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Dispossession and defeat also have psychological, social and c u l t u r al consequences for Native Hawaiians. By a l l major social indices — health, education, employment, income — Nat: e Hawaiians display d i s t i n c t d i s - par- t i e s with their fellow c i t i z e n s. Health Concerns. The impact of Western diseases on Native Hawaiians was h i s t o r i c a l l y devastating. Waves of epidemics reduced the estimated contact population of 300,000 in 1778, to 34,000 by 1893. The implications of this decimation have been considered in a variety of contexts. Western observers, beginning in 1838, noted that unless some dramatic improvement were made in the health conditions of Native Hawaiians that the race would disappear. These i n i t i a l feelings of horror and dismay over the fatal impact of Western contact gradually altered. After the publication of Darwin's Origin of Species, Europeans and Americans began to adopt the a t t i t u d es and policies of Social Darwinism. The theory of "the survival ^f the f i t t e s t " was applied to nations, and validated Western expansion and imperialism as the natural working out of an inevitable progression of conquest and colonization. Acquired immunity and i n t e r marriage among Native Hawaiians, however, was reversing this trend. Demographic trends now indicate that the population had reached i t s lowest level in the final decade of the 19th i_entury, would s t a b i l i z e for about twenty years, and then begin a dramatic recovery. Today's Native Hawaiian population numbers an estimated 175,000 i n d i v i d u a l s , more than half of whom are less than 19 years old. The health c h a r a c t e r i s t i c s of this groupi however, are adversely and c o n s i s t e n t l y affected by mental health d i s o r d e r s , s t r e s s - r e l a t e d diseases, and an absence of c u l t u r a l l y - s e n s i t i ve health professionals. As developed in depth within the body of this study, the followinq findings are offered: • the psychological despair and sense of being a conquered people in their own homeland is a factor in the health conditions of Native Hawaiians; • Native Hawaiians have the lowest l i f e expectancy of any ethnic group in the State of Hawai'i: 67 years compared to a Statewide average of 74 years; • the leading causes of death for Native Hawaiians, in order of prevalence, are heart diseases, cancers, stroke, and accidents; • Native Hawaiians have the highest infant death rate in the State of Hawai'i: 14 per 1,000 live births compared to a statewide average of 10 per thousand; • mental health assessments indicate that Native Hawaiians have a higher-than-expected incidence of personality d i s o r d e r s , mental retardation, and drug abuse than their proportion of the population; and • suicide rates among Native Hawaiian males - ( s t a t i s t i c s are unavailable for females) is the highest in the State of Hawai'i: 22.5 per 100,000 in the population, compared to a r a t e of 13.5 for males of all races in Hawai'i — rates in the 20-34 year age group of Native Hawaiians was even higher. 487