Assimilation and Acculturation in Native Hawaiian and Other Pacific Islander (NHOPI) Health and Well-Being

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