Year: 2021
Type: article
Abstract: Native Hawaiian and Other Pacific Islanders (NHPIs or NHOPIs) are the least represented racial group in US medical schools-comprising less than 0.4% of entering students annually.1 Even in Hawaii, where NHPI individuals represent more than 25% of the state population, they account for less than 5% of physicians. 2 Despite being 1 of the 5 federally recognized major racial groups, NHPIs are often the forgotten minority group that is underrepresented in multiple facets of medicine, including the physician workforce and clinical research.Many people in the US are unaware that NHPIs originate from 3 Oceanic ethnogeographic regions: Melanesia, Micronesia, and Polynesia.As the largest water mass on the planet, the Pacific Ocean covers more than 30% of Earth's total surface area.Representing approximately 30 Pacific nations and more than 20 000 islands, NHPIs are deeply rooted in their shared languages, traditions, and heritage of Oceanic voyaging.Two important distinctions of the American term "NHPI" may be confusing.First, the designation "NH" in "NHPI" emphasizes that unlike "Other Pacific Islanders," Native Hawaiians did not immigrate to the US.They are indigenous to islands that were illegally annexed by the US in 1898 and entered statehood in 1959.3,4 Second, while the "O" is commonly dropped in the acronym, the "Other" in NHPI/NHOPI signifies that Native Hawaiians are also Pacific Islanders.In publications, the word "Other" should always be included when writing out "Native Hawaiian and Other Pacific Islanders," even when abbreviated NHPI.This is the official term authorized by the federal Office of Management and Budget and used by the US Census and other federal agencies.It is critical to understand that NHPIs are distinct from Asian Americans, and these 2 groups were legally disaggregated during the Clinton administration.2 NHPI nations contain no Asian countries and do not share any unifying history with Asian nations.Thus, using the antiquated term "Asian Americans and Pacific Islanders" (or "AAPI") obscures the health disparities and oppression specific to the NHPI experience.When disaggregated, Native Hawaiians have shorter life spans and higher incidence of diabetes, asthma, substance abuse, and obesity compared with all major Asian American ethnic groups.2,5,6 The largest NHPI subgroup in the US, Native Hawaiians, are descendants of navigators who populated the Hawaiian Islands between 200 and 900 CE.Unfortunately, popular culture has often romanticized Hawaii, whitewashing the reality that these Native people nearly faced extinction.After a millennium of geographic and immunologic isolation, the Native Hawaiian population declined from approximately 700 000 to 20 000 within the first century of Western contact.The Hawaiian Kingdom was an internationally recognized monarchy with complete independence until 1893 when Queen Lili'uokalani abdicated her throne to avoid bloodshed by armed US forces, thus beginning an illegal occupation and health disparities.Within Hawaii, Native Hawaiians are now the group most likely to be medically uninsured, impoverished, homeless, incarcerated, and without education beyond high school.5 Native Hawaiians have the highest rates of nearly all chronic diseases in Hawaii, 5,6 and they are still recovering to population levels that preceded Western contact.Despite centuries adapting and surviving the most geographically isolated habitats on the planet, modern Native Hawaiians are struggling to thrive.Unsurprisingly, amid the coronavirus disease 2019 (COVID-19) pandemic, NHPIs have some of the highest COVID-19 incidence rates in state and county data.5,7 While other ethnic minorities certainly face similar disparities, a search of the medical literature in January 2021 for "COVID-19" with Black, Latinx, American Indian/Alaska
Source: JAMA Health Forum
Author: Kekoa Taparra
Institutions: Gundersen Health System, Mayo Clinic
Language: English
Subfield: Gender Studies
Field: Social Sciences
Domain: Social Sciences
Open Access status: gold
Estimated APC paid: $5,000
OpenAlex ID: W3129645691