Dr. Kekoa Taparra stresses the importance of disaggregating data on the health of Pacific Islanders – State of Reform

Accurate representation of Native Hawaiians and Pacific Islanders (NHPI) is badly needed in the healthcare system, especially as the long-term impacts of the COVID pandemic continue to occur, according to Native Hawaiian oncologist Kekoa Taparra, MD, PhD.

Paka Ola Lokahi, a nonprofit focused on improving the health of Native Hawaiians, recently hosted a webinar where Taparra spoke on the historical context that has led to the current health disparities in Pacific island communities and on ways to address the disparities in the future.

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Prior to contact with Western societies, Pacific Island communities had established a wide variety of health practices, including an emphasis on connection with nature and a framework of holistic medicine. Eventual contact with Western society brought diseases such as gonorrhea, syphilis and tuberculosis which decimated the population. In 1900, Taparra declared that over 95% of the native Hawaiian population had been wiped out, resulting in a genetic bottleneck that continues to influence health issues today.

Colonization and warfare across the Pacific not only led to racial discrimination and loss of land and culture for Pacific Islanders, Taparra said, but also had a direct impact on their health.

“The physical consequences of radioactive iodine fallout from nuclear bomb testing are associated with increased risks of certain cancers,” he said. “It also leads to generations of people who are very adverse to radiation. [treatment] …because of the perception of radiation as the only things that can be harmful. As a doctor, it can be very difficult to talk people out of this.

Besides an increased risk of certain cancers, Taparra noted that Pacific Islanders also have higher rates of obesity, infant mortality and shorter lifespans.

These disparities are also notable when it comes to COVID. Citing a March 2021 study from the UCLA Center for Health Policy Research, 18 of 20 reporting states identified Native Hawaiians and Pacific Islanders as the ethnic group with the highest per capita death rate.

However, Taparra said little attention is paid to this issue, due to data tending to cluster the NHPI with Asians, which may mask the disparity.

“When we’re not represented in clinical trials, it really calls into question whether or not the data applies to the patients we’re trying to treat,” he said.

As for what health leaders can do to address these disparities, Taparra recommends more culturally sensitive trials that disaggregate NHPI data as a single group. He also advocated for greater NHPI representation in the health workforce, including bolstering federal funding or scholarships. programs for those looking to enter the job market.

Taparra also noted the ongoing shift in the Native Hawaiian diaspora across the United States. He said the 2020 census marks the first time that more Native Hawaiians indicated they lived on the mainland than in Hawaii, due to the rise Cost of life and frozen wages. To support those living on the mainland, Taparra encouraged local support groups to think about how they could reallocate their resources to better reach those living on the mainland.

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