Transforming the Health of Native Hawaiian Men

Kānehō‘ālani Transforming the Health of Native Hawaiian Men

Kānehō‘ālani – Transforming the Health of Native Hawaiian Men 3

Table of Contents

Introduction 5 Methodology 6 Part One: Historical Strengths 7 ‘O Ka Wā Mamua (The Past) 7 Kāne: Spirituality and Religion 7 Kāne: The ‘Āina, Kai, and Resources 8 Kāne: Family and Relationships 9 Kāne: Education and Occupation 10 Kāne: Leadership and Politics 11 Mo‘ohihia 12 Economic Transformations 12 Political Transformations 13 Social Transformations 14 Transformations in Hawai‘i during the Twentieth Century 15 Native Hawaiian Resiliency 16 Part Two: ‘O Kēia Au (The Present) 17 Demographics: The Kāne Population in Hawai‘i 17 Social Determinants of Kāne Health 18 Keiki 18 ‘Ohana make-up 18 Education 20 Juvenile Crime 24 Mākua 24 Post-secondary Education 24 Economic Stability 26 Marital Status 28 Behavioral Risk Factors 28 Involvement with Criminal Justice System 31 Kūpuna 31 Household Context 31 Preventive Services 32 Age and life expectancy 32 Health Outcomes 32 Mental Health 36 Morbidity 36 Further Conclusion and Recommendations 37 Discussion Questions 39 Works Cited 40 Part One: ‘O Ka Wā Mamua 40 Part Two: ‘O Kēia Au 41 Acknowledgements 45

Kānehō‘ālani – Transforming the Health of Native Hawaiian Men

Copyright © 2017. Office of Hawaiian Affairs. All Rights Reserved. No part of this report may be reproduced or transmitted in whole or in part in any form without the express written permission of the Office of Hawaiian Affairs. Suggested Citation: Office of Hawaiian Affairs. (2017). Kānehō‘ālani – Transforming the Health of Native Hawaiian Men. Honolulu, HI: Office of Hawaiian Affairs. 4 Kānehō‘ālani – Transforming the Health of Native Hawaiian Men Kānehō‘ālani – Transforming the Health of Native Hawaiian Men 5

Introduction

This report aims to provide a picture of traditional and contemporary wellbeing of kāne, Native Hawaiian men. Based on these descriptions, the report will also offer recommendations to support the strength of future generations of kāne. The focus here is on kāne, specifically, as we apply Hawaiian framework and methodology that incorporates a gendered perspective of both the social, spiritual, and physical word. Both the study and the recommendations are intended as starting points for additional research, discussions, and programming. Part 1: ‘O Ka Wā Mamua (The Past) starts with a depiction of the placement of kāne in Native Hawaiian society. This section will explore traditional Native Hawaiian culture and historical past. It highlights strengths that contributed to the vitality of a thriving kānaka ‘ōiwi (Native Hawaiian) nation, and also examines historical challenges that have negatively affected Native Hawaiians. It looks at the traditional kuleana (responsibilities) and contributions of kāne in Hawaiian society as a foundation for pono (proper) action. This section will also examine the mo‘ohihia, the chronology of historical difficulties which altered the traditional roles and contributions ofkāne . Finally, the section will include an examination of the continued resilience of Native Hawaiian kāne. What you will see is that Native Hawaiian men had a significant place across both the breadth and depth of Hawaiian culture, and a healthily functioning society spoke to healthy kāne, and vice versa. The idea of an individual’s well-being is directly reflected in a healthy society. That Hawaiian culture was able to flourish for hundreds of years, prior to western contact, is a testa- ment to the ways Hawaiian society kept Hawaiians healthy, and in turn healthy Hawaiians were able to tend their families, gods, avocations, and the ‘āina (land). The second part of this overview, Part 2: ‘O Kēia Au (The Present), seeks to also create a similar narrative—but this one is based on data collected from various contemporary sources— of the health of kāne, in relation to his socio-economic and other disparities. Obviously, these two sections cannot be compared directly, but it is hoped that, together, they create their own narrative—one of how rapid change in so many facets of a society has had long-lasting and far-reaching effects, in ways that are both clear and can only be fully understood in relation to other, shifting forces. Throughout, we pose questions for your consideration, about ways your organization and policymaking can affect real change forkāne . Although your organization may not work directly with some topics, we hope that using the social determinants of health (SDH) as a framework will create links between seemingly disconnected points. This report then become a jumping- off point for reflection and discussion. We also seek to highlight pathways of Native Hawaiian resiliency, even in the face of adversity that threatened and threatens to collapse the Hawaiian culture, as well as recommendations for future ways—in policy, practice, and data collection—to direct our energies and resources, in order to monitor, support, and enhance kāne health. 6 Kānehō‘ālani – Transforming the Health of Native Hawaiian Men

Methodology

This report makes significant usage of the Kūkulu Hou Methodology, which was developed by Dr. Kamana‘opono Crabbe in 2009, and is rooted in the Native Hawaiian cultural practice of umu hau pōhaku (rock-wall masonry). This practice was a fundamental aspect of constructing ancient temples, shrines, fishponds, houses, and other structures. Umu hau pōhaku required particular steps for gathering resources, site selection, construction planning, and skills training. The primary objective of the Kūkulu Hou Methodology for research and reporting is fourfold:

∫∫ To articulate the historical-cultural context of resilient and positive cultural strengths of the Hawaiian heritage as a foundation of knowledge and practice; ∫∫ To highlight the contemporary disparities in the conditions of Native Hawaiians based on available data and research; ∫∫ To provide critical analyses of systemic barriers and/or challenges with parallel solutions; and ∫∫ To make recommendations to improve the conditions of Native Hawaiians, their families and communities, as well as the broader Native Hawaiian society or lāhui.

It should be noted that first component of the report, O Ka Wā Mamua, is more narrative and historically based, as opposed to data-driven. Thus, the sources of information include traditional oral accounts that were preserved as mo‘okū‘auhau (genealogies), mo‘olelo (historical narratives), and mele (songs and chants). Written historical accounts authored by foreigners at contact were also analyzed for information relative to kāne or societal well-being. These primary sources record the long history of Native Hawaiians and were explored to affirm that Hawaiian society consisted of thriving lands, resources, and peoples. Finally, the work of contemporary scholars and academics were exhaustively researched and referenced where appropriate. The second component of this report, ‘O Kēia Au, focuses on social determinates of health which have been identified within current medical and social research literature. Data from numerous sources were compiled to provide a context or overview of how social, economic, and environment factors impact Native Hawaiian men in Hawai‘i. Major sources utilized include: the U.S. Census Bureau’s American Community Survey, the Hawai‘i State Department of Education, State of Hawai‘i Department of Human Services Statistical Report on Child Abuse and Neglect, the University of Hawai‘i Center on the Family Homelessness Services Utilization Report, and the Hawai‘i State Department of Health Behavioral Risk Factor Survey System. Finally, data on kāne health outcomes are explored as the physical manifestations of the social determinates of health. Major sources of this information include Hawai‘i State Department of Health Office of Health Status Monitory datasets and research from the University of Hawai‘i Cancer Research Center. From all sources, the most recent data at the time of writing for Native Hawaiian men was extracted and analyzed. In most cases, this selection includes data from 2014 or, where sample sizes were smaller, five-year estimates were used, which represents data that was collected over a five-year period, as opposed to a point-in-time count. Other findings reference data for the Native Hawaiian population at large. Unfortunately, in some cases data specific to kāne was not collected or was unable to be annualized due to small sample sizes. In these instances, data for the larger Native Hawaiian population is referenced, along with data for the total State male population—the populations within which kāne form a part. While specific data for kāne in regards to some topics are not available, these findings likely apply for kāne also. Kānehō‘ālani – Transforming the Health of Native Hawaiian Men 7

Part One: Historical Strengths

Note: The following sections are an abridged account of Mana Kū Kane: Native Hawaiian Men’s Wellbeing, a report prepared by ‘Aha Kāne in 2016, as well as information about the overthrow of the Hawaiian monarchy and Hawai‘i’s annexation from a 2011 internal OHA report. ‘Aha Kāne is a non-profit organization whose mission is “to strengthen the Native Hawaiian community through nurturing and perpetuating the traditional male roles and responsibilities that contribute to the physical, mental, spiritual, and social well-being of Native Hawaiian males, their families, and communities.”

‘O Ka Wā Mamua (The Past) Kāne, Native Hawaiian men, were an The Duality between Kāne and Wāhine integral part of the systems and structures One of the hallmarks of traditional Native that contributed to the well-being of all Native Hawaiian spirituality and religion is that of Hawaiians. Some academics estimate that the pono (balance) between complementary population of Hawai‘i in the late 1700s was as forces. Dualities based on light and dark, land large as 800,000 to 1 million people (Stannard, and sea, male and female, are presented in 1989). This abridged chapter is a historical ways that illustrate the importance of pono in exploration of the traditional social, economic, the Hawaiian worldview (Tengan, 2008). The and political roles of Native Hawaiian men in word “pono” has many meanings depending Hawaiian society. on the context in which it is used: it can The Mo‘ohihia section of this report refer to excellence, wellbeing, and balance includes a critical examination of historical (Pukui & Elbert, 1986). Pono can also refer to events that altered or challenged the ability of something’s true condition or nature, as well Native Hawaiian men to maintain traditional as something that is perceived as necessary. beliefs and practices within the context of the For Native Hawaiians, the balance embodied by transformations within Hawaiian society during pono could be considered to be the essential, the nineteenth and twentieth centuries. original state of something. This discussion will be sub-divided into five Many Native Hawaiian beliefs and practices areas of focus: reflected the values embodied in the divine ancestors Papa and Wākea, as well as Kū ∫∫ Kāne: Spirituality and Religion and Hina. Paired, male and female mana ∫∫ Kāne: The ‘Āina, Kai, and Resources represented a balance and harmony that was ∫∫ Kāne: Family and Relationships considered vital in Hawaiian epistemologies. ∫∫ Kāne: Education and Occupation Without kāne, wāhine would not be balanced, ∫∫ Kāne: Leadership and Politics and vice versa. Both masculine and feminine mana were essential to wellbeing in traditional Kāne: Spirituality and Religion Hawaiian society. From individual prayers offered before starting everyday tasks, to formal rituals completed by Akua and ‘Aumākua chiefs and priests, spirituality and religion were In addition to the divine ancestors named intertwined into every aspect of traditional in familiar genealogies like the Kumulipo, many Native Hawaiian life. As compared to wāhine, other akua (gods) were significant to kāne in kāne had very direct, active, and visible roles ancient Hawaiian society. The great number of in ceremonial religious practices. This section gods in traditional Hawaiian religion has been explores Native Hawaiian men and traditional described by foreign scholars as a pantheon, spiritual beliefs and practices. while Native Hawaiians acknowledged the 8 Kānehō‘ālani – Transforming the Health of Native Hawaiian Men

mano (4,000), kini (40,000), lau (400,000) and including genealogy and rank, participation lehu (great multitude, infinite) akua (Kanahele, in religious ceremonies, place of residence, or 1986). Not only were there a multitude of gods, familial observation of an individual. there were rituals, prayers, and beliefs that The application of kapu also differed accor- were specific to every area of life for Native ding to an individual’s gender. In particular, Hawaiians. Hawaiian society was characterized by the Despite the existence of countless akua, ritual separation of the sexes through kapu there were four male gods who were believed and social norms, which protected the spiritual to be primary gods and who were invoked differences in male and female mana. Because almost universally in rituals and ceremonies of their more active role in formal religious conducted by all Native Hawaiians. These ceremonies, it was necessary for kāne to gods included Kū, Kāne, Lono, and Kanaloa. maintain their spiritual sacredness through Many gods served as models for the behavior the observation of kapu in ways that were not of kāne. In mo‘olelo, the akua Kāne and usually required of wāhine. Kanaloa travelled throughout Hawai‘i and There were also specific rituals that were pierced the ground in places where there performed for and by kāne, including those was no water to form springs; they also built that marked significant milestones or events a fishpond in Honua‘ula (Helu 2, Ka Nupepa in the lives of Native Hawaiian men. These Kuokoa, January 12, 1865). These life-giving included birth, betrothal, marriage, and death. activities were imitated by generations of ali‘i, Although celebrations and ceremonies were many of whom sought to develop irrigation held for all kāne, their complexity varied systems and build fishponds as part of their according to a number of factors, including kuleana (responsibilities) as rulers to ensure rank and genealogy (Valeri, 1985). the wellbeing of people and lands under their One of the most significant ceremonies in care. the life of a kāne was known as kā i mua, which Gods were often specific to certain acti- described the transition of a young boy from vities, skills, knowledge sets, and occupations. taking his meals common eating house where In a newspaper article published on March 30, women and young children ate to the men’s 1865 in Ka Nupepa Kuokoa, S. Ekaula listed the eating house (Malo, 1951). “Kā i mua” can various ‘aumākua specific to kahuna ‘anā‘anā be translated to “thrust into the men’s eating (sorcerous priests), po‘e kanu ‘ai (farmers), house,” (Pukui, Haertig & Lee, 1972). As part lā‘au lapa‘au (medicinal healers), kahuna heiau of the kā i mua ceremony, a boy was given his (temple priests), po‘e lawai‘a (fishermen), and first malo (loincloth), which served both as a nā ali‘i (the chiefs). In this way, a kāne was mark of his entrance to the hale mua and his believed to have divine mentors and spiritual growth into manhood (Pukui, Haertig, & Lee, guidance in every part of his life. 1972). A boy was also taught to humehume, to tie or gird himself with a malo by his close Kapu and ‘Aikapu male relatives. Another important ceremony in Kapu were sacred restrictions that served the lives of kāne was the incision of the penis as guidelines for spiritual and moral behavior (kahe ule). in traditional Native Hawaiian society. There were many different types of kapu. Certain Kāne: The ‘Āina, Kai, and Resources kapu were meant to prevent overuse of The deep relationship between kāne resources; for example a konohiki (land and the ‘āina (lands) and kai (sea) is well manager) could place a kapu on a specific documented in traditional oral history and type of plant or fish if they were not abundant literature. Mo‘olelo, mele, and mo‘okū‘auhau or out of season (Malo, 1951). A kapu could be were part of a large body of knowledge main- specific to a place or a resource, but could also tained by the rigorous intellectual traditions of be specific to classes of people.Kapu were Native Hawaiians, whose studied observation also put in place to protect the sacredness of of their surroundings allowed for a deep gods, people, places, and objects. understanding of the systemic physical and The number and severity of kapu was spiritual interactions of people, resources, and applied differently in traditional Hawaiian environments. society depending on a number of factors, In mele ko‘ihonua the Hawaiian Islands Kānehō‘ālani – Transforming the Health of Native Hawaiian Men 9

were born as a result of mating between kuleana (reciprocal responsibility) resulted Papa and Wākea and their respective lovers. in self-restraint in the use of resources, and In these chants, Papa and Wākea also had also cultivated a feeling social obligation to a human daughter named Ho‘ohokukalani. the larger community. Ultimately, these values Desiring his daughter, Wākea mated with helped to protect land and marine resources Ho‘ohokukalani and they had a stillborn son, from overexploitation. who was named Hāloanakalaukapalili. He was Traditional resource management was buried in the earth, and from his body grew characterized by extensive ‘ike ‘āina and ‘ike kai the first kalo (taro; Colocasia esculenta) plant. (knowledge and close familiarity with the land Wākea and Ho‘ohokukalani had a second child, and sea, respectively). Kāne who were native to Hāloa, who is the chiefly ancestor of all Native an area carried unique cultural and historical Hawaiians (Malo, 1898). For this reason, Native knowledge, which had been passed from one Hawaiians considered themselves to be the generation to the next (McGregor, 2007). This younger siblings of both the kalo plant and the knowledge of land and sea systems and cycles Hawaiian Islands (Pukui, Haertig, & Lee, 1972). were important for gaining optimum resource These familial relationships were reflected in yield; for this reason, certain crops were the beliefs and practices surrounding mālama planted during specific moon phases to ensure ‘āina, or Hawaiian stewardship of lands, waters, that they would be ready for consumption in and resources (Kame‘eleihiwa, 1997). the best possible times. Fishermen would only catch fish in certain stages of growth, to Fishing and Farming ensure that new generations of fish would be One of the most poignant ways that kāne born for future generations of kānaka. were linked to the land and sea was through activities that were necessary for long term Kāne: Family and Relationships sustainability and survival; farming and fishing The cultural concept of piko (spiritual were foremost among these activities. centers) demonstrated the importance of While women also fished and farmed, men genealogy and familial relationships for kāne were the ones who usually engaged in the in traditional Native Hawaiian culture. Every heavier and more physically intensive forms Native Hawaiian was believed to have three of these activities. Spiritually, men were also piko, which connected him to past, present, believed to be more appropriately suited to and future generations: his manawa (fontanel) certain types of work, because of the mana connected him to his ancestors; his ma‘i they embodied. In this respect, men had (genitals) connected him to his descendants, relationships and knowledge of the land and and his umbilicus connected him to the present sea that was often specialized and different generation, parents, and blood relatives. Thus, than that of women. the ‘ohana was one of the most important formative forces in the lives of kāne. Resource Management/ Traditional Hawaiian Stewardship Family Relationships Trade and exchange between fishermen The importance of familial relationships and farmers, and between the lowlands and is readily evident in Hawaiian culture. The uplands, formed the basis of the traditional Hawaiian word for family, “‘ohana,” comes Hawaiian economic system. To sustain their from the kalo plant: the main stalk of a kalo communities and ensure that their farming is known as the ‘ohā. From this original plant, and fishing activities would not exhaust the many new plants and clusters of kalo can be resources of their lands, Native Hawaiian formed. Native Hawaiians believed families men were instrumental resource managers were similar to kalo, in that they clustered and stewards of the lands and sea. Kāne around the same root or originating source traditionally managed resources according (Pukui, Haertig, & Lee, 1976). to spiritual and cultural values and practices, Although shared ancestry was an employing extensive knowledge of physical important determining factor of ‘ohana, place. traditional Native Hawaiian families were not The societal Native Hawaiian cultural and limited to a core nuclear unit. This expansive spiritual values of mālama (to care for) and understanding of ‘ohana included extended 10 Kānehō‘ālani – Transforming the Health of Native Hawaiian Men

family who were blood relations. Native was also an important site of mentoring by Hawaiians also recognized important social male family members. In this setting, male relationships of varying degrees with other children were guided by their fathers, uncles, non-related members of the community. grandparents, and even elder brothers and The concept of ‘ohana also encompassed cousins in all manners of life and living. The deceased ancestors, who often remained hale mua allowed a boy’s learning, discipline, active in family affairs as ‘aumākua. and modeling to occur within a close-knit It was also the sacred kuleana of kāne to community; such activities were undertaken see to the physical and spiritual care of his with the support of the extended network of family. Scholar Ty Tengan (2008) notes, “On all kāne, rather than in isolated nuclear family levels, the responsibility for feeding both the units. Thus, the hale mua was one of the most family and the gods fell on the shoulders of important facets of the ‘ohana system which men” (p. 35). This responsibility encompassed shaped the lives of kāne (Tengan, 2008). all the processes associated with being able The family was such an important part of to provide nourishment, including farming social organization in traditional Hawaiian and fishing, preparation of food (such as the society, that Native Hawaiians developed building of imu) and learning and observing ways to maintain familial harmony and the necessary prayers and rituals involved in minimize discord. Ho‘oponopono was a those activities. In the hale mua, kāne were ceremonial familial mediation meant for responsible for making daily offerings and conflict resolution. If ho‘oponopono and other prayers on behalf of the entire ‘ohana (family), methods of mediation failed, a ceremony ritually feeding the gods in order to care for known as mō ka piko (cutting the navel cord) the ancestors (Pukui, Haertig & Lee, 1972). In could occur; this involved cutting all ties recognition of men’s roles as providers, Pukui between an individual and the family. For (1986) notes that the word “kua,” which has Native Hawaiians, mō ka piko was a terrible connotations of a backbone or a support, was thing, because it cut a person off from the also used to refer to a husband. support, aloha, and mana of his family (Pukui, Haertig & Lee, 1972). The ‘Ohana as a Network of a Support One of the most important functions of Kāne: Education and Occupation the ‘ohana was as a network of support, which From the time of his birth, a Native was present throughout the life of a Native Hawaiian man was groomed for familial and Hawaiian men. Networks of kinship and aloha societal roles. From the general knowledges sustained the growth of young boys into and skills necessary to survive, to the more men, perpetuating a cycle that fostered the specialized knowledges that were specific passage of knowledge and promoted learning to the deft practice of elevated occupations, throughout a lifetime. kāne were part of a genealogy of knowledge The ‘ohana played a role in the life of a that spanned generations. kāne even before he was born; it was believed that the actions, health, and even diet of a The Nature of Traditional Education pregnant woman would affect the disposition Education was not only an important means and attributes of a child. Therefore, a woman of passing on traditional knowledge, but also a would carefully follow the strictures of kahuna highly spiritual process which allowed kāne to pale keiki (midwives), with the support and gradually acquire mana. For this reason, kapu care of her family and the community (Pukui, reinforced structure and protocol in education Haertig, & Lee, 1972). and training. The ‘ohana system provided a safe Several ‘ōlelo no‘eau illustrate Native environment for learning. As a young child who Hawaiian educational values and methods ate in the hale noa, a boy was cared for by his of learning: The first, “Pa‘a ka waha, hana mother, female relatives, and other women ka lima,” “The mouth is shut, the hands are of the village. Once a boy had undergone the doing” stresses the importance of observation kā i mua ceremony, the hale mua became an without question and the importance of important place of instruction and learning actually working to learn. within the community of men. However, it Kānehō‘ālani – Transforming the Health of Native Hawaiian Men 11

elements of stone masonry, meteorology, Settings for Learning hydrology, botany, architecture, engineering, Because general learning began in the hale and so on. The same scope and depth of noa, members of the ‘ohana were the first knowledge was necessary for kāne to master formal instructors of children. According to any given practice, field, or occupation. Kamakau, the child’s parents took a lesser role In addition to the common occupations in the early nurturing of the child and “rearing of fishers and farmers, there were more was in the hands of the grandparents or their specialized esoteric occupations. Sometimes, younger or older brothers and sisters, or other entrance to these occupations was limited lateral relatives (hoahānau), or in the hands of by rank and genealogy, other times by family, the lateral relatives of the parents” (Kamakau, and natural skill or inclination. However, if a 1991, p. 26). boy demonstrated special talents or skills, he In contrast to Euro-American education might be apprenticed to a relative or expert models, young boys did not rely on a central for training in occupations such as prophecy knowledgeable authority figure, such as a or healing (Pukui, Haertig, & Lee, 1972). classroom teacher. Instead, they learned The complex structures of Hawaiian from the community through listening to their society both allowed for and necessitated elders and those more knowledgeable than the diversification and specialization of themselves, observing particular tasks, and occupations among Native Hawaiian men. eventually by doing said tasks themselves. No matter a man’s occupation, however, high While parents were important for these value was placed on deft and skilled practice educational processes, a boy’s education was and knowledge. conducted by the entire community. Cradled in a familial network of the village, which included Kāne: Leadership and Politics extended family members, the community In many ways, kāne were important leaders was responsible for the education of all within Hawaiian society. For example, within the children. The strong support of the extended maka‘āinana class, the eldest son was usually family, as well as the specific guidance of a provided with an education and trained in ways community of men found in villages, provided that would allow him to take over leadership of support networks of kinship and aloha were the family and in the hale mua; this included what sustained the growth of young boys into instruction in the proper observance of rituals men, perpetuating a cycle that fostered safe and kapu, the care of others (including the environments for learning. ancestors and family gods) as well as problem resolution and mediation (Pukui, Haertig, and Traditional Occupations Lee, 1972). However, within broader Hawaiian Traditional Hawaiian education was cen- society, male ali‘i had important responsibilities tered on preparing kāne to assume societal as sacred religious and political leaders. and occupational roles. In a fishing village or in a family of fishers for example, a boy would The Ali‘i learn knowledge specific to fishing; the same As a class, the ali‘i were responsible for was true of boys raised in families with other governance over the land, resources, and occupations. people. Rank and related responsibility was For male maka‘āinana, the most common stratified according to genealogy, and each occupations were farmers and fishers; these class of chief had different responsibilities individuals were responsible for feeding their within the political structures of Hawaiian families and communities. However, there were society. For example, the ali‘i nui or ali‘i ‘aimoku also bird catchers, cordage makers, wood and (also later known as mō‘ī) was the ruler of stone carvers, and so on. Each occupation had an entire island or several moku (districts). its own set of specialized knowledges, skills, Chiefs of lesser rank, known as kaukau ali‘i rituals, and gods. and konohiki were responsible for governance Translated to modern professions, the tasks on smaller units of land for the ali‘i nui. skills and knowledge needed to simply grow The ‘aha ali‘i was a body of the highest kalo for survival required kāne to have working ranking chiefs who were distinguished by the and sometimes expert knowledge of various use of a sacred cord called an ‘aha. In addition 12 Kānehō‘ālani – Transforming the Health of Native Hawaiian Men

to its members being representative of the would impact Native Hawaiian men within the highest mana, the ‘aha ali‘i was also a council Islands are complex, this report will highlight a of chiefs, which provided political advice in number of the economic, social, and political matters of governance, war, and diplomacy. transformations of the nineteenth and twentieth Pono leadership was tied to mana. An ali‘i centuries that had a particularly deep effect. inherited the right to rule through genealogy, as well as a specific set of kapu, which Economic Transformations sanctified him as a sacred and religious leader Some of the most visible transformations of (Malo, 1952). However, his decisions and Hawaiian society are reflected in the changing actions regarding the care of his people, the structures of the Hawaiian economy during expansion of territory, the apportionment of the nineteenth century. Whereas ancient resources, were all factors which affected his Native Hawaiians maintained highly productive ability to continue ruling. Kame‘eleihiwa (1999) economies that were carefully regulated by describes two paths to mana for ali‘i. The path the ali‘i, Euro-American commercial ideals and through Lono was accomplished through activity would redirect the basis of the Hawaiian diplomacy and marriage. The path through Kū economy to one of capitalism and place a new was accomplished through warfare. emphasis on the accumulation of wealth and As sacred religious and political leaders, personal property (Hitch, 1992). Indeed, the Native Hawaiians believed that it was the kuleana early commerce and industry in the islands, of the ali‘i to intercede in heavenly matters on which consisted primarily of the trade of furs behalf of the people, much as it was the kuleana and sandalwood, would shift to whaling, sugar of the kāne to petition the gods on behalf of a and pineapple production, and eventually maka‘āinana family. Famines, epidemics, or tourism over the course of two hundred years. other troubles could be understood as resulting The far-reaching effects of commerce in the displeasure of the gods with the ritual in the Islands are especially apparent in the observations of an ali‘i. increasing urbanization that occurred during Furthermore, a good chief would ensure the the 1800s: the concentration of new economic care of his people by facilitating the building opportunities in commercial trading centers, of infrastructure, including heiau, irrigation such as Honolulu and Lāhaina, would prompt systems, agricultural systems, and fishponds. many Native Hawaiians to leave rural areas of Issues of taxation were important, and an ali‘i the islands, a process that would ultimately would know when and how much to tax in ways alter ties among families, communities, and that would not overburden the people. It was places (McGregor, 2007). Such population believed that a wise and good chief could make shifts are evident in demographic statistics of the land and resources themselves flourish, the nineteenth century. In 1850, Hawai‘i Island and that the mana of a good ali‘i was essential was the most populated island. By 1872, O‘ahu to maintaining the wellbeing of the people. had become the most populous island with an There are many oral histories surrounding estimated population of 20,671, as compared the pono actions of ali‘i, who served as models to the estimated population of 16,001 for for leadership for future generations. Hawai‘i Island (Schmitt, 1989). As farmers and fishermen whose labor Mo‘ohihia produced the basis of subsistence, kāne had Beginning in the late 1700s, a series of traditionally provided enough food for their changes at all levels of society would both families, communities, and the ali‘i. However, hinder and alter the ability of Native Hawaiians Tengan (2008) notes that during the nineteenth to practice their culture, and in the historically century, Native Hawaiian men moved to cities short span of 100 years, Hawaiian society and were engaged in wage work away from would be fundamentally transformed. These their traditional communities. In the growing changes would disrupt the succession and capitalist systems introduced by Europeans flow of knowledge and support within Hawaiian and Americans, men were seen as the primary society, creating breakages in the systems economic and political actors, and were much that had preserved and perpetuated Native more directly involved in powerful mediums of Hawaiian culture. imperialism. For this reason, men were often Although the processes and events that more disconnected from traditional culture, Kānehō‘ālani – Transforming the Health of Native Hawaiian Men 13

whereas women were often the ones who access to the land and its resources. preserved and reinforced it (Tengan, 2008). Political Transformations Other economic activities would have large The political transformations in Hawai‘i impacts on the lives of Native Hawaiian kāne. during the nineteenth and twentieth century The introduction of goods and materials (such were indeed revolutionary, particularly when as flour, tinned foods, iron, glass, oil, and cloth) considering the scope of changes within reduced the use of some traditional materials Native Hawaiian governance structures. For and tools and increased men’s integration in example, the transition from the traditional the wage economy. The rise of sugar cultivation ali‘i system of governance to a constitutional in the islands would eliminate thousands of monarchy was astonishingly rapid. The acres of forests and alter ecosystems. Sugar presence of a unified political entity that plantations would affect the availability of spanned across the Islands was relatively new agricultural land for kalo cultivation by diverting in the early nineteenth century. The formation both land and resources, especially water of the monarchy within the Kamehameha (Wilcox, 1997). Eventually the introduction lineage as a result of unification would lead of pesticides, the switch in farming to cash to the development and strengthening of the crops, the increasing use of monocropping, Hawaiian Kingdom government. and the exhaustion of soil nutrients and would The 1819 breaking of the ‘ai kapu (eating devastate native agricultural practices. It would restrictions) and the subsequent ‘ai noa also foster immigration for sugar labor, and (free eating) by Liholiho, Keōpūolani, and intermarriage with Native Hawaiians became Ka‘ahumanu mā (Ka‘ahumanu and her more common. The introduction of ranching supporters), transformed traditional sources would have similarly devastating effects. of authority and shifted the traditional During the reign of King Kamehameha III, relationships between the ali‘i and the a system was developed to māhele (divide maka‘āinana (members of the general or portion) lands in the Islands that were populace) (Kame‘eleihiwa, 1992). once held in common under ali‘i and konohiki The 1820 arrival of the first company of system. The land of Hawai‘i was divided into missionaries, who were sent by the American individual parcels that could be held as fee Board of Commissioners for Foreign Missions simple by private individuals. The body of (ABCFM), would also impact governance; a legislation which are commonly known as number of Hawai‘i‘s most powerful ali‘i nui Māhele Acts were actually a series of laws that (high chiefs) embraced the religious doctrines were enacted in stages, which were meant of the missionaries and moved to establish laws to incorporate Western and Hawaiian legal based on Christianity, including edicts against frameworks into the Kingdom’s governance prostitution, polygamy, and adultery (Merry, structures for the purpose of caring for the 2000). To some extent, the incorporation of Native Hawaiian people. Although primarily Euro-American frameworks within Hawaiian recognized as a system of land redistribution, laws (such as voting requirements), coupled the Māhele also redistributed fishery rights. with other such factors (such as the increase The Māhele process allowed for the in the number of non-Hawaiians in the Islands) acquisition of private title to lands and would contribute to diminishing political resources; although access and resource use participation among Native Hawaiians. rights for Native Hawaiians were preserved in By the middle of the nineteenth century, the laws surrounding the Māhele, these rights members of the Hawaiian government also would be eroded by the practices of private began to consciously integrate Euro-American landowners, through court cases and the secular legal frameworks within the Kingdom’s enforcement of laws in the judicial systems, governance structures (Osorio, 2002, p. as well as in the transition of governance from 13). A Declaration of Rights was adopted by the Kingdom of Hawai‘i to the Republic of Kamehameha III on June 7, 1839; it recognized Hawai‘i, the Territory of Hawai‘i and the State a division and protection of rights between the of Hawai‘i. In later years, particularly with the Mō‘ī (King) as sovereign, the chiefs, and the erosion of many of the safeguards that were common people (McGregor, 2007). in place within traditional Hawaiian society, The first Constitution of the Kingdom was Native Hawaiians would increasingly lose adopted by Kamehameha III in 1840. The 14 Kānehō‘ālani – Transforming the Health of Native Hawaiian Men

creation and adoption of the Constitution United States, the Provisional Government represented a voluntary shift from the formed the Republic of Hawai‘i in 1894 traditional ali‘i system of governance towards (Coffman, 2009). Native Hawaiians would resist a constitutional monarchy. The Constitution the Provisional Government and annexation codified existing governmental structure by the United States during the mid-and and practice, recognizing partially separated late 1890s through forming of political hui executive, legislative and judicial branches, (groups), collecting Native petitions and establishing a Supreme Court and a bicameral testimonies, and trying to encourage political legislative body (Kingdom of Hawai‘i, 1840). advocacy among Native Hawaiians in Hawai‘i, The Legislative Session of 1851 marked a the United States, and internationally. Despite definitive shift in the governance structures the illegality of the overthrow, the lack of of the Kingdom (Osorio, 1999). In particular, support for annexation from the majority of non-Hawaiians were able to gain control of the Kingdom’s population, and the presence the authority of the House of Representatives of strong resistance movements, Hawai‘i was in 1851, and although they remained annexed through a joint resolution of the U.S. outnumbered by native representatives in Congress in 1898, during the administration 1851, their influence altered the form and of President William McKinley. By 1900, Hawai‘i purpose of the legislature. It introduced new would become a U.S. territory without the elements of governance to the Kingdom customary approval by a two-thirds majority structure and drastically shifted the purpose of Congress (Coffman, 2009). and form of Kingdom politics. For one thing, the Constitution severely limited the authority Social Transformations of the King and his ability to fulfill his traditional Many historians point to the breaking of role as an ali‘i. the 1819 ‘ai kapu (eating restrictions) and the In the transition of Hawaiian governance subsequent ‘ai noa (free eating) by Liholiho, to a constitutional monarchy during the Keōpūolani, and Ka‘ahumanu mā (Ka‘ahumanu nineteenth century, men became the primary and her supporters) as a seminal event in political actors; although ali‘i women had Hawaiian history that would greatly impact served as kuhina nui (prime minister) and had the practice of the formal state religion. been part of early House of nobles, they later However, despite the revolutionary nature of would be excluded from political proceedings. the event, many Native Hawaiian maka‘āinana, Additionally, only men were franchised under particularly in rural areas, maintained and the constitutions. Over time, men who could perpetuated their practices and beliefs not prove they owned land paid taxes, or (McGregor, 2007, p. 9). were illiterate, were also excluded from voting Besides changing the demography of (Lydecker, 1918). Hawai‘i, the influx of non-Hawaiians would Agitation from sugar and commercial instigate a flood of ideas, beliefs, and practices interests in the Kingdom, as well as those that would not only impact the traditional with American nationalist proclivities, led practice of Native Hawaiian culture and to increasing tensions within the Kingdom. history, but would also alter their value within Eventually, this resulted in the 1887 Bayonet the Islands. The settlement of foreigners Constitution, which would effectively strip in Hawai‘i began in the late 1700s; the King Kalākaua of most of his executive powers escalation of travel and the establishment of (Silva, 2004). In an effort to restore these regular trade routes within the Pacific Ocean powers to the monarchy, Queen Lili‘uokalani led to the formation of small populations attempted to promulgate a new constitution in of foreigners and beachcombers within the January 1893, but was illegally overthrown in a Hawaiian Islands by the opening decades of coup led by a group that included individuals the 1800s (Kamakau, 1992). This period also heavily associated with American commercial marked the beginning of an extended period of interests in the Islands. Stevens granted the Native Hawaiian diaspora, in which significant so-called Provisional Government a measure portions of the Native Hawaiian population of official U.S. recognition as the legitimate would move abroad (Chappell, 1997). government of Hawai‘i (Silva, 2004). Following The growth of populations of foreign a failed attempt to secure annexation by the nationals corresponded to the growing Kānehō‘ālani – Transforming the Health of Native Hawaiian Men 15

commercial activities within the Islands, and vice versa. For example, beginning in the 1850s Transformations in Hawai‘i and 1860s, the massive importation of Chinese, during the Twentieth Century Japanese, Filipino, Korean, Puerto Rican, and It is difficult to pinpoint which factors most Portuguese contract laborers for the sugar contributed to the shifting value of a traditional plantations would lead to the phenomenal Native Hawaiian cultural identity in Hawai‘i, expansion and diversification of non-Hawaiian because the changes permeated society and populations in Hawai‘i (Beechert, 1985). occurred over a period of two hundred years. Missionaries would also impact the And, while many transformations that would practice of Native Hawaiian culture (Hawai‘i affect the practice of Native Hawaiian culture Mission Children’s Society, 1969). Instead of in the Islands would occur during the Kingdom being educated by their families, boys were period in the nineteenth century, some of the now educated in missionary-run classrooms greatest and most formidable would happen by foreign teachers. Many missionaries and in the twentieth century. their descendants would become involved The difference between the transform- in Hawaiian politics and would participate in ations of the nineteenth century and those economic ventures and commercial activities, of the twentieth is that many of the socio- such as the purchase of land and investment cultural supports and protections that had in the sugar plantations (Osorio, 2002; been in place during the Kingdom period Kame‘eleihiwa, 1992; Silva, 2004). Some were severely diminished or fragmented laws that were heavily influenced by Euro- during the twentieth century. During this American religious and social mores outlawed time, fundamental paradigm shifts devalued or discouraged the performance of certain and denigrated elements of Native Hawaiian cultural activities, such as the practices of the identity, inhibiting the ability of Native kahuna lā‘au lapa‘au (Chai, 2005) and hula Hawaiians to practice their culture as they (Silva, 2000). had under the protection of the Hawaiian While the increase of non-Hawaiian monarchy. These transformations occurred in populations in Hawai‘i during the nineteenth all political, economic, and social aspects of century was remarkable, the decrease of the Native Hawaiian life. For example, English-only Native Hawaiian population was even more instruction was established in 1896, which dramatic and rapid. The introduction and Kamanā and Wilson note “had devastating spread of highly infectious diseases, such effects on literacy, academic achievement, as cholera, venereal diseases, smallpox, and and the use of standard English among Native leprosy, would decimate the Native Hawaiian Hawaiians” (in Benham and Heck, 1998, p. population (Bushnell, 1993). Population loss 261). The legislation restricting the use of the would complicate the transmission of ‘ike ‘āina Hawaiian language in schools would also have pertaining to specific places, and was likely a a deep impact on wider Hawaiian society and significant factor in the loss of historical and nearly extinguish Hawaiian-language fluency. cultural knowledge. In turn, the loss of language would As a result of the influx of foreigners and the impact the Native Hawaiian historiography rapid depopulation of Native Hawaiians, non- and significantly alter conceptions of Native Hawaiians would come to greatly outnumber Hawaiian culture (Nogelmeier, 2010). The Native Hawaiians and part Hawaiians. An loss of the ability to practice self-governance, analysis of the racial composition of the the presence of the American government Hawai‘i population shows that by 1890, Native and military, and the growing importance of Hawaiians and part Hawaiians collectively tourism would have similar effects on Hawaiian made up about 45 percent of the total society. Cumulatively, these and other changes population and non-Hawaiians the remainder. during the twentieth century would result in By 1896, the gap was even wider. Native the transformation of Native Hawaiian culture Hawaiians and part Hawaiians made up only from one that was practiced daily to one that 36 percent of the total population. Over time, must be actively recovered and revitalized. the economic, social, and political activities of foreign nationals would dominate Hawaiian society, in large part as a result of the growth of these non-Hawaiian communities. 16 Kānehō‘ālani – Transforming the Health of Native Hawaiian Men

Native Hawaiian Resiliency Despite the existence of a series of historical difficulties and the impact of deep transformations within Hawaiian society, Native Hawaiians have actively sought to preserve and perpetuate their history and culture. For example, the significance of mo‘okū‘auhau was maintained into the late 1800s: a Board of Genealogy was established in 1880 by King Kalākaua and the Legislative Assembly of the Hawaiian Kingdom (Hawaiian Kingdom, 1880). It is also important to remember that Native Hawaiians were able to rapidly adapt to many of the changes occurring within society during the nineteenth century. One of the most poignant examples can be seen in the proliferation of Native Hawaiian writings in the nūpepa, or Hawaiian-language newspapers, as documented by Puakea Nogelmeier (2010): In just over a century, from 1834 to 1948, Hawaiian writers filled 125,000 pages in nearly 100 different newspapers with their writings. While literacy was at its highest, Hawaiians embraced the Hawaiian-language newspapers as the main venue for news, opinion, and national dialogue, but also as an acknowledged public repository for history, cultural description, literature and lore.... The contents of those papers span a period when noted historians, expert genealogists, skilled storytellers, and cultural specialists were numerous, and their knowledge was intentionally recorded in writing. Kānehō‘ālani – Transforming the Health of Native Hawaiian Men 17

Part Two: ‘O Kēia Au (The Present)

Having examined the historical roles and responsibilities of Native Hawaiian kāne (Native Hawai- ian men) in traditional Hawaiian society, we turn now to a discussion of the contemporary state of kāne health and well-being. Within this discussion the larger social, economic, and cultural context must also be considered, as these factors continue to determine the health and well- being of Native Hawaiian men today.

Demographics: Hawaiians. 62.8% of Native Hawaiians The Kāne Population in Hawai‘i in the State lived in Honolulu County, As previously illustrated, there was a 18.9% lived in Hawai‘i County, 12.7% considerable decline in the Native Hawaiian lived in Maui County (including population throughout the 1800s. However, Kalawao), and 5.6% lived in Kaua‘i beginning in the 1900s the Native Hawaiian County. population began to stabilize, and then grow. ∫∫ Of the 289,970 Native Hawaiians in Naturally, kāne population figures also followed Hawai‘i, 145,849 or 50.3% were kāne, this trend. While not comparable to population with a median age 26.3 years. The figures from previous years, the new population median age for the 681,243 State figures for 2000 and 2010 showed a further males was 37.2 years. increase in the kāne population: ∫∫ In 2010, there were 527,077 Native Hawaiians in the United States: 45% ∫∫ Of the 1,360,301 State population, living in the Continental U.S. and 55% in Percent of289,970 Native (21.3%) Hawaiian were Native Population by GenderHawai‘i.

■ Native Hawaiian Male ■ State Male

0.1% 90 years and over 0.5% 0.3% 85 to 89 years 1.1% 0.7% 80 to 84 years 1.7% 1.1% 75 to 79 years 2.2% 1.6% 70 to 74 years 2.8% 2.6% 65 to 69 years 4.2% 3.5% 60 to 64 years 6.0% 4.6% 55 to 59 years 6.8% Male Population in 5.5% 50 to 54 years 7.2% Hawai‘i by Age and 6.1% 45 to 49 years 7.1% Native Hawaiian 5.9% 40 to 44 years 6.6% status 6.0% 35 to 39 years 6.5% Note. Adapted from (U.S. Census Bureau, 2010a) 6.6% 30 to 34 years 6.6% 7.5% 25 to 29 years 7.4% 7.9% 20 to 24 years 7.6% 9.6% 15 to 19 years 6.5% 9.4% 10 to 14 years 6.1% 10.2% 5 to 9 years 6.3% 10.9% Under 5 years 6.6% 10% 8% 6% 4% 2% 0% 0% 2% 4% 6% 8% 10%

Note. Adapted from (U.S. Census Bureau, 2010a)

Reading Proﬁciency, by Gender and Native Hawaiian Status, SY2015

■ Proﬁcient ■ Non-Proﬁcient

100%

72.5 58.7 52.8 39.1 58.1 44.4

50%

27.5 41.3 47.2 60.9 41.9 55.6

0% Male Female Male Female Male Female Native Hawaiian Non-Hawaiian All Students

Notes. Calculated from (DOE, 2015).

Math Proﬁciency by Gender and Native Hawaiian Status, SY2015

■ Proﬁcient ■ Non-Proﬁcient

100%

73.70 70.60 56.10 52.10 60.80 57.10

50%

26.30 29.40 43.90 47.90 39.20 42.90

0% Male Female Male Female Male Female

Native Hawaiian Non-Hawaiian All Students

Notes. Calculated from (DOE, 2015).

Science Proﬁciency, by Gender and Native Hawaiian Status, SY2015

■ Proﬁcient ■ Non-Proﬁcient

100%

65.80 67.40 47.10 50.50 52.30 55.10

50%

34.20 32.60 52.90 49.50 47.70 44.90

0% Male Female Male Female Male Female

Native Hawaiian Non-Hawaiian All Students

Notes. Calculated from (DOE, 2015).

Enrollment of Male Students, by School Type and Native Hawaiian Status, SY2015

■ Charter: Hawaiian-Focused ■ Charter: Other ■ DOE

100%

91.5 95.8 94.7

50%

2.4 0.8 2.2 6.1 3.4 3.1 0% Native Hawaiian Non-Hawaiian All Male

Notes. Calculated from (DOE, 2015).

Population of Hawai‘i with a Bachelor's Degree or Higher, by Gender and Native Hawaiian Status, 2005-2014

Total Male Population Native Hawaiian Male Native Hawaiian Female 35%

30.0% 28.3% 30%

25%

18.9% 20% 18.2% 18.4% 17.8% 16.6% 15.6% 16.0% 14.3% 15.0% 15.3% 15% 15.4% 15.0% 14.3% 14.6% 13.3% 12.8% 12.0% 12.5% 11.8% 10% 10.4%

5% 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Notes. Adapted from (U.S. Census Bureau, 2014a)

Male Unemployment in Hawai‘i, by Age and Native Hawaiian Status, 2006-2010

Non-Hawaiian Hawaiian

0.00 75 years 0.01 0.01 70 to 74 0.00 0.03 65 to 69 0.02 0.06 62 to 64 0.03 0.05 60 and 0.06 0.14 55 to 59 0.12 0.32 45 to 54 0.57 0.33 35 to 44 0.62 0.14 30 to 34 0.37 0.23 25 to 29 0.45 0.13 22 to 24 0.42 0.05 20 and 0.39 0.21 16 to 19 0.76 1.00% 0.80% 0.60% 0.40% 0.20% 0.00% 0.00% 0.20% 0.40% 0.60% 0.80% 1.00%

Notes. Adapted from (U.S. Census Bureau, 2014a)

Median Individual Earnings in Hawai‘i, by Gender and Hawaiian Status, 2005 - 2014

Hawai‘i State: Native Hawaiian: Hawai‘i State: Native Hawaiian: Male Male Female Female

$50K $48,440 $46,786 $45,911 $45,577 $45,443 $45,494 $45,748 $44,802 $45K $41,821 $41,821 $41,811 $41,238 $44,194 $43,740 $42,832 $42,826 $41,706 $38,870 $40K $38,040 $40,618 $40,259 $37,242 $40,370 $40,162 $36,242 $35,471 $36,709 $36,707 $35K $33,780 $35,977 $32,305 $35,596 $35,725

$32,739 $33,008 $32,378 $32,135 $31,950 $30K $30,872 $30,193

$25K

$20K 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Notes. Adapted from (U.S. Census Bureau, 2014a)

Male Occupational Representation in Hawai‘i, by Native Hawaiian Status, 2006 -2010 as percent of all men in occupation in Hawai‘i)

■ Native Hawaiian ■ Non Hawaiian

Material moving 33.43 66.57 Law enforcement workers including supervisors 31.08 68.92 Firefighting and prevention and other protective service workers including supervisors 27.44 72.56 Construction and extraction 27.22 72.82 Transportation occupations 27.1 72.9 Farming, fishing, and forestry 22.61 77.39 Personal care and service 20.86 79.13 Building and grounds cleaning and maintenance 20 80 Community and social service 19.73 80.27 Production 18.95 81.05 Installation, maintenance, and repair 18.42 81.58 Office and administrative support 17.35 82.65 Healthcare support 16.57 83.43 Food preparation and serving related 14.72 85.28 Arts, design, entertainment, sports, and media 13.57 86.43 Education, training, and library 11.62 88.38 Architecture and engineering 11.24 88.76 Sales and related 11.08 88.92 Management 10.6 89.4 Computer and mathematical 8.91 91.09 Business and financial 8.73 91.27 Health diagnosis and treating practitioners and other technical 7.67 92.33

Health technologists and technicians 7.44 92.56

Life, physical, and social science 5.75 93.25

Legal 5.51 93.49 0 20 40 60 80 100

Notes. Adapted from (U.S. Census Bureau, 2014a)

Average Travel Time to Work in minutes, by Gender and Native Hawaiian Status, 2014

■ Male ■ Female

35% 30.10 29.30 30% 28.20 28.50 26.70 27.30

25%

20%

15%

10%

0% Native Hawaiian Non-Hawaiian Total

Notes. Adapted from (U.S. Census Bureau, 2014a)

Homeless Service Clients in Hawai‘i, by Native Hawaiian Status, 2011 - 2015

■ Non Hawaiian ■ Native Hawaiian

16000

3,975 3,943 3,906 4,241 4,554 12000

8000 10,225 10,037 9,733 10,041 10,400

4000

0 2001 2012 2013 2014 2015

Notes. Adapted from (Yuan, 2014)

Risk Behaviors by Race-Ethnicity in Hawai‘i – Binge Drinking: 2013

40%

35% 32.6 29.1 30% 25.8 26.6 24.8 25%

20%

15% 12.1

10%

0% Native Hawaiian Caucasian Filipino Chinese Japanese State of Hawai‘i

Notes. Adapted from (Yuan, 2014)

Incarceration of Native Hawaiians as a percentage of the state prison population, by custody classiﬁcation and sex, 2012

■ Native Hawaiian ■ Non-Hawaiian

100%

90% 64.4 65.5 63.2 54.2 61.9 58.7 64.8 37.5 65.4 57.1 55.5 60.0 63.0 60.0 80%

70%

60%

50%

40%

30% 35.6 34.5 36.8 45.8 38.1 41.3 35.2 62.5 34.6 42.9 44.5 40.0 37.0 40.0

20%

10%

0% Male Female Male Female Male Female Male Female Male Female Male Female Male Female

Community Minimum Medium Close Maximum Unclassiﬁed Total

Notes. Adapted from (Yuan, 2014) 18 Kānehō‘ālani – Transforming the Health of Native Hawaiian Men

∫∫ 261,907 (49.7%) of Native Hawaiians effective solution in improving the health of in the U.S. were kāne. Their median age kāne will likely require targeted strategies in was 25.8 years. many of these areas. These health areas are all ∫∫ The kāne age-distribution plot connected to one another, and efforts towards resembles a pyramid with a wide base, improving kāne health as a whole will likely which indicates a higher fertility rate. require improvements in the various parts. Percentwise, the kāne population was The structure of this second section of the larger than the State male population report mirrors a kāne’s lifecycle, starting from before it reached parity between prenatal and familial health through morbidity, 30-34 years of age. From that point, and highlights significant health factors and the trend reversed, with the largest figures. It concludes with examples of Native percentage point difference (2.5%) Hawaiian resiliency and recommendations between 60-64 years of age. The peak for policymaking and other factors that can indicates a higher mortality rate. The positively affect kāne health and well-being. State male age-distribution plot is more rectangular below 65 years and Keiki tapers at the top, indicating a more Health begins before birth during ho‘okau- stationary population (U.S. Census hua (gestation); social determinants can affect Bureau, 2010a). health resources for the hāpai (pregnant) makuahine (mother). Keiki (child’s) early years Social Determinants can be conceptualized in three phases: infancy, of Kāne Health childhood, and adolescence. The financial and Although individuals generally strive to social resources at a family’s disposal can achieve health and well-being, not everyone enhance or inhibit their ability to provide keiki has the same opportunities to make health- (children) with nurturing and stimulating envi- Social promoting choices. Even with great motivation, ronments conducive to cognitive and Determinants of the barriers to health can be too great for behavioral development. The effects of educ- Kāne Health individuals to overcome. Health behaviors, ation and income impact health at all Using the lens of the quality and affordable medical care, genetic stages of life, but are most profound during social determinants makeup, and physical and social environments childhood. ‘Ōpio (adolescents) are generally of health (SDH), are critical in understanding an individual’s a healthy group, and when ‘ōpio experience what are the ability to be healthy. These factors are better adverse health outcomes, the causes can be interconnected known as the social determinants of health preventable. (Office of Hawaiian Affairs, 2015).) elements your (SDH). organization The social determinants of health describe ‘Ohana make-up addresses? the complex and interconnected structures, The ‘ohana continues to be the center of circumstances, environments, institutions, and Native Hawaiian identity. In 2014, there were systems that contribute to the health or harm 52,686 Native Hawaiian families in Hawai‘i. of individuals and communities. Some of the Native Hawaiian families made up 16.8% of Keiki most commonly cited factors to impact long families in the State of Hawai‘i, and had an How can your term health and well-being are early childhood average family size of 4.06 people (U.S. Census organization work to experiences, educational attainment, employ- Bureau, 2014a). address the health ment, income, housing, culture, public policy, and well-being of social and familial support networks, built and Larger Families keiki kāne? physical environments, and access to health Empirical national studies have long care and social services. Leading national and supported the theory that family size is international organizations recognize the com- negatively associated with children’s education, bination of these determinants is the most due to the impact of decreased parental time important influence on individual and popu- and financial resources. Newer studies, however, lation health outcomes (Office of Hawaiian indicate this association may vary by different Affairs, 2015). cultural conditions, such as communities with Thus, the multiple variables discussed high levels of collectivism, where parents share in the following sections interact in complex responsibility for raising children with many and multifaceted ways; such that any lasting, relatives (Chilhaya and Styrc, 2015). Kānehō‘ālani – Transforming the Health of Native Hawaiian Men 19

Additional research is necessary to parent, while of Native Hawaiian families determine if the presence of more children 39% are single-parent. Specially, 28% in Native Hawaiian families and households is of Native Hawaiian families were single- also negatively associated with education and mother and 11% were single-father. other social determinate of health, or if these ∫∫ Additionally, in 2014, of the 4,201 Native impacts are mitigated by Native Hawaiian Hawaiian women who had given birth traditions of extended family involvement and in the past 12 months, 2,514 or 60% support. were unmarried. This figure compares with 32% of the total State (U.S. Census ∫∫ The total State average family size was Bureau, 2014a). 3.61, considerably smaller than those of Native Hawaiians. This figure includes Multi-Generational Living members of the household who are not Since the Great Recession of 2008, multi- related by birth, adoption, or marriage. generational living across the United States ∫∫ Of these families, 17,228 or 32.7% has grown in popularity. In Native Hawaiian had children younger than 18 years, communities, however, these household in comparison with 27.3% of the total structures are consistent with traditional State family households (U.S. Census practices which emphasized the importance Bureau, 2014a). of ‘ohana and kūpuna (grandparent). Current research indicates three-generation living Single Parent Families as a protective factor in early childhood The number of parents in a household can experiences (Kamehameha Schools, 2014). impede a family’s ability to provide resources This setting includes the keiki, mākua for its keiki. In 2014, the Hawai‘i median family (parents), and kūpuna living together in one income for single-father households was home, as opposed to “skipped- generation” 68% that of a married couples, while single- households in which kūpuna are the primary Single Parent mother households median family income caregivers and the mākua is absent. National Families was 56% that of married couple families (U.S. research on skipped-generation households In what ways can Census Bureau, 2014a). Additionally, current indicates that these children might face your approach research on fatherhood in Hawai‘i concluded additional risk factors, which can negatively change or vary that “fathering matters because it is related impact their future health (Scommergna, towards improving to important outcomes of children, including 2012). the situation of cognitive, social, and behavioral. Both the single parents? quantity and quality of father involvement ∫∫ In 2014, 8.6% of the Native Hawaiian appear to be important in shaping child population over the age of 30 lived with outcomes, above and beyond the contribution their mo‘opuna (grandchildren). of mothers” (Lewin-Bizan, 2015). National ∫∫ 37.2% of these kūpuna were financially research suggests that “the absence of stable responsible for their mo‘opuna’s basic fathers from children’s lives has particularly needs, such as food, shelter, and day significant adverse consequences for boys’ care. This responsibility may indicate a psychosocial development and educational skipped-generation household. achievement” (Autor and Wasserman, 2013). ∫∫ By comparison, of the total State Thus, many future social determinates of population over the age of 30, 6.4% men’s health, such as education, occupation, lived with their grandchild(ren); 25.3% and earnings, can be affected by the early of whom were responsible for the childhood experience of family structure. child(ren)’s basic needs. ∫∫ Additionally, 19.1% of Native Hawaiian ∫∫ Data on the ‘ohana makeup for Native households included other relatives Hawaiian households from 2014 not related to the householder by demonstrate that Native Hawaiian keiki birth, marriage, or adoption, compared are more likely to come from single- to 14.2% for the State (U.S. Census parent households than other keiki in Bureau, 2014a). the State of Hawai‘i. 26% of families in the total State population are single- 20 Kānehō‘ālani – Transforming the Health of Native Hawaiian Men

Abuse/Neglect Education Countless national and international There are many long-term health effects studies confirm that sustained childhood of education that reach into adulthood, experiences of abuse or neglect also including improved cognitive development, have long-term consequences for mental improved social-emotional development, and and physical health, as well as for social general health knowledge. Improved cognitive adjustment, academic achievements, and development is associated with greater subsequent employment histories. Adults academic achievement, which translates with a history of childhood abuse have been into better employment opportunities and found to suffer from significantly more health higher earning potential. Improved social- conditions, and mental health effects include emotional development is associated with depressive disorders, anxiety disorders, drug decreased propensity for risk-taking, stress, abuse, and suicidal behavior (Moore, McDonald absenteeism from school, and self-regulation. & McHugh-Dillon, 2015; Cashmore & Shakel, General health knowledge informs students 2013; McLeod et al., 2014; Macmillan, 2009; of health promoting and risky behaviors. Norman et al., 2012; Reeve & van Gool, 2013; High educational attainment predisposes Zielinski, 2009). the recipient to a higher health trajectory. Limited research points to links between These individuals report lower chronic and boys’ experience of abuse or neglect in child- acute disease burden, independent of basic hood and increased rates of substance abuse, demographic and employment indicators sexual transmitted diseases, and perpetration (Office of Hawaiian Affairs, 2015). of domestic violence in adulthood. Far more studies focused on the effects of child abuse School Enrollment in Kindergarten through and neglect in women, making it difficult to Twelfth Grade compare differences between men and women Historically, the State of Hawai‘i has one as less is known on the effects of child abuse of the highest percent of students enrolled in and neglect on men (Springer, 2007). private schools nationwide. Factors which may Although Native Hawaiian keiki kāne (boys) influence a student’s school enrollment may experience increased protective factors due include family income, parent educational to cultural values and traditional practices, attainment, race, ethnicity, religious affiliation, Abuse/Neglect current social, economic, and political condi- and Hawai‘i State Department of Education How can your tions (such as financial insecurity and unem- (DOE) School Quality rating. The long-term organization address ployment) create disproportionately high levels impact of private education in comparison to the need to reduce of child abuse and neglect within Native Hawaiian DOE education has not been determined. the incidence and households (Kamehameha Schools, 2014). prevalence of ∫∫ In 2015, Native Hawaiians constituted childhood abuse and ∫∫ In 2014, 31% of all children in Hawai‘i 26.1% of male students in the DOE neglect? were Native Hawaiian, yet Native system, including charter schools (24,659 Hawaiian keiki constituted 42.6% of all of 94,590 male students) (DOE, 2015). confirmed victims of abuse and neglect ∫∫ Of these Native Hawaiian male in Hawai‘i (State of Hawai‘i, Dept. of students, 70.2% were classified as Human Services, 2014), a dramatic economically disadvantaged, as over-representation (U.S. Census indicated through their eligibility Bureau, 2014a). for the federal free/reduced lunch ∫∫ Notably, though, confirmed cases of program (DOE, 2015). Native Hawaiian child abuse and neglect ∫∫ Although not directly comparable have decreased from 1,456 cases in with the information from 2015, data 2000 to 600 in 2014 (State of Hawai‘i, from the 2010 U.S. Census indicated Dept. of Human Services, 2014). that 14.8% of Native Hawaiian male ∫∫ Although data are not available specific students in kindergarten thorough to Native Hawaiian boys, in the total twelfth grade were enrolled in private State population boys constituted 46.8% school and 85.2% were enrolled in DOE of confirmed victims (State of Hawai‘i, schools (calculated from U.S. Census Dept. of Human Services, 2014). Bureau, 2010b). Percent of Native Hawaiian Population by Gender

■ Native Hawaiian Male ■ State Male

0.1% 90 years and over 0.5% 0.3% 85 to 89 years 1.1% 0.7% 80 to 84 years 1.7% 1.1% 75 to 79 years 2.2% 1.6% 70 to 74 years 2.8% 2.6% 65 to 69 years 4.2% 3.5% 60 to 64 years 6.0% 4.6% 55 to 59 years 6.8% 5.5% 50 to 54 years 7.2% 6.1% 45 to 49 years 7.1% 5.9% 40 to 44 years 6.6% 6.0% 35 to 39 years 6.5% 6.6% 30 to 34 years 6.6% 7.5% 25 to 29 years 7.4% 7.9% 20 to 24 years 7.6% 9.6% 15 to 19 years 6.5% 9.4% 10 to 14 years 6.1% 10.2% 5 to 9 years 6.3% 10.9% Under 5 years 6.6% 10% 8% 6% 4% 2% 0% 0% 2% 4% 6% 8% 10%

Note. Adapted from (U.S. Census Bureau, 2010a) Kānehō‘ālani – Transforming the Health of Native Hawaiian Men 21 Reading Proﬁciency, by Gender and Native Hawaiian Status, SY2015

■ Proﬁcient ■ Non-Proﬁcient

100%

72.5 58.7 52.8 39.1 58.1 44.4 Reading Proficiency, by Gender and Native Hawaiian Status, 50% SY2015 Notes. Calculated from (DOE, 2015).

27.5 41.3 47.2 60.9 41.9 55.6

0% Male Female Male Female Male Female Native Hawaiian Non-Hawaiian All Students

Notes. Calculated∫∫ In comparison, from (DOE, 18.1% 2015). of non-Hawaiian the new system reports results within four male students in Hawai‘i were enrolled categories, including Exceeded Standard, in private schools, and 81.9% were Met Standard, Nearly Met Standard, and enrolled in DOE schools. Across the Did Not Meet Standard. As in any evaluation nation, 10.3% of male students were based on standardized achievement tests, enrolled in private schools, and 89.7% this discussion must consider the inherent in DOE schools (calculated from U.S. limitations of this form of assessment. Many Census Bureau, 2010). education scholars suggest that standardized Math Proficiency by Gender and Native Hawaiian Status, SY2015 assessment methods are culturally bias and Standardized Kamehameha Schools is the■ largest Proficient Native■ Non-Proficientskew results by actually measuring test-taking Educational Hawaiian-serving private school in the State. skills rather than educational achievement. Achievement 100%Within a comparable time period, an annual The following data on Native Hawaiian student Tests average of 5,369 Native Hawaiian students test results is presented within the larger How can your were enrolled at Kamehameha Schools context of these debates. organization impact campuses (calculated from Kamehameha kāne youth within Schools,73.70 2011). If 50%70.60 of these students56.10 ∫∫52.10Reading 60.80 57.10 Hawai’i’s educational are assumed male, these averages equate ΩΩ In 2015, 27.5% of all Native Hawaiian system? with 7.5% of Native Hawaiian male students male students tested were proficient statewide and 50.9% of Native Hawaiian male in reading. private school students. ΩΩ A higher percent of Native Hawaiian 50% female students tested proficient Standardized Educational Achievement Tests in reading than Native Hawaiian In school year 2014 – 2015 the Hawai‘i male students, by 13.8 percentage State DOE fully implemented a new standard- points. ized achievement test system: The Smarter ΩΩ A higher percent of non-Hawaiian Balanced26.30 Assessments.29.40 This system43.90 was 47.90male students39.20 tested proficient42.90 in designed to align the new Hawai‘i Common reading than Native Hawaiian male Core Standards and measure whether students, by 19.7 percentage points. 0%students are “on track” for college and career (DOE, 2015) readiness.Male These testsFemale are administeredMale ∫Female∫ Math Male Female in grades three through eight and 11. Like ΩΩ In 2015, 26.3% of all Native Hawaiian previous standardizedNative Hawaiian tests used in the Non-HawaiianDOE, male students testedAll Students were proficient

Notes. Calculated from (DOE, 2015).

Science Proﬁciency, by Gender and Native Hawaiian Status, SY2015

■ Proﬁcient ■ Non-Proﬁcient

100%

65.80 67.40 47.10 50.50 52.30 55.10

50%

34.20 32.60 52.90 49.50 47.70 44.90

0% Male Female Male Female Male Female

Native Hawaiian Non-Hawaiian All Students

Notes. Calculated from (DOE, 2015).

Enrollment of Male Students, by School Type and Native Hawaiian Status, SY2015

■ Charter: Hawaiian-Focused ■ Charter: Other ■ DOE

100%

91.5 95.8 94.7

50%

2.4 0.8 2.2 6.1 3.4 3.1 0% Native Hawaiian Non-Hawaiian All Male

Notes. Calculated from (DOE, 2015).

Population of Hawai‘i with a Bachelor's Degree or Higher, by Gender and Native Hawaiian Status, 2005-2014

Total Male Population Native Hawaiian Male Native Hawaiian Female 35%

30.0% 28.3% 30%

25%

18.9% 20% 18.2% 18.4% 17.8% 16.6% 15.6% 16.0% 14.3% 15.0% 15.3% 15% 15.4% 15.0% 14.3% 14.6% 13.3% 12.8% 12.0% 12.5% 11.8% 10% 10.4%

5% 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Notes. Adapted from (U.S. Census Bureau, 2014a)

Male Unemployment in Hawai‘i, by Age and Native Hawaiian Status, 2006-2010

Non-Hawaiian Hawaiian

Notes. Adapted from (U.S. Census Bureau, 2014a)

Median Individual Earnings in Hawai‘i, by Gender and Hawaiian Status, 2005 - 2014

Hawai‘i State: Native Hawaiian: Hawai‘i State: Native Hawaiian: Male Male Female Female

$32,739 $33,008 $32,378 $32,135 $31,950 $30K $30,872 $30,193

$25K

$20K 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Notes. Adapted from (U.S. Census Bureau, 2014a)

Male Occupational Representation in Hawai‘i, by Native Hawaiian Status, 2006 -2010 as percent of all men in occupation in Hawai‘i)

■ Native Hawaiian ■ Non Hawaiian

Health technologists and technicians 7.44 92.56

Life, physical, and social science 5.75 93.25

Legal 5.51 93.49 0 20 40 60 80 100

Notes. Adapted from (U.S. Census Bureau, 2014a)

Average Travel Time to Work in minutes, by Gender and Native Hawaiian Status, 2014

■ Male ■ Female

35% 30.10 29.30 30% 28.20 28.50 26.70 27.30

25%

20%

15%

10%

0% Native Hawaiian Non-Hawaiian Total

Notes. Adapted from (U.S. Census Bureau, 2014a)

Homeless Service Clients in Hawai‘i, by Native Hawaiian Status, 2011 - 2015

■ Non Hawaiian ■ Native Hawaiian

16000

3,975 3,943 3,906 4,241 4,554 12000

8000 10,225 10,037 9,733 10,041 10,400

4000

0 2001 2012 2013 2014 2015

Notes. Adapted from (Yuan, 2014)

Risk Behaviors by Race-Ethnicity in Hawai‘i – Binge Drinking: 2013

40%

35% 32.6 29.1 30% 25.8 26.6 24.8 25%

20%

15% 12.1

10%

0% Native Hawaiian Caucasian Filipino Chinese Japanese State of Hawai‘i

Notes. Adapted from (Yuan, 2014)

Incarceration of Native Hawaiians as a percentage of the state prison population, by custody classiﬁcation and sex, 2012

■ Native Hawaiian ■ Non-Hawaiian

100%

90% 64.4 65.5 63.2 54.2 61.9 58.7 64.8 37.5 65.4 57.1 55.5 60.0 63.0 60.0 80%

70%

60%

50%

40%

30% 35.6 34.5 36.8 45.8 38.1 41.3 35.2 62.5 34.6 42.9 44.5 40.0 37.0 40.0

20%

10%

0% Male Female Male Female Male Female Male Female Male Female Male Female Male Female

Community Minimum Medium Close Maximum Unclassiﬁed Total

Notes. Adapted from (Yuan, 2014) Percent of Native Hawaiian Population by Gender Percent of Native Hawaiian Population by Gender ■ Native Hawaiian Male ■ State Male ■ Native Hawaiian Male ■ State Male 0.1% 90 years and over 0.5% 0.3%0.1% 9085 years to 89 and years over 1.0.5%1% 0.7%0.3% 8085 to 8489 years 1.7%1.1% 1.1%0.7% 7580 to 7984 years 2.2%1.7% 1.6%1.1% 7075 to 7479 years 2.8%2.2% 2.6%1.6% 6570 to 6974 years 4.2%2.8% 3.5%2.6% 6065 to 6469 years 6.0%4.2% 4.6%3.5% 5560 to 5964 years 6.8%6.0% 5.5%4.6% 5055 to 5459 years 7.2%6.8% 6.1%5.5% 4550 to 4954 years 7.1%7.2% 5.9%6.1% 4045 to 4449 years 6.6%7.1% 5.9%6.0% 3540 to 3944 years 6.5%6.6% 6.6%6.0% 3035 to 3439 years 6.6%6.5% 6.6%7.5% 2530 to 2934 years 7.4%6.6% 7.9%7.5% 2025 to 2429 years 7.6%7.4% 9.6%7.9% 1520 to 1924 years 6.5%7.6% 9.4%9.6% 1015 to 1419 years 6.1%6.5% 10.2%9.4% 105 to 914 years years 6.3%6.1% 10.9%10.2% Under5 to 9 5 years years 6.6%6.3% 10% 8% 6% 4% 10.9%2% 0% Under 5 years 0% 6.6%2% 4% 6% 8% 10% 10% 8% 6% 4% 2% 0% 0% 2% 4% 6% 8% 10% Note. Adapted from (U.S. Census Bureau, 2010a) Note. Adapted from (U.S. Census Bureau, 2010a)

Reading Proficiency, by Gender and Native Hawaiian Status, SY2015 Reading Proficiency, by Gender and Native Hawaiian Status, SY2015 ■ Proficient ■ Non-Proficient ■ Proficient ■ Non-Proficient 100% 100%

72.5 58.7 52.8 39.1 58.1 44.4 72.5 58.7 52.8 39.1 58.1 44.4

50% 50%

27.5 41.3 47.2 60.9 41.9 55.6 27.5 41.3 47.2 60.9 41.9 55.6

22 Kānehō‘ālani – Transforming the Health of Native Hawaiian Men

Math Proficiency by Gender and Native Hawaiian Status, SY2015 Math Proficiency by Gender and Native Hawaiian Status, SY2015 ■ Proficient ■ Non-Proficient ■ Proficient ■ Non-Proficient 100% 100%

73.70 70.60 56.10 52.10 60.80 57.10 Math Proficiency by 73.70 70.60 56.10 52.10 60.80 57.10 Gender and Native Hawaiian Status, SY2015 50% Notes. Calculated from (DOE, 2015). 50%

26.30 29.40 43.90 47.90 39.20 42.90 26.30 29.40 43.90 47.90 39.20 42.90

0% 0% Male Female Male Female Male Female Male Female Male Female Male Female Native Hawaiian Non-Hawaiian All Students Native Hawaiian Non-Hawaiian All Students Notes. Calculatedin math. from (DOE, 2015). (DOE, 2015). Notes. CalculatedΩΩ A higher from percent (DOE, of2015). Native Hawaiian female students tested proficient ∫∫ Science (The Hawai‘i State in math than Native Hawaiian male Assessments are still used for science students, by 3.1 percentage points. and are administered in grades 4 and 8) ΩΩ A higher percent of non-Hawaiian ΩΩ In 2015, 34.2% of all Native Hawaiian male students tested proficient in male students tested were proficient Science Proficiency,math than Native by Gender Hawaiian and male Native Hawaiianin science. Status, SY2015 Science Proficiency,students, by 17.6 by percentage Gender and points. Native HawaiianΩΩ A higher Status, percent SY2015 of Native Hawaiian ■ Proficient ■ Non-Proficient ■ Proficient ■ Non-Proficient 100% 100%

65.80 67.40 47.10 50.50 52.30 55.10 65.80 67.40 47.10 50.50 52.30 55.10

Science Proficiency, 65.8% 67.4% 47.1% 50.5% 52.3% 55.1% 50% by Gender and Native 50% Hawaiian Status, SY2015 Notes. Calculated from (DOE, 2015). 34.20 32.60 52.90 49.50 47.70 44.90 34.20 32.60 52.90 49.50 47.70 44.90

0% 34.2% 32.6% 52.9% 49.5% 47.7% 44.9% 0% Male Female Male Female Male Female Male Female Male Female Male Female Native Hawaiian Non-Hawaiian All Students Native Hawaiian Non-Hawaiian All Students Notes. Calculated from (DOE, 2015). Notes. Calculated from (DOE, 2015).

Enrollment of Male Students, by School Type and Native Hawaiian Status, SY2015 Enrollment of Male Students, by School Type and Native Hawaiian Status, SY2015 ■ Charter: Hawaiian-Focused ■ Charter: Other ■ DOE ■ Charter: Hawaiian-Focused ■ Charter: Other ■ DOE 100% 100% 91.5 95.8 94.7 91.5 95.8 94.7

50% 50%

2.4 0.8 2.2 2.4 0.8 2.2 6.1 3.4 3.1 0% 6.1 3.4 3.1 0% Native Hawaiian Non-Hawaiian All Male Native Hawaiian Non-Hawaiian All Male Notes. Calculated from (DOE, 2015). Notes. Calculated from (DOE, 2015).

Population of Hawai‘i with a Bachelor's Degree or Higher, byPopulation Gender and of Hawai‘i Native Hawaiianwith a Bachelor's Status, 2005-2014Degree or Higher, by Gender and Native Hawaiian Status, 2005-2014 Total Male Population Native Hawaiian Male Native Hawaiian Female 35% Total Male Population Native Hawaiian Male Native Hawaiian Female 35% 30.0% 28.3% 30% 30.0% 28.3% 30%

25% 25% 18.9% 20% 18.2% 18.4% 17.8% 16.6% 18.4% 18.9% 20% 15.6% 16.0% 18.2% 17.8% 14.3% 16.6% 15.0% 15.3% 15.6% 15.3% 16.0% 15% 14.3% 15.0% 15.4% 15.0% 15% 14.3% 14.6% 13.3% 12.8% 15.4% 15.0% 12.0% 14.3% 12.5% 11.8% 10% 14.6% 13.3% 12.8% 12.0% 10.4% 12.5% 11.8% 10% 10.4% 5% 5% 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Notes. Adapted from (U.S. Census Bureau, 2014a) Notes. Adapted from (U.S. Census Bureau, 2014a)

Male Unemployment in Hawai‘i, by Age and Native Hawaiian Status, 2006-2010 Male Unemployment in Hawai‘i, by Age and Native Hawaiian Status, 2006-2010 Non-Hawaiian Hawaiian Non-Hawaiian Hawaiian 0.00 75 years 0.01 0.010.00 7570 yearsto 74 0.000.01 0.030.01 6570 to 6974 0.020.00 0.060.03 6265 to 6469 0.030.02 0.050.06 6260 to and 64 0.060.03 0.140.05 5560 to and 59 0.120.06 0.320.14 4555 to 5459 0.570.12 0.330.32 3545 to 4454 0.620.57 0.140.33 3035 to 3444 0.370.62 0.230.14 2530 to 2934 0.450.37 0.130.23 2225 to 2429 0.420.45 0.050.13 2220 to and 24 0.390.42 0.210.05 1620 to and 19 0.760.39 1.00% 0.80% 0.60% 0.40% 0.210.20% 0.00%16 to 190.00% 0.760.20% 0.40% 0.60% 0.80% 1.00% 1.00% 0.80% 0.60% 0.40% 0.20% 0.00% 0.00% 0.20% 0.40% 0.60% 0.80% 1.00% Notes. Adapted from (U.S. Census Bureau, 2014a) Notes. Adapted from (U.S. Census Bureau, 2014a)

Median Individual Earnings in Hawai‘i, by Gender and Hawaiian Status, 2005 - 2014 Median Individual Earnings in Hawai‘i, by Gender and Hawaiian Status, 2005 - 2014 Hawai‘i State: Native Hawaiian: Hawai‘i State: Native Hawaiian: Hawai‘iMale State: NativeMale Hawaiian: Hawai‘iFemale State: NativeFemale Hawaiian: Male Male Female Female $50K $48,440 $46,786 $48,440 $50K $45,911 $45,577 $45,443 $45,494 $45,748 $46,786 $44,802 $45,911 $45,577 $45,443 $45,494 $45,748 $45K $44,802 $41,821 $41,821 $41,811 $45K $41,238 $44,194 $41,821 $43,740 $41,821 $41,811 $41,238 $42,832 $42,826 $44,194 $43,740 $41,706 $38,870 $40K $42,832 $42,826 $38,040 $40,618 $40,259 $41,706 $38,870 $37,242 $40,370 $40,162 $40K $36,242 $38,040 $40,618 $40,259 $35,471 $37,242 $40,370 $40,162 $36,242 $33,780 $35,471 $36,709 $35,977 $36,707 $35K $32,305 $36,709 $35,596 $36,707 $35,725 $35K $33,780 $35,977 $32,305 $35,596 $35,725 $32,739 $33,008 $32,378 $32,135 $31,950 $33,008 $30K $30,872 $32,739 $30,193 $32,378 $32,135 $31,950 $30K $30,872 $30,193 $25K $25K

$20K $20K 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Notes. Adapted from (U.S. Census Bureau, 2014a) Notes. Adapted from (U.S. Census Bureau, 2014a)

Male Occupational Representation in Hawai‘i, by Native Hawaiian Status, 2006Male Occupational -2010 as percent Representation of all men in in occupation Hawai‘i, by in Native Hawai‘i) Hawaiian Status, 2006 -2010 as percent of all men in occupation in Hawai‘i) ■ Native Hawaiian ■ Non Hawaiian ■ Native Hawaiian ■ Non Hawaiian Material moving 33.43 66.57 Material moving 33.43 66.57 Law enforcement workers including supervisors 31.08 68.92 Law enforcement workers including supervisors 31.08 68.92 Firefighting and prevention and other protective service workers including supervisors 27.44 72.56 Firefighting and prevention and other protective service workers including supervisors 27.44 72.56 Construction and extraction 27.22 72.82 Construction and extraction 27.22 72.82 Transportation occupations 27.1 72.9 Transportation occupations 27.1 72.9 Farming, fishing, and forestry 22.61 77.39 Farming, fishing, and forestry 22.61 77.39 Personal care and service 20.86 79.13 Personal care and service 20.86 79.13 Building and grounds cleaning and maintenance 20 80 Building and grounds cleaning and maintenance 20 80 Community and social service 19.73 80.27 Community and social service 19.73 80.27 Production 18.95 81.05 Production 18.95 81.05 Installation, maintenance, and repair 18.42 81.58 Installation, maintenance, and repair 18.42 81.58 Office and administrative support 17.35 82.65 Office and administrative support 17.35 82.65 Healthcare support 16.57 83.43 Healthcare support 16.57 83.43 Food preparation and serving related 14.72 85.28 Food preparation and serving related 14.72 85.28 Arts, design, entertainment, sports, and media 13.57 86.43 Arts, design, entertainment, sports, and media 13.57 86.43 Education, training, and library 11.62 88.38 Education, training, and library 11.62 88.38 Architecture and engineering 11.24 88.76 Architecture and engineering 11.24 88.76 Sales and related 11.08 88.92 Sales and related 11.08 88.92 Management 10.6 89.4 Management 10.6 89.4 Computer and mathematical 8.91 91.09 Computer and mathematical 8.91 91.09 Business and financial 8.73 91.27 Business and financial 8.73 91.27 Health diagnosis and treating practitioners and other technical 7.67 92.33 Health diagnosis and treating practitioners and other technical 7.67 92.33 Health technologists and technicians 7.44 92.56 Health technologists and technicians 7.44 92.56 Life, physical, and social science 5.75 93.25 Life, physical, and social science 5.75 93.25 Legal 5.51 93.49 Legal 5.51 93.49 0 20 40 60 80 100 0 20 40 60 80 100 Notes. Adapted from (U.S. Census Bureau, 2014a) Notes. Adapted from (U.S. Census Bureau, 2014a)

Average Travel Time to Work in minutes, by Gender and NativeAverage Hawaiian Travel Time Status, to Work 2014 in minutes, by Gender and Native Hawaiian Status, 2014 ■ Male ■ Female ■ Male ■ Female 35% 35% 30.10 29.30 30% 30.10 28.20 28.50 29.30 26.70 27.30 30% 28.20 28.50 26.70 27.30 25% 25% 20% 20% 15% 15% 10% 10% 5% 5% 0% 0% Native Hawaiian Non-Hawaiian Total Native Hawaiian Non-Hawaiian Total Notes. Adapted from (U.S. Census Bureau, 2014a) Notes. Adapted from (U.S. Census Bureau, 2014a)

Homeless Service Clients in Hawai‘i, by Native Hawaiian Status, 2011 - 2015 Homeless Service Clients in Hawai‘i, by Native Hawaiian Status, 2011 - 2015 ■ Non Hawaiian ■ Native Hawaiian ■ Non Hawaiian ■ Native Hawaiian 16000 16000

3,975 3,943 3,906 4,241 4,554 12000 3,975 3,943 3,906 4,241 4,554 12000

8000 10,225 10,037 9,733 10,041 10,400 8000 10,225 10,037 9,733 10,041 10,400

4000 4000

0 0 2001 2012 2013 2014 2015 2001 2012 2013 2014 2015 Notes. Adapted from (Yuan, 2014) Notes. Adapted from (Yuan, 2014)

Risk Behaviors by Race-Ethnicity in Hawai‘i – Binge Drinking: 2013 Risk Behaviors by Race-Ethnicity in Hawai‘i – Binge Drinking: 2013 40% 40% 35% 32.6 35% 32.6 29.1 30% 29.1 25.8 26.6 30% 24.8 25.8 26.6 25% 24.8 25% 20% 20% 15% 12.1 15% 12.1 10% 10% 5% 5% 0% 0% Native Hawaiian Caucasian Filipino Chinese Japanese State of Hawai‘i Native Hawaiian Caucasian Filipino Chinese Japanese State of Hawai‘i Notes. Adapted from (Yuan, 2014) Notes. Adapted from (Yuan, 2014)

Incarceration of Native Hawaiians as a percentage of the stateIncarceration prison population, of Native Hawaiians by custody as classification a percentage and of the sex, 2012 state prison population, by custody classification and sex, 2012 ■ Native Hawaiian ■ Non-Hawaiian ■ Native Hawaiian ■ Non-Hawaiian 100% 100% 90% 90% 64.4 65.5 63.2 54.2 61.9 58.7 64.8 37.5 65.4 57.1 55.5 60.0 63.0 60.0 80% 64.4 65.5 63.2 54.2 61.9 58.7 64.8 37.5 65.4 57.1 55.5 60.0 63.0 60.0 80% 70% 70% 60% 60% 50% 50% 40% 40% 30% 35.6 34.5 36.8 45.8 38.1 41.3 35.2 62.5 34.6 42.9 44.5 40.0 37.0 40.0 30% 35.6 34.5 36.8 45.8 38.1 41.3 35.2 62.5 34.6 42.9 44.5 40.0 37.0 40.0 20% 20% 10% 10% 0% 0% Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Community Minimum Medium Close Maximum Unclassified Total Community Minimum Medium Close Maximum Unclassified Total Notes. Adapted from (Yuan, 2014) Notes. Adapted from (Yuan, 2014) Percent of Native Hawaiian Population by Gender

■ Native Hawaiian Male ■ State Male

0.1% 90 years and over 0.5% 0.3% 85 to 89 years 1.1% 0.7% 80 to 84 years 1.7% 1.1% 75 to 79 years 2.2% 1.6% 70 to 74 years 2.8% 2.6% 65 to 69 years 4.2% 3.5% 60 to 64 years 6.0% 4.6% 55 to 59 years 6.8% 5.5% 50 to 54 years 7.2% 6.1% 45 to 49 years 7.1% 5.9% 40 to 44 years 6.6% 6.0% 35 to 39 years 6.5% 6.6% 30 to 34 years 6.6% 7.5% 25 to 29 years 7.4% 7.9% 20 to 24 years 7.6% 9.6% 15 to 19 years 6.5% 9.4% 10 to 14 years 6.1% 10.2% 5 to 9 years 6.3% 10.9% Under 5 years 6.6% 10% 8% 6% 4% 2% 0% 0% 2% 4% 6% 8% 10%

Note. Adapted from (U.S. Census Bureau, 2010a)

Reading Proﬁciency, by Gender and Native Hawaiian Status, SY2015

■ Proﬁcient ■ Non-Proﬁcient

100%

72.5 58.7 52.8 39.1 58.1 44.4

50%

27.5 41.3 47.2 60.9 41.9 55.6

0% Male Female Male Female Male Female Native Hawaiian Non-Hawaiian All Students

Notes. Calculated from (DOE, 2015).

Math Proﬁciency by Gender and Native Hawaiian Status, SY2015

■ Proﬁcient ■ Non-Proﬁcient

100%

73.70 70.60 56.10 52.10 60.80 57.10

50%

26.30 29.40 43.90 47.90 39.20 42.90

0% Male Female Male Female Male Female

Native Hawaiian Non-Hawaiian All Students

Notes. Calculated from (DOE, 2015).

Science Proﬁciency, by Gender and Native Hawaiian Status, SY2015

■ Proﬁcient ■ Non-Proﬁcient

100%

65.80 67.40 47.10 50.50 52.30 55.10

50%

34.20 32.60 52.90 49.50 47.70 44.90

0% Male Female Male Female Male Female

Native Hawaiian Non-Hawaiian All Students

Notes. Calculated from (DOE, 2015).

Kānehō‘ālani – Transforming the Health of Native Hawaiian Men 23

Enrollment of Male Students, by School Type and Native Hawaiian Status, SY2015

■ Charter: Hawaiian-Focused ■ Charter: Other ■ DOE

100%

91.5 95.8 94.7

Enrollment of Male Students, by School Type and Native Hawaiian Status, 50% SY2015 Notes. Calculated from (DOE, 2015).

2.4 0.8 2.2 6.1 3.4 3.1 0% Native Hawaiian Non-Hawaiian All Male

Notes. Calculatedmale from students (DOE, 2015). tested proficient in science than Native Hawaiian female ∫∫ Data on graduation rates are reported male students, by 1.6 percentage by ethnicity or gender, not as a points. combination. In 2014, Native Hawaiian ΩΩ A higher percent of non-Hawaiian students in the Hawai‘i State DOE had a male students tested proficient in graduation rate of 77.8%, in comparison science than Native Hawaiian male to the total student rate of 82.1%. In Populationstudents, of Hawai‘i by 18.7 with percentage a Bachelor's points. Degree or2014, Higher, male students in the Hawai‘i (DOE, 2015) State DOE had a graduation rate of by Gender and Native Hawaiian Status, 2005-201479.1%, in comparison to the female student rate of 85.2% (DOE, 2016). Graduation from HighTotal School Male Population Native Hawaiian∫∫ WhenMale consideringNative Hawaiian the total Female population 35% According to research from the U.S. of Hawai‘i of 25 years or older, Centers for Disease Control, education is one however, an equal portion of Native of the strongest predictors of health. There Hawaiian men have attained a high 30.0% 28.3% 30%are numerous ways completing a high school school diploma or higher. In 2014, education can impact health outcomes. First, 92.9% of Native Hawaiian men had it has a direct correlation of levels of future attained this level of education. This 25%income, as high school completion is also the rate is comparable to 92.2% of Native gateway into college, which offers even greater Hawaiian women and 92.5% of the total benefits than high school alone. Second, male population (U.S. Census18.9% Bureau, 20% 18.2% 18.4% 17.8% high school16.6% education facilitates healthier 2014a). 15.6% 16.0% behavior14.3% choices by 15.0%offering learners access15.3% ∫∫ These results may suggest that Native 15%to health information and tools to acquire help Hawaiian male students are not and resources, such as smoking cessation completing high school on time,15.4% but15.0% do 14.3% programs.14.6% Third, people are able13.3% to acquire eventually gain their12.8% diploma by age 25. 12.0% 12.5% 11.8% 10%social support, strengthen social networks, and mitigate social stressors; simply 10.4%put, Connection to Native Hawaiian Epistemology the more education people have, the more and Traditional Practices 5%social support they have. Finally, education Although by several measures of academic helps2005 people to2006 gain a 2007sense of 2008control over2009 achievement,2010 2011 Native Hawaiian2012 2013male students2014 their lives, an outcome associated with better appear to be lagging behind their peers in Notes.health Adapted (Freudenberg from (U.S. and Census Ruglis, Bureau, 2007). 2014a) the Hawai‘i DOE system, alternative systems

Male Unemployment in Hawai‘i, by Age and Native Hawaiian Status, 2006-2010

Non-Hawaiian Hawaiian

Notes. Adapted from (U.S. Census Bureau, 2014a)

Median Individual Earnings in Hawai‘i, by Gender and Hawaiian Status, 2005 - 2014

Hawai‘i State: Native Hawaiian: Hawai‘i State: Native Hawaiian: Male Male Female Female

$32,739 $33,008 $32,378 $32,135 $31,950 $30K $30,872 $30,193

$25K

$20K 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Notes. Adapted from (U.S. Census Bureau, 2014a)

Male Occupational Representation in Hawai‘i, by Native Hawaiian Status, 2006 -2010 as percent of all men in occupation in Hawai‘i)

■ Native Hawaiian ■ Non Hawaiian

Health technologists and technicians 7.44 92.56

Life, physical, and social science 5.75 93.25

Legal 5.51 93.49 0 20 40 60 80 100

Notes. Adapted from (U.S. Census Bureau, 2014a)

Average Travel Time to Work in minutes, by Gender and Native Hawaiian Status, 2014

■ Male ■ Female

35% 30.10 29.30 30% 28.20 28.50 26.70 27.30

25%

20%

15%

10%

0% Native Hawaiian Non-Hawaiian Total

Notes. Adapted from (U.S. Census Bureau, 2014a)

Homeless Service Clients in Hawai‘i, by Native Hawaiian Status, 2011 - 2015

■ Non Hawaiian ■ Native Hawaiian

16000

3,975 3,943 3,906 4,241 4,554 12000

8000 10,225 10,037 9,733 10,041 10,400

4000

0 2001 2012 2013 2014 2015

Notes. Adapted from (Yuan, 2014)

Risk Behaviors by Race-Ethnicity in Hawai‘i – Binge Drinking: 2013

40%

35% 32.6 29.1 30% 25.8 26.6 24.8 25%

20%

15% 12.1

10%

0% Native Hawaiian Caucasian Filipino Chinese Japanese State of Hawai‘i

Notes. Adapted from (Yuan, 2014)

Incarceration of Native Hawaiians as a percentage of the state prison population, by custody classiﬁcation and sex, 2012

■ Native Hawaiian ■ Non-Hawaiian

100%

90% 64.4 65.5 63.2 54.2 61.9 58.7 64.8 37.5 65.4 57.1 55.5 60.0 63.0 60.0 80%

70%

60%

50%

40%

30% 35.6 34.5 36.8 45.8 38.1 41.3 35.2 62.5 34.6 42.9 44.5 40.0 37.0 40.0

20%

10%

0% Male Female Male Female Male Female Male Female Male Female Male Female Male Female

Community Minimum Medium Close Maximum Unclassiﬁed Total

Notes. Adapted from (Yuan, 2014) 24 Kānehō‘ālani – Transforming the Health of Native Hawaiian Men

provide educational opportunities which may offenses on the Crime Index (murder address these disparities. Many Hawaiian- and non-negligent homicide, forcible focus charter schools offer cultural-based rape, robbery, aggravated assault, education, which can be defined “as a holistic burglary, motor vehicle theft, larceny- and comprehensive application of culturally theft, and arson). The majority of the relevant education and referred to education arrests were for crimes related to approaches that are ground in a particular larceny-thefts. cultural worldview” (Kana‘iaupuni, 2010)–in ∫∫ Between 2000 and 2014, however, there this case, a Native Hawaiian worldview. was a 61% decrease of Native Hawaiian Recent studies found that the use of cul- juveniles arrested for Part I offenses. ture-based education strategies by teachers ∫∫ In 2014, 1,750 Native Hawaiian juveniles and school systems is linked with education were arrested for Part II offenses, outcomes of Native Hawaiian students. First, which represented 30% of total arrests. strategies positively impact student socio- Crimes related to runaways accounted emotional well-being, which are directly related for the highest number of these arrests to current health outcomes, including identity, (34%). self-efficacy, social relationships. Second, ∫∫ From 2003 - 2012, Native Hawaiian enhanced socio-emotional well-being, in youth accounted for: turn, positively affects math and reading test ΩΩ The highest number of individual scores, which is a predictor of future health juvenile arrests (26,788 or 34% of all outcome. juvenile arrests). ΩΩ The highest number of total juvenile ∫∫ 8.5% of all Native Hawaiian male arrests (60,685 or 37% of 161,901 students (or one out of every 12 total juvenile arrests). students) is enrolled in a charter ΩΩ The highest number of juveniles school, in comparison to 4.2% of non- confined to the Hawaii Youth Hawaiian male students. Correctional Facility (802 or 55% of ∫∫ 6.1% all Native Hawaiian male 1,470 total juveniles). students are enrolled in a Hawaiian- (Hawai‘i State Department of the Attorney focused charter school, over twice General, 2003 – 2014) Juvenile Crime the percentage of non-Hawaiian male In what ways can students (3.4%). Mākua your organization ∫∫ The vast majority of Native Hawaiian Aging can also be viewed as two phases, combat the male students, however, are enrolled adulthood and elderhood. Mākua (adults) prevalence and in a mainstream DOE school (91.5%). and kūpuna (older adults) are also vulnerable incidence of keiki (DOE, 2015) to stressors and social conditions—in their kāne involvement in case, though, the concern becomes how the the criminal justice Juvenile Crime accumulation of these circumstances over time system? Juvenile crime can be seen as both an lead to chronic diseases, which then have to outcome of early childhood social determinates be managed. Some stressors common among of health, and a factor contributing to adult mākua include working long or irregular hours, barriers to well-being. Recent research dealing with daily parental responsibilities, or demonstrates the over-representation of caring for older family members. Long-term Native Hawaiians in the criminal justice systems exposure to these stressors can put mākua (Umemoto et al., 2012). These disparities are at higher risk for injuries, digestive problems, reportedly the effect of the social, political, hypertension, obesity, or heart disease. and economic conditions which increase the The social determinants of health impact prevalence of antisocial and criminal behavior individuals in similar ways, but manifest among Native Hawaiian youth, as well as the themselves differently at each stage of life. results of institutional bias. Post-secondary Education ∫∫ In 2014, 391 Native Hawaiian One of the most significant factors in the juveniles—representing 31% of total future of a young adult is their level of educational arrests—were arrested for Part I attainment. Research has shown that there are Percent of Native Hawaiian Population by Gender

■ Native Hawaiian Male ■ State Male

0.1% 90 years and over 0.5% Percent of Native Hawaiian 0.3%Population85 byto 89 Gender years 1.1% 0.7% 80 to 84 years 1.7% ■ 1.1%Native Hawaiian75 Male to 79 ■years State Male2.2% 1.6% 70 to 74 years 2.8% 0.1% 90 years and over 0.5% 2.6% 65 to 69 years 4.2% 0.3% 85 to 89 years 1.1% 3.5% 60 to 64 years 6.0% 0.7% 80 to 84 years 1.7% 4.6% 55 to 59 years 6.8% 1.1% 75 to 79 years 2.2% 5.5% 50 to 54 years 7.2% 1.6% 70 to 74 years 2.8% 6.1% 45 to 49 years 7.1% 2.6% 65 to 69 years 4.2% 5.9% 40 to 44 years 6.6% 3.5% 60 to 64 years 6.0% 6.0% 35 to 39 years 6.5% 4.6% 55 to 59 years 6.8% 6.6% 30 to 34 years 6.6% 5.5% 50 to 54 years 7.2% 7.5% 25 to 29 years 7.4% 6.1% 45 to 49 years 7.1% 7.9% 20 to 24 years 7.6% 5.9% 40 to 44 years 6.6% 9.6% 15 to 19 years 6.5% 6.0% 35 to 39 years 6.5% 9.4% 10 to 14 years 6.1% 6.6% 30 to 34 years 6.6% 10.2% 5 to 9 years 6.3% 7.5% 25 to 29 years 7.4% 10.9% Under 5 years 6.6% 7.9% 20 to 24 years 7.6% 10% 8% 6% 4% 2% 0% 0% 2% 4% 6% 8% 10% 9.6% 15 to 19 years 6.5% Note. Adapted from (U.S. Census Bureau,9.4% 2010a)10 to 14 years 6.1% 10.2% 5 to 9 years 6.3% 10.9% Under 5 years 6.6% Reading10% Proﬁciency,8% 6% by4% Gender2% and0% Native Hawaiian0% Status,2% 4% SY20156% 8% 10%

Note. Adapted from (U.S. Census Bureau,■ Proficient 2010a) ■ Non-Proficient 100% Reading Proficiency, by Gender and Native Hawaiian Status, SY2015

■ Proﬁcient ■ Non-Proﬁcient

100% 72.5 58.7 52.8 39.1 58.1 44.4

50% 72.5 58.7 52.8 39.1 58.1 44.4

27.5 41.3 47.2 60.9 41.9 55.6 50%

0% Male27.5 Female41.3 Male47.2 Female60.9 Male41.9 Female55.6 Native Hawaiian Non-Hawaiian All Students

Notes. Calculated from (DOE, 2015). 0% Male Female Male Female Male Female Native Hawaiian Non-Hawaiian All Students

Notes. Calculated from (DOE, 2015).

Math Proﬁciency by Gender and Native Hawaiian Status, SY2015

■ Proﬁcient ■ Non-Proﬁcient

100% Math Proﬁciency by Gender and Native Hawaiian Status, SY2015

■ Proﬁcient ■ Non-Proﬁcient 73.70 70.60 56.10 52.10 60.80 57.10 100%

50% 73.70 70.60 56.10 52.10 60.80 57.10

50% 26.30 29.40 43.90 47.90 39.20 42.90

0% Male Female Male Female Male Female 26.30 29.40 43.90 47.90 39.20 42.90 Native Hawaiian Non-Hawaiian All Students

Notes.0% Calculated from (DOE, 2015). Male Female Male Female Male Female

Native Hawaiian Non-Hawaiian All Students

Notes. Calculated from (DOE, 2015). Science Proﬁciency, by Gender and Native Hawaiian Status, SY2015

■ Proﬁcient ■ Non-Proﬁcient

100% Science Proﬁciency, by Gender and Native Hawaiian Status, SY2015

65.80 67.40 ■ Proﬁcient47.10 ■ 50.50Non-Proﬁcient 52.30 55.10

100%

50% 65.80 67.40 47.10 50.50 52.30 55.10

34.20 32.60 52.90 49.50 47.70 44.90 50%

0% 34.20Male Female32.60 52.90Male Female49.50 47.70Male Female44.90

Native Hawaiian Non-Hawaiian All Students

Notes.0% Calculated from (DOE, 2015). Male Female Male Female Male Female

Native Hawaiian Non-Hawaiian All Students

Notes. Calculated from (DOE, 2015). Enrollment of Male Students, by School Type and Native Hawaiian Status, SY2015

■ Charter: Hawaiian-Focused ■ Charter: Other ■ DOE

100% Enrollment of Male Students, by School Type and Native Hawaiian Status, SY2015 91.5 95.8 94.7 ■ Charter: Hawaiian-Focused ■ Charter: Other ■ DOE

100%

91.5 95.8 94.7 50%

50% 2.4 0.8 2.2 6.1 3.4 3.1 0% Native Hawaiian Non-Hawaiian All Male

Notes. Calculated from2.4 (DOE, 2015). 0.8 2.2 6.1 3.4 3.1 0% Native Hawaiian Non-Hawaiian All Male

Notes. Calculated from (DOE, 2015).

Population of Hawai‘i with a Bachelor's Degree or Higher, Kānehō‘ālani – Transforming the Health of Native Hawaiian Men 25 by Gender and Native Hawaiian Status, 2005-2014

Total Male Population Native Hawaiian Male Native Hawaiian Female Total Male Population Native Hawaiian Male Native Hawaiian Female Population of Hawai‘i 35% Population of Hawai‘i with a Bachelor's Degree or Higher, with a Bachelor’s by Gender and Native Hawaiian Status, 2005-2014 30.0% Degree or Higher, by 28.3% 30% Gender and Native Hawaiian Status, Total Male Population Native Hawaiian Male Native Hawaiian Female 30.0% 2005-2014 (as 35% 25% a percent of the 30.0% population 25 Years 28.3% and Older) 30% 18.4% 18.9% 17.8% Notes. Adapted from (U.S. 20% 18.2% 30.0% 16.6% Census Bureau, 2014a) 15.6% 16.0% 14.3% 15.0% 15.3% 25% 15% 15.4% 15.0%15.0% 14.3% 14.6% 13.3% 12.8% 18.9% 20% 12.0% 12.5% 18.2%11.8% 18.4% 17.8% 10% 16.6% 15.6% 10.4% 16.0% 14.3% 15.0% 15.3% 15% 5% 15.4% 15.0% 2005 2006 14.3%2007 2008 2009 2010 2011 2012 2013 2014 14.6% 13.3% 12.8% 12.0% 12.5% 11.8% 10% Notes.not Adaptedonly economic from (U.S. advantages Census Bureau, for individuals 2014a)10.4% higher, half as many as the total male who obtain college degrees in comparison to population in the State. those with high school diplomas only, but also ∫∫ The percent of Native Hawaiian men 5%increased well-being in terms of health and civic 25 years and over with a bachelor’s 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 engagement (Day and Newburger 2002; Dee degree or higher increased by only 0.4 Notes.2004; Adapted Ross and from Wu (U.S. 1996). Census The higher Bureau, the 2014a) level of percentage points from 2005, while the education an individual attains, the higher their percent of the total male population future income, enabling them to purchase better increased by 1.7 percentage points. Malehousing Unemployment in safer neighborhoods, in Hawai‘i, healthier by Agefood, and Native∫∫ The Hawaiian percent of Native Status, Hawaiian 2006-2010 men 25 better medical care and health insurance; each years and over with a bachelor’s degree Non-Hawaiian Hawaiian of these factors is associated with improved or higher continued to be lower than the health. Native Hawaiian female population from Post-secondary 0.00 75 years 0.01 ∫∫ In 2014, 15% of Native Hawaiian men 2006 to 2014. (U.S. Census Bureau, Education Male Unemployment25 and older had in a bachelor’s Hawai‘i,0.01 degree by Age or70 and to 74 Native2014a)0.00 Hawaiian Status, 2006-2010 In what ways can 0.03 65 to 69 0.02 your organization Non-Hawaiian Hawaiian help promote post- 0.06 62 to 64 0.03 secondary education 0.050.00 7560 years and 0.060.01 amongst kāne? 0.140.01 5570 to 5974 0.120.00 0.320.03 4565 to 5469 0.570.02 0.330.06 3562 to 4464 0.620.03 0.140.05 3060 to and 34 0.370.06 0.230.14 2555 to 2959 0.450.12 Male Unemployment 0.130.32 2245 to 2454 0.420.57 in Hawai‘i, by Age and Native Hawaiian 0.33 35 to 44 0.62 0.05 20 and 0.39 Status, 2006-2010 0.210.14 1630 to 1934 0.760.37 Notes. Adapted from (U.S. Census Bureau, 2014a) 1.00% 0.80% 0.60% 0.40% 0.230.20% 0.00%25 to 290.00% 0.450.20% 0.40% 0.60% 0.80% 1.00% 0.13 22 to 24 0.42 Notes. Adapted from (U.S. Census Bureau, 2014a) 0.05 20 and 0.39 0.21 16 to 19 0.76 1.00% 0.80% 0.60% 0.40% 0.20% 0.00% 0.00% 0.20% 0.40% 0.60% 0.80% 1.00%

Notes. Adapted from (U.S. Census Bureau, 2014a)

Median Individual Earnings in Hawai‘i, by Gender and Hawaiian Status, 2005 - 2014

Hawai‘i State: Native Hawaiian: Hawai‘i State: Native Hawaiian: Male Male Female Female

$50K $48,440 $46,786 Median Individual Earnings in Hawai‘i,$45,911 by Gender and Hawaiian Status, 2005 - 2014 $45,577 $45,443 $45,494 $45,748 $44,802 $45K Hawai‘i State: Native Hawaiian: Hawai‘i State: Native Hawaiian: Male$41,821 Male Female Female$41,821 $41,811 $41,238 $44,194 $43,740 $42,832 $42,826 $50K $41,706 $38,870 $48,440 $46,786 $40K $40,259 $38,040 $40,370 $40,162 $40,618 $45,911 $37,242 $45,748 $45,577 $36,242$45,443 $45,494 $44,802$35,471 $45K $33,780 $36,709 $35,977 $36,707 $35K $41,821 $41,821 $41,811 $41,238$32,305 $44,194$35,596 $35,725 $43,740 $42,826 $38,870 $42,832 $41,706 $32,739 $33,008 $40K $32,378 $32,135 $31,950 $38,040 $40,618 $40,259 $40,370 $40,162 $30K $30,872 $37,242 $30,193 $36,242 $35,471 $36,709 $36,707 $35K $33,780 $35,977 $25K $32,305 $35,596 $35,725

$32,739 $33,008 $32,378 $32,135 $31,950 $30K $30,872 $20K $30,193 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Notes.$25K Adapted from (U.S. Census Bureau, 2014a)

$20K 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Notes. Adapted from (U.S. Census Bureau, 2014a)

Male Occupational Representation in Hawai‘i, by Native Hawaiian Status, 2006 -2010 as percent of all men in occupation in Hawai‘i)

■ Native Hawaiian ■ Non Hawaiian

Male Occupational RepresentationMaterial moving in33.43 Hawai‘i, by Native66.57 Hawaiian Status, Law2006 enforcement -2010 workersas percent including of allsupervisors men in occupation31.08 in Hawai‘i)68.92

Firefighting and prevention and other protective service workers including supervisors ■27.44 Native Hawaiian ■ 72.56Non Hawaiian Construction and extraction 27.22 72.82 Material moving 33.43 66.57 Transportation occupations 27.1 72.9 Law enforcement workers including supervisors 31.08 68.92 Farming, fishing, and forestry 22.61 77.39 Firefighting and prevention and other protective service workers including supervisors 27.44 72.56 Personal care and service 20.86 79.13 Construction and extraction 27.22 72.82 Building and grounds cleaning and maintenance 20 80 Transportation occupations 27.1 72.9 Community and social service 19.73 80.27 Farming, fishing, and forestry 22.61 77.39 Production 18.95 81.05 Personal care and service 20.86 79.13 Installation, maintenance, and repair 18.42 81.58 Building and grounds cleaning and maintenance 20 80 Office and administrative support 17.35 82.65 Community and social service 19.73 80.27 Healthcare support 16.57 83.43 Production 18.95 81.05 Food preparation and serving related 14.72 85.28 Installation, maintenance, and repair 18.42 81.58 Arts, design, entertainment, sports, and media 13.57 86.43 Office and administrative support 17.35 82.65 Education, training, and library 11.62 88.38 Healthcare support 16.57 83.43 Architecture and engineering 11.24 88.76 Food preparation and serving related 14.72 85.28 Sales and related 11.08 88.92 Arts, design, entertainment, sports, and media 13.57 86.43 Management 10.6 89.4 Education, training, and library 11.62 88.38 Computer and mathematical 8.91 91.09 Architecture and engineering 11.24 88.76 Business and financial 8.73 91.27 Sales and related 11.08 88.92 Health diagnosis and treating practitioners and other technical 7.67 92.33 Management 10.6 89.4 Health technologists and technicians 7.44 92.56 Computer and mathematical 8.91 91.09 Life, physical, and social science 5.75 93.25 Business and financial 8.73 91.27 Legal 5.51 93.49 Health diagnosis and treating practitioners and other technical 7.67 92.33 0 20 40 60 80 100 Health technologists and technicians 7.44 92.56

Notes. AdaptedLife, from physical, (U.S. Census and social Bureau, science 2014a)5.75 93.25

Legal 5.51 93.49 0 20 40 60 80 100

Notes. Adapted from (U.S. Census Bureau, 2014a)

Average Travel Time to Work in minutes, by Gender and Native Hawaiian Status, 2014

■ Male ■ Female

Average35% Travel Time to Work in minutes, by Gender and Native Hawaiian30.10 Status, 2014 30% 29.30 28.50 28.20 27.30 ■ Male26.70 ■ Female

35%25% 30.10 29.30 30%20% 28.20 28.50 26.70 27.30

25%15%

20%10%

15%5%

10%0% Native Hawaiian Non-Hawaiian Total

Notes.5% Adapted from (U.S. Census Bureau, 2014a)

0% Native Hawaiian Non-Hawaiian Total

Notes. Adapted from (U.S. Census Bureau, 2014a) Homeless Service Clients in Hawai‘i, by Native Hawaiian Status, 2011 - 2015

■ Non Hawaiian ■ Native Hawaiian

16000 Homeless Service Clients in Hawai‘i, by Native Hawaiian Status, 2011 - 2015

3,975 3,943■ Non Hawaiian 3,906■ Native Hawaiian 4,241 4,554 12000 16000

10,225 10,037 9,733 10,041 10,400 8000 3,975 3,943 3,906 4,241 4,554 12000

4000 8000 10,225 10,037 9,733 10,041 10,400

0 4000 2001 2012 2013 2014 2015

Notes. Adapted from (Yuan, 2014)

0 2001 2012 2013 2014 2015

Notes. Adapted from (Yuan, 2014)

Risk Behaviors by Race-Ethnicity in Hawai‘i – Binge Drinking: 2013

40%

35% Risk Behaviors32.6 by Race-Ethnicity in Hawai‘i – Binge Drinking: 2013 29.1 30% 40% 25.8 26.6 24.8 25% 35% 32.6 20% 29.1 30% 25.8 26.6 15% 12.1 24.8 25% 10% 20% 5% 15% 12.1 0% 10% Native Hawaiian Caucasian Filipino Chinese Japanese State of Hawai‘i

5% Notes. Adapted from (Yuan, 2014) 0% Native Hawaiian Caucasian Filipino Chinese Japanese State of Hawai‘i

Notes. Adapted from (Yuan, 2014)

Incarceration of Native Hawaiians as a percentage of the state prison population, by custody classiﬁcation and sex, 2012

■ Native Hawaiian ■ Non-Hawaiian

Incarceration100% of Native Hawaiians as a percentage of the state90% prison population, by custody classiﬁcation and sex, 2012 64.4 65.5 63.2 54.2 61.9 58.7 64.8 37.5 65.4 57.1 55.5 60.0 63.0 60.0 80% ■ Native Hawaiian ■ Non-Hawaiian

100%70%

60%90% 64.4 65.5 63.2 54.2 61.9 58.7 64.8 37.5 65.4 57.1 55.5 60.0 63.0 60.0 50%80%

40%70%

30%60% 35.6 34.5 36.8 45.8 38.1 41.3 35.2 62.5 34.6 42.9 44.5 40.0 37.0 40.0

20%50%

10%40%

30%0% 35.6 34.5 36.8 45.8 38.1 41.3 35.2 62.5 34.6 42.9 44.5 40.0 37.0 40.0 Male Female Male Female Male Female Male Female Male Female Male Female Male Female 20% Community Minimum Medium Close Maximum Unclassiﬁed Total 10% Notes. Adapted from (Yuan, 2014) 0% Male Female Male Female Male Female Male Female Male Female Male Female Male Female

Community Minimum Medium Close Maximum Unclassiﬁed Total

Notes. Adapted from (Yuan, 2014) Percent of Native Hawaiian Population by Gender

■ Native Hawaiian Male ■ State Male

0.1% 90 years and over 0.5% 0.3% 85 to 89 years 1.1% 0.7% 80 to 84 years 1.7% 1.1% 75 to 79 years 2.2% 1.6% 70 to 74 years 2.8% 2.6% 65 to 69 years 4.2% 3.5% 60 to 64 years 6.0% 4.6% 55 to 59 years 6.8% 5.5% 50 to 54 years 7.2% 6.1% 45 to 49 years 7.1% 5.9% 40 to 44 years 6.6% 6.0% 35 to 39 years 6.5% 6.6% 30 to 34 years 6.6% 7.5% 25 to 29 years 7.4% 7.9% 20 to 24 years 7.6% 9.6% 15 to 19 years 6.5% 9.4% 10 to 14 years 6.1% 10.2% 5 to 9 years 6.3% 10.9% Under 5 years 6.6% 10% 8% 6% 4% 2% 0% 0% 2% 4% 6% 8% 10%

Note. Adapted from (U.S. Census Bureau, 2010a)

Reading Proﬁciency, by Gender and Native Hawaiian Status, SY2015

■ Proﬁcient ■ Non-Proﬁcient

100%

72.5 58.7 52.8 39.1 58.1 44.4

50%

27.5 41.3 47.2 60.9 41.9 55.6

0% Male Female Male Female Male Female Native Hawaiian Non-Hawaiian All Students

Notes. Calculated from (DOE, 2015).

Math Proﬁciency by Gender and Native Hawaiian Status, SY2015

■ Proﬁcient ■ Non-Proﬁcient

100%

73.70 70.60 56.10 52.10 60.80 57.10

50%

26.30 29.40 43.90 47.90 39.20 42.90

0% Male Female Male Female Male Female

Native Hawaiian Non-Hawaiian All Students

Notes. Calculated from (DOE, 2015).

Science Proﬁciency, by Gender and Native Hawaiian Status, SY2015

■ Proﬁcient ■ Non-Proﬁcient

100%

65.80 67.40 47.10 50.50 52.30 55.10

50%

34.20 32.60 52.90 49.50 47.70 44.90

0% Male Female Male Female Male Female

Native Hawaiian Non-Hawaiian All Students

Notes. Calculated from (DOE, 2015).

Enrollment of Male Students, by School Type and Native Hawaiian Status, SY2015

■ Charter: Hawaiian-Focused ■ Charter: Other ■ DOE

100%

91.5 95.8 94.7

50%

2.4 0.8 2.2 6.1 3.4 3.1 0% Native Hawaiian Non-Hawaiian All Male

Notes. Calculated from (DOE, 2015).

Population of Hawai‘i with a Bachelor's Degree or Higher, by Gender and Native Hawaiian Status, 2005-2014

Total Male Population Native Hawaiian Male Native Hawaiian Female 35%

30.0% 28.3% 30%

25%

18.9% 20% 18.2% 18.4% 17.8% 16.6% 15.6% 16.0% 14.3% 15.0% 15.3% 15% 15.4% 15.0% 14.3% 14.6% 13.3% 12.8% 12.0% 12.5% 11.8% 10% 10.4%

5% 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Notes. Adapted from (U.S. Census Bureau, 2014a)

Male Unemployment in Hawai‘i, by Age and Native Hawaiian Status, 2006-2010

Non-Hawaiian Hawaiian

Notes. Adapted from (U.S. Census Bureau, 2014a)

26 Kānehō‘ālani – Transforming the Health of Native Hawaiian Men

Median Individual Earnings in Hawai‘i, by Gender and Hawaiian Status, 2005 - 2014

Hawai‘i State: Native Hawaiian: Hawai‘i State: Native Hawaiian: Male Male Female Female

$50K $48,440 $46,786 $45,911 $45,577 $45,443 $45,494 $45,748 $44,802 $45K $41,821 $41,821 $41,811 $41,238 $44,194 $43,740 $42,832 $42,826 $41,706 $38,870 $40K $38,040 Median Individual $40,618 $40,259 $37,242 $40,370 $40,162 $36,242 Earnings in Hawai‘i, $35,471 by Gender and $36,709 $36,707 $35K $33,780 $35,977 Hawaiian Status, $32,305 $35,596 $35,725 2005 - 2014 $32,739 $33,008 Notes. Adapted from (U.S. $32,378 $32,135 $31,950 $30K $30,872 Census Bureau, 2014a) $30,193

$25K

$20K 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Notes.Economic Adapted S fromtability (U.S. Census Bureau, 2014a) Earnings Because of its high cost of living, Hawai‘i poses a great economic challenge for not only Native ∫∫ In 2014, the average annual earnings Hawaiians, but all residents. With the nation’s of Native Hawaiian men was $41,811; highest food and electricity costs, householders this figure is 89.4% of the average of all must make difficult choices to select which men statewide ($46,786). bills get paid every month. Parents working long ∫∫ From 2005 to 2014, Native Hawaiian hours may be too exhausted from working a long male average annual earnings Economic Maleshift toOccupational cook nutritious Representation meals, and instead inrely Hawai‘i, byincreased Native by Hawaiian 2.9%, while Status, the earnings of Stability 2006on cheap, -2010 high-calorie as percent food. ofIndividuals all men without in occupation all in men Hawai‘i) statewide increased 13.5% and In terms of economic health insurance cannot receive preventive the earnings of Native Hawaiian women shifts over time, services or seek care when they fall ill. The closest■ Native Hawaiianincrease■ Non 18.3%. Hawaiian (U.S. Census Bureau, how can the State primary care physician may be an hour away by 2014a) address the report bus, making the visit costly andMaterial time-consuming. moving 33.43 66.57 findings that are Families unable to pay monthly mortgages or rent Occupation linked to kāne Laware enforcement left to move workers in with includingother family supervisors members 31.08or 68.92 Firefighting and prevention andhealth? other protectiveseek other service shelter, workers creating including crowded supervisors living spaces.27.44 ∫∫ In the most72.56 recent data, from 2006 With barely enough financial resources for daily through 2010, Native Hawaiian men Construction and extraction 27.22 72.82 living expenses, planning for the future becomes comprised 17.6% of the total male nearly impossible,Transportation leaving people occupations with the ability27.1 populations72.9 but were over-represented to only respondFarming, to urgent fishing, needs. and forestry Research22.61 in moving77.39 materials (33.4%), law findings on unemployment rates, earning levels, enforcement (31.1%), firefighters occupation, commutingPersonal times, care poverty and service rates, and20.86 (27.4), 79.13construction and extraction Buildinghomelessness and grounds indicate cleaning that and Native maintenance Hawaiian men20 (27.2%),80 and transportation (27.1%) are disparately affected by economic factors. occupations. Community and social service 19.73 80.27 ∫∫ During this same time period, Unemployment Production 18.95 Native 81.05Hawaiian men had the lowest In theInstallation, most recent maintenance, data, from 2006and repair through18.42 representation81.58 in legal (5.5%), life/ 2010, 3.8% of Native Hawaiian men were physical/ social service (6.8%), unemployed,Office compared and administrative with 2.1% of support all men 17.35in health 82.65technologists and technicians Hawai‘i (U.S. Census Bureau,Healthcare 2010c). support 16.57 (7.4%),83.43 health diagnosis and treating practitioners (7.7%), and business and Food preparation and serving related 14.72 85.28 Arts, design, entertainment, sports, and media 13.57 86.43 Education, training, and library 11.62 88.38 Architecture and engineering 11.24 88.76 Sales and related 11.08 88.92 Management 10.6 89.4 Computer and mathematical 8.91 91.09 Business and financial 8.73 91.27 Health diagnosis and treating practitioners and other technical 7.67 92.33

Health technologists and technicians 7.44 92.56

Life, physical, and social science 5.75 93.25

Legal 5.51 93.49 0 20 40 60 80 100

Notes. Adapted from (U.S. Census Bureau, 2014a)

Average Travel Time to Work in minutes, by Gender and Native Hawaiian Status, 2014

■ Male ■ Female

35% 30.10 29.30 30% 28.20 28.50 26.70 27.30

25%

20%

15%

10%

0% Native Hawaiian Non-Hawaiian Total

Notes. Adapted from (U.S. Census Bureau, 2014a)

Homeless Service Clients in Hawai‘i, by Native Hawaiian Status, 2011 - 2015

■ Non Hawaiian ■ Native Hawaiian

16000

3,975 3,943 3,906 4,241 4,554 12000

8000 10,225 10,037 9,733 10,041 10,400

4000

0 2001 2012 2013 2014 2015

Notes. Adapted from (Yuan, 2014)

Risk Behaviors by Race-Ethnicity in Hawai‘i – Binge Drinking: 2013

40%

35% 32.6 29.1 30% 25.8 26.6 24.8 25%

20%

15% 12.1

10%

0% Native Hawaiian Caucasian Filipino Chinese Japanese State of Hawai‘i

Notes. Adapted from (Yuan, 2014)

Incarceration of Native Hawaiians as a percentage of the state prison population, by custody classiﬁcation and sex, 2012

■ Native Hawaiian ■ Non-Hawaiian

100%

90% 64.4 65.5 63.2 54.2 61.9 58.7 64.8 37.5 65.4 57.1 55.5 60.0 63.0 60.0 80%

70%

60%

50%

40%

30% 35.6 34.5 36.8 45.8 38.1 41.3 35.2 62.5 34.6 42.9 44.5 40.0 37.0 40.0

20%

10%

0% Male Female Male Female Male Female Male Female Male Female Male Female Male Female

Community Minimum Medium Close Maximum Unclassiﬁed Total

Notes. Adapted from (Yuan, 2014) Kānehō‘ālani – Transforming the Health of Native Hawaiian Men 27 Male Occupational Representation in Hawai‘i, by Native Hawaiian Status, 2006 -2010 as percent of all men in occupation in Hawai‘i)

■ Native Hawaiian ■ Non Hawaiian

Material moving 33.43 66.57 Law enforcement workers including supervisors 31.08 68.92 Firefighting and prevention and other protective service workers including supervisors 27.44 72.56 Construction and extraction 27.22 72.82 Transportation occupations 27.1 72.9 Farming, fishing, and forestry 22.61 77.39 Personal care and service 20.86 79.13 Building and grounds cleaning and maintenance 20 80 Community and social service 19.73 80.27 Male Occupational Production 18.95 81.05 Representation in Installation, maintenance, and repair 18.42 81.58 Hawai‘i, by Native Office and administrative support 17.35 82.65 Hawaiian Status, Healthcare support 16.57 83.43 2006 -2010 as Food preparation and serving related 14.72 85.28 percent of all men Arts, design, entertainment, sports, and media 13.57 86.43 in occupation in Education, training, and library 11.62 88.38 Hawai‘i) Notes. Adapted from (U.S. Architecture and engineering 11.24 88.76 Census Bureau, 2010d) Sales and related 11.08 88.92 Management 10.6 89.4 Computer and mathematical 8.91 91.09 Business and financial 8.73 91.27 Health diagnosis and treating practitioners and other technical 7.67 92.33

Health technologists and technicians 7.44 92.56

Life, physical, and social science 5.75 93.25

Legal 5.51 93.49 0 20 40 60 80 100

Notes. Adapted from (U.S. Census Bureau, 2014a) financial occupations (8.7%). on housing costs. Households that spend (U.S. Census Bureau, 2010d) more are considered cost-burdened because they have less to spend on other necessities Commuting (HUD, 2014), such as nutritious food and health care. ∫∫ On average, Native Hawaiian men spend In 2014, 55% of Native Hawaiian households 30.1 minutes a day traveling to work. who rent their homes were considered cost- Therefore, it can be estimated that they burdened and 35% of those who own their spend 60.2 minutes traveling to and homes (U.S. Census Bureau, 2014a). These from work, which equates to 5.1 hours figures were lower than total State percent- a week and 260.9 hours, or over 1.5 ages, even though as previously mentioned weeks a year. Native Hawaiian household income was consi- ∫∫ On average, Native Hawaiian men spend derably less. These differences may be attri- 3.4 more minutes a day traveling to buted to the higher rates of Native Hawaiian work each day, than non-Hawaiian men. households “doubling-up” (multiple families Therefore, it can be estimated that living together to share costs) and the selection they spend an additional 6.8 minutes of housing in lower cost neighborhoods. Thus, traveling to and from work, which although income is saved on direct housing equates to an additional 34 minutes a costs, Native Hawaiian household may experi- week and 29.5 hours a year. ence related negative health outcomes due (U.S. Census Bureau, 2014b) to factors such as lack of appropriate green space for activity and longer commuting Housing times. The Department of Housing and Urban Development definition of affordability is for a Poverty Status in the Past 12 Months household to pay no more than 30% of income Between 2006 and 2010, 12.1% of Native Percent of Native Hawaiian Population by Gender

■ Native Hawaiian Male ■ State Male

0.1% 90 years and over 0.5% 0.3% 85 to 89 years 1.1% 0.7% 80 to 84 years 1.7% 1.1% 75 to 79 years 2.2% 1.6% 70 to 74 years 2.8% 2.6% 65 to 69 years 4.2% 3.5% 60 to 64 years 6.0% 4.6% 55 to 59 years 6.8% 5.5% 50 to 54 years 7.2% 6.1% 45 to 49 years 7.1% 5.9% 40 to 44 years 6.6% 6.0% 35 to 39 years 6.5% 6.6% 30 to 34 years 6.6% 7.5% 25 to 29 years 7.4% 7.9% 20 to 24 years 7.6% 9.6% 15 to 19 years 6.5% 9.4% 10 to 14 years 6.1% 10.2% 5 to 9 years 6.3% 10.9% Under 5 years 6.6% 10% 8% 6% 4% 2% 0% 0% 2% 4% 6% 8% 10%

Note. Adapted from (U.S. Census Bureau, 2010a)

Reading Proﬁciency, by Gender and Native Hawaiian Status, SY2015

■ Proﬁcient ■ Non-Proﬁcient

100%

72.5 58.7 52.8 39.1 58.1 44.4

50%

27.5 41.3 47.2 60.9 41.9 55.6

0% Male Female Male Female Male Female Native Hawaiian Non-Hawaiian All Students

Notes. Calculated from (DOE, 2015).

Math Proﬁciency by Gender and Native Hawaiian Status, SY2015

■ Proﬁcient ■ Non-Proﬁcient

100%

73.70 70.60 56.10 52.10 60.80 57.10

50%

26.30 29.40 43.90 47.90 39.20 42.90

0% Male Female Male Female Male Female

Native Hawaiian Non-Hawaiian All Students

Notes. Calculated from (DOE, 2015).

Science Proﬁciency, by Gender and Native Hawaiian Status, SY2015

■ Proﬁcient ■ Non-Proﬁcient

100%

65.80 67.40 47.10 50.50 52.30 55.10

50%

34.20 32.60 52.90 49.50 47.70 44.90

0% Male Female Male Female Male Female

Native Hawaiian Non-Hawaiian All Students

Notes. Calculated from (DOE, 2015).

Enrollment of Male Students, by School Type and Native Hawaiian Status, SY2015

■ Charter: Hawaiian-Focused ■ Charter: Other ■ DOE

100%

91.5 95.8 94.7

50%

2.4 0.8 2.2 6.1 3.4 3.1 0% Native Hawaiian Non-Hawaiian All Male

Notes. Calculated from (DOE, 2015).

Population of Hawai‘i with a Bachelor's Degree or Higher, by Gender and Native Hawaiian Status, 2005-2014

Total Male Population Native Hawaiian Male Native Hawaiian Female 35%

30.0% 28.3% 30%

25%

18.9% 20% 18.2% 18.4% 17.8% 16.6% 15.6% 16.0% 14.3% 15.0% 15.3% 15% 15.4% 15.0% 14.3% 14.6% 13.3% 12.8% 12.0% 12.5% 11.8% 10% 10.4%

5% 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Notes. Adapted from (U.S. Census Bureau, 2014a)

Male Unemployment in Hawai‘i, by Age and Native Hawaiian Status, 2006-2010

Non-Hawaiian Hawaiian

Notes. Adapted from (U.S. Census Bureau, 2014a)

Median Individual Earnings in Hawai‘i, by Gender and Hawaiian Status, 2005 - 2014

Hawai‘i State: Native Hawaiian: Hawai‘i State: Native Hawaiian: Male Male Female Female

$32,739 $33,008 $32,378 $32,135 $31,950 $30K $30,872 $30,193

$25K

$20K 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Notes. Adapted from (U.S. Census Bureau, 2014a)

Male Occupational Representation in Hawai‘i, by Native Hawaiian Status, 2006 -2010 as percent of all men in occupation in Hawai‘i)

■ Native Hawaiian ■ Non Hawaiian

Health technologists and technicians 7.44 92.56

Life, physical, and social science 5.75 93.25

Legal 5.51 93.49 0 20 40 60 80 100

Notes. Adapted from (U.S. Census Bureau, 2014a)

28 Kānehō‘ālani – Transforming the Health of Native Hawaiian Men Average Travel Time to Work in minutes, by Gender and Native Hawaiian Status, 2014

■ Male ■ Female

35% 30.10 29.30 30% 28.20 28.50 26.70 27.30 Average Travel Time to Work in minutes, 25% by Gender and Native Hawaiian Status, 20% 2014 Notes. Adapted from (U.S. Census Bureau, 2014b) 15%

10%

0% Native Hawaiian Non-Hawaiian Total

Notes.Hawaiians Adapted had from income (U.S. in Census the past Bureau, 12 months 2014a) divorced, 1.9% were widowed, and 0.9% were below the poverty level. Of these, 45.8% were separated. Percentages for total State male kāne and 54.2% were wāhine (U.S. Census were 9.2 percentage points lower for never Bureau, 2010e). married, 9.8 percentage points higher for now married, and comparable for divorced, widowed Homelessness or separated (U.S. Census Bureau, 2014a). HomelessData on Service Native Hawaiian Clients malein Hawai‘i, homeless by Native Hawaiian Status, 2011 - 2015 service clients are not currently reported Behavioral Risk Factors within the Homeless Service Utilization■ Non or Hawaiian the ■ NativeSeveral Hawaiian lifestyle behaviors can, over time, State Point-in-Time Count Reports. Generally lead to a variety of health issues. This section 16000speaking, Native Hawaiians in total were over- explores these behaviors. represented in the population of homeless service clients: they comprised 30.5% of Nutrition clients in 2015 as compared to 20.8% of the The Behavioral Risk Factor Surveillance 3,975 3,943 3,906 4,241 4,554 12000population. System (BRFSS) collects and reports on these ∫∫ Over 5 years (2011 - 2016) the number nutritional data for Native Hawaiians, including of total homeless service clients has fruit, vegetable, and soda consumption, which increased by 5.3%, while the number assist in analyzing behavioral health choices. 8000 of Native10,225 Hawaiian homeless10,037 service 9,733 10,041 10,400 clients has increased by 14.6%. ∫∫ Daily frequency of total vegetable ∫∫ Male homeless service clients are also consumption for 2015 did not show over-represented; they comprise 57.0% differences between kāne and all of the total homeless service client men statewide, with 17.4% of kāne 4000 population in 2015. (Yuan, 2014) consuming the recommended three or more vegetables per day (HHDW, Marital Status 2016b). Further data indicated no In 2014, there were 108,091 kāne age considerable differences across races 15 0 and older (50.5% of Native Hawaiian for daily frequency of fruit consumption. 2001 2012 2013 2014 2015 population, 15 and older). 47.1% were never ∫∫ However, kāne did have one of the Notes.married, Adapted 40.5% from were (Yuan, now 2014) married, 9.6% were higher rates of soda consumption as

Risk Behaviors by Race-Ethnicity in Hawai‘i – Binge Drinking: 2013

40%

35% 32.6 29.1 30% 25.8 26.6 24.8 25%

20%

15% 12.1

10%

0% Native Hawaiian Caucasian Filipino Chinese Japanese State of Hawai‘i

Notes. Adapted from (Yuan, 2014)

Incarceration of Native Hawaiians as a percentage of the state prison population, by custody classiﬁcation and sex, 2012

■ Native Hawaiian ■ Non-Hawaiian

100%

90% 64.4 65.5 63.2 54.2 61.9 58.7 64.8 37.5 65.4 57.1 55.5 60.0 63.0 60.0 80%

70%

60%

50%

40%

30% 35.6 34.5 36.8 45.8 38.1 41.3 35.2 62.5 34.6 42.9 44.5 40.0 37.0 40.0

20%

10%

0% Male Female Male Female Male Female Male Female Male Female Male Female Male Female

Community Minimum Medium Close Maximum Unclassiﬁed Total

Notes. Adapted from (Yuan, 2014) Percent of Native Hawaiian Population by Gender

■ Native Hawaiian Male ■ State Male

0.1% 90 years and over 0.5% 0.3% 85 to 89 years 1.1% 0.7% 80 to 84 years 1.7% 1.1% 75 to 79 years 2.2% 1.6% 70 to 74 years 2.8% 2.6% 65 to 69 years 4.2% 3.5% 60 to 64 years 6.0% 4.6% 55 to 59 years 6.8% 5.5% 50 to 54 years 7.2% 6.1% 45 to 49 years 7.1% 5.9% 40 to 44 years 6.6% 6.0% 35 to 39 years 6.5% 6.6% 30 to 34 years 6.6% 7.5% 25 to 29 years 7.4% 7.9% 20 to 24 years 7.6% 9.6% 15 to 19 years 6.5% 9.4% 10 to 14 years 6.1% 10.2% 5 to 9 years 6.3% 10.9% Under 5 years 6.6% 10% 8% 6% 4% 2% 0% 0% 2% 4% 6% 8% 10%

Note. Adapted from (U.S. Census Bureau, 2010a)

Reading Proﬁciency, by Gender and Native Hawaiian Status, SY2015

■ Proﬁcient ■ Non-Proﬁcient

100%

72.5 58.7 52.8 39.1 58.1 44.4

50%

27.5 41.3 47.2 60.9 41.9 55.6

0% Male Female Male Female Male Female Native Hawaiian Non-Hawaiian All Students

Notes. Calculated from (DOE, 2015).

Math Proﬁciency by Gender and Native Hawaiian Status, SY2015

■ Proﬁcient ■ Non-Proﬁcient

100%

73.70 70.60 56.10 52.10 60.80 57.10

50%

26.30 29.40 43.90 47.90 39.20 42.90

0% Male Female Male Female Male Female

Native Hawaiian Non-Hawaiian All Students

Notes. Calculated from (DOE, 2015).

Science Proﬁciency, by Gender and Native Hawaiian Status, SY2015

■ Proﬁcient ■ Non-Proﬁcient

100%

65.80 67.40 47.10 50.50 52.30 55.10

50%

34.20 32.60 52.90 49.50 47.70 44.90

0% Male Female Male Female Male Female

Native Hawaiian Non-Hawaiian All Students

Notes. Calculated from (DOE, 2015).

Enrollment of Male Students, by School Type and Native Hawaiian Status, SY2015

■ Charter: Hawaiian-Focused ■ Charter: Other ■ DOE

100%

91.5 95.8 94.7

50%

2.4 0.8 2.2 6.1 3.4 3.1 0% Native Hawaiian Non-Hawaiian All Male

Notes. Calculated from (DOE, 2015).

Population of Hawai‘i with a Bachelor's Degree or Higher, by Gender and Native Hawaiian Status, 2005-2014

Total Male Population Native Hawaiian Male Native Hawaiian Female 35%

30.0% 28.3% 30%

25%

18.9% 20% 18.2% 18.4% 17.8% 16.6% 15.6% 16.0% 14.3% 15.0% 15.3% 15% 15.4% 15.0% 14.3% 14.6% 13.3% 12.8% 12.0% 12.5% 11.8% 10% 10.4%

5% 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Notes. Adapted from (U.S. Census Bureau, 2014a)

Male Unemployment in Hawai‘i, by Age and Native Hawaiian Status, 2006-2010

Non-Hawaiian Hawaiian

Notes. Adapted from (U.S. Census Bureau, 2014a)

Median Individual Earnings in Hawai‘i, by Gender and Hawaiian Status, 2005 - 2014

Hawai‘i State: Native Hawaiian: Hawai‘i State: Native Hawaiian: Male Male Female Female

$32,739 $33,008 $32,378 $32,135 $31,950 $30K $30,872 $30,193

$25K

$20K 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Notes. Adapted from (U.S. Census Bureau, 2014a)

Male Occupational Representation in Hawai‘i, by Native Hawaiian Status, 2006 -2010 as percent of all men in occupation in Hawai‘i)

■ Native Hawaiian ■ Non Hawaiian

Health technologists and technicians 7.44 92.56

Life, physical, and social science 5.75 93.25

Legal 5.51 93.49 0 20 40 60 80 100

Notes. Adapted from (U.S. Census Bureau, 2014a)

Average Travel Time to Work in minutes, by Gender and Native Hawaiian Status, 2014

■ Male ■ Female

35% 30.10 29.30 30% 28.20 28.50 26.70 27.30

25%

20%

15%

10%

0% Native Hawaiian Non-Hawaiian Total

Notes. Adapted from (U.S. Census Bureau, 2014a)

Kānehō‘ālani – Transforming the Health of Native Hawaiian Men 29

Homeless Service Clients in Hawai‘i, by Native Hawaiian Status, 2011 - 2015

■ Non Hawaiian ■ Native Hawaiian

16000

3,975 3,943 3,906 4,241 4,554 12000 Homeless Service Clients in Hawai‘i, by Native Hawaiian Status, 2011 - 2015 Notes. Adapted from 8000 10,225 10,037 9,733 10,041 10,400 (Yuan, 2014)

4000

0 2001 2012 2013 2014 2015

Notes. Adaptedcompared from (Yuan, to the 2014) other racial/ethnic the highest group to use e-cigarettes groups in the State of Hawai‘i: 24.6% of (30.3%) (HHDW, 2016a). kāne consumed one or more sodas per day (HHDW, 2016b). Alcohol Use/Drunk Driving Existing studies regarding the way alcohol Tobacco Use/Smoking consumption affects years of life by race and Native Hawaiians have historically been sex have found that interventions need to be challenged with high rates of tobacco use. 2015 specifically suited to the targeted subgroups Riskdata Behaviors from the three by Race-Ethnicity category smoking in report Hawai‘i of – the Binge population. Drinking: 2013 from the Behavioral Risk Factor Surveillance 40%Survey (BRFSS) classifies individuals into one ∫∫ Binge drinking is defined by the U.S. of three categories: Current Smoker, Former Centers for Disease Control and 35%Smoker, 32.6and Never Smoked. Prevention as four or more drinks for women and five or more drinks for men 29.1 30% ∫∫ As of 2015, the kāne rate of 21.6% on an occasion in the past thirty days. current smokers exceeded the total25.8 In 2015, kāne had the highest risk26.6 24.8 25% male rate of average of 17.7% (HHDW, behaviors for binge drinking (32.6%) 2016b). among all major ethnic groups—six 20% ∫∫ Through a comparison across gender percentage points higher than all men of the 2015 data, it can be seen that statewide. within the Native Hawaiian community ∫∫ Additional data from 2015 show that 15% the kāne rate (21.6%) also exceeds the 12.1kāne have higher rates of heavy alcohol wāhine (18.5%) (HHDW, 2016b). There consumption (drinking more than 10% is evidence that smoking behaviors (as two drinks per day for men). 13.5% may be the case with many detrimental of kāne experienced heavy alcohol 5% health behaviors) are being transmitted consumption. across generations. The high rate of ∫∫ In 2014, 10.2% of kāne reported 0% tobacco and smoking prevalence with having driven under the influence, as NativeNative Hawaiian HawaiianCaucasian adults persists withinFilipino Chinesecompared toJapanese 5.3% for the Statetotal State.of Hawai‘i Native Hawaiian youth. In 2015, Native (HHDW, 2016a). Notes. AdaptedHawaiians from under (Yuan, the age 2014) of eighteen were the second highest group to smoke in high school (19.2%)—and

Incarceration of Native Hawaiians as a percentage of the state prison population, by custody classiﬁcation and sex, 2012

■ Native Hawaiian ■ Non-Hawaiian

100%

90% 64.4 65.5 63.2 54.2 61.9 58.7 64.8 37.5 65.4 57.1 55.5 60.0 63.0 60.0 80%

70%

60%

50%

40%

30% 35.6 34.5 36.8 45.8 38.1 41.3 35.2 62.5 34.6 42.9 44.5 40.0 37.0 40.0

20%

10%

0% Male Female Male Female Male Female Male Female Male Female Male Female Male Female

Community Minimum Medium Close Maximum Unclassiﬁed Total

Notes. Adapted from (Yuan, 2014) Percent of Native Hawaiian Population by Gender

■ Native Hawaiian Male ■ State Male

0.1% 90 years and over 0.5% 0.3% 85 to 89 years 1.1% 0.7% 80 to 84 years 1.7% Percent of Native Hawaiian 1.1%Population75 byto 79 Gender years 2.2% 1.6% 70 to 74 years 2.8% ■ Native Hawaiian Male ■ State Male 2.6% 65 to 69 years 4.2%

3.5%0.1% 9060 years to 64 and years over 6.0%0.5% 4.6%0.3% 5585 to 5989 years 6.8%1.1% 5.5%0.7% 5080 to 5484 years 7.2%1.7% 6.1%1.1% 4575 to 4979 years 7.1%2.2% 5.9%1.6% 4070 to 4474 years 6.6%2.8% 6.0%2.6% 3565 to 3969 years 6.5%4.2% 6.6%3.5% 3060 to 3464 years 6.6%6.0% 4.6%7.5% 2555 to 2959 years 7.4%6.8% 5.5%7.9% 2050 to 2454 years 7.6%7.2% 9.6%6.1% 1545 to 1949 years 6.5%7.1% 9.4%5.9% 1040 to 1444 years 6.1%6.6% 10.2%6.0% 355 to 939 years years 6.3%6.5% 10.9%6.6% 30Under to 34 5 yearsyears 6.6% 10% 8% 6% 4% 7.5%2% 0% 25 to 29 years 0% 7.4%2% 4% 6% 8% 10% 7.9% 20 to 24 years 7.6% Note. Adapted from (U.S. Census Bureau, 2010a) 9.6% 15 to 19 years 6.5% 9.4% 10 to 14 years 6.1% Reading Proficiency, by Gender10.2% and Native5 to 9 years Hawaiian6.3% Status, SY2015 10.9% Under 5 years 6.6% ■ Proficient ■ Non-Proficient 10% 8% 6% 4% 2% 0% 0% 2% 4% 6% 8% 10% 100% Note. Adapted from (U.S. Census Bureau, 2010a)

Reading Proficiency, by Gender and Native Hawaiian Status, SY2015 72.5 58.7 52.8 39.1 58.1 44.4 ■ Proficient ■ Non-Proficient

100% 50%

72.5 58.7 52.8 39.1 58.1 44.4 27.5 41.3 47.2 60.9 41.9 55.6

50% 0% Male Female Male Female Male Female Native Hawaiian Non-Hawaiian All Students 27.5 41.3 47.2 60.9 41.9 55.6 Notes. Calculated from (DOE, 2015).

0% Male Female Male Female Male Female Native Hawaiian Non-Hawaiian All Students

MathNotes. CalculatedProﬁciency from by (DOE, Gender 2015). and Native Hawaiian Status, SY2015

■ Proﬁcient ■ Non-Proﬁcient

100%

Math Proﬁciency73.70 by Gender70.60 and Native56.10 Hawaiian52.10 Status, SY201560.80 57.10

■ Proﬁcient ■ Non-Proﬁcient

100% 50%

73.70 70.60 56.10 52.10 60.80 57.10

26.30 29.40 43.90 47.90 39.20 42.90

50% 0% Male Female Male Female Male Female

Native Hawaiian Non-Hawaiian All Students 26.30 29.40 43.90 47.90 39.20 42.90 Notes. Calculated from (DOE, 2015).

0% Male Female Male Female Male Female

Native Hawaiian Non-Hawaiian All Students

ScienceNotes. Calculated Proﬁciency, from (DOE, by 2015). Gender and Native Hawaiian Status, SY2015

■ Proﬁcient ■ Non-Proﬁcient

100%

Science Proﬁciency,65.80 67.40 by Gender and47.10 Native Hawaiian50.50 Status, 52.30SY2015 55.10

■ Proﬁcient ■ Non-Proﬁcient

100% 50%

65.80 67.40 47.10 50.50 52.30 55.10

34.20 32.60 52.90 49.50 47.70 44.90

50% 0% Male Female Male Female Male Female

34.20Native Hawaiian32.60 52.90Non-Hawaiian49.50 47.70All Students44.90 Notes. Calculated from (DOE, 2015).

0% Male Female Male Female Male Female

Native Hawaiian Non-Hawaiian All Students

EnrollmentNotes. Calculated of fromMale (DOE, Students, 2015). by School Type and Native Hawaiian Status, SY2015

■ Charter: Hawaiian-Focused ■ Charter: Other ■ DOE

100%

91.5 95.8 94.7 Enrollment of Male Students, by School Type and Native Hawaiian Status, SY2015

■ Charter: Hawaiian-Focused ■ Charter: Other ■ DOE

100% 50% 91.5 95.8 94.7

2.4 0.8 2.2 50% 6.1 3.4 3.1 0% Native Hawaiian Non-Hawaiian All Male

Notes. Calculated from (DOE, 2015).

2.4 0.8 2.2 6.1 3.4 3.1 0% Native Hawaiian Non-Hawaiian All Male

Notes. Calculated from (DOE, 2015). Population of Hawai‘i with a Bachelor's Degree or Higher, by Gender and Native Hawaiian Status, 2005-2014

Total Male Population Native Hawaiian Male Native Hawaiian Female 35%

30.0% 28.3% Population30% of Hawai‘i with a Bachelor's Degree or Higher, by Gender and Native Hawaiian Status, 2005-2014

25% Total Male Population Native Hawaiian Male Native Hawaiian Female 35% 18.9% 20% 18.2% 18.4% 17.8% 16.6% 30.0% 28.3% 15.6% 16.0% 30% 14.3% 15.0% 15.3% 15% 15.4% 15.0% 14.3% 25% 14.6% 13.3% 12.8% 12.0% 12.5% 11.8% 10% 10.4% 18.9% 20% 18.2% 18.4% 17.8% 16.6% 15.6% 16.0% 5% 14.3% 15.0% 15.3% 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 15% 15.4% 15.0% Notes. Adapted from (U.S.14.3% Census Bureau, 2014a) 14.6% 13.3% 12.8% 12.0% 12.5% 11.8% 10% 10.4%

5% 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

MaleNotes. UnemploymentAdapted from (U.S. Census in Hawai‘i, Bureau, by 2014a) Age and Native Hawaiian Status, 2006-2010

Non-Hawaiian Hawaiian

0.00 75 years 0.01 0.01 70 to 74 0.00 0.03 65 to 69 0.02 Male Unemployment in Hawai‘i, by Age and Native Hawaiian Status, 2006-2010 0.06 62 to 64 0.03 0.05Non-Hawaiian 60 and Hawaiian0.06

0.140.00 7555 yearsto 59 0.120.01 0.320.01 4570 to 5474 0.570.00 0.330.03 3565 to 4469 0.620.02 0.140.06 3062 to 3464 0.370.03 0.230.05 2560 to and 29 0.450.06 0.130.14 2255 to 2459 0.420.12 0.050.32 4520 to and 54 0.390.57 0.210.33 1635 to 1944 0.760.62 1.00% 0.80% 0.60% 0.40% 0.20% 0.00% 0.00% 0.20% 0.40% 0.60% 0.80% 1.00% 0.14 30 to 34 0.37 Notes. Adapted from (U.S. Census 0.23Bureau, 2014a)25 to 29 0.45 0.13 22 to 24 0.42 0.05 20 and 0.39 0.21 16 to 19 0.76 1.00% 0.80% 0.60% 0.40% 0.20% 0.00% 0.00% 0.20% 0.40% 0.60% 0.80% 1.00%

MedianNotes. Adapted Individual from (U.S. Earnings Census Bureau, in Hawai‘i, 2014a) by Gender and Hawaiian Status, 2005 - 2014

Hawai‘i State: Native Hawaiian: Hawai‘i State: Native Hawaiian: Male Male Female Female

$50K $48,440 $46,786 $45,911 $45,577 $45,443 $45,494 $45,748 $44,802 Median$45K Individual Earnings in Hawai‘i, by Gender and Hawaiian Status, 2005 - 2014 $41,821 $41,821 $41,811 $41,238 $44,194 $43,740 Hawai‘i State: Native Hawaiian: $42,832Hawai‘i State:$42,826 Native Hawaiian: $41,706 $38,870 $40K Male Male Female $38,040 Female $40,618 $40,259 $37,242 $40,370 $40,162 $36,242 $50K $35,471 $48,440 $46,786 $33,780 $36,709 $35,977$45,911 $36,707 $35K $45,577 $45,443 $45,494 $45,748 $32,305 $44,802 $35,596 $35,725

$45K $33,008 $41,821 $32,378 $32,739 $41,821 $41,811 $41,238 $32,135 $31,950 $44,194 $30K $30,872 $43,740 $30,193 $42,832 $42,826 $41,706 $38,870 $40K $38,040 $40,618 $40,259 $37,242 $40,370 $40,162 $36,242 $25K $35,471 $36,709 $36,707 $35K $33,780 $35,977 $32,305 $35,596 $35,725 $20K $32,739 $33,008 2005 2006 $32,3782007 $32,1352008 2009 2010$31,950 2011 2012 2013 2014 $30K $30,872 $30,193 Notes. Adapted from (U.S. Census Bureau, 2014a)

$25K

$20K 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Notes. Adapted from (U.S. Census Bureau, 2014a) Male Occupational Representation in Hawai‘i, by Native Hawaiian Status, 2006 -2010 as percent of all men in occupation in Hawai‘i)

■ Native Hawaiian ■ Non Hawaiian

Material moving 33.43 66.57 Law enforcement workers including supervisors 31.08 68.92 Male Occupational Representation in Hawai‘i, by Native Hawaiian Status, Firefighting and prevention and other protective2006 -2010 service workersas percent including of allsupervisors men in occupation27.44 in Hawai‘i)72.56 Construction and extraction 27.22 72.82 ■ Native Hawaiian ■ Non Hawaiian Transportation occupations 27.1 72.9 Farming, fishing,Material and forestry moving 22.6133.43 77.3966.57 Law enforcement workersPersonal including care supervisorsand service 20.8631.08 79.1368.92 Firefighting and prevention and other Buildingprotective and service grounds workers cleaning including and maintenance supervisors 2027.44 8072.56 CommunityConstruction and and social extraction service 19.7327.22 80.2772.82 Transportation occupationsProduction 18.9527.1 81.0572.9 Installation,Farming, maintenance, fishing, and and forestry repair 18.4222.61 81.5877.39 Office andPersonal administrative care and support service 17.3520.86 82.6579.13 Building and grounds cleaningHealthcare and maintenance support 16.5720 83.4380 Food preparationCommunity and and serving social relatedservice 14.7219.73 85.2880.27 Arts, design, entertainment, sports, Productionand media 13.5718.95 86.4381.05 Installation,Education, maintenance, training, andand libraryrepair 11.6218.42 88.3881.58 OfficeArchitecture and administrative and engineering support 11.2417.35 88.7682.65 HealthcareSales and support related 11.0816.57 88.9283.43 Food preparation and servingManagement related 10.614.72 89.485.28 Arts, design, entertainment,Computer andsports, mathematical and media 8.9113.57 91.0986.43 Education,Business training, and and financial library 8.7311.62 91.2788.38 Health diagnosis and treating practitionersArchitecture and and other engineering technical 7.6711.24 92.3388.76 Health technologistsSales and techniciansand related 7.4411.08 92.5688.92 Life, physical, and socialManagement science 5.7510.6 93.2589.4 Computer and mathematicalLegal 5.518.91 93.4991.09 Business and financial0 8.73 20 91.2740 60 80 100 Health diagnosis and treating practitioners and other technical 7.67 92.33 Notes. Adapted from (U.S. Census Bureau, 2014a) Health technologists and technicians 7.44 92.56

Life, physical, and social science 5.75 93.25

Legal 5.51 93.49 0 20 40 60 80 100

Notes. Adapted from (U.S. Census Bureau, 2014a) Average Travel Time to Work in minutes, by Gender and Native Hawaiian Status, 2014

■ Male ■ Female

35% 30.10 29.30 Average30% Travel Time to Work in minutes, by Gender28.20 and 28.50 26.70 27.30 Native Hawaiian Status, 2014 25% ■ Male ■ Female

20%35% 30.10 29.30 15%30% 28.20 28.50 26.70 27.30

10%25%

20%5%

15%0% Native Hawaiian Non-Hawaiian Total

Notes.10% Adapted from (U.S. Census Bureau, 2014a)

0% Native Hawaiian Non-Hawaiian Total

HomelessNotes. Adapted Service from (U.S. Clients Census in Bureau, Hawai‘i, 2014a) by Native Hawaiian Status, 2011 - 2015

■ Non Hawaiian ■ Native Hawaiian

16000

Homeless 3,975Service Clients 3,943in Hawai‘i, by Native3,906 Hawaiian 4,241Status, 2011 - 4,5542015 12000 ■ Non Hawaiian ■ Native Hawaiian

16000 8000 10,225 10,037 9,733 10,041 10,400

3,975 3,943 3,906 4,241 4,554 12000 4000

8000 10,225 10,037 9,733 10,041 10,400 0 2001 2012 2013 2014 2015

Notes.4000 Adapted from (Yuan, 2014)

0 2001 2012 2013 2014 2015

Notes. Adapted from (Yuan, 2014) Risk Behaviors by Race-Ethnicity in Hawai‘i – Binge Drinking: 2013

40%

35% 32.6 30 Kānehō‘ālani – Transforming the Health of Native Hawaiian Men 29.1 30% Risk Behaviors by Race-Ethnicity in25.8 Hawai‘i – Binge Drinking: 2013 26.6 24.8 25% 40% 20% 35% 32.6 15% 29.1 12.1 Risk Behaviors by 30% 25.8 26.6 Race-Ethnicity in 10% 24.8 Hawai‘i – Binge 25% Drinking: 2015 5% Source. HHDW. 2016a 20% 0% 15% Native Hawaiian Caucasian Filipino Chinese12.1 Japanese State of Hawai‘i

10% Notes. Adapted from (Yuan, 2014) 5%

0% Native Hawaiian Caucasian Filipino Chinese Japanese State of Hawai‘i

Notes. Adapted from (Yuan, 2014) Incarceration of Native Hawaiians as a percentage of the Community Minimum Medium Close Maximum Unclassified Total state prison Malepopulation,Female Male byFemale custodyMale classiﬁcationFemale Male Female andMale sex,Female 2012Male Female Male Female Incarceration of Native Hawaiian 35.6% 34.5% 36.8% 45.8% 38.1% 41.3% 35.2% 62.5% 34.6% 42.9% 44.5% 40.0% 37.0% 40.0% ■ ■ Native Hawaiians Non-Hawaiian 64.4% 65.5% 63.2% 54.2%Native 61.9%Hawaiian58.7% 64.8% Non-Hawaiian37.5% 65.4% 57.1% 55.5% 60.0% 63.0% 60.0% as a percentage 100% of the State prison population, 90% by custody Incarceration64.4 65.5 of Native63.2 54.2 Hawaiians61.9 58.7 as a percentage64.8 37.5 65.4 of the57.1 55.5 60.0 63.0 60.0 classification and state80% prison population, by custody classiﬁcation and sex, 2012 sex, 2012 70% Source. Ka Huaka‘i: Native ■ Native Hawaiian ■ Non-Hawaiian Hawaiian Educational 60% Assessment. 2012. 100%

50%90% 64.4 65.5 63.2 54.2 61.9 58.7 64.8 37.5 65.4 57.1 55.5 60.0 63.0 60.0 40%80% 35.6 34.5 36.8 45.8 38.1 41.3 35.2 62.5 34.6 42.9 44.5 40.0 37.0 40.0 30%70%

20%60%

10%50%

40%0% Male Female Male Female Male Female Male Female Male Female Male Female Male Female 30% 35.6 34.5 36.8 45.8 38.1 41.3 35.2 62.5 34.6 42.9 44.5 40.0 37.0 40.0 Community Minimum Medium Close Maximum Unclassiﬁed Total

Note.20% The five custody levels shown are defined by the Hawai‘i Department of Public Safety (2012) as follows: Notes.Community: Adapted “for inmates from who have (Yuan, 24 months 2014) or less to serve on their sentence and are eligible to participate [in] furlough programs, extended furlough, or residential transitional living facilities.” Minimum: “for inmates with less than 48 months until their parole eligibility date; who have demonstrated through institutional conduct that they can function with minimal supervision in a correctional setting, or in the community under direct supervision.” Medium: “for inmates who have more than 48 months10% to their parole eligibility date; whose institutional conduct and adjustment require frequent supervision/intervention.” Close: “for those who have minimum sentences of 21 years or more, who are serious escape risks or have chronic behavioral/management problems.” Maximum: “inmates who are chronically disruptive, violent,0% predatory or are a threat to the safe operation of a facility.” ∫ Native HawaiiansMale Femaleare over-representedMale Female in the Hawai‘i Maleprison Femalepopulation. In 2012,Male NativeFemale HawaiiansMale constitutedFemale 17.7% ofMale the totalFemale adult populationMale inFemale Hawai‘i, while in the male prison population Native Hawaiians accounted for 37.0% and in the female prison population 40.0%. ∫ Even within more secure custody levels of close of maximum, Native Hawaiian men account for a lower percent of the population than Native Hawaiian women. ∫ These findingsCommunity are consistent withMinimum those of the 2006 DisparateMedium Treatment of NativeClose Hawaiians inMaximum the Criminal JusticeUnclassiﬁed System report, which concludedTotal that while both Native Hawaiian men and women are disproportionately represented in the criminal justice system, the disparity was less for women. In these data, 44% of incarcerated women were Native Hawaiian, while 37% of incarcerated men were Native Hawaiian. Notes. Adapted from (Yuan, 2014) Kānehō‘ālani – Transforming the Health of Native Hawaiian Men 31

Involvement with high healthcare costs, low retirement rates, Criminal Justice System increased dietary complications due to health ∫∫ In 2014, 1,962 Native Hawaiian adults conditions requiring nutritional support or were arrested for Part I offenses on the multiple medications, and the desire to “age Crime Index (i.e., murder, forcible rape, in place” with limited financial resources. robbery, aggravated assault, burglary, Kūpuna kane have a life expectancy shorter larceny-theft, motor vehicle theft, and than the total State population. arson). This was 31% of the State’s 6,300 arrests; the second highest racial Household Context group after Whites (2,215 or 35%). Many kūpuna kāne in Hawai‘i continue to live Larceny-theft accounted for 1,100 or in their communities, outside of institutions, 56% of arrests, followed by aggravated and rely on themselves, family, and services assault (259 or 13%). Arson was lowest to keep them healthy; and this lifestyle is (2%). Larceny-theft was consistently considered to be the most desirable. Studies the highest for both Native Hawaiians have shown that nearly one out of every six and the State arrest populations from adults is a caregiver to an older adult, but 2000 - 2014. these studies also acknowledge that there ∫∫ In 2014, 9,837 Native Hawaiian is very limited information about the needs adults (27%) were arrested for of these kūpuna and their family caregivers seven categories of Part II offenses. (Browne et al., 2011). These comprise all other offenses characterized by type: violent, property- ∫∫ As recorded in the most recent U.S. related, drug manufacturing/sale, Census in 2010, Native Hawaiians drug possession, gambling, and other 65 years and older constitute only crimes. This was the second highest of 7.3% of the total Native Hawaiian 11 racial groups after Whites (35% or population in Hawai‘i. However, 23.7% 12,902 of 36,587 State arrests). of Native Hawaiian households include ∫∫ From the most recent incarceration a kūpuna member. Although the total reports available by ethnicity and State population had almost twice the gender (2012), Native Hawaiians were percentage of older adults (14.3%) over-represented in Hawaii’s prison as the Native Hawaiian population, Age and life population. While Native Hawaiian men the percentages of households to expectancy accounted for 17.7% of total adult include an older adult member was How can we, as a population in Hawai’i, they were 37% of only 6.6 percentage points higher lāhui, raise the life the male prison population. (30.3%). These figures indicate that expectancy for all ∫∫ Of the five classes of custody (i.e., Native Hawaiian kūpuna are living in kāne? What would Community, Minimum, Medium, Close households at greater rates than the be needed to reform and Maximum), Native Hawaiians make total State population. in the current up 35.6%, 36.8%, 38.1%, 35.2%, and ∫∫ A larger percent of Native Hawaiian health care system 34.6% of the population, respectively. kūpuna kāne lived their mo‘opuna to improve kāne (Kamehameha Schools. 2011) (8.4%), in comparison to the total State health? older adult population (5.3%). 2.6% Kūpuna of Native Hawaiian kūpuna kāne were Kūpuna kāne (male Native Hawaiian older also financially responsible for their adults) hold a unique and highly respected mo‘opuna’s basic needs, such as food, place in Native Hawaiian communities today shelter, and day care, which is twice as leaders of the ‘ohana, as well as keepers of the percentage of the total State adult knowledge and traditions. Kūpuna, however, population (1.3%). often experience increased health, social, ∫∫ Conversely, Native Hawaiian kūpuna and economic vulnerabilities. Many of these kāne living alone comprised 1.8% of concerns can be traced to social determinants Native Hawaiian households; less than of health, which kūpuna kāne were exposed the percent total State male older to earlier in their lives, and many are related adults (2.7%) and kūpuna wāhine (3%). to kūpuna’s current needs. Many of these needs are related to high poverty rates, 32 Kānehō‘ālani – Transforming the Health of Native Hawaiian Men

Preventive Services U.S. average of 77 years. This trend of To keep Native Hawaiian kūpuna kāne higher life expectancy in Hawai‘i versus healthy, services that provide preventive care the U.S. was established since 1950. must be accessible. Core preventive care ∫∫ Native Hawaiian life expectancy was services include a flu shot within the year, 74.3 years; kāne 71.5 years and wāhine pneumonia vaccination ever, and either a 77.1 years. Of six race-ethnicities, colonoscopy/sigmoidoscopy in ten years or Native Hawaiians had the shortest life Fecal Occult Blood Test (FOCT) within the year. expectancy. (Health Trends in Hawai‘i, 2003-2013) ∫∫ In 2014, 30.6% of Native Hawaiian male kūpuna (65 years and older) received Health Outcomes the necessary core preventive health The physical manifestations on an services. This percentage compares individual of the social determinants of with 37.8% of the total State male older health can manifest in many ways. This adult population and 27.6% of kūpuna section explores some of the leading serious wāhine (for whom core services include adverse health effects afflicting the Hawaiian a mammogram within two years). community. (HHDW. 2016a) Obesity Age and life expectancy Generally speaking, the Native Hawaiian For kūpuna, mobility, or the ability to community is particularly challenged with being effectively and safely move in the environment overweight and obese. A greater understanding is essential to health and well-being. Impaired of the Native Hawaiian obesity problem is mobility can cause mental distress from complimented by recent academic research. the inability to independently perform daily One such study, published in the Hawai‘i activities, access goods and services, and Journal of Medicine and Public Health— interact with ‘ohana. The physical problems conducted by Dr. Laura McCubbin, PhD. associated from limitations in mobility include and Mapuana Antonio M.P.H.—investigated depression, cardiovascular (heart) disease, whether social stigmas as manifested in Health Outcomes cancer, and injuries. perceived discrimination is a contributing What are good factor to the adverse health outcome of examples of ∫∫ The kāne population had 40% (26% being overweight or obese. This study also existing approaches State) under the age of 20, 15.4% explains that the variability in health risks of that should be between the ages of 20-29 (15.0% obesity/overweight Native Hawaiians may be drawn upon in the State) and 6.4% (13% State) 65 and more fully understood and addressed as the development of a older, signifying high birth and death combination and interacting influence of both framework to create rates and lower life expectancies. risk and protective factors rather than a single positive health ∫∫ In 2013, of the total Native Hawaiian negative causal influence of discrimination outcomes? resident deaths (1,693), 54% or 918 complemented by “controlling” other variables. were kāne and 46% were wāhine. Resident males died at a higher rate ∫∫ The obesity rates for both Native (AAMR – Age Adjusted Mortality Rates) Hawaiian kāne and wāhine are high, but than females. the obesity rates of kāne much higher ∫∫ In 2000, life expectancy at birth in (45.7%) (outside of the margins of Hawai‘i was 80 years, compared to the error) relative to wāhine (36.1%). Kānehō‘ālani – Transforming the Health of Native Hawaiian Men 33

∫∫ Logistic regression analyses of “Other Pacific Islanders.” In this year of confirmed a negative influence of measurement, 82.7% of kāne were considered overt discrimination in explaining overweight or obese, based on the body mass the variability in obesity/overweight index (BMI); in comparison to 66.0% of all men in Native Hawaiians. There were Statewide (HHDW, 2016b). statistically significant demographic predictors which varied in the nature Asthma of their association, but could be A related outcome connected to high used to present an “at-risk” profile. tobacco use is asthma. Specifically, being male (OR=2.73), between the ages of 35 and 54 (OR = ∫∫ The most recent data from 2012 1.29), having a household income of documents Native Hawaiians with the $35,000 or less (OR = 2.45), and living highest prevalence of asthma in the in the Hawaiian Islands 6–20 years State of Hawai‘i at 16.3%. While specific (OR = 1.29) were positively related to data about kāne with asthma is not being obese/overweight. Thus, kāne currently available, combined male/ may be particularly susceptible to female data demonstrates that asthma obesity if they have lived in Hawai‘i for a prevalence among Native Hawaiians considerable time, are poor, and generally is higher (as a percentage) are between 35 and 54 years of age when compared to all other races within (McCubbin & Antonio). the State of Hawai‘i. ∫∫ Data from the aggregated years 2011- Data from 2015 reflects that kāne 2014, show that wāhine are more likely continue to have a higher prevalence of being to currently have asthma compared to overweight or obese than other racial groups kāne. in the State of Hawai‘i, with the exception

Hypertension Compared to the rates from the State of Hawai‘i, kāne had slightly higher rates of hypertension in 2011 and 2013. However, because the confidence intervals do overlap, it is difficult to ascertain with absolute certainty that the kāne rate for hypertension.

2011 – 2013 Combined Data Health Indicator Gender Race/Ethnicity Percent Lower CI (95%) Upper CI (95%) Male Native Hawaiian 33.6% 28.8% 38.4% Hypertension Male State of Hawaii 29.2% 27.6% 30.7% 34 Kānehō‘ālani – Transforming the Health of Native Hawaiian Men

High Cholesterol Compared to the rates from the State of Hawai‘i, kāne had slightly lower rates of high cholesterol for 2011 and 2013. The difference is marginal, and once again, the confidence intervals overlap. Diabetes & Pre-Diabetes 2011 & 2013 Combined Data Health Indicator Gender Race/Ethnicity Percent Lower CI (95%) Upper CI (95%) Male Native Hawaiian 36.1% 30.5% 41.6% High Cholesterol Male State of Hawai‘i 37.7% 35.8% 39.6%

Both kāne and wāhine diabetes and pre-diabetes rates are relatively comparable to one another for both categories, for the aggregated years 2011 through 2014. Heart Attack 2011-2014 Health Indicator Gender Race/Ethnicity Percent Lower CI (95%) Upper CI (95%) Male Native Hawaiian 10.6% 8.3% 12.8% Diabetes Female Native Hawaiian 11.2% 9.4% 12.9%

2011-2014 Health Indicator Gender Race/Ethnicity Percent Lower CI (95%) Upper CI (95%) Male Native Hawaiian 11.9% 9.7% 14.0% Pre-Diabetes Female Native Hawaiian 11.7% 9.8% 13.6%

Data from the aggregated years 2011-2014, show that kāne are only slightly more likely to have ever had a heart attack compared to wāhine. Differences may not be notable or significant, given that the confidence intervals overlap. Stroke

2011-2014 Health Indicator Gender Race/Ethnicity Percent Lower CI (95%) Upper CI (95%) Coronary Heart Male Native Hawaiian 4.7% 3.6% 5.9% Disease (ever) Female Native Hawaiian 3.5% 2.5% 4.6%

Data from the aggregated years 2011-2014, show that wāhine are only slightly more likely to have ever had a stroke compared to kāne. Differences may not be notable or significant, given that the confidence intervals overlap. Cancer 2011-2014 Health Indicator Gender Race/Ethnicity Percent Lower CI (95%) Upper CI (95%) Stroke Male Native Hawaiian 3.4% 2.5% 4.4% (ever) Female Native Hawaiian 3.6% 2.6% 4.7%

Although data exists for both incidence—any diagnosis of contracting cancer—and for mortality—a scenario where cancer leads to death, the data for cancer specific to kāne are available for the State of Hawai‘i, but have not been updated in nearly a decade. The kāne incidence rate becomes particularly troubling when the mortality rate for kāne Kānehō‘ālani – Transforming the Health of Native Hawaiian Men 35

Incidence Race-Ethnicity Male Female Incidence Count Incidence Rate Incidence Count Incidence Rate Native Hawaiian 369 479.6 441 447.8 White 980 542.4 767 413.6 Table 7.122a Average Chinese 186 423.5 166 317.3 Annual Incidence & Filipino 403 466.8 336 341.4 Mortality Counts & Japanese 842 476.3 776 363.9 Rates for All Cancer Sites by Gender and Total, All Races 2,967 485.7 2,684 382.2 Race-Ethnicity Source: Hawai‘i State, Mortality University of Hawai‘i, Cancer Research Center Race-Ethnicity Male Female of Hawai‘i , Hawai‘i Tumor Mortality Count Mortality Rate Mortality Count Mortality Rate Registry, Hawai‘i Cancer Facts & Figures 2010. Native Hawaiian 173 231.7 162 171 White 336 198.2 252 133.6 Chinese 68 154.4 61 107.2 Filipino 158 178.7 95 98.3 Japanese 337 187.1 273 109.9 Total, All Races 1,158 192 912 124.7

Note: Invasive cases only, in-situ cases are excluded. Counts are 6 year average annual, rounded to the nearest whole. All races include race/ethnic groups listed plus all other race/ethnic groups combined. Rates are average annual and are per 100,000 population, age-adjusted to the 2000 U.S. standard population.

is also considered. Taken together, we get a clearer picture. For whatever reason, kāne are contracting cancer at the second highest rate, but dying from it with the highest mortality rate of all groups broken down by race and sex (in 2010).

Perhaps shedding a little light on why incidence and mortality rates may be so high is one statistic on prostate cancer. Compared to all other ethnic groups, kāne have the lowest rate of early stage prostate cancer, and the highest rate of late stage prostate cancer. One potential reason for explaining this outcome lies in detection. If detection happens later for kāne, then cancer is likely more advanced. Admittedly, drawing broad conclusions on one outcome must be done with caution. Nevertheless, this trend is particularly instructive. If this trend were reversed, it could potentially lead to parity with other ethnicities regarding early, late, and un-staged cancer rates. Understanding why kāne are not as participatory in detection will be an important component to determining and strategizing potential solutions.

∫∫ Data from the aggregated years 2011-2014, show that wāhine are more likely to have ever had cancer compared to kāne. This is keeping with the general trend of men having lower rates of ever having cancer compared to women, throughout the State of Hawai‘i overall. ∫∫ The five leading cancer sites for mortality for kāne from the most recently recorded years of 2000-2005: Lung and Bronchus (31.3%), Colon and Rectum (10.1%), Prostate (6.1%), Pancreas (5.6%), and Liver (5.3%).

36 Kānehō‘ālani – Transforming the Health of Native Hawaiian Men

∫∫ Trends for lung and bronchus cancer Morbidity during the years 2000-2005 indicate There are many health challenges facing that this type of cancer kills more kāne the kāne population. Data specific tokāne than any other. In fact, this trend had demonstrates that the kāne population has remained unchanged since 1975. grown over time and stabilized, that kāne have ∫∫ Referring to incidence, the event when high suicide rates, and high rates of heavy cancer is contracted and detected, alcohol consumption. In regards to cancer, kāne have a higher rate of incidence the leading cancer site for kāne is lung and than every female group, and every bronchus cancer—which kāne contract more other male group with the exception than any other race; kāne also have the second of White males, who have the highest highest incidence rate of cancer and the incidence rate of all (from 2010). highest mortality rate of cancer. Kāne have the ∫∫ Kāne had the second lowest rate of lowest rate of early stage prostate cancer, and “Ever Had a Prostate-Specific Antigen the highest rate of late stage prostate cancer. (PSA) Test” (Among Men Age 40+) in In regards to cancer prevention, kāne have the 2013 and have the lowest rates among lowest rates among all other ethnicities for all other ethnicities for PSA tests within Prostate Specific Antigen (PSA) tests within the past two years. This is specific the past two years, with kāne overall being evidence demonstrating that kāne are significantly less likely to participate in both not as engaged in cancer detection cancer prevention and treatment trials. behaviors. Clinical trials also confirm thatkāne cancer prevention behaviors can be improved. A Mental Health recent 2015 study by Bantum, et. al found that kāne were significantly less likely to participate ∫∫ Data from 2015 shows that kāne are in both cancer prevention and treatment trials more likely to report six or more days than wahine (Native Hawaiian females), and of bad mental health in the past 30 that both groups—kāne and wahine alike—had days (18.6%) than total men statewide the lowest proportion of participation in cancer (12.9%). (HHDW, 2016b) Kāne also clinical trials in comparison to White and Asian have slightly higher rates of depression American men and women in Hawai‘i. These Morbidity disorder (12.4%) as compared to total findings identify both gender and ethnic/ How can your men statewide (9.0%) (HHDW, 2016b). racial gaps in clinical trials conducted in the organization help ∫∫ In the State of Hawai‘i, both the entire State of Hawai‘i with cancer participants. This with early detection male population (nearly double that of serves as another piece of evidence indicating of health risks and the female) and the Native Hawaiian the need for future cancer research to illnesses amongst population and Other Pacific Islander investigate the relationship between factors kāne? What effective generally (nearly double that of the like race and culture with distinct participation interventions can second highest ethnic group) are demographics. Such research may inform improve their health both much more likely to commit promotional strategies that increase trial and well-being? suicide, as measured by the Age- participation, with the hopeful prospect of Adjusted Mortality Rate per 100,000 decreasing cancer incidence and increasing (AAMR). Kāne susceptibility to suicide quality of life for kāne diagnosed with cancer. and the factors that influence such negative outcomes need to be better understood, and promptly addressed from a prevention lens (HHDW, 2016c). Kānehō‘ālani – Transforming the Health of Native Hawaiian Men 37

Conclusion and Recommendations

In many ways, the situation looks grim. Native Hawaiians are more likely to come from single parent homes; have high rates of child abuse and neglect; a higher prevalence of being overweight or obese with the highest risk factors associated with obesity; and with high rates of tobacco use. Complicating a deep understanding of kāne health is the absence of holistic research that would otherwise complement already-existing information. There is much that we do not know. For example, there is little data on illicit drug use. Diet and nutrition data could be expanded to include comprehensive nutritional examination surveys of traditional diets. It would be especially helpful to understand the “why” that motivates many of these outcomes. For example, why are kāne behaviors sometimes at odds with their own best interests, especially in cancer prevention and treatment? Support from schools, government, and other institutions could include the following:

Better policies

∫∫ Basic public health research methodologies and indigenous ways of knowing should be incorporated into State policy planning. ∫∫ Policies that address children and adolescents should be improved to go “upstream,” to consider causal and associated risk factors. ∫∫ HRS §226-20 should be implemented in specific policies. The Hawai‘i State Planning Act was amended to codify a commitment to addressing the health disparities and social determinants of health (SDH) of Native Hawaiians, other Pacific islanders, and Filipinos.

Better programs

∫∫ Public-private partnerships can be created, which convene to outline a “master plan” for the well-being of kāne. This plan will focus on reducing kāne inequities through policies, programs, and practice for the State of Hawai‘i. ∫∫ Expand ‘ohana-based programming that looks at prevention and interventions through a family-based model, especially to address multigenerational patterns of SDH disparities.

Better research/evaluation or data

∫∫ Advanced research, assessment, and evaluation can be conducted, to understand Hawaiian indicators for connectedness to traditional interventions, especially those outlined in ‘O Ka Wā Mamua. ∫∫ Estimates suggest that investments to improve educational achievement can save more lives than can medical advances. According to a recent review by Cutler and Lleras-Muney (3), policies that increase educational attainment could have a large effect on population health. To realize these possibilities, public health researchers need to develop new conceptual and analytic approaches to studying the reciprocal relationships between health and education and consider education as an arena for intervention as well as a marker or moderator for social position (Office of Hawaiian Affairs, 2015). ∫∫ The above work could be conducted with non-profit, culturally based organizations (such as ‘Aha Kāne). 38 Kānehō‘ālani – Transforming the Health of Native Hawaiian Men

Better collaboration

∫∫ We can showcase how collaborations between OHA and ‘Aha Kāne show laulima and collective effort to uplift the community needs. This report is an example of how a collective effort can make important progress. ∫∫ State agencies can improve data sharing and data disaggregation for advanced analysis, to make data-informed decisions and deployment of resources.

Better practice

∫∫ A statewide study could produce a complete, statewide data set (which included information on cultural practices and values, etc.), which then would enable researchers to start making correlations between various SDH. This study could include data collection by age group and gender, as this report is outlined, and could be conducted cross-agency (for example, by: OHA, DOH, DOE, DHS, DPS, UH, and DBEDT).

This report is somewhat unique as it begins to paint a more complete picture of the Native Hawaiian male experience in Hawai‘i. If we were able to include indicators of cultural connection, this picture would become even clearer. This report might be able to lend some insight into how and why kāne health needs more holistic interventions, departing from a more traditional, siloed approach of education, early detection, and treatment. In fact, it goes back to the fact that we need to support the whole person and positive experience throughout his entire life. Kānehō‘ālani – Transforming the Health of Native Hawaiian Men 39

Further Discussion Questions

Which aspects of kāne well-being are of interest or apply to your organization?

After reading this report, what ecological factor is the most important to address about kāne well-being?

How does having healthy kāne positively affect the entire State?

How can your organization address kāne well-being for kāne of all ages?

In what ways can you work with outside organizations on Native Hawaiian men’s health?

In what ways can this report be used by your organization to achieve greater health outcomes for Native Hawaiian males?

Who or what organizations need to be part of your planning for next steps towards greater kāne health?

What should be the next steps for the current administration to develop and implement a shared outcomes framework for ‘ohana-centered wellness? 40 Kānehō‘ālani – Transforming the Health of Native Hawaiian Men

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Silva, N. (2004). Aloha Betrayed: Native Hawaiian Resistance to American Colonialism. Durham, NC: Duke University Press. Stannard, D. (1989). Before the Horror: The Population of Hawai‘i on the Eve of Western Contact. Honolulu, HI: University of Hawai‘i Press. Tengan, T. K. (2008). Native Men Remade: Gender and Nation in Contemporary Hawai‘i. Durham: Duke University Press. Wilcox, C. 1997. Sugar Water: Hawaii’s Plantation Ditches. Honolulu, HI: University of Hawai‘i Press.

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Smoke – current smoker, Age Adjusted. Retrieved from http://ibis.hhdw.org/ibisph- view/query/result/brfss/SmokeCurrent/SmokeCurrentAA11_.html. Hawai‘i Health Data Warehouse. (2016c). Hawai‘i State Department of Health. Office of Health Status Monitoring (OHSM); United States Census. Death Counts, Age-Adjusted Mortality Rates, and Years of Potential Life Lost for Suicide for the State of Hawai‘i (Residents Only), by State, County of Residence, Gender, and Census Race-Ethnicity, by 3-Year Aggregates, for the Years 2000-2014. Retrieved from http://hhdw.org/wp- content/uploads/AAMR_Suicide_3AGG1.pdf Hawai‘i State Department of the Attorney General. Crime in Hawai‘i: A Review of Uniform Crime Reports. 2003 through 2014 Hawai‘i State Department of Education (DOE). (2016). Graduation/Retention. ARCH Accountability Data Center. Retrieved from https://adc.hidoe.us/#/graduation- retention Hawai’i State Department of Education (DOE). (2015). OHA 2014-2015. Unpublished raw data. State of Hawai‘i, Department of Human Services. A Statistical Report on Child Abuse and Neglect in Hawaii, 2000-2014. Health Trends in Hawai‘i. (2000-2013). Retrieved from www.healthtrends.org/status_life_ expect.aspx Jensen, U. (2011). Factors Influencing Student Retention in Higher Education. Retrieved from http://www.ksbe.edu/_assets/spi/pdfs/Retention_Brief.pdf Kamehameha Schools. (2011). Kamehameha Schools Annual Report: July 1, 2010 – June 30, 2011. Retrieved from: http://www.ksbe.edu/assets/annual_reports/KS_Annual_ Report_2011.pdf Kamehameha Schools (2014). Incarceration of Native Hawaiians. Ka Huaka‘i: 2014 Native Hawaiian Educational Assessment. Honolulu, HI: Kamehameha Publishing. Kana‘iaupuni, S., Ledward, B., & Jensen, U. (2010). Culture-Based Education and Its Relationship to Student Outcomes. Honolulu: Kamehameha Schools, Research & Evaluation. Retrieved from http://www.ksbe.edu/_assets/spi/pdfs/CBE_relationship_ to_student_outcomes.pdf Lewin-Bizan, S. (2015). 24/7 Dad© Program in Hawai‘i: Sample, Design, and Preliminary Results. Retrieved from http://cdn2.hubspot.net/hubfs/135704/247-Dad-Evaluation- Lewin-Bizan-06102015.pdf McCubbin, L. D. Antonio; M. (2012). Discrimination and Obesity Among Native Hawaiians, Hawai‘i Journal of Medicine & Public Health. 2012 Dec; 71(12): 346-352. Moore, T., McDonald, M., & McHugh-Dillon, H. (2015). Evidence review: Early childhood development and the social determinants of health inequities. Victorian Health Promotion Foundation. Retrieved from: http://www.rch.org.au/uploadedFiles/Main/ Content/ccch/151014_Evidence-review-early-childhood-development-and-the- social-determinants-of-health-inequities_Sept2015.pdf Kānehō‘ālani – Transforming the Health of Native Hawaiian Men 43

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Acknowledgements

About this report Kānehō‘ālani – Transforming the Health of Native Hawaiian Men is the first in a series of reports by the Office of Hawaiian Affairs on the health of Native Hawaiians. According to scholar Dr. Pua Kanahele, Kānehō‘ālani literally means, “The fire that ignites the sky,” and is the name of Pele’s father. In the context of this report, hō‘ā is transformative energy, the heat that is necessary to generate life on earth (water systems, food systems etc); lani is symbolic of the ideal state of health; and Kāne represents the connection of akua to kanaka.

Contributors Part One: Historical Strengths is adopted from Mana Kū Kāne: Native Hawaiian Men’s Wellbeing, a report written by ‘Aha Kāne, a non-profit organization whose mission is to “strengthen the Native Hawaiian community through nurturing and perpetuating the traditional male roles and responsibilities that contribute to the physical, mental, spiritual, and social well-being of Native Hawaiian males, their families, and communities.”

Cover art and illustrations by Solomon RN Enos. The kukui glyph was also designed by Enos, The kukui is a kinolau form of Kamapua‘a; pairing it with makawalu (eight eyes)—which encourages seeing something in several, dynamic ways— speaks of enlightened, masculine energy that is understood through many lenses.

About the Office of Hawaiian Affairs Vision “Ho‘oulu Lāhui Aloha” – To Raise a Beloved Nation. OHA’s vision statement blends the thoughts and leadership of both King Kalākaua, and his sister, Queen Lili‘uokalani. Both faced tumultuous times as we do today, and met their challenges head on. “Ho‘oulu Lāhui” was King Kalākaua’s motto. “Aloha” expresses the high values of Queen Lili‘uokalani. Mission Statement To mālama (protect) Hawai‘i’s people and environmental resources and OHA’s assets, toward ensuring the perpetuation of the culture, the enhancement of lifestyle, and the protection of entitlements of Native Hawaiians, while enabling the building of a strong and healthy Hawaiian people and nation, recognized nationally and internationally. Overview The Office of Hawaiian Affairs is a public agency with a high degree of autonomy. OHA is responsible for improving the well-being of Native Hawaiians. OHA is governed by a Board of Trustees made up of nine members who are elected statewide for four-year terms to set policy for the agency. OHA is administered by a Ka Pouhana (Chief Executive Officer) who is appointed by the Board of Trustees to oversee a staff of about 170 people. Mana is Our Legacy, Mauli Ola is Our Destiny E ho‘okanaka. Be a man. (said by Kamehameha to his son Liholiho on his deathbed)

– ‘Ōlelo No‘eau #290.

48 Kānehō‘ālani – Transforming the Health of Native Hawaiian Men

Empowering Hawaiians, Strengthening Hawai‘i www.oha.org

560 N. Nimitz Hwy., Ste. 200 • Honolulu, HI 96817 • 808.594.1888