foregrounding Hawaiian resistance to colonization, contemporaneous with the sick Hawaiian as the colonization of the physical, mental and spiritual body, as the political body was colonized. Epigenetics potentially offers a unique perspective on these processes, by locating morbidity and mortality as the interaction of genes and environment in a heritable manner. History is then written on the genes, and current and future research and interventions provide the opportunity to uncover these genealogies, and reconstruct the healthy Hawaiian, individual, family and nation.