Indigenous communities and climate-related hazards: A protocol for a systematic review

As reported by World Bank figures, in 2020, there were about 476 million indigenous people living in more than 90 countries around the world. They represented more than 6 % of the world's population. Approximately 15 % of these indigenous people lived in conditions of extreme poverty, facing economic disparity and chronic vulnerability [36]. This review analyzes the risks faced by indigenous communities due to climate change and their perception of risk. Hazards are identified in different regions, considering direct and indirect impacts on territories, resources and ways of life.

Assessing inclusiveness for indigenous communities in mineral rights allocation in Ghana

Ghana is blessed with an abundance of mineral resources. These mineral resources are situated in indigenous communities, but the ownership is vested in the government. Indigenous communities where these resources are located are mostly marginalized. Significant legal reforms have been implemented to ensure the inclusivity of these indigenous communities in allocating mineral rights, yet the problem persists. This research investigates the legal framework that governs the allocation of mineral rights in Ghana and the impact thereof on the empowerment of indigenous communities, bringing attention to the difficulties that indigenous communities must overcome to have access to and benefit from mineral resources. To this end, one hundred and eight (108) documents, including legislations and reports on mineral rights allocation in Ghana, were analyzed using thematic analysis. The study found that the current legal framework is deficient in providing sufficient protection for the rights of indigenous communities. Specifically, the absence of a workable scheme for mineral rights allocation from various stakeholders to these indigenous communities is an identifiable lapse in the current legal framework. The findings of this research are relevant to policymakers, legal practitioners, and other stakeholders to improve the rights and well-being of indigenous communities following the analysis of the legal complexities and implications associated with the allocation of mining rights distribution of ensuing royalties inter alia expounded in this paper.

When another one bites the dust: Environmental impact of global copper demand on local communities in the Atacama mining hotspot as registered by tree rings

Assessing the impact of mining activity on the availability of environmental pollutants is crucial for informing health policies in anticipation of future production scenarios of critical minerals essential for the transition to a net-zero carbon society. However, temporal and spatial monitoring is often sparse, and measurements may not extend far enough back in time. In this study, we utilize variations of chemical elements contained in tree-rings collected in local villages from an area heavily affected by copper mining in the Atacama Desert since the early 20th century to evaluate the temporal distribution of pollutants and their relationship with local drivers. By combining time-varying data on local drivers, such as copper production and the dry tailings deposit area, we show how the surge in copper production during the 1990s, fueled by trade liberalization and increased international demand, led to a significant increment in the availability of metal(loid)s related to mining activities on indigenous lands. Our findings suggest that the environmental legislation in Chile may be underestimating the environmental impact of tailing dams in neighboring populations, affecting the well-being of Indigenous Peoples from the Atacama mining hotspot region. We argue that future changes in production rates driven by international demand could have negative repercussions on the environment and local communities. Therefore, mining emissions and the management of tailing dams should be carefully considered to anticipate their potential negative effects on human and ecosystem health.

Local knowledge of homegarden plants in Miao ethnic communities in Laershan region, Xiangxi area, China

BACKGROUND

Homegardens are small-scale land use systems with significant implications for local livelihoods, biodiversity conservation, and sustainable development due to their diverse flora and fauna. Conducting homegarden surveys enables researchers to gain insights into the traditional ecological knowledge of indigenous communities, preserve homegarden biodiversity, and promote sustainable livelihoods. This study has two objectives: first, to collect, record, and organize data on homegarden plants and related traditional knowledge from three communities in the Laershan Plateau, and second, to analyze the species and functional diversity of homegarden plants in the region while exploring the factors that contribute to the heterogeneous distribution of these plants among the communities of three townships.

METHODS

This research employed field surveys in the Laershan Miao Autonomous Region in Xiangxi, China, from September 2021 to August 2023. Data were collected through observation and semi-structured interviews. The study utilized descriptive statistics and quantitative analysis, including the Relative Importance Value (RI), Use Value Index (UV), Jaccard Index (JI), and Comprehensive Index of Land Use Degree (La), to examine the diversity of local homegarden plants and related traditional knowledge, as well as community heterogeneity.

RESULTS

The study area exhibited rich biodiversity, with 152 plant species recorded belonging to 62 families and 124 genera. These findings highlight the importance of homegarden plants in maintaining ecological balance and enhancing system resilience against disturbances. Homegarden plants serve multiple functions such as food, ornamental, medicinal, and fodder purposes, with edible and trade plants having the most abundant knowledge. Furthermore, this research revealed that communities with similar forest resource compositions may have similar homegarden plant compositions, demonstrating the connection between cultural exchange among different communities and patterns of plant species distribution.

CONCLUSIONS

The Laershan region boasts diverse homegarden plant species crucial for ecological balance and resilience. Their multifunctionality reflects human impact. Plant diversity varies with residents' lifestyles, needs, and cultural exchanges. The close connection between plants and local life is clear. Factors like resource distribution, cultural exchange, and lifestyle influence plant distribution. Further research is needed for conservation and sustainable development. Future research should focus on culturally valuable plant species and traditional knowledge applications.

Navigating University Openness in Research Policy Inconsistent with Indigenous Data Sovereignty: A Case Analysis

Indigenous nations and communities in the United States have rights as sovereign governments to exercise control and ownership over all data and information generated by or from the tribes, tribal members, or tribal resources. Indigenous nations exercise these rights through data ownership policies established in response to unethical research practices in research involving Indigenous communities. Most universities in the U.S. have "openness in research" policies to ensure academic freedom to publish freely, exercised by retaining university control of data. Here, we describe our study of cultural ecosystem services in the St. Louis River estuary region (Nagaajiwanaang in the language Ojibwemowin) in Duluth, Minnesota, and Superior, Wisconsin, U.S., an area that includes portions of the 1854 and 1842 Ceded Territories and reservation lands of a local band of Ojibwe (hereafter referred to as "the Band"). In this university-led, Band-supported study, both the university and the Band sought ownership of data collected based on their respective policies, resulting in a research delay of nearly a year. We found that open research policies that do not consider Indigenous sovereignty can hamper collaboration between university researchers and tribal nations, even when there is broad agreement on research goals and objectives. University open research policies that do not explicitly address Indigenous sovereignty fall short of the open research principles they intend to support and should be revised. Formal adoption of principles for ethical research with sovereign tribal governments by universities is needed to improve coordination and trust among university and tribal researchers and members.

Examining the connection between water concerns, water anxiety, and resilience among Indigenous persons: A systematic scoping review

BACKGROUND & OBJECTIVE

Despite Canada's and the United States' acceptance of the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP), achieving equitable water, sanitation and hygiene (WASH)-related services among Indigenous peoples remain at issue for the 2030 Sustainable Development Goals (SDGs). Water anxiety is a mental health burden threatening resilience, given cultural stewardship imperatives for water well-being.

PARTICIPANTS AND SETTINGS

Peer-reviewed literature documenting water anxiety/insecurity was explored in relation to resilience among Indigenous communities in Canada and the United States (including Hawaii and Alaska).

METHODS

A systematic scoping review was conducted using three databases (Medline, Sociological Abstracts and PsycINFO) and key words pertaining to Indigenous Peoples, Canada, U.S., and water. Two reviewers screened and extracted each article.

RESULTS

The search yielded six quantitative studies. Large diversity among Indigenous communities resulted in different water concerns tied to geographical locales, industry, and the health of water bodies. Environmental concerns, poor access to safe drinking water, and negative effects of water insecurity (water costs, food scarcity) was associated with water anxiety. Indigenous ecological knowledge, cultural continuity, water advocacy, and participatory community interventions was associated with resilience.

CONCLUSION

There is limited research exploring water anxiety and resilience among Indigenous communities. Particularly among women, water related health risks, concern for future generations, and cultural gender role expectations for water stewardship, contribute to water anxiety. An important next step is to recognize water anxiety as a mental health burden, and advance Indigenous-led research to not only optimally redress water inequities, but also the broader scope of its impact to ongoing trauma among Indigenous peoples.

Maternal healthcare seeking and determinants of adequate antenatal care and institutional childbirth among Indian tribes: A cross-sectional study from nine districts

OBJECTIVE

To report the utilisation of maternal healthcare services and factors associated with adequate antenatal care and institutional childbirths among mothers in the tribal communities from nine districts in India.

METHODS

Cross-sectional data were collected from 2636 tribal women who had a childbirth experience in the past 12 months. Socio-demographic, maternal healthcare services and health system-related details were collected. Multiple logistic regression analyses were done to identify factors associated with adequate antenatal care (receiving at least four antenatal care visits, the first visit being in the first trimester and receiving a minimum of 100 iron-folic acid tablets) and institutional childbirth (mother giving birth in a health facility).

RESULTS

Only 23% of the mothers received adequate antenatal care. 82% were institutional childbirths. The logistic regression revealed that particularly vulnerable tribal groups (PVTGs), those lacking all-weather roads, and women of advanced age were at risk of inadequate antenatal care. Mother's education, health worker's home visits during pregnancy and reception of advice on antenatal care were significantly associated with the reception of adequate antenatal care. Having all-weather roads, and education of the mother and head of the household were positively associated with institutional childbirths, whereas PVTGs, children of birth order three or above, and working mothers were more likely to give childbirth at home.

CONCLUSION

PVTGs are at risk of foregoing adequate antenatal care and are more likely to give childbirth at home. Having all-weather roads is a strong correlate of adequate maternal care. Outreach activities by the health workers are to be strengthened as they are positively and significantly associated with the reception of adequate antenatal care. Investing in education and other social determinants and addressing certain socio-cultural practices is important to improve maternal health.

Beyond resilience: A scoping review of Indigenous survivance in the health literature

Health inequity scholars, particularly those engaged with questions of structural and systemic racism, are increasingly vocal about the limitations of "resilience." This is true for Indigenous health scholars, who have pushed back against resilience as a descriptor of modern Indigeneity and who are increasingly using the term survivance. Given the growing frequency of survivance in relation to health, we performed a scoping review to understand how survivance is being applied in health scholarship, with a particular interest in its relationship to resilience. Results from 32 papers indicate that health scholars are employing survivance in relation to narrative, temporality, community, decolonization, and sovereignty, with varying degrees of adherence to the term's original conception. Overwhelmingly, authors employed survivance in relation to historical trauma, leading us to propose the analogy: as resilience is to trauma, so survivance is to historical trauma. There may be value in further operationalizing survivance for health research and practice through the development of a unified definition and measurement tool, ensuring comparability across studies and supporting future strengths-based Indigenous health research and practice.

The local medicinal plant knowledge in Kashmir Western Himalaya: a way to foster ecological transition via community-centred health seeking strategies

BACKGROUND

The mountainous region of Kashmir is a biodiversity hotspot, with diverse local communities and a rich cultural history linked to nature. Mountain ecosystems are highly vulnerable to climate change. This study emphasises the need to record the indigenous ethnoecological knowledge of wild plants used for the treatment of various ailments at higher elevations in remote areas where globalisation poses a threat to this traditional knowledge.

METHODS

The field survey was carried out in 2020-2022, to collect data on wild medicinal plants. Informants were selected randomly to collect indigenous medicinal knowledge using semi-structured interviews and group discussions. Various quantitative indices were employed to evaluate ethnomedicinal data.

RESULTS

A total of 110 medicinal plants belonging to 49 families were recorded in the study area. These medicinal plants are extensively used by local communities for the treatment of 20 major disease categories. Asteraceae was the dominant family contributing (9.09%) to medicinal plants, followed by Polygonaceae (8.18%), Apiaceae (7.27%), Lamiaceae (5.45%), and Ranunculaceae (5.45%). We observed 166 remedies were used for the treatment of various diseases in humans, and 9 remedies were used for animals. The most frequently used medicinal remedy was tea or decoction (30.91%). Among the medicinal plants, herbs (85.5%) were most frequently used by the local populations of Kashmir, whereas leaves (10.26%) were used for the treatment of various ailments. Out of 110 species, 31 were endemic, 15 of which are endemic to the Kashmir region and 16 to the Western Himalaya. The highest RFC value was reported for Allium humile (0.77), the highest UV value for Fritillaria cirrhosa (1.33), and the highest ICF value for gastro-intestinal/digestive disorders (0.85).

CONCLUSIONS

Local communities still rely on wild medicinal plants for primary healthcare. These communities retained valuable indigenous knowledge, which needs to be preserved for the conservation and sustainable utilisation of natural resources. Further field exploration is required to fully explore indigenous knowledge in the mountainous regions of Kashmir, and this knowledge has the potential to support the ongoing ecological transition.

The Center for Indigenous Innovation and Health Equity: The Osage Nation's Mobile Market

Over the last decade, the Osage Nation has actively worked to build Tribal food sovereignty within the reservation where rates of chronic disease and food insecurity are higher than the United States general population. In 2013, the Nation repurposed land toward the development of a Tribal farm with the aim of providing healthy foods to Osage citizens. Produce from the farm is distributed to elders groups, at Tribal Head Starts and schools, and to support the tribal food distribution program. These efforts have led to improved vegetable intake among Osage children, contributing to improved food security, but there is concern that tribal members who live in more remote areas of the Nation or have transportation or mobility issues are not able to access farm production. In partnership with the Center for Indigenous Health Equity (CIIHE), Osage Nation engaged in a community-based participatory research study to assess reservation areas with the greatest barriers to healthy foods and to identify community priorities for intervention. Guided by the principles of food sovereignty, which assert that intervention efforts must address the underlying structural issues of inequality, Osage has designed a mobile market initiative to expand the reach of the Harvest Land farm and deliver healthy, tribally produced meats, herbs, and fresh vegetables to areas with the highest rates of food insecurity. We describe the participatory research efforts and evaluation strategies that center Osage priorities for food security and food sovereignty.

The Development of a Community-Led Alaska Native Traditional Foods Gathering

Traditional foods and foodways are a critical part of health and well-being for Alaska Native/American Indian (ANAI) peoples. However, many of these foods are being replaced by ultra-processed foods high in fat, sugar, and sodium. The cultural knowledge needed to gather, hunt, and fish to acquire these foods is not being passed down to younger generations, due to lingering effects of colonialism, leading to poor health outcomes among ANAI peoples. Southcentral Foundation (SCF) and the Center for Indigenous and Health Equity (CIIHE) are using community-based participatory research to identify and prioritize food sovereignty interventions to strengthen the transmission of cultural knowledge across generations and improve ANAI health. Through the implementation of a comprehensive landscape analysis and the development of a community advisory board, SCF has planned an Alaska Native Traditional Foods Gathering to highlight regional efforts to document, revitalize, and share cultural food knowledge and practices to build healthy communities.

The Choctaw Nation's Growing Hope Program

The Choctaw Nation of Oklahoma's Historic Preservation Department (HPD) and the Center for Indigenous Health Equity (CIIHE) are partnering to implement and evaluate food sovereignty interventions to better understand the potential impact of such programs on individual and community health. The HPD's Growing Hope Program is a food sovereignty initiative that aims to restore traditional Choctaw gardens, which were once a physical, social, and cultural center of Choctaw life. The program combines heirloom seeds and the stories of their origins, gardening education and technical assistance, cooking classes, and a Choctaw youth internship program to support intergenerational knowledge and the restoration of culture and food security. Since its inception the program has provided Choctaw families with ancestral Choctaw cultivar seeds and provided the technical assistance to support the growing of sustainable, healthy, traditional Choctaw foods.

Food Systems, Food Sovereignty, and Health: Conference Shares Linkages to Support Indigenous Community Health

The Center for Indigenous Innovation and Health Equity (CIIHE) at Oklahoma State University Center for Health Sciences (OSU-CHS) is a community-academic partnership with Indigenous peoples from Alaska, Hawai'i, and Oklahoma. The CIIHE supports communities to strengthen traditional food practices and food sovereignty and evaluate the impact of those efforts on health. In February 2022, the CIIHE sponsored and hosted a virtual conference to better understand how food sovereignty initiatives can improve health. More than 600 participants gathered to hear the latest research and practice in the areas of public health and agriculture, nutrition, community-based and Indigenous knowledge, and health economics. Community-led food sovereignty initiatives being implemented as part of the CIIHE were featured along with other Indigenous initiatives in urban, rural, and reservation communities. A survey was administered to conference participants to assess food sovereignty topics and priorities for future research. In this Practice Note, we describe innovative community-led initiatives presented as part of the conference and recommendations for action emerging from qualitative and quantitative data collected from conference participants.

Enhancing Indigenous Food Sovereignty and Community Health Through the Karuk Agroecosystem Resilience Initiative: We Are Caring for It: xúus nu'éethti

Indigenous communities in the United States experience some of the highest rates of food insecurity and diet-related diseases despite an abundance of food assistance programs and other public health interventions. New approaches that center Indigenous perspectives and solutions are emerging and urgently needed to better understand and address these challenges. This Practice Note shares lessons learned from ongoing collaboration between the Karuk Tribe and University of California, Berkeley researchers and other partners to assess and enhance food sovereignty among Tribes and Tribal communities in the Klamath River Basin. Through two participatory research and extension projects, we demonstrate the importance of centering Indigenous knowledge to strengthen research findings and identify more culturally appropriate solutions to community identified food access, health, and ecosystem challenges. Key findings suggest that approaches to food sovereignty and community health must emanate from the community, be approached holistically, reflect community values and priorities, and center Indigenous land stewardship.

Corporate Engagement Strategies in Northern Mining: Boliden, Sweden and Cameco, Canada

The role of corporations in societal outcomes continues to grow. Mining companies now face the expectation of not only providing economic benefits to communities, but act as a facilitator for social wellbeing and environmental stewardship. In the mining sector, this has placed renewed attention to defining corporate social responsibility and, in turn, how social license to operate is understood. These developments are particularly pertinent when mining operations affect Indigenous communities - where land use is central to livelihood. This study looks at the community engagement strategies of two mining companies in northern countries, Cameco (Canada) and Boliden (Sweden). By comparing their approaches, this paper explores the development of their practices over time and assess to what extent their corporate policy has translated into everyday practice and outcomes. The findings of demonstrate that high levels of trust are established when corporate approaches are built around transparency and collaboration - resulting in agreements that include long-term partnerships around socio-economic and environmental management.

Mental illness stigma among indigenous communities in Bangladesh: a cross-sectional study

BACKGROUND

Mental illnesses stigma is a universal and transcultural phenomenon. While mental illnesses stigma is pervasive in Bangladesh, very little research exists on stigma toward mental illnesses among indigenous communities. This study aimed to investigate the prevailing stigma and the risk factors among different indigenous communities in the Chattogram Hill Tracts (CHT) in Bangladesh.

METHODS

A cross-sectional survey was carried out and participants were recruited purposively from Rangamati, a South-Eastern district of Bangladesh in the CHT. Participants from various indigenous communities including Chakma, Marma, Rakhine, Tripura, and Pangkhua were recruited. The 28- item Bangla translated version of the Mental Illnesses Stigma Scale was used. Independent-samples t-test, ANOVA, and multiple regression were performed.

RESULTS

The results indicate evidence of a gender difference with females reporting more stigma than their male counterparts. Age, gender, socioeconomic status, and monthly income are associated with stigma among indigenous people. Further analyses of the subscales indicated significant differences among sociodemographic variables.

CONCLUSIONS

The results provide an insight into the prevailing stigma and associate risk factors among indigenous communities. The results may help inform anti-stigma interventions targeting indigenous communities in Bangladesh.

A Review on Traditional Ecological Knowledge and Its Role in Natural Resources Management: North East India, a Cultural Paradise

Sustainable management of natural resources plays a critical role in poverty alleviation and overall socio-economic development. North East (NE) India is blessed as a biodiversity hotspot, being also home to around 150 ethnic tribes with diverse ethical, cultural and traditional beliefs, endorsing the region as a cultural paradise rich in natural resources and traditional ecological knowledge (TEK). Conversely, the severely constrained nature of TEK, has juxtaposed TEK practices and sustainable natural resources management (NRM) in this review. Deliberating on the broader perspectives of TEK and ensuing practices, we have identified twelve sustainable development goals (SDGs) which are directly correlated to the TEK and practices of NE region. This review has meticulously detailed TEK and practices that can help in achieving various sustainable development targets of different SDGs in a more comprehensive and eco-friendly manner. Houde's manifestation to differentiate each element of TEK and practices present in the NE region of the country, such as traditional farming and irrigation systems, sacred groves, and cultural belief systems of different tribes, have been systematically analyzed and documented for each of the eight states of this region. The benefits accrued modern practices related to NRM are correlated with TEK, or adaptive empirical knowledge system. Indigenous agricultural systems, watershed management, biodiversity conservation, and ethnomedicinal therapeutic systems in NE India formed a vital part of the review. However, rapid urbanization, industrialization, and deforestation warrant an urgent need to systematically collate, document, analyze, and conserve the TEK of the indigenous communities of NE India.

"Working on a Shoestring": Critical Resource Challenges and Place-Based Considerations for Telehealth in Northern Saskatchewan, Canada

Rural, remote, and northern Indigenous communities in Canada frequently face limited access to healthcare services with ongoing physician and staff shortages, inadequate infrastructure, and resource challenges. These healthcare gaps have produced significantly poorer health outcomes for people living in remote communities than those living in southern and urban regions who have timely access to care. Telehealth has played a critical role in bridging long-standing gaps in accessing healthcare services by connecting patients and providers across distance. While the adoption of telehealth in Northern Saskatchewan is growing, its initial implementation faced several barriers related to limited and stretched human and financial resources, infrastructure challenges such as unreliable broadband, and a lack of community involvement and engaged decision-making. Emerging ethical issues during the initial implementation of telehealth in community contexts have been wide ranging including concerns around privacy that have also shaped patients' experiences and particularly the need to consider place and space within rural contexts. Drawing from a qualitative study with four Northern Saskatchewan communities, this paper offers critical perspectives on the resource challenges and place-based considerations that are shaping telehealth in the Saskatchewan context and provides recommendations and lessons learned that could inform other Canadian regions and countries. This work responds to the ethics of tele-healthcare in rural communities in Canada and contributes perspectives of community-based service providers, advisors, and researchers.

Actualizing Cultural Humility: An Exploratory Study of Veterinary Students' Participation in a Northern Community Health Rotation

Rotations in diverse, marginalized communities may offer health care students opportunities to develop cultural humility through different clinical experiences and activities. Through the actualization of cultural humility, veterinarians may offer accessible, affordable, culturally proficient, high-quality care to all their patients with a better understanding of how cultural differences affect the animal patient's health, well-being, and care. The purpose of this study was to explore whether participation in a community rotation in remote northern Indigenous communities promotes cultural humility among final-year veterinary students. Small groups of University of Calgary veterinary students travel annually to the Sahtu Settlement Area of the Northwest Territories, Canada, to participate in the Northern Community Health Rotation (NCHR). During the 4-week rotation, students spend 2.5 weeks providing veterinary services to domestic animals in five communities in the Sahtu. Eleven veterinary students who attended the NCHR between 2015 and 2020 answered exploratory open-ended questions in an online survey. Responses highlight areas of learning that contributed to their development of cultural humility. The rotation appears successful in increasing students' confidence working with people from diverse cultures, offering students opportunities to implement a client-centered approach, and advancing their capacity to recognize and challenge their preconceived biases about Indigenous cultures and animal ownership. These experiences are important to the acquisition of cultural humility for veterinary care providers.

Contribution of natural food environments to nutritional intake and biomarker status: insights from the women of indigenous santhal communities of Jharkhand, India

BACKGROUND

Many indigenous communities reside in biodiverse environments replete with natural food sources but show ​poor access and utilization.

METHODS

To understand the links between indigenous food access, dietary intakes, and biomarkers, we conducted a cross-sectional study among women of the Santhal Community (n = 211) from 17 villages in the Godda district of Jharkhand, India. Survey methods included household surveys, dietary intake assessment (24 HDR) and micronutrient and inflammatory biomarkers' estimation.

RESULTS

The diversity in access to foods from different natural sources expressed as Food access diversity index was low. This led to poor consumption and thus a low Minimum Dietary Diversity. The mean nutrient intake was less than the estimated average requirement for all nutrients. Women with higher dietary diversity scores had higher nutrient intakes. Thiamine and calcium intakes were significantly higher in women consuming indigenous foods than non-consumers. One-fourth of the women had elevated levels of inflammatory biomarkers. The prevalence of iron deficiency was approximately 70%. Vitamin A insufficiency (measured as retinol-binding protein) was observed in around 33.6% women, while 28.4% were deficient. Household access to natural food sources was associated with specific biomarkers. The access to kitchen garden (baari) was positively associated with retinol-binding protein levels and negatively with inflammatory biomarkers, while access to ponds was positively associated with ferritin levels.

CONCLUSION

The findings highlight the role of access to diverse natural foods resources, including indigenous foods, for improving nutrition security in indigenous communities. Nutrition and health programs promoting indigenous food sources should include the assessment of biomarkers for effective monitoring and surveillance.

'An incorporeal disease': COVID-19, social trauma and health injustice in four Colombian Indigenous communities

Worldwide, medical doctors and lawyers cooperate in health justice projects. These professionals pursue the ideal that, one day, every individual on Earth will be equally protected from the hazards that impair health. The main hindrances to health justice are discrimination, poverty and segregation, but we know that beyond concrete, quantifiable barriers, symbolic elements such as beliefs and fears also play a significant role in perpetuating health injustice. So, between March 2020, when the World Health Organization declared COVID-19 a global pandemic, and June 2021, when vaccines against the virus were globally available, we collected original information about the ways in which four Colombian Indigenous communities confronted COVID-19. Knowing that Colombian Indigenous communities often face health injustices, our goal was to understand the role of symbolic elements in the situation. Our main insight is that historical genocidal processes, in which the powerful have betrayed the trust of Indigenous communities, have created a trauma in the latter, resulting in reluctance and suspicion regarding the acceptance of 'gifts' from external sources, including potentially beneficial health treatments.

A Paradigm Shift is Expected in Ethnobiology: Challenges and Opportunities Post-COVID-19

Documentation of the folk knowledge of indigenous communities forms an integral part of the subject "ethnobiology". Pursuing leads obtained through ethnobiological documentation has played a key role in maintaining human health and wellbeing. The current pandemic that we are passing through is expected to strengthen the subject with many challenges and opportunities. In this paper, we highlight the avenues and the role of the subject in the times to come. We strongly believe a paradigm shift in ethnobiology is lurking around the corner.

Discrepancies in infant feeding recommendations between grandmothers and healthcare providers in rural Mexico

BACKGROUND

Infant feeding practices are rapidly changing within rural areas in Mexico, including indigenous communities. The aim of this study was to compare infant feeding recommendations between grandmothers and healthcare providers, to better understand the factors that may influence these practices within these communities. This study builds on research that recognizes the legacy of colonization as an ongoing process that impacts the lives of people through many pathways, including the substandard healthcare systems available to them.

METHODS

Qualitative study based on secondary data analysis from interviews and focus groups guided by a socioecological framework conducted in 2018 in two rural, Indigenous communities in Central Mexico. Participants were purposively selected mothers (n = 25), grandmothers (n = 11), and healthcare providers (n = 24) who offered care to children up to two years of age and/or their mothers. Data were coded and thematically analyzed to contrast the different perspectives of infant feeding recommendations and practices between mother, grandmothers, and healthcare providers.

RESULTS

Grandmothers and healthcare providers differed in their beliefs regarding appropriate timing to introduce non-milk foods and duration of breastfeeding. Compared to grandmothers, healthcare providers tended to believe that their recommendations were superior to those from people in the communities and expressed stereotypes reflected in negative attitudes towards mothers who did not follow their recommendations. Grandmothers often passed down advice from previous generations and their own experiences with infant feeding but were also open to learning from healthcare providers through government programs and sharing their knowledge with their daughters and other women. Given the contradictory recommendations from grandmothers and healthcare providers, mothers often were unsure which advice to follow.

CONCLUSIONS

There are important differences between grandmothers and healthcare providers regarding infant feeding recommendations. Healthcare providers may perceive their recommendations as superior given the neocolonial structures of the medical system. Public health policies are needed to address the different recommendations mothers receive from different sources, by harmonizing them and following an evidence-informed approach. Breastfeeding programs need to value and to seek the participation of grandmothers.

Understanding the Associations among Social Vulnerabilities, Indigenous Peoples, and COVID-19 Cases within Canadian Health Regions

Indigenous Peoples are at an increased risk for infectious disease, including COVID-19, due to the historically embedded deleterious social determinants of health. Furthermore, structural limitations in Canadian federal government data contribute to the lack of comparative rates of COVID-19 between Indigenous and non-Indigenous people. To make visible Indigenous Peoples' experiences in the public health discourse in the midst of COVID-19, this paper aims to answer the following interrelated research questions: (1) What are the associations of key social determinants of health and COVID-19 cases among Canadian health regions? and (2) How do these relationships relate to Indigenous communities? As both proximal and distal social determinants of health conjointly contribute to COVID-19 impacts on Indigenous health, this study used a unique dataset assembled from multiple sources to examine the associations among key social determinants of health characteristics and health with a focus on Indigenous Peoples. We highlight key social vulnerabilities that stem from systemic racism and that place Indigenous populations at increased risk for COVID-19. Many Indigenous health issues are rooted in the historical impacts of colonization, and partially invisible due to systemic federal underfunding in Indigenous communities. The Canadian government must invest in collecting accurate, reliable, and disaggregated data on COVID-19 case counts for Indigenous Peoples, as well as in improving Indigenous community infrastructure and services.

A kia ora, a wave and a smile: an urban marae-led response to COVID-19, a case study in manaakitanga

BACKGROUND

When COVID-19 emerged, there were well-founded fears that Māori (indigenous peoples of Aotearoa (New Zealand)) would be disproportionately affected, both in terms of morbidity and mortality from COVID-19 itself and through the impact of lock-down measures. A key way in which Kōkiri (a Māori health provider) responded was through the establishment of a pātaka kai (foodbank) that also provided a gateway to assess need and deliver other support services to whānau (in this case, client). Māori values were integral to this approach, with manaakitanga (kindness or providing care for others) at the heart of Kōkiri's actions. We sought to identify how Kōkiri operated under the mantle of manaakitanga, during Aotearoa's 2020 nationwide COVID-19 lockdown and to assess the impact of their contributions on Māori whānau.

METHODS

We used qualitative methods underpinned by Māori research methodology. Twenty-six whānau interviews and two focus groups were held, one with eight kaimahi (workers) and the other with seven rangatahi (youth) kaimahi. Data was gathered between June and October 2020 (soon after the 2020 lockdown restrictions were lifted), thematically analysed and interpreted using a Māori worldview.

RESULTS

Three key themes were identified that aligned to the values framework that forms the practice model that Kōkiri kaimahi work within. Kaitiakitanga, whānau and manaakitanga are also long-standing Māori world values. We identified that kaitiakitanga (protecting) and manaakitanga (with kindness) - with whānau at the centre of all decisions and service delivery - worked as a protective mechanism to provide much needed support within the community Kōkiri serves.

CONCLUSIONS

Māori health providers are well placed to respond effectively in a public-health crisis when resourced appropriately and trusted to deliver. We propose a number of recommendations based on the insights generated from the researchers, kaimahi, and whānau. These are that: Māori be included in pandemic planning and decision-making, Māori-led initiatives and organisations be valued and adequately resourced, and strong communities with strong networks be built during non-crisis times.

Five culturally protected water body practices in Fiji: Current status and contemporary displacement challenges

Community-based natural resource management in Oceania has its roots in culturally protected water body (CPWB) practices. However, CPWBs in Fiji have been under-researched regarding what practices exist, and the extent to which they are currently practiced. Archival research and interviews with 201 individuals across Fiji's 189 districts revealed five CPWB types. Conception, Meconium, and Circumcision CPWBs are at risk of practice cessation, while Chiefly investiture and Funerary, have 15% and 42% actively practicing districts, respectively. Primarily serving a ceremonial and food provisioning service, the view that CPWBs do not contribute to biodiversity conservation can be counterproductive to conservation efforts. CPWBs as a place-based practice are eroding due to low awareness by conservation practitioners, and exclusion from community management plans. Knowledge of CPWBs and the practical challenges of implementing them can help conservation practitioners and Indigenous peoples maintain cultural practices, while ensuring food security and conservation into the future.

Barriers to cutaneous leishmaniasis care faced by indigenous communities of rural areas in Colombia: a qualitative study

BACKGROUND

Neglected tropical diseases (NTDs) such as cutaneous leishmaniasis (CL) are often associated with rural territories and vulnerable communities with limited access to health care services. The objective of this study is to identify the potential determinants of CL care management in the indigenous communities in the rural area of the municipality of Pueblo Rico, through a people-centered approach.

METHODS

To achieve this goal, qualitative ethnographic methods were used, and a coding framework was developed using procedures in accordance with grounded theory.

RESULTS

Three dimensions that affect access to health care for CL in this population were identified: (1) contextual barriers related to geographic, economic and socio-cultural aspects; (2) health service barriers, with factors related to administration, insufficient health infrastructure and coverage, and (3) CL treatment, which covers perceptions of the treatment and issues related to the implementation of national CL treatment guidelines. This study identified barriers resulting from structural problems at the national level. Moreover, some requirements of the national guidelines for CL management in Colombia impose barriers to diagnosis and treatment. We furthermore identified cultural barriers that influence the perceptions and behavior of the community and health workers.

CONCLUSIONS

While the determinants to CL management are multidimensional, the most important barrier is the inaccessibility to CL treatment to the most vulnerable populations and its inadequacy for the socio-territorial setting, as it is not designed around the people, their needs and their context.

How did Nunavummiut youth cope during the COVID-19 pandemic? A qualitative exploration of the resilience of Inuit youth leaders involved in the I-SPARX project

This study investigated how COVID-19 has affected the wellness of a group of Inuit youth leaders in Nunavut in the context of their involvement with an ongoing mental health research initiative, the Making I-SPARX Fly in Nunavut [I-SPARX] project. The study had three goals: (1) to understand how the pandemic has affected I-SPARX leaders’ perceived involvement in the I-SPARX Project; (2) to build knowledge around how the pandemic has impacted the daily life and wellbeing of youth in Nunavummiut communities; and (3) to acquire a culturally specific understanding of their coping mechanisms and resilience strategies through the lens of Inuit Qaujimajatuqangit (IQ). Nine Inuit youth were interviewed virtually about their participation in I-SPARX, their life during the pandemic, and their coping strategies. Their comments were analysed using inductive thematic analysis. Pandemic challenges, the utility of I-SPARX teachings and participation, and culturally and community-embedded pathways to resilience were discussed.

The implications of COVID-19 on Inuit youth in remote communities are not fully understood. The current study illuminates their experiences of the pandemic to inform future research on ways in which Inuit youth might be supported in situations, such as a global pandemic, that restrict their traditional resilience-enhancing activities and create social isolation.

Barriers, frameworks, and mitigating strategies influencing the dissemination and implementation of health promotion interventions in indigenous communities: a scoping review

BACKGROUND

Many Indigenous communities across the USA and Canada experience a disproportionate burden of health disparities. Effective programs and interventions are essential to build protective skills for different age groups to improve health outcomes. Understanding the relevant barriers and facilitators to the successful dissemination, implementation, and retention of evidence-based interventions and/or evidence-informed programs in Indigenous communities can help guide their dissemination.

PURPOSE

To identify common barriers to dissemination and implementation (D&I) and effective mitigating frameworks and strategies used to successfully disseminate and implement evidence-based interventions and/or evidence-informed programs in American Indian/Alaska Native (AI/AN), Native Hawaiian/Pacific Islander (NH/PI), and Canadian Indigenous communities.

METHODS

A scoping review, informed by the York methodology, comprised five steps: (1) identification of the research questions; (2) searching for relevant studies; (3) selection of studies relevant to the research questions; (4) data charting; and (5) collation, summarization, and reporting of results. The established D&I SISTER strategy taxonomy provided criteria for categorizing reported strategies.

RESULTS

Candidate studies that met inclusion/exclusion criteria were extracted from PubMed (n = 19), Embase (n = 18), and Scopus (n = 1). Seventeen studies were excluded following full review resulting in 21 included studies. The most frequently cited category of barriers was "Social Determinants of Health in Communities." Forty-three percent of barriers were categorized in this community/society-policy level of the SEM and most studies (n = 12, 57%) cited this category. Sixteen studies (76%) used a D&I framework or model (mainly CBPR) to disseminate and implement health promotion evidence-based programs in Indigenous communities. Most highly ranked strategies (80%) corresponded with those previously identified as "important" and "feasible" for D&I The most commonly reported SISTER strategy was "Build partnerships (i.e., coalitions) to support implementation" (86%).

CONCLUSION

D&I frameworks and strategies are increasingly cited as informing the adoption, implementation, and sustainability of evidence-based programs within Indigenous communities. This study contributes towards identifying barriers and effective D&I frameworks and strategies critical to improving reach and sustainability of evidence-based programs in Indigenous communities.

REGISTRATION NUMBER

N/A (scoping review).

Healthcare professionals' experiences and perceptions regarding health care of indigenous pregnant women in Ecuador

BACKGROUND

Pregnancy is an important life experience that requires uniquely tailored approach to health care. The socio-cultural care practices of indigenous pregnant women (IPW) are passed along the maternal line with respect to identity, worldview and nature. The cultural differences between non-indigenous healthcare professionals (HPs) and IPW could present a great challenge in women's health care. This article presents an analysis from a human rights and gender perspective of this potential cultural divide that could affect the health of the IPW in an Andean region of Ecuador with the objective of describing the health challenges of IPWs as rights holders through the experiences and perceptions of HP as guarantors of rights.

METHODS

We conducted 15 in-depth interviews with HPs who care for IPW in Chimborazo, Pichincha provinces of Ecuador. We utilized a semi-structured interview guide including questions about the experiences and perceptions of HPs in delivering health care to IPW. The interviews were recorded, transcribed and subjected to thematic analysis in Spanish and translated for reporting.

RESULTS

We found disagreements and discrepancies in the Ecuadorian health service that led to the ignorance of indigenous cultural values. Common characteristics among the indigenous population such as illiteracy, low income and the age of pregnancy are important challenges for the health system. The gender approach highlights the enormous challenges: machismo, gender stereotypes and communication problems that IPWs face in accessing quality healthcare.

CONCLUSIONS

Understanding the diverse perspectives of IPW, acknowledging their human rights particularly those related to gender, has the potential to lead to more comprehensive and respectful health care delivery in Ecuador. Further, recognizing there is a gender and power differential between the provider and the IPW can lead to improvements in the quality of health care delivery and reproductive, maternal and child health outcomes.

Sleep Under Preindustrial Conditions: What We Can Learn from It

Human sleep is regulated by light in two fundamental ways: The light-dark (LD) cycle entrains a circadian clock that in turn regulates sleep timing, and light per se can acutely inhibit sleep. Throughout evolution, these sleep regulatory systems became highly sensitive to the effects of light and they can be affected by the relatively low light intensities that are used indoors. Thus, postindustrial living conditions have created built environments that have isolated humans from the natural LD cycle and exposed them to an artificial one that can affect daily sleep timing. Studying indigenous communities that have differential access to electricity, as well as communities living in highly urbanized areas, we and others have shown that human access to artificial light has delayed the daily onset of sleep but has had a smaller effect on its offset, leading to an overall reduction in sleep duration that is pervasive in modern societies. In this chapter we discuss these studies, highlight their main findings, and point to their limitations.

Exploring Indigenous Ways of Coping After a Wildfire Disaster in Northern Alberta, Canada

In May 2016, a wildfire devastated a northern region of Alberta, Canada, resulting in negative consequences on physical and mental stress, social relationships, and overall resilience among Indigenous residents. Research on coping and managing stress following a disaster has failed to incorporate unique characteristics from Indigenous perspectives. Sharing circles were held in urban and rural community settings to capture: (a) Indigenous perspectives of coping, (b) individual and collective strengths that helped Indigenous residents and communities to cope during and after the wildfire, and (c) intergenerational experiences of coping from stress among Indigenous residents. Indigenous residents' experience with coping from the wildfire was shaped by: (a) heightened physical and emotional stress, (b) existing structural inequities, and (c) strong community cohesion and connection to culture. An unexpected outcome of this research was the therapeutic value of the sharing circles for participants to share their experience.

Responsible Leadership and the Reflective CEO: Resolving Stakeholder Conflict by Imagining What Could be done

In light of grand societal challenges, most recently the global Covid-19 pandemic, there is a call for research on responsible leadership. While significant advances have been made in recent years towards a better understanding of the concept, a gap exists in the understanding of responsible leadership in emerging countries, specifically how leaders resolve prevalent moral dilemmas. Following Werhane (1999), we use moral imagination as an analytical approach to analyze a dilemmatic stakeholder conflict (between indigenous communities in rural India and an emerging market multinational enterprise headquartered in the same country) through the lense of different responsible leadership mindsets and in light of different ethical principles and moral background theories. Based on this analysis, we arrive at a tentative moral judgement, concluding that the instrumental approach is morally inferior and recommending the integrative approach as the morally superior choice. In the subsequent discussion-focussed on what "could" (instead of "should") be done, we apply the integrative script and use moral imagination as a pathway for generating morally justifiable solutions. Through this analysis, we provide novel insights on how to apply an integrative responsible leadership approach to a stakeholder conflict situation, using the single case study to expand the responsible leadership discussion to emerging markets.

Shifting cultivation and hunting across the savanna-forest mosaic in the Gran Sabana, Venezuela: facing changes

BACKGROUND

Human encroachment and overexploitation of natural resources in the Neotropics is constantly increasing. Indigenous communities all across the Amazon, are trapped between a population rise and a hot debate about the sustainability of hunting rates. The Garden Hunting hypothesis states that shifting cultivation schemes (conucos) used by Amazon indigenous communities may generate favorable conditions, increasing abundance of small and medium wildlife species close to the 'gardens' providing game for indigenous hunters.

METHODS

Here, we combined camera trap surveys and spatially explicit interview dataset on Pemón indigenous hunting scope and occurrence in a mosaic of savanna and forest in the Gran Sabana, Venezuela to evaluate to what extent the wildlife resource use corresponds to Garden Hunting hypothesis. We applied the Royle-Nichols model and binomial regression in order to: (1) assess whether abundance of small and medium wildlife species is higher close to conucos and (2) evaluate whether hunters select hunting localities based on accessibility to wildlife resources (closeness to conuco) more than wildlife abundance.

RESULTS

We find mixed evidence supporting the Garden Hunting hypothesis predictions. Abundance of small and medium species was high close to conucos but the pattern was not statistically significant for most of them. Pemón seem to hunt in locations dominated by forest, where species abundance was predicted to be higher, than in close vicinity to conucos. Hunting scope was focused on the most abundant species located close to the conuco (Cuniculus paca), but also in less abundant and unavailable species (Crax alector, Tapirus terrestris and Odocoileus virginianus).

CONCLUSIONS

Our research provided the first attempt of a systematic sampling survey in the Gran Sabana, generating a quantitative dataset that not only describes the current pattern of wildlife abundance, but sets the base-line to monitor temporal and spatial change in this region of highland Amazon. We discuss the applicability of the estimates generated as a baseline as well as, environmental challenges imposed by economic, social and cultural changes such as mining encroachment for wildlife management.

Ethical considerations for community-based participatory research with Sami communities in North Finland

This study examines the perspectives of Sami community members and university researchers regarding the ethical considerations for engagement in Community-Based Participatory Research (CBPR) with Sami communities in northern Finland. Key informant interviews were conducted with Sami people from Finland who were exposed to or participated in research in their communities as well as with researchers who have conducted research with the Sami in Finland across diverse topics. Five themes were identified: establishing trust, research preparation, research comprehension, research ethics, and inclusion in research. The differences in participant perspectives were compared based on their community versus researcher roles. Our findings emphasize the need for (1) strategies to develop and maintain trust between Sami communities and researchers; (2) methods to bridge concepts of bias projected onto Sami communities and researchers by the others' differing world views and beliefs about research; and (3) increased education in community-engaged methods for social and natural scientists working with Sami communities. This study supports the need for the development of formalized ethical protocols for conducting community-based engaged research with and for Sami people in Finland that ensure mutually beneficial research for all involved.

Alkylated polycyclic aromatic hydrocarbons are the largest contributor to polycyclic aromatic compound concentrations in traditional foods of the Bigstone Cree Nation in Alberta, Canada

Rising global demand for energy promotes extensive mining of natural resources, such as oil sands extractions in Alberta, Canada. These extractive activities release hazardous chemicals into the environment, such as polycyclic aromatic compounds (PACs), which include the parent polycyclic aromatic hydrocarbons (PAHs), alkylated PAHs, and sulfur-containing heterocyclic dibenzothiophenes (DBTs). In areas adjacent to industrial installations, Indigenous communities may be exposed to these PACs through the consumption of traditional foods. Our objective was to evaluate and compare the concentrations of total PACs (∑PAC), expressed as the sum of the 16 U.S. EPA priority PAHs (∑PAH), 49 alkylated PAHs (∑alkyl-PAH), and 7 DBTs (∑DBT) in plant and animal foods collected in 2015 by the Bigstone Cree Nation in Alberta, Canada. We analyzed 42 plant tissues, 40 animal muscles, 5 ribs, and 4 pooled liver samples. Concentrations of ∑PAC were higher in the lichen, old man's beard (Usnea spp.) (808 ± 116 ng g^-1 w.w.), than in vascular plants, and were also higher in smoked moose (Alces alces) rib (461 ± 120 ng g^-1 w.w.) than in all other non-smoked animal samples. Alkylated-PAHs accounted for between 63% and 95% of ∑PAC, while the concentrations of ∑PAH represented 4%-36% of ∑PAC. Contributions of ∑DBT to ∑PAC were generally lowest, ranging from <1% to 14%. While the concentrations of benzo(a)pyrene (B[a]P) and ∑PAH4 (∑benzo[a]anthracene, chrysene, benzo[b]fluoranthene, and B[a]P) in all samples were below guideline levels for human consumption as determined by the European Commission, guideline levels for the more prevalent alkylated PAHs are not available. Given the predominance of alkylated PAHs in all food samples and the potentially elevated toxicity relative to parent PAHs of this class of PACs, it is critical to consider a broader range of PACs other than just parent PAHs in research conducted close to oil sands mining activities.

Alkylated polycyclic aromatic hydrocarbons are the largest contributor to polycyclic aromatic compound concentrations in traditional foods of the Bigstone Cree Nation in Alberta, Canada

Rising global demand for energy promotes extensive mining of natural resources, such as oil sands extractions in Alberta, Canada. These extractive activities release hazardous chemicals into the environment, such as polycyclic aromatic compounds (PACs), which include the parent polycyclic aromatic hydrocarbons (PAHs), alkylated PAHs, and sulfur-containing heterocyclic dibenzothiophenes (DBTs). In areas adjacent to industrial installations, Indigenous communities may be exposed to these PACs through the consumption of traditional foods. Our objective was to evaluate and compare the concentrations of total PACs (∑PAC), expressed as the sum of the 16 U.S. EPA priority PAHs (∑PAH), 49 alkylated PAHs (∑alkyl-PAH), and 7 DBTs (∑DBT) in plant and animal foods collected in 2015 by the Bigstone Cree Nation in Alberta, Canada. We analyzed 42 plant tissues, 40 animal muscles, 5 ribs, and 4 pooled liver samples. Concentrations of ∑PAC were higher in the lichen, old man's beard (Usnea spp.) (808 ± 116 ng g^-1 w.w.), than in vascular plants, and were also higher in smoked moose (Alces alces) rib (461 ± 120 ng g^-1 w.w.) than in all other non-smoked animal samples. Alkylated-PAHs accounted for between 63% and 95% of ∑PAC, while the concentrations of ∑PAH represented 4%-36% of ∑PAC. Contributions of ∑DBT to ∑PAC were generally lowest, ranging from <1% to 14%. While the concentrations of benzo(a)pyrene (B[a]P) and ∑PAH4 (∑benzo[a]anthracene, chrysene, benzo[b]fluoranthene, and B[a]P) in all samples were below guideline levels for human consumption as determined by the European Commission, guideline levels for the more prevalent alkylated PAHs are not available. Given the predominance of alkylated PAHs in all food samples and the potentially elevated toxicity relative to parent PAHs of this class of PACs, it is critical to consider a broader range of PACs other than just parent PAHs in research conducted close to oil sands mining activities.

Dataset: Ecosystem services and uses of dune systems of the coast of the Araucanía Region, Chile: A perception study

The dataset shows the relationship and valuation of the coastal dunes of the Araucanía region in Chile. The valuation of the local population was surveyed using a questionnaire applied to 49 subjects belonging to Mapuche communities and local government. The data consists of eight tables that show a list of questions, the number of times per year that visit the dunes, cultural practices carried out in the dunes, valuation of ecosystem services provided by the coastal dunes, and knowledge about flora and fauna. Lastly, the original questionnaire and its responses in Spanish and English are included in supplemantary material. This dataset was generated within the framework of the manuscript "Ecosystem services and uses of dune systems of the coast of the Araucanía Region, Chile: a perception study" where 23 leaders of Mapuche communities and 26 representatives of the local government were interviewed. The dataset can be used to compare the valuation of ecosystems by local communities, especially when quantitative data are scarce or do not exist.

Planning for social and community-engaged closure: A comparison of mine closure plans from Canada's territorial and provincial North

The inevitable closure and remediation phase of a mine's lifecycle routinely causes negative socio-economic and environmental impacts for nearby communities. While closure planning is meant to ensure post-closure human and environmental safety, it tends to favour short-term technical fixes over longer-term socio-economic, cultural, and ecological considerations. For mines operating on Indigenous territories, where communities have complex and nuanced connections to land and varying levels of jurisdiction, these issues are further exacerbated by the exclusion of Indigenous voices from planning and decision-making. This research employed a qualitative document analysis of ten mine closure plans for mines in Northern Canada that are still operational to understand how the industry is actively planning for the closure and remediation of their sites. In particular, this work asks whether or not mine companies are incorporating Indigenous Knowledge into their mine closure plans, and how they are addressing the complex socio-economic aspects of closure. This analysis showed that mine closure plans across Northern Canada inconsistently apply Indigenous Knowledge and expertise, and the methods used for community consultation in mine closure planning are left vague. While differences in policy between Northern territories and regions account for some of these inconsistencies, a company's willingness to work beyond baseline requirements imposed by governments is also an important factor. Additionally, these closure plans further demonstrate that the industry prioritizes technical aspects of mine closure over the social, cultural, economic, and ecological. For mine closure to be successful in a Northern context it must incorporate community expertise, emerge from the values and priorities of the Indigenous peoples whose lands mines are operating on, and account for a wider scope of social, economic, and cultural impacts.

Language, Culture, and Collectivism: Uniting Coalition Partners and Promoting Holistic Health in the Menominee Nation

Recent perspectives on Indigenous health have recognized language, culture, and values as central to well-being and recovery from historical trauma. Health coalitions, which identify community health concerns and mobilize members to implement strategies for change, have begun to shift their focus from programs to policy, systems, and environmental change but have been slower to recognize the possibilities of centering Indigenous ways of being in their work. This article details a case study of the Menominee Wellness Initiative, an Indigenous health coalition that has increasingly made language, culture, and collective values the focus of their health promotion work, and often due to the participation and influence of community organizers in the coalition. The study is presented as a collaborative writing effort between coalition members and academic partners. Qualitative data were gathered through observations of coalition meetings; in-depth, semistructured interviews with coalition members; and interactive data analysis discussions within the collaborative writing team. In the results, we describe how the shift in the coalition's framework came to be and the influence this shift has had on the coalition, its activities, and its community impacts. These findings illustrate and extend understanding of several principles of Collaborating for Equity and Justice and supports literature and practice related to health promotion through the centering of Indigenous ways.

"Everything is provided free, but they are still hesitant to access healthcare services": why does the indigenous community in Attapadi, Kerala continue to experience poor access to healthcare?

BACKGROUND

Inequity in access to healthcare services is a constant concern. While advances in healthcare have progressed in the last several decades, thereby significantly improving the prevention and treatment of disease, these benefits have not been shared equally. Excluded communities such as Indigenous communities typically face a lack of access to healthcare services that others do not. This study seeks to understand why the indigenous communities in Attapadi continue to experience poor access to healthcare in spite of both financial protection and adequate coverage of health services.

METHODS

Ethnographic fieldwork was carried out among the various stakeholders living in Attapadi. A total of 47 in-depth interviews and 6 focus group discussions were conducted amongst the indigenous community, the healthcare providers and key informants. The data was coded utilising a reflexive and inductive approach leading to the development of the key categories and themes.

RESULTS

The health system provided a comprehensive financial protection package in addition to a host of healthcare facilities for the indigenous communities to avail services. In spite of this, they resisted attempts by the health system to improve their access. The failure to provide culturally respectful care, the discrimination of the community at healthcare facilities, the centralisation of the delivery of services as well as the lack of power on the part of the indigenous community to negotiate with the health system for services that were less disruptive for their lives were identified as the barriers to improving healthcare access. The existing power differentials between the community and the health system stakeholders also ensured that meaningful involvement of the community in the local health system did not occur.

CONCLUSION

Improving access to health care for indigenous communities would require UHC interventions to be culturally safe, locally relevant and promote active involvement of the community at all stages of the intervention. Continuing structural power imbalances that affect access to resources and prevent meaningful involvement of indigenous communities also need to be addressed.

A case study of using the He Pikinga Waiora Implementation Framework: challenges and successes in implementing a twelve-week lifestyle intervention to reduce weight in Māori men at risk of diabetes, cardiovascular disease and obesity

Background

Māori men have stark health inequities around non-communicable diseases. This study describes the case of a partnership attempting to develop and implement a culturally centred intervention through a collaborative partnership to potentially address the inequities. In particular, the partnership followed a participatory, co-design approach using the He Pikinga Waiora (HPW) Implementation Framework; the study presents lessons learnt in addressing health inequities following this framework.

Methods

The partnership involved a university research team and a Māori community health provider. They engaged with other stakeholders and several cohorts of Māori men through a co-design process to adapt a 12-week lifestyle intervention. The co-design process was documented through meeting notes and interviews with partners. Two cohorts participated in separate single group pre-intervention/post-intervention designs with multi-method data collection. Key outcome measures included weight loss, self-reported health, physical activity, and nutrition. Post-intervention data collection included qualitative data.

Results

The co-design process resulted in a strong and engaged partnership between the university team and the provider. There were significant challenges in implementing the intervention including having two additional partner organisations dropping out of the partnership just after the initial implementation phase. However, a flexible and adaptable partnership resulted in developing two distinct lifestyle interventions run with 32 Māori men (in two different cohorts of 8 and 24). All but one in the first cohort completed the programme. The first cohort had a modest although statistically insignificant improvement in weight loss (d = 1.04) and body mass index (BMI; d = 1.08). The second cohort had a significant reduction in weight loss (d = 1.16) and BMI (d = 1.15). They also had a significant increase in health-related quality of life (d = 1.7) and self-rated health (d = 2.0).

Conclusion

The HPW Framework appears to be well suited to advance implementation science for Indigenous communities in general and Māori in particular. The framework has promise as a policy and planning tool to evaluate and design interventions for chronic disease prevention in Indigenous communities. Despite this promise, there are structural challenges in developing and implementing interventions to address health inequities.

Trial registration

Retrospectively registered, Australia New Zealand Clinical Trials Registry, ACTRN12619001783112.

Barriers and Mitigating Strategies to Healthcare Access in Indigenous Communities of Canada: A Narrative Review

The objective of this review is to document contemporary barriers to accessing healthcare faced by Indigenous people of Canada and approaches taken to mitigate these concerns. A narrative review of the literature was conducted. Barriers to healthcare access and mitigating strategies were aligned into three categories: proximal, intermediate, and distal barriers. Proximal barriers include geography, education attainment, and negative bias among healthcare professionals resulting in a lack of or inadequate immediate care in Indigenous communities. Intermediate barriers comprise of employment and income inequities and health education systems that are not accessible to Indigenous people. Distal barriers include colonialism, racism and social exclusion, resulting in limited involvement of Indigenous people in policy making and planning to address community healthcare needs. Several mitigation strategies initiated across Canada to address the inequitable health concerns include allocation of financial support for infrastructure development in Indigenous communities, increases in Indigenous education and employment, development of culturally sensitive education and medical systems and involvement of Indigenous communities and elders in the policy-making system. Indigenous people in Canada face systemic/policy barriers to equitable healthcare access. Addressing these barriers by strengthening services and building capacity within communities while integrating input from Indigenous communities is essential to improve accessibility.

Microscopic and submicroscopic Plasmodium infections in indigenous and non-indigenous communities in Colombia

BACKGROUND

The indigenous population is considered a highly susceptible group to malaria because individuals usually live in areas with high exposure to Anopheles and poverty, and have limited access to health services. There is a great diversity of indigenous communities in Colombia living in malaria-endemic areas; however, the burden of infection in these populations has not been studied extensively. This study aimed to determine the prevalence of Plasmodium infections in indigenous and non-indigenous communities in two malaria-endemic areas in Colombia.

METHODS

A community-based cross-sectional survey was conducted in seven villages of Turbo and El Bagre municipalities; three of these villages were indigenous communities. Inhabitants of all ages willing to participate were included. Sociodemographic and clinical data were recorded as well as household information. The parasitological diagnosis was performed by microscopy and nested PCR. The prevalence of microscopy and submicroscopic infection was estimated. An adjusted GEE model was used to explore risk factors associated with the infection.

RESULTS

Among 713 participants, 60.7% were from indigenous communities. Plasmodium spp. was detected in 30 subjects (4.2%, CI 95% 2.9-5.9); from those, 29 were in the indigenous population, 47% of infections were afebrile, and most of them submicroscopic (10/14). Microscopic and submicroscopic prevalence was 2.5% (CI 95% 1.6-3.9) and 1.7% (CI 95% 0.9-2.9), respectively. In El Bagre, all infections occurred in indigenous participants (3.9%, CI 95% 2.2-7.1), and 81% were submicroscopic. By contrast, in Turbo, the highest prevalence occurred in indigenous people (11.5%; CI 95%: 7.3-17.5), but 88.8% were microscopic. Living in an indigenous population increased the prevalence of infection compared with a non-indigenous population (PR 19.4; CI 95% 2.3-166.7).

CONCLUSION

There is a high proportion of Plasmodium infection in indigenous communities. A substantial proportion of asymptomatic and submicroscopic carriers were detected. The identification of these infections, not only in indigenous but also in the non-indigenous population, as well as their associated factors, could help to implement specific malaria strategies for each context.

Community mobilisation to prevent violence against women and girls in eastern India through participatory learning and action with women's groups facilitated by accredited social health activists: a before-and-after pilot study

Background

Almost one in three married Indian women have ever experienced physical, sexual, or emotional violence from husbands in their lifetime. We aimed to investigate the preliminary effects of community mobilisation through participatory learning and action groups facilitated by Accredited Social Health Activists (ASHAs), coupled with access to counselling, to prevent violence against women and girls in Jharkhand, eastern India.

Methods

We piloted a cycle of 16 participatory learning and action meetings with women’s groups facilitated by ASHAs in rural Jharkhand. Participants identified common forms of violence against women and girls, prioritised the ones they wanted to address, developed locally feasible strategies to address them, implemented the strategies, and evaluated the process. We also trained two counsellors and two ASHA supervisors to support survivors, and gave ASHAs information about legal, health, and police services. We did a before-and-after pilot study involving baseline and endline surveys with group members to estimate preliminary effects of these activities on the acceptability of violence, prevalence of past year emotional and physical violence, and help-seeking.

Results

ASHAs successfully conducted monthly participatory learning and action meetings with 39 women’s groups in 22 villages of West Singhbhum district, Jharkhand, between June 2016 and September 2017. We interviewed 59% (679/1149) of women registered with groups at baseline, and 63% (861/1371) at endline. More women reported that violence was unacceptable in all seven scenarios presented to them at endline compared to baseline (adjusted Odds Ratio [aOR]: 1.87, 95%: 1.39–2.52). Fewer women reported experiencing emotional violence from their husbands in the last 12 months (aOR: 0.55, 95% CI: 0.43–0.71), and more sought help if it occurred (aOR: 2.19, 95% CI: 1.51–3.17). In addition, fewer women reported experiencing emotional or physical violence from family members other than their husbands in the last 12 months (aOR: 0.41, 95% CI: 0.32–0.53, and aOR: 0.36, 95% CI: 0.26–0.50, respectively).

Conclusion

Combining participatory learning and action meetings facilitated by ASHAs with access to counselling was an acceptable strategy to address violence against women and girls in rural communities of Jharkhand. The approach warrants further implementation and evaluation as part of a comprehensive response to violence.

Barriers to cervical cancer screening in Guatemala: a quantitative analysis using data from the Guatemala Demographic and Health Surveys

OBJECTIVES

Examine the association between commonly reported barriers to health care, including discordant spoken languages between patients and providers, and reported previous cervical cancer screening.

METHODS

Data from the nationally representative Guatemala National Maternal and Child Health Survey from the Demographic and Health Surveys Program were used to explore associations between barriers and screening rates nationwide and in high-risk populations, such as rural and indigenous communities. Negative binomial regressions were run accounting for survey sample weights to calculate prevalence ratios.

RESULTS

64.0%, 57.5% and 47.5% of women reported ever screening, in the overall, indigenous, and rural populations, respectively. Overall, never screened for cervical cancer was associated with the following health barriers: needing permission, cost, distance, not wanting to go alone, and primary language not spoken by health providers, even after adjustment for age, ethnicity, and literacy.

CONCLUSIONS

Offering screening programs alone is not enough to reduce the burden of cervical cancer in Guatemala. Measures need to be taken to reduce barriers to health care, particularly in rural areas, where screening rates are lowest.

Polychlorinated biphenyl (PCB) contamination of subsistence species on Unalaska Island in the Aleutian Archipelago

Polychlorinated biphenyls (PCBs) are a group of synthetic, lipophilic organochlorines that were banned due to their impacts on human and wildlife health and environmental persistence. Although banned, the continued release from pre-banned products allows them to persist at toxic levels in the environment. This is especially the case in lipid rich food webs of the Arctic, where PCBs accumulate due to both long-range atmospheric transport and locally contaminated sites such as formerly used defense (FUD) sites. At the request of the leadership of the Qawalangin Tribe of Unalaska Island in the Aleutian Archipelago, we analyzed PCB concentrations in samples of threespine stickleback (Gasterosteus aculeatus) and subsistence foods (i.e., salmonid species and blue mussels [Mytilus edulis]) collected at both FUD and non-FUD sites. PCBs were extracted from samples using a QuEChERS method. The mean PCB concentrations across all mussel samples was 6.1 ppb; mussels from FUD sites had nearly double the PCB concentrations (7.6 ppb) compared to non-military sites (3.9 ppb), and at two FUD sites the PCB concentrations exceeded safe consumption guidelines. The mean total PCB concentration for fish was 2.8 ppb; fish PCB concentrations were higher at FUD sites (3.2 ppb) compared to non-military sites (1.2 ppb). These results support the need to remediate the FUD sites of "Building 551/T Dock to Airport" and "Delta Western". More generally, these results provide further evidence of the continued problem of PCB contamination at FUD sites in the Arctic, many of which are co-located with indigenous communities.

'Desculturización,' urbanization, and nutrition transition among urban Kichwas Indigenous communities residing in the Andes highlands of Ecuador

BACKGROUND

The nutrition transition continues to affect populations throughout the world. The added impact of market integration and urbanization exacerbates the impact of the nutrition transition upon Indigenous populations worldwide.

OBJECTIVES

This study aims to explore the nutritional concerns of the urban Kichwas community residing in the Andes highlands of Ecuador.

STUDY DESIGN

This is a qualitative study.

METHODS

Eight focus groups were conducted with Kichwas men and women in November 2015 in the Imbabura province of the Andes in Ecuador.

DATA ANALYSIS

Applied thematic analysis was used to analyze findings regarding nutrition.

RESULTS

The participants shared concerns regarding increased intake of fast food, poor meal timing, and a shift in the child's food preferences that rejects traditional foods. They attributed these concerns to urbanization resulting from an increase in dual-income households and a loss of cultural identity.

CONCLUSIONS

Synergistic cultural factors are related to nutritional concerns voiced by the urban Kichwas community.

PUBLIC HEALTH IMPLICATIONS

Syndemic theory is a useful interpretive lens regarding nutritional trends within the Kichwas communities as they relate to the increased risk of chronic disease.

Do individual liquor permit systems help Indigenous communities to manage alcohol?

Introduction and Aims

Liquor permits were once used throughout Scandinavia and North America for managing alcohol, but largely disappeared in the late 20th century. Today, they are used in some Indigenous communities in Nunavut, Canada and the Northern Territory, Australia. This paper examines the extent to which liquor permits: (i) contribute to reducing alcohol‐related harms in Indigenous communities; and (ii) offer a viable mechanism for managing alcohol in Indigenous communities.

Design and Methods

The study draws on published and unpublished international literature on liquor permit systems in Indigenous communities, and on field visits to northern territory (NT) communities.

Results

Apart from one anecdotal report, the study found no evidence that liquor permit systems in Nunavut communities have reduced alcohol‐related problems. In the NT, they have reduced alcohol‐related harms in some communities. However, management of liquor permit systems generates significant administrative demands in communities.

Discussion and Conclusions

Effectiveness of liquor permit systems is a product of five factors: permits themselves; agencies and procedures for issuing and managing permits; agencies and procedures for supplying liquor; enforcement of permit conditions, and the presence of other agencies—legal and illegal—affecting supply and consumption of liquor. Liquor permits continue to be valued by some Indigenous communities for managing alcohol. This study suggests that they can do so provided: (i) agencies administering permits have adequate support; (ii) controls over non‐legal purchasing and consumption of liquor are effective, and (iii) the permit system is viewed in the community as legitimate, equitable and transparent.