What we do matters: Supporting anti-racism and decolonisation of public health teaching and practice through the development of Māori public health competencies

OBJECTIVE

This research sought to expand on a set of core Māori hauora ā-iwi/public health competencies initially designed for teaching and to enable their use in workplaces.

METHODS

The research used a kaupapa Māori methodology in four stages including the development of draft levels of competence for all core competencies, consultation hui (meetings), analysis of feedback and redrafting, and respondent validation.

RESULTS

Key themes elicited in relation to the content of the competencies included increasing language expectations, the importance of strength-based approaches and self-determination, and the need for individual responsibility to address structural racism. Reflective practice was identified as a fundamental cross-cutting competency. Participants suggested planetary health and political ideologies be included as additional socio-political determinants of health with equity impacts. Key concerns related to the application of the competency document included the need for cultural safety and ensuring that all public health practitioners are 'seen'.

CONCLUSIONS

The Māori hauora ā-iwi/public health competencies have been published under a Creative Commons licence.

IMPLICATIONS FOR PUBLIC HEALTH

The process of drafting a set of Māori public health competencies elicited key themes potentially relevant for public health practice in other countries and resulted in a competency document for use by universities and workplaces.

Climate change, biodiversity loss, and Indigenous Peoples' health and wellbeing: A systematic umbrella review

Indigenous Peoples worldwide are experiencing a cascade of impacts on their health and wellbeing as a result of climate change and biodiversity loss. Existing literature at the interface of climate change, biodiversity loss, and Indigenous health tells us that Indigenous Peoples are among those most disproportionately and acutely affected by these impacts. Yet, a gap exists with respect to comprehensively and critically synthesizing the impacts reported across this literature and identifying Indigenous-led responses. Guided by an Indigenous advisory group, we employed a systematic umbrella review methodology, following PRISMA guidelines, to characterize the global secondary literature (PROSPERO registration #: CRD42023417060). In so doing, we identified the proximal, intermediate, distal, and gendered impacts of climate change and biodiversity loss on Indigenous health and wellbeing as well as Indigenous-led responses. Five databases were searched for published reviews, along with a grey literature search that focused on underrepresented geographic regions in the academic literature. Two independent reviewers conducted two-stage screening, data extraction, and quality assessment of retrieved records. Basic descriptive statistics were calculated. Qualitative data were analyzed thematically, using a constant comparative approach. A total of 38 review articles met the eligibility criteria and 37 grey literature records were retrieved and included in the review. Reviews were published between 2010-2023 and geographically clustered in the Circumpolar North. Intersecting proximal, intermediate, and distal impacts were characterized as place-based and specific, and linked to colonialism as an antecedent to and driver of these impacts. Gendered impacts were underexplored within reviews. Reviewed literature underscored the value of engaging diverse knowledge systems; platforming localized, community-led adaptation to climate change and biodiversity loss, while addressing sociopolitical constraints to these efforts; and applying a broader conceptualization of health that aligns with Indigenous frameworks. Going forward, we must foreground equity- and rights-based considerations within integrated responses to climate and biodiversity crises.

Kin relationality and ecological belonging: a cultural psychology of Indigenous transcendence

In this article, we consider prosociality through the lens of an Indigenous "ethics of belonging" and its two constitutive concepts: kin relationality and ecological belonging. Kin relationality predicates that all living beings and phenomena share a familial identity of interdependence, mutuality, and organization. Within the value system of ecological belonging, an individual's identity is constituted in relation to the natural environment, centered on the sentiments of responsibility and reverence for Nature. We detail how Indigenous perspectives upon prosociality differ from Western scientific accounts in terms of the motives, scope, and rewards of altruistic action. Grounded in this understanding, we then profile three self-transcendent states, compassion, gratitude, and awe, and their similarities across Indigenous and Western approaches, and how kin relationality and ecological belonging give rise to cultural variations. We consider convergent insights across Indigenous and Western science concerning the role of ritual and narrative and the cultural cultivation of kin relationality and ecological belonging. We conclude by highlighting how these two core concepts might guide future inquiry in cultural psychology.

Indigenous Peoples: Traditional knowledges, climate change, and health

Indigenous Peoples around the globe make up approximately six percent of the global population, yet they sustainably care for around eighty percent of the world's remaining biodiversity. Despite continued political, economic, and racial marginalization, as well as some of the worst health inequities on the planet, Indigenous Peoples have worked hard to maintain their cultures and languages against all odds. Indigenous Peoples' close connections to land, water, and ecosystems, however, have placed them at increasing vulnerability from the effects of climate change. With this, the health risks from climate change have unique considerations within Indigenous Nations for both mitigation and adaptation responses that are largely unappreciated. This Indigenous narrative review will synthesis the current climate and health landscape of Indigenous Peoples at a global, high-level scale, including relevant international mechanisms and considerations for Indigenous Peoples' health. This Indigenous narrative review will also explore and reflect on the strengths of Indigenous traditional knowledges as it pertains to climate change and health.

"We Need to Live off the Land": An Exploration and Conceptualization of Community-Based Indigenous Food Sovereignty Experiences and Practices

Although Indigenous food systems are sustainable in nature, many of these systems have been forcibly altered among Indigenous communities within Canada, as a consequence of colonization. Indigenous Food Sovereignty (IFS) movements work to counteract the dismantling of Indigenous food systems as well as the negative health impacts of environmental dispossession experienced by Indigenous communities. Through community-based participatory research methodologies and the utilization of Etuaptmumk, or two-eyed seeing, this research project explored community perspectives of IFS in Western Canada. Reflexive thematic analysis of qualitative data collected during a sharing circle held with community members identified the influence of Indigenous Knowledge and community support on three main aspects of Indigenous food sovereignty, including (1) environmental concerns, (2) sustainable practices and (3) a strong relationship with the land and waters. Through the sharing of stories and memories related to traditional foods and current sovereignty projects, community members identified concerns for their local ecosystem as well as a desire to preserve its natural state for generations to come. The strengthening of IFS movements is critical to the overall wellbeing of Indigenous communities within Canada. Support is needed for movements that honour relationships with traditional foods and recognize traditional lands and waters as necessary for healing and sustaining the health of Indigenous communities.

Te Maramataka-An Indigenous System of Attuning with the Environment, and Its Role in Modern Health and Well-Being

The connection between the natural environment and human health is well documented in Indigenous narratives. The maramataka-a Māori system of observing the relationships between signs, rhythms, and cycles in the environment-is underpinned by generations of Indigenous knowledge, observation, and experimentation. The maramataka enabled Māori and our Pacific relatives to attune with the movements of the environment and ensure activities essential for survival and well-being were conducted at the optimal times. A recent revival of the maramataka in various communities in New Zealand is providing uniquely Indigenous ways to 'reconnect' people, and their health, with the natural environment. In a world where people have become increasingly disconnected from the natural environment, the maramataka offers an alternative to dominant perspectives of health. It also provides a mechanism to enhance the many facets of health through an understanding of the human-ecosystem relationship in a uniquely Indigenous way. This conceptual paper (i) highlights a uniquely Indigenous way of understanding the environment (the maramataka) and its connection to health, (ii) discusses the connections between the maramataka and scientific research on health and the environment, and (iii) introduces current and potential applications of the maramataka in improving health and well-being.

All systems are interrelated: Multilevel interventions with indigenous communities

Colonial historical trauma and ongoing structural racism have impacted Indigenous peoples for generations and explain the ongoing health disparities. However, Indigenous peoples have been engaging in multilevel, clinical trial interventions with Indigenous and allied research scientists resulting in promising success. In this paper, National Institutes of Health funded scientists in the field of Indigenous health have sought to describe the utility and need for multilevel interventions across Indigenous communities (Jernigan et al., 2020). We posit limitations to the existing socioecological, multilevel frameworks and propose a dynamic, interrelated heuristic framework, which focuses on the inter-relationships of the collective within the environment and de-centers the individual. We conclude with identified calls for action within multilevel clinical trial research.

Patient- and Community-Oriented Primary Care Approaches for Health in Rural, Remote and Resource-Dependent Places: Insights for Eco-Social Praxis

Accelerating ecological and societal changes require re-imagining the role of primary care and public health to address eco-social concerns in rural and remote places. In this narrative review, we searched literatures on: community-oriented primary care, patient-oriented research engagement, public health and primary care synergies, and primary care addressing social determinants of health. Our analysis was guided by questions oriented to utility for addressing concerns of social-ecological systems in rural, remote contexts characterized by a high degree of reliance on resource extraction and development (e.g., forestry, mining, oil and gas, fisheries, agriculture, ranching and/or renewables). We describe a range of useful frameworks, processes and tools that are oriented toward bolstering the resilience and engagement of both primary care and public health, though few explicitly incorporated considerations of eco-social approaches to health or broader eco-social context(s). In synthesizing the existing evidence base for integration between primary care and public health, the results signal that for community-oriented primary care and related frameworks to be useful in rural and remote community settings, practitioners are required to grapple with complexity, durable relationships, sustainable resources, holistic approaches to clinician training, Indigenous perspectives, and governance.

River conversations: A confluence of lessons and emergence from the Taieri River and the Nechako River

Drawing on ongoing patterns of learning and relationship, this paper offers a reflection and acknowledgement on the notable influence of two rivers and their role as respected and highly valued "eco-social elders": The Taieri River in Otago, New Zealand, and the Nechako River in northern British Columbia, Canada. The paper is motivated by the question: "If a river has 'voice', what can be learned from the emergence arising from rivers 'in conversation'?". At the heart of the reflection are the themes of confluence and emergence-ways in which we grasp the coming together of things, especially when that combination is more than the sum of their parts. The paper aims to explore a "conversation" between the river teachings of the Taieri River and the Nechako River, identifying examples of patterns and connections between distinct river "voices," and how these may contribute to emergence and ongoing conversations among different rivers and their teachings. The paper commences with an introduction to both rivers, identifying points of direct comparison and contrast, then moving to explore themes of confluence, weaving and emergence, combining ecological, metaphorical, and personal perspectives. The conversation then progresses downstream to river-ocean relationships, reflecting on rivers as eco-social elders that inspire conversations, provide a sense of home, and offer a point of reference to consider the wider influence on rivers and waterways on the health of diverse species within catchments and across the planet.

Towards healthy One Planet cities and communities: planetary health promotion at the local level

Health promotion has paid a lot of attention to the social determinants of health and to health equity but much less attention to the ecological determinants. Yet the most fundamental determinants of health are the natural systems that make the Earth liveable and are the source of our air, water, food, fuels and materials. Yet they are threatened by the very economic and social development that we have created to meet the social determinants of health. Moreover, the benefits and burdens of that development are inequitably distributed, resulting in both ecological and social injustice. In the past few years the new field of planetary health-'the health of human civilization and the state of the natural systems on which it depends'-has emerged, while WHO has confirmed that 'the source of human health [is] nature'. So arguably the most important task facing health promotion in the 21st century is to turn its attention to planetary health: health promotion workers must become planetary health promoters. Local health promotion in the 21st century needs to incorporate the concept of planetary health promotion and its application in the creation of healthy 'One Planet' communities and must become part of the emerging network of community organizations and individuals working to create sustainable, just and healthy communities.

'It all comes back to community!': A qualitative study of Aboriginal Elders promoting cultural well-being

OBJECTIVE

To examine Australian Aboriginal Elders' (Elders) views on their contributions to and their potential to contribute to the well-being of their community.

DESIGN

Participatory action research methodology was employed. Data collection methods included yarning interviews and group circle discussions. Data were thematically analysed.

SETTING

The project was undertaken in collaboration with Elders from a discrete Aboriginal community in rural/remote Tasmania, an island state in southern Australia.

PARTICIPANTS

Twelve Aboriginal community Elders.

INTERVENTION

N/A.

MAIN OUTCOME MEASURES

N/A.

RESULTS

Elders were promoting cultural well-being through interconnected themes of mentoring, cultural healing and seeking balance between health services and the community's cultural foundation. Cultural values, identity, community cohesion and connections to country were further embedded in these themes.

CONCLUSION

The study findings draw attention to the age-old wisdom of Aboriginal Elders, who actively promote cultural well-being as a main determinant of community health.

The Food Equity and Environmental Data Sovereignty (FEEDS) Project: Protocol for a Quasi-Experimental Study Evaluating a Digital Platform for Climate Change Preparedness

Background

Despite having the tools at our disposal to enable an adequate food supply for all people, inequities in food acquisition, distribution, and most importantly, food sovereignty, worsen food insecurity. The detrimental impact of climate change on food systems and mental health is further exacerbated by a lack of food sovereignty. We urgently require innovative solutions to enable food sovereignty, minimize food insecurity, and address climate change–related mental distress (ie, solastalgia). Indigenous communities have a wealth of Traditional Knowledge for climate change adaptation and preparedness to strengthen food systems. Traditional Knowledge combined with Western methods can revolutionize ethical data collection, engagement, and knowledge mobilization.

Objective

The Food Equity and Environmental Data Sovereignty (FEEDS) Project takes a participatory action, citizen science approach for early detection and warning of climate change impacts on food sovereignty, food security, and solastalgia. The aim of this project is to develop and implement a sustainable digital platform that enables real-time decision-making to mitigate climate change–related impacts on food systems and mental well-being.

Methods

Citizen science enables citizens to actively contribute to all aspects of the research process. The FEEDS Project is being implemented in five phases: participatory project planning, digital climate change platform customization, community-led evaluation, digital platform and project refinement, and integrated knowledge translation. The project is governed by a Citizen Scientist Advisory Council comprising Elders, Traditional Knowledge Keepers, key community decision makers, youth, and FEEDS Project researchers. The Council governs all phases of the project, including coconceptualizing a climate change platform, which consists of a smartphone app and a digital decision-making dashboard. Apart from capturing environmental and health-related big data (eg, weather, permafrost degradation, fire hazards, and human movement), the custom-built app uses artificial intelligence to engage and enable citizens to report on environmental hazards, changes in biodiversity or wildlife, and related food and mental health issues in their communities. The app provides citizens with valuable information to mitigate health-related risks and relays big data in real time to a digital dashboard.

Results

This project is currently in phase 1, with the subarctic Métis jurisdiction of Île-à-la-Crosse, Saskatchewan, Canada.

Conclusions

The FEEDS Project facilitates Indigenous Peoples’ self-determination, governance, and data sovereignty. All citizen data are anonymous and encrypted, and communities have ownership, access, control, and possession of their data. The digital dashboard system provides decision makers with real-time data, thereby increasing the capacity to self-govern. The participatory action research approach, combined with digital citizen science, advances the cocreation of knowledge and multidisciplinary collaboration in the digital age. Given the urgency of climate change, leveraging technology provides communities with tools to respond to existing and emerging crises in a timely manner, as well as scientific evidence regarding the urgency of current health and environmental issues.

International Registered Report Identifier (IRRID)

PRR1-10.2196/31389

Indigenous perspectives on education for sustainable healthcare

A range of global environmental changes are contributing to an increasing global burden of disease. Since human health and well-being are intimately associated with the health of our planet, healthcare providers will not only be charged with caring for this expanding disease burden but will also need to become more environmentally sustainable in their professional practice. There is thus an urgent need in the health professions education community to prioritize environmentally sustainable healthcare practice, which must include and prioritize Indigenous voices and Indigenous knowledge systems. Critical global dialogue on the significance of Indigenous knowledge systems in educating health professionals for a sustainable future will be required if we are ready to ensure the generations that follow us are able to live healthy lives. Indigenous ways of 'being' in the world, which emphasize the importance of interconnection and reciprocal stewardship with everything in the natural world, are essential for advancing education for sustainable healthcare and overall well-being. Given the colonial legacy however, Indigenous people, despite their essential knowledge systems and abilities, still face many barriers accessing safe decolonizing spaces and presence in health professions education, which needs to be addressed.

A radical revision of the public health response to environmental crisis in a warming world: contributions of Indigenous knowledges and Indigenous feminist perspectives

Indigenous peoples have long been successful at adapting to climatic and environmental changes. However, anthropogenic climatic crisis represents an epoch of intensified colonialism which poses particular challenges to Indigenous peoples throughout the world, including those in wealthier ‘modern’ nation states. Indigenous peoples also possess worldviews and traditional knowledge systems that are critical to climate mitigation and adaptation, yet, paradoxically, these are devalued and marginalized and have yet to be recognized as essential foundations of public health. In this article, we provide an overview of how public health policy and discourse fails Indigenous peoples living in the colonial nation states of Canada and Aotearoa New Zealand. We argue that addressing these systemic failures requires the incorporation of Indigenous knowledges and Indigenous feminist perspectives beyond superficial understandings in public health-related climate change policy and practice, and that systems transformation of this nature will in turn require a radical revision of settler understandings of the determinants of health. Further, public health climate change responses that centre Indigenous knowledges and Indigenous feminist perspectives as presented by Indigenous peoples themselves must underpin from local to global levels.

Molecular Decolonization: An Indigenous Microcosm Perspective of Planetary Health

Indigenous peoples are resilient peoples with deep traditional knowledge and scientific thought spanning millennia. Global discourse on climate change however has identified Indigenous populations as being a highly vulnerable group due to the habitation in regions undergoing rapid change, and the disproportionate burden of morbidity and mortality already faced by this population. Therefore, the need for Indigenous self-determination and the formal recognition of Indigenous knowledges, including micro-level molecular and microbial knowledges, as a critical foundation for planetary health is in urgent need. Through the process of Indigenous decolonization, even at the smallest molecular scale, we define a method back to our original selves and therefore to our planetary origin story. Our health and well-being is directly reflected at the planetary scale, and we suggest, can be rooted through the concept of molecular decolonization, which through the English language emerged from the ‘First 1000 Days Australia’ and otherwise collectively synthesized globally. It is through our evolving understanding of decolonization at a molecular level, which many of our Indigenous cultural and healing practices subtly embody, that we are better able to translate the intricacies within the current Indigenous scientific worldview through Western forms of discourse.

A qualitative study of classical Chinese medicine in community health focusing on self-care: practitioner and staff perspectives

Introduction

Classical Chinese medicine (CCM) encompasses many simple lifestyle recommendations which can be adopted into daily routines in support of short and long-term health outcomes. The rise in non-communicable diseases (NCDs) globally in recent decades has led to a need for cost-effective and scalable health care interventions to address lifestyle risk for NCDs in the community. This analysis explores the experience of staff and practitioners delivering a CCM community health care program designed to improve health behaviors in the community in rural Scotland.

Methods

A qualitative study employed semi-structured interviews with a sample of program practitioners and staff (n = 7). Informants were asked to share their experience in delivering the CCM program. Emergent themes were identified via analysis using the Framework Approach.

Results

Themes emerged from the data in three key areas: Cultural challenges within the local region; Integration with the existing local health care network; and Team dynamics, co-creation and communication integrity.

Conclusion

This study highlights the importance of accessibility, integration, networking, secure funding and team unity in the context of community health program delivery, as well as noting a diversity of practice among Chinese medicine practitioners. CCM concepts may hold potential for integration into community health, however, further research is warranted.

Preparing for the future of public health: ecological determinants of health and the call for an eco-social approach to public health education

As a collective organized to address the education implications of calls for public health engagement on the ecological determinants of health, we, the Ecological Determinants Group on Education (cpha.ca/EDGE), urge the health community to properly understand and address the importance of the ecological determinants of the public’s health, consistent with long-standing calls from many quarters—including Indigenous communities—and as part of an eco-social approach to public health education, research and practice. Educational approaches will determine how well we will be equipped to understand and respond to the rapid changes occurring for the living systems on which all life—including human life—depends. We revisit findings from the Canadian Public Health Association’s discussion paper on ‘Global Change and Public Health: Addressing the Ecological Determinants of Health’, and argue that an intentionally eco-social approach to education is needed to better support the health sector’s role in protecting and promoting health, preventing disease and injury, and reducing health inequities. We call for a proactive approach, ensuring that the ecological determinants of health become integral to public health education, practice, policy, and research, as a key part of wider societal shifts required to foster a healthy, just, and ecologically sustainable future.

The CCGHR Principles for Global Health Research: Centering equity in research, knowledge translation, and practice

Medical geography and global health share a fundamental concern for health equity. Both fields operate within similar multiple intersecting funding, academic, health systems, and development landscapes to produce scholarship. Both reflect complex interactions and partnerships between people, communities and institutions of unequal power. The Canadian Coalition of Global Health Research Principles for Global Health Research evolved from deep concern about the absence of standards for how Canadians engage in this field. They can serve as a broadly relevant framework to guide how to integrate equity considerations into everyday research, knowledge translation, and practice activities. Comprised of six principles (authentic partnering, inclusion, shared benefits, commitment to the future, responsiveness to causes of inequities, and humility), they are an aspirational and reflective frame that can elevate equity as a central procedural goal and outcome. In this commentary, we describe each of the six principles and offer examples of how they are being applied to guide research practices, inform knowledge translation science and build capacity. We invite collective reflection about moving our field toward more meaningful health equity research and action, using the CCGHR Principles for Global Health Research to spark dialogue about how to align our practices with desire for a more equitable world.