Values-Based Measures of Impacts to Indigenous Health

Preference-based measures of health-related quality of life in Indigenous people: a systematic review

PURPOSE

In many countries, there are calls to address health inequalities experienced by Indigenous people. Preference-based measures (PBMs) provide a measurement of health-related quality of life and can support resource allocation decisions. This review aimed to identify, summarize, and appraise the literature reporting the use and performance of PBMs with Indigenous people.

METHODS

Eleven major databases were searched from inception to August 31, 2022. Records in English that (1) assessed any measurement property of PBMs, (2) directly elicited health preferences, (3) reported the development or translation of PBMs for Indigenous people, or (4) measured health-related quality of life (HRQL) using PBMs were included. Ethically engaged research with Indigenous people was considered as an element of methodological quality. Data was synthesized descriptively (PROSPERO ID: CRD42020205239).

RESULTS

Of 3139 records identified, 81 were eligible, describing psychometric evaluation (n = 4), preference elicitation (n = 4), development (n = 4), translation (n = 2), and HRQL measurement (n = 71). 31 reported ethically engaged research. Reports originated primarily from Australia (n = 38), New Zealand (n = 20), USA (n = 9) and Canada (n = 6). Nearly all (n = 73) reported indirect, multi-attribute PBMs, the most common of which was the EQ-5D (n = 50).

CONCLUSION

A large number of recent publications from diverse disciplines report the use of PBMs with Indigenous people, despite little evidence on measurement properties in these populations. Understanding the measurement properties of PBMs with Indigenous people is important to better understand how these measures might, or might not, be used in policy and resource decisions affecting Indigenous people. (Funding: EuroQoL Research Foundation).

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.

Minority Community Resilience and Cultural Heritage Preservation: A Case Study of the Gullah Geechee Community

The Gullah Geechee community of the south-eastern United States endures today as a minority group with a significant cultural heritage. However, little research has been conducted to explore this community’s resilience in the face of climate change and other environmental impacts. The database Web of Science was searched and 109 publications on the Gullah Geechee community were identified. Using quantitative and qualitative methods, we analyzed the publications to identify patterns and primary research themes related to the Gullah Geechee community’s resilience. Findings revealed that Gullah Geechee‘s cultural heritage is vulnerable to climatic and societal changes, but can also be a source for enhancing community resilience and promoting more sustainable community-led heritage and tourism developments. A framework is proposed for building community resilience in the context of minority and/or marginalized communities (e.g., Gullah Geechee). This study highlights the urgent need to not only better understand and incorporate a community’s economic dimensions and losses in various decision- and policy-making processes but also their cultural and social dimensions and losses. This systematic analysis can help inform both heritage preservation and community-led tourism practices and policies related to the Gullah Geechee community, as well as help direct new research efforts focusing on minority and/or marginalized community resilience.

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.

A Cautionary Tale: Examining the Interplay of Culturally Specific Risk and Resilience Factors in Indigenous Communities

Efforts to build empirical evidence for the protective effects of Indigenous cultural factors on psychological health have yielded mixed findings. We examine the interplay of previously hypothesized culturally relevant risk (discrimination, historical loss) and protective (spiritual activities) factors among Indigenous people. The sample includes 569 Indigenous adolescents (M age = 17.23, SD = 0.88; 51.0% girls) and 563 Indigenous adult caregivers (M age = 44.66, SD = 9.18; 77.4% women). Our central finding was that indigenous spirituality was associated with poorer psychological outcomes across several domains (depressive symptoms, anger, anxiety, somatization and interpersonal difficulties), but observed effects were attenuated once perceived discrimination and historical losses were added to statistical models. Thus, consideration of relevant stressors drastically changed our conclusions, underscoring the uncertain dynamics through which specific Indigenous cultural factors impact mental health. Researchers should work in collaboration with Indigenous communities to improve measurement and empirical investigation of these complex constructs.