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179 Chapter 10 Native Hawaiians: Kānaka Maoli Pacific Smoke Inhalation Case Study Number 3 This final case study of the negative health effects of smoking is focused on “Native Hawaiians,” also called Kānaka Maoli. They will be referred to below as Native Hawaiians since most of the published literature uses this designation. The indigenous Polynesian inhabitants of the Hawaiian archipelago were believed to have numbered about 300,000 at the time Captain James Cook arrived in 1778 (Ito 1999, 39). As a consequence of introduced diseases—notably epidemics of cholera, influenza, measles, whooping cough, and venereal disease—the population plummeted to just over 44,000 by 1878, although out-migration by Hawaiian men as sailors on whaleships and to participate in the North American fur trade also contributed to this decline (ibid., 40). This 85 percent drop in population numbers can also be explained, as Jo C. Scheder (2006) points out, by the profound psychobiological consequences of emotion, loss, and grief as Native Hawaiians reacted to the chronic stress of foreign intrusion and social system collapse and suffered compromised immune systems as they coped with caregiving and bereavement. In like manner, John Casken states that the physical stress and mortality from introduced diseases were the most apparent reasons for the huge population decline, but he argued that “in retrospect, more critical to their decline were the attacks on their social structure, land values, religion, and language” (2001, 78). These points by Scheder and Casken highlight conditions that favor the development of a syndemic: “Syndemics are more likely under unstable social and environmental conditions. Social disruption frays personal and communal support networks, increasing individual emotional stress and reducing the capacity to mount an effective immune 180 Chapter 10 response to microbial threat” (Singer 2009, 195). The material to follow in this chapter will demonstrate the syndemic that plagues contemporary Native Hawaiians, who, as Hope and Hope remark, “still have evidence of remarkable spiritual, mental, and physical illness since western contact over two centuries ago” (2003, 1). Largely because Hawai‘i has been linked directly to the United States for more than a hundred years, first as a colonized territory and then after 1959 as a state, health statistics and related information are more systematic than those for U.S. Associated Micronesia in chapter 9. And especially after the John A. Burns School of Medicine was established at the University of Hawai‘i’s Mānoa campus in 1973,1 medical research that gave particular attention to the state’s ethnic diversity grew in amount and importance and has contributed to what we know about Native Hawaiian health today. Similar to the situation found with Māori in New Zealand discussed in chapter 8, individuals who nowadays are classified as Native Hawaiians in the U.S. census and for other purposes are those who self-identify as such regardless of their blood quantum. Previous to the 1990 census, Asian and Pacific Islander Americans were lumped together in a single category. In the 1990 census, however, each individual was asked to specify a primary race on the census form. For the 2000 and 2010 censuses, respondents could select more than one racial category to attempt to depict their heritage more accurately. Nearly all who identify as Native Hawaiians have part-Hawaiian ancestry, and most of them maintain aspects of Hawaiian culture in their daily lives (see, e.g., Ito 1999). Typical of how the matter of Native Hawaiian ethnicity is classified in research projects is to be found in Maskarinec et al. where “If any Hawaiian ethnicity was present, then the classification was Native Hawaiian” (2005, 317). There are a little over 400,000 Americans who identify themselves as Native Hawaiians, and more than half of this number reside in the State of Hawai‘i, where they made up approximately 20 percent of the population at the time of the 2000 census. In contemporary Hawai‘i there are very few “pure-blooded” Native Hawaiians left due primarily to generations of gene flow and intermarriage with the many other ethnic groups that have migrated to the islands. As a part of the resurgence of interest in Native Hawaiian cultural identity during the 1970s and 1980s, health problems of this population came under greater scrutiny, and this resulted in a five-volume document issued in 1985 titled, E Ola Mau: The Native Hawaiian Health Needs Study (Casken 2001, 79). One consequence of this attention was passage by the U.S. Congress of the...

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