Historian Seth Archer traces the cultural impact of disease and health problems in the Hawaiian Islands from the arrival of Europeans to 1855. Colonialism in Hawai?i began with epidemiological incursions, and Archer argues that health remained the national crisis for more than a century. Introduced diseases resulted in drastically reduced lifespans, crushing infertility and infant mortality, and persistent poor health for generations of Islanders, leaving a deep imprint on Hawaiian culture and national consciousness. Scholars have noted the role of epidemics in the depopulation of Hawai?i and broader Oceania, yet few have considered the interplay between colonialism, health, and culture - including Native religion, medicine and ideas about the body, and gender and sexuality. This study emphasizes Islanders' own ideas about, and responses to, disease and other health challenges on the local level. Ultimately, Hawai?i provides a case study for health and culture change among indigenous populations across the Americas and the Pacific.