Comparing the Native Hawaiian Health Care Improvement Act and the Reauthorization Act: An Intersectional Feminist Policy Analysis

The historical trauma and loss of life resulting from colonial and oppressive healthcare practices have cultivated deep mistrust among Native Hawaiians toward Western medicine. This mistrust continues to contribute to stark health disparities, with Native Hawaiians experiencing the shortest life expectancy and highest mortality rates in Hawai‘i. Legislative efforts such as the Native Hawaiian Health Care Act of 1988 and its later iteration, the Native Hawaiian Health Care Improvement Act, were designed to address these disparities. This study conducts a critical feminist policy analysis of the Native Hawaiian Healthcare Improvement Act, with particular attention to the implications of its failed 2005 Reauthorization. The analysis uses the Intersectional Feminist Policy Analysis Framework to assess how gender and structural inequities are acknowledged—or overlooked—within the policy's development and implementation. This study was guided by two research questions: 1) How do U.S. government policies regarding the Native Hawaiian Health Care Improvement Act and its 2005 Reauthorization address gender and gendered issues? 2) How do these policies capture the root causes of health disparities among Native Hawaiian women?

This study employed the Intersectional Feminist Policy Analysis Framework to critically examine the Native Hawaiian Health Care Improvement Act and its failed 2005 Reauthorization. This framework was selected for its integration of intersectionality, qualitative inquiry, and attention to how policies differentially impact marginalized communities. Following Ferritto’s (2023) application of this model, I conducted a two-step analysis. First, I reviewed the historical policy context to situate the legislation within Hawai‘i’s socio-political landscape. Second, a policy content analysis was performed, using a scoring system (0–3) to evaluate how effectively each topic addressed gender and intersectional concerns.

Content analysis of the Native Hawaiian Health Care Improvement Act and its failed 2005 Reauthorization revealed partial recognition of intersectional identities, with limited attention to systemic oppressions such as colonialism and gendered racism. Both policies largely assumed gender neutrality, failing to address identity-based discrimination or the lived realities of Native Hawaiian women. Symbolic reforms were prioritized over material change, with insufficient accountability mechanisms and transparency. Although the 2005 Reauthorization expanded cultural references and health equity provisions, it still lacked robust engagement with issues like incarceration and economic inequality. Power dynamics remained concentrated, with limited representation and empowerment of Native Hawaiian women in policymaking.

This study critically examined the Native Hawaiian Health Care Improvement Act and its failed 2005 Reauthorization through an intersectional feminist lens. Findings reveal that while both policies acknowledge historical context and Native Hawaiian cultural identity, they fail to adequately address the specific health needs and gendered disparities faced by Native Hawaiian women. The 2005 Reauthorization offered more culturally grounded language and programming, but its failure to pass underscores systemic resistance to accountability and equity. Current policy remains limited in its scope, transparency, and applicability. These findings underscore the urgent need for policy reforms that center intersectionality, acknowledge structural oppression, and prioritize culturally responsive healthcare. Future research must address the complexities of Native Hawaiian women’s experiences to transform health policy and promote equity.