Pilinahā: An Indigenous Framework for Health

Abstract

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.

Wellbeing of Indigenous Peoples in Canada, Aotearoa (New Zealand) and the United States: A Systematic Review

“…Of the included studies, 41 [ 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 ] papers related to the wellbeing of Indigenous peoples in the United States. The United States comprises of different Indigenous groups (American Indians, Alaska Natives and Native Hawaiians) [ 2 , 120 ], with unique cultures and languages.…”

“…The holistic nature of wellbeing was reported by ten papers [ 87 , 94 , 95 , 99 , 101 , 107 , 108 , 110 , 112 , 117 ]. Wellbeing among the Indigenous peoples in the United States is a holistic concept placing value on the integration of physical, mental, emotional and spiritual health [ 87 , 94 , 95 , 101 , 108 , 110 , 112 , 117 ], with some explicitly locating the concept of wellbeing within the conceptualisation of the Medicine Wheel that contain the quadrants: mental, physical, emotional and spiritual [ 87 , 95 , 99 ].…”

“…In order to realise “ full integration ”, ten papers reported the importance of finding balance [ 87 , 94 , 101 , 107 , 110 , 117 ], which could be maintained or achieved through strong spiritual and relational connections [ 95 , 101 , 107 , 112 , 117 ], and maintaining a sense of cultural identity [ 107 ].…”

Towards attainment of Indigenous health through empowerment: resetting health systems, services and provider approaches

“…Kõkua Kalihi Valley began as a health centre initiated to promote healing and reconciliation through medical and dental services. Under community direction and a cultural approach to health, the Pilinahā Framework for Health, which relates the connections vital for health, has been employed throughout the entire organisation, 19 and Kõkua Kalihi Valley expanded to being a full primary healthcare service which provides social supports and innovative environmental and physical activity promotion initiatives. 20 …”

Understanding the Role of Mental Health Clubhouses in Promoting Wellness and Health Equity Using Pilinahā—An Indigenous Framework for Health

“…One Ko'olau Clubhouse member had the idea of creating a Member Stories book, which would include content from all the Clubhouses and could be used for advocacy at the Hawai'i State Legislature. While sorting photographs and excerpts for the book, it became clear that (a) there were cross-cutting themes among the Clubhouses even though the prompts were different at each site, and (b) these themes aligned closely with Pilinah a, a Native Hawaiian framework for health (Odom, Jackson, Derauf, Inada, & Aoki, 2019).…”