UCLA

ABSTRACT OF THE DISSERTATION

How do Native Hawaiian Concepts of Well-being Inform

the Meaning And Social Function of Food?

By

Darrah Leigh Goo Kuratani

Doctor of Philosophy in Public Health

University of California, Los Angeles, 2015

Professor Marjorie Kagawa Singer, Chair

It is well known that indigenous communities are vulnerable to the plight of the social gradient of health and are overly burdened by chronic diseases. One common risk factor for the major chronic illnesses among indigenous communities, such as heart disease, metabolic syndrome, diabetes, and cancer is obesity. The indigenous people of Ka Pae Aina (the Hawaiian Islands), the Kanaka Maoli (Native Hawaiians), reside as minorities in their native land, and have the poorest health outcomes. They also have one of the highest rates of obesity in the world. Even though obesity rates have risen for all groups nationally, Native Hawaiians are almost twice as likely to be obese. In Hawaii, Native Hawaiians have the highest obesity rate (47%) when compared to other ethnic and racial groups, including Non-Hispanic Whites (NHW) (21%), Japanese (16%), and Filipinos (21%) (HHDW, 2013). The epidemiology clearly shows that the problem exists, but current research does not explain why the obesity rate for Native Hawaiians is so incredibly high. Such reasons remain poorly explored, and this lack of knowledge undermines efforts to effectively reduce the rates of obesity.

The U.S. colonized native Hawaiians in 1898, and colonial culture and laws have worked to marginalize, stigmatize and alienate Native Hawaiian people from the larger society. The overarching impact of imposed and embedded colonial denigration of the Native Hawaiian people has been reported to be the perpetuation of negative self-image and their social position has been restricted to the bottom of the political hierarchy. The consequences of both these forces generally has been to limit their lifestyle choices and options about their own health and well-being. Yet these factors are rarely included as active factors in the theoretical frameworks used to address the health status of this population.

Rather, studies that address Native Hawaiians and other indigenous peoples, often intimate that their culture is a large part of the problem. However, interventions designed to improve the negative health status of native peoples and Native Hawaiians, in particular, do not seem to identify what it is about culture, and in particular, whose culture, may actually be influencing the behaviors that lead to overweight and obesity. Previous interventions that have integrated cultural values and practices in weight loss programs with Native Hawaiians have shown initial benefit, but were unable to sustain long term results. This is likely because the focus was on individual level beliefs and practices. The larger social and political forces that address daily realities of work and low incomes, and institutionalized discrimination towards Native Hawaiians were not addressed. Individual level strategies are necessary, but not sufficient to sustain healthier choices if these contextual forces are not addressed.

In the 1970s, the Hawaiian Renaissance was founded and became an emotional and political turning point for Native Hawaiians. Its goal was to reinvigorate cultural pride and interest in the values and wisdom of Native Hawaiian culture in contrast to the 120 years of explicit denigration of Native Hawaiian culture, and explicit pressure to assimilate into white European Christian culture. The spirit of the Hawaiian renaissance has given rise to a counter consciousness and spurred an ongoing struggle to recognize and reconcile the two competing sets of cultural messages for the native peoples and, primarily, the political power and social structure of Hawaiian society today.

This study applied a socio-ecologic conceptual cultural lens to understand the concepts of well-being among Native Hawaiians to investigate if and how social, political, and historical contextual forces may still affect Native Hawaiians’ sense of self, and if and how these forces may impact their conceptualizations of and decisions regarding health. The intent was to investigate how a multi-level, multidimensional concept of culture might better elucidate how we understand the relationships of these contextual forces on the meaning of well-being and food, the use of food in social relationships, and, ultimately, its potential relationship to rates of obesity.

This ethnographic study was conducted on the island of Oahu with participant, observational, archival investigations and one-on-one inductive qualitative, interviews with twenty-nine Native Hawaiian participants. Interviews were audio-recorded, transcribed, and analyzed. The conceptual frameworks that guided this study included, the Cultural Framework for Health (CFH), and the philosophical and theoretical concept of empathy. The CFH recognizes and incorporates an explicit definition of culture as a scientifically grounded, multidimensional, and multi-level construct, inclusive of biopsychosocial and ecological frameworks and recognizes and incorporates geographical, historical, social and political realities of diverse communities.

The findings show that Native Hawaiians’ conceptualizations of well-being are based on five core Native Hawaiian cultural values: 1) ohana (family), 2) aloha (love, care, and compassion), 3) kokua (to help without being asked), 4) lokahi (harmony), and 5) mana (life force, energy, power). One of the key ways these values are expressed and manifested interpersonally is symbolically through the meaning and use of food. Food was found to be a key component in how Native Hawaiian identity is conceptualized and as a way to express and access love, compassion, and comfort. Notably, the findings showed that the conceptualizations of well-being extend beyond the individual and include family, community, social, political and historical issues and structures that have the potential to provide a sense of worth and empowerment.

This study suggests that the use of food may also be a coping mechanism for Native Hawaiians to seek comfort from the feelings of powerlessness and denigration by the overarching social structure that has relegated them to being “the forgotten people.” Health interventions would likely be more effective and long lasting if this more comprehensive and scientifically grounded cultural analysis informed the design and implementation of such efforts.