hula class
Papakolea, Oʻahu with Kumu hula Hina Kamauʻu. (Photo credit: Nicosello)

A groundbreaking study on the prevalence and popularity of the art of hula in Hawaiʻi has found a quarter of the state’s residents have danced or still do. And nearly half of those who identified as Native Hawaiian have danced hula. According to researchers, these key findings from this collaborative new study by the University of Hawaiʻi at Mānoa Office of Public Health Studies (OPHS) presents a valuable opportunity to innovatively promote public health within mutli-cultural communities in the islands.

Hula, which is seen by many as an iconic representation of Hawaiʻi will be celebrated globally this week at the annual Merrie Monarch Festival in Hilo. Some forms of dancing require physical activity demands that can be as vigorous as a basketball game. Kumu hula and scientists agree hula restores and creates health from a multi-level approach involving physical, mental, emotional and spiritual health.

“It is a remarkable opportunity to have a quarter of our state population say they engage in a culturally-relevant physical activity,” said Tetine Sentell, interim dean of the Thompson School of Social Work & Public Health and study lead. “Overall, strong engagement with hula was seen across gender, age, education, income and health status, especially among Native Hawaiians and Pacific Islanders. Notably, 65% of Native Hawaiian women had participated in hula over their lifetime, as had 31% of Native Hawaiian men.”

Quantifying hula engagement for public health

keiki hula dancers

Questions on lifetime experiences in hula were added to the Hawaiʻi-specific Behavioral Risk Factor Surveillance System (BRFSS) in 2018 and 2019. The BRFSS is a national gold standard surveillance tool providing a picture of public health in the state. Researchers analyzed results from more than 13,500 respondents to quantify hula engagement across important public health factors. This study was a partnership with OPHS, the Hawaiʻi State Department of Health (DOH) and the Department of Native Hawaiian Health (DNHH) at UH Mānoa’s John A. Burns School of Medicine.

“This work is exciting for health promotion in our state especially from a strength-based approach to build health equity,” said Lance Ching, a DOH collaborator. “These findings indicate that hula is enjoyed among people in a wide array of life circumstances, making it a promising area for community health promotion to support wellness and prevent chronic disease.”

Given that only 24% of adults in Hawaiʻi meet physical activity guidelines, and rates of physical activity among Native Hawaiians and other Pacific Islanders are lower than the state average, scientists recognize the need for culturally-relevant approaches to public health programming, research and practice.

Opportunities to promote an accessible, cultural activity

“There are real opportunities here,” said Mele Look, of DNNH and a study collaborator. “We can promote a popular, accessible, health-creating activity that celebrates the best of our island home and Hawaiian culture.” She also noted that health insurers like AlohaCare and UHA are taking note and discussing ways to help members participate in hula classes.

“This work is also important because typically state-wide public health surveillance systems do not measure culturally-relevant activities, limiting key knowledge for research, policy and practice,” said Sentell. “Hula is so important to our communities. We are pleased to have hula included in this state-level data along with key health indicators, like diabetes and heart disease rates. We can see relationships and make plans from this work to improve public health for all.”

Findings will be presented at a major upcoming international public health conference in Montreal, the International Union for Health Promotion and Education. Other study co-authors are from OPHS (Yan Yan Wu, Tonya Lowery St. John, Riko Lee and Catherine Pirkle) and DNNH (Kapuaola Gellert).