The Healthy Ancestor

Embodied Inequality and the Revitalization of Native Hawai'ian Health

Juliet McMullin

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781315418315
• Edition: 1
• Topic: Sciences sociales
• Subtopic: Anthropologie

Native Americans, researchers increasingly worry, are disproportionately victims of epidemics and poor health because they "fail" to seek medical care, are "non-compliant" patients, or "lack immunity" enjoyed by the "mainstream" population. Challenging this dominant approach to indigenous health, Juliet McMullin shows how it masks more fundamental inequalities that become literally embodied in Native Americans, shifting blame from unequal social relations to biology, individual behavior, and cultural or personal deficiencies. Weaving a complex story of Native Hawai'ian health in its historical, political, and cultural context, she shows how traditional practices that integrated relationships of caring for the land, the body, and the ancestors are being revitalized both on the islands and in the indigenous diaspora. For the fields of medical anthropology, public health, nursing, epidemiology, and indigenous studies, McMullin's important book offers models for more effective and culturally appropriate approaches to building healthy communities.

1

HAWAIIAN HEALTH: A CASUALTY OF HISTORY

Ideas about health in the Hawaiian context are framed by historical events such as contact with Europeans and Americans, depopulation, colonization, and resistance.¹ The familiar concepts of a “healthy Hawaiian body” and its counterpart the “unhealthy Hawaiian body” in conversations about Native Hawaiians create potent symbols for the renaissance and sovereignty movements. It is not simply, however, that these images are symbols of current efforts at self-determination. Rather, the body and health are an integral part of how Native Hawaiians can conceptualize social relationships with each other and their land base. Anderson notes that, “nationalism has to be understood by aligning it, not with self-consciously held political ideologies, but with the large cultural systems that preceded it, out of which—as well as against which—it came into being (1991 [1983]:12).” Historical and contemporary understandings of health are indeed a part of the “large cultural systems” within which Hawaiian nationalism is understood. Talking about health in a national context serves a dual purpose: it allows us to conceptualize it as a state of being everyone experiences as an individual and, when defined by normalizing effects of scientific knowledge or by local genealogical knowledge, as a population. Consequently, it follows that health is not only a political ideology but also part of a larger cultural system that connects individual and group as well as past and present. Examining the political facets of health leads to a denaturalization of healthy and unhealthy bodies, revealing the tensions and embodiments of inequality and normalizing effects as experienced by Native Hawaiians.

While Friedman (1994) has noted that a key aspect of Hawaiian identity is defined in direct opposition to the ways of the Europeans and Americans. Hawaiians’ return to their history, to understanding the knowledge and practices of their ancestors, brings into view the political economy of health that produced transformations in social structure, knowledge and the physical well-being of so many. As we explore how Native Hawaiians remember the health of their ancestors it can be argued that identity is not simply a rejection of aspects of modernity and American colonialism, but rather an opportunity to remember shared histories and put forth other Hawaiian subjectivities.

Many Native Hawaiians I spoke with and much of contemporary Hawaiian literature positions Hawaiians and constitutes their identity as a group through the shared understanding of indigenous history, which provides a counterpoint to dominant European and American ideologies. Anderson 1991 [1983] and others (Hobsbawm and Ranger 1983) have argued that the use of familiar aspects of a shared history is necessary in order to build a sense of commonality that recognizes the fluidity of identity and resists the fragmentation of identity in the face of a more dominant homogenizing history that suppresses Hawaiian knowledge. The hegemony of Western² history and ideologies is precisely what Native Hawaiians continue to struggle against. The ability to draw on their history to build national and cultural identity binds people together in the sense of sharing common experiences and also gives them an alternative history that can be used to fragment the dominant history of the West.

Contact with the Western world has clearly affected the health status of Hawaiians in dramatic ways. Explorers and later waves of immigrants brought diseases that contributed to the depopulation of Hawai‘i. The introduction of Western medicine and efforts by missionaries to devalue Hawaiian ways eclipsed traditional treatment of illness and health maintenance. In response, efforts made by na kāhuna (Hawaiian medical practitioners) to restore the health of Hawaiians, combining both Native and introduced knowledge and practices, illustrate the determination of the people to maintain the value of their own knowledge and well-being. This chapter will briefly explore events and processes in Hawaiian history by outlining a political economy of health for the era that has contributed to an understanding that health is integral to the crafting of cultural and national identity.

Ali‘i, Social Structure, and Transformation

Although physical health is the primary focus of medicine, we must not forget the larger social contexts that produce poor health. The physical health of Hawaiians is often linked to inequalities produced by colonial encounters that disparaged their beliefs, undermined their spiritual health and the knowledge of na kahuna, and the alienation of Kanaka Maoli from the land. This is not to say that there was no hierarchy in the Hawaiian Islands before the arrival of Captain Cook in 1778. Hawai‘i had one of the most hierarchical social systems in the Pacific. Described as similar to a feudal system, the basic classes of people included the ali‘i nui (a chief of an island) who held the greatest amount of power, the kāhuna were the priestly class who served and enforced the dictates of the four main gods; Ku, Kane, Lono, and Kanaloa, the konohiki (headmen under the chief) and maka‘āinana (the commoners, literal translation: people who looked to the land). This system was often amenable to merchants and traders who arrived in the Islands after Cook (Fuchs 1961; Howe 1996 [1988]). Merchants found Ali‘i with whom they could negotiate trade agreements and the Ali‘i had laborers, the maka‘āinana, who could obtain natural resources from the land, such as sandalwood. Merchants were also used by the Ali‘i for their own political purposes. It is argued that Kamehameha I’s skill at military tactics and the guns he acquired from traders were key factors in uniting the archipelago under one ruler.

The Ali‘i were active agents in colonial encounters and the instigators of some of the major transformations in Hawaiian society. Some of their acts included creating agreements between merchant traders and foreign governments, and abolishing long-held kapu (taboo). Scholars have discussed the motivations behind the actions of the Ali‘i from the breaking of the ‘ai kapu (the taboo against men and women eating food together) to the inclusion of foreigners as advisors in their uppermost political cabinets (Kame‘eleihiwa 1992; Howe 1996 [1988]; Silva 2004). For example, after the death of Kamehameha I in 1819, Ka‘ahumanu, Kamehameha II (Liholiho), the wife and son of Kamehameha I, and Keōpūolani (Liholiho’s mother) decided to sit together and eat in public. In this one public act, the ‘ai kapu would no longer be followed, paving the way for the dismissal of other kapu and religious rituals as well. One of the consequences of breaking the ‘ai kapu and other rituals was that the kāhuna no longer held control over spiritual matters and over the daily tasks necessary to serve the will of the gods (Shiva 2004). These tasks were primarily performed by the maka‘āinana. The transformation of the kapu freed the maka‘āinana from spiritual duties, but also gave them more time to work for the Ali‘i (Kame‘eleihiwa 1992). This dismantling of the religious structure through the breaking of the kapu, however, did not extend into the structure and practices of the medical kahuna. As will be discussed later, the silencing of Hawaiian medical practices was accomplished through the outcries of the missionaries and some of their own medical practitioners. Shortly after the death of Kamehameha I and the shift in the kapu system, the first missionaries from the American Board of Commissioners for Foreign Missions arrived in 1820. Their disdain for the apparent “barbarism” of Hawaiians has been well documented in the memoir of Hiram Bingham (1847). The missionaries’ ongoing dialogues with the Ali‘i, while always tentative, also resulted in Ka‘ahumanu being one of the first Hawaiians to publicly proclaim her conversion to Christianity.

Social hierarchy in Hawai‘i at the time of early colonial encounters was in some ways amenable to the values of capitalism. Given the racial biases and desire for property exhibited by missionaries and merchant capitalists (categories that are not mutually exclusive) the locus of political power would not reside with the Hawaiian monarchy and the Ali‘i for long. In the end, through the appropriation of land, waves of epidemics, and new forms of government intervention (such as registering ownership of land, licensing of physicians, and documentation of heritage/blood quantum), we find the ali‘i disenfranchised and subject to the same stature as the maka‘āinana. Thus, if we think of social inequality in terms of access to resources and in the way individuals are valued in society as factors in poor health, we begin to see the combined effects of colonization, missionization, and their toll on all Kanaka Maoli. The interaction of these social processes on discourses of health and the body will be explored further in this chapter. Given the multiple levels at which Hawaiian ideals were denigrated, regardless of hierarchies among Hawaiians themselves, what is important today for their survival and their national and cultural understanding of who they are is their emphasis on the relationship between land and health.

Alienation from the Land

One of the most damaging blows to the Hawaiians was the Māhele (division) in 1848. The Māhele was a transformation from the traditional communal land tenure system to private ownership. As American missionaries and businessmen required more acreage for their coffee, sugar, and pineapple plantations, and as they gained greater prominence as counselors in the monarchy there was a significant amount of economic and political power to push for a privatization of the land. Prior to the Māhele all the groups, the ali‘i, konohiki, and the maka‘āinana, cooperated with one another to subsist on the land. The land was divided by the ahupua‘a system, a pie-shaped division from the mountains to the ocean. Segmenting the land in this way allowed the maka‘āinana to share their food with the surrounding areas, giving the food to the ali‘i and konohiki, who would in turn redistribute the food. This redistribution ensured that everyone had access to a variety of foods and maintained pono (balance or unity) with the land, the people, and the gods. The communal land tenure system was organized such that it could provide for all the people. It emphasized sharing and easy access to the land, while in the post-Māhele era private ownership emphasized restricted, unavailable land. The Māhele divided the land into the ali‘i or crown lands, chiefs’ lands, and the maka‘āinana land or common land. Hawaiians, who emphasized sharing as part of their cultural identity, were unfamiliar with the foreigners’ grab for private wealth and were at a disadvantage in a capitalist system (Kame‘eleihiwa 1992). Kame‘eleihiwa (1992) argues that when the Ali‘i agreed to the Māhele, they believed that they were sharing the land or ‘Āina³ with the people and did not know that they were creating private ownership. This is based on two issues, one being that the word māhele also means to share; the second issue is that the ‘Āina could only be owned by the gods, the akua, and the ‘Āina was in essence an akua. Therefore no one could own an akua and thus no one could own the land. Because of the Māhele, Native Hawaiians had to present a claim to the Land Commission⁴ before the individual could be awarded any land. According to Kame‘eleihiwa, an appallingly small number (approximately 13 percent) of the Hawaiian population made claims to the Land Commission for their plot of land. Thus, many Hawaiians lost access to and control of the land that had sustained them and their ancestors for generations. It is notable that the Māhele took place after many had lost their lives to earlier epidemics of smallpox and syphilis, and during the same year (1848) as the flu, measles, and whooping cough epidemics that continued to take more lives. As a result, there were fewer individuals to make land claims, leaving much of the land available for purchase by foreigners. As Trask (1993) states with regard to the American missionaries and businessmen: “they came to do good, and did very well.” Kame’eleihiwa notes that the disjuncture between the Hawaiian way of caring for and living off the land and the new capitalist way of using the land to make a profit not only led to a loss of physical access to the land but also to a loss of pono, that is, a loss of spirit and health.

The importance of Native Hawaiian attitudes towards the land is evident in many contemporary statements that have been carried down through history. For example, Hawai‘i’s state motto is a quote from Kamehameha IV, “Ua mau ke ea o ka ‘Āina I ka pono,” which has been translated as “The life of the Land is perpetuated by righteousness.” This statement was made after the restoration of the Hawaiian kingdom following a British commander’s failed attempt to acquire control of the land (Silva 2004). Kamehameha announced to the people in 1843 that the kingdom had a verbal agreement from the United States recognizing its independence. Furthermore, Great Britain and France had signed a joint resolution recognizing Hawai‘i as an independent nation because it was “just and good.” This phrase became the motto for the kingdom and ultimately the state motto. Yet, Native Hawaiians and researchers have argued that a more appropriate translation of the motto revolves around the word ea, which means both life and sovereignty (Kame‘eleihiwa 1992, 1994; Trask 1993). Thus, the underlying meaning is, “The sovereignty of the land is perpetuated by pono, or by righteous behavior (Kame‘eleihiwa 1994:36).” Silva (2004) has also researched the phrase focusing on the multiple meanings of the word pono. It is not only that pono can mean justice or righteousness, but that foreigners who sought to control the land interpreted it in terms of the righteousness associated with their belief in a Christian God. In contrast, for Kanaka Maoli it means a recognition that the perpetuation of justice is in the sovereignty of the land that is genealogically linked to the mo‘i, ali‘i and people themselves. As Kame‘eleihiwa states, “For our Hawaiian ancestors, being an independent Nation, not being controlled by foreigners of any sort, was the very foundation of life. It was the life of the ‘āina, the land, the life of the ali‘i nui, the high chiefs, and the life of the maka‘āinana, the commoners” (1994:36).

Concerns about the poor health of Native Hawaiians initiated early attempts to return Hawaiians to the land. The ‘Ahuahui Pu‘uhonua O Na Hawai‘i, organized in 1914 by a group of Hawaiians, encouraged people to purchase land and take care of the health of their family (McGregor 1989; Hasager 1994). As discussed by Hasager (1994), the group promoted change among the Hawaiians by drafting a “rehabilitation solution” that consisted of “living the traditional ‘Hawaiian fish-and-poi’ way, which indicates a way of life based on cultivating the taro gardens and fishing (1994:168).” The Hawaiian Homes Commission Act was the result of the organization’s “rehabilitation solution.” Its main goal was to return Hawaiians to the land of their ancestors. Unfortunately, the Act benefited a small number of people who actually obtained plots of land. The majority of land requests to the Hawaiian Homes Commission resulted in long waiting lists, with many Hawaiians dying before any award would ever be made. This is a situation that continues into the present. Many of the people I spoke with testified to the despair and anger they feel over watching their parents wait for land and are now waiting themselves. Importantly, according to Hasager (1994), the land that was set aside for the Hawaiian Homes Commission had already been rejected by capitalist entrepreneurs as unsuitable for farming. Lack of irrigation and poor soil content made living off the land extremely difficult. Hawaiians’ inability to have access to the land of their ancestors, to fertile land for subsistence, further contributed to the decline in their health.

Foreigners’ beliefs and business interests not only conflicted with Native Hawaiians’ subsistence, their interests were also in opposition to spiritual attachments to the land. The concept of malama ‘āina is derived from the Kumulipo, the Hawaiian origin story. The Kumulipo also highlights the importance of the relationship between land and health. One version of the origin chant tells of Papa (earth mother) and Wākea (sky father) creating the Hawaiian Islands.

‘O Wākea Kahikoluamea e a,	Wākea the son of Kahikoluamea,
‘O Papa, Papa-nui-hanau-moku	Papa, Papa-nui-hanau-moku the
ka wahine;	wife;
Hanau Kahiki-kū, Kahiki-moe,	Kahiki-kū, Kahiki-moe, were born
Hanau ke ‘āpapanu‘u,	The upper stratum was born,
Hanau ke ‘āpapalani,	The uppermost stratum was born,
Hanau Hawai‘i, i ka moku	Hawai‘i was born, the first-born of
makahiapo,	the islands,
Ke keiki makahiapo a laua …	The first-born of the two …
(Kamakau 1991:126)

From the union of Wākea and Ho‘ohōkūkalani (Papa and Wakea’s daughter), a half-formed child named Hāloa-naka was born. The child was buried at the end of a house and there grew the first kalo/taro plant. Wākea and Ho‘ohōkūkalani also gave birth to a second son, Hāloa, who is regarded as the ancestor of all Hawaiians (Kame‘eleihiwa 1992). Since the kalo is considered the elder sibling of all Native Hawaiians, it is held in high esteem. From this creation story derives the responsibility Hawaiians have to take care of the land that feeds them and gives them life.

Alienation from the land resulted in both spiritual and physical death for Hawaiians. It signifies the consistent push of colonists to disenfranchise Natives from their land, leading to a political economy wherein options for all Native Hawaiians are constrained. Establishing the history of the seizure of Hawaiian land has become an important part of the process of re-territorializing the boundaries of Hawai‘i and reestablishing the health of Native Hawaiians through their relationship to the land. N...