Kūkulu Ola Hou: to rebuild, reinstate, and revitalize the spirit of health

In a new book chapter published by UNESCO to support the launch of the International Decade of Indigenous Languages (2022–2032), Kealoha Fox examines culture and language at the source of resiliency. Her Indigenous health and wellbeing research weaves ancient and contemporary practices of knowledge, storage systems, and traditional application by Kānaka ʻŌiwi through a taxonomy of seeking balance in Kūkulu Ola Hou.


Uncle Howard Kahale Pe‘a handed me plants from his garden to help me prepare for his next exchange day at the Keaukaha-Pana‘ewa Farmers Market. A sure sign that teaching had commenced and the lesson of the day was already underway. That day’s cultural anchor grounding my ha‘awina (assignment) would be rooted in plants and the structure of their complex root system that he cared for on his farm. Born, raised, and rejoining our ancestral realm from Hilo on Hawai‘i Island, Uncle Howard was a guiding elder to me and my family for many years. This is the methodology of intergenerational teaching in our community; by loea (wise persons) like Uncle Howard applying culture and language through messages with deep meaning to haumana (student learner) like me.

Now that I grieve his passing, I know the pricelessness of those words only grows to full maturity long after he planted them. Given the urgency to protect knowledge keepers and their ancient wisdom, sustained effort to preserve, revitalize and promote Indigenous languages means we must take urgent steps to capture and apply culturally specific healing practices to remedy the greatest ailments facing our society. The elders in our community gave me this responsibility and sense of purpose when I was eighteen years old and will always be central to my life’s work. Fifteen years ago, kūpuna (elders) and loea in my home islands of Hawaiʻi called upon me to investigate the historical and cultural context of what ails us, so that we can design treatments that apply our ancient medicine for greater ola: Health, wellbeing, recovery, life, and salvation.

Thus, Kūkulu Ola Hou was designed more than a dozen years ago and was fully birthed during the pandemic. It has been more than a decade of my own healing, learning, knowledge acquisition, research, and writing to rebuild, reinstate, and revitalize the life and spirit of health. Grounding me and this research has been an ʻōlelo no’eau (traditional Hawaiian proverb) which encourages me as a young Native Hawaiian scientist and practitioner of health. It’s the calling of our ancestors to return to the taproot:

E hoʻi hou i ka mole.

A message like this — being a rootlet of the ancient Kānaka ʻŌiwi (Native Hawaiian) healing system — spiritually stimulates me to look to our culture if we are to fully heal our peoples. I will miss Uncle Howard greatly and to honor him, I will continue my responsibility to reconnect the knowledge of our ancestors at the source of our enduring resiliency.


Indigenous peoples experience a high degree of socio-economic marginalization and are at disproportionate risk in public health emergencies, owing to factors such as the lack of access to effective monitoring and early-warning systems, and adequate health and social services. For example, in Hawai‘i, modern healthcare systems have failed Native Hawaiian women and girls as illustrated through the following data:

  • Highest rates of infant mortality,
  • Highest rates of self-harm reported among high school students,
  • High obesity rates, especially among women aged 45–54,
  • Double the rates of cancer,
  • Make-up almost half of the incarcerated population,
  • 1 in 10 Native Hawaiian kūpuna have depressive disorder.

In fact, senior United Nations officials have reported that Indigenous peoples have been disproportionately affected by COVID-19. Tragically in Hawai‘i, to date, Native Hawaiians and Pacific Islanders have made up 20% and 7% of COVID-19 cases and 18% and 16% of related deaths. Despite these losses during the pandemic, Indigenous communities demonstrate innovation and strength.

The IDIL Chapter and Research

In the framework of the International Decade of Indigenous Languages 2022–2032 (IDIL), a multilingual collection of articles has been released, with the aim of assessing the status of Indigenous languages in research. Materialized in a new book, the State-of-the-Art of Indigenous Languages In Research was published in May 2022 to help launch the IDIL worldwide.

Since I was working on publishing the findings from Kūkulu Ola Hou during the pandemic, I was encouraged to respond to the global call for research to promote worldwide knowledge on Indigenous languages, especially in scientific and academic fields. There were 300 different articles submitted from 63 different countries and I am honored to have my work celebrated as one of the 48 articles by researchers and analytical pieces by peer reviewers from 30 countries.

Chapters in the book are organized into seven sectors that highlight the urgent need for documentation, description, and revitalization efforts throughout the IDIL:

(i) Sustainable development;

(ii) Linguistic diversity and cultural heritage;

(iii) Social inclusion and gender equality;

(iv) Knowledge, education, and science;

(v) Human rights;

(vi) Technology,

(vii) Humanitarian Affairs

Links to the publication “State of the art of Indigenous Languages in Research” and virtual launch event on May 20, 2022.

This Indigenous research study examined customs, rituals, and practices relating to Hawaiian maʻi — Kānaka ʻŌiwi perceptions of imbalance, illness, sickness, and disease — and produced the first comprehensive taxonomy to accelerate the application of Indigenous wisdom and traditional medicine as necessary solutions for greater health and wellbeing.

The concepts and identification of “imbalance” were explored through Ka ʻOihana Mauli Ola, referring to the Traditional Hawaiian Health Structure to which medicinal practitioners were experts of many healing arts and functions. In Native Hawaiian society, ancestral practices of health traditionally belonged within this detailed and regulated system of care management for the people and environment. This research categorized themes in 24 specific traditional Hawaiian practices associated with Hawaiian medicinal specialists and ola:

  1. ʻāina: land-based practices
  2. ʻai pono: balanced meal
  3. ʻai kūpele: therapeutic nutrition
  4. hāhā: diagnostician and pathology
  5. hakihaki ʻiwi: chiropractic
  6. hoʻohāpai keiki: conception of pregnancy
  7. hoʻomaʻemaʻe: cleansing
  8. hoʻonaʻauao: education and knowledge creation
  9. hoʻoponopono: to set to pono, resolution
  10. hula: dance
  11. kai: sea water
  12. kāula: seer
  13. ku‘i a lua: warrior art form
  14. kilo: expert observation
  15. lāʻau lapaʻau: medicinal plants and herbs
  16. lāʻau kāhea: calling for instant healing
  17. lau hala: pandanus leaf used for plaiting
  18. lawaiʻa: fishing
  19. lomilomi: physiotherapy, massage
  20. mahi ʻai: agriculturalist
  21. oli: chanting
  22. pōhaku: sacred stones possessing mana
  23. pūloʻuloʻu: steam bath for illness
  24. wai: fresh water

These healing forms are for individual, familial, communal, and environmental purposes. Healing is directed through physical, spiritual, emotional and ecological pathways away from imbalance, illness, sickness, or disease, toward recovery, wellbeing, and salvation.

So, what are Hawaiian ma‘i?

Misfortune is but one-way Hawaiian maʻi is defined in the literature to varying degrees of culture-bound terminology, for example illness, sick, unhealthy, pain, discomfort, ailment, disease or simply an imbalance. Maʻi shape biomedical classification of illness by Native Hawaiians from our own Ka ‘Oihana Mauli Ola and hold the stories of loss, trauma, and population collapse experienced since Western intrusion to our islands. They are recounted in this published chapter from an ancient nosology and updated using Native intelligence within our traditional Hawaiian health structure relying on Indigenous language foundations.

Approach and Key Findings

A Hawaiian epistemological framework was developed to conduct this mixed method study across eight arms before interpreting both ancient and contemporary knowledge and beliefs. This research took a keen approach to both building the theoretical orientation and translating research into practice.

Traditional and contemporary Kānaka ʻŌiwi perceptions of imbalance as illness and disease apprised this work utilizing one hundred thousand (100,000) pages from ‘ōlelo Hawai‘i (Hawaiian language) and English sources. Further, I was able to access 11 archives from the 18th to 21st centuries to construct this Native Hawaiian medical inventory in this project from the language and histories of many generations. The study is informed by primary and secondary sources like nūpepa (Hawaiian language newspapers), oral histories, literature, archives and interview narratives from 50 living experts and practitioners of traditional Hawaiian medicine. More than 7,000 terms accounting for various maʻi in Hawai‘i and the Pacific were identified, further evidencing the ways in which our kupuna connected discord in the individual, family, community, society, and environment with maʻi.

Study significance indicates the first comprehensive medical inventory documenting knowledge of Hawaiian maʻi across time periods and traditional practices, systematically referencing more than 7,000 Hawaiian maʻi terms and dozens of unique disease classes and categories.

Key findings presented in this chapter speak to the contextual links for reclaiming Native intelligence to address contemporary health disparities; content of this lexicon of medical, psychiatric and health terms; and the translational research process which reinforces the role of culturally and linguistically appropriate medical services for Native Hawaiians and resurgence of health through our own worldview.

Information, Collaboration, and Policy Transformation

The Institute for Climate and Peace values service honoring culture and proximity. Our work elevates Indigenous practices, generational knowledge, and ancient wisdom. Culturally specific healing practices are critical to rebuild, reinstate, and revitalize as the world continues year three of a global pandemic.

Opportunities to tailor Native Hawaiian culturally specific data on diseases, symptoms, reasons for encounter, internal factors that influence health status and external causes of conditions are numerous. This study fills a gap in research and suggests quality standards in the role for maʻi through culturally and linguistically appropriate solutions for Native Hawaiians.

All World Health Organization member countries, including the US, are required by international treaty to collect and report health statistics to the WHO using the ICD as a framework. Thus, Kūkulu Ola Hou is a part of Hawaiʻi’s constitutional responsibilities for health development and maintenance for its people (HRS §226–20). International progress of Kānaka ʻŌiwi demands global cooperation and alignment with issues unique to our right for free participation in the cultural health of our community.

The creation and implementation of our own medical inventory and classification structure protects the material and moral conditions of our lāhui (society, populace). Theoretically supported within the spirit of the WHO Traditional Medicine Strategy 2014–2023, we have an opportunity to create an emic classification system that values traditional medicine and incorporates etic taxonomy and classification where applicable and necessary.

Indigenous Futures

As described in this publication, to rebuild, reinstate, and revitalize the life and spirit of health through Indigenous wisdom and language is an urgent need. Applying this wisdom has the opportunity to heal individuals, families, communities and the environment through physical, spiritual, emotional and ecological pathways.

When Indigenous peoples are able to access necessary healthcare and medical services, they can face bias and discrimination in systems that lack proactive policies or action plans that strengthen the role traditional medicine plays in keeping populations healthy. Kūkulu Ola Hou promotes integrating medicine for Indigenous people, and healing by Indigenous people. It reconnects the ancestral conditions with unique cultural arts and specialty knowledge systems like those of Native Hawaiians. While being ancient stewards of planetary health, many Indigenous communities suffer the burden of disease with opportunities for wellbeing research weaves ancient and contemporary practices of knowledge, storage systems, and traditional application by Kānaka ʻŌiwi through a taxonomy of seeking balance in Kūkulu Ola Hou.

In summary, this study accomplishes the following:

  • provides the IDIL 2022–2032 with an opportunity to amplify cultural transformation and language integration into health care, medical training, public health intervention, and traditional protocols on the root causes of ma‘i among indigenous peoples in the Pacific.
  • presents considerations for developing strategies, policies, and priorities for understanding indigenous conceptualizations of health or sickness as a fundamental human right for all indigenous peoples.
  • finds that to achieve greater wellbeing for indigenous peoples, clinical research should advocate for empirical investigation that addresses health disparities based on culturally causal pathways such as spiritual, social, ecological, environmental, and behavioral concepts.

In the spirit of our ancestors: Is there a wise saying or proverb in your language that connects you to your culture?

Feel welcome to share it with us, to speak them aloud wherever you are in the world right now as we celebrate the International Decade of Indigenous Languages and walk the path of the ancient ones and our wise leaders who have gone before us.

. . .

Kealoha Fox is a senior advisor with the Institute for Climate and Peace and is an Obama Leader: Asia Pacific with the Obama Foundation. A graduate of the John A. Burns School of Medicine, she is the recipient of more than 50 awards and distinctions, including being named one of the 20 leaders to follow for the next 20 years in 2022 by Hawaii Business Magazine and a 2022 candidate for the prestigious Pritzker Environmental Genius Award. As a Native Hawaiian woman, Kealoha has been deeply and purposefully trained by esteemed community elders in traditional and ancient Native Hawaiian practices and protocol such as ho‘oponopono, hāhā, and lā‘au lapa‘au.

. . .


“Community Leader Howard Pe‘a: Talented Family Man, Haku Ho‘oponopono’’ by Puanani Woo and Pualani Louis. Featured on Ke Ola Magazine. 2019.

“Indigenous Peoples Have Been Disproportionately Affected by COVID-19 — Senior United Nations Official Tells Human Rights Council” by United Nations Human Rights Office of The High Commissioner, 28 Sept. 2021

COVID-19 Updates by The Native Hawaiian & Pacific Islander Hawaiʻi COVID-19 Response Team

“Indigenous communities demonstrate innovation and strength despite unequal losses during COVID-19” by Victoria M. O’Keefe and Melissa L. Walls. Featured on The Brookings Institution website, 2 April 2021

Information on International Decade of Indigenous Languages 2022–2032 by the United Nations

“State-of-the-Art of Indigenous Languages In Research” by The United Nations Educational, Scientific and Cultural Organization (UNESCO), 20 May 2022

State of the Art of Indigenous Languages in Research: a collection of selected research papers by The United Nations Educational, Scientific and Cultural Organization (UNESCO)

State of the Art of Indigenous Languages in Research virtual launch event by The United Nations Educational, Scientific and Cultural Organization (UNESCO), 20 May 2022

WHO traditional medicine strategy: 2014–2023 by the World Health Organization

Photo Credit: Courtesy of the Institute for Climate and Peace, All Rights Reserved.