Review Article
Teruya SA1,2*, Pang J3, Pang K3
1Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
2Department of Internal Medicine, College of Medicine, Charles R. Drew University of Medicine and Science, California, USA
3Pacific Islander Health Project (PIHP), Orange County, California, USA
Corresponding Author: Stacey A. Teruya, EdD, MS, Assistant Professor, Department of Internal Medicine, College of Medicine, Charles R. Drew University of Medicine and Science, 1731 East 120th Street Los Angeles, California 90059, USA, Tel:+310-463-0332; Email: staceyteruya@cdrewu.edu.
Received Date: January 03, 2020 Accepted Date: January 28, 2020 Published Date: February 03, 2020
Citation: Teruya SA, Pang J, Pang K (2020). Assimilation and Acculturation in Native Hawaiian and Other Pacific Islander (NHOPI) Health and Well-Being. POJ Nurs Prac Res. 4(1):1-5. DOI: https://doi.org/10.32648/2577-9516/4/1/1.
Copyright: ©2020. Teruya SA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
ABSTRACT
Our recent scoping review revealed a general scarcity of Native Hawaiian and other Pacific Islander (NHOPI) research, and a disproportionately high number of studies on different interpretations of “culture.” Because this area appears to be significant in NHOPI health and well-being, we examined the applicability and effect of assimilation and acculturation on this population.
The literature suggests that NHOPI assimilation is not pervasive, given wide-spread, even institutionalized discrimination and bias in housing and employment. NHOPI may also resist assimilation for a variety of reasons, including ethnic and national pride. Knowing how acculturation may improve or compromise NHOPI health and well-being is constrained by a lack of studies on traditional modalities and practices compared against Western or non-indigenous methods. Moreover, even if we could unequivocally identify health disparities that arise from low assimilation or “bad” acculturation, forced assimilation and acculturation into the dominant culture may be both unethical and ineffective.
Assimilation and acculturation constructs also seem inadequate in addressing NHOPI health disparities caused by structural and social barriers. NHOPI cultural and physical assimilation may be challenging, due to differences in race, socioeconomic status, and distinguishing traditions. For many NHOPI, acculturation may even be irrelevant. A highly acculturated indigenous person, for example, may still encounter the same discrimination, racism and challenges as a low-acculturated peer. Common acculturation models are also limited in that they do not reveal factors that predict specific negative outcomes, nor do they offer exact solutions. In addition, there is no universal consensus on acculturation’s indicators, measures and proxies. However, the following three processes in acculturation seem significant in NHOPI health and well-being.
Ghettoization induced by living on an island with relatively poor infrastructure and limited resources and opportunities may in itself compromise health and introduce health disparities. Even those NHOPI who have left their island homelands may experience isolation in poor and underserved neighborhoods due to social and economic factors. NHOPI may also pursue separation by maintaining traditional behaviors and practices, and reject those from the dominant culture, even if more effective and beneficial.
Keywords: Native Hawaiian, Pacific Islander, NHOPI, health disparities, assimilation, acculturation, enculturation, NHOPI culture, separation, isolation, marginalization, ghettoization
INTRODUCTION
In a recent scoping review, we surveyed and reported on current Native Hawaiian and other Pacific Islander (NHOPI) health and health disparities research [1]. We found studies on “culture” to be the most numerous. Permutations and interpretations varied widely, and included diet and feasts, perceptions of a history of colonization, large ideal body weight and size, preserving traditions and customs, and a connection to place. “Culture” was also naturally seen as an integral part of community-based, culturally-sensitive and culturally-appropriate research approaches and service programs, designed with stakeholder feedback.
Based on the literature, “culture” therefore seems highly significant in NHOPI health and health disparities. However, we found no studies on the effect of assimilation and acculturation. Although these processes are often thought to involve immigrants, NHOPI culture will also invariably merge, interact, and sometimes clash with those of other native and non-native populations. In previous research, we even examined similarities and differences between traditional, non-native newcomers to the USA, or aspirational immigrants, and native-born homeless populations, or urban immigrants [2]. Clearly, intracultural differences exist, and the interaction of both native and non-native groups with dominant and other cultures, it seems, can create stress and conflict.
Conventions and Limitations
According to the United States Office of Management and Budget (OMB), “Native Hawaiian or other Pacific Islanders” are those with origins in “Hawaii, Guam, Samoa, or other Pacific Islands” [3]. In current research, “Native Hawaiian and other Pacific Islanders” and “NHOPI” are generally used to refer to those of Polynesian, Melanesian and Micronesian ancestry. In this article, “NHOPI” may refer to an individual, or to the population as a whole.
NHOPI ethnicities are numerous and diverse. Among others, these include Tongans, Samoans, Tahitians, Native Hawaiians, Māoris, Chuukese, and Marshallese (or Marshall Islanders). The aboriginal people of Australia are generally not included in the NHOPI designation, as they do not reside in, or originate from Polynesia, Melanesia or Micronesia. However, stressors, processes and strategies that affect NHOPI may also apply to these indigenous people.
ACCULTURATION AND ASSIMILATION
Broadly speaking, acculturation is any change that results from contact between individuals, or groups of individuals, and others of different cultural backgrounds [4]. It has also been characterized as a process of attitudinal changes and responses that result from adapting to unfamiliar, and often uncomfortable environments and settings [5]. In assimilation, the ethnological, and even certain physical traits of the non-dominant culture become more and more like those of the dominant mainstream [6].
Voluntary assimilation may be challenging for Polynesians, Micronesians and Melanesians, as they often differ physically and culturally from the usually White mainstream, and from other minorities. Even those who attempt to “pass” will probably find that native values and traditions such as large body size and Māori facial tattoos are easily discerned. Many NHOPI, on the other hand, may resist assimilation in attempting to preserve cultures that have suffered from discrimination, racism, and past colonialism. NHOPI may also have nativist feelings and thoughts of national, native independence [1].
Identifying and assessing acculturation in NHOPI is compromised and complicated by several factors. Firstly, we must account for individual and collective attitudes, values, perspectives, and strategic choices in rejecting, adopting or adapting to a different culture [7]. This is especially true in light of the many different ethnicities, histories, cultures, languages and individual variation of the people we collectively call Native Hawaiian and other Pacific Islanders.
Acculturation and assimilation models also do not seem optimal in addressing health disparities caused by structural and social barriers. Berry’s taxonomy and Ward’s model, for example, are well known and often cited [7]. However, they do not describe how forces in acculturation can yield adverse effects and outcomes, nor do they offer any explicit solutions as to how these may be mitigated or eliminated [7].
Integration and Enculturation
In adapting to any new or challenging environment, integration can bring together native traditions and culture with that of the established mainstream. This process or strategy is thought to result in the least amount of conflict and stress [8]. However, integration is somewhat loosely defined, and is often interpreted in the context of bi- or multiculturalism [9]. In these, whole parts of different cultures are incorporated, voluntarily or involuntarily. For example, this may mean embracing Western medicine in its entirety, while adhering exclusively to a traditional Hawaiian diet. A better option may be enculturation, [10] through which people consciously “pick and choose” exactly which aspects of the dominant culture they wish to adopt or reject, and to what degree.
Clearly, it is in the individual’s best interest to adopt behaviors and components which lead to better outcomes. Unfortunately, there is scant research on traditional practices and modalities such as NHOPI healing rituals [7]. It is therefore difficult to determine exactly what indigenous practices or aspects should be maintained or (re)adopted, and what should be abandoned in favor of those of the dominant culture.
Separation and Marginalization
Another way of adapting to challenging environments is to employ separation, through which people physically and/or mentally distance themselves from the prevailing culture and society [7]. Whereas integration and enculturation may theoretically incorporate the best of both worlds, separation would preserve indigenous health behaviors and exclude Western practices, for example. However, given the lack of studies on non-native versus traditional methods and practices, the objective benefits of separation are also uncertain. Without these, we cannot know exactly what should be preserved, excluded, or separated culturally to achieve the best outcomes.
A separation strategy also carries the risk of marginalization, [11] when the mainstream and other cultures react negatively to the apparent refusal of an individual or group to adopt prevailing customs and practices. The majority of NHOPI may be at special risk, given their history of discrimination, a possible inability to easily assimilate, and generally low socioeconomic status [1]. The marginalization of NHOPI populations, in fact, may already be seen in ongoing poverty, [12] the lack of employment opportunities, [13,14] barriers to social advancement, [15] and political disenfranchisement [16].
Ghettoization and Isolation
Ghettoization arises when groups of people are isolated physically, socially and culturally [10]. For the majority of NHOPI, ghettoization may be involuntary, often with severe negative outcomes. Island people are of course naturally isolated, and may be expected to enjoy few employment and educational opportunities, limited technology and infrastructure, and at best only fair medical and social services, compared to those who live in large urban, mainland communities. Even those who do not live on islands may be at risk. Unless isolated populations are well-off, thriving, and have access to adequate resources, it is reasonable to expect at least some socioeconomic and health disparities between them and surrounding communities. It seems though that most NHOPI live in poverty [12] regardless of where they live, and that isolation makes their circumstances even worse.
Marshall Islanders, for example, have established communities in Arkansas, where they have resettled for employment. People living in these “ghettos” suffer from poverty, [17] food insecurity, and cultural barriers [18]. Besides their low socioeconomic status, they face communication and language barriers, have poor educational opportunities, little or no health insurance, live in crowded conditions conducive to the spread of disease, and have limited access to transportation [17,18].
Acculturation, Assimilation, and NHOPI Health and Well-Being
NHOPI who preserve a healthy traditional diet [19-27] and participate in physical activities or exercise as did their ancestors [19,20,28-33] were shown to enjoy better health than those deemed more acculturated, who consumed Western “junk” food, [34,35] and who lead more sedentary lifestyles [36]. Despite such research, it is largely unclear exactly which practices and behaviors, besides the obvious, should be excluded, and which should be maintained or adopted.
Our review, for example revealed no credible studies on the efficacy of traditional NHOPI healing modalities [1]. Similarly, cultural traditions such as feasting and family gatherings are thought to be beneficial for NHOPI [1]. However, research has not yet identified which components are the most significant, why, and how these may be leveraged to improve NHOPI health and well-being. We expect that findings may even prove somewhat contradictory, as in encouraging feasting events while discouraging positive perceptions of obese status.
DISCUSSION
NHOPI may be less able to assimilate physically and culturally than Caucasians or other races due to discrimination and racism. Understandably, NHOPI in autonomous or semi-autonomous island countries such as Tonga and Samoa may also have no desire or need to assimilate with races and cultures of other areas or nations. NHOPI may also wish to retain their cultural identity as much as possible, out of ethnic pride, a sense of community, past experiences of discrimination and racism, nativist and nationalist feelings, and past colonialism. These considerations indicate that assimilation as a strategy in improving NHOPI health and well-being may prove largely ineffective.
Using acculturation also seems limited and impractical. Acculturation is “personal” and “human,” and must account for the attitudes, values, perspectives, and choices of the individual, and of the many different subgroupings of the people we call NHOPI. Moreover, there is a scarcity of research in this area, and no universal consensus on the indicators, measures and proxies of acculturation. Except for the obvious, there is no general agreement on exactly what in acculturation is “good” and “bad” for individuals, for each of the many different subgroupings of NHOPI, and for this population as a whole.
It is also unclear whether we can demonstrate an unequivocal association between purported components and measures of acculturation, and health or social outcomes. High acculturation, for example, may be determined as adopting a non-indigenous diet. However, this does not necessarily mean that what a non-traditional individual eats is unhealthy, or less healthy than traditional island fare. NHOPI health seems more severely compromised by voluntary behaviors such as high rates of smoking, [25-27,29,30,37-39] which appear to be a conscious, [40] if not cultural choice.
Acculturation may also be practically irrelevant in NHOPI communities where poverty, the lack of basic services, and limited resources would seem to better predict poor health outcomes and major health disparities. While low acculturation may not satisfactorily explain living in NHOPI mainland “ghettos,” for example, poverty, limited opportunities, disenfranchisement, and discrimination may. Even if we could identify a specific health disparity caused by the lack of assimilation, it is debatable as to whether public policy and practice should encourage or enforce NHOPI assimilation into the dominant mainstream as a corrective measure. Similarly, if some highly acculturated individuals were shown to have better health outcomes, should all NHOPI be forced to abandon or reject their traditional practices and behaviors?
CONCLUSIONS AND RECOMMENDATIONS
Acculturation and assimilation would seem highly relevant given the large amount of NHOPI “culture” research found in the literature. It therefore seems natural to assume that processes and strategies in both could be leveraged to improve NHOPI health and well-being. However, assimilation for many NHOPI does not seem widespread. This is understandable given differences in race, socioeconomic status, and distinguishing cultural traditions. NHOPI may also resist assimilation for a variety of reasons, including ethnic and national pride.
Likewise, the value of acculturation as a tool or strategy in improving NHOPI health and well-being is equivocal. There is a general scarcity of research, especially on native modalities, traditions and interventions compared to Western or non-indigenous methods. Besides the obvious, we simply do not know objectively which parts of NHOPI “culture” should be preserved, adopted, or rejected. Moreover, acculturation and assimilation models do not seem directly aligned, or consistent with, the serious social, structural and policy barriers that negatively affect NHOPI health and well-being.
The literature suggests, however, that three acculturation processes or strategies may contribute to NHOPI health disparities. Living on an island with relatively poor infrastructure and limited resources in itself implies involuntary ghettoization. Even those who have left their island homelands may also find themselves isolated in poor and underserved neighborhoods due to social and economic factors. Some NHOPI may also pursue voluntary cultural separation, in which traditions and native practices are maintained, and possibly beneficial Western behaviors and modalities are excluded.
The literature indicates that it may be more practical and effective to examine NHOPI lifestyle and health behaviors in predicting health outcomes, rather than employ acculturation and assimilation constructs and measures. However, the negative effects of ghettoism, isolation, and separation appear significant and applicable for all NHOPI and subgroups.
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