Walk For Hawai’i Filipinos’ Health

by Dr. Arcelita Imasa

Let us celebrate the first Hawai’i Walk For Health!

Last August 11th, several Filipino organizations and supporters successfully held the Lakad Para sa Kalusugan, or Walk for Health, Hawaiʻi’s first “walk as a community” initiative.

In other U.S. states, Lakad Para sa Kalusugan has brought Filipinos together to promote physical activity and wellness within the warm embrace of community spirit.

Over a hundred Hawai’i Filipinos walked for a good cause and raised issues affecting the community’s health such as livable wages, migrant rights, and affordable housing.

This event was organized by the University of the Philippines Alumni Association of Hawaiʻi (UPAAH), the National Alliance for Filipino Concerns (NAFCON), and the Hawaiʻi Workers Center (HWC).

The first two groups UPAAH and NAFCON advocate for the rights and welfare of Filipinos who form the majority of their members, while HWC is a non-profit center serving low-wage workers in Hawai’i, many of whom are Filipinos.

Walking with the community for health
The Walk promoted walking as a healthy activity for the heart, lungs, muscles, brain, and mood. It is generally believed that a good walk is about 10,000 steps, and for most people, this is equivalent to ~8 kilometers, or 5 miles, per day.

Walking is easy, free, and accessible to almost everyone. Our Hawaii communities generally have walk-friendly spaces and we should use these spaces.

Walking activities are also ways to learn so much – about our bodies, our relationships with each other, and the community!

By walking, we get to meet new people! You see, walking is very beneficial!

Participants of the Walk also enjoyed the stretching and escrima activities that were planned.

“Our health is our most valuable asset. Without it, we can accomplish nothing in life,” said Johnny Verzon, a martial arts practitioner who led the escrima session in the Walk.

“There is no such thing as “I do not have time.” We all have 24 hours in a day. It is what we do with our time. Make time to take care of our health – mind, body, and spirit.”

Another community member who took the bus from Kalihi to be able to join the Walk with his doctor shared his enthusiasm about the event.

“It is a great idea to promote walking as a good exercise, but it is really something else to do walking with the community who cares! Please hold another Walk next year!” he shared.

For Mylene Reyes, current president of the UPAAH, organizing the Walk was not a walk in the park but felt it was a worthwhile endeavor.

“When we organized the Walk, we were thinking of creating a family-friendly, community event that will also help raise awareness about health issues faced by the Filipino community in Hawaii,” Reyes said.

Reyes also said that scouting the location for the event was just the first step.

“As soon as we decided that Central Oahu (Aiea) was a good choice, we immediately thought about designing the Walk’s path within the grassy part of the part. The Walk also featured creative stakes containing health-related information that was placed on the ground throughout the path,” she shared.

Dr. Rainier Bautista who is the current president of the Philippine Medical Association of Hawai’i, which helped sponsor the Walk, said:

“We did the Walk not only for good physical health. Not a lot of our patients receive culturally sensitive care, and I believe the Walk brings this issue out in the open – that receiving culturally sensitive care can positively impact the health of Filipinos.”

Hawai’i Filipinos: health status, determinants of health
The Walk also sought to highlight issues affecting the health of Filipinos in Hawaiʻi.

Sergio Alcubilla, executive director of Hawai’i Workers Center, stated:

“Filipinos tend to neglect health because of the need to work multiple jobs. But why do we need to work multiple jobs? There are many reasons, starting with the high cost of living in Hawaii. While some of these reasons seem obvious, the Walk served as a time to pause to reflect.”

Filipinos are known to have the highest rate of physical inactivity among ethnic groups in the state. They are also known to have the highest rates of high blood pressure and cholesterol, heart and kidney disease, and other chronic diseases.

Next to Native Hawaiians, Filipinos have the second highest rate of diabetes. Compared to other ethnic groups, Native Hawaiians and Filipinos also face higher mortality rates for coronary heart disease, according to the State’s Department of Health.

Filipinos also have the highest mortality rates for stroke among all ethnic groups.

“While studies say life expectancy is higher in Hawaii and surveys claim residents have improved health, that is not entirely the case for the Filipino community,” said Kit Z. Furukawa, who flew with her husband from Maui to participate in the Walk.

“We wanted to bring to light the reasons why our people generally have poor health – it’s the social and economic factors such as employment, education, and lifestyle. Underlying issues of poverty, discrimination, stigma, and social justice all makeup reasons why we are walking – the Walk has been a way to talk about these,” she added.

The Walk also highlighted Hawai’i Filipinos’ mental health, especially in the aftermath of the tragic wildfire in Lahaina a year ago.

Signs that said, “I walk for Lahaina” were prominent along the Walk’s path. Many have been deeply saddened by the news about wildfire survivor Nanay Edralina Diezon’s recent passing.

Many Filipinos who survived the wildfire are still under constant uncertainty about their future and are having a hard time bouncing back from the tragedy.

The Walk promises to be a regular activity in Hawai’i, as the state has the highest concentration of Filipinos among U.S. states. Of Hawaiʻi’s 1.4 million population, roughly one-fourth are Filipinos, and a significant 80,000 were born in the Philippines.

It is said that 3,500 Filipinos have arrived in Hawai’i every year since the 1970s. Around 56% or a majority of Filipinos in Hawai‘i are immigrants, and we all know that migrants face cultural, language, and communication challenges in migrant-receiving countries.

At the same time, 85% of Filipinos in Hawai’i are Ilocanos who either directly descended from, or have relatives among, the older generation of seasonal agricultural workers called sakadas.

Working as a primary care physician in a small clinic in Kalihi, I attend to the healthcare needs of patients who are mostly migrant Filipinos.

Kalihi is known to be heavily populated by Filipinos, and a predominantly Filipino neighborhood in Oahu, next to Waipahu, according to the U.S. Census.

It became a working-class community after immigrant laborers who worked in Hawaiʻi’s plantations settled in the area and transformed it from agricultural land to an urbanized area.

Interestingly, my patient population is largely composed of seniors (age 65 and higher) who are continuously employed in their 70s and 80s. One wonders, what are their motivations to continue working despite being at retirement age?

To find some answers, one needs to look at what’s called social determinants of health or SDOH.

A population’s SDOH refers to non-medical factors that influence their health outcomes – such as the conditions in which its members are born, grow, live, work, and age, and the wider set of forces shaping their daily lives.

In short, health and diseases are intimately related to income, employment, and education. SDOH significantly shapes Hawai’i Filipinos’ health and quality of life.

How stable are their economic conditions based on their income and employment? What can be said about their access to quality education and lifelong learning opportunities?

Only a minority of Filipinos are seen as belonging to the upper strata in Hawai’i. Not too many among them succeeded economically or were able to complete higher education.

Why are Filipinos mostly in low socioeconomic status and the working class?

A strong correlation exists between low educational attainment and low income.

While 12.6% of Filipinos who are 25 years or older across the U.S. have no diploma, in Hawaiʻi, the figure is 23.9% – the highest percentage across the U.S.

While 33.9% of Filipinos who are 25 years or older across the U.S. have a bachelor’s degree, in Hawai’i, the figure is only 14.1% – the lowest percentage across the U.S.

Indeed, a big majority of working Filipinos in Hawai’i are found in factories and the service industry, with 30% working as hotel workers, housekeepers, service policemen, and healthcare workers – jobs that typically provide the lowest pay.

An estimated 60-65% of tourism industry workers are Filipinos, mostly found in housekeeping departments, reputedly the lowest paid in hotels.

Other aspects of SDOH are just as important: access to, and quality of, healthcare, housing, healthy food and social support, and exposure to environmental hazards and levels of discrimination.

Social stigma and other cultural factors play major roles in many Filipinos’ mental health. Many Filipinos also tend to normalize taking on multiple jobs, prioritizing work over rest and recreation, refusing to rest from stress, and neglecting their healthcare needs – all of which adversely impact their health.

They need to send money to families back home in the Philippines, grapple with the high cost of living in Hawai’i, and cope with the lack of insurance or under-insurance that is common among many new migrants.

Addressing SDOH factors in general is crucial to improving Hawai’i Filipinos’ health as these disproportionately affect them as a disadvantaged population.

Studies show that among all ethnic groups, the lower the income, the higher the rate of physical inactivity – showing how low income often creates an unhealthy and sedentary lifestyle.

Creating social change: Promoting Filipino health and wellness
It is my observation that Hawai’i Filipinos are hardworking and very resilient amidst adversities. They also have a mindset of finding solutions collectively, as a people, and for the benefit of everyone.

Concepts like bayanihan and pakikipagkapwa are alive. I agree with what Kami Yamamoto, national education officer of NAFCON, shared:

“The Walk reflected an outpouring of support from the community. The Walk served as a venue to prop up our culture and heritage as Filipinos.”
Since elections are coming up, I hope that Hawai’i politicians with Filipino heritage will champion the health of Filipinos as a people by supporting the 2024 Filipino-American Agenda and by passing legislation that benefits Hawai’i Filipinos.

The Agenda builds upon Filipinos’ rich history of collective action, amplifies the concerns and demands of Filipino communities in the U.S., and fosters unity and empowerment to hold public officials responsible for meeting the needs of the Filipino community even after elections.

I previously wrote an article in the Hawaii Filipino Chronicle about the FAA; it can be found here: https://thefilipinochronicle.com/backup/2024/04/07/the-filipino-american-agenda-in-2024/.

Local politicians in Hawai’i can pass laws increasing funds for care homes and healthcare programs directly affecting most Filipinos in the state and can advocate for better pay.

Healthcare remains an important issue for many Filipino voters. Apart from the reasons mentioned above, a high percentage of Filipinos are employed in caregiving services, a phenomenon in many parts of the world but has a particular resonance in Hawai’i.

Nearly one-third of employed registered nurses or RNs and nearly half of employed licensed practical nurses or LPNs in Hawai’i are Filipinos.

Although data is not available, it is widely believed that Filipinos also dominate the nurse assistant profession in the state.

Other low-income jobs in the healthcare industry employing Filipinos include nursing, psychiatric aides, and home health aides, physical/occupational therapy aides, medical transcriptionists, dental assistants, pharmacy aides, phlebotomists, medical assistants, massage therapists, and other healthcare support workers.

If a Filipino is not employed as a caregiver or domestic worker, the Filipino is the employer, as 95% of care homeowners or operators in Hawai’i are Filipinos.

As for Filipinos voting in the upcoming elections, I sincerely hope that they, individually and as a community, will support candidates who will truly represent the issues and concerns of Hawai’i Filipinos and champion measures that address their health issues.

ARCELITA IMASA, MD is a practicing family physician serving largely Filipino patient population in Kalihi, Oahu, and Hilo, Big Island. She invites everyone to join her at the Walk With A Doc event every 2nd and 4th Saturday of the month from 6:30am to 7:30am at Kalihi-Waena Neighborhood Park in Kalihi.