The leading cause of death of adults in the United States is heart disease. The death rate for Hawaiians from heart disease is 44 percent higher than that for the total U.S. population (U.S. Congress, Office of Technology Assessment, 1987). The age-adjusted mortality rate (computations that reflect risk as if all groups being compared have the same age distribution) of heart disease for Hawaiians is 273 per 100,000 persons; for the total U.S. population it is 190 per 100,000 persons.
In this article, the term Hawaiians means the people indigenous to the islands of Hawaii; Hawaiians comprise 13 percent of the population in Hawaii. Other cultural groups include Japanese, Chinese, Filipino, and Samoan people, as well as white, African American, American Indian, and Hispanic people. The majority of Hawaiians reside in Hawaii, a state that is considered "healthy." In general, when comparing the health status of Hawaii's ethnically diverse population with the populations of other U.S. states, people in Hawaii are found to live longer and have lower rates of heart disease and cancer (Burris, 1989). However, Hawaiians are one ethnic group in Hawaii who are not a part of that health record. The heart disease mortality rate for Hawaiian men (344 per 100,000) is disproportionately higher than the rate for all men of other ethnic groups (212 per 100,000), and the rate for Hawaiian women (244 per 100,000) is higher than that for all women of other ethnic groups (109 per 100,000) (Wegner, 1989a). In addition, the life expectancy of Hawaiians is about five years less than the state's population as a whole (Johnson, 1989a). Hawaiians have one of the poorest health profiles of any ethnic group in the United States (Burris, 1989).
The high prevalence of heart disease justifies the development of services that respond to this population's needs. Mortality rates from heart disease can be reduced when there is adequate health care that promotes prevention and early treatment. This article describes heart disease and associated risk factors among Hawaiians and identifies barriers to health care. The article provides strategies relevant to the development and implementation of culturally responsive community intervention and discusses broad implications for social work practice.
HEART DISEASE AND ASSOCIATED RISK FACTORS
Risk factors commonly associated with heart disease include diabetes, hypertension, obesity, and smoking and are prevalent among Hawaiians (Aluli, 1991; Curb et al., 1991; Johnson, 1989b; Wegner, 1989a).
Diabetes is a contributor to heart disease. The diabetes mortality rate for Hawaiians (29 per 100,000) is significantly higher than for the total U.S. population (nine per 100,000) (U.S. Congress, Office of Technology Assessment, 1987). Within the Hawaiian population, women have slightly higher diabetes rates than men, and women older than age 45 are at the highest risk (Johnson, 1989b).
If left untreated, hypertension contributes to heart disease (Wegner, 1989a). In the Molokai Heart Study, the first population-based study on cardiovascular risk factors among Hawaiians (n = 257) (Aluli, 1991; Curb et al. 1991), hypertension was prevalent in about one-fourth of the population. The study indicated that this proportion is slightly lower than that of the total U.S. population. However, the hypertension rate remains important for Hawaiians, because it often serves as a complicating variable in heart disease. It is also important to note that within the study sample, some Hawaiians were not aware that they had high blood pressure, and many did not have their condition under adequate control.
Table 1. Comparison of Rates of Heart Disease and Related Risk Factors among
the Hawaiian and Total U.S. Population
Health Problem and Population Rate
Heart disease(a) (age-adjusted mortality rate)
Hawaiians 273 per 100,000
Total U. …