THE 14th ANNUAL NATIVE HAWAIIAN CONVENTION
HEALTH BRIEFING & POLICY CAUCUS
AGENDA
Tuesday, September 22, 2015
10:45 AM
Pule a Welina
10:50 AM
Introduction of U.S. Census Bureau speakers
Sharlene Chun-Lum
Momi Fernandez
“Producing Data for Native Hawaiians and other Pacific Islanders in the 2020
Census,” co-presented by Nicholas A. Jones, Director, Race and Ethnic Research
and Outreach and Roberto R. Ramirez, Assistant Division Chief, Special
Population Statistics
Questions and Answers
12:35 PM
Preview of Afternoon Session
Return to afternoon session, receive a special gift
Sharlene Chun-Lum
12:45 PM
Morning Session Pau
1:00 PM
Convention Leadership Luncheon ~ Hawaiian Health Awards Presentation
Winifred Pele Hanoa
Claire Ku`uleilani Hughes Ph.D.
2:30 PM
Proposed Policy Recommendations
1. Native Hawaiian Health Care Improvement Act
2. Data Issues Impacting Native Hawaiians
3. Health In All Policies
 What does health in all policies mean to you?
Sharlene Chun-Lum
Brief Update on Ke Ala Mālamalama I Mauli Ola
Native Hawaiian Health Master Plan
Reflections on presentations, discussion, additional suggestions
 What is your vision of a healthy community?
5:30 PM
Pau a Mahalo
Return your evaluation and receive a special gift
ʻAʻohe hana nui ke aluʻia. No task is too big when done together by all.
ʻŌlelo Noʻeau, # 142 Mary Kawena Pukui
POLICY RECOMMENDATION #1
Native Hawaiian Health Care Improvement Act
Permanently reauthorize the Native Hawaiian Health Care Improvement Act (until such time
as there may be federal recognition or the establishment of a sovereign Hawaiian lāhui).

The United States has a special trust relationship to the Native Hawaiians, preceding the illegal
overthrow of the sovereign Hawaiian monarchy on January 17, 1893 and the subsequent passage of
the Newlands Resolution, which annexed Hawaiʻi to the US (July 7, 1898) and the Hawaiian Organic
Act (April 30, 1900). Under the Act of March 18, 1959 entitled “An Act to provide for the admission
of the State of Hawaii into the Union” (48 U.S.C. prec. 491 note; 73 Stat. 4), referred to in paragraph
(22), the United States “reaffirmed the trust relationship that existed between the United States and
the Native Hawaiian people by retaining the legal responsibility of the State for the betterment of
the conditions of Native Hawaiians under section 5(f) of that Act (73 Stat. 4, 6).” In 1993, President
Bill Clinton signed legislation apologizing for the U.S. role in the 1893 overthrow of the Hawaiian
monarchy. The Apology Resolution (P.L. 103-150), meant as a means of reconciliation with Native
Hawaiians, acknowledges the historic significance of the event.1

This historical and unique legal relationship has been consistently recognized and affirmed by the
Congress through the enactment of more than 160 Federal laws which extend to the Hawaiian
people the same rights and privileges accorded to American Indian, Alaska Native, Eskimo, and
Aleut communities, including the Economic Opportunity Act of 1964, the Native American Programs
Act of 1974 [42 U.S.C. 2991 et seq.]; the American Indian Religious Freedom Act [42 U.S.C. 1996,
1996a]; the National Museum of the American Indian Act [20 U.S. C. 80q et seq.]; and the Native
American Graves Protection and Repatriation Act [25 U.S.C. 3001 et seq.].

The United States Congress has also recognized and reaffirmed the trust relationship to the
Hawaiian people by enacting legislation which authorizes the provision of services to Native
Hawaiians, specifically the Developmental Disabilities Assistance and Bill of Rights Act Amendments
such as the Act of June 20, 1938 (52 Stat. 781 et seq.); the Older Americans Act of 1965 [42 U.S.C.
3001 et seq.]; the Rehabilitation Act of 1973 [29 U.S.C. 3001 et seq.]; the Developmental Disabilities
Assistance and Bill of Rights Act Amendments of 1987; the Veterans’ Benefits and Services Act of
1988; the Indian Arts and Crafts Act of 1990 (P.L. 101-644); and the Veterans Access, Choice and
Accountability Act of 2014 (P.L. 113-146).

Under the United States Constitution, Congress has the authority to legislate in matters affecting
the aboriginal or indigenous peoples of the United States, including the native people of the
States of Alaska and Hawaiʻi. The United States has recognized that Native Hawaiians, as aboriginal,
indigenous, native people of the State of Hawai‘i, are a unique population group in the State and in
the continental United States.
1
National Library of Medicine. Native Voices: Native Peoples’ Concepts of Health and Illness. Retrieved from
http://www.nlm.nih.gov/nativevoices/timeline/578.html
2
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Timeline of the Native Hawaiian Health Care Improvement Act (NHHCIA):
o In furtherance of the trust responsibility for the betterment of the conditions of Native
Hawaiians, the United States legislated the provision of comprehensive health promotion and
disease prevention services to maintain and improve the health status of the Hawaiian people,
the Native Hawaiian Health Care Act of 1988 (Public Law 100–579; 102 Stat. 2916). The
legislation recognized Papa Ola Lōkahi as the Native Hawaiian Health Board and provided it with
financial resources to undertake the Native Hawaiian health master plan and other initiatives
and actions. The legislation also recognized, for the first time, traditional Native Hawaiian
healing and traditional Native Hawaiian healing practitioners – the first of any federal legislation
to recognize traditional health practitioners of any Indigenous Peoples.
o The Native Hawaiian Health Care Act of 1988 is incorporated within Subtitle D of Anti-Drug
Abuse Act of 1988 (P.L. 100-690). It explicitly provides Papa Ola Lōkahi with grants (1) to plan
for Native Hawaiian health centers, (2) to implement the Native Hawaiian health master plan,
(3) to train appropriate Native Hawaiian health care professionals in health promotion, disease
prevention education, and (4) to research diseases prevalent in the Native Hawaiian community.
It also authorizes funding for FY 1990 through 1992.
o On April 14, 1992 in Honolulu, a hearing was held on the Reauthorization of the Native Hawaiian
Health Care Improvement Act, Select Committee on Indian Affairs, US Senate, 102nd Congress,
2nd session for the purpose of consideration of the draft or proposed legislation of P.L. 100-579.
On May 7, 1992, Senator Daniel Inouye introduced S. 2681, the Native Hawaiian Health Care
Improvement Act (NHHCIA). This legislation (1) retitled the Native Hawaiian Health Care Act as
the Native Hawaiian health Care Improvement Act, (2) declared it the policy of the United States
to improve the health of Native Hawaiians to the highest possible level, (3) made Papa Ola
Lōkahi the major coordinating agency for Native Hawaiian health, (4) recognized the Native
Hawaiian health care systems, (5) revised the Native Hawaiian health scholarship program to
make scholarships under the same terms as the National Health Service Corps, and (6) indicates
that the Indian health Service shall not administer the program. This measure was passed in the
Senate but failed in the House. The companion measure, H.R. 5346 – Native Hawaiian Health
Care Amendments of 1992, was introduced on June 9, 1992 by Representative Neil
Abercrombie. This measure was placed on the Union calendar.
o In 1992, the NHHCIA was reauthorized under section 9168 of the Department of Defense
Appropriations Act, 1993 (P.L. 102–396; 106 Stat. 1948). This legislation enacted into law the
NHHCIA by reference to S. 2681 “as passed in the Senate” in the body of the legislation. The
NHHCIA was reauthorized from 1992 through 2002.
o On August 16, 1999, there was a hearing in Honolulu regarding ”Federally Funded Native
Hawaiian Programs,” Subcommittee of the Committee on Appropriations, US Senate, 106th
Congress, 1st session. On November 16, 1999, Senator Daniel Inouye introduced S. 1929: Native
Hawaiian Health Care Improvement Act Reauthorization of 2000. There was a series of
hearings hosted by the US Senate Committee on Indian Affairs regarding ”Reauthorization of the
Native Hawaiian Health Care Improvement Act,” on Molokaʻi, Kauaʻi, Maui, Hawaiʻi, Oʻahu,
Lanaʻi, January 19-21 and March 16, 2000. This legislation, which did not pass into law, revises
the NHHCIA and amends the act in a number of ways including (1) sharing responsibilities with
the Office of Hawaiian Affairs, (2) limiting the number of Native Hawaiian Health Care Systems
to eight (including new Systems for Lanaʻi and Niʻihau), (3) expanding the Native Hawaiian
Health Scholarship Program to include fellowships and providing a priority to employees of
Native Hawaiian Health Care Systems and Native Hawaiian health Centers, and (4) establishing a
National Bipartisan Native Hawaiian Health Care Entitlement Commission to establish a study
commission to collect and analysis Native Hawaiian health data and to make recommendations
3
o
o
o
o
o
o
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to Congress on the provision of such services as an entitlement. This measure was referred to
the Senate Subcommittee on Health and Environment.
On January 22, 2001, Senator Daniel Inouye introduced S.87, the Native Hawaiian Health Care
Improvement Act Reauthorization of 2001. This legislation is similar to S. 1929, the Native
Hawaiian Health Care Improvement Act Reauthorization of 2000, and extends reauthorization of
the NHHCIA through FY 2012. This measure was placed on the Senate calendar. On February 13,
2001, Representative Neil Abercrombie introduced H.R. 562, the Native Hawaiian Health Care
Improvement Act Reauthorization of 2001. This measure was referred to the House
Subcommittee on Health.
On March 25, 2003, Senator Daniel Inouye introduced S. 702, the Native Hawaiian Health Care
Improvement Reauthorization Act of 2003. This legislation reauthorized the NHHCIA from FY
2004-FY2009. It enables Papa Ola Lōkahi (POL) to receive research endowments under the
Public Health Services Act and allows POL to undertake “culturally-appropriate activities
enhancing health and wellness.” It enables POL through the Native Hawaiian Health Scholarship
Program to award fellowships and to award scholarship recipients additional scholarships during
their obligated service. Additionally, it enables POL to allocate funds to “demonstration projects
of national significance” including the establishment of Native Hawaiian Centers of Excellence.
This measure was placed on the Senate calendar. On June 25, 2003, Representative Neil
Abercrombie introduced H.R. 2597, the Native Hawaiian Health Care Improvement
Reauthorization Act of 2003, the companion bill to S. 702. This measure was referred to the
House Subcommittee on Health.
On January 31, 2005, Senator Daniel Inouye introduced S. 215, the Native Hawaiian Health Care
Improvement Reauthorization Act of 2005, which would “amend the Native Hawaiian Health
Care Improvement Act, to revise and extend that Act.” This legislation has similar language to S.
702 – Native Hawaiian Health Care Improvement Reauthorization Act of 2003. This measure was
read twice and referred to the Senate Committee on Indian Affairs.
On January 30, 2007, Senator Daniel Inouye introduced S. 429, the Native Hawaiian Health Care
Improvement Reauthorization Act of 2007. This legislation has the same language as S. 702 –
Native Hawaiian Health Care Improvement Reauthorization Act of 2003. This measure was read
twice and referred to the Senate Committee on Indian Affairs.
On January 6, 2009, Senator Daniel Inouye introduced S. 76, the Native Hawaiian Health Care
Improvement Reauthorization Act of 2009. This legislation has the same language as S. 702 –
Native Hawaiian Health Care Improvement Reauthorization Act of 2003. This measure was read
twice and referred to the Senate Committee on Indian Affairs. On November 4, 2009,
Representative Mazie Hirono introduced H.R. 4024, the Native Hawaiian Health Care
Improvement Reauthorization Act of 2009. This measure was referred to the House
Subcommittee on Health.
The Native Hawaiian Health Care Act was reauthorized as an “Other Provision” within the
body of the Indian Health Care Improvement Act, 2010 Patient Protection and Affordable Care
Act (P.L. 111-148). The provision granted reauthorization from 2010 through the year 2019.
The budget allocation for Papa Ola Lōkahi and the Native Hawaiian Health Care Systems was
reduced in 2010 and has never been restored to previous levels.
On January 25, 2011, Senator Daniel Inouye introduced the Native Hawaiian Health Care
Improvement Reauthorization Act of 2011, a bill to amend the NHHCIA, and to revise and
extend the Act. This legislation has the same language as S. 702 – Native Hawaiian Health Care
Improvement Reauthorization Act of 2003. This measure was read twice and referred to the
Senate Committee on Indian Affairs.
4

The Indian Health Care Improvement Act – Implications for Native Hawaiians. The IHCIA is the
cornerstone legal authority for the provision of health care to American Indians and Alaska Natives.
o The Indian Health Care Amendments of 1985 first mentioned and provided financial resources
for the development of a Native Hawaiian health promotion and disease prevention project in
Hawaii for Native Hawaiians “to meet the unique health care needs of Native Hawaiians.” The
legislation also makes Native Hawaiians eligible for health scholarships through the Indian
Health Service and provides for their serving in the Indian Health Service or contracted services
to the Indian Health Service as a means of fulfilling their service requirement. This measure was
indefinitely postponed by Senate voice vote.
o The Indian Health Care Amendments of 1988 (P.L. 100-713) has a major section directed at
Native Hawaiian health. It directed the Secretary (1) to establish a Native Hawaiian health
promotion disease prevention demonstration project and (2) to enter onto contracts with
Native Hawaiian organizations to research and develop diabetes programs in the Native
Hawaiian population.
o The Indian Health Amendments of 1992 (P.L. 102-573). This legislation incorporated the
provisions of S. 2928 relating to Native Hawaiian health scholarships which initiated this
program under Kamehameha Schools/Bishop Estate management (see “Title IX: Technical
Corrections”).
o On October 15, 2009, Senator Byron Dorgan (D-ND) introduced S. 1790, the Indian Health Care
Improvement Reauthorization and Extension Act of 2009. Title II: “Amendments to Other
Acts”; Section 202 of this legislation reauthorized the Native Hawaiian Health Care Improvement
Act through 2019 and added a paragraph entitled “Health and Education” primarily for the
benefit of Kamehameha Schools (see H.R. 3590 below). This measure was placed in the Senate
Legislative Calendar.
o The Indian Health Care Improvement Act (IHCIA) was made permanent when President
Obama signed the bill on March 23, 2010, as part of the Patient Protection and Affordable
Care Act (ACA).2 The authorization of appropriations for the IHCIA had expired in 2000, and
while various versions of the bill were considered by Congress since then, the act now has no
expiration date. While the Native Hawaiian Health Care Act was written into the IHCIA/ACA, it
does not have the same permanently reauthorized status granted to American Indians and
Alaska Natives, nor does it correctly reference the previous amendment to the Act that renamed
it the Native Hawaiian Health Care Improvement Act.
Native Hawaiians are the only group indigenous to the U.S. that must still request reauthorization from
US Congress. This puts funding for health services to Native Hawaiians at-risk for further reduction and
potential elimination. Despite all the strides we have made towards bringing the health of Native
Hawaiians to the highest possible level, Native Hawaiians still make up the majority of health disparities
in the state of Hawaiʻi. The continued health disparities are now understood to be attributed to larger
issues known as the social determinants of health.3
2
Heisler, E.J. (2011). The Indian Health Care Improvement Act Reauthorization and Extension as Enacted by the
ACA: Detailed Summary and Timeline. Congressional Research Service. Retrieved from
http://www.ncsl.org/documents/health/indhlthcarereauth.pdf
3
Liu, D.M. & Alameda, C.K. (2011). Social Determinants of Health for Native Hawaiian Children and Adolescents.
Hawaiʻi Medical Journal 2011 Nov; 70 (11): 2. Retrieved from
http://www.rwjf.org/content/dam/farm/reports/reports/2010/rwjf63023
5
POLICY RECOMMENDATION #2
Data Issues Impacting Native Hawaiians
Gather and distribute detailed race data representing Native Hawaiians in compliance
with federal and state requirements.

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
In 1997, the Office of Management and Budget (OMB) issued its revised standards for the collection,
analysis, and reporting of racial and ethnic data in the United States. This includes data on African
Americans, American Indians/Alaska Natives, Asians, Latinos/Hispanics, and Native Hawaiians &
Other Pacific Islanders (NHOPI). OMB Directive 15 (rev 1997) created NHOPI as a separate race
category consisting of 19 detailed races (including Native Hawaiian). Disaggregated data were
needed to monitor compliance to the Voting Rights Act of 1965, Civil Rights laws, Education, Fair
Housing Act, Immigration laws, Redistricting, Employment and Public Contracting, Criminal Justice
data, and distribution of funding from government offices, e.g. Health Resources and Services
Administration (HRSA), Administration on Children and Families (ACF) of the Department of Health
and Human Services, and student assistance tuition loans and scholarship programs. Despite this
federal administrative action, a number of federal and state reports and those of private
foundations still aggregate Native Hawaiians under an outdated Asian American and Pacific Islander
(AAPI) identifier.
In November 2013, the Association of Hawaiian Civic Clubs Convention passed Resolution 13-16 re:
reporting and distributing disaggregated data representing NHs in statistics
In May 2014, the CIC and data partner Empowering Pacific Islander Communities (EPIC) co-wrote
Resolution 14-21 that passed in Novermber 2014 at the Association of Hawaiian Civic Clubs’ (AHCC)
annual convention.4 The Resolution supports the preservation of the NH checkbox on the paper
version of the 2020 Census; gathering and reporting detailed race data and increase checkboxes or
print the detailed races under the “write-in” line on the paper version of the 2020 Census;
requested additional testing of NHPI populations in preparation for the 2020; increase distribution
of the NH “alone and in any combination” category to maximize the representation of NHs; provide
language materials and assistance for same populations during the 2020 Census.
The NHOPI race group increased 40% from Census 2000 to 2010. NHOPI now has 22 distinct
ethnicities and nationalities. Since 2010, Hawaiʻi has consistently recorded the most diverse, multiracial population in the nation.
Other federal departments have not complied with OMB-15 (rev 1997), such as: Centers for Disease
Control, Centers for Medicare and Medicaid Services, Department of Health and Human Services,
Department of Labor/Occupation, Office of Minority Health, U.S. Department of Education, and the
White House Initiative on Asian Americans & Pacific Islanders.
4
Association of Hawaiian Civic Clubs. A Resolution 14-21: Supports Native Hawaiian and Pacific Islander Deatiled
Races Printed on Census 2020 Survey Panels. Retrieved from
http://aohcc.org/images/stories/2014/Shane/FINAL%20RESOS%2013-26.PDF
6
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National health advocacy groups frequently utilize the identifier, Asian American, Native Hawaiian &
Other Pacific Islander (AANHOPI), which does not identify the unique needs of Native Hawaiians or
Pacific Islanders. Many of these national groups focus on the primary platform of language access
and immigration issues in the context of ACA implementation, issues that are not directly relevant or
reflective of the complex landscape of Native Hawaiian health.
The State of Hawaiʻi reports data intermittently on NHPIs5 or Asians and Pacific Islanders6 7, and
other times reports disaggregated data on Native Hawaiians8. Some of the state’s data reports
utilize Native Hawaiians/Pacific Islanders, while simultaneously reporting detailed race data on
other groups, including Japanese and Filipinos instead of Asians, on the same data reports.
Several offices within the state government inaccurately report NH population data, indicating that
the state population of Native Hawaiians is as low as 6-10% when, in fact, Native Hawaiians
comprise approximately 21-26% of the state population9. This is due, in large part, to the use of
incorrect reporting of data, for example, “Native Hawaiians” on Census data tables as opposed to
“Native Hawaiians alone and in any combination.” The reliance on inaccurate data has vast
implications for policy priorities and funding to address health equity for Native Hawaiians, who
consistently make up the largest health disparities in the state.
In 2015, the U.S. Congress decreased funding to the Census Bureau and ceased distribution of
American Communities Survey (ACS) 3-year reports, relying only on 1-year and 5-year ACS data. The
elimination of the 3-year ACS creates a gap in population thresholds and more frequent estimated
data of small populations and some rural estimates. At a minimum, for federally-sponsored
statistical data collection where race and/or ethnicity is required, POL supports lowering the ACS-1
year population threshold and lower the margin of error (MOE) in ACS.
5
Hawaii Health Data Warehouse; Hawaii State Department of Health, Office of Health Status Monitoring, Vital
Statistics; United States Census, Deaths in Hawaii Due to Cancer, Death Counts, Age-Adjusted Mortality Rates,
and Years of Potential Life Lost for Cancer for the State of Hawaii (Residents Only), by State, County of
Residence, Gender, and Census Race-Ethnicity, by 3-Year Aggregates, for the Years 2002-2013, Report Created:
2/19/15.
6
Centers for Medicare and Medicaid Services; Chronic Conditions, Prevalence State Level: All Beneficiaries by
Race/Ethnicity and Age, 2008-2012. Retrieved from https://www.cms.gov/Research-Statistics-Data-andSystems/Statistics-Trends-and-Reports/Chronic-Conditions/CC_Main.html
7
National Cancer Institute, Incidence Rate Report for Hawaii by County, Asian or Pacific Islander (includes
Hispanic), Both Sexes, All Cancer Sites, All Ages, Sorted by Rate. Retrieved from
http://statecancerprofiles.cancer.gov/incidencerates/index.php?stateFIPS=15&cancer=001&race=04&sex=0&age=
001&type=incd&sortVariableName=rate&sortOrder=default
8
Hawaii Health Data Warehouse; Hawaii State Department of Health, Office of Health Status Monitoring, Hawaii
Health Survey, Have health insurance (HHS), by State, County, Island, Community, Gender, HHS Age Group, DOH
Race-Ethnicity, Education Level, Household Income, Poverty Level, Marital Status, for the Year(s) - 2010, 2011,
2012, Report Created: 5/11/15.
9
QT-9, Race Reporting for the Native Hawaiian and Other Pacific Islander Population by Selected Categories: 2010
Census Summary File 1, 100% data; QT-7, Race Alone or in Combination for AI/AN, and for Selected Categories of
Asian and of NHOPI: Census 2000 Summary File 1, 100% data. S0201, Selected Population Profile in the U.S., 2013
ACS 1-Year Est., MOE +/-19,984; 65,000 minimum threshold, sample size approx. 3.54 million housing unit
addresses.
7
Continuing to use aggregated race data and inaccurate reporting does a tremendous disservice to Native
Hawaiians and masks a number of major health disparities affecting Native Hawaiians. The reporting of
aggregated and inaccurate race data prevents us from gaining a true picture of health status. Access to
detailed race data for Native Hawaiians in the “alone and in any combination” category allows health
inequities to be accurately identified and appropriately addressed. Public and private entities need to
recognize the distinct differences between the diverse populations included within NHOPI race
categories.
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POLICY RECOMMENDATION #3
Health In All Policies
Expand implementation of Hawaii Revised Statutes 226-20 to ensure inclusion of Native
Hawaiian health in all policies by: (1) incorporating health, equity, and sustainability into
specific policies, programs, and processes, and (2) embedding health, equity, and
sustainability considerations into government decision-making processes so that healthy
public policy becomes the normal way of doing business.
On June 30, 2014 Governor Neil Abercrombie signed into law HRS 226-0. The Act adds to the Hawaii
State Planning Act's objectives and policies for health, the identification of social determinants of health
and prioritization of programs, services, interventions, and activities that address identified social
determinants of health to improve Native Hawaiian health in accordance with federal law and reduce
health disparities of disproportionately affected demographics.
The Centers for Disease Control and Prevention (CDC) defines social determinants of health as “[t]he
complex, integrated, and overlapping social structures and economic systems that are responsible for
most health inequities.”10 These social structures and economic systems include:
• Physical and social environment - such as how a community looks (e.g., property neglect), what
residents are exposed to (e.g., advertising, violence), and what resources are available there (e.g.,
transportation, grocery stores)
• Health services - such as the availability and quality of medical services
• Structural and societal factors - poverty, lack of education, racism, discrimination, and stigma
The World Health Organization, a leading entity that identified the need for structural changes to occur,
further contextualizes social determinants for Indigenous People11:
“Indigenous People worldwide are in jeopardy of irrevocable loss of land, language, culture, and
livelihood, without their consent or control – a permanent loss differing from immigrant
populations where language and culture continue to be preserved in a country of origin.
Indigenous Peoples are unique culturally, historically, ecologically, geographically, and politically
by virtue of their ancestors’ original and long-standing nationhood and their use of and
occupancy of the land. Colonization has deterritorialized and has imposed social, political, and
economic structures upon Indigenous Peoples without their consultation, consent, or choice.
Indigenous Peoples’ lives continue to be governed by specific and particular laws and
10
Centers for Disease Control and Prevention – Division of Community Health (2013). A Practitioner’s Guide for
Advancing Health Equity: Community Strategies for Preventing Chronic Disease. Atlanta, GA: US Department of
Health and Human Services. Retrieved from http://www.cdc.gov/nccdphp/dch/pdfs/health-equity-guide/HealthEquity-Guide-intro.pdf
11
Commission on Social Determinants of Health (2008). Closing the gap in a generation: health equity through
action on the social determinants of health. Final Report of the Commission on Social Determinants of Health.
Geneva, World Health Organization. Retrieved from
http://whqlibdoc.who.int/publications/2008/9789241563703_eng.pdf?ua=1
9
regulations that apply to no other members of civil states….As such, Indigenous Peoples have
distinct status and specific needs relative to others.”
The following entities/coalitions have recognized the importance of addressing the social determinants
of health in order to reduce health disparities and improve health equity for Native Hawaiians (and
other disparate groups):
 Department of Native Hawaiian Health, University of Hawaiʻi John A. Burns School of Medicine
 Hawaiʻi Primary Care Association
 Hawaiʻi Public Health Association
 Ke Ala Mālamalama I Mauli Ola, the Native Hawaiian Health Master Plan
 Nā Limahana O Lonopūhā, the Native Hawaiian Health Consortium
 Native Hawaiian Education Council
 Office of Hawaiian Affairs
 Office of Healthcare Transformation, Office of the Governor
 State of Hawaiʻi Department of Health
Health In All Policies, at its core, is an approach to addressing the social determinants of health that are
the key drivers of health outcomes and health inequities. The American Public Health Association’s
Health In All Policies Guidebook provides the following description12:
 Health in All Policies is a collaborative approach to improving the health of all people by
incorporating health considerations into decision-making across sectors and policy areas.
 Health in All Policies supports improved health outcomes and health equity through collaboration
between public health practitioners and those nontraditional partners who have influence over the
social determinants of health.
 Health in All Policies approaches include five key elements: promoting health and equity, supporting
cross-sector collaboration, creating co-benefits for multiple partners, engaging stakeholders, and
creating structural or process change.
 Many factors, such as the context, authority, participation, resources, politics, community concerns,
key leader interests, and any formal legislation or administrative action will play a role in
determining the focus and scope of a Health in All Policies initiative. Policy agendas are influenced
by: 1) what issues are considered “significant problems,” 2) what solutions are considered sound at
any given moment, 3) the electoral process, and 4) public opinion. Any of these can shift
unexpectedly, opening an opportunity for a new collaborative approach, such as Health in All
Policies.
Establishing a Health in All Policies approach for Native Hawaiians would be consistent with existing
laws, organizational commitments that have already been made, various coalitions and consortiums that
have been formed, and plans for public and private entities to work together towards health equity.
12
Rudolph, L., Caplan, J., Ben-Moshe, K., & Dillon, L. (2013). Health in All Policies: A Guide for State and Local
Governments. Washington, DC and Oakland, CA: American Public Health Association and Public Health Institute.
Retrieved from http://www.phi.org/uploads/files/Health_in_All_PoliciesA_Guide_for_State_and_Local_Governments.pdf
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