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Structural Racism and Its Effects on Native Hawaiians and Pacific Islanders in the United States: Issues of Health Equity, Census Undercounting, and Voter Disenfranchisement

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Abstract

In the current historical moment, Native Hawaiians and Pacific Islanders (NHPIs) in the United States experience high levels of CO-VID-19 infection and death, risk losing billions in federal funding due to census undercounting, and have less political power due to systemic voter disenfranchisement. We believe these challenges result in large part from structural racism-the inequitable systems that reinforce racial discrimination in society-that unjustly disadvantages NHPIs and other people of color. In this paper, we describe how structural racism is manifesting in health and social inequities for NHPIs in the United States. Lastly, we provide recommendations for achieving justice and equity for NHPI communities.

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... 38 37 These disparities are reflective of historical and existing systemic inequities that were exacerbated by the COVID-19 pandemic. [39][40][41][42] This study seeks to identify potential socioeconomic inequities experienced by Pasifika in 10 US states. Only a few studies have focused on the relationship between Pasifika and COVID-19, 38,39,[42][43][44] and this is the first to examine the socioeconomic impact of COVID-19 on Pasifika communities. ...
... Data disaggregation has been identified as a critical health policy issue in addressing health equity within Pasifika, Black, Indigenous, and other communities of color. [53][54][55][56][57][58] Although we acknowledge the importance of disaggregating Pasifika from the API umbrella, 36,40,41,43,53 having a singular monolithic category for Pasifika is equally problematic. 40 Aggregated data can be harmful to the construction of social welfare and health policies and the development of welfare and health interventions. ...
... 40 Aggregated data can be harmful to the construction of social welfare and health policies and the development of welfare and health interventions. 40,41,43,59,60 Tuck and Yang 61 define data aggregation as a settler move to innocence in which the settler state simultaneously acknowledges health and social disparities experienced by Indigenous communities, but ''asterisk'' these groups into larger aggregates for the sake of data security or methodological accuracy. Nation states utilize the definition of Indigeneity as a colonial assault to erase Indigenous people, further contributing to their colonial dispossessionallowing settlers to continue to exploit Indigenous lands, resources, and culture. ...
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Introduction: Pasifika (Native Hawaiian and Pacific Islander) people living in the United States experience health, economic, and social inequities, and a disproportionate burden of COVID-19 cases and deaths. This study examines employment among Pasifika living in the 10 US states with the largest Pasifika populations during the COVID-19 pandemic. Methods: We use the Current Population Survey to examine racial differences in employment status, paid work from home (PWFH), and industry telework friendliness. We use data from the Washington Office of Fiscal Management and the Washington State (WA) Employment Security Department to examine county-level unemployment claims. Results: Nationally, Pasifika did not self-report unemployment significantly more than Black, Latino, Asian, and American Indian/Alaska Native respondents, but in WA counties with high Pasifika concentrations, unemployment insurance claim rates were higher compared with all other racial groups, particularly Whites and Asians. Surprisingly, Pasifika had more PWFH opportunities, but worked in less telework-friendly industries nationally. Discussion: This study demonstrates the complexity of employment among Pasifika during the COVID-19 pandemic. The findings correspond with national reports of racialized communities impacted by unemployment, including Pasifika. Marginally significant differences in unemployment nationally may be due to Pasifika working largely in essential industries requiring workplace attendance. Health Equity Implications: Although overlooked or overshadowed by size, our findings highlight the need for continued advocacy to support data disaggregation and Pasifika data sovereignty. This can be achieved through collaborations between researchers as well as local and community organizations to address data needs of Pasifika communities.
... Not only has the COVID-19 pandemic revealed how a society can use a disease as a weapon to discriminate against a group of people, but also, it has created an environment in which existing issues of structural racism have exacerbated the disease impact [48][49][50]. This is exemplified in the disproportionate burden of COVID-19 deaths among NHPIs [51,52]. ...
... Preliminary research reveals that in California counties where the highest percentage of Asian Americans are Southeast Asians (i.e., Burmese, Cambodian, Hmong, Indonesian, Laotian, Malaysian, Thai, and Vietnamese), the ratio of COVID-19 related deaths over total cases is highest among Asian Americans [52]. By comparison, if the percentage of East Asian (i.e., Chinese, Japanese, Korean, or Taiwanese) or South Asian (i.e., Asian Indian, Bangladeshi, Burmese, Nepalese, Pakistani, and Sri Lankan) among Asian Americans was high in counties, the ratio was lower. ...
... The stark differences in the rates of infection and death highlight these key differences. One important way to strengthen health equity is to consistently provide data disaggregated by race and subgroup in a meaningful manner and to work in collaboration with the communities being affected [52,[72][73][74]. ...
Article
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Purpose of Review The COVID-19 pandemic has revealed the importance of considering social determinants of health, including factors such as structural racism. This review discusses some of the evidence that triangulates on this issue, including data from hate crime statistics, social media analysis, and survey-based research. It also examines the data needs for Asian Americans, Native Hawaiian, and Pacific Islander (NHPI) communities. Recent Findings The available data provides evidence that the pandemic has contributed to an increase in anti-Asian sentiment and discriminatory incidents. Many reports have surfaced showing a surge in anti-Chinese discrimination, which has “spilled over” into other Asian communities. Research is beginning to emerge to show that such discrimination may also impact health issues such as psychological distress. Given prior research, we would expect many more studies to emerge in the future. Also, the pandemic has illustrated the major gaps in data available to disentangle the health and social concerns facing Asian Americans and NHPI communities. Significant issues include the lack of systematic reporting of data for these communities both across states, and even among agencies within a state; erroneous aggregation of Asians with NHPIs; and censoring of data. These gaps and issues contribute to bias that obscures objective data and amplifies health inequalities. Summary The COVID-19 pandemic has had a negative impact on the well-being of Asian American and NHPI communities. It is critical to provide disaggregated data, not only so that we can have accurate reporting, but also to ensure data and health equity.
... NHPI are a diverse group who trace their ancestry to the islands of Polynesia (e.g., Tonga, Sāmoa, Hawai'i, and Aotearoa New Zealand), Micronesia (e.g., Marshall Islands, Guam, and Palau), and Melanesia (e.g., Fiji, Papua New Guinea, and Vanuatu) [19]. American colonialism driven by white supremacy generated social and political currents that displaced many NHPI and led many to migrate to the USA after World War II [19][20][21]. More than 1.5 million people in the USA identified as NHPI alone or in combination with another race in 2020 [22]. ...
... Finally, it could be that more upstream factors of structural racism are more salient for health among NHPI than the interpersonal level of racism captured by experiences of discrimination. Morey and colleagues describe how structural racism is impacting NHPI health in the USA [21]. ...
Article
Background: Medical researchers have historically utilized the variable of race uncritically, rarely defining race, rarely acknowledging it as a social construct, and often omitting information about how it was measured. In this study, we use the following definition of race: "a system of structuring opportunity and assigning value based on the social interpretation of how one looks." We examine the influence of racial misclassification, racial discrimination, and racial consciousness on the self-rated health of Native Hawaiian and Pacific Islanders (NHPI) living in the United States of America (USA). Methods: Our analysis used online survey data from a subgroup of NHPI adults living in the USA (n = 252) who were oversampled as part of a larger study of US adults (N = 2022). Respondents were recruited between September 7, 2021 and October 3, 2021, from an online opt-in panel of individuals across the USA. Statistical analyses include weighted and unweighted descriptive statistics for the sample, as well as a weighted logistic regression for poor/fair self-rated health. Results: Odds of poor/fair self-rated health were greater for women (OR = 2.72; 95% CI [1.19, 6.21]) and those who experienced racial misclassification (OR = 2.90; 95% CI [1.20, 7.05]). No other sociodemographic, healthcare, or race-related variables were significantly associated with self-rated health in the fully adjusted results. Conclusions: Findings suggest that racial misclassification may be an important correlate of self-rated health among NHPI adults in the US context.
... Disaggregated data is critical to addressing racial disparities, including experiences of racism and discrimination and health-related disparities, among the NHPI population in the USA [21]. To mitigate structural racism among the NHPI population, Morey et al. pressed for researchers to provide disaggregated health and demographic data [22]. NHPI leadership and researchers have echoed the need to shift to disaggregated data to provide a transparent appraisal of NHPI health and social issues [23]. ...
... Sociodemographic information was collected and included age, gender, and education. Age (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44), and 45 +) and gender (man, woman, non-binary, or self-described) were categorical variables; however, none of the NHPI respondents selected a non-binary gender or self-described. Therefore, the analytic sample included only self-identified men and women. ...
Article
Experiences of racism and discrimination are stressors that adversely affect the well-being of marginalized populations, including Native Hawaiians and Pacific Islanders (NHPI). However, commonly used data aggregation methods obscure information on NHPI communities and their lived experiences. The aim of our study is to understand the types and frequency of discrimination experienced by NHPI adults in the USA. The study utilized online survey data collected from 252 NHPI adults living in the USA between September and October 2021. Older NHPI adults, those who report constantly thinking about their race/ethnicity, and those who are socially assigned a race/ethnicity that does not match their own report experiencing more types of discrimination. NHPI who constantly think about their race/ethnicity and those who are socially assigned a race/ethnicity that does not match their own report a greater frequency of discrimination. Findings indicate the need to understand the experiences of discrimination in this population.
... Structural and social determinants of health are social, physical, and economic barriers that can impact an individual's health-seeking behavior and well-being. These barriers include cultural and historical trauma, as well as perceived racism and discrimination resulting from the colonization of Hawai'i by foreign explorers who introduced infectious diseases that nearly decimated the entire, once-healthy Native Hawaiian population and forcefully seized ancestral land to exploit its natural resources for commerce [9]. These injustices undermined traditional subsistence practices due to forced relocation, and gave rise to the social and health disparities seen today. ...
Article
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Native Hawaiians (NHs) are a historically oppressed population disproportionately burdened by diabetes and related complications. The Kilolani Project, a patient navigator-centered, chronic disease management program, targets upstream drivers of health among vulnerable NH adult patients with diabetes within an urban academic safety-net clinic. To investigate the impact of the Kilolani Project, we performed a qualitative study to examine patient perspectives. Our goal is to ensure that their values, needs, and priorities drive future navigator-based strategies and healthcare delivery. Fifteen current Kilolani Project patients participated in one of three focus group sessions. Each session followed a semi-structured format with open-ended questions regarding their experiences with the Kilolani Project, patient navigators, and healthcare in general. Iterative transcript readings and coding revealed seven core themes: (1) Humanistic approach, (2) Trusting relationships, (3) Improved access, (4) Trauma-informed care, (5) Self-efficacy, (6) Resilience, and (7) Ethnic concordance. The Kilolani Project created a safe and culturally relevant experience for NH patients. They felt seen, heard, and valued, which resulted in an improved healthcare experience, engagement, and empowerment. Importantly, trust was the cornerstone to building a provider–patient relationship. Such culturally informed approaches are necessary to close the gap in health disparities faced by our NH communities.
... We believe that limiting our focus in this way is important because, firstly, "in comparison to many non-Indigenous populations, Indigenous people face greater social disadvantages, disproportionate burdens of diseases, and deleterious social determinants of health, much of which are related to forced migration and colonization" (Yamane & Helm, 2022, p. 168). Furthermore, statistics on Native Hawaiian youth in particular show that they experience higher rates of depression and suicide (Goebert et al., 2019;Trinidad, 2009), socio-emotional challenges (Liu & Alameda, 2011), incarceration (Morey et al., 2020;Trinidad, 2009), drug use (Helm et al., 2017;Trinidad, 2009), and the like. Arguably, Native Hawaiian youth could benefit from culture-as-health interventions which can be accomplished through the teaching of TEK through place-based education projects. ...
Article
Place-based education that incorporates traditional ecological knowledge is a potential source of psychological and emotional well-being for indigenous youth. Our research explores the connection between place-based cultural education and well-being among Native Hawaiian youth as they engage in restoring a royal Native Hawaiian fishpond, Loko Iʻa Pāʻaiau. We collected data from ten Native Hawaiian high school participants over six months including survey measures, pre- and post-on emotions and values after each weekly session at the fishpond, as well as pre-and post- focus group sessions. The quantitative data revealed gains in positive emotions and mental states, with happiness and focus being the most salient. Phenomenological coding of the qualitative results revealed five overarching themes in the values-emotion interface: 1) valuing the importance of Pāʻaiau; 2) valuing kuleana (reciprocal responsibility) and feeling a sense of accomplishment; 3) valuing sacred land and cultivating humility; 4) valuing and strengthening 'ohana (family) and feeling sense of belonging; and 5) valuing Pāʻaiau as a healing place and feeling peaceful and happy. Findings support providing Indigenous youth, especially Native Hawaiians, with place-based traditional ecological knowledge and biocultural opportunities to promote well-being, character, and identity development.
... Data limitations in territories, for example, have direct impacts on the availability of resources and the visibility of at-risk populations. 85,86,87 Policy processes and governance also influence the formation of socioecological landscapes before and after climate change-related disasters. 88,89,90 For example, the use of a cost-benefit analysis for the allocation of hazard mitigation funding, and disaster-related assistance for rebuilding, gives priority to areas of denser population and higher-value housing stock. ...
Chapter
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Social systems—including governance, economies, organizations, laws, and customs—cause climate change by driving greenhouse gas emissions. These systems are also responsible for the inequitable distribution of both the benefits of energy consumption and the impacts of climate change. Actions that acknowledge differences in peoples’ understanding of climate change and incorporate diverse histories, cultures, and forms of knowledge can promote climate justice.
... A conceptual issue with the present research is that while it demonstrates disparities in exposure to risk factors for respiratory disease, it does not prove how the differential exposures came about in the first place. For example, differences in cigarette smoking can have roots in historical trauma [54][55][56], or present-day experiences of discrimination and governmental policies that restrict access to higher education opportunities or to secure employment and safe housing [44,51,57]. Understanding of health disparities requires research designed to illuminate the origins of social conditions that contribute to differences in health status today [58]. ...
Article
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Objective The prevalence of asthma and chronic obstructive pulmonary disorder (COPD) is elevated for Native Hawaiians but the basis for this differential is not well understood. We analyze data on asthma and COPD in two samples including Native Hawaiians Pacific Islanders, and Filipinos to determine how ethnicity is related to respiratory disease outcomes. Methods We analyzed the 2016 and 2018 Behavioral Risk Factor Surveillance Survey (BRFSS), a telephone survey of participants ages 18 and over in the State of Hawaii. Criterion variables were a diagnosis of asthma or COPD by a health professional. Structural equation modeling tested how five hypothesized risk factors (cigarette smoking, e-cigarette use, second-hand smoke exposure, obesity, and financial stress) mediated the ethnic differential in the likelihood of disease. Age, sex, and education were included as covariates. Results Structural modeling with 2016 data showed that Native Hawaiian ethnicity was related to higher levels of the five risk factors and each risk factor was related to a higher likelihood of respiratory disease. Indirect effects were statistically significant in almost all cases, with direct effects to asthma and COPD also observed. Mediation effects through comparable pathways were also noted for Pacific Islanders and Filipinos. These findings were replicated with data from the 2018 survey. Conclusions Native Hawaiian and Pacific Islander ethnicity is associated with greater exposure to five risk factors and this accounts in part for the ethnic differential in respiratory disease outcomes. The results support a social-ecological model of health disparities in this population. Implications of the findings for preventive interventions are discussed.
... That being said, one of queer theory's strongest applications is in the study of marginalized physicists. Many studies which involve analyses of race and gender base their categorizations on large databases like IPEDS or the Unites States Census, when we know that these definitions are usually inadequate and contribute to the further marginalization of the people these studies are ostensibly trying to help [20,27,28]. While this may be inevitable for meta-analyses, we do not need to perpetuate it in our data collection, and should prioritize self identification wherever it is possible. ...
... 3,4 The historical mistrust toward the intentions of government and science shared by AA/ NHPI communities has resurfaced during this global pandemic, in part, complicating COVID-19 mitigation efforts in these communities. 5 To support the objectives of CEAL, the AA/NHPI Interest Group has concentrated its advocacy efforts on two major issues that pose significant and immediate barriers to reducing the COVID-19 burden on AA/NHPI communities across the U.S. They are the pervasive and arbitrary practice of data aggregation by public health agencies and health-related researchers and the lack of culturally responsive education and outreach strategies that account for their linguistic and cultural diversity. ...
Article
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The COVID-19 pandemic disproportionately impacted Asian Americans, Native Hawaiians, and Pacific Islanders (AA/NHPIs) in the United States. AA/NHPIs have historically been subjected to discrimination, which was exacerbated by the pandemic. To bring attention to their unique concerns, an AA/NHPI Interest Group of the National Institutes of Health Community Engagement Alliance Against COVID-19 Disparities (CEAL) was formed. This article highlights major concerns raised by the Interest Group: The pervasive and arbitrary practice of data aggregation by public health agencies and health-related researchers, the lack of culturally responsive services in the context of cultural safety, and leadership underrepresentation.
... Individual and com-munal acceptance of and adherence to xenophobic bullying and propaganda resulted in the abandonment and boycott of Chinese businesses and communities, especially those located in areas commonly known as Asian-ethnic enclaves [29,31]. Other studies also cited significant increases in hate crimes directed towards Chinese communities, such as vandalism and the destruction of property see [32]. Cases of physical assault and/or bullying of Asian-Americans in commonly shared places such as public transport busses, grocery stores, and public sidewalks were also reported [33,34]. ...
Article
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Extant literature suggests that xenophobic bullying is intensified by isolated national or global events; however, the analysis of such occurrences is methodologically limited to the use of self-reported data. Examining disclosures of racist bullying episodes enables us to contextualize various perspectives that are shared online and generate insights on how COVID-19 has exacerbated the issue. Moreover, understanding the rationale and characteristics present in xenophobic bullying may have important implications for our social wellbeing, mental health, and inclusiveness as a global community both in the short and long term. This study employs a mixed-method approach using Big Data techniques as well as qualitative analysis of xenophobic bullying disclosures on Twitter following the spread of COVID-19. The data suggests that about half of the sample represented xenophobic bullying. The qualitative analysis also found that 64% of xenophobic bullying-related tweets referred to occasions that perpetuated racist stereotypes. Relatedly, the rationale for almost 75% of xenophobic bullying incidents was due to being Chinese or Asian. The findings of this study, coupled with anti-hate reports from around the world, are used to suggest multipronged policy interventions and considerations of how social media sites such as Twitter can be used to curb the spread of misinformation and xenophobic bullying.
... 15 COVID-19 vaccine inequities are best understood through public health frameworks of structural and social determinants of health, fundamental causes, and racial capitalism, which illuminate the obdurate influence of systemic structural factors in maintaining and exacerbating health inequities at individual, family, community, and population levels: even as new diseases emerge and new resources are harnessed and distributed to end the pandemic. [16][17][18][19] Hereunder, we describe the Orange County, California (OC) experience with vaccine inequities and present vaccine equity guidelines developed by the OC Health Equity COVID-19 community-academic partnership, which was formed in response to ongoing COVID-19 inequities and further harm generated by local COVID-19 response strategies. These guidelines integrate community knowledge and public health literature to inform strategic actions in equitable COVID-19 vaccine implementation at present, future COVID-19 booster vaccinations, and vaccine distribution efforts for future pandemics. ...
Article
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Introduction: The coronavirus disease 2019 (COVID-19) pandemic has exacerbated longstanding inequities throughout the United States, disproportionately concentrating adverse social, economic, and health-related outcomes among low-income communities and communities of color. Inequitable distribution, prioritization, and uptake of COVID-19 vaccines due to systemic and organizational barriers add to these disproportionate impacts across the United States. Similar patterns have been observed within Orange County, California (OC). Methods: In response to COVID-19 vaccine inequities unfolding locally, the Orange County Health Equity COVID-19 community–academic partnership generated a tool to guide a more equitable vaccine approach. Contents of the OC vaccine equity best practices checklist emerged through synthesis of community-level knowledge about vaccine inequities, literature regarding equitable vaccination considerations, and practice-based health equity guides. We combined into a memo: the checklist, a written explanation of its goals and origins, and three specific action steps meant to further strengthen the focus on vaccine equity. The memo was endorsed by partnership members and distributed to county officials. Discussion: Since the initial composition of the checklist, the local vaccine distribution approach has shifted, suggesting that equitable pandemic responses require continual re-evaluation of local needs and adjustments to recommendations as new information emerges. To understand and address structural changes needed to reduce racial and socioeconomic inequities exacerbated by the pandemic, authentic partnerships between community, academic, and public health practice partners are necessary. Conclusion: As we face continued COVID-19 vaccine rollout, booster vaccination, and future pandemic challenges, community knowledge and public health literature should be integrated to inform similar equity-driven strategic actions.
... Every one person not counted can result in a net loss of about $1500 per person each year (George, 2020;Krisberg, 2020). Since NHPI are at a higher risk of being undercounted, this results in a loss of funding for public health programs they utilize at higher rates (Morey et al., 2020;Zelaya et al., 2017). ...
Article
The decennial Census survey marks the emergence of federal classifications of race and ethnicity by which the U.S. government has historically conflated Native Hawaiians and Pacific Islanders (NHPI, hereafter) as "Asian or Pacific Islander." This conflation amplifies health injustices and inequities of NHPIs through multiple mechanisms because it masks the complex and heterogeneous experiences of NHPIs, whose positions and relations with the settler state are qualitatively and substantially distinct from Asian Americans. This critical review examines federal documents and research to examine how the panethnic categorizations are often sustained through scientific inquiry and methodologies. We found that self-determination and self-identification for NHPIs are impeded by settler-colonial relations between U.S. colonization of parts of Oceania (e.g., Hawai'i, Sāmoa, Fiji, and Guam) and the forcefully imposed categorization that continues to be in use to legitimize the domination of Indigenous Peoples through race misclassification. Specifically, Census data collection fails to capture accurate and reliable data due to serious methodological limitations. These implications for psychological research compel us to make several recommendations for psychologists: (1) engage with NHPI community partners in all research processes; (2) critically examine Census research design and consider oversampling NHPI households to ensure just data representation; (3) meaningfully engage when, whether and how to aggregate Asian Americans with NHPIs; and (4) use Indigeneity as a critical framework.
... However, community leaders suggest that it may also be because the idea of separating from an ill family member conflicts with strong cultural values of community connectedness and familial support, as well as psychosocial factors, such as fear of being blamed and stigmatized for spreading the disease in the community. Additionally, Pacific Islanders, like other marginalized communities, often have high levels of distrust of government institutions as a result of historical and current experiences of structural racism often resulting in inaccessible, culturally inappropriate, or low-quality health care services (Morey et al., 2020). Therefore, community leaders have suggested using churches as places to quarantine or isolate infected or exposed Pacific Islanders, as churches are often a This document is copyrighted by the American Psychological Association or one of its allied publishers. ...
Article
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The 2019 coronavirus disease-19 (COVID-19) pandemic has impacted the physical and mental health of individuals and communities worldwide. While research is being conducted in real-time to address the unique impacts of COVID-19, this moment is also an opportunity to learn from previous infectious disease outbreaks. The goal of this paper is to review the literature on previous infectious disease outbreaks to better understand and identify effective interventions that may help mitigate the psychological impact and collective trauma on a given community. Five strategies are recommended for developing a plan of action: (1) engage and partner with community leaders and community-based organizations; (2) establish (and re-establish) community support networks including self-help groups; (3) conduct community outreach, education, and training on the signs and symptoms of mental health issues, how to access mental health resources, and effective supportive and coping skills; (4) deploy Community Health Workers to access, engage, and educate community members; and (5) use a community capacity-building and community empowerment-oriented approach. When implemented together, these strategies have been shown to help communities reduce the mental health impact and heal from the collective trauma of an infectious disease outbreak and increase the collective efficacy of a community, resulting in increased resiliency and preparedness for future outbreaks.
Chapter
Air pollution poses significant health risks, exacerbating asthma and adversely affecting respiratory and cardiovascular systems, while increasing the likelihood of heart disease and stroke. Marginalized populations, often in underprivileged communities, frequently experience disproportionate exposure to toxins due to socioeconomic inequalities. The concepts in health and environmental justice that concerns air quality involve equity vs. equality, the cumulative impact of environmental and social stressors, participatory approaches in environmental decision-making, and the preventive and precautionary principle. Strategies rooted in environmental justice and health seek to rectify these disparities by advocating for a fair distribution of environmental benefits and adverse burdens. This chapter focuses on Health and Environmental Justice Strategies for Mitigating Air Pollution. The strategies, which have their origins in the civil rights movements, strive to ensure universal access to clean air and a healthy environment, regardless of financial status. These efforts often employ various tactics, including health impact assessments that integrate health considerations into decision-making processes for policies and programs. Cumulative risk assessments often evaluate compounded risks from multiple sources, guiding the prioritization of interventions in high-risk areas. Social determinants of health theory often inform strategies by addressing factors influencing susceptibility to pollution exposure. Participatory action research often empowers communities to advocate for tailored solutions, enhancing environmental conditions collaboratively. Climate justice frameworks can link climate change mitigation with improved air quality, advocating for equitable distribution of benefits. The precautionary principle guides proactive measures in uncertain situations to protect public health amidst evolving scientific understanding. Therefore, effective strategies involve implementing energy-saving practices, promoting sustainable transportation, and enhancing urban green spaces to mitigate air pollution. Also, policies should ensure equitable access to clean air, enforce stricter emissions regulations, and prioritize renewable energy sources. Integrated health and environmental justice measures can foster resilient and equitable communities by addressing the main causes of air pollution and minimizing immediate health impacts.
Article
Limited literature exists on structural racism measures on health outcomes for Asian Americans, Native Hawaiians, and Pacific Islanders (AAs and NH/PIs). AAs and NH/PIs make up approximately 6.2% of the U.S. population and consist of diverse ethnic subgroups with distinct languages, cultures, religions, socioeconomic statuses, and historical backgrounds. The lack of disaggregated data collection and contextualized measures hinders our understanding of how structural racism affects health outcomes in these populations. We conducted a scoping review to assess the extent to which measures of structural racism are used in research with AAs and NH/PIs. Databases, including CINAHL, EBSCO, PsychINFO, PubMed, Scopus, and Social Science Citation Index, were searched for peer-reviewed articles on the measures of and empirical impacts of structural racism on AA and NH/PI health. We identified 23 full-text articles from a pool of 11,660 screened articles. Four articles were included in the final analysis. Among the selected studies, two studies identified an association between racial segregation and mental and behavioral health outcomes within AAs and NH/PIs. The other two studies found redlining on chronic health outcomes in these communities. These studies uncovered associations between government systems and policies and AA and NH/PI health outcomes. Existing measures may not adequately capture the complex relationships between structural racism and health outcomes in AAs and NH/PIs. Future research should contextualize and operationalize the multifaceted manifestations of structural racism unique to AAs and NH/PIs to achieve health equity.
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A critical component for health equity lies in the inclusion of structurally excluded voices, such as Filipina/x/o Americans (FilAms). Because filam invisibility is normalized, denaturalizing these conditions requires reimagining power relations regarding whose experiences are documented, whose perspectives are legitimized, and whose strategies are supported. in this community case study, we describe our efforts to organize a multidisciplinary, multigenerational, community-driven collaboration for FilAm community wellness. Catalyzed by the disproportionate burden of deaths among FilAm healthcare workers at the onset of the COVID-19 pandemic and the accompanying silence from mainstream public health leaders, we formed the Filipinx/a/o Community Health Association (FilCHA). FilCHA is a counterspace where students, faculty, clinicians, and community leaders across the nation could collectively organize to resist our erasure. By building a virtual, intellectual community that centers our voices, FilCHA shifts power through partnerships in which people who directly experience the conditions that cause inequities have leadership roles and avenues to share their perspectives. We used Pinayism to guide our study of FilCHA, not just for the current crisis State-side, but through a multigenerational, transnational understanding of what knowledges have been taken from us and our ancestors. By naming our collective pain, building a counterspace for love of the community, and generating reflections for our communities, we work toward shared liberation. Harnessing the collective power of researchers as truth seekers and organizers as community builders in affirming spaces for holistic community wellbeing is love in action. This moment demands that we explicitly name love as essential to antiracist public health praxis.
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Objectives Undocumented Asians and Pacific Islanders (UndocuAPI) comprise 25% of undocumented students. Yet few studies have examined UndocuAPI mental health in the context of the contradictory political environment which encompasses both inclusionary policies, such as Deferred Action for Childhood Arrivals (DACA), and exclusionary policies, like immigration enforcement. Methods Using cross-sectional survey data collected in 2019 from UndocuAPI college students and recent alumni in California (n = 174), we used multiple logistic regression to estimate the effect of DACA status on clinical levels of depressive symptoms. We tested whether immigration enforcement experiences mediated this relationship using the Karlson, Holm, and Breen (KHB) method. Results Adjusted logistic regression results revealed that UndocuAPI with DACA had significantly lower odds of depression (OR = 0.32, 95% CI: 0.13–0.79). Out of five immigration enforcement factors, limited contact with friends and family (OR = 2.36, 95% CI: 1.08, 5.13) and fearing deportation most or all of the time (OR = 3.62, 95% CI: 1.15, 11.34) were associated with significantly higher odds of depression. However, we did not detect a statistically significant mediation effect of immigration enforcement using KHB decomposition. Conclusion Findings suggest that the benefits of DACA protected UndocuAPI in California from depressive symptoms, even when accounting for immigration enforcement experiences. Because it was unclear whether immigration enforcement mediates DACA, future research should investigate the underlying mechanisms between immigration policies and mental health with larger samples. Practitioners should consider the short-term need for mental health support and legal services for UndocuAPI students as well as the long-term goal to decriminalize immigrant communities to advance racial health equity.
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Objective: To test the mechanisms by which exposure to point-of-sale (POS) e-cigarette marketing mediate the relationship between an ethnic minority group highly vulnerable for tobacco product use, namely Native Hawaiian/Other Pacific Islander (NHPI), and increased future e-cigarette use through explicit (positive outcome expectancies) and implicit (spontaneous positive reactions) pathways. Method: Four waves of data were collected in 6-month intervals from 2,327 multiethnic young adults (Mage = 21.2, SD = 2.2; 54% women) enrolled across two 4-year and four 2-year colleges belonging to a University system in Hawaii. POS e-cigarette marketing exposure was assessed with an objective measure involving store visit patterns and store audits, as well as a measure of self-reported exposure. Spontaneous reactions were assessed with an implicit measure, namely Affect Misattribution Procedure (AMP). Path analyses were used to test the hypotheses. Results: In a model employing the objective measure of POS exposure, a statistically significant pathway was found from NHPI ethnicity to increased current e-cigarette use at Wave 4 mediated through increased POS exposure at Wave 2, and increased affect regulation expectancies at Wave 3. Similar indirect effects on prospective e-cigarette use were found for Asian ethnicity. The dual process model of the effects of POS exposure on e-cigarette use was not fully supported, although the implicit measure was found to independently predict e-cigarette use. Conclusions: Differential exposure to POS marketing may explain some of the ethnic disparities in tobacco product use behavior such as e-cigarette use. POS marketing may affect e-cigarette use behavior mainly through the explicit pathway, notably affect regulation expectancies.
Article
There have been over one hundred years of literature discussing the deleterious influence of racism on health. Much of the literature describes racism as a driver of social determinants of health such as housing, employment, income, and education. More recently, increased attention has been given to measuring the structural nature of a system that advantages one racialized group over others rather than solely relying on individual acknowledgement of racism. Despite these advances, there is still a need for methodological and analytical approaches to complement the aforementioned. This commentary calls on epidemiologists and other health researchers at-large to engage the discourse on measuring structural racism. First, we address the conflation between race and racism in epidemiological research. Next, we offer methodological recommendations (linking of interdisciplinary variables and datasets and leveraging mixed-method and life course approaches) and analytical recommendations (integration of mixed data, use of multidimensional models) that epidemiologists and other health researchers may consider in health equity research. The goal of this commentary is to inspire the use of up-to-date and theoretically-driven approaches to increase discourse amongst public health researchers on capturing racism as well as to improve evidence of its role as the fundamental cause of racial health inequities.
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Background The burden of cardiovascular disease (CVD) is increasing in the aging population. However, little is known about CVD risk factors and outcomes for Asian American, Native Hawaiian, and Other Pacific Islander (NH/PI) older adults by disaggregated subgroups. Methods Data were from the Centers for Medicare & Medicaid Services 2011-2015 Health Outcomes Survey, which started collecting expanded racial/ethnic data in 2011. Guided by Andersen and Newman’s theoretical framework, multivariable logistic regression analyses were conducted to examine the prevalence and determinants of CVD risk factors (obesity, diabetes, smoking status, hypertension) and CVD conditions (coronary artery disease [CAD], congestive heart failure [CHF], myocardial infarction [MI], other heart conditions, stroke) for 12 Asian American and NH/PI subgroups and white adults. Results Among the 639,862 respondents, including 26,853 Asian American and 4,926 NH/PI adults, 13% reported CAD, 7% reported CHF, 10% reported MI, 22% reported other heart conditions, and 7% reported stroke. CVD risk factors varied by Asian American and NH/PI subgroup. The prevalence of overweight, obesity, diabetes and hypertension was higher among most Asian American and NH/PI subgroups than white adults. After adjustment, Native Hawaiians had significantly greater odds of reporting stroke than white adults. Conclusions More attention should focus on NH/PIs as a priority population based on the disproportionate burden of CVD risk factors compared to their white and Asian American counterparts. Future research should disaggregate racial/ethnic data to provide accurate depictions of CVD and investigate the development of CVD risk factors in Asian Americans and NH/PIs over the life course.
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As of March 2021, Native Hawaiians and Pacific Islanders (NHPIs) in the United States have lost more than 800 lives to COVID-19—the highest per capita death rate in 18 of 20 US states reporting NHPI deaths. However, NHPI risks are overlooked in policy discussions. We discuss the NHPI COVID-19 Data Policy Lab and dashboard, featuring the disproportionate COVID-19 mortality burden for NHPIs. The Lab democratized NHPI data, developed community infrastructure and resources, and informed testing site and outreach policies related to health equity.
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Pacific Islander (PI) young adults are suspected to bear heavy risk for hazardous drinking, alcohol use disorders (AUD), and alcohol-related harms. Yet, PIs remain among the most understudied racial groups in the United States-creating a lack of empirical data documenting their alcohol use problems and treatment needs. The present study presents the first known data on PI young adults' hazardous drinking, possible AUDs, alcohol-related harms, and treatment needs. Survey data were collected from 156 community-dwelling PI young adults (40% women, age 18-30 years) in 2 large PI communities: Los Angeles County and Northwest Arkansas. We screened participants for alcohol, cigarette, and marijuana use, hazardous drinking, possible AUD, alcohol-related harms, and past-year need for mental health and substance use disorder (SUD) treatment. Logistic regressions examined whether experiencing possible AUD and alcohol-related harms were associated with past-year need for treatment. PI young adults reported 78% lifetime rate of alcohol use with 56% screening positive for hazardous drinking, 49% for any possible AUD, and 40% experiencing significant alcohol-related harm (e.g., health, finances). Yet, just 25% of participants reported past-year need for SUD treatment. Although having possible AUD was not associated with perceived SUD treatment need, experiencing any alcohol-related harm associated with 4.7-13.2 times greater adjusted odds for needing treatment. Therefore, despite having low self-perceived treatment need, PI young adults experience excessive burden of hazardous drinking and alcohol-related harms. Given the profound negative social and health effects of AUDs, culturally grounded interventions should be designed to reduce PI young adults' elevated rates of hazardous drinking and alcohol-related harms. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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This commentary outlines the health insurance disparities of Compact of Free Association (COFA) migrants living in the United States. Compact of Free Association migrants are citizens of the Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Palau who can live, work, and study in the United States without a visa. Compact of Free Association migrants make up a significant proportion of the rapidly growing Pacific Islander population in the United States. This article describes the historical and current relationships between the United States and the Compact nations and examines national policy barriers constraining health insurance access for COFA migrants. In addition, the commentary describes the state-level health policies of Arkansas, Hawai’i, and Oregon, which are the states where the majority of COFA migrants reside. Finally, policy recommendations are provided to improve health equity for COFA migrants.
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In general, the count of Native Hawaiian or Pacific Islanders Alone or in Combination in the U.S. Census is relatively accurate. The net undercount rate for Native Hawaiian or Pacific Islanders Alone or in Combination in 2010 was 1.0% compared to a net overcount of 0.8% for the Non-Hispanic White Alone population. The omissions rate for Native Hawaiian or Pacific Islanders Alone or in Combination (7.9%) is about double the rate for Non-Hispanic White Alone (3.8%). The Native Hawaiian or Pacific Islanders Alone or in Combination demographic group with the highest net undercount rate was males age 18–29 who had a net undercount rate of 8.0% in 2010. This is the only net undercount rate among Native Hawaiian or Pacific Islanders that was statistically significantly different than zero.
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Context: Arkansas currently has the largest Marshallese community in the continental US. The limited research available demonstrates that Marshallese have significant health disparities, with higher rates of obesity, diabetes, cardiovascular disease and infectious diseases than the US population. Objectives: The purpose of this paper is 2-fold: (1) to describe the formation and capacity building efforts of a community-based participatory research partnership with the Marshallese community in Arkansas and (2) to describe key findings and lessons learned from 5 years of collaborative research. Methods: A community-based participatory research approach was implemented to build alliances and improve health disparities in a Marshallese community. Results: Overarching lessons learned from collaboration with the Marshallese community include the: (1) Intensive involvement of Marshallese from multiple sectors of the community and in multiple roles in the research process, (2) Importance of interprofessional teams, (3) Importance of church, (4) Consideration of sex, (5) Importance of family and definition of family, (6) Talk Story and qualitative methods and the (7) Importance of cultural humility. Conclusions: This research helps fill important gaps in documenting the health disparities and interventions to address those disparities in the Marshallese community.
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This article illustrates how a collaborative research process can successfully engage an underserved minority community to address health disparities. Pacific Islanders, including the Marshallese, are one of the fastest growing US populations. They face significant health disparities, including extremely high rates of type 2 diabetes. This article describes the engagement process of designing patient-centered outcomes research with Marshallese stakeholders, highlighting the specific influences of their input on a randomized control trial to address diabetes. Over 18 months, an interdisciplinary research team used community-based participatory principles to conduct patient-engaged outcomes research that involved 31 stakeholders in all aspects of research design, from defining the research question to making decisions about budgets and staffing. This required academic researcher flexibility, but yielded a design linking scientific methodology with community wisdom.
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In 1858, a scandal rocked Sydney – the captain and the owner of the Sydney-based barque Sutton were accused of kidnapping 65 Pacific Islanders to sell to sugar planters on the Indian Ocean island of Reunion. While Dorothy Shineberg highlighted this incident in a 1984 publication, she based her story on official documents located in the French and British archives and, understandably, largely portrayed it as a diplomatic dispute between the colonial powers. This paper revisits this notorious yet little known episode, taking into account the press coverage the affair received in Australia as well as the archival correspondence. It repositions the narrative in the complex colonial space of Sydney, where culpability was very much tied to local politics, class and notions of nationality. Set against the backdrop of the British anti-slavery laws, it considers the implications of this affair on future recruiting ventures in the region, including the introduction of indentured labour to Australia in 1863. Click here for a free ecopy: http://www.tandfonline.com/eprint/Z5z6bESAVgI9zqkNeX4E/full
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This study aims to contribute to environmental justice research by examining how Native Hawaiians and Pacific Islanders (NHPIs), a relatively small minority group, are disproportionately impacted by environmental toxins. Proximity to three different environmental hazards is considered: toxic waste, industrial air pollution, and freeways. 2010 U.S. Census, Superfund, Toxic Release Inventory, and Los Angeles Department of Regional Planning data are used to analyze where NHPI populations live relative to these environmental hazards in Los Angeles County, California. Findings show that NHPI neighborhoods have high rates of being located near toxic waste, industrial air pollution, and freeways when compared to non-Hispanic whites and other racial/ethnic groups. Further analysis reveals that high percentages of the total NHPI population in Los Angeles are potentially exposed to toxic waste, industrial air pollution, and freeway pollution, placing them at risk for experiencing poor health due to environmental degradation.
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Non-communicable diseases (NCDs) now account for more than 36 million deaths each year; many of which are premature. Pacific Islanders are some of the worst afflicted by obesity and diabetes with prevalence of both diseases rising disproportionately faster in the Pacific region over the past three decades than in the rest of the world. A high burden of disease is also found among enclaves of Pacifican migrants in the USA, Australia, and New Zealand. Urgent action is needed to alleviate the high economic and personal costs now associated with NCDs in Pacific Islanders. In this article, we describe contributors to the temporal trends in obesity and diabetes, discuss the current burden of disease in the Pacific Islands and among migrant communities, and suggest priorities for future research in this area. Finally, we discuss challenges unique to intervention among Pacific Islanders and highlight promising opportunities to reduce the NCD burden.
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The Republic of the Marshall Islands is a sovereign nation previously under the administrative control of the United States. Since 1986, the Compacts of Free Association (COFA) between the Republic of the Marshall Islands and the United States allows Marshall Islands citizens to freely enter, lawfully reside, and work in the United States, and provides the United States exclusive military control of the region. When the COFA was signed, COFA migrants were eligible for Medicaid and other safety net programs. However, these migrants were excluded from benefits as a consequence of the Personal Responsibility and Work Opportunity Reconciliation Act. Currently, COFA migrants have limited access to health care benefits in the United States, which perpetuates health inequalities.
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US government research on the health effects of exposure to radiation from nuclear weapons in-volved gross violations of the human rights of peo-ple in the Marshall Islands. In all likelihood, fallout from US nuclear weapons testing in the Pacific was deposited on other Micronesian islands. The US government should release the classified data it pos-sesses on the history of nuclear testing, fallout pat-terns, and the effects on the people of the Marshall Islands and the rest of Micronesia. Health workers should work to ensure that nuclear-armed states ful-fill their treaty obligations to pursue negotiations toward the elimination of nuclear weapons. As a matter of social justice, in order to ensure the human right to health, the federal government should ex-tend Medicaid eligibility to all Micronesian people from the Compact of Free Association nations.
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Urban food swamps are typically situated in low-income, minority communities and contribute to overweight and obesity. Changing the food landscape in low income and underserved communities is one strategy to combat the negative health consequences associated with the lack of access to healthy food resources and an abundance of unhealthy food venues. In this paper, we describe Proyecto MercadoFRESCO (Fresh Market Project), a corner store intervention project in East Los Angeles and Boyle Heights in California that used a multi-level approach with a broad range of community, business, and academic partners. These are two neighboring, predominantly Latino communities that have high rates of overweight and obesity. Located in these two communities are approximately 150 corner stores. The project used a community-engaged approach to select, recruit, and convert four corner stores, so that they could become healthy community assets in order to improve residents' access to and awareness of fresh and affordable fruits and vegetables in their immediate neighborhoods. We describe the study framework for the multi-level intervention, which includes having multiple stakeholders, expertise in corner store operations, community and youth engagement strategies, and social marketing campaigns. We also describe the evaluation and survey methodology to determine community and patron impact of the intervention. This paper provides a framework useful to a variety of public health stakeholders for implementing a community-engaged corner store conversion, particularly in an urban food swamp.
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Racial minorities bear a disproportionate burden of morbidity and mortality. These inequities might be explained by racism, given the fact that racism has restricted the lives of racial minorities and immigrants throughout history. Recent studies have documented that individuals who report experiencing racism have greater rates of illnesses. While this body of research has been invaluable in advancing knowledge on health inequities, it still locates the experiences of racism at the individual level. Yet, the health of social groups is likely most strongly affected by structural, rather than individual, phenomena. The structural forms of racism and their relationship to health inequities remain under-studied. This article reviews several ways of conceptualizing structural racism, with a focus on social segregation, immigration policy, and intergenerational effects. Studies of disparities should more seriously consider the multiple dimensions of structural racism as fundamental causes of health disparities.
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Differences in pathophysiology may affect the diagnosis, prevention, and treatment of diabetes in Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs). Equally important are differences in cultural beliefs, dietary habits, and behavioral patterns among AANHPIs that require culturally effective translation of interventions into the community. These issues were discussed by clinicians and investigators at a conference held in Honolulu, Hawaii, in September 2011 with the theme “Diabetes in Asian Americans, Native Hawaiians, and Pacific Islanders: A Call to Action” by a coalition of health care organizations, clinicians, and scientists with strong interests in the topic and in the health of AANHPI populations (1). The discourse begins with an evaluation of pathophysiologic differences, followed by a discussion of the standard diagnostic criteria and current treatment algorithms as well as dietary recommendations. The focus then shifts to various diabetes prevention studies specific to AANHPIs and their relevance to this growing ethnic minority group in America. This review concludes with two investigations that demonstrate culturally appropriate interventions and a brief description of the role played by the National Diabetes Education Program (NDEP). ### Pathophysiology—type 1 diabetes Diabetes has reached an epidemic level around the world, with most of the increase attributable to type 2 diabetes in developing Asian countries such as India and China (2). Type 1 diabetes is also increasing, although at a much less dramatic rate than type 2 diabetes and is now also increasingly associated with obesity and insulin resistance (3). The highest rates for type 1 diabetes are found in Northern European and Scandinavian countries and among the Caucasian population of the U.S. In contrast, type 1 diabetes is approximately 5 to 10 times lower in prevalence in those of Asian than those of European descent (4). In the U.S., the incidence of type 1 diabetes is lower by two- to fivefold in …
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In 2005, approximately 26% of Micronesian women aged 40 or older in Hawai'i used mammography for breast cancer screening. We describe an 18-month project to increase screening participation in this population by tailoring educational materials and using a lay educator approach. New immigrants to Hawai'i are Marshallese from the Republic of the Marshall Islands and Chuukese, Pohnpeians, and Kosraeans from the Federated States of Micronesia. In Hawai'i, these 4 groups refer to themselves collectively as Micronesians, although each group has its own distinct culture and language. From 2006 through 2007, we applied principles of community-based participatory research--trust building, joint assessment, cultural tailoring of materials, and skills transfer--to develop and track the reach of Micronesian women lay educators in implementing a cancer awareness program among Micronesian women living in Hawai'i. Using our tailored in-language materials, 11 lay educators (5 Chuukese, 3 Marshallese, 2 Pohnpeians, and 1 Kosraean) provided one-on-one and small group in-language cancer information sessions to 567 Micronesian women (aged 18-75 years). Among the 202 women aged 40 or older eligible for mammography screening, 166 (82%) had never had a mammogram and were assisted to screening appointments. After 6 months, 146 (88%) of the 166 had received a mammogram, increasing compliance from 18% to 90%. Lay educators reported increases in their skills and their self-esteem and want to extend their skills to other health issues, including diabetes management and immunization. Tailoring materials and using the lay educator model successfully increased participation in breast cancer screening. This model may work in other communities that aim to reduce disparities in access to cancer screening.
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Under the Compacts of Free Association (COFA), people from the Freely Associated States--the Republic of Palau (ROP), the Republic of the Marshall Islands (RMI), and the Federated States of Micronesia (FSM)--have been migrating to the United States in increasing numbers. In 1996, Congress passed broad welfare reform (Personal Responsibility and Work Opportunity Reconciliation Act) which limited certain federal benefits previously available to COFA migrants, including Medicaid benefits. Prior to July 2010, the State of Hawai'i had continued to include COFA migrants under its state-funded Medicaid program. In the face of budget constraints, the State removed these people from its Medicaid rolls. A challenge on the legal basis of the denial of equal protection of the laws, ie, the Fourteenth Amendment to the US Constitution, was successful in reinstating health care to the COFA migrants in December 2010. From the health worker's perspective, regardless of various social justice arguments that may have been marshaled in favor of delivering health care to the people, it was an appeal to the judicial system that succeeded. From the attorney's perspective, the legal victories are potentially limited to the four walls of the courtroom without community involvement and related social justice movements. Together, the authors propose that in order to better address the issue of health care access for Micronesian peoples, we must work together, as health and legal advocates, to define a more robust vision of both systems that includes reconciliation and community engagement.
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The political, economic, and military relationship between the former Pacific Trust Territories of the United States is defined by the Compact of Free Association (COFA) treaty. The respective COFA treaties allow the United States military and strategic oversight for these countries, while COFA citizens can work, reside, and travel with unlimited lengths of stay in the United States. The unforeseen consequences of the diaspora of the people of the COFA nations to the United States and its territories is called the "Compact Impact." In 2007 the social, health, and welfare system costs attributed to the estimated 13,000 COFA migrants in Hawaii was $90 million. The US federal government does not take full responsibility for the adverse economic consequences to Hawaii due to COFA implementation. The lack of health and education infrastructure in the COFA nations, as well as the unique language, culture, political, and economic development of the region have contributed to the adverse elements of the Compact Impact. The Department of Human Services of Hawaii, once supportive of the COFA peoples, now looks to withdraw state sponsored health care support. This paper reviews the historical, political, and economic development, which surrounds the Compact Impact and describes Hawaii's government and community response. This paper attempts to understand, describe, and search for solutions that will mitigate the Compact Impact.
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Young to middle-aged residents of impoverished urban areas suffer extra-ordinary rates of excess mortality, to which deaths from chronic disease contribute heavily. Understanding of urban health disadvantages and attempts to reverse them will be incomplete if the structural factors that produced modern minority ghettos in central cities are not taken into account. Dynamic conceptions of the role of race/ethnicity in producing health inequalities must encompass (1) social relationship between majority and minority populations that privilege the majority population and (2) the autonomous institutions within minority populations that members develop and sustain to mitigate, resist, or undo the adverse effects of discrimination. Broad social and economic policies that intensify poverty or undermine autonomous protections can reap dire consequences for health. Following from this structural analysis and previous research, guiding principles for action and suggestions for continued research are proposed. Without taking poverty and race/ethnicity into account, public health professionals who hope to redress the health problems of urban life risk exaggerating the returns that can be expected of public health campaigns or overlooking important approaches for mounting successful interventions.
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Objectives – Translation and implementation of a diabetes mellitus type 2 educational curriculum in Ebeye, an island within the Republic of Marshall Islands, and a preliminary evaluation of improvements in health outcomes. Methods – Ebeye Public Health Clinic Health Educators held a series of hourly diabetes mellitus type 2 educational sessions with 17 Marshallese participants, based on a curriculum previously used with a group of Marshallese diabetics in Hawaii, focusing on diet, exercise, medications, and insulin administration. Baseline and six month data was collected on surrogate markers of health status. Results – After 6 months, statistically significant improvements were seen in the percentage of participants with blood pressure < 130/80 mmHg and weight loss of at least 10 pounds since their last visit. Minor trends toward improvement were observed in participation with; statin treatment, self monitoring of blood glucose goals set, and nutritional counseling. Discussion – Some markers of diabetic health improvement were observed in this preliminary translational study, and similar studies in other Pacific areas are being planned.
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Context: Obesity, diabetes and cardiovascular disease (CVD) have reached epidemic proportions among Native Hawaiians/Pacific Islanders (NHPI). Culturally responsive interventions that account for their interpersonal, sociocultural and socioeconomic realities are a public health priority. Objective: To describe cultural adaptation and culturally grounded approaches to developing health interventions for NHPI and to review the culturally responsive approaches used by, and outcomes from, two long-standing community-based participatory research projects (CBPR) in Hawai‘i: PILI ‘Ohana and KāHOLO Projects. Methods: A literature review of 14 studies from these two projects was done to exemplify the methods applied to culturally adapting existing evidence-based interventions and to developing novel interventions from the ‘ground up’ to address health disparities in NHPI. Of the 14 studies reviewed, 11 were studies of the clinical and behavioural outcomes of both types of interventions. Results: Both culturally adapted and culturally grounded approaches using community-based assets and NHPI cultural values/practices led to establishing sustainable and scalable interventions that significantly improved clinical measures of obesity, diabetes and hypertension. Conclusion: Several recommendations are provided based on the lessons learned from the PILI ‘Ohana and KāHOLO Projects. Multidisciplinary and transdisciplinary research using CBPR approaches are needed to elucidate how human biology is impacted by societal, environmental and psychological factors that increase the risk for cardiometabolic diseases among NHPI to develop more effective health promotion interventions and public health policies.
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Anti-immigrant rhetoric and political actions gained prominence and public support before, during, and after the 2016 presidential election. This anti-immigrant political environment threatens to increase health disparities among undocumented persons, immigrant groups, and people of color. I discuss the mechanisms by which anti-immigrant stigma exacerbates racial/ethnic health disparities through increasing multilevel discrimination and stress, deportation and detention, and policies that limit health resources. I argue that the anti-immigrant sociopolitical context is a social determinant of health that affects mostly communities of color, both immigrants and nonimmigrants. Public health has a moral obligation to consider how immigration policy is health policy and to be prepared to respond to worsening health disparities as a result of anti-immigrant racism.
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Objective: This study examined the state of obesity, diabetes, and associated health disparities among understudied multiracial, Native Hawaiian and Other Pacific Islander (NHOPI), and American Indian and Alaskan Native (AIAN) adults. Methods: Aggregated data for 184,617 adults from the California Health Interview Survey (2005 to 2011) were analyzed to determine obesity, diabetes, poor/fair health, and physical disability prevalence by racial group. Logistic regressions controlling for age, gender, and key social determinants (education, marital status, poverty, health insurance) generated multiracial, NHOPI, and AIAN adults' odds ratios (ORs) for our targeted health conditions versus non-Hispanic white adults. Results: Obesity, diabetes, and other targeted health conditions were highly prevalent among multiracial, NHOPI, and AIAN adults, who displayed significantly greater adjusted odds than non-Hispanic white adults for obesity (ORs = 1.2-1.9), diabetes (ORs = 1.6-2.4), poor/fair health (ORs = 1.4-1.7), and, with the exception of NHOPI adults, physical disability (ORs = 1.5-1.6). Multiracial and AIAN adults with obesity also had significantly higher adjusted odds of diabetes (OR = 1.5-2.6) than non-Hispanic white adults with obesity. Conclusions: Multiracial, NHOPI, and AIAN adults experience striking obesity-related disparities versus non-Hispanic white adults, urging further disparities research with these vulnerable minority populations.
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Background: Pacific Islanders (PIs) have one of the highest rates of cigarette use, but evidence-based smoking cessation programs designed specifically for PIs are practically nonexistent. Objectives: This paper reports on the development of a culturally tailored smoking cessation curriculum designed specifically for young adult PIs using a community-based participatory research (CBPR) approach. This paper demonstrates the shared leadership and equal contribution of community and academic partnerships. Methods: Together community and academic partners conceptualized and developed a smoking cessation curriculum. Data from formative studies shaped the various components of the educational modules. Results: Eight educational modules were developed through CBPR. Information on the dangers of cigarettes, benefits to cessation, and ways to cope with cravings and stress through cognitive behavioral therapy were offered in both narrative and non-narrative formats. Conclusions: Use of CBPR is critical in the development of the curriculum because it allowed for the sharing of ideas and knowledge between academics and community members.
Book
This groundbreaking book presents a global perspective on the history of forced migration over three centuries and illuminates the centrality of these vast movements of people in the making of the modern world. Highly original essays from renowned international scholars trace the history of slaves, indentured servants, transported convicts, bonded soldiers, trafficked women, and coolie and Kanaka labor across the Pacific, Indian, and Atlantic Oceans. They depict the cruelty of the captivity, torture, terror, and death involved in the shipping of human cargo over the waterways of the world, which continues unabated to this day. At the same time, these essays highlight the forms of resistance and cultural creativity that have emerged from this violent history. Together, the essays accomplish what no single author could provide: a truly global context for understanding the experience of men, women, and children forced into the violent and alienating experience of bonded labor in a strange new world. This pioneering volume also begins to chart a new role of the sea as a key site where history is made. © 2007 by The Regents of the University of California. All rights reserved.
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This resource paper analyzes the growth of the Native Hawaiian and Other Pacific Islander (NHOPI) population over the next quarter century based on projections from the U.S. Census Bureau and supplementary estimates by the authors. Overall, this population will increase from about 1.5 million in 2015 to nearly 2.3 million in 2040, about three times greater than the increase for the total U.S. population. Most NHOPIs are indigenous, but immigrants comprise about a fifth of the population. This group is relatively young, but median age will increase over time. Youth comprised about a third of the population in 2015 and over a quarter in 2014. The elderly share will nearly double to about one in eight by 2040. NHOPIs are more likely to be multiracial than any other racial group, and NHOPIs of mixed-race will comprise over half the population a quarter century from now.
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Pacific Islanders experience enduring and growing poverty in the United States, yet our understanding of their financial distress and needs is limited. Financial institutions, government agencies, and community-based organizations in areas with large Pacific Islander communities need better information with which to develop tailored programs, improve outreach and education, and improve economic security for these and other underserved populations. This paper describes the results from a unique in-language survey that asked detailed questions regarding the financial knowledge, status, and needs of Pacific Islanders, including poverty and wealth questions beyond those in the Census, in Los Angeles, Orange, and San Diego counties of Southern California.
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When former New York City mayor and presidential candidate Rudy Giuliani asked disparagingly during the 2008 primary campaign, "What's a community organizer?" he did more than unleash a rash of soon forgotten letters to the editor and blogs. National organizations, including the Society for Public Health Education and the National Association of Social Workers, adopted position papers reaffirming the centrality of community organizing in their craft. And both presidential candidate Barack Obama's eloquent articulation of the importance of community building and organizing and the success of a well-orchestrated realworld and online organizing campaign in his assent to the presidency brought much renewed attention to the field and its methods (Daniels 2011; Dreier 2008; Hyatt 2008; Wolff 2010).
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Knowledge is power in social change efforts, and data and diverse approaches are needed to fuel it. Recommendations from this section's experts in the field are united in calling for using Office of Management and Budget (OMB) guidelines consistently; disaggregating data collection and reporting on socioeconomic, educational, cultural, youth, and health challenges facing Native Hawaiian and Pacific Islanders (NHPIs); improving data estimates by addressing small sample sizes with oversampling methods and targeted surveys; and collaborating with public and private community-based organizations to promote high response rates and/or data partnerships. A great need exists for trend analyses over time on NHPIs. These analyses will shed insight on the effects of programs and policies, including longitudinal studies, such as the ECLS and the National Longitudinal Survey of Youth. Consistently, research by these authors highlights the power of culturally relevant approaches and the importance of developing innovat...
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Background. Pacific Islanders (PIs) experience high cervical cancer rates in the United States. Stage of diagnosis is also later for PIs than non-Hispanic Whites. The Pap test is severely underutilized among PIs: only 71% of Asian American and Pacific Islander women age 25 years or older received a Pap test within the last 3 years (U.S. average, 82%). Community-based participatory research (CBPR) is increasingly seen as an essential approach in designing and conducting culturally relevant and appropriate studies that reduce cancer incidence and other health disparities among minority and other medically underserved populations. Purpose. The purpose of this article is to describe the lessons learned thus far regarding the identification, recruitment, and retention of PI community organizations and members into a CBPR-informed, randomized, community trial promoting Pap testing. Methods. This 5-year study used CBPR to develop and test the efficacy of a social support intervention for Chamorro, Samoan, and Tongan women to increase Pap testing in southern California. Eligible women were between the ages of 21 and 65, and married or in a long-term relationship with a man for at least 5 years. Women and their husbands or significant others received a 2-hour, culturally tailored workshop that include a group activity, information on Pap testing, a video, and corresponding materials. Comparison participants received a brochure about Pap testing. Three waves of data are collected from all participants: pretest (before workshop or brochure), posttest 1 (immediately after workshop or brochure), and posttest 2 (6 months follow-up). Results. Of the 76 organizations approached to participate in the study, 67 (88.2%) eventually agreed to participate. Thus far, 473 women and 419 men completed the study pretest, post-test, education, and 6-month follow-up. Only 242 women and 204 men of the eligible participants have completed the follow-up survey (63.5% of women and 60.5% of men retained after 6 months). Lessons Learned. The main strategy to overcome initial recruitment challenges was study staff persistence, because they averaged five contacts with each church or clan leader before receiving confirmation that an educational session can be scheduled. Personal connections provided an introduction to the most appropriate church or clan leader. Other efforts for retention include creation of an online version of the survey, re-attending church services, and creating special events organized around clan activities. Conclusions. Although CBPR improves the cultural competence and relevance of study activities for ethnically diverse populations, selected past research shows that it does not ensure that such designs overcome all of the unique challenges in ethnically diverse communities. PI-specific organizational recruitment and individual retention is influenced by study issues and cultural factors in each community.
Article
Pacific Islander (PI) populations of Southern California experience high obesity and low physical activity levels. Given PI's rich cultural ties, efforts to increase physical activity using a community-tailored strategy may motivate members in a more sustainable manner. In this paper, we (1) detail the program adaptation methodology that was utilized to develop the Weaving an Islander Network for Cancer Awareness, Research and Training (WINCART) Center's PI Let's Move Program, a culturally tailored program aimed to increase physical activity levels among members of PI organizations in Southern California, and (2) share the program's pilot evaluation results on individual and organizational changes. The WINCART Center applied the National Cancer Institute's program adaptation guidelines to tailor the evidence-based Instant Recess program to fit the needs of PIs. The end product, the PI Let's Move Program, was piloted in 2012 with eight PI organizations, reaching 106 PI adults. At baseline, 52 % of participants reported that they were not physically active, with the average number of days engaged in medium-intensity physical activity at 2.09 days/week. After the 2-month program, participants increased the number of days that they engaged in medium-intensity physical activity from 2.09 to 2.90 days/week. Post-pilot results found that 82 % of participants reported intentions to engage in physical activity for at least the next 6 months. At baseline, only one organization was currently implementing a physical activity program, and none had implemented an evidence-based physical activity program tailored for PIs. After the 2-month timeframe, despite varying levels of capacity, all eight organizations were able to successfully implement the program. In conclusion, results from our program provide evidence that disparity populations, such as PIs, can be successfully reached through programs that are culturally tailored to both individuals and their community organizations.
Article
Good population health data are often taken for granted, and the people and organizations that gather it are often unsung heroes. For communities of color, immigrants, the LGBTQ population, and other special populations, such as the 50 ethnic and 100 language groups that make up Asian Americans (AAs) and Native Hawaiians and Pacific Islanders (NHPIs), generating good population-representative data continues to be a major challenge. For AAs and NHPIs, characteristics of good population data are in-language administration and cultural adaptation of surveys, detailed collection of ethnic groups within the AA and NHPI aggregate categories, and adequate samples for reportable estimates, oversampling of smaller ethnic groups—elements that were non-existent 30 years ago. Nationally, AA and NHPI population health data today are products of the mettle, vigilance, and constant relay of data heroes representing many sectors and communities who have paved the way for all individuals to be recognized and counted. With that understanding, we seek to document the AA and NHP story beginning in 1985, with the hopes of inspiring and informing future data equity efforts. In 1985, Secretary of Health and Human Services’ Margaret M. Heckler’s landmark report, Black and Minority Health, considered AAs and NHPIs as one aggregate group. The report depicted an AA and NHPI population that lived longer, had lower infant mortality rates and had fewer excess deaths in several disease categories. This approach of aggregated statistics was troubling in two ways: First, the Asian Pacific Islander catchall category did not inform specific efforts needed to improve the health of distinct AA and NHPI cultural and linguistic groups. Second, the aggregated picture of good health was driven largely by AA and NHPI segments with more favorable health and economic well-being, perpetuating a model minority myth, and thus denying needed resources for vulnerable constituents of this group. The release of the 1985 Secretary’s Report was a pivotal moment that could have led to two alternative paths—one of status quo, a world of complacence and acceptance of routine data collection on populations—or another path of awakening a social movement of AA and NHPI data advocates and heroes. If the first path was taken, then health disparities—including high uninsurance rates among Koreans, low cervical cancer screening among Vietnamese women despite higher rates of cervical cancer—would have been undetected. Thankfully, the second path was chosen and marked the beginnings of organized community data advocacy led by Tessie Guillermo, Laurin Mayeno, Sherry Hirota, Hardy Spoehr, Pat Luce, and other community champions calling for national voices to represent AAs and NHPIs and their health concerns (Figure 1). Two national health advocacy organizations, the Asian & Pacific Islander American Health Forum (APIAHF) and the Association of Asian Pacific Community Health Organizations (AAPCHO), were founded as a direct response to the Heckler Report to influence policy and to strengthen community-based organizations to achieve health equity for AAs and NHPIs across our nation. Data development became a top priority for these national health advocacy organizations in their work to improve and assure the health of all AAs and NHPIs. Early on, community and public sector engagement was critical to the data development agenda. From the community, key leadership was provided by APIAHF’s Executive Director, Tessie Guillermo, AAPCHO’s Executive Director, Laurin Mayeno, and APIAHF’s board members, namely Dr. Harry Lee, Dr. Rolland Lowe, Ms. Sherry Hirota, Dr. Christopher Jenkins, and Dr. Herbert Hatanaka, each also representing community health providers and health delivery systems. Key federal partners included Dr. Samuel Lin (former Assistant U.S. Surgeon General and Deputy Assistant Secretary for Health, Department of Health and Human Services), Betty Lee Hawks (formerly with the Federal Office of Minority Health), and Dr. Jane Lin-Fu (formerly with Health Resources and Services Administration). In 1989, the APIAHF established the National Research Advisory Committee (NRAC). The NRAC greatly benefited from the advice, and later, active participation from Dorothy Rice, an internationally recognized pioneer of health statistics, the director of the National Center for Health Statistics (NCHS) from 1976–1982, and prior to that, Deputy Assistant Commissioner for Research with the Social Security Administration. Dorothy Rice’s guidance and engagement with the...
Article
This policy brief examines the status of federal data since the implementation of the 1997 Revised OMB 15 standards for the collection of race and ethnic data, identifies ongoing data limitations, and present recommendations to improve policy and interventions for Native Hawaiians and other Pacific Islanders (NHPI). While most federal agencies are taking appropriate steps to comply with the revised OMB standards, many are having less success reporting disaggregated information on NHPIs. This suggests that increased efforts to obtain robust samples of NHPIs warrants immediate attention in order for federal agencies to fully comply with the revised OMB standards.
Article
We describe ethical issues that emerged during a one-year CBPR study of HIV and human papillomavirus (HPV) vulnerabilities and prevention in two Pacific Islander (PI) communities, and the collaborative solutions to these challenges reached by academic and community partners. In our project case study analysis, we found that ethical tensions were linked mainly to issues of mutual trust and credibility in PI communities; cultural taboos associated with the nexus of religiosity and traditional PI culture; fears of privacy breaches in small, interconnected PI communities; and competing priorities of scientific rigor versus direct community services. Mutual capacity building and linking CBPR practice to PI social protocols are required for effective solutions and progress toward social justice outcomes.
Article
To understand the persistence of racial disparities across multiple domains (e.g., residential location, schooling, employment, health, housing, credit, and justice) and to develop effective remedies, we must recognize that these domains are reciprocally related and comprise an integrated system. The limited long-run success of government social policies to advance racial justice is due in part to the ad hoc nature of policy responses to various forms of racial discrimination. Drawing on a systems perspective, I show that race discrimination is a system whose emergent properties reinforce the effects of their components. The emergent property of a system of race-linked disparities is über discrimination—a meta-level phenomenon that shapes our culture, cognitions, and institutions, thereby distorting whether and how we perceive and make sense of racial disparities. Viewing within-domain disparities as part of a discrimination system requires better-specified analytic models. While the existence of an emerg...
Article
The Pacific Islander (PI) community suffers disproportionately from illnesses and diseases, including diabetes, heart disease and cancer. While there are tremendous health needs within the PI community, there are few health care providers from the community that exist to help address these particular needs. Many efforts have focused on health care workforce diversity to reduce and eliminate health disparities, but few have examined the issues faced in the health care work force pipeline. Understanding educational attainment among PI young adults is pivotal in speaking to a diverse health care workforce where health disparities among Pacific Islanders (PIs) may be addressed. This paper provides an in-depth, qualitative assessment of the various environmental, structural, socio-economic, and social challenges that prevent PIs from attaining higher education; it also discusses the various needs of PI young adults as they relate to psychosocial support, retention and recruitment, and health career knowledge and access. This paper represents a local, Southern California, assessment of PI young adults regarding educational access barriers. We examine how these barriers impact efforts to address health disparities and look at opportunities for health and health-related professionals to reduce and care for the high burden of illnesses and diseases in PI communities.
Article
Health disparities and the social determinants of health are often discussed, but their relationship to political forces, the integrity of cultures, social and environmental change, and mental health outcomes are not well understood. Specifically the US Affiliated Pacific Islands Jurisdictions (USPAIJ) is an area of profound isolation and deprivation with a unique sociocultural history. This article provides an overview of health disparities in the US Affiliated Pacific in the context of the environment, and international and state policies. The article explores how the political, economic, social, and environmental context of the USAPIJ shapes health status and provides a "social determinants of health" model for health improvement for the people of the region.
Article
The concept of health transitions assumes that health status improves with the introduction of western medicine. In this paper I demonstrate that the health of the people of Rongelap, Marshall Islands, has undergone serious damage as a result of nuclear testing, and that women in particular have suffered unduly. Exposure to nuclear radiation over a period of almost fifty years has been recognised by US authorities as a major contributory cause to the high rates of cancers and birth defects suffered by the Rongelap people. Women's reproduction has been severely affected, as evidenced by the many stillbirths and small stature of children born alive. Two generations have been exposed to both background radiation and to radiation ingested with the local foods on which they rely in the absence of other food sources. Clean up has commenced only after this and other communities sought compensation from the United States. The Rongelap people will live with the effects of radiation for generations to come. This transition to ongoing health problems is thus a negative outcome of modern health transition.
Coronavirus Kills California Blacks and Pacific Islanders at Excessive Rate, Numbers Show
  • C Anderson
Anderson, C. 2020, April 20. "Coronavirus Kills California Blacks and Pacific Islanders at Excessive Rate, Numbers Show." The Sacramento Bee. https://www.sacbee.com/news/local/health-and-medicine/arti-cle242045956.html (accessed June 15, 2020).
Structural Racism and Health Inequities in the USA: Evidence and Interventions
  • Z D Bailey
  • N Krieger
  • M Agénor
  • J Graves
  • N Linos
  • M T Bassett
Bailey, Z. D., Krieger, N., Agénor, M., Graves, J., Linos, N., & Bassett, M. T. 2017. "Structural Racism and Health Inequities in the USA: Evidence and Interventions." The Lancet 389(10077): 1453-1463. doi:https://doi.org/10.1016/ S0140-6736(17)30569-X.
Track Us Better: Overlooked Pacific Islanders Hit Hard by Coronavirus
  • J Botts
Botts, J. 2020, May 5. "Track Us Better: Overlooked Pacific Islanders Hit Hard by Coronavirus." Cal Matters. https://calmatters.org/california-divide/cadivide-health/2020/05/california-pacific-islanders-hit-hard-coronavirusoverlooked/ (accessed May 5, 2020).
Fact Sheet: Health Disparities by Race and Ethnicity
  • S Carratala
  • C Maxwell
Carratala, S., & Maxwell, C. 2020. Fact Sheet: Health Disparities by Race and Ethnicity. Washington, DC: Center for American Progress.
Count Native Hawaiian and Pacific Islanders in COVID-19 Data-It's an OMB Mandate
  • R C Chang
  • C Penaia
  • K Thomas
Chang, R. C., Penaia, C., & Thomas, K. 2020. "Count Native Hawaiian and Pacific Islanders in COVID-19 Data-It's an OMB Mandate." Health Affairs Blog. doi:10.1377/hblog20200825.671245
A History of Asian American, Native Hawaiian, Pacific Islander Health Policy Advocacy: From Invisibility to Forging Policy
  • K K Chin
  • A Ferati
Chin, K. K., & Ferati, A. 2020. "A History of Asian American, Native Hawaiian, Pacific Islander Health Policy Advocacy: From Invisibility to Forging Policy. "Asian American Policy Review 30: 41-78.
History of East Palo Alto
  • I Daeenabi
  • M Sosa-Ramos
Daeenabi, I., and Sosa-Ramos, M. 2019. History of East Palo Alto. https://bos. smcgov.org/history-east-palo-alto (accessed June 15, 2020).
Policy Platform Blueprint for Native Hawaiians and Pacific Islanders in the United States
  • M Dougherty
Dougherty, M. 1992. To Steal a Kingdom. Waimanalo, HI: Island Style Press. Empowering Pacific Islander Communities (Producer). 2014, June 19. Policy Platform Blueprint for Native Hawaiians and Pacific Islanders in the United States. [Policy Platform]. https://www.empoweredpi.org/ uploads/1/1/4/1/114188135/2014-03-20-policy-platform-blueprint.pdf (accessed June 15, 2020).