One of the most difficult aspects of the COVID-19 pandemic has been the prolonged period of social distancing. From a public health perspective, social distancing makes sense. But for individuals and families in tight-knit communities, social distancing goes against many of the long-standing cultural values and practices that have helped them survive.
Small ethnic communities in the U.S. such as Pacific Islanders often rely on their strong community ties to stay connected to their ancestral roots and to help each other navigate unfamiliar U.S. processes like accessing health care and enrolling children in school. These community networks also help nurture and empower Pacific Islanders alienated by generations of colonization and oppressed by systemic racism.
Yet the very thing that has helped these communities thrive has also been a contributing factor to the high COVID-19 hospitalization rates among Pacific Islanders. States with the highest Pacific Islander populations in the U.S. such as Hawai’i, Washington, Oregon, Utah, and Arkansas are reporting hospitalization rates up to 10 times that of white people. In Los Angeles county, Pacific Islanders have the highest infection rate of any racial or ethnic group.
Pacific Islanders include people with ancestry from the U.S. territories of American Samoa, Guam, and the Commonwealth of the Northern Mariana Islands; Compact of Free Association (“COFA”) migrants from the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau; and other individuals from nations in the Pacific including Fiji and the Kingdom of Tonga.
Health insurance coverage for Pacific Islanders varies considerably due to the complexity of the relationships between each Pacific Island territory, compact nation, or sovereign state and the U.S. Some Pacific Islander groups such as COFA migrants are excluded from Medicaid because of their immigration status and are more likely to be uninsured or underinsured due to their disproportionate employment in low-wage industries.
The pandemic has only exacerbated existing health inequities within the Pacific Islander community. Infectious diseases have decimated Pacific Islander populations in the past, and some communities had little choice but to travel to the U.S. to escape the lingering devastation of nuclear testing in the 1940s and 1950s in the Pacific region by the U.S. military. In addition, many Pacific Islanders have higher rates of chronic conditions such as heart and lung disease, asthma and diabetes.
In addition to reduced access to health care, higher levels of poverty, and higher rates of underlying health conditions, many Pacific Islanders live in multigenerational households that make it more difficult to physically distance or quarantine. Further, about one in four Pacific Islanders are frontline essential workers in the military, security and service-related industries and are at increased exposure to COVID-19. According to a recent survey, 82% of the Pacific Islanders in Arkansas live in a household with at least one essential worker.
Yet, even with these challenges, the community ties that may have contributed to the rapid spread of COVID-19 infections among Pacific Islanders are also driving innovation and culturally tailored education efforts to stop the spread of the disease. National initiatives such as the Pacific Islander COVID-19 Response Team, comprised of a group of researchers, health experts, community leaders and advocates, created an infrastructure for informing and supporting Pacific Islander families and communities about COVID-19.
Pacific Islander community leaders are also working with public health agencies to develop culturally tailored infographics and messaging to educate Native Hawaiians and Pacific Islanders about COVID-19 prevention, testing, and treatment. For many Pacific Islanders, community is what will save them.