Hawaii's "spirit of aloha," which embodies the state's sense of friendship, congeniality and inclusion, also is a part of its healthcare delivery system.
Through its public health services, the Hawaii Health Department has sought to expand access to primary care throughout Oahu, the state's most populous island, and the seven other islands (See map, p. 34).
State-operated community health centers in Oahu and on the large island of Hawaii provide primary care largely to the state's medically underserved, estimated at 88,000.
However, problems related to the state's geography and a limited supply of physicians in those areas have slowed efforts to extend preventive medicine to all Hawaiians, health officials note.
One population that hadn't been adequately cared for by public health services, largely because of geographic hardships and bureaucratic hurdles, was Hawaii's native citizenry. Some 218,000 native Hawaiians, most of whom live in the state's outlands, aren't eligible for care from the Indian Health Service, as are other Native Americans. That's because the federal government doesn't recognize native residents of Hawaii as members of a tribe or Indian community.
The Native Hawaiian Health Care Act of 1988, which enacted a series of initiatives designed to improve the health of native Hawaiians, cleared the way for services to be more widely provided, including preventive care, primary care, health promotion, outreach and nutrition. The federal government is providing $3.6 million to help fund the program.
Under the law, nine healthcare systems for native Hawaiians were established on the Hawaiian Islands: two for Kauai and Niihau, two for Oahu, one for Molokai and Lanai, two for Maui and two for the Big Island.
A new authority, called Papa Ola Lokahi, meaning board of health in unity, is charged with implementing the program. The board is considering a plan to provide traditional healers, known as kahunas, who use herbal medicines and native remedies for treating infectious diseases.-Della de Lafuente