Pacific Islander cultural health practices and Medicare in Hawaii

Hawaii's Medicare population is one of the most ethnically diverse in the country. For Native Hawaiian, Samoan, Tongan, Marshallese, Chuukese, Filipino, Japanese, and Korean kupuna, traditional health practices are often part of how care is given and received — sometimes alongside Western medicine, sometimes in tension with it.

How cultural practices show up in care

Across Hawaii's Pacific and Asian communities, several patterns recur:

• Family-centered decision-making — major medical decisions are typically made by the family, not the individual patient alone
• Respect for elders' authority — kupuna often defer to children or grandchildren for healthcare logistics, but retain decision authority
• Use of traditional healers alongside MDs — herbalists, lomilomi practitioners, prayer healers, traditional birth attendants in some communities
• Communal practices around illness — extended family visits to hospitals, prayer gatherings, food traditions during illness
• Specific dietary traditions — that may complicate or complement medical advice (poi for digestion, kava preparations, traditional fish dishes)
• Distrust of unfamiliar systems — particularly among COFA migrants whose communities have historical trauma with U.S. institutions

Native Hawaiian healing traditions

Several traditional Native Hawaiian healing practices have formal recognition in Hawaii:

• Lomilomi — traditional Hawaiian massage, often used for musculoskeletal issues and stress; some practitioners are licensed massage therapists who incorporate Hawaiian techniques
• La'au lapa'au — traditional herbal medicine using native Hawaiian plants
• Ho'oponopono — traditional family conflict resolution and forgiveness practice, often relevant in family medical decisions
• Pule (prayer) — central to many healing practices
• Hula and chant — traditional health and wellness practices

The five Native Hawaiian Health Care Systems integrate these traditions with Western primary care. Some Hawaii Medicare beneficiaries see an NHHCS-affiliated MD for medical care and a traditional practitioner for related cultural and spiritual health.

Filipino and Ilocano health traditions

Hawaii has the highest per-capita Filipino population in the U.S. mainland states (after the Philippines itself, only the Northern Mariana Islands and Guam have higher concentrations). Among Filipino kupuna in Hawaii, common cultural patterns include:

• "Hilot" — traditional Filipino healing practice involving massage and herbal remedies
• Strong intergenerational caregiving — adult children, especially daughters, often take primary caregiving roles
• Use of native Filipino medicinal plants alongside prescribed medications
• Religious involvement in healing — particularly Catholic prayer and saint veneration

Japanese and Okinawan traditions

Hawaii's Japanese-American community includes many third- and fourth-generation kupuna with deep cultural ties:

• "Gaman" — the value of enduring difficulty stoically, which can affect how kupuna report symptoms
• Kampo — Japanese traditional herbal medicine, sometimes used alongside prescribed medications
• Strong preference for keeping medical matters private
• Specific dietary practices tied to longevity and chronic disease prevention

Samoan and Tongan traditions

Hawaii has significant Samoan and Tongan communities, particularly in West Oahu (Waianae, Ewa Beach) and parts of the Big Island:

• Strong family-based decision-making — extended family (aiga in Samoan, kainga in Tongan) is the unit of care
• Traditional healers — fofo in Samoan tradition, with continuing roles in some communities
• Religious involvement — particularly through Christian congregations, which are central to community health
• Specific cultural foods that may need adaptation for diabetes or hypertension management

COFA community health practices

Marshallese, Chuukese, Pohnpeian, and other COFA community members bring traditional health practices that are often unfamiliar to Hawaii providers:

• Traditional birth attendants and midwives
• Herbal medicine traditions
• Strong community-based health communication — health information often flows through churches and community organizations
• Concerns about Western medicine rooted in nuclear testing legacy in Marshallese communities

How Medicare and Medicare Advantage handle traditional practices

Federal Medicare does not specifically cover traditional cultural healing practices. Some traditional practices may be covered when delivered by licensed practitioners under standard Medicare benefits — for example, lomilomi delivered by a licensed massage therapist as part of a Medicare-covered physical therapy plan, when ordered by a physician.

Some Hawaii Medicare Advantage plans include supplemental wellness benefits (gym memberships, fitness programs, group exercise) that can support culturally grounded wellness — including hula classes, tai chi, qigong, and similar.

The Native Hawaiian Health Care Systems are the primary structure that integrates traditional practices with Medicare-billed care in Hawaii. NHHCS clinics bill Medicare for medical services and offer culturally grounded programs through HRSA grant funding.

What providers should know

Hawaii Medicare beneficiaries deserve providers who understand cultural context:

• Major Hawaii health systems offer cultural competency training, but quality varies
• Some MA plans publish provider directories with cultural and language information
• The Native Hawaiian Health Care Systems train healthcare workers in culturally grounded care
• Bilingual community health workers (CHWs) play an increasingly important role bridging traditional and Western care

Working between systems

If you or a family member uses traditional practices alongside Medicare-covered care, a few practical considerations:

• Tell your doctor what traditional remedies, herbs, or supplements you're using — many can interact with prescription medications
• Tell your traditional practitioner what medications you're on
• Coordinate rather than choose between systems when possible
• Bring a family member to important appointments, especially for translation and decision support
• Native Hawaiian Health Care Systems are designed to make this coordination easier