For the student who
designed this tapa,
the connecting of the
fish hooks to form a
flower symbolizes
the bounty of the
ocean, new life, new
sustainability, and
health. The tips of
the fish hooks also
represent the ten
students in the class
and the teacher.
Running through
the design is a wave
pattern that depicts
connections between
the power of the sea
and the beauty of
every new blossom
as with the
connections between
a mother and father.

Annette Pakele-ChangAnnette Pakele-Chang

I’m currently in my Senior year at Chaminade University of Honolulu and the Community Partners Chair of the WCC Nursing Pathway. I completed the Certified Nurse Aide program in July of 2009 and have been a part of the pathway program ever since.  The Pathway has made my dreams of becoming a nurse a reality.  I look forward to the future of nursing where I am able to embrace my Native Hawaiian culture as well as Western medicine for holistic health care.




Our Pathway Program is one solution to Hawai‘i’s increasingly significant disparities in health, education, income and workforce diversity:

  1. Health
    • <55% of Native Hawaiians meet physical activity recommendations
    • 75% of Native Hawaiians are overweight and obese
    • Native Hawaiians are 60% more likely to die from chronic diseases than other ethnic groups in Hawaii
  2. Education
    • ~40% of Native Hawaiians experience high school stop-out
    • Only 10% of Native Hawaiians enroll in college
    • Evidence of education disparities show that only 10% of Native Hawaiians in college earn 4-year degrees
  3. Income
    • Native Hawaiians hold lower paying jobs than other ethnicities in the state
    • Majority of incarcerated inmates in Hawaii are Native Hawaiian
    • Native Hawaiians make up the greatest segment of homeless in Hawai‘i
  4. Healthcare Workforce
    • Native Hawaiians make up 29% of Hawaii’s population
    • Native Hawaiian nurses make up less than 3.5% of the RN workforce
    • Native Hawaiian physicians make up 4% of the MD workforce

The U.S. Department of Labor lists nursing three (3) separate times among the Top 10 industries with the largest wage and salary employment growth, 2008 – 2018: home health care services, services for the elderly and persons with disabilities and nursing care facilities.

Public Health and Aging: Trends in Aging in United States

  • 20 year increase in lifespan from WWII – 2030
  • 7.2% increase in population older than 65 years
  • In 2025, 48 states will have >15% population older than 65 years

Epidemiologic Transition

  • Increased chronic diseases
  • Increased disability
  • Diminished quality of life
  • Increased health care costs

College – Community – Workforce Partnerships to Improve Socioeconomic and Health Outcomes

  1. Education and income security are directly related to lower chronic disease risks
  2. Impoverished students are more likely to enroll in community colleges
    • Community colleges offer few health/fitness resources
    • Community colleges experience higher stop-out rates than four-year colleges
  3. Motivation for change is a key component of adopting disease prevention behaviors
    • Enrolling in college is a significant sign of motivation
  4. Educating minorities in health careers imparts health knowledge, improves income security and reduces workforce disparities

Potential Increase in Income with Advanced Training
Nurse AideLicensed Practical NurseRegistered Nurse


Lawe i ka ma'alea a ku'ono'ono:

Acquire skill and make it deep