community health

Over the years, Islander Institute has worked to improve our understanding of community health with the ultimate goal of remaking practices and policies to generate true well-being in our islands.

I believe that the community - in the fullest sense: a place and all its creatures - is the smallest unit of health and that to speak of the health of an isolated individual is a contradiction in terms.
— Wendall Berry,

community health needs assessment

Download the entire CHNA in PDF (15.2 MB)

Download the entire CHNA in PDF (15.2 MB)

In 2018, the Healthcare Association of Hawaiʻi (HAH) selected Islander Institute to conduct a statewide community health needs assessment (CHNA). HAH stated its intent for this report in this way: “HAH and its member hospitals are committed to engaging in deep and transformative relationships with local communities to address the social determinants of health and to increase access to high quality of care.”

Intrigued by this statement of intent, Islander Institute designed a process and conducted our work in accordance with the following principles:

  1. Local style. The first rule was to honor our home by conducting the work in accordance with the values and practices of Hawaiʻi: to be respectful of places and traditions, to be generous with time and spirit, and to approach the work with humility, joy, and aloha.

  2. Start with people’s lived experiences. The study started with people’s own stories and conceptions of health, accepting the fact that what people share is their truth. Individual accounts were considered to be at least as important and real as statistics and the opinions of subject matter experts.

  3. Honor everyone’s contribution. So that individual ideas were not lost in the process, the report presents many ideas in people’s own words. When people provided thoughts that stood in conflict with someone else’s, those differences were allowed to coexist.

  4. Be open to different narratives. To avoid making assertions on false understandings, Islander Institute always tried to keep an open mind, to deepen understandings through conversation and empathy, and to be cautious not to reinforce commonly held beliefs without first examining them against people’s real lives.

  5. Keep looking upstream. With guidance from community members, Islander Institute and its partners asked about and sought the root causes of downstream health effects, resisting the common urge to medicalize problems and solutions.

  6. Build relationships. Throughout the process, Islander Institute and its partners looked for opportunities to strengthen existing relationships and facilitate new ones, knowing that the likelihood of the CHNA leading to real action in the future depends greatly on successful communication and strong partnerships.

The final result was a comprehensive document made public in January 2019 and available for download here. For more information on the CHNA or to discuss any ideas for community health initiatives, please contact us.


what is health?

Despite tremendous growth of the healthcare system in the United States, it is becoming clearer that it is failing to make people feel healthier. In this atmosphere of skepticism, community efforts are taking root to challenge, reform, reject, and/or remake the health care system to improve its effectiveness.

Beginning in 2014, Kōkua Kalihi Valley and Islander Institute held a series of formal and informal conversations to hear people’s perspectives on personal and community health. Much can be learned from listening to stories of struggle and success, pain and joy, frustration and understanding. In this process, our aim was to find common themes that define what matters to indigenous and island people. In doing so, a more universal view of health and wellness emerged. The new framework of health we are developing together is described in this article:

Pilinahā: An Indigenous Framework for Health

When I see people working together on the ‘āina, or in a fishpond, or gathering limu and doing traditional practices, I actually see them get physically stronger. They get connected to who they are, and to each other. And they feel power—not power over others, but power and control over their own destiny.
— Community leader from Windward Oʻahu