PURPOSE OF THE PAPER: To summarize the current health status of Kanaka Maoli (indigenous Hawaiians) with historical background, underlying factors responsible for the Kanaka Maoli health plight and recommendations. METHODS: The author reviewed the available literature and some not readily available, unpublished information. PRINCIPAL FINDINGS: Kanaka Maoli continue to have the worst health and socio­economic indicators of the various ethnic groups in their home islands of Ka Pae'aina (Hawai'i). Cardiovascular disorders, cancer, diabetes, obstructive lung disease, maternal and infant health and mental distress are the prominent maladies. Tobacco smoking, high­fat diet, alcohol drinking, hyperlipidemia and obesity are the major lifestyle risk factors. Societal factors, such as depopulation, foreign transmigration, colonial exploitation, coercive assimilation, cultural conflict and racism persist. Since 1990, Kanaka Maoli communities have established five island­wide Native Hawaiian Health Care Systems to improve availability, accessibility, and acceptability of health services to their people, but with inadequate resources. CONCLUSIONS: Under present conditions, while the future may bring some amelioration of Kanaka Maoli ill health, the price will be progressive acculturation and loss of Kanaka Maoli identity. Accordingly, recommendations include augmented revitalization of the traditional culture, effective recontrol by the Kanaka Maoli of their lives and natural resources and thus, improved total health. KEY WORDS: Pacific Islander Americans, Kanaka Maoli, Hawaiians, Indigenous Health, Culture, Ethnicity, Racism, Colonialism, Sovereignty