Healthcare Access Barriers for Native Hawaiian and Pacific Islander (NHPI) Populations

By Darryl Mitteldorf, LCSW

Native Hawaiian and Pacific Islander (NHPI) communities face a range of obstacles when trying to get health care. These barriers are often rooted in systemic issues, geographic challenges, financial constraints, cultural factors, and other structural problems​

kff.org. Below is an overview of these key barriers, explained in clear terms:

Systemic Issues

• Discrimination and Bias: NHPI individuals have reported experiences of racism or bias in medical settings. Some have felt that doctors or nurses make assumptions about them, blame them unfairly for health problems, or dismiss their concerns and traditions because of their NHPI identity or appearance​kff.org. Such discrimination and marginalization contribute to mistrust and can discourage people from seeking care, leading to worse health outcomes​kff.org​pmc.ncbi.nlm.nih.gov. In other words, past negative experiences or fear of being treated poorly can make NHPI patients avoid going to the doctor, even when they need to.
• Lack of Culturally Competent Care: The health system often fails to provide care that is sensitive to NHPI languages and cultures​kff.org. Many providers are not well-trained in NHPI cultural norms or might not understand patients’ values and beliefs about health. This lack of cultural understanding can lead to miscommunication. For example, if a patient’s approach to healing or expressing pain differs from what a provider expects, it might result in the provider not fully addressing the patient’s needs​pmc.ncbi.nlm.nih.gov. Overall, when the healthcare system doesn’t accommodate different cultural perspectives, NHPI patients may feel alienated or misunderstood.

Geographic Limitations

Many NHPI people live in isolated or rural areas (such as small Pacific Islands or remote parts of Hawaiʻi), where health services are limited. These geographic challenges make accessing care difficult. For instance, on less populated islands there may be no specialist doctors or advanced treatment facilities​

kff.org. Patients often have to travel long distances or even fly to larger islands or the U.S. mainland for surgeries, cancer treatment, or other specialized care​

kff.org. This travel is not only costly but can also delay timely treatment. In emergencies, the time it takes to reach appropriate care can be life-threatening. Additionally, remote areas might have fewer clinics and healthcare professionals (“limited system capacity”), meaning longer wait times and less preventive care available locally​

kff.org. All these factors create a physical barrier to regular and prompt healthcare for NHPI communities.

Financial Challenges

Financial difficulties are a major barrier that prevents many NHPI individuals from getting care. On average, NHPI people have higher uninsured rates and lower incomes compared to some other groups, which makes paying for medical care harder​

kff.org. In the U.S., having no health insurance or inadequate insurance means doctor visits, medications, and procedures can be very expensive out-of-pocket. About one in five NHPI adults reports not seeing a doctor when needed due to worries about cost​

kff.org. Even routine check-ups are skipped by many because of affordability issues (roughly a quarter of NHPI adults went without a routine check-up in a recent year)​

kff.org. Studies show that around 20% of NHPI adults experience financial barriers to care – for example, they cannot afford the care or insurance – and this is linked to poorer health status​

pubmed.ncbi.nlm.nih.gov. Furthermore, while programs like Medicaid help low-income people, certain NHPI subgroups have fallen through the cracks. (For example, Pacific Islanders from nations with Compacts of Free Association were long ineligible for Medicaid coverage in the U.S., leaving many without any health benefits until policy changes in recent years​

pmc.ncbi.nlm.nih.gov.) In short, the high cost of healthcare and gaps in insurance coverage mean many NHPI families delay or forgo medical care because they simply cannot afford it.

Cultural Barriers

Cultural factors can also impede access to healthcare for NHPI populations. One significant issue is language. A portion of NHPI individuals, especially elders or those who recently moved from Pacific Island nations, are not fully fluent in English. About 8% of NHPI adults in the U.S. speak English “less than very well,” but this rate is much higher in some communities (for example, roughly one-third of Marshallese adults have limited English proficiency)​

kff.org. Limited English proficiency can make it hard to communicate with doctors, understand medical instructions, or navigate the healthcare system. Language barriers are often made worse by a lack of interpreters for the diverse Pacific Island languages. In many cases, family members (including children) have to step in as informal interpreters because professional medical interpreters who speak the right language or dialect are not available​

kff.org. This situation is not ideal – important information can get lost or misunderstood, and patients might not feel comfortable discussing private health issues through a family member.

Beyond language, cultural differences in communication and health beliefs play a role. NHPI cultures place a strong emphasis on family and respect, and patients may feel uncomfortable unless providers show respect for their traditions and involve family in care decisions. If a doctor is very businesslike or doesn’t take time to build rapport, NHPI patients might feel the care is impersonal. There can also be differing beliefs about illness and treatment. For example, some NHPI individuals may initially turn to home remedies or traditional healing practices and view them as part of their care – if doctors ignore or disrespect these practices, patients may lose trust. Conversely, when healthcare providers show respect for a patient’s cultural background and preferences, it leads to much better experiences​

kff.org. Many NHPI patients have reported positive outcomes when providers honor their traditions and listen, whereas dismissive attitudes from providers (such as ignoring cultural practices or being insensitive) are a barrier that makes patients less likely to seek care in the future​

kff.org.

Additionally, stigma surrounding certain health topics can be a cultural barrier. In some NHPI communities, there is a cultural expectation of strength and privacy, which means people might hesitate to discuss personal or mental health issues openly​

kff.org. Conditions like depression or anxiety, or even serious illnesses, might carry stigma or a sense of shame. As a result, individuals may avoid seeking mental health counseling or delay treating illnesses because they fear community judgment or believe they should handle problems on their own. This stigma, coupled with a shortage of providers who understand NHPI cultural contexts for issues like mental health, can lead to underutilization of important health services​

kff.org.

Other Structural Obstacles

Beyond the above categories, there are broader structural challenges that affect NHPI healthcare access:

• Data Invisibility and Policy Neglect: NHPI populations are relatively small in number, and historically their health data often gets lumped together with Asian American data or left out entirely. This practice can mask the true extent of health problems in NHPI communities​pmc.ncbi.nlm.nih.gov. For instance, if Pacific Islanders’ outcomes are averaged in with a larger Asian population, it might look like everything is fine (due to the “model minority” myth), even if NHPIs are actually struggling. When health disparities are hidden in data, policymakers and healthcare funders may overlook NHPI needs, resulting in fewer resources and programs targeted to them. In short, the lack of disaggregated (separate) data is a structural barrier because it makes it harder to recognize and address NHPI health inequities​pmc.ncbi.nlm.nih.gov.
• Underrepresentation in the Healthcare Workforce: There are very few NHPI doctors, nurses, and other healthcare professionals. This matters because having providers who share your background can improve communication and trust. Research shows that when patients see a provider of the same race or ethnicity, they often report higher satisfaction and better quality of care​pmc.ncbi.nlm.nih.gov. Culturally concordant providers are more likely to understand subtle cultural cues, speak the language or dialect, and build a comfortable rapport. The shortage of NHPI healthcare workers means NHPI patients rarely get this kind of culturally attuned care. It’s a structural issue – whether due to barriers in the educational pipeline or hiring – that there are not enough NHPI professionals in health fields. Increasing their presence is frequently cited as a way to improve care for NHPI communities (because it addresses language gaps, builds trust, and reduces cultural misunderstandings)​pmc.ncbi.nlm.nih.gov.
• Historical and Legal Barriers: The unique historical and political circumstances of Pacific Islander communities have also created access issues. For example, citizens of certain Pacific Islands (such as the Marshall Islands, Micronesia, and Palau) can live in the United States under treaties but for decades were not eligible for many federal health benefits. After 1996, these migrants were excluded from Medicaid, the public health insurance for low-income people​pmc.ncbi.nlm.nih.gov. This exclusion left many law-abiding Pacific Islander families without any affordable insurance or care, clearly a structural barrier beyond individual control. Although this policy was finally reversed in 2020, the legacy of that gap is still felt – many older adults went uninsured for years, and even now there may be confusion or delays in enrollment. More broadly, historical events like the colonization of Hawaiʻi or nuclear testing in the Pacific have fostered mistrust in government health programs. Such historical trauma can make NHPI communities wary of medical institutions, which is an underlying structural challenge to building trust and ensuring consistent care.

Sources: The information above is drawn from research and reports focusing on NHPI health. For example, Kaiser Family Foundation analyses highlight issues like geographic isolation, language access, and economic inequities in NHPI health care​

kff.org​

kff.org. Peer-reviewed studies have documented higher rates of cost-related care avoidance in NHPI groups​

kff.organd the negative impact of discrimination and cultural mismatches in care​

kff.org​

pmc.ncbi.nlm.nih.gov. Efforts by researchers also note the importance of disaggregating NHPI data and increasing NHPI representation among providers to address these disparities​

pmc.ncbi.nlm.nih.gov​

pmc.ncbi.nlm.nih.gov. All of these barriers—systemic, geographic, financial, cultural, and structural—interact to affect the health of NHPI populations. Recognizing and addressing them is crucial for improving healthcare access and outcomes in these communities.