Lack of Native Hawaiian Neurologists and Disparities in Care for Native Hawaiians in Hawaiʻi

Main Article Content

Maiya Smith
Christina Tse
Nicholas Fancher
Ryoko Hiroi
William Harris
Selin Kutlu
Nicole Anzai
Heather Miura
Bryce Chang
Douglas Miles


Native Hawaiian, Neurology, Racial Concordance, Health Disparities, Physician Shortage


Introduction: In Hawai?i, there are 367,000 Native Hawaiian and Pacific Islanders. Native Hawaiians experience health disparities in a variety of conditions, including stroke, diabetes, and cancer.  Ethnic minorities are underrepresented among physicians; this lack of physician-patient racial concordance may contribute to the disparities, as recent studies suggest that racial discordance resulted in poorer healthcare quality. This study aims to assess the current status of neurological health disparities in the Native Hawaiian population in Hawai?i, with a focus on identifying neurologist ethnic representation, neurological diseases, and healthcare-related challenges disproportionately affecting Native Hawaiians. Methods: An anonymous survey on physician’s attitudes and practice was emailed to all neurologists in the Hawai?i Neurological Society from February 2019 to June 2019. Findings: Twenty-three full responses and one partial response was received. No participants self-identified as Native Hawaiian nor did they know of any Native Hawaiian neurologists in Hawai?i, yet all who completed the survey reported treating Native Hawaiians in their practice (n = 23), which identifies a gap in Native Hawaiian representation in the field of neurology in Hawai?i. In addition, majority of participants perceived that Native Hawaiians are disproportionately affected by neurological diseases and have difficulty accessing neurology services and obtaining quality care. Conclusions: Future focus on creating opportunities to improve racially discordant physician-patient relationships and to increase Native Hawaiian representation in neurology may help narrow the gap in health disparities experienced by Native Hawaiians. 

Abstract 324 | PDF Downloads 44


1. Home Page - Office of Minority Health (OMH) [Internet]. [cited 2020 Feb 1]. Available from:
2. Alsan M, Garrick O, Graziani G. Does Diversity Matter for Health? Experimental Evidence from Oakland. Am Econ Rev. 2019 Dec;109(12):4071–111.
3. Laveist TA, Nuru-Jeter A. Is doctor-patient race concordance associated with greater satisfaction with care? J Health Soc Behav. 2002 Sep;43(3):296–306.
4. LaVeist TA, Nuru-Jeter A, Jones KE. The association of doctor-patient race concordance with health services utilization. J Public Health Policy. 2003;24(3–4):312–23.
5. Kana‘iaupuni SM, Malone N. This land is my land: The role of place in Native Hawaiian identity. H?lili Multidiscip Res Hawaii WellBeing. 2006;3(1):281–307.
6. McCubbin LD, Marsella A. Native Hawaiians and psychology: The cultural and historical context of indigenous ways of knowing. Cultur Divers Ethnic Minor Psychol. 2009;15(4):374–87.
7. Hilgenkamp K, Pescaia C. Traditional Hawaiian Healing and Western Influence. Calif J Health Promot. 2003;1:34–9.
8. van Ryn M, Burke J. The effect of patient race and socio-economic status on physicians’ perceptions of patients. Soc Sci Med. 2000 Mar 1;50(6):813–28.
9. ’Iwalani E, Palafox N, Little D. Where are the Native Hawai’ian physicians? Pac Health Dialog. 1998;5(2):246–52.
10. Else I. Native Hawaiian physician location and service to the underserved in Hawai’i. Pac Health Dialog. 2001 Sep;8(2):312–21.
11. Nakagawa K, Koenig MA, Asai SM, Chang CW, Seto TB. Disparities among Asians and native Hawaiians and Pacific Islanders with ischemic stroke. Neurology. 2013 Feb 26;80(9):839–43.
12. Nakagawa K, Koenig MA, Seto TB, Asai SM, Chang CW. Racial disparities among Native Hawaiians and Pacific Islanders with intracerebral hemorrhage. Neurology. 2012 Aug 14;79(7):675–80.
13. Cooper-Patrick L, Gallo JJ, Gonzales JJ, Vu HT, Powe NR, Nelson C, Ford DE. Race, gender, and partnership in the patient-physician relationship. JAMA. 1999 Aug 11;282(6):583–9.
14. Saha S, Komaromy M, Koepsell TD, Bindman AB. Patient-physician racial concordance and the perceived quality and use of health care. Arch Intern Med. 1999 May 10;159(9):997–1004.
15. Capstick S, Norris P, Sopoaga F, Tobata W. Relationships between health and culture in Polynesia – A review. Soc Sci Med. 2009 Apr 1;68(7):1341–8.
16. Smedley BD, Stith AY, Colburn L, Evans CH, Institute of Medicine (US). The Right Thing to Do, The Smart Thing to Do: Enhancing Diversity in the Health Professions: Summary of the Symposium on Diversity in Health Professions in Honor of Herbert W.Nickens, M.D [Internet]. Washington (DC): National Academies Press (US); 2001 [cited 2020 Feb 1]. Available from:
17. Ambrose AJH, Arakawa RY, Greidanus BD, Macdonald PR, Racsa CP, Shibuya KT, Tavares TPM, Yamada S. Geographical maldistribution of native Hawaiian and other Pacific Islander physicians in Hawai’i. Hawaii J Med Public Health J Asia Pac Med Public Health. 2012 Apr;71(4 Suppl 1):13–20.
18. Burton A. How do we fix the shortage of neurologists? Lancet Neurol. 2018 Jun 1;17(6):502–3.
19. Larsen DP, Santini VE. Increasing student recruitment into neurology: Joining the family. Neurology. 2015 Jun 9;84(23):2302–3.
20. Clerkship Requirements by Discipline [Internet]. AAMC. [cited 2020 Feb 1]. Available from:
21. Beach MC, Price EG, Gary TL, Robinson KA, Gozu A, Palacio A, Smarth C, Jenckes MW, Feuerstein C, Bass EB, Powe NR, Cooper LA. Cultural competence: A systematic review of health care provider educational interventions. Med Care. 2005 Apr;43(4):356–73.
22. Kamaka ML, Paloma DSL, Maskarinec GG. Recommendations for medical training: a Native Hawaiian patient perspective. Hawaii Med J. 2011 Nov;70(11 Suppl 2):20–4.
23. Carpenter D-AL, Kamaka ML, Kaulukukui CM. An Innovative Approach to Developing a Cultural Competency Curriculum; Efforts at the John A. Burns School of Medicine, Department of Native Hawaiian Health. Hawaii Med J. 2011 Nov;70(11 Suppl 2):15–9.