Food Sovereignty as a Path to Health Equity for Indigenous Communities: Introduction to the Focus Issue

In recent years, the focus of public health has evolved from a recognition of the social determinants of health to a focus on health equity, the state in which everyone has a fair and just opportunity to attain their highest level of health (Braveman et al., 2017). A health equity approach actively intervenes upon systems of oppression rooted in colonialism, racism, and capitalism. Indigenous knowledge, inherently systems-focused and holistic, has been increasingly recognized for its value to inform health equity. In its 2022 report, “Reframing Childhood Obesity,” the Robert Wood Johnson Foundation included among its top 3 recommendations to build upon Indigenous knowledge to better address childhood obesity (Fisher et al., 2022). The White House recently issued the first ever guidance for Federal agencies on including Indigenous knowledge in all Federal efforts, citing food sovereignty as a promising strategy for improving health (The White House, 2022).

Food sovereignty is defined as the right of peoples to healthy and culturally appropriate food produced through ecologically sound and sustainable methods, and their right to define their own food and agriculture systems (Via Campesina, 2008). Food sovereignty within Indigenous communities expands upon this definition to incorporate relational responsibilities between Indigenous peoples, the land, and all living beings (Indigenous Food Systems Network, 2006). Food sovereignty initiatives can be found throughout Indigenous communities, but few have been formally evaluated to assess their impact on health, and the conceptual linkages between food sovereignty and health have not been well documented within the public health literature (Maudrie et al., 2021).

In 2021, the Office of Minority Health funded the Center for Indigenous Innovation and Health Equity (CIIHE), a partnership between Oklahoma State University Center for Health Sciences and the University of Hawaiʻi and communities of practice in American Indian, Alaska Native, Native Hawaiian, and Pacific Islander populations. The CIIHE initiative developed a food sovereignty conceptual framework and adapted this framework to guide food sovereignty initiatives within the diverse partnering communities. Partners tailored the framework to community priorities and contexts to design and implement their initiatives and are evaluating the impact of these initiatives on health.

In this focus issue of Health Promotion Practice, we present a collection of articles that describe the genealogy of the CIIHE and the development and application of the food sovereignty conceptual framework for health (Jernigan, Maudrie, et al., 2023). We distinguish between food sovereignty and food security and the ways in which food security neglects to capture Indigenous concepts fundamental to food and health, including relationality and reciprocity (Maudrie et al., 2023).

We present seven Practice Notes describing how food sovereignty has been conceptualized and implemented in the diverse cultural, geographic, and institutional contexts of the CIIHE partnership. Hayman et al. (2023) describe the development of a Tribal farm on the Osage reservation in northeastern Oklahoma and a mobile market that distributes the farm’s produce across the reservation where there is limited access to healthy foods. Foods grown include healthy “Western” produce (e.g., spinach, carrots) along with traditional foods (yankapins, squash), advancing Osage goals of food security while strengthening culture and food sovereignty.

The Choctaw Growing Hope program presented by Thompson et al. (2023) describes a food sovereignty initiative in southeastern Oklahoma to restore traditional Choctaw gardening practices. The Growing Hope program distributes heirloom seeds and gardening education to Choctaw citizens with the goal of restoring Indigenous knowledge and promoting health and food security. Many of the seeds originated from seeds carried by Choctaw families from their original homelands in the southeastern part of the United States to Oklahoma during the Trail of Tears. The program shares these seeds and their stories and provides support to Choctaw families in starting and maintaining their gardens. Growing Hope emphasizes the transmission of generational knowledge by training student interns in Choctaw traditional foods and food practices. The interns then share this knowledge with their own families and the larger community.

Two initiatives in Alaska are described. Indigenous researchers from the University of Alaska Fairbanks, Center for Alaska Native Health Research (Demientieff et al., 2023), are partnering with the nonprofit organization Denakkanaaga, Inc. (Elders program) and are being guided by Athabascan Elders who are committed to mentoring emerging elders to step into their elder roles. The Denakkanaaga Athabascan Elders identified one of their top priorities as the intergenerational transmission of cultural knowledge and practices, to include traditional foodways. They are implementing an Elders Mentoring Elders Camp in which emerging Elders can feel supported in learning traditional skills like filleting salmon, tanning moose hide, beading, tufting, and harvesting plants and roots for salves and baskets, with the goal of sharing what they learn at the camp with their family and community. These activities support transmission of traditional knowledge and practices that add to the well-being of future generations.

The other Alaskan case study is presented by Wark et al. (2023). It is led by the Southcentral Foundation, a Tribal health care organization serving 65,000 predominantly Alaska Native people, that is exploring how traditional foods, food sovereignty, diet, and health are addressed within the Tribal health system and broader community in Southcentral Alaska. Topics explored to date include traditional food sharing networks for Elders; integrating traditional foods into urban context; the relationship between spirituality and traditional plants, food policy, supplying traditional foods for government aid boxes for needy families; teaching youth and community members about healthy diets; and research around traditional foods. The initiative is developing a conference style gathering on the topics of traditional foods, food sovereignty, diet, and health with presenters from across Alaska.

Sowerwine et al. (2023) focus on the environmental aspects of food sovereignty. Conceptualized by The Karuk Tribe—University of California Berkeley Collaborative, The Karuk Agroecosystem Resilience Initiative: xúus nu’éethti—we are caring for it—sought to respond to community-identified environmental barriers to food sovereignty and cultural resource access, such as environmental degradation, declining health of ecosystems and availability of gathered, fished, and hunted foods, and climate change impacts from prolonged drought and shifting weather patterns. The Karuk Resilience Initiative cared for ecocultural landscapes and supported capacity building for Karuk people through co-produced monitoring of Karuk gathering areas, seasonal assessments of climate impact and harvest led by cultural practitioners, and community workshops with youth and adults. The process reconnected people with cultural landscapes in new ways and supported Tribal decision-making and management capacity in food producing ecosystems experiencing compounded stress from environmental change and legacies of mismanagement.

Food sovereignty initiatives within the Native Hawaiian and Pacific Islander populations are presented in two Practice Notes. Ka’ula et al. (2023) describe the creation of a loʻi (irrigated terrace, especially for taro) in Oregon by the Kaʻaha Lāhui O ʻOlekona Hawaiian Civic Club. While the aim of the loʻi was initially to increase knowledge among Native Hawaiian youth about Hawaiian foods, promote empowerment and pride in making their own food, the loʻi became a place for the community to work together and connect with the land, promoting mental health and a home away from home in their new ʻāina. Not only is the creation of loʻi in Oregon feasible, but it may also be an important opportunity for the growing number of Native Hawaiian and Pacific Islander adults living on the continent to connect with each other and cultural foods, and promote food sovereignty.

Another initiative presented by Maunakea et al. (2023) focuses on Native Hawaiians experiencing high rates of food insecurity and diabetes on the island of Oahu. MAʻO Organic Farms, a Native Hawaiian nonprofit social enterprise, developed and operates a 2-year farm-to-college program designed to create a local food system that incorporates cultural, educational, lifestyle, and socioeconomic development focused on connecting youth and land through the daily practice of aloha ʻāina (land stewardship). In partnering with MAʻO Organic Farms, University of Hawaiʻi at Mānoa social and biomedical researchers examined social network effects on health-related behaviors and diabetes risk following the experiences of farm student interns as they progressed through this indigenous-led program in the pilot Mauli Ola longitudinal cohort study.

In February 2022, the CIIHE held a 2-day virtual conference on food sovereignty within the context of public health to connect partnering communities as well as other scholars, practitioners, and communities interested in the topic. Jernigan, Taniguchi, et al. (2023) describe the development, planning, and implementation of the conference and findings from a survey administered to conference participants that prioritized areas for future research. Building upon these findings, as well as best practices and lessons learned from the CIIHE and partners, Nguyen et al. (2023) propose a research agenda to incorporate a food sovereignty framework within public health practice.

In summary, these articles highlight the multiple ways in which food sovereignty is being conceptualized, applied, practiced, and evaluated for its impact on health. Although the initiatives are distinct, they are all actively intervening upon systems-level inequities by centering the transmission of generational knowledge and uplifting Indigenous practices. Notably, the CIIHE is led by Indigenous researchers in partnership with community practitioners. Many of us are the children and grandchildren of residential school survivors. We are building upon, and in some cases relearning our own Indigenous traditions, and pairing that knowledge with Western scientific approaches to uproot oppressive and harmful systems. We hope this focus issue expands the knowledge base of existing Indigenous frameworks in public health, documents the importance of Indigenous ways of knowing, and presents a path forward for an Indigenous health equity agenda.