HONOLULU (KHON2) -- In a recent interview, KHON2.com talked story with three experts who discussed the importance of community health workers in Hawaiʻi, particularly for Native Hawaiian and Pacific Islander communities.
Their work highlights how culture and language play crucial roles in healthcare, addressing historical mistrust, and promoting better health outcomes.
Dr. Nia Aitaoto, Executive Director of the National Association of Pasifika Organizations, began by explaining the scope of her organization, which operates in all six U.S. Pacific jurisdictions, including Hawaiʻi, and in 40 states across the continental U.S.
“Culture is a determinant of health we haven’t looked at closely enough,” said Dr. Aitaoto emphasizing the importance of integrating culture into healthcare.
She has been involved in community work around diabetes for over 20 years, noting the lack of studies that consider cultural determinants of health.
Dr. Keawe Kaholokula, a Health Professor and Chair of Native Hawaiian Health at the John A. Burns School of Medicine, has also focused on diabetes and related health issues for over two decades.
He highlighted the role of community health workers, especially those from Native Hawaiian and Pacific Islander communities, who bring cultural expertise and meaningful connections.
Dr. Kaholokula stated, “Community health workers hold the cultural expertise needed to reach our communities in meaningful ways to prevent chronic diseases.”
Tellie Matagi, a Director at Papa Ola Lōkahi and community site coordinator for the Peau o le Vasa project, shared her experience as a Pacific Islander. She described how Pacific Islanders are very communal and have always practiced community health work informally.
“During COVID-19, we saw huge disparities in our communities," explained Matagi. "We had higher cases and deaths, and there was a lack of resources.”
She further explained how the Department of Health, in collaboration with community advocates, created a case investigation team that incorporated community health workers. This model proved effective, leading to efforts to build and train this workforce further.
Building trust and understanding
Community health workers can bridge the gap between traditional healthcare and the communities they serve.
Matagi explained, “There’s a big difference when you’re a native speaker. You understand the culture and can speak the language, which makes engaging with the community much easier.”
She shared an example from a conference on maternal health where traditional customs prevented new mothers from leaving their homes for checkups. Community health workers, understanding these customs, could guide and support these mothers in ways that traditional healthcare providers could not.
Dr. Kaholokula expanded on this, noting that the historical and cultural factors contributing to mistrust in healthcare systems stem from colonization and its lasting impacts.
He said, “Colonization is a determinant of health for us as native people. It has placed us at a disadvantage, leading to higher risks for diseases like diabetes.”
He also emphasized the importance of addressing economic and social determinants of health to improve health outcomes in these communities.
The Peau o le Vasa Initiative
The Peau o le Vasa initiative aims to address health disparities in Native Hawaiian and Pacific Islander communities by incorporating language, culture and environmental significance into its comprehensive curriculum for community health workers.
“The curriculum we are developing includes sessions on social determinants of health," Dr. Aitaoto explained. "It’s not just mentioned on the side but is a core part of the lessons.”
This approach ensures that community health workers are well-equipped to address the unique needs of their communities.
Matagi highlighted the importance of tailoring the curriculum to different regions.
“Here in Hawaiʻi, we realize that Native Hawaiians and Pacific Islanders face challenges based on location," she said. "We need to adapt our approach for rural areas differently than we do for urban areas like Honolulu.”
This flexibility allows community health workers to provide relevant and effective support based on the specific needs of their communities.
The role of NIH and future directions
Dr. Kaholokula discussed the role of the National Institutes of Health (NIH) in supporting the Peau o le Vasa initiative.
“The NIH recognized the effectiveness of community health workers during the COVID-19 pandemic and is continuing to support programs that address chronic diseases and mental health issues,” he explained.
The $1.4 million in funding is significant as it helps build the foundational work for the project’s first phase, with hopes for further funding to continue the initiative.
Overcoming barriers to healthcare
One of the major health issues faced by Native Hawaiian and Pacific Islander communities is the high prevalence of cardiometabolic risk factors, such as obesity, high blood pressure, and diabetes.
Dr. Kaholokula noted, “Community health workers can help people manage their health better by providing culturally relevant support and encouraging regular screenings and checkups.”
This early detection can lead to better treatment outcomes.
Dr. Aitaoto added that mistrust and economic challenges often prevent people from seeking healthcare.
“Many people don’t trust the healthcare system or can’t afford it," she further explained. "Even if they have insurance, they might not use it because they’re too busy working multiple jobs and taking care of their families.”
Community health workers can address these barriers by building trust and providing support that aligns with the community’s needs.
The impact of community health workers
During the pandemic and recent Maui wildfires, the importance of community health workers became even more apparent.
“We brought healthcare to the community instead of expecting them to go to hospitals," said Matagi. "This approach was very effective.”
She emphasized the role of language and culture in building trust and ensuring effective communication.
Dr. Kaholokula highlighted the economic challenges faced by many families.
“People are working multiple jobs and don’t have time for checkups," he added. "Community health workers can help by meeting people where they are and providing services that fit their lifestyle.”
The work of community health workers in Hawaiʻi, particularly for Native Hawaiian and Pacific Islander communities, is crucial in addressing health disparities. By incorporating culture, language and environmental factors into healthcare, these workers can build trust and provide meaningful support.
The Peau o le Vasa initiative, supported by the NIH, aims to continue this important work, helping communities navigate and overcome the barriers to better health.
As Dr. Kaholokula said, “Community health workers can be the leverage point to facilitate conversations with providers and get people into clinics.”
By understanding and addressing the unique needs of their communities, these health workers are making a significant impact on the health and well-being of Native Hawaiians and Pacific Islanders.
By focusing on these stories and the personal experiences of the speakers, we can appreciate the vital role that community health workers play in promoting health equity and improving health outcomes for all.