This article speaks to the abundance and wisdom of indigenous community members in Kalihi, an urban neighborhood in Honolulu, Hawaii. Its findings result from community members sharing their stories of health, health care, and healing. These stories evolved into a distinct framework for health—Pilinahā or the Four Connections Framework. Pilinahā addresses 4 vital connections that people typically seek to feel whole and healthy in their lives: connections to place, community, past and future, and one's better self. This article describes the origins, intent, key concepts, and implementation of this framework. By doing so, the authors hope to add to the growing body of work on community and indigenous well-being, further the dialogue with other indigenous communities, and collectively foster a more meaningful and effective health system for all.
Background Evidence-Based Medicine. Physicians who properly practise EBM use both individual clinical expertise and the best available external evidence-neither one to the exclusion of the other. This remains the modality of EBM however and, unfortunately, is rarely practised. EvidenceBased Public Health. Similar to EBM, EBPH too is often misunderstood to mean a direct application of the evidence. Such a dogmatic interpretation of this evidence can be seen as a manifestation of representationalism, the philosophic stance that some ways of looking at the world give a more privileged and unmediated view of reality than others. Methods and resultsThis commentary provides a critical perspective on the current use and misuse of EBPH. As EBM has been in usage longer than EBPH, we start with comments on EBM. Conclusion A reconsideration of EBPH would admit that values cannot be expunged from our work; rather, they need to play a foundational role. We must draw upon other forms of knowing, such as the arts, in order to practice medicine and public health with attention to transcendent concerns such as morality and social justice.
We read with great interest the recent studies in Pediatrics on missed opportunities for childhood immunization. Given the current national debate on ways to control health care costs and the recent proposals for federal procurement of all vaccine supplies, it is encouraging and illuminating to know that significant increases in immunization rates might be achieved without tremendous additional expense. One of the major limitations of these studies, clearly acknowledged by the authors of the first but not the second study, was the inability to assess the role of immunization record availability in missed opportunities. Our experience leads us to agree that lack of immunization records contribute to missed opportunities for immunization far more often than the 2% of visits suggested by the first study.
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