Structural Racism and Micronesians in Hawaii: The COVID-19 Syndemic

By August 2020, non-Hawaiian Pacific Islanders-4% of Hawaii's population-accounted for 30% of the cumulative COVID-19 cases in the state. Micronesians, mostly Chuukese and Marshallese, were the most severely affected. Disproportionate COVID-19 infection in racial or ethnic groups in the US occur because of socioeconomic factors. The COVID-19 pandemic can be thought of as a syndemic-where cases cluster "on a background of social and economic disparity". In this brief report, we describe factors that put Chuukese and Marshallese at increased risk for COVID-19 in Hawaii. We show that Micronesians had increased risk for COVID-19 due to limited employment opportunities, housing insecurity, and underlying comorbid conditions in the context of rescinded federal health insurance and broken government promises. We also highlight the resiliency that many community members demonstrated in preventing new infections and supporting those infected. We conclude that COVID-19 in Hawaii should be understood as a syndemic, where Micronesians were disproportionately affected due to disparities in housing, employment, and health access. Our work supports efforts to continue addressing underlying socioeconomic disparities in creating a more equitable future for our Micronesian community in Hawaii.