Liu David M K I, Alameda Christian K
Native Hawaiian Center of Excellence, Department of Native Hawaiian Health, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI, USA.
Hawaii Med J. 2011 Nov;70(11 Suppl 2):9-14.
Traditional Hawaiian thought places children in a position of prominence in the family. Yet in Hawai'i, Native Hawaiian children and adolescents face significant inequity in health outcomes. From prenatal alcohol and tobacco use, late or no prenatal care, macrosomia as well as low birth rates, to exclusive breastfeeding rates at 6 months, and high rates of infant mortality, Native Hawaiians face inequities in pre and early childhood indicators. During childhood and adolescence, Native Hawaiians experience high rates of obesity, and physical, mental and sexual abuse. This review examines the determinants behind the health inequities encountered by Native Hawaiian children and adolescents, and contextualizes those inequities s in a human rights-based approach to health.
A literature review was conducted for relevant research on Native Hawaiian and other indigenous children and adolescents. Existing data sources were also reviewed for relevant Native Hawaiian data.
There is a significant dearth of data on the determinants of health for Native Hawaiian children and adolescents. Some prenatal data is available from the Prenatal Risk Assessment Monitoring System, while selected youth data is available from the Youth Behavioral Risk Factor system. Available data show significant inequities for Native Hawaiian children and adolescents, compared to other groups in Hawai'i. Based on comparisons with other indigenous and marginalized peoples, the etiology of these disparities may be a lack of health equity, deriving from multigenerational trauma and discrimination as well as poverty and inequities of housing, education, environment, healthcare access, and social capital.
The significant barriers facing Native Hawaiian children and adolescents achieving their full potential constitute a challenge to the fulfillment of the human right to health. Future research needs to more fully articulate the linkage between the health status of Native Hawaiian children and adolescents, the determinants of that status, and the requirements of the human right to health. Needed particularly are longitudinal studies which provide data that may link multigenerational trauma and discrimination to poverty and other factors, ultimately producing healthy inequity for Native Hawaiian children and adolescents.
传统夏威夷思想将儿童置于家庭中的显著地位。然而在夏威夷，夏威夷原住民儿童和青少年在健康结果方面面临重大不平等。从产前酒精和烟草使用、产前护理延迟或缺乏、巨大儿以及低出生率，到6个月时的纯母乳喂养率，以及高婴儿死亡率，夏威夷原住民在幼儿期和儿童早期指标方面面临不平等。在儿童期和青少年期，夏威夷原住民肥胖率高，且遭受身体、心理和性虐待。本综述探讨了夏威夷原住民儿童和青少年所面临的健康不平等背后的决定因素，并将这些不平等置于基于人权的健康方法背景下进行考量。
对有关夏威夷原住民及其他原住民儿童和青少年的相关研究进行了文献综述。还对现有数据源中有关夏威夷原住民的数据进行了审查。
关于夏威夷原住民儿童和青少年健康决定因素的数据严重匮乏。产前风险评估监测系统提供了一些产前数据，而青年行为风险因素系统提供了部分青少年数据。现有数据显示，与夏威夷其他群体相比，夏威夷原住民儿童和青少年存在显著不平等。基于与其他原住民和边缘化群体的比较，这些差异的病因可能是缺乏健康公平，这源于多代人的创伤和歧视以及贫困，还有住房、教育、环境、医疗保健可及性和社会资本方面的不平等。
夏威夷原住民儿童和青少年充分发挥潜力面临的重大障碍对实现健康权构成了挑战。未来的研究需要更全面地阐明夏威夷原住民儿童和青少年的健康状况、该状况的决定因素以及健康权要求之间的联系。特别需要纵向研究，提供可将多代人的创伤和歧视与贫困及其他因素联系起来的数据，最终为夏威夷原住民儿童和青少年消除健康不平等。
