The impact of the military presence in Hawai'i on the health of Na Kănaka Maoli

Abstract

The presence of the United States military on the islands of Hawai'i has affected the health and well-being of Native Hawaiians through large-scale historical processes, most notably Western colonization. This history has been shaped by the takeover of land for the purposes of military and commercial interests. We explore the effects that these interests have had upon the health of Native Hawaiian people, also known as Na Kănaka Maoli. Changes in policy and new program development are needed to improve the current poor health status of Native Hawaiians. In addition, potential avenues of research are proposed to evaluate the effects that the military presence has had upon the indigenous peoples of Hawai'i.

Full text

172
Pacific Public HealtH 3 Vol 13. No 2. 2006 Pacific Public HealtH 3 Vol 13. No 2. 2006
ViewPoiNts aNd PersPectiVe ViewPoiNts aNd PersPectiVe
Pacific Public HealtH 3 Vol 13. No 2. 2006 Pacific Public HealtH 3 Vol 13. No 2. 2006
ViewPoiNts aNd PersPectiVe ViewPoiNts aNd PersPectiVe
The History Of The Military In Hawai‘I
The process of military takeover for the purpose of
economic prot is discussed in this paper. A brief
historical overview serves as a logical starting point
for understanding the present resources and health
outcomes for the Native Hawaiian people, also known
as na Kānaka Maoli.
Militarization, commodication of island resources and
foreign land ownership characterizes the nineteenth
century in Ka Pae ‘Aina (the indigenous term for
Hawai‘i). Captain James Cook and his crew were
the rst Europeans to come in contact with Hawai‘i
in 1778.a While it is often said that their voyages
were driven by the spirit of scientic exploration,
Cook was an ofcer and the HMS Resolution was
a military vessel in the British Royal Navy. This
makes the rst Hawai‘i contact a military contact.
Shortly after, Hawai‘i became an integral part of trade
routes and a source of valuable resources such as, cheap
reliable labor and sandalwood. In 1842, President John
Tyler and The U.S. House Committee on Foreign Affairs
recognized the strategic value of the islands, both in
The Impact of the Military Presence in Hawai ‘i on the
Health of Na Kanaka Maoli
Kalamaoka‘aina Niheu, MD*
Laurel Mei Turbin, MPH**
Seiji Yamada, MD, MPH***
*(Please direct all correspondence to this author), Email: kniheu@keolamamo.org. Phone: (808)393-4903. **Email: LaurelMei@
gmail.com.*** Hawai‘i/Pacific Basin Area Health Education Center, University of Hawai‘I, John A. Burns School of Medicine, Email:
seiji@hawaii.edu
Abstract
The presence of the United States military on the islands of Hawai‘i has affected the health and well-being of Native Hawaiians
through large-scale historical processes, most notably Western colonization. This history has been shaped by the takeover of
land for the purposes of military and commercial interests. We explore the effects that these interests have had upon the health
of Native Hawaiian people also known as na Kānaka Maoli. Changes in policy and new program development are needed to
improve the current poor health status of Native Hawaiians. In addition, potential avenues of research are proposed to evaluate
the effects that the military presence has had upon the indigenous peoples of Hawai‘i.
war and commerce, when they declared control of the
islands as a “virtual right of conquest.”b A small group
of haole (white) businessmen, later referred to as “The
Big Five,” exploited the strategic importance of Hawai‘i
in their pursuit of political and economic power. By the
mid to late 1800’s sugar cane was the cornerstone
of Hawai‘i’s economy. The Big Five exerted political
inuence on the Hawaiian Monarchy to grant exclusive
rights to Pearl Harbor, identied as the military “key to
the central Pacic ocean.” In exchange, the tariff on
importing sugar to America was decreased. The extent
of this political inuence is seen clearly in the infamous
“Bayonet Constitution” of 1886. National protests over
the excessive inuence of the Big Five resulted in then
King Kalχkaua’s attempt to return political power to
the Monarchy. The backlash resulted in a constitution,
signed at gunpoint, which ceded most of the sovereign
power over to the Big Five.c The U.S. countered
challenges to its client state through military means.
When King Kalχkaua’s successor, Queen Liliu‘okalani,
attempted to return power to the Kingdom of Hawai‘i,
U.S. Minister Stevens landed U.S. Navy troops on the
shores of Ka Pae ‘Aina in what was later recognized as
an illegal Act of War.d
The health of na Kanaka Maoli suffered tremendously
in the years following European arrival. Infectious
diseases became rampant resulting in death tolls of
holocaust proportions. Wave after wave of epidemics
were introduced, including tuberculosis, scabies, small
pox, measles, leprosy, and typhoid fever. Venereal
diseases, previously not seen in Ka Pae ‘Aina, quickly
spread and killed at least 10,000 Kānaka Maoli over the
twenty years after rst contact.1 By 1890, a little over
one hundred years after the arrival of Captain Cook,

Pacific Public HealtH 3 Vol 13. No 2. 2006 Pacific Public HealtH 3 Vol 13. No 2. 2006
ViewPoiNts aNd PersPectiVe ViewPoiNts aNd PersPectiVe
Pacific Public HealtH 3 Vol 13. No 2. 2006 Pacific Public HealtH 3 Vol 13. No 2. 2006
ViewPoiNts aNd PersPectiVe ViewPoiNts aNd PersPectiVe
173
the population of Hawaiians had dwindled from an
estimated one million people to forty thousand, a 96%
decline so devastating that it has been described as a
population collapse (Figure 1).2, e While many see the
death toll as an inevitable result of contact, the original
purpose of that contact remains a military expedition
for the purposes of economic gain. Signicantly, the
population of all na Kanaka Maoli, both part Hawaiian
and pure Hawaiian, was at an all time low in the time
following the overthrow of the Hawaiian monarchy in
1893.f It was during this time that the Big Five seized
control of Hawai‘i with the necessary aid of American
naval troops and subsequently consolidated political
control over the islands.4 The Big Five, now occupied
the highest political seats in the Republic of Hawaii,
including that of President, needed to enforce martial
law over Ka Pae ‘Aina from 1893 to 1898 to maintain
control of a population opposed to their rule.1, 2, g
The presence of the American military increased
tremendously over the next century, especially following
the Spanish-American War. According to scholar and
activist Kyle Kajihiro, co nstruction of a naval base
at Pearl Harbor began in 19 00, destroying 36
trad it ional Hawai ia n fis hp onds and transform ing
what was once a r ich food source for O‘ahu into a
vast naval st ation. This was soon to be followed
by the construction of Fort Shafter, Fort Ruger,
Fort Armstrong, Fort DeRussy, For t Kamehameha,
Fort Weaver and Schofield Barracks. General
Macomb wrote “Oahu is to be enc ir cled with a ri ng
of steel.”h
A fundamental process that affected the mental and
physical health of na Kānaka Maoli is structural violence.
Johan Galtung dened “structural violence” as the
harmful inuence of economic and political structures
on human potential and well-being.i Such violence
includes the denial of a community or an individual’s
opportunities to reach full physical and mental potential.
In Hawai‘i, structural violence has occurred through the
invasion of space, notably military take-over of land.
The loss of land, the mounting political presence of
the U.S. imposed by military forces, and the dwindling
number of Native Hawaiians due to death from disease
resulted in the loss of indigenous political autonomy.
Thus, expansion of the American empire in the Pacic
and Asia1 via military and commercial interests brought
about the loss of lives, political autonomy, and nation for
na Kānaka Maoli.
THE MILITARY PRESENCE IN HAWAI‘I TODAY
Currently, Ka Pae ‘Aina is the most densely militarized
state in the nation. Ac cording to the U.S. De pa rtm ent
of Defense, the combined militar y branches in
20 04 include 161 military installations in Hawai‘i.j
Furthermore, the militar y c ontrols 236,303 acres,
or 5.7% of the total land area. On O‘ahu, the most
densely populate d island, the mili tar y controls
85,718 acres, or 22.4% of its land. On O‘ahu these
lands include Pearl Harbor, Schoeld Barracks, Hickam
Air Force Base, Lualualei Naval Reservation, and the
Kane‘ohe Marine Corps Air Station. We will show that
the occupation of land for military use has resulted in
the destruction of the natural environment, the
release of dangerous toxins, the destruction of
people’s homes, and the displacement of people.
The environmental impacts of such widespread
presence are far-reaching. According to the
Environmental Defense Fund, 2002 rankings of
major chemical releases and waste generation,
Honolulu County ranks in the top 20% of the
“dirtiest/worst counties in the U.S.” for total
environmental releases.k Milit ary insta ll at ions
make up five of the top ten polluters in Hawai‘i.
l More than 798 military contamination sites
have been identified by a report prepared
for Congress, entitled t he 2004 Defense
and Restoration Program. Currently, there are
three “Superfund” locationsm in Honolulu County.
“Superfund” is a deceptively benign sounding term
for areas that are dened by the signicant dangers
they impose upon the environment and the population
due to abandoned or uncontrolled waste. Two out of
the three sites are associated with the U.S. military,
including the U.S. Pacic Command Naval Computer
and Telecommunications area, and the Pearl Harbor
Naval Complex.
4
1).2, 5 While many see the death toll as an inevitable result of contact, the original purpose of that contact remains a military
expedition for the purposes of economic gain. Significantly, the population of all na Kanaka Maoli, both part Hawaiian and
pure Hawaiian, was at an all time low in the time following the overthrow of the Hawaiian monarchy in 1893.6It was during
this time that the Big Five seized control of Hawai‘i with the necessary aid of American naval troops and subsequently
consolidated political control over the islands.4The Big Five, now occupied the highest political seats in the Republic of
Hawaii, including that of President, needed to enforce martial law over Ka Pae ‘Aina from 1893 to 1898 to maintain control of
a population opposed to their rule.1, 2, 7
Submitted for print with permission from Dr. Kekuni Blaisdell, 2002.
The presence of the American military increased tremendously over the next century, especially following the Spanish-
American War. According to scholar and activist Kyle Kajihiro,

174
Pacific Public HealtH 3 Vol 13. No 2. 2006 Pacific Public HealtH 3 Vol 13. No 2. 2006
ViewPoiNts aNd PersPectiVe ViewPoiNts aNd PersPectiVe
Pacific Public HealtH 3 Vol 13. No 2. 2006 Pacific Public HealtH 3 Vol 13. No 2. 2006
ViewPoiNts aNd PersPectiVe ViewPoiNts aNd PersPectiVe
Numerous additional examples of military negligence in
the treatment of toxic substances exist. These include
but are not limited to the following.
Military cont amination hazards (suc h as)
unexploded ordnance, n various t ypes of fuels
and p etroleum products; organic solve nt s such as
perchloroethylene and trichloroethylene; dioxins
and polychlorinate d biphenyls (PCB); explosives
and p ropellants such as cyclotr imethylenetrin
itramine(RDX ), tr initrotoluene (TNT), octogen
(HMX) and perc hlorate; heav y metals such as
lead and m ercur y; napalm, chemical weapons,
and radioactive waste from nuclear powered
ships. Cobalt 60, a radi oactive waste product
from nuclear-powered ships, has been found in
sediment at Pear l Harbo r. Between 19 6 4 and
1978, 4,843,00 0 gallons of low-level radioactive
waste was disc ha rged into Pearl H arbor.8
The complete magnitude and prevalence of environmental
toxicity is unknown because the routine monitoring of
toxins and any correlating effects upon health is not
required.o The information cited above is from areas
already designated as sites for cleanup response and
likely represent only the tip of the iceberg.
Nevertheless, military bases in Hawai‘i continue to
expand because Hawai‘i is home to the Pacic Command,
the command center for U.S. military operations for half
of the globe.p Its outposts include bases in the Marshall
Islands, Guam, Okinawa,
Japan, and Korea. According
to the U.S. military, bases
are built for the purpose of
“defense” in the event of
violent struggle with other
nations. However, military
dominance also protects and
enables commercial interests.
The most direct example is
the armaments industry, a
business worth $200 billion
worldwide.q
THE HEALTH OF NATIVE HAWAIIANS
European contact has had a devastating effect upon Na
Kanaka Maoli. Although the disease processes have
changed, epidemiological data show na Kānaka Maoli
continues to experience signicant health disparities.
Native Hawaiians represent 22% of Hawai‘i’s population.r
Compared to all other ethnic groups in Hawai‘i, Kānaka
Maoli have the highest prevalence rates for chronic
diseases such as obesity (69%) and asthma (33%),
and when adjusted for age, among the highest rates
of cancer, diabetes, hypertension, and heart disease.
s The rate of deaths due to cancer and heart disease
are also highest when compared to other ethnic groups
in Hawai‘i. The prevalence of high risk behaviors such
as smoking, substance abuse, and violent behavior
are higher than the general population and have been
identied by na Kānaka Maoli as signicant problems
facing the Native Hawaiian community today.t Not
surprisingly, na Kanaka Maoli die at younger ages than
Hawai‘i residents in other ethnic groups.19
Low education level, working class job status, and low
income correlates with poor health status.u We argue
that the military presence in Hawai‘i has played a
signicant role in the loss of political autonomy, access to
land, and therefore healthy food sources for na Kanaka
Maoli. Furthermore, previously healthy lifestyles have
been replaced by toxic activities with unknown and
unstudied health ramications. Therefore, the resultant
poor health status of the indigenous people of Ka Pae
‘Aina is a form of structural violence.
MAKUA VALLEY: A LIVING HISTORY
The history of Mχkua Valley is a striking example of the
history of Ka Pae ‘Aina and the complex relationship
between the islands and the U.S. military. At the time
of European contact a vital community existed, based
upon ahupua‘a, the traditional pie-shaped land division
extending from the mountain to the sea on the western
coast of the island of O‘ahu. The infrastructure included
sacred sites, rich shing ponds, irrigation, schools for
specialized training, and agriculture designed to be
almost completely self-sustaining.7
In 1929, the U.S. Army began to acquire parcels of
land for the purposes of military training. The strategic
importance of Mχkua valley increased following World
War II, and the army eventually seized more than 4,000
acres for the purpose of training operations.v The
8
View of Makua Military Reservation from Farrington Hwy. Photo Courtesy of Ed Greevy.
The most recent major land clearance took place on June 18, 1996. At the time, the community at M_kua was comprised of
approximately 60 families and 282 people who built hale (homes) and created their own form of self-governance. The
residents could be defined as homeless, because all were indigent and living in a village that existed outside of the
boundaries of western land ownership. In a population comprised of the dispossessed, 83% of the population was K_naka
Maoli, many of whom represented generations of displaced M_kua residents.26 The village exemplified the current living
conditions of many of the indigenous people of Hawai‘i.

Pacific Public HealtH 3 Vol 13. No 2. 2006 Pacific Public HealtH 3 Vol 13. No 2. 2006
ViewPoiNts aNd PersPectiVe ViewPoiNts aNd PersPectiVe
Pacific Public HealtH 3 Vol 13. No 2. 2006 Pacific Public HealtH 3 Vol 13. No 2. 2006
ViewPoiNts aNd PersPectiVe ViewPoiNts aNd PersPectiVe
175
injustices associated with this land seizure are apparent
in a lease granting the Army rights to 1,500 acres for a
mere $1 a year.w Over the next 70 years, the people
of Mχkua were repeatedly and forcibly removed from
the valley in a cycle of dispossession and reclamation.
From 1848 to the present, Mχkua residents have been
displaced more than six times, a gure which includes
only the major land
clearances. x, y
The most recent major
land clearance took place
on June 18, 1996. At the
time, the community at
Mχkua was comprised
of approximately 60
families and 282 people
who built hale (homes)
and created their own
form of self-governance.
The residents could be
dened as homeless,
because all were indigent
and living in a village that
existed outside of the
boundaries of western
land ownership. In a
population comprised of
the dispossessed, 83%
of the population was
Kānaka Maoli, many
of whom represented
generations of displaced
Mχkua residents.z The village exemplied the current
living conditions of many of the indigenous people of
Hawai‘i.
HOMELESS VS. HOUSELESS
Though severely compromised by generations of
colonization, depopulation, and westernization, Kānaka
Maoli cultural values provided inspiration to survive in
Mχkua, where living conditions were extremely difcult.
Scant rainfall, almost constant exposure to the sun,
infrastructure damaging ocean winds, lack of electricity,
almost no access to potable water, no real sewage
system, and frequent harassment by local authorities
were conditions that dened their daily life. Sparky, a
former resident, described the community as consisting
of Hawaiians who practiced a “traditional lifestyle,”
symbolizing the resilience of the Hawaiian culture in the
face of oppression and injustice.aa Many of the villagers
resisted the term “homeless,” and instead redened
themselves as “houseless.” “We’re not homeless,”
stated another resident. “We’re Hawaiians. Before
the word ‘homeless’ they called us squatters. But let’s
go even further back. Before that it was Hawaiian
lifestyle.”ab In traditional times, na Kanaka Maoli had
access to pu‘uhonua, or place of refuge, in times of
trouble. Due to the loss of a land base, Native Hawaiians
no longer have access to places of refuge. Despite
signicantly adverse conditions, the people of Mχkua
created a sanctuary, drawing
upon the traditional concept
of pu‘uhonua. As one resident
described, Mχkua served as a
safe place for “healing our past
of torment and destruction.”34
With no outside funding or
social support from the wider
population, an intertwined
community of governance,
agriculture, shing, and self-
protection evolved which was
arguably more successful
at dealing with issues of
malnutrition, familial instability,
hygiene, shelter, and substance
abuse cessation, than many
g o ve r nm e nt -s a n c tio n ed
programs. Unfortunately, all
public health efforts focused
upon transferring the residents
of Mχkua to State and Federal
programs, and little data was
collected on the effectiveness of their own interventions.
Not only had the residents identied their own needs,
but they also did the work necessary to address these
own concerns. Community-initiated programs, such as
those seen at Mχkua, are often less expensive, have
more inherent loyalty by participants, and maintain
more cultural relevance. More importantly, they
empower their creators to reclaim a feeling of being
active participants in their own destiny. Instead of the
world simply acting upon them, they had the power to
act upon the world. Contemporary clinical discourse
on empowering patients and clients often fails to
recognize that community members are engaged in this
constructive and challenging process themselves.
The effectiveness of culturally-based interventions in the
healing of na Kānaka Maoli has been well established.
ac, ad, ae Of note, such interventions require a stable land
base with access to an abundant supply of clean water
in order to provide the means to cultivate and harvest
traditional food sources. As noted above, Pearl Harbor
10
Truck filled with explosives at Makua Military Reservation, 1996. Photo courtesy of Ed Greevy.

176
Pacific Public HealtH 3 Vol 13. No 2. 2006 Pacific Public HealtH 3 Vol 13. No 2. 2006
ViewPoiNts aNd PersPectiVe ViewPoiNts aNd PersPectiVe
Pacific Public HealtH 3 Vol 13. No 2. 2006 Pacific Public HealtH 3 Vol 13. No 2. 2006
ViewPoiNts aNd PersPectiVe ViewPoiNts aNd PersPectiVe
is a striking example of how a source of healthy food in
the form of traditional aquaculture has been replaced by
a toxic military site.
The stated purpose of the 1996 Mχkua eviction was
to clear the area for public use.af However, it was no
coincidence that the land clearance occurred at a time
when the need for military training sites became a priority.
ag To this day, the U.S. Army continues to utilize Mχkua
Military Reservation and their activity has resulted in
signicant damage to the valley. Damage includes but
is not limited to numerous disastrous res. The most
recent example was in the summer of 2003. The re,
deliberately set by the Army, was meant to clear 900
acres of land. Due
to a shift of wind,
the re raged out
of control burning
2,100 acres and
destroying many
of the remaining
sacred sites in the
valley.ah In Mχkua
Valley, the homes
and communities
have been burned
repeatedly, both
literally and
guratively.
In 2004, the Hawai‘i
state legislature
passed Act 50, banning people from living on all
beaches and public parks. The act calls for arrest, a
$1,000 ne and/or thirty days in jail if a banned individual
returns to the location of their citation within a year.
ai The Act has effectively prevented the return of the
Mχkua community, and has served as another step in
the criminalization of homelessness in the islands.
Mχkua Valley is not an isolated incident of the ongoing
separation of na Kanaka Maoli from a land base. The
transfer of land to foreign interests and unkept promises
to return land continues to this day. During Hawai‘i’s
Statehood Act, two million acres of land were reserved
for Native Hawaiians and thousands were promised
homestead awards. Today, 45 years after statehood,
an estimated 30,000 have died while waiting for their
land, and approximately 22,000 Hawaiians remain on
the waiting list.aj Next, we will explore the effects that
the proposed military expansion in Ka Pae ‘Aina, the
Stryker Brigade, may have upon the islands.
THE STRYKER BRIGADE
The presence of the military in Ka Pae‘Aina is part of a
global dynamic. The control of extensive land masses
in the Pacic as sites for military training, storage, and
testingak is particularly pertinent to current international
politics, such as the ongoing war in Iraq and tension with
North Korea. The tragedy lies not only in the historical
dispossession of Ka Pae ‘Aina, but also in the fact that
Hawai‘i is now part of an empire, serving as a location
for soldiers drawn from working class communities
all over the U.S.. At the crux of a global stratagem,
the militarization of Ka Pae‘Aina is a base for further
injustice and dispossession throughout the world.
The pattern continues with the July 2004 approval for
a Stryker Brigade
on the islands of
O‘ahu and Hawai‘i.
Strykers are 20 -
ton light armor ed
combat vehicles
desi gn ed for rapi d
depl oyme nt in an
ur ba n setting. A
new squadron
of C-17 cargo
aircraft, plus 291
vehicles along
with new high-
spee d attack ships
will be st ationed to
provide transport
for this br igade.
Army plans call for further U.S. military acquisition of
1,400 acres of land on O‘ahu in addition to 23,000 acres
on the island of Hawai‘i, costs are estimated at $1.5
billion.al The construction threatens to take more land
and natural resources from na Kānaka Maoli.
Environmental hazards and health risks include
the release of particulate matter, volatile organic
compounds and metals into the air, the contamination
of groundwater resources from munitions, fuel and
support facilities, the risk of range res, and the
destruction of habitat and ecosystems.15,37 Na Kanaka
Maoli suffer from disproportionate rates of asthma.
The signicant amount of particulate matter generated
will disproportionately affect those who suffer from
this respiratory ailment. Environmental damage that
disproportionately affects the poor and communities of
color is called environmental racism.
The Stryker Brigade will also ultimately increase risk to
civilians globally. Unlike most other military brigades,
designed for environments such as the jungle or the
11
Young boy living at Makua, 1996. Photo courtesy of Ed Greevy.
With no outside funding or social support from the wider population, an intertwined community of governance, agriculture,
fishing, and self-protection evolved which was arguably more successful at dealing with issues of malnutrition, familial
instability, hygiene, shelter, and substance abuse cessation, than many government-sanctioned programs. Unfortunately,
all public health efforts focused upon transferring the residents of M_kua to State and Federal programs, and little data was
collected on the effectiveness of their own interventions. Not only had the residents identified their own needs, but they also
did the work necessary to address these own concerns. Community-initiated programs, such as those seen at M_kua, are
often less expensive, have more inherent loyalty by participants, and maintain more cultural relevance. More importantly,
they empower their creators to reclaim a feeling of being active participants in their own destiny. Instead of the world simply
acting upon them, they had the power to act upon the world. Contemporary clinical discourse on empowering patients and
clients often fails to recognize that community members are engaged in this constructive and challenging process
themselves.
The effectiveness of culturally-based interventions in the healing of na K_naka Maoli has been well established.29, 30,31 Of
note, such interventions require a stable land base with access to an abundant supply of clean water in order to provide the

Pacific Public HealtH 3 Vol 13. No 2. 2006 Pacific Public HealtH 3 Vol 13. No 2. 2006
ViewPoiNts aNd PersPectiVe ViewPoiNts aNd PersPectiVe
Pacific Public HealtH 3 Vol 13. No 2. 2006 Pacific Public HealtH 3 Vol 13. No 2. 2006
ViewPoiNts aNd PersPectiVe ViewPoiNts aNd PersPectiVe
177
desert, the Stryker Brigade was primarily designed as
an urban assault vehicle. Around the world, civilians
are often killed in counter-insurgency operations;am
these fatalities will inevitably increase when warfare
is practiced in heavily populated urban centers. The
examples of New Orleans after Hurricane Katrinaan and
the announced plans for the use of the military to enforce
quarantine in the event of an avian inuenza pandemic,ao
are symptomatic of the increasingly domestic use of the
military. Residents of the U.S. must critically address
the potential for harm imposed by such military training
and technology, both globally and domestically.
RECOMMENDATIONS
Structural violence has impacted the health of na
Kānaka Maoli through historical and political processes.
Addressing the health of na Kānaka Maoli necessitates
action on multiple levels, including policy reform,
program development, and much needed research.
Policy
The United Nations Declaration on the Rights of
Indigenous People states that the deprivation of Kānaka
Maoli nationality and the theft of land represent human
rights violations. In the process of self-determination,
all indigenous people should rightfully and freely pursue
economic, social and cultural development.ap Therefore,
land repatriation, education, medical, and social
services for na Kānaka Maoli should be prioritized.
We recommend halting further military expansion in
Hawai‘i while the health effects of the military presence
is investigated. The historical effects have been of such
magnitude and devastation to na Kānaka Maoli, that we
also recommend the cessation of the global deployment
of soldiers and arms based in Hawai‘i. The concern is
to prevent globally the negative repercussions that have
occurred locally.
Program Development
Effective public health programs must be culturally
appropriate, relevant, community based, and sustainable.
A key strategy would be to identify community created
systems that seek to redene healthy alternatives. The
residents of Mχkua Beach organized themselves to
form a self-governing community, and tried to establish
an ofcially recognized pu‘uhonua (place of refuge) for
houseless residents of Hawai‘i. If a community were
to arise that had self-initiated systems that addressed
their own needs, such processes need to be identied
and evaluated for effectiveness. If they are found to be
effective, we should then lend our resources, education,
and expertise to support such approaches. At the
very least, we must defend them from destruction and
identify and discontinue policies such as Act 50 which
inhibit growth and survival.
Future Research
The health effects of the military in Hawai’i have been
inadequately researched. Initial efforts should include
a detailed catalogue of all the major toxins that have
historically been discharged into the air, water, and land
of Ka Pae ‘Aina. Routine monitoring of common toxins
produced by military activity should be required. An
entity funded by the U.S. government but comprised of
researchers mutually chosen by the community needs
to be created. In addition, all known toxic sites, in
particular those designated to be Superfund sites, need
a comprehensive environmental study. Also an in-depth
evaluation of the health status of the residents in the
surrounding areas should be undertaken. Such a study
would have to take into account time spent in the area,
water source, habits such as shing in contaminated
waters, and age of residents, to assess degree of
exposure. Ethnicity and income should be taken into
account as historically, toxic exposure has been seen
disproportionately among the poor and people of color.
Evaluating the effects of the military and dispossession
of land on the current poor health of na Kanaka Maoli
will be a challenge. Another potential avenue of
research would be to perform a genealogical survey of
a population that has been removed (e.g. Mχkua), and
evaluate the rate of disease among their descendants.
The rates would then have to be compared against
not only that of the general population of all Native
Hawaiians, but also those Kanaka Maoli who have had a
history of a stable land base for generations. The latter
would be very difcult to nd as very few populations
exist in Ka Pae ‘Aina that have not been removed from
their ancestral base.
Policy changes, program development, and research
can be made possible by reallocating funds away from
such projects as the $1.5 billion appropriated for the
Stryker Brigade.
GLOSSARY OF TERMS
ahupua‘a; traditional land division extending from the
mountain to the sea
‘aina; earth/land
haole; originally, foreigner; current usage, of Caucasian
ancestry
Ka Pae ‘Aina; the traditional name for Hawai‘i used
prior to Western contact. The literal translation is a
group of islands or archipelago. Also seen referred to
as Ka Pae’aina O Ka Moananui, referring to Hawai’i’s
connection to all of Oceania.
Kanaka Maoli; Native Hawaiian

178
Pacific Public HealtH 3 Vol 13. No 2. 2006 Pacific Public HealtH 3 Vol 13. No 2. 2006
ViewPoiNts aNd PersPectiVe ViewPoiNts aNd PersPectiVe
Pacific Public HealtH 3 Vol 13. No 2. 2006 Pacific Public HealtH 3 Vol 13. No 2. 2006
ViewPoiNts aNd PersPectiVe ViewPoiNts aNd PersPectiVe
na; makes the noun following plural
pu‘uhonua; places of refuge, where in traditional times
people could to go in times of trouble and nd safety
REFERENCE
a McGregor D. Engaging Hawaiians in the expansion
of the U.S. Empire. Journal of Asian American
Studies. 2004;7:209-222.
b Trask H. From a Native Daughter. Honolulu, HI:
University of Hawai‘i Press; 1999.
c Linn BM. Guardians of Empire: The U.S. Army and
the Pacic, 1902-1940. Chapel Hill, NC: University
of North Carolina Press;1997.
d Public Law 103-150. United States of America,
103d Congress Joint Resolution 19, Nov 1993.
e Chun M. Ed and translator. Must we wait in despair:
The 1867 Report of ‘Ahahui La‘au Lapa‘au of
Qailuku, Maui on Native Hawaiian Health. Honolulu,
HI: First People’s Production;1994. Original
manuscript Available Library of Congress, Catalog
Card Number: 94-61690.
f Stannnard, David. Disease and infertility: A new look
at the Demographic collapse of native populations
in the wake of western contact. Journal of American
Studies.1990; 24: 325-350.
g M. Kelly and S. Quintal. Cultural history report of
Mχkua Military Reservation and vicinity: Mχkua
Valley, O`ahu, Hawaii, Prepared for the Department
of the Army. U.S. Army Engineer Division, Pacic
Ocean Bldg. 230, Ft Shafter. Contract No DACA84-
76-C-0182. Dept. of Anthro. BP. Bishop Museum,
Honolulu, HI, Unpublished manuscript, April 1977.
h Kajihiro, Kyle. An overview of the U.S. military in
Hawai‘i. Unpublished manuscript, November 17,
2005.
i Galtung, Johan. Violence, peace, and peace
research. Journal of Peace Research. 1969;6:167-
191.
j U.S. Department of Defense, Ofce of the Deputy
Under Secretary of Defense (Installations &
Environment), Base structure report (A summary
of DoD’s real property inventory), Fiscal Year 2004
Baseline. Available at: http://www.acq.osd.mil/ie/
irm/index.html. Accessed February 12, 2006.
k Environmental Defense Fund. Scorecard: The
pollution information site. Available at www.
scorecard.org. Accessed February 15, 2007.
l U.S. Environmental Protection Agency. Hawaii
report: 2003 toxics release inventory. May 2005.
m United States Environmental Protection Agency.
FY 2004 Superfund annual report. Ofce of Solid
Waste and Emergency Response. September
2005.
n U.S. Department of Defense. Defense
environmental restoration program, annual report
to Congress, Fiscal Year 2004. Available at: http://
derparc.egovservices.net/Derparc_FY04/do/home.
Accessed February 17, 2006.
o Baier-Anderson C. Environmental Impact
Statement (EIS) for the Army Transformation of the
2nd Brigade of the 25th Infantry Division (Light) to
a Stryker Brigade Combat Team (SBCT): Summary
of Concerns 2004. University of Maryland, Program
in Toxicology, College Park, Maryland, Unpublishe
manuscript, June 2004.
p Kaplan RD. Atlantic Monthly. How we would ght
China. 2005; 295: 49-64.
q Yamada S. Militarism and the social production of
disease. Sickness and wealth. Fort M, Mary Anne
Mercer MA, and Gish O, ed. Cambridge, MA: South
End Press; 2004.
r Hawaii Health Survey 2005, Hawaii State Department
of Health, Ofce of Health Status Monitoring. http://
www.hawaii.gov/health/statistics/hhs/hhs_05/index.
html, accessed February 7, 2007.
s Johnson DB, Oyama N, LeMarchand L, Wilkens L.
Native Hawaiians mortality, morbidity, and lifestyle:
comparing data from 1982, 1990, and 2000. Pacic
Health Dialog. 2004; 11(2): 120-130.
t Austin A. Alcohol, tobacco, other drug use, and
violent behavior among Native Hawaiians: Ethnic
pride and resilience. Substance Use and Misuse.
2004;39:721-746.
u Krieger N. Theories for social epidemiology in the
21st century: An ecosocial perspective. International
Journal in Epidemiology. 2001;30:668-677.
v Kakesako G. Mχkua Valley ideal training area for
soldiers to ne-tune skills. Honolulu Star-Bulletin.
April 26, 1996, A-4.
w General Lease No. S-3848. State Department of
Land and Natural Resources. August 20, 1964
x Niheu K. Pu’uhonua: Sanctuary and Struggle at
Mχkua Hawai‘i. Unpublished manuscript. Ohana
Koa-NFIP; 1997.
y Mχkua Beach encampment gets orders to pack up
and go. Honolulu Star-Bulletin. March 13, 1996.
z Suka E. Report to the Wai‘anae Neighborhood

Pacific Public HealtH 3 Vol 13. No 2. 2006 Pacific Public HealtH 3 Vol 13. No 2. 2006
ViewPoiNts aNd PersPectiVe ViewPoiNts aNd PersPectiVe
Pacific Public HealtH 3 Vol 13. No 2. 2006 Pacific Public HealtH 3 Vol 13. No 2. 2006
ViewPoiNts aNd PersPectiVe ViewPoiNts aNd PersPectiVe
179
Board, unpublished report, 1996.
aa Mχkua. To Heal a Nation. Na‘alehu, HI, Na Maka o
ka ‘Aina; 1996. (vid)
ab Wahine Mχkua Speak. Honolulu, HI: Paoa
Productions; 1996. (vid)
ac Blaisdell RK. The meaning of health. Asian
American Pacic Island Journal of Health. 1996
Winter;4:232.
ad Mokuau N. Culturally based interventions for
substance use and child abuse among Native
Hawaiians. 2002 U.S. Department of Health and
Human Services; Public Health Reports. 2002;117:
S82-S87.
ae Shintani T, Beckham S, O’Conner HI, Hughes C,
Sato A. Waianae Diet Program: a culturally sensitive,
community-based obesity and clinical intervention
program for the Native Hawaiian population. Hawaii
Medical Journal. 1994;53(5): 136-41.
af Mχkua Beach encampment gets orders to pack up
and go. Honolulu Star-Bulletin. March 13, 1996.
ag Kakesako G. Mχkua Valley ideal training area for
soldiers to ne-tune skills. Honolulu Star-Bulletin.
April 26, 1996 A-4.
ah Kayal M. On Oahu, the high cost of an archeological
nd. The New York Times. News; Aug 6, 2003.
ai Act 50. Hawaii State Legislature, SB2294 SD1 HD1
(HSCR 901-04), 2004.
aj LaDuke W. Homeless in Hawaii: More land for the
military than for Hawaiians: Part One. Indian Country
Today. July 12, 2004. Available at: http://www.
indiancountry.com/content.cfm?id=1091536055.
Accessed February 15, 2007.
ak Stryker Brigade Combat Team Final EIS, Hawai‘i
May 2004. Available at http://www.tsfo.com/sbcteis/
feis/index.htm. Accessed November 13, 2005.
al Cole W. Lawsuit opposes Stryker brigade. The
Honolulu Advertiser. August 18, 2004.
am Glantz A. How America lost Iraq. New York, NY:
Jeremy P. Tarcher/Penguin; 2005.
an Scahill J. The militarization of New Orleans.
Democracy Now! Sept 16, 2005. Available at http://
www.democracynow.org/article.pl?sid=05/09/16/12
22257. Accessed February 15, 2007.
ao Brown D. Role in a u pandemic; troops might be
used to ‘effect a quarantine,’ Bush Says. Washington
Post, October 5, 2005: A-5.
ap United Nations Declaration on the Rights of
Indigenous Peoples. Sub-Commission on Prevention
of Discrimination and Protection of Minorities on its
46th Session. Geneva, Switzerland, 1-26 August
1994.