The Native Hawaiian and other Pacific Islander population in the US is an extremely diverse racial and ethnic group with regard to identification with culture, work experience, socioeconomic status and education. This diversity extends into the geriatric population. For example, some elder Native Hawaiians may be very familiar with Native Hawaiian traditional practices, customs and beliefs while other elder Native Hawaiians may completely identify with the western culture. The traditional Native Hawaiian elder may speak the Hawaiian language and follow traditional practices and diet while the more westernized Native Hawaiian elder may have limited participation in cultural practices (i.e. singing Hawaiian music and eating traditional foods on special occasions only). Many in the latter group grew up during the time that Hawaii was a US territory and Native Hawaiians were trying to assimilate with the American way of life. As Hawaii tried to attain statehood, anything western or American was perceived as “better” and anything Native Hawaiian was inferior or “less than desirable”.
Native Hawaiians were frequently subjected to discrimination and their children were discouraged from speaking the Hawaiian language as well as practicing any cultural activities. Not surprisingly, many of these traditional practices went “underground”. This recognized diversity in the lived experience of Native Hawaiian elders requires that the elder Native Hawaiian patient be individually assessed for their health beliefs and knowledge during the interviewing process. An important caveat to assessing the elderly patient about his/her cultural perspective is to avoid “grouping or labeling” the patient because this may inadvertently diminish the person’s individuality, and doing so risks establishing a less than ideal patient-physician relationship. In addition, it is important to keep in mind that many Native Hawaiians are multicultural, i.e. of mixed ethnicities, and thus may identify with more than one ethnic or racial group.
Similarly, other Pacific Islanders who have lived away from their island homes for extended periods of time (including subsequent generations who may have been born in the United States) will be more acculturated to an American way of life, and may have adopted many beliefs associated with western cultures. By contrast, those who have emigrated more recently are more likely to hold onto cultural traditions even if in a reminiscent way. Unlike Native Hawaiians, these recent immigrant populations tend to retain much of their traditional culture, language, and belief systems.
In general, other Pacific Islanders in the US are a young and fast growing population. In 2000, nearly three-quarters (73%) of Pacific Islanders in the U.S. lived in Western states,
- 58% in California and Hawaii,
- 14% in the South,
- 7% in the Northeast,
- and 6% in the Midwest (Aiu, Ono, Burgess, Takahashi, & Kameoka, 2001).
In 1989, 17% of Pacific Islanders lived at or below the federal poverty level compared to 14% of Asian Americans/Pacific Islanders overall. Additionally, approximately a quarter of Pacific Islanders over age five spoke more than one language at home, indicating that Pacific Islanders are, in general, a bi- or multilingual population.