Hawaiian Health

Healing in Hawaiian society before Western medicine

A 2016 history in the Hawaii Journal of Medicine and Public Health describes David Malo's account of medical treatment as the first written account of traditional healing, and says it links healing to worship of the gods, including Mai-ola, the god of medicine. The same history lists lāʻau lapaʻau (healing medicines), kāhea, lomilomi, hoʻoponopono, pule (prayer) and oli (chant) among the domains of Hawaiian healing.

According to that history, the kahuna lapaʻau specialized in compounding remedies, and other specialties included diagnosis (hāhā), bone setting, care of infants, conception and childbirth, and restoration of the soul. It also says healing temples (heiau hoʻola) existed only in Hawaiʻi among the islands of Polynesia and trained students over a long curriculum. These are historical descriptions drawn from secondary accounts, and the sources reviewed here do not allow the details to be checked independently.

Western medicine and the colonial period

The same history dates the first Western prescription in the islands to 1825, a Board of Health to 1851 and a short-lived medical school to the 1870s. It reports that the population fell to 135,000 by 1820 and 53,900 by 1876, largely because of introduced diseases.

Oneha and colleagues write that Native Hawaiian religious practices were outlawed in 1830 and that in 1905 Native Hawaiian healing practices and healers were forbidden by the government of the territory, with punishments including fines and imprisonment. They describe a revitalization of Native Hawaiian healing in contemporary Hawaiʻi. The paper is a health services study, not a legal history, and details of these restrictions are not assessed here.

The 1985 needs study and the Native Hawaiian health network

The National Library of Medicine records that the Native Hawaiian Health Research Consortium, under ALU LIKE, released the E Ola Mau health needs study in 1985, and says the study identified the importance of culture and traditional healing practices for addressing health issues and increasing wellness in Native Hawaiian communities.

Papa Ola Lōkahi describes itself as a nonprofit founded in 1988 that coordinates and supports Native Hawaiian health. It reports that the effort that followed E Ola Mau led to five Native Hawaiian Health Care Systems, which provide services in their communities and are said to be designed so that Native Hawaiians reach Native Hawaiians. This account comes from the organization itself.

How the label is used

Hawaiian Health is not the name of a single technique. In the sources reviewed, it works as a convenient label for the health beliefs and healing practices of Native Hawaiians (Kānaka ʻŌiwi or Kānaka Maoli), which are practiced alone, alongside conventional care, or inside clinics that serve Native Hawaiian communities. The practices differ by family, island and lineage.

Stanford Medicine's ethnogeriatrics curriculum lists lomilomi (massage), lāʻau lapaʻau (herbal or plant-based healing), lāʻau kāhea (prayer) and hoʻoponopono (conflict resolution) as commonly used practices, and says practitioners may use some or all of them. It also states that these practices involve prayer, a willing patient, and an effort to restore balance or harmony.

Key Hawaiian terms

Kawakami and colleagues define lāʻau lapaʻau as Hawaiian herbal medicine covering the gathering, cultivation, preparation and administration of plant remedies, with pule (prayer) practiced throughout. Oneha and colleagues describe lāʻau lapaʻau and lomilomi as forms of healing with spiritual, psychological and physical components, and say illness (maʻi) is understood as an imbalance, with lōkahi (harmony) central to ola, health and wellbeing.

Papa Ola Lōkahi uses the phrase mauli ola for health and wellbeing, and describes it as including physical, mental, emotional and spiritual dimensions together with connection to ancestors, community, the natural environment, identity, cultural practices and language. Lomilomi and hoʻoponopono have their own entries on this site, and this page mentions them only as part of the wider tradition.

Practitioners and kūpuna councils

Papa Ola Lōkahi describes kūpuna councils as groups of healing and cultural practitioners, with a minimum of three Native Hawaiians proficient in traditional Hawaiian healing practices. Councils recognized by Papa Ola Lōkahi aim to preserve, protect and perpetuate traditional healing, and the organization says they were created to distinguish practitioners of Hawaiian healing traditions from medical clinicians and to complement and integrate into holistic health care.

The councils are described as self-governing in setting their own membership criteria, eligibility for practitioner recognition and governance. The impact report says five councils, each attached to one of the Native Hawaiian Health Care Systems, have been established since 1998, while the council brochure says they were established in 2002. The sources reviewed do not explain the difference.

Healing in community and clinic settings

The Native Hawaiian Health Care Systems are described as providing services through Native Hawaiian health care practitioners and cultural educators, and services may be provided by traditional healers. At Waimānalo Health Center on Oʻahu, a Native Hawaiian healing practitioner worked within primary care, and the center's staff, patients and community members were interviewed about it in 2017 to 2019.

Participants in that study described integration as focused on the whole person, as recalling ancestral knowledge, and as leading to greater disclosure by patients. This page does not describe what happens in a healing session, the preparation of remedies or ceremonial content, which practitioners treat as their own responsibility.

What practitioners and communities describe

In Kawakami and colleagues' interviews with ten Native Hawaiian elders in 2021, participants described growing up with family-based traditional healing, and said they now use Western and Hawaiian approaches together. Many preferred holistic options such as prayer, traditional diet and herbal medicine, and wanted more integration of the two approaches.

Participants in the Waimānalo study described Native Hawaiian healing as an alternative to Western medicine and as central to a decolonizing process. In a different community study, Kelihiholokai and colleagues report that 12 adults from Waimānalo described ʻāina (land) as central to physical, mental, emotional and spiritual health, and caring for the land as a path to healing.

Claims made by organizations

Papa Ola Lōkahi states that interventions using cultural knowledge or practices have improved health outcomes in diabetes, obesity and hypertension, and that benefits of pursuing wellbeing through a Native Hawaiian lens can be measured with modern research standards. The report does not give the studies behind this statement in the section reviewed, so the claim is recorded here as the organization's position rather than a finding.

What kinds of studies exist

No randomized trials or systematic reviews of Native Hawaiian traditional healing were found. A PubMed query combining Native Hawaiian or Hawaiian with traditional healing, lomilomi, lomi lomi and lāʻau lapaʻau returned 139 records on the search date, and the first 18 titles examined were unrelated to these practices or concerned other topics. Searches for trials and systematic reviews on the same subject were also run, and no matching study was identified. This is a limited search, not an exhaustive review.

Oneha and colleagues state that, although native healing practitioners have been incorporated into health centers serving large Native Hawaiian populations, no studies had examined their impact. Their own study used semi-structured interviews with 24 providers, staff, patients and community residents, so it describes experiences and does not measure health outcomes.

Qualitative and community findings

The Waimānalo study and the elder interviews are small. The Waimānalo authors list a small sample, reliance on self-reported experience, possible bias because the healing practitioner conducted some interviews, and limited generalizability beyond one health center. Kawakami and colleagues note ten participants, nine of them women, from three islands, and the possibility that people who were more isolated were missed.

Oneha and colleagues also cite a pilot at an Oʻahu clinic offering Western and Native Hawaiian healing, especially lomilomi, in which 76 percent of patients held the belief that Indigenous and Western treatments used together give the best care. That figure measures a belief reported by patients and not a clinical outcome, and the pilot itself was not opened for this review.

Lomilomi and related massage research

A 2009 narrative review by Posadzki and colleagues in Alternative Therapies in Health and Medicine proposed a concept of massage with movement built on passive movement and gentle massage as used in Lomi Lomi, mainly to enhance relaxation. The authors called for further empirical study. Only the repository abstract was read, and the article does not test Native Hawaiian lomilomi as practiced by Native Hawaiian healers.

Frameworks for wellbeing

Native Hawaiian health frameworks generally treat wellbeing as relational. The Pilinahā framework, developed from community stories gathered in Kalihi, Honolulu, in 2014, names four connections: to place, to community, to past and future, and to a better self. Its authors describe it as a perspectives piece, state that it may not apply to every community, and say that further work is needed on how it addresses spirituality.

Kelihiholokai and colleagues cite the Kūkulu Kumuhana framework, built on six concepts including ʻāina momona (healthy and productive land and people) and pilina (relationships). They draw on it conceptually and did not test it. Their participants described balance and harmony as basic to health, and the authors note limits from a small sample in one community.

Revitalization and the health-system relationship

Oneha and colleagues write that Native Hawaiians may be reluctant to tell providers about the use of traditional healing for fear of judgment or discrimination, and that provider skepticism or bias toward Western medicine can lead to alienation, nonadherence or early ending of services. Kawakami and colleagues report that elders valued providers who took time to know them and respected Hawaiian culture.

What the sources report about harms

The sources reviewed for this page do not report adverse events, herb and drug interactions or contamination concerns for Native Hawaiian traditional healing, and the Stanford curriculum page contains no caution statements. Absence of reports in these sources does not show absence of risk, and the studies reviewed were not designed to detect harms.

One plant used in many Pacific Islander traditions, kava (ʻawa in Hawaiian), has a documented safety profile. The National Center for Complementary and Integrative Health says kava products have been linked to rare liver injury, some serious or fatal, and that kava should not be combined with other sedatives such as alcohol. Papa Ola Lōkahi mentions that kūpuna council members contributed an overview of the traditional and medicinal use of ʻawa to a harm reduction toolkit, but the sources do not describe how healers use it.

Care boundaries and choosing practitioners

The Waimānalo authors state that Native healing practices will not resolve every health problem, and the elders interviewed by Kawakami and colleagues used traditional and Western care together. People with a serious, urgent or worsening condition, or who take prescription medicines, are generally advised to involve a licensed clinician and to tell every provider about any remedies used. This page is not a substitute for medical care.

Recognition of practitioners is described as the work of kūpuna councils, which set their own criteria, and not of a single national standard. The sources reviewed do not describe a uniform training pathway, and this page does not assess any regulation. The Native Hawaiian Health Care Systems and kūpuna councils are the organizations most often named for local referral.