Poisoning the body to nourish the soul: Prioritising health risks and impacts in a Native American community

The injustice of risk avoidance: the limitations of fish consumption restrictions as institutional controls for superfund sites

The Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) is a landmark environmental policy. It broadly empowers the federal government to manage hazardous waste sites to ensure the protection of human and environmental health. In many ways, CERCLA is the result of the environmental justice movement, and public concern about hazardous sites. Because the goal of CERCLA is explicitly managing risk from hazardous sites, it is central to the regulatory structure for management of environmental injustice in the United States of America. However, CERCLA does not fully consider the full scope of environmental justice, and may fail to fully ensure environmental justice for communities impacted directly by proximity to hazardous sites. Specifically, the use of institutional controls such as fish consumption advisories as long terms risk management strategies may prolong and compound environmental injustice as a matter of policy.

Socioeconomic disruptions of harmful algal blooms in indigenous communities: The case of Quinault Indian nation

Harmful algal blooms (HABs) have been a pervasive challenge across coastal communities of the U.S. West Coast in recent years negatively affecting local economies and livelihoods. We focus on the effects of HABs to the Quinault Indian Nation (QIN) triggered by Pseudo-nitzschia that produce the toxin domoic acid (DA). This toxin accumulates in filter feeders and poses threats to human health via shellfish consumption. Consumption of razor clams with high levels of DA and Dungeness crab that prey on them can cause amnesic shellfish poisoning in humans and therefore requires closure of commercial, recreational and subsistence fisheries, postponing or limiting harvesting seasons. These disruptions result in significant losses in revenues along with negative effects to sociocultural dimensions of key importance to coastal communities. Livelihoods and wellbeing of tribal communities are affected disproportionately due to higher vulnerability and reliance on these marine resources for subsistence. We assess these effects at multiple levels for the QIN and discuss and reflect, through a tribal lens, upon advances and opportunities for impact mitigation and adaptation in the face of HABs, along with persisting challenges.

Improving Chronic Illness Self-Management with the Apsáalooke Nation: The Báa nnilah Project, a cluster randomized trial protocol

Chronic illness (CI) is a major cause of morbidity and mortality for Indigenous people. In Montana, Indigenous communities disproportionately experience CI, a legacy of settler colonialism. For over two decades, Messengers for Health, an Apsáalooke (Crow Indian) non-profit, and Montana State University have partnered to improve community health using a community-based participatory research (CBPR) approach. We developed Báa nnilah, an intervention utilizing community strengths, to improve CI self-management. This manuscript describes the protocol for a cluster randomized trial with two arms: an intervention group and a wait list control group, who both participated in the Báa nnilah program. Enrollment occurred through family/clan networks and community outreach and attended to limitations of existing CI self-management interventions by using an approach and content that were culturally consonant. Participants received program materials, attended seven gatherings focused on improving CI management, and received and shared health information through storytelling based on a conceptual framework from the Apsáalooke culture and incorporating CI self-management strategies. Participant support occurred within partnership dyads during and between gatherings, from community mentors, and by program staff. The study used mixed methods to evaluate the intervention, with qualitative measures including the Short Form Health Survey (SF-12), Patient Health Questionnaire (PHQ-9), Patient Activation Measure (PAM), and a suite of PROMIS measures, various physical tests and qualitative survey responses, semi-structured interviews, and outcomes shared by participants with program staff. We hypothesized that Báa nnilah would significantly improve participant health outcome measures across multiple dimensions with quality of life (QoL) as the primary outcome. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03036189. Registered on 30 January 2017. (From https://clinicaltrials.gov/ct2/show/NCT03036189).

[DNVF Memorandum Health Literacy (Part 2) - Operationalisation and Measuring of Health Literacy from a Health Services Research Perspective]

Das vorliegende „DNVF Memorandum Gesundheitskompetenz (Teil 2) – Operationalisierung und Messung von Gesundheitskompetenz aus Sicht der Versorgungsforschung“ des Deutschen Netzwerks Versorgungsforschung e.V. (DNVF) stellt die Fortführung des Memorandums „DNVF Memorandum Gesundheitskompetenz (Teil 1) – Hintergrund, Gegenstand und Fragestellungen in der Versorgungsforschung“ dar. Neben den allgemeinen Anforderungen an die Messung der Gesundheitskompetenz, beschäftigt sich dieses Memorandum auch mit den speziellen Anforderungen, wie die Abgrenzung zu verwandten Konstrukten, den Unterschieden zwischen performanzbasierten und Selbsteinschätzungsverfahren, den Unterschieden zwischen generischen und spezifischen Instrumenten, dem Einsatz von Screeninginstrumenten sowie der Messung der Gesundheitskompetenz bei speziellen Personengruppen. Weiterhin werden Besonderheiten bei der Messung der digitalen Gesundheitskompetenz, Potenziale qualitativer und partizipativer Forschungszugänge sowie forschungsethische Gesichtspunkte bei der Messung der Gesundheitskompetenz erarbeitet. Ein besonderer Wert wird auf den Praxisbezug gelegt, der am Ende der jeweiligen Abschnitte mit einem Fazit für die Versorgungsforschung aufgegriffen wird. Abschließend wird einen Blick auf Herausforderungen und Forschungsdesiderate im Zusammenhang mit der Messung von Gesundheitskompetenz im Rahmen der Versorgungsforschung geworfen.

Community sharing: Contextualizing Western research notions of contamination within an Indigenous research paradigm

Báa nnilah is a chronic illness self-management program designed by and for the Apsáalooke (Crow) community. Arising from a collaboration between an Indigenous nonprofit organization and a university-based research team, Báa nnilah's development, implementation, and evaluation have been influenced by both Indigenous and Western research paradigms (WRPs). Báa nnilah was evaluated using a randomized wait-list control group design. In a WRP, contamination, or intervention information shared by the intervention group with the control group, is actively discouraged as it makes ascertaining causality difficult, if not impossible. This approach is not consonant with Apsáalooke cultural values that include the encouragement of sharing helpful information with others, supporting an Indigenous research paradigm's (IRP) goal of benefiting the community. The purpose of this paper is to address contamination and sharing as an area of tension between WRP and IRP. We describe how the concepts of contamination and sharing within Báa nnilah's implementation and evaluation are interpreted differently when viewed from these contrasting paradigms, and set forth a call for greater exploration of Indigenous research approaches for developing, implementing, and evaluating intervention programs in Indigenous communities. (Improving Chronic Illness Management with the Apsáalooke Nation: The Báa nnilah Project.: NCT03036189), ClinicalTrials. gov: NCT03036189).

Perspectives on managing fisheries for community wellbeing in the face of climate change

Coastal communities are being impacted by climate change, affecting the livelihoods, food security, and wellbeing of residents. Human wellbeing is influenced by the heath of the environment through numerous pathways and is increasingly being included as a desired outcome in environmental management. However, the contributors to wellbeing can be subjective and the values and perspectives of decision-makers can affect the aspects of wellbeing that are included in planning. We used Q methodology to examine how a group of individuals in fisheries management prioritize components of wellbeing that may be important to coastal communities in the California Current social-ecological system (SES). The California Current SES is an integrated system of ecological and human communities with complex linkages and connections where commercial fishing is part of the culture and an important livelihood. We asked individuals that sit on advisory bodies to the Pacific Fisheries Management Council to rank 36 statements about coastal community wellbeing, ultimately revealing three discourses about how we can best support or improve wellbeing in those communities. We examine how the priorities differ between the discourses, identify areas of consensus, and discuss how these perspectives may influence decision-making when it comes to tradeoffs inherent in climate adaptation in fisheries. Lastly, we consider if and how thoughts about priorities have been affected by the COVID-19 pandemic.

Our Relationship to Water and Experience of Water Insecurity among Apsáalooke (Crow Indian) People, Montana

Affordable access to safe drinking water is essential to community health, yet there is limited understanding of water insecurity among Native Americans. Therefore, the focus of this paper is to describe Apsáalooke (Crow Indian) tribal members' experiences with water insecurity. For Apsáalooke people, local rivers and springs are still vitally important for traditional cultural activities. We interviewed 30 Native American adults living on the Crow Reservation in Southeastern Montana. Participants answered six open-ended interview questions about their water access, costs of obtaining water and changes in their domestic and traditional water uses. Participants emphasized how the use of water has changed over time and described the complex challenges associated with addressing water insecurity in their community, including the importance of considering the spiritual and cultural impacts of water insecurity on health. Water insecurity is a growing global problem and more attention and efforts are needed to find appropriate and affordable solutions.

How Indigenous Communities Are Adapting To Climate Change: Insights From The Climate-Ready Tribes Initiative

Climate change directly threatens human health, with substantial impacts on Indigenous peoples, who are uniquely vulnerable as climate-related events affect their practices, lifeways, self-determination, and physical and cultural health. At the same time, Indigenous communities are leading the way in innovative health-related climate change adaptation work, using traditional knowledges and novel approaches. In 2016 the Centers for Disease Control and Prevention and the National Indian Health Board created the Climate-Ready Tribes Initiative to support these efforts. The initiative has funded tribes, shared information nationally, and supported a learning cohort, resulting in pioneering work to protect health from climate hazards. We describe how two tribes-the Pala Band of Mission Indians and the Swinomish Indian Tribal Community-implemented their Climate-Ready Tribes Initiative projects, and we provide recommendations for making climate and health policy more effective for tribes. Lessons learned from the Climate-Ready Tribes Initiative can inform climate and health policy and practice nationwide.

Climate Change and Health: Local Solutions to Local Challenges

Purpose of Review

Climate change has direct impacts on human health, but those impacts vary widely by location. Local health impacts depend on a large number of factors including specific regional climate impacts, demographics and human vulnerabilities, and existing local adaptation capacity. There is a need to incorporate local data and concerns into climate adaptation plans and evaluate different approaches.

Recent Findings

The Centers for Disease Control and Prevention (CDC) has provided funding, technical assistance, and an adaptation framework to assist localities with climate planning and activities. The differing processes with which states, cities, and tribes develop and implement adaptation plans have been observed. We outline examples of the implementation of CDC’s framework and activities for local adaptation, with a focus on case studies at differing jurisdictional levels (a state, a city, and a sovereign tribe).

Summary

The use of local considerations and data are important to inform climate adaptation. The adaptable implementation of CDC’s framework is helping communities protect health.

A State-of-the-Art Review of Indigenous Peoples and Environmental Pollution

Indigenous peoples (IPs) worldwide are confronted by the increasing threat of pollution. Based on a comprehensive review of the literature (n = 686 studies), we present the current state of knowledge on: 1) the exposure and vulnerability of IPs to pollution; 2) the environmental, health, and cultural impacts of pollution upon IPs; and 3) IPs' contributions to prevent, control, limit, and abate pollution from local to global scales. Indigenous peoples experience large burdens of environmental pollution linked to the expansion of commodity frontiers and industrial development, including agricultural, mining, and extractive industries, as well as urban growth, waste dumping, and infrastructure and energy development. Nevertheless, IPs are contributing to limit pollution in different ways, including through environmental monitoring and global policy advocacy, as well as through local resistance toward polluting activities. This work adds to growing evidence of the breadth and depth of environmental injustices faced by IPs worldwide, and we conclude by highlighting the need to increase IPs' engagement in environmental decision-making regarding pollution control. Integr Environ Assess Manag 2020;16:324-341. © 2019 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

One health in the circumpolar North

The North faces significant health disparities, especially among its many Indigenous peoples. In this article we discuss historical, environmental, and cultural variables that contribute to these disparities and propose a One Health approach to address them in a holistic and culturally appropriate manner. The One Health paradigm recognizes the interdependence among the health and well-being of people, animals and the environment. As such, the framework aligns well with many Indigenous world views. This proactive, interdisciplinary, constructivist, and collaborative approach promise earlier detection of risks and threats, as well as more effective responses, in part by engaging community level stakeholders in all stages of the process. In the far North, humans, especially Indigenous peoples, continue to live closely connected to their environment, in settings that exert significant impacts on health. In recent decades, rapid warming and elevated contaminant levels have heightened environmental risks and increased uncertainty, both of which threaten individual and community health and well-being. Under these circumstances especially, One Health's comprehensive approach may provide mitigating and adaptive strategies to enhance resilience. While many of the examples used in this manuscript focus on Alaska and Canada, the authors believe similar conditions exist among the indigenous and rural residents across the entire Circumpolar North.

Improving chronic illness self-management with the Apsáalooke Nation: Development of the Báa nnilah program

RATIONALE

Since 1996, members of the Apsáalooke (Crow) Nation and faculty and students at Montana State University have worked in a successful community-based participatory research (CBPR) partnership, leading to increased trust and improvements in health awareness, knowledge, and behaviors. As major barriers to health and healthy behaviors have caused inequities in morbidity and mortality rates for multiple chronic diseases among the Apsáalooke people, community members chose to focus the next phase of research on improving chronic illness management.

OBJECTIVE

Existing chronic illness self-management programs include aspects inconsonant with Apsáalooke culture and neglect local factors seen as vital to community members managing their health conditions. The aim of this study was to use CBPR methods grounded in Apsáalooke cultural values to develop an intervention for improving chronic illness self-management.

METHOD

Community members shared stories about what it is like to manage their chronic illness, including facilitators and barriers to chronic illness management. A culturally consonant data analysis method was used to develop a locally-based conceptual framework for understanding chronic illness management and an intervention grounded in the local culture.

RESULTS

Components of the intervention approach and intervention content are detailed and similarities and differences from other chronic illness management programs are described.

CONCLUSIONS

Our collaborative process and product may be helpful for other communities interested in using story data to develop research projects, deepen their understanding of health, and increase health equity.

Traditional Sheep Consumption by Navajo People in Cameron, Arizona

Over 500 abandoned uranium mines are located on the Navajo Reservation. Different pathways of environmental uranium exposure have been studied with respect to the Navajo people including water, soil, and plants; however, uranium exposure from traditional Navajo food, specifically mutton (sheep), has not been reported. This study focuses on mutton consumption in the small community of Cameron, Arizona, located in the southwestern region of the Navajo Nation and initiated after community members expressed concern with the uranium exposure of their sheep. Preliminary investigation into the presence of uranium in sheep raised near Cameron showed elevated uranium levels in the kidneys the sheep tested. The goal of this study is to investigate mutton consumption among the Navajo living in Cameron. Mutton is a traditional food of the Navajo, but consumption practices are not well documented. An important aspect of determining the extent of exposure through food consumption is to assess the frequency of consumption. The results of this study indicate the Cameron participants consume mutton most commonly at family gatherings or celebrations. The survey suggests that less mutton is consumed now compared to the past, and there is concern that contaminated mutton may change traditional ceremonies.

A passive sampling model to predict PAHs in butter clams (Saxidomus giganteus), a traditional food source for Native American tribes of the Salish Sea Region

Native Americans face disproportionate exposures to environmental pollution through traditional subsistence practices including shellfish harvesting. In this study, the collection of butter clams (Saxidomus giganteus) was spatially and temporally paired with deployment of sediment pore water passive samplers at 20 locations in the Puget Sound region of the Salish Sea in the Pacific Northwest, USA, within adjudicated usual and accustomed tribal fishing grounds and stations. Clams and passive samplers were analyzed for 62 individual PAHs. A linear regression model was constructed to predict PAH concentrations in the edible fraction of butter clams from the freely dissolved fraction (C_free) in porewater. PAH concentrations can be predicted within a factor of 1.9 ± 0.2 on average from the freely dissolved PAH concentration in porewater using the following equation: PAHClam=4.1±0.1×PAHporewater This model offers a simplified, cost effective, and low impact approach to assess contaminant levels in butter clams which are an important traditional food.

Water is Medicine: Reimagining Water Security through Tr’ondëk Hwëch’in Relationships to Treated and Traditional Water Sources in Yukon, Canada

There is growing acknowledgement that the material dimensions of water security alone are inadequate; we also need to engage with a broader set of hydrosocial relationships. Indeed, more holistic approaches are needed to explain Indigenous peoples’ relationships to water including the use of traditional water sources such as mountain creeks and springs. In this paper, we seek to reimagine water security through a case study of Tr’ondëk Hwëch’in’s relationships to both treated and traditional water sources throughout the First Nation’s traditional territory in Yukon, Canada. Through community-based research including interviews with Elders and other community members, we examine the importance of traditional water sources for meeting important health requirements including physical, spiritual and cultural wellbeing. This intervention contributes to ongoing debates about what it means to secure safe and affordable water in three key ways: First, we argue that Indigenous water relations invite a shift towards more a holistic understanding of water security; second, we contend that settler colonial politics should be understood as a root cause of water insecurity; finally, we explore how Two-Eyed Seeing can be applied as an alternative to the ‘integration’ of Western scientific and Indigenous approaches to drinking water.

Native American Perspectives on Health and Traditional Ecological Knowledge

BACKGROUND

Traditional ecological knowledge (TEK) is a conceptual framework that highlights Indigenous knowledge (IK) systems. Although scientific literature has noted the relevance of TEK for environmental research since the 1980s, little attention has been given to how Native American (NA) scholars engage with it to shape tribal-based research on health, nor how non-Native scholars can coordinate their approaches with TEK. This coordination is of particular importance for environmental health sciences (EHS) research exploring interdisciplinary approaches and the integration of environmental and human health.

OBJECTIVE

Our perspective on TEK arose from a series of Health and Culture Research Group (HCRG) workshops that identified gaps in existing EHS methodologies that are based on a reliance on Euro-American concepts for assessing environmental exposures in tribal communities. These prior methods neither take into account cultural behavior nor community responses to these. Our objective is to consider NA perspectives on TEK when analyzing relationships between health and the environment and to look at how these may be applied to address this gap.

DISCUSSION

The authors—the majority of whom are NA scholars—highlight two research areas that consider health from a TEK perspective: food systems and knowledge of medicinal plants. This research has yielded data, methods, and knowledge that have helped Indigenous communities better define and reduce health risks and protect local natural food resources, and this TEK approach may prove of value to EHS research.

CONCLUSION

NA perspectives on TEK resulting from the HCRG workshops provide an opportunity for developing more accurate Indigenous health indicators (IHI) reflecting the conceptualizations of health maintained in these communities. This approach has the potential to bridge the scientific study of exposure with methods addressing a tribal perspective on the sociocultural determinants of health, identifying potential new areas of inquiry in EHS that afford nuanced evaluations of exposures and outcomes in tribal communities. https://doi.org/10.1289/EHP1944.

Responses of deposition and bioaccumulation in the Great Lakes region to policy and other large-scale drivers of mercury emissions

Mercury (Hg) emissions pose a global problem that requires global cooperation for a solution. However, neither emissions nor regulations are uniform world-wide, and hence the impacts of regulations are also likely to vary regionally. We report here an approach to model the effectiveness of regulations at different scales (local, regional, global) in reducing Hg deposition and fish Hg concentrations in the Laurentian Great Lakes (GL) region. The potential effects of global change on deposition are also modeled. We focus on one of the most vulnerable communities within the region, an Indigenous tribe in Michigan's Upper Peninsula (UP) with a high fish consumption rate. For the GL region, elements of global change (climate, biomass burning, land use) are projected to have modest impacts (<5% change from the year 2000) on Hg deposition. For this region, our estimate of the effects of elimination of anthropogenic emissions is a 70% decrease in deposition, while our minimal regulation scenario increases emissions by 35%. Existing policies have the potential to reduce deposition by 20% with most of the reduction attributable to U.S. policies. Local policies within the Great Lakes region show little effect, and global policy as embedded in the Minamata Convention is projected to decrease deposition by approximately 2.8%. Even within the GL region, effects of policy are not uniform; areas close to emission sources (Illinois, Indiana, Ohio, Pennsylvania) experience larger decreases in deposition than other areas including Michigan's UP. The UP landscape is highly sensitive to Hg deposition, with nearly 80% of lakes estimated to be impaired. Sensitivity to mercury is caused primarily by the region's abundant wetlands. None of the modeled policy scenarios are projected to reduce fish Hg concentrations to the target that would be safe for the local tribe. Regions like Michigan's UP that are highly sensitive to mercury deposition and that will see little reduction in deposition due to regulations require more aggressive policies to reduce emissions to achieve recovery. We highlight scientific uncertainties that continue to limit our ability to accurately predict fish Hg changes over time.

Fish for Dinner? Balancing Risks, Benefits, and Values in Formulating Food Consumption Advice

Many and complex factors underlie seemingly simple decisions about what to eat. This is particularly so for foods such as fish, which present consumers with both risks and benefits. Advice about what type of and how much fish to consume is abundant, but that advice is often confusing or contradictory, reflecting the differing mandates and orientations of those advising. We survey a range of issues that can and should be incorporated into dietary advice, and offer tools for health agencies tasked with providing it. We argue that risks and benefits should not be limited to direct physical health. Rather, socioeconomic and community factors, unintended or indirect effects, and nonhuman-health outcomes such as animal welfare and planetary health should also be considered and weighed. We provide examples of existing fish consumption guidance to highlight the conflicting messages that emerge when different sources of advice with singular aims of avoiding risk, gaining nutritional benefit, or sustaining fish populations are juxtaposed. We then offer tools borrowed from health and other fields to guide health agencies toward developing more comprehensive advice and targeting that advice for specific populations.

What Touched Your Heart? Collaborative Story Analysis Emerging From an Apsáalooke Cultural Context

Community-based participatory research and decolonizing research share some recommendations for best practices for conducting research. One commonality is partnering on all stages of research; co-developing methods of data analysis is one stage with a deficit of partnering examples. We present a novel community-based and developed method for analyzing qualitative data within an Indigenous health study and explain incompatibilities of existing methods for our purposes and community needs. We describe how we explored available literature, received counsel from community Elders and experts in the field, and collaboratively developed a data analysis method consonant with community values. The method of analysis, in which interview/story remained intact, team members received story, made meaning through discussion, and generated a conceptual framework to inform intervention development, is detailed. We offer the development process and method as an example for researchers working with communities who want to keep stories intact during qualitative data analysis.

Developing Responsive Indicators of Indigenous Community Health

How health is defined and assessed is a priority concern for Indigenous peoples due to considerable health risks faced from environmental impacts to homelands, and because what is “at risk” is often determined without their input or approval. Many health assessments by government agencies, industry, and researchers from outside the communities fail to include Indigenous definitions of health and omit basic methodological guidance on how to evaluate Indigenous health, thus compromising the quality and consistency of results. Native Coast Salish communities (Washington State, USA) developed and pilot-tested a set of Indigenous Health Indicators (IHI) that reflect non-physiological aspects of health (community connection, natural resources security, cultural use, education, self-determination, resilience) on a community scale, using constructed measures that allow for concerns and priorities to be clearly articulated without releasing proprietary knowledge. Based on initial results from pilot-tests of the IHI with the Swinomish Indian Tribal Community (Washington State, USA), we argue that incorporation of IHIs into health assessments will provide a more comprehensive understanding of Indigenous health concerns, and assist Indigenous peoples to control their own health evaluations.

Values-Based Measures of Impacts to Indigenous Health

Values-based indicators of risks to Indigenous health have the potential to improve the accuracy and quality of a wide range of decisions affecting Native lands and cultures. Current health impact assessment approaches often omit important health priorities rooted in the history, social structures, and cultural context of Indigenous communities. Insights and methods from the decision sciences can be used to develop more culturally appropriate and context-relevant health indicators that can articulate and track changes to important dimensions of Indigenous health. Identifying and addressing priority cultural, social, economic, and environmental contributors to the health of Indigenous communities will help to generate better project alternatives and foster more responsive choices.

Communicating Results of a Dietary Exposure Study Following Consumption of Traditionally Smoked Salmon

One expectation of community-based participatory research (CBPR) is participant access to study results. However, reporting experimental data produced by studies involving biological measurements in the absence of clinical relevance can be challenging to scientists and participants. We applied best practices in data sharing to report the results of a study designed to explore polycyclic aromatic hydrocarbons absorption, metabolism, and excretion following consumption of traditionally smoked salmon by members of the Confederated Tribes of the Umatilla Indian Reservation (CTUIR). A dietary exposure study was developed, in which nine Tribal members consumed 50 g of traditionally smoked salmon and provided repeated urine samples over 24 hours. During recruitment, participants requested access to their data following analysis. Disclosing data is an important element of CBPR and must be treated with the same rigor as that given to the data analysis. The field of data disclosure is relatively new, but when handled correctly can improve education within the community, reduce distrust, and enhance environmental health literacy. Using the results from this study, we suggest mechanisms for sharing data with a Tribal community.

Evaluating Threats in Multinational Marine Ecosystems: A Coast Salish First Nations and Tribal Perspective

Despite the merit of managing natural resources on the scale of ecosystems, evaluating threats and managing risk in ecosystems that span multiple countries or jurisdictions can be challenging. This requires each government involved to consider actions in concert with actions being taken in other countries by co-managing entities. Multiple proposed fossil fuel-related and port development projects in the Salish Sea, a 16,925 km2 inland sea shared by Washington State (USA), British Columbia (Canada), and Indigenous Coast Salish governments, have the potential to increase marine vessel traffic and negatively impact natural resources. There is no legal mandate or management mechanism requiring a comprehensive review of the potential cumulative impacts of these development activities throughout the Salish Sea and across the international border. This project identifies ongoing and proposed energy-related development projects that will increase marine vessel traffic in the Salish Sea and evaluates the threats each project poses to natural resources important to the Coast Salish. While recognizing that Coast Salish traditions identify all species as important and connected, we used expert elicitation to identify 50 species upon which we could evaluate impact. These species were chosen because Coast Salish depend upon them heavily for harvest revenue or as a staple food source, they were particularly culturally or spiritually significant, or they were historically part of Coast Salish lifeways. We identified six development projects, each of which had three potential impacts (pressures) associated with increased marine vessel traffic: oil spill, vessel noise and vessel strike. Projects varied in their potential for localized impacts (pressures) including shoreline development, harbor oil spill, pipeline spill, coal dust accumulation and nearshore LNG explosion. Based on available published data, impact for each pressure/species interaction was rated as likely, possible or unlikely. Impacts are likely to occur in 23 to 28% of the possible pressure/species scenarios and are possible in another 15 to 28% additional pressure/species interactions. While it is not clear which impacts will be additive, synergistic, or potentially antagonistic, studies that manipulate multiple stressors in marine ecosystems suggest that threats associated with these six projects are likely to have an overall additive or even synergistic interaction and therefore impact species of major cultural importance to the Coast Salish, an important concept that would be lost by merely evaluating each project independently. Failure to address multiple impacts will affect the Coast Salish and the 7 million other people that also depend on this ecosystem. These findings show the value of evaluating multiple threats, and ultimately conducting risk assessments at the scale of ecosystems and highlight the serious need for managers of multinational ecosystems to actively collaborate on evaluating threats, assessing risk, and managing resources.

Fish consumption as a driver of risk-management decisions and human health-based water quality criteria

The use and interpretation of fish consumption surveys and interviews, the application of fish consumption rates for sediment evaluation and cleanup, and the development of human health water quality criteria (HH WQC) are complex and interrelated issues. The present article focuses on these issues using examples from the United States, although the issues may be relevant for other countries. Some key considerations include the fact that there are many types of fish consumption surveys (e.g., 24-h recall surveys, food frequency questionnaires, creel surveys), and these surveys have different advantages and limitations. Identification of target populations for protection, identification of the species and quantities of fish consumed, and determination of bioaccumulation assumptions are important factors when developing water quality and sediment screening levels and standards. Accounting for the cultural importance of fish consumption for some populations is an even more complex element. Discussions about HH WQC often focus only on the fish consumption rate and may not have broad public input. Some states are trying to change this through extensive public participation efforts and use of probabilistic approaches to derive HH WQC. Finally, there are limits to what WQC can achieve. Solutions beyond the establishment of WQC that target toxics reduction from other sources may provide the greatest improvements to water quality and reductions in human health risks in the future.

Community-based research as a mechanism to reduce environmental health disparities in american Indian and alaska native communities

Racial and ethnic minority communities, including American Indian and Alaska Natives, have been disproportionately impacted by environmental pollution and contamination. This includes siting and location of point sources of pollution, legacies of contamination of drinking and recreational water, and mining, military and agricultural impacts. As a result, both quantity and quality of culturally important subsistence resources are diminished, contributing to poor nutrition and obesity, and overall reductions in quality of life and life expectancy. Climate change is adding to these impacts on Native American communities, variably causing drought, increased flooding and forced relocation affecting tribal water resources, traditional foods, forests and forest resources, and tribal health. This article will highlight several extramural research projects supported by the United States Environmental Protection Agency (USEPA) Science to Achieve Results (STAR) tribal environmental research grants as a mechanism to address the environmental health inequities and disparities faced by tribal communities. The tribal research portfolio has focused on addressing tribal environmental health risks through community based participatory research. Specifically, the STAR research program was developed under the premise that tribal populations may be at an increased risk for environmentally-induced diseases as a result of unique subsistence and traditional practices of the tribes and Alaska Native villages, community activities, occupations and customs, and/or environmental releases that significantly and disproportionately impact tribal lands. Through a series of case studies, this article will demonstrate how grantees—tribal community leaders and members and academic collaborators—have been addressing these complex environmental concerns by developing capacity, expertise and tools through community-engaged research.

Perceptions of the Environment and Health Among Members of the Confederated Tribes of the Umatilla Indian Reservation

Indigenous cultures perceive the natural environment as an essential link between traditional cultural practices, social connectedness, identity, and health. Many tribal communities face substantial health disparities related to exposure to environmental hazards. Our study used qualitative methods to better understand the Confederated Tribes of the Umatilla Indian Reservation (CTUIR) members' perspectives about their environment and its connections with their health including views on environmental health hazards. Three 90-minute focus group sessions with a total of 27 participants were held to elicit opinions on meanings of health and how the environment interacts with health. A systematic text analysis was used to derive themes across focus groups. Participants expressed a holistic view of health that included environmental, physical, mental, spiritual, and social components. A healthy natural environment was identified as an essential component of a healthy individual and a healthy community. Participants also described many environmental health concerns including second-hand smoke, outdoor smoke, diesel exhaust, mold, pesticides, contaminated natural foods, and toxic wastes from the Hanford nuclear site and methamphetamine labs. Many believe the identified environmental hazards contribute to diseases in their community. The natural environment is an important resource to CTUIR members and plays an integral role in achieving and maintaining health. Knowledge about the values and concerns of the community are useful to the tribal and federal governments, health professionals, environmental health practitioners, and community members who seek to achieve sustainable and healthy rural Native communities.

Culture, intangibles and metrics in environmental management

The demand for better representation of cultural considerations in environmental management is increasingly evident. As two cases in point, ecosystem service approaches increasingly include cultural services, and resource planners recognize indigenous constituents and the cultural knowledge they hold as key to good environmental management. Accordingly, collaborations between anthropologists, planners, decision makers and biodiversity experts about the subject of culture are increasingly common-but also commonly fraught. Those whose expertise is culture often engage in such collaborations because they worry a practitioner from 'elsewhere' will employ a 'measure of culture' that is poorly or naively conceived. Those from an economic or biophysical training must grapple with the intangible properties of culture as they intersect with economic, biological or other material measures. This paper seeks to assist those who engage in collaborations to characterize cultural benefits or impacts relevant to decision-making in three ways; by: (i) considering the likely mindset of would-be collaborators; (ii) providing examples of tested approaches that might enable innovation; and (iii) characterizing the kinds of obstacles that are in principle solvable through methodological alternatives. We accomplish these tasks in part by examining three cases wherein culture was a critical variable in environmental decision making: risk management in New Zealand associated with Māori concerns about genetically modified organisms; cultural services to assist marine planning in coastal British Columbia; and a decision-making process involving a local First Nation about water flows in a regulated river in western Canada. We examine how 'culture' came to be manifest in each case, drawing from ethnographic and cultural-models interviews and using subjective metrics (recommended by theories of judgment and decision making) to express cultural concerns. We conclude that the characterization of cultural benefits and impacts is least amenable to methodological solution when prevailing cultural worldviews contain elements fundamentally at odds with efforts to quantify benefits/impacts, but that even in such cases some improvements are achievable if decision-makers are flexible regarding processes for consultation with community members and how quantification is structured.

Cultural and health implications of fish advisories in a Native American community

INTRODUCTION

Fish advisories are issued in an effort to protect human health from exposure to contaminants, but Native American communities may suffer unintended health, social, and cultural consequences as a result of warnings against eating local fish. This paper focuses on the Mohawk community of Akwesasne, which lies downstream from a Superfund site, and explores how fish advisories have impacted fish consumption and health.

METHODS

65 Akwesasne community members were interviewed between March 2008 and April 2009. Interviews were semi-structured, lasted from 30-90 minutes and consisted of open-ended questions about the impacts of environmental contamination on the community. Detailed field notes were also maintained during extensive visits between 2007-2011. Interviews were transcribed, and these transcripts as well as the field notes were analyzed in NVivo 8.0. This research received approval from the Akwesasne Task Force on the Environment Research Advisory Committee, as well as the Brown University Institutional Review Board.

RESULTS

Three-quarters of the 50 Akwesasne Mohawks interviewed have ceased or significantly curtailed their local fish consumption due to the issuance of fish advisories or witnessing or hearing about deformities on fish. Many of these respondents have turned to outside sources of fish, from other communities or from grocery stores. This change in fish consumption concerns many residents because cultural and social connections developed around fishing are being lost and because fish has been replaced with high-fat high-carb processed foods, which has led to other health complications. One-quarter of the 50 interviewees still eat local fish, but these are generally middle-aged or older residents; fish consumption no longer occurs in the multi-generational social context it once did.

CONCLUSIONS

Human health in Native American communities such as Akwesasne is intimately tied to the health of the environment. Fish advisories should not be used as an institutional control to protect humans from exposure to contaminants; if Akwesasne are to achieve optimal health, the contaminated environment has to be remediated to a level that supports clean, edible fish.