Causal Linkages between Culture and Hawaiian Health

1. Political-Economic “Diaspora” • Introduction and domination of Western technology and values • Land usurpation and the collapse • Denigration of cultural values and resources • Denial of cultural practices • Ecological degradation • Disease introduction and demographic collapse • Cultural Disintegration • Fragmentation of social organization • Incomplete Acculturation/cultural identity • Lack of economic opportunity • Lost access to land and resources • Denial of ritual • Traditional worldview and practices maladaptive • Stress Response • Early childhood development • Neglect or abuse • Poor self-regard • Arrested cognitive and emotional development • Maladaptive behavior • Poor nutrition • Lack of exercise • Underemployment • Loss of “Sense of Coherence” • Coherence is an individual and family’s shared feeling of confidence that the world is: • Comprehensible • Manageable • Meaningful • Stress Response Manifestations • Psychiatric/Emotional Disorders • Depression • ADD/ADAH • PTSD • Somatic Disorders • Cardio-vascular disease • Diabetes Mellitus • Obesity • Renal failure • Loss of Resiliency • Resiliency is the behavioral patterns and functional competence that individuals and families demonstrate under stressful or adverse circumstances. Its loss results in: • Inability to attenuate dysfunction or pathology • Loss of “hardiness” and problem-solving communication Causal Linkages between Culture and Hawaiian Health

2. Community-Culture-Health Model (Patient History) Political economic change – socio-cultural disempowerment Community/cultural dislocation/detachment (from the “land”) Generational decline in Sense of Coherence  increased stress response, lowered immune response (intergenerational) Family loss of coherence, hardiness, coping mechanisms Arrested/poor cognitive and emotional development  mentally and behaviorally-related illness

3. Community-Culture-Health Recovery Model Type/Level of Intervention Continuum Community/Cultural Restoration------------------------------Medicine/Psycotherapy Community--------------------Family --------------------Individual Continuous renewal of social capital, cultural attachment, stewardship of community resources Generational increase in Sense of Coherence  decreased stress response, increased immune response (intergenerational) Family coherence, hardiness, coping mechanisms Optimal cognitive and emotional development  Reduced frequency of mentally and behaviorally-related illness