Challenges to Health and Well-Being of Pacific Islander Clients

Barriers to improved health for Pacific Islanders are not solely explained by the lack of available facilities, inadequate personnel, or socioeconomic factors that limit insurance and block access. Barriers also exist because of a lack of acceptability of services for the populations served. Pacific Islanders who have access to services may still underutilize these services if the health care system is not responsive to cultural norms. Often, health care systems neglect to incorporate cultural worldviews and values into service delivery and thus discourage use by different groups who subscribe to such values. For example, mainstream health care systems in the United States do not generally attribute importance to holistic health, nor do they typically include family members or the community in prevention and treatment efforts. For Pacific Islanders who subscribe to a concept of health that takes into account physical, social, mental, and spiritual health, and who believe in the centrality of the family, these mainstream services may be viewed as culturally incompatible and may be underutilized. A health care system that does not include the patient's family in prevention and treatment may exacerbate stress in a period of poor health.¹³

Spiritual despair

Feelings of sadness and depression may underlie negative health, social, educational, and economic experiences for Hawaiians and other Pacific Islanders and can lead to the loss of the will to live.¹⁴ This sadness, or malaise, is not to be confused with a clinical mental health diagnosis but should be interpreted more broadly as “circles of despair” in a population that has experienced historical oppression.¹⁵ Spiritual despair may be reflected in feelings of sadness and loss over cultural ways and exacerbated when there is a sense of lack of control and lack of self-determination.

Desire to keep problems in the family

A health care system that does not include the patient’s family in prevention and treatment may exacerbate stress in a period of poor health. Patients may not respond to treatment that focuses on the individual rather than the individual in relationship to his or her family and social support system. An important issue related to family is the phenomena of codependency, in which family members conceal the abuser and abusive behaviors. In Pacific Islander families, codependency may operate due to the strong commitment to “take care of one’s own,” or may be seen as a matter to be handled within the family. An understanding of this behavioral pattern is critical to solid intervention. Successful intervention with Hawaiians with an alcohol problem requires a recognition that families may feel ambivalence about seeking help.¹⁶

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