Measuring Impact of Climate Change on Indigenous Health in the Background of Multiple Disadvantages: A Scoping Review for Equitable Public Health Policy Formulation

Abstract

How climate change is uniquely affecting Indigenous health remains a very less explored area in the existing research literature. The imperative of inclusive climate action to protect indigenous health multiplies manifolds due to their unique vulnerabilities owing to predominant dependence on natural resources and multiple disadvantages faced. The current article attempted to add to the evidence pool regarding climate change impacts on the indigenous population by systematically collecting, processing, and interpreting data as a scoping literature review for effective and inclusive climate policymaking. Twenty-Nine articles of varied study designs were identified employing a systematically organized search strategy using PubMed (Field, MeSH, and advanced search) and Google scholar; relevant data were extracted for further analysis. The Preferred Reporting Items for Systematic Review and Meta-Analysis for Scoping Reviews (PRISMA-ScR) guidelines were followed. Changing climate scenarios had both direct and indirect health-related impacts on indigenous health, and altered the epidemiological triad for various health-related events, causing the emergence and re-emergence of infectious diseases, and increased prevalence of chronic diseases and mental disorders. An expanded framework was developed showcasing the variability of climate change events, multiple disadvantages, and its impacts on indigenous populations. Few studies also reported a wide range of adaptation responses of indigenous peoples towards climate change. It was substantiated that any climate-change mitigation policy must take into account the trials and tribulations of indigenous communities. Also, due to the complexity and large variability of the impacts and differences in mitigation capabilities, policies should be contextualized locally and tailored to meet the climate need of the indigenous community.

Introduction

Humanity’s impact on the Earth has been profoundly leading to the Anthropocene epoch. The striking acceleration since the mid-twentieth century of carbon dioxide emissions and the transformation of land by deforestation and development has marked change in climate by effects like a rise in earth’s average temperature, sea level rise, and increased episodes of drought change in global average precipitation over land areas and increased incidences of natural disasters. The term “Climate change” refers to changes in climate properties (temperature, precipitation, extreme events, and wind patterns) that persist for a long period (decades or longer). (Liang & Gong, 2017) It is a powerful determinant of current and future health for all human populations. Though its far-reaching impact is on all parts of society; the impact of climate and ecosystem change has a direct impact on local livelihoods and sustenance of Indigenous people. Indigenous peoples are descent from populations, who inhabited the country or geographical region at the time of conquest, colonization, or establishment of present state boundaries. They retain some or all of their own social, economic, cultural, and political institutions, irrespective of their legal status. (Who Are the Indigenous & Tribal Peoples, 2016) The territories of the world’s 370 million indigenous peoples cover 24% of land worldwide and contain 80% of the world’s biodiversity. (The Role of Indigenous Peoples in Combating Climate Change | Humanities and Social Sciences Communications, 2022) Due to their subsistence economies and spiritual connection to lands and territories, most indigenous peoples suffer disproportionately from loss of biological diversity and environmental degradation resulting from climate change. (Indigenous Peoples & the Nature They Protect, 2020) Climate change presents substantial risks to their health and well-being.

Indigenous peoples also face multiple disadvantages and intersecting inequalities in terms of their economic situation (e.g., income), social support (e.g., social networks), and personal characteristics (e.g., health and educational attainment). (Research_summary_no1_2004_-_multiple_disadvantage)They are among the poorest of the poor; though they make up just 6 percent of the global population, they account for about 19 percent of the extreme poor. (Indigenous Peoples, 2022) They often lack formal recognition over their lands, territories, and natural resources, are often last to receive public investments in basic services and infrastructure, and face multiple barriers to participating fully in the formal economy, and participating in political processes and decision-making. (Indigenous Peoples, 2022) This legacy of inequality and exclusion has made Indigenous peoples the most threatened segment of the world’s population in terms of social, economic, and environmental vulnerability and hence at the receiving end of the impacts of climate change and impending natural hazards. This also highlights an important and difficult challenge in achieving the 2030 Agenda for Sustainable Development, which was adopted with the pledge that “no one will be left behind”. (Social Development for Sustainable Development | DISD, 2022) Surmounting this challenge will require focusing on indigenous peoples with inclusive policies. In particular, protecting Indigenous health now and into the future with rapid, equitable, and effective policies and practices.

It is thus imperative that climate mitigation policies and practices are designed to maximize positive impacts and minimize adverse outcomes for Indigenous health. However, evidence on which to base these decisions is limited.

Research Question: This scoping review sought to explore the current evidence for important potential impacts of climate change on Indigenous health in the background of multiple disadvantages and how it engages with Indigenous perspectives and experiences.

Methodology

We identified scoping review, as the most appropriate review method for mapping the impacts of climate change on Indigenous health as scoping reviews are useful for bodies of research that have cross-disciplinary and methodological boundaries, which is undoubtedly the case with the indigenous health and climate change literature. Scoping reviews are also helpful for identifying research gaps and emerging research priorities. We utilized standard scoping review methods for this study according to the relevant sections of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-ScR guidelines. (Tricco et al., 2018).

Information Source and Search Strategy

The review was undertaken conforming with the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping review (PRISMA-ScR) statement. (Tricco et al., 2018) We searched three major electronic databases of MEDLINE/PubMed (https://www.ncbi.nlm.nih.gov), Google Scholar (https://scholar.google.com), and Cochrane Library for pre-print and published literature from January 1, 2000, until May 31, 2022. Initial database search was done through field search using Boolean Operators with a combination of the following text words: “Indigenous people*”, “indigenous population*”, “indigenous health”, “indigenous communit*”, “tribal population”, “native peoples”, “climate change”, and “global warming”. A search strategy was formulated following a detailed analysis of the keywords and index terms (Medical Sub-Headings or MeSH terms for MEDLINE) based on their presence in the title and text of the articles. (Refer to Appendix A) Furthermore, reference lists from the identified articles selected through electronic databases were searched manually (backward chronological search).

Eligibility Criteria and Study Selection

The selection of articles was restricted to human studies published in the last 20 years. Original research findings based on both primary and secondary data were explored and included if found suitable. After completing the literature search with various databases with the search strategy discussed, the data for the found articles were transferred to Zotero 5.0 software (AGPL). In the next step, the duplicate articles in different databases were identified and merged. All titles and abstracts were examined to remove irrelevant studies or documents. In the next step, the available full texts of the selected studies were retrieved by filtering the abstract-only papers, and then the full texts were screened in detail.

Article entries were included in the review based on the following criteria:

• (i)Description of the impact of climate change, in its various form, on the health and well-being of indigenous communities
• (ii)Perspective of the indigenous population towards climate change,
• (iii)Association of disruption of health services in the indigenous community due to climate change.

Articles that were protocols and methodological studies were further excluded, and after reading the full texts, articles that did not fulfill the research question, or included any specific population or health-related outcomes were also excluded.

The search strategy was first developed and completed by MS & BC independently. To validate the process, RD and SC independently reviewed a random sample of 10% of the documents included for full-text review, and any discrepancies concerning inclusion were discussed by MS, BC, RD, and SC to reach consensus.

Data Extraction and Charting

Data extraction was done from individual full-text studies in two separate structured extraction sheets in Microsoft Excel. The following data items were collected during the data charting process:

1. Publication characteristics: title, author name, journal, year of publication, country of origin.

2. Contextual characteristics of the study: Study design (e.g., review study, intervention study, qualitative or mixed-methods design study), study setting, sample characteristics including sampling design, source of data

Relevant output data from each full-text study were extracted for further analysis. Namely,

1. Nature of climate change and its influence on the indigenous population. (e.g., unexpected weather changes, reduction of ice levels, heatwaves, bushfires)

2. Health outcomes (e.g., mortality, morbidity, risk factors, various determinants of health affected)

Few additional outcomes were extracted from articles, whenever applicable and necessary, such as the perspective of the indigenous community about climate change and its effect on their health and adaptive measures if taken any.

Results

From the 506 unique citations identified in the initial database search; the screening and eligibility assessments resulted in a final set of 29 (See Fig. 1).

Fig. 1.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) flow diagram for study inclusion

In the following sections, we summarize the reviewed literature in terms of general characteristics and our research questions.

General Characteristics of Papers

Our review included empirical studies, non-empirical review studies, and some editorial/ commentaries/ perspectives that examined a range of climate change events, with health-related outcomes and analyzed by ethnicity. The search identified 518 articles. After, removing duplicates, and applying exclusion criteria detailed full-text search was done for 134 articles. On full-text screening it was found that 60 articles did not discuss climate change impacts; 10 were not related to health; 22 of them were not discussing Indigenous peoples, five articles were an editorial call for data collection and another five were protocols. Hence, finally, twenty-nine publications remained eligible for inclusion. Out of these 29 articles, five articles were incorporating qualitative research (Bryson et al., 2021; Keatts et al., 2021; Kowalczewski & Klein, 2018; Rautela & Karki, 2015; Westoby et al., 2020), two articles incorporated Mixed Method Research (Chatwood et al., 2017; Durkalec et al., 2015); case studies, time series, community-based project and symposium report were one piece each(Amstislavski et al., 2013; Galway et al., 2022; Huber et al., 2020b; Rahman & Alam, 2016); Seven review articles (1 systematic review, 2 Scoping Review, 4 narrative review) (Ellwanger et al., 2020; Galway et al., 2019; Jones et al., 2020; Lansbury Hall & Crosby, 2022; Lebel et al., 2022; Schramm et al., 2020; Standen et al., 2022); 6 commentaries (Hernandez et al., 2022; Leal Filho et al., 2021; Lewis et al., 2020; Redvers et al., 2022; Richards et al., 2019; Zavaleta-Cortijo et al., 2020); 4 perspectives (Callaghan et al., 2020; Houde et al., 2022; Redvers et al., 2020; Timler & Sandy, 2020) and 1 editorial was included in the final analysis. (Pollock & Cunsolo, 2019) We did not find any meta-analyses, randomized controlled trials, cohort, or case–control studies.

The studies examined a diverse set of both direct and indirect adverse effects of climate change on indigenous health worldwide. Out of these articles, most of them concentrated on physical health; five articles emphasized mental and psychosocial aspects of health (Galway et al., 2019; Huber et al., 2020b; Kowalczewski & Klein, 2018; Lebel et al., 2022; Standen et al., 2022); One article had discussed majorly on the access to health care system (Amstislavski et al., 2013); and another one discussed in detail about Health stewardship for indigenous peoples. (Chatwood et al., 2017) A few articles also discussed adaptive measures against climate change undertaken by various tribes and some community-based projects on climate-ready tribe initiatives. (Schramm et al., 2020) One article particularly discussed Gardening as an important solution to overcome climate change-led food insecurity. (Timler & Sandy, 2020) One article discussed how youth are being affected by climate change and how they can play a role in mitigation measures. Another article discussed how vulnerable groups like pregnant mothers are being affected by climate change. (Bryson et al., 2021) Tables 1, 2, and 3 have summarized the findings and spatial distribution of included reviews, empirical studies, and editorial/comments/perspectives respectively.

Table 1.

Summarized findings and spatial distribution of included reviews (n = 8)

SN	Author, Year, Title, Source	Study methodology	Spatial distribution (Indigenous Population)	Nature of climate change	Impact on health outcomes and adaptation/response mechanism
1	Lebel et al. (2022) Climate change and Indigenous mental health in the Circumpolar North: A systematic review to inform clinical practice Transcultural Psychiatry	Systematic review	The Indigenous community of the circumpolar north: Canada: Nunatsiavut, Nunavut, Northwest Territories US: Alaska Russia: Sakha Republic Sweden: Sapmi	Environmental changes like: The unpredictability of weather, extreme weather, decreased thickness and extent of the ice, changes in animal behavior, changes in wildlife	Immediate impacts of climate change on mental health were felt through restricted mobility and disrupted livelihoods Effects on mental health were further felt through changes in culture and identity, food insecurity, interpersonal stress and conflicts, and housing problems The mental health outcomes reported: Anxious reactions, including chronic stress Depressive reactions (i.e., grief, sadness, boredom, hopelessness, suicidal ideations) Anger and frustration Concerns about the future
2	Galway et al (2019) Mapping the Solastalgia Literature: A Scoping Review Study Int J Environ Res Public Health	Scoping Review	Mostly Australia and United States	Emotional, mental, and spiritual health dimensions of climatic and environmental change	Solastalgia experiences often come “on top of other economic and social stressors”, thereby exacerbating health disadvantages and inequities
3	Jones et al. (2020) International Journal of Environmental Research and Public Health	Scoping Review	Global distribution:—Indigenous communities of Canada, the Dominican Republic, Ecuador, India, Mexico, New Zealand, Venezuela, the United States, Brazil, Australia, Peru, Cameroon, Tanzania, Indonesia, and Vietnam	Climate change mitigation policies were evaluated through various methodologies according to the impact on Indigenous health	Co-benefits and co-harms on indigenous health were detected Intergenerational knowledge transmission, strengthening community resiliency, reduced energy use and fuel poverty, reduced air pollution, increased physical activities Economically regressive impacts like job losses, and negative impacts on the diet
4	Standen et al (2022) Aboriginal Population and Climate Change in Australia: Implications for Health and Adaptation Planning Int. J. Environ. Res. Public Health	Review	Australian Aboriginal populations	Current evidence on the health risks of climate change for Aboriginal populations in New South Wales Increased Temperatures and Heatwaves Rainfall Variability and Risks of Flooding and Drought Fire Danger	Pre-existing health sensitivities (such as chronic diseases and psychosocial distress) and factors limiting adaptive capacity (such as socioeconomic disadvantage and political environments) already put Aboriginal populations in NSW at greater risk of the impacts of climate change, and this will continue unless significant challenges are addressed
5	Schramm et al. (2020) Current Environmental Health Reports	Review of Three case studies	Swinomish Indian Tribal Community, which is located in present-day Washington State, US	Climate-related warming and other changes, including storm surges, flooding, erosion from wind and wave actions	Negative physiological (contamination, infectious disease) and non-physiological health impacts like, fishing and hunting resources initiated the policy of ‘Indigenized BRACE framework’ which incorporates a complex definition of health considering mental, social, cultural, and environmental facets and reflecting non-physiological priorities with the local context BRACE =  Anticipate climate impacts and assess vulnerabilities Project the disease burden Assess public health interventions Develop and Implement a Climate and Health adaptation plan Evaluate impact and Improve the quality of activities
6	Lansbury-Hall et al. (2020) International Journal of Environmental Health Research	Narrative Review	Remote Indigenous people of Australia	Extreme weather events like: Storms, cyclone Heavy rainfall Heatwaves, bushfires Droughts	Increased ozone formation in warmer weather and increased air-borne allergens Food safety and security are compromised—food-borne diseases and malnutrition Vector-borne diseases: Warmer temperatures and increased rainfall are the main drivers of providing breeding conditions for mosquitoes Water-borne diseases like bacterial gastroenteritis, Cryptosporidium, Giardia, Salmonella, and Hepatitis A incidence has increased over a few years due to climate change
7	Ellwanger et al. (2020) Annals of the Brazilian Academy of Sciences	Narrative review	Indigenous community in Amazon Rainforest	Climate change, deforestation, rainfall, flooding, water contamination, human agglomeration, urbanization	Habitat loss and pathogen spillover, and changes in vector dynamics lead to an increase in infectious diseases Increased incidence of Leishmaniasis cases Emergence and re-emergence of Arboviral diseases High prevalence of Malaria and Hantavirus pulmonary syndrome among gold miner community of Amazon Increase in Rabies attack Higher density of Chagas disease
8	Keatts et al. (2021) Implications of Zoonoses from Hunting and Use of Wildlife in North American Arctic and Boreal Biomes: Pandemic Potential, Monitoring, and Mitigation Frontiers in Public Health	Qualitative Literature Review	North American Arctic and Boreal Biomes	Arctic and boreal ecosystems are undergoing rapid changes through climate warming, habitat encroachment, and development	All of these can change the host and pathogen relationships, thereby affecting the probability of the emergence of new (and re-emergence of old) zoonoses

Table 2.

Summarized findings and spatial distribution of included empirical studies (n = 9)

SN	Author, Year, Title, Source	Study methodology	Spatial distribution (Indigenous Population)	Nature of climate change	Impact on Health Outcomes and Adaptation/ response mechanism
1	Amstislavski et al (2013) Effects of increase in temperature and open water on transmigration and access to health care by the Nenets reindeer herders in northern Russia Int Journal of Circumpolar Health	Correlational and time series analyses	Nenets reindeer herders in northern Russia	Autumn temperature anomalies and increases in open water on health care access and transmigration of reindeer herders on the Kanin Peninsula	Later arrival of freezing temperatures in the autumn followed by the earlier spring thaws and more open water delay transmigration and reduce herders’ access to health care. The recently observed delays in arrival to the clinic are likely related to the warming trend and concomitant hydrologic changes
2	Chatwood et al (2017) Indigenous Values and Health Systems Stewardship in Circumpolar Countries Int. J. Environ. Res. Public Health	Embedded, Transformative, Emergent Mixed Methods Design	First Nations, Inuit, Métis, Sámi, and non-indigenous	To understand indigenous values that underlie and direct effective health systems stewardship in circumpolar countries including the	Nine values were identified and described: humanity, cultural responsiveness, teaching, nourishment, community voice, kinship, respect, holism, and empowerment
3	Durkalec et al. (2015) Social Science and Medicine	Sequential mixed-methods design	Inuit Community (sea ice users) of Arctic Canada	Changing sea and freshwater ice,	Physical health: Strain and discomfort from physical exertion, hypothermia from falling off the ice, impact from cold exposure, injuries from unintentional impacts Mental, emotional, and spiritual health impacts Social well-being
4	Galway et al (2022) "Land is everything, the land is us": Exploring the connections between climate change, land, and health in Fort William First Nation Social Science & Medicine	Community-based Project	Fort William First Nation, which is an Anishinaabe community in Northern Ontario	Understanding the links between climate change and physical, mental, emotional, and spiritual health	Five themes at the intersection of climate change, land, and health, with theme three- Healthy lands, healthy people describing the pathways through which knowledge holders spoke to the physical, mental, emotional, and spiritual health implications of climate change. a central idea that emerged is that when the land is sick, and when Mother Earth is sick, people are sick
5	Rahman et al. (2016) Climate	Case-study	Four indigenous communities living in and around Lawachara National Park located in North-eastern Bangladesh: Khasi, Tripura, Garo, Manipuri	Increasing temperature, variation in rainfall, irregularity in rainfall, landslide, soil erosion, flash flood, drying up of streams and well, natural calamities, heavy fog, and cold	Increased water-borne diseases (diarrhea, dysentery, skin diseases) Malaria and allergies
6	Kowalczewski et al. (2018) International Journal of Circumpolar Health	Qualitative study	Youths of the Sami community from Kautokeino, Norway	Climate change like thinning of the ice, altered ice stability, and decreased snow cover	Youths are particularly susceptible to being negatively impacted by climate change through increased safety issues (unstable snow routes traversed during Reindeer herding) or anxiety
7	Rautela et al. (2015) American Journal of Environmental Protection	Qualitative research	Bhotiya tribe of Johar, Byans, Niti Valley in the Northern frontier of Uttarakhand state, India	Perception of climate change among the indigenous population was: - Increased temperature, glacial retreat, early melting of snow, less snowfall, increased winter precipitation (rain), change in duration and timing of rain	Impact on livelihood, reduced agro-diversity, food insecurity, scarcity of drinking water, increased workload for women and children, and thus, being vulnerable to a plethora of diseases
8	Bryson et al (2021) Seasonality, climate change, and food security during pregnancy among indigenous and non-indigenous women in rural Uganda: Implications for maternal-infant health PLOS One	Community-based research approach, we conducted eight focus group discussions—	Indigenous Batwa communities	Pathways through which climate change influenced food security during pregnancy among Indigenous and non-Indigenous women in rural Uganda	Women indicated that food insecurity was common during pregnancy and had a bidirectional relationship with antenatal health issues. Food security was thought to be decreasing due to weather changes including extended droughts and unpredictable seasons harming agriculture. Women linked food insecurity with declines in maternal-infant health over time, despite improved antenatal healthcare. While all communities described food security struggles, the challenges Indigenous women identified and described were more severe
9	Westoby et.al. (2020) From community-based to locally-led adaptation: Evidence from Vanuatu Ambio	focus group discussions, formal interviews and conversations about the projects	Four Ni-Vanuatu Communities	Adaptation response of community towards climate change	Pacific Islanders in situ are the best judge of their own agendas, needs, aspirations and futures and in the best position to make decisions for themselves about what and how they might become more resilient. Rather than adaptation being ‘community-based’, it needs to be ‘locally led’, and should take place across different entry points and incorporate, as appropriate, elements of autonomous/Indigenous peoples ownership

Table 3.

Summarized findings and spatial distribution of included editorial/ commentaries/ perspectives. (n = 12)

SN	Author, Year, Title, Source	Study methodology	Spatial distribution (Indigenous Population)	Nature of climate change	Impact on Health Outcomes and Adaptation/ response mechanism
1	Huber et al., (2020a), (2020b) (Huber et al., 2020a) International Journal of Circumpolar Health	Symposium report	Yakutia indigenous community in the Republic of Sakha, Russia	Extreme weather changes, prolonged heat periods, smoke, exposure to ultraviolet radiation, thawing of permafrost	Increased cases of zoonotic diseases: Diphyllobothriasis Echinococcosis Yersiniosis Lyme Disease Brucellosis Mental health deterioration due to inadequate coping strategies Asthma due to increased air pollution
2	Filho et al., (2021) (Impacts of Climate Change to African Indigenous Communities and Examples of Adaptation Responses | Nature Communications, n.d.) Impacts of climate change on African indigenous communities and examples of adaptation responses Nature Communication	Commentary	Five African Indigenous communities (Afar, Borana, Endorois, Fulani, and Hadza)	Increased frequency and intensity of extreme weather events such as droughts, floods, storms, cyclones, as well as heatwaves, among others	The scarcity of drinking water, reduction of fresh crops, and the emergence of zoonotic diseases led to the formulation of climate-change mitigation strategies, like livestock destocking and diversification, rainwater harvesting, and mixed cropping
3	Redvers et al., (2022) (Redvers et al., 2022) Lancet Planet Health	Commentary/ personal view	Global distribution of Indigenous Peoples from around the world (Kenya [Ogiek], Canada [Denésuliné, Sahtu’ot’ine, and Haudenosaunee], USA [Blackfeet and Tsimshian], Australia [Gamilaraay, Nyikina Warrwa, and Wangkumara], Mexico [Yaqui, Nahua, and Maya], El Salvador [Nahua], and Nicaragua [Miskita])	Global Environmental changes within indigenous communities, including climate change and pollution	Planetary Health Determinants: Indigenous people’s health is considered a determinant of planetary health as global climate change affects indigenous people’s health. The indigenous people’s health must be approached from a holistic lens that acknowledges cultural and land-based practices
4	Lewis et al (2020) A radical revision of the public health response to the environmental crisis in a warming world: contributions of Indigenous knowledge and Indigenous feminist perspectives Canadian Journal of Public Health	Commentary	Indigenous peoples living in the colonial nation-states of Canada and Aotearoa New Zealand	How public health policy and discourse fails Indigenous peoples living in the colonial nation states of Canada and Aotearoa New Zealand	Addressing these systemic failures requires the incorporation of Indigenous knowledge 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
5	Pollock et al. (2019) Collaborative approaches to wellness and health equity in the Circumpolar North: Introduction to the Special Issue International Journal of Circumpolar Health	Editorial	Circumpolar North	To help bridge local insights, innovations, and varied forms of evidence from the Circumpolar North, with global conversations about health equity, health system transformation, and the rights of Indigenous peoples	Indigenous self-determination in health care and health research; access to traditional medicines; language and identity; youth engagement; mental health; climate change; and health technology
6	Redvers et al. (2020) Molecular Decolonization: An Indigenous Microcosm Perspective of Planetary Health Int. J. Environ. Res. Public Health	Perspective	US & Australia	Need for Indigenous self-determination and the formal recognition of Indigenous pieces of knowledge, including micro-level molecular and microbial knowledge, as a critical foundation for planetary health is in urgent need	The planet’s health is a reflection of our health and well-being right down to the molecular level. When Mother Earth is sick and unbalanced, we are also sick and unbalanced. Due to the interconnected web of our existence, there is a great need to reconsider our daily practices and thought processes through the lens of reciprocity, responsibility, and relationality to Mother Earth
7	Timler et al., (2020) Gardening in Ashes: The Possibilities and Limitations of Gardening to Support Indigenous Health and Well-Being in the Context of Wildfires and Colonialism Int. J. Environ. Res. Public Health	Perspective	Indigenous Peoples in Canada	Gardening as a relationship with nature and an ongoing process to support Indigenous health and well-being in the context of the climate crisis and increasingly widespread forest fires	The concept of gardening as both a Euro-Western agricultural practice and as a longstanding Indigenous tradition—wherein naturally occurring gardens were tended in the relationship—and the influences of colonialism and climate change on both. The foundational importance of reciprocity and relationship in the context of foodways to support holistic health and well-being will be outlined
8	Callaghan et.al. (2020) Improving dialogue among researchers, local and indigenous peoples, and decision-makers to address issues of climate change in the North Ambio	Perspective	Circumpolar North (Eurasian Arctic and Siberia)	Climate change impacts Siberian and global weather systems, increasing the frequency and intensity of extreme weather events. Examples are local scale hurricanes, tornados, extremely dry/wet periods (e.g. Forbes et al. 2016), and increased frequency of tundra and forest fires (Bret-Harte et al. 2013). Another example is the rapid methane release from below-ground reservoirs that can cause explosions, creating craters in the physical landscape (Kizyakov et al. 2017). This is potentially dangerous if future explosions occur under oil and gas pipelines	Understanding and adapting to both types of changes are important to local and indigenous peoples in the Arctic and for the wider global community due to transboundary connectivity
9	Cortijo et al., (2020) Climate change and COVID-19: reinforcing Indigenous food systems The Lancet Planetary Health (2021)	Commentary		The nature and extent of the effects of COVID-19 on Indigenous food systems are still largely unknown, but the direct results include mortality from severe illness, reduced access to food, changes in the local diet, and economic losses resulting from lockdowns	Effects of climate change undermine Indigenous food security, in turn compromising the resilience of Indigenous populations to pandemics. At the same time, disruptions to food and nutrition security and the resulting health implications for Indigenous populations during pandemics exacerbate their vulnerability to climate change
10	Richards et al., (2019) The Climate Change and Health Adaptation Program: Indigenous Climate Leaders' Championing Adaptation Effort Health Promotion and Chronic Disease Prevention in Canada	Commentary	First Nations Inuit	Needs of climate change and health in First Nation and Inuit communities to support resiliency and adaptation to a changing climate both now and in the future through its emphasis on youth and capacity building	Engaging youth and Elders to respectively learn and pass along Indigenous Knowledge from generation to generation strengthens communities’ resiliency and helps ensure that the projects and initiatives are sustainable as capacity within the community and amongst youth is built. Through both peer and professional training each project builds capacities in different areas, such as research and interview skills, technological skills, and skills on the land
11	Houde et al., (2022) Contributions and perspectives of Indigenous Peoples to the study of mercury in the Arctic Sci Total Environ	Perspectives	Arctic Indigenous Peoples	Overview of the contributions of Indigenous Peoples to Hg monitoring in the Arctic, and discuss approaches that could be used, and improved upon, when carrying out these activities	In recent years, Indigenous communities often have chosen to participate in, or initiate contaminant research projects because they were, or are, worried about the health of the ecosystem and the safety of their traditional country foods. During the early stages of contaminant research in the Arctic (i.e., starting in the late 1980s in Canada), the finding of high contaminant levels in the remote Arctic environment rattled researchers and led to fear-inducing communication and messages directed toward public
12	Hernandez et al., (2022) Prevent pandemics and halt climate change? Strengthen land rights for Indigenous peoples The Lancet Planetary Health	Commentary	USA	Indigenous, pastoralist, and rural farming communities are especially dependent on land, which is widely recognized by conservation organizations. Such communities are often uniquely vulnerable to the effects of ecosystem destruction while simultaneously having strong social norms and cultural values that support ecosystem preservation	Planetary health and “One Health” researchers should make explicit the links between land rights and health. This includes the marginalization, exclusion, and forced displacement of Indigenous peoples, which have been shaped by colonial and postcolonial politics and economics. Such groups are often at the margins of state control and experience state incursion through systems of taxation, isolation, monetization, commodification, and deculturation

Spatial Distribution of the Articles

Concerning geographic distribution among the papers in our final sample, there is a clear predominance of circumpolar countries underlying the imminent impact of climate change that the indigenous population of those countries is facing. Of these 29 articles, nearly half had a focus on the Canadian region; and another 11 (38%) had a focus on the United States; seven studies (24%) focused on Russia; Australia (five articles) and the Scandinavian countries (Sweden five, Norway and Finland and Denmark three apiece) were next for the most-focused countries in the review. Very few articles studied the indigenous communities of Asia (India, China) and Africa (Uganda, Kenya, Tanzania, Ethiopia). The Global South was underrepresented in the review as a whole. Figure 2 provides the geographic distribution of articles within the globe.

Fig. 2.

Choropleth Map showing the geographical distribution of the indigenous population within the articles included in the review

Temporal Distribution of the Articles

There was an increasing trend in the number of articles published over the last twenty years’ time, especially after 2015–May 2022 (Fig. 3). The number of Indigenous health research articles has been increasing over time with a few notable drops and peaks. In 2020, there was a steep increase in, which had 11 published articles. A potential reason for the increase in publications may be attributed to the COVID-linked lockdown and increased overall publication frequency of research papers that may have contributed to the increased publications during that year.

Fig. 3.

Number of included studies by years of publication (n = 29)

How Climate Change is Affecting Indigenous Health?

To better understand the impacts of climate change on Indigenous health, we focused on the subset of studies with empirical data, specifically (n = 20). Study populations were quite varied and ranged from geographically based residents of specific regions and culturally identified subpopulations such as Pregnant Batwa women of Uganda, Sami youths in Norway, Swinomish tribes in Washington, and Bhotia Tribe in India, etc. It was found that Indigenous health is impacted by climate change in three main stages (primary, secondary and tertiary impacts):

Firstly, climate change can directly or primarily cause injury and death from extreme weather events including heat waves and droughts, violent storms, cyclones, flooding, landslides, bushfires increasing sea levels, and rising infectious disease. It was reported that extreme weather events and decreased thickness and extent of ice lead to increased safety hazards. Among the Inuit community in northern Canada, the changing nature and increasing variability of environmental hazards are predicted to increase the frequency and severity of physical health impacts from environmental exposure reporting increasing injuries related to changing ice and weather conditions (ACIA 2005, 2022; Prowse & Furgal, 2009). The Yakutia indigenous community in the Republic of Sakha, Russia has reported increased illness resulting from extreme weather events. (Kowalczewski & Klein, 2018). Indigenous remote settlements in Australia suffer from various physical health impacts due to the severity and frequency of extreme weather events—namely heatwaves, bushfires, floods, cyclones, and drought. (Lansbury Hall & Crosby, 2022) In indigenous communities from Bangladesh (Khasia, Tripura, and Garo) changes in temperature and rainfall patterns, have led to increased frequency of landslides, soil erosions, flash floods, heavy cold, and fog, increasing injuries, diseases, and deaths. (Rahman & Alam, 2016) Productivity and other workforces also get impacted by hotter/colder working conditions, and damage to infrastructure from extreme events, such as on housing and healthcare systems further devastating for the indigenous people.

Secondly, indirect or secondary impacts are triggered through environmental and ecosystem changes and manifest as impacts on water quality and availability, food quality, security, and sovereignty. For example, it was reported that extreme weather events and decreased thickness and extent of ice lead to decreased access to country food and result in impaired food security and sovereignty. In the higher Himalayan Region increase in average temperatures and abrupt changes in the precipitation regime have resulted in water scarcity, food insecurity due to crop failure, increased incidences of pest infestations, and animal attacks affecting the indigenous people adversely. (Rautela & Karki, 2015). In-utero exposure to climate change effect like food insecurity also leads to poor maternal and child health.

Impact on air quality secondary to climate change leads to a rise in associated respiratory health and other chronic diseases, and on distribution and breeding/propagating conditions for vector-borne diseases and pathogens of various infectious diseases. Climate change is also altering the epidemiological triad resulting in ‘the epidemiological transition’ through a changing climate and a resulting change in the environmental component of the triad. (Lansbury Hall & Crosby, 2022) Also, the interaction between hosts and pathogens is regulated in part by highly synchronized temperature and photoperiod changes during seasonal transitions. (Casadevall & Pirofski, 2000) With a warming climate and altered humidity, these key biological cues are undergoing drastic changes, resulting in drastic consequences on host–pathogen interactions especially on indigenous populations as they have a greater dependence on environmental resources for their basic needs. The Yakutia indigenous community in the Republic of Sakha, Russia has reported increased incidences of zoonotic diseases resulting from extreme weather events. (Kowalczewski & Klein, 2018). In Amazonia, deforestation and climate change have become the major drivers of emerging diseases in the indigenous population. (Ellwanger et al., 2020) In forest-based indigenous communities, namely, Khasia, Tripura, and Garo from Bangladesh changes in temperature and rainfall patterns, and natural calamities have increased pests, diseases, and the attack by wild animals. (Rahman & Alam, 2016).

Finally, impacts can be tertiary or indirect through changes to social systems; affecting socio-economic, mental, emotional, and spiritual well-being. Indigenous peoples have a deep sense of their place and belongingness which gets perturbed due to climate-related changes compelling them to migrate resulting in solastalgia. It was also reported that extreme weather events and decreased thickness and extent of ice that adversely affects food security and sovereignty, indirectly bring changes in culture and identity, accentuating interpersonal stress and conflicts.

Impacts of climate change on mental health happen due to restricted mobility and disrupted livelihoods and are further accentuated through changes in culture and identity, food insecurity, interpersonal stress and conflicts, and housing problems. (Lebel et al., 2022). In the Inuit community in northern Canada which has deep cultural connections with sea ice, the changing ice and weather conditions have been reported to result in anxiety-related episodes (ACIA 2005, 2022; Prowse & Furgal, 2009).

Indigenous People and the Multiple Disadvantages

In addition, Indigenous people across the world tend to suffer multiple types of socioeconomic disadvantages, including extreme poverty, poor living conditions, low educational attainment, unemployment due to failure of traditional livelihoods, racism, and limited access to various healthcare services which are important determinants of Indigenous health. Living on marginal land with poorer infrastructure, socioeconomic deprivation, various inequities, and political marginalization; they are doomed to suffer from a greater burden of disease, and poorer access to quality health care.

In this review we analyzed the data from a vast body of heterogenous literature and synthesized an expanded framework with the background of multiple disadvantages, depicting the effects of climate change on Indigenous health through various direct and indirect pathways.

Figure 4 proposes an expanded framework of climate change impacts on indigenous health.

Fig. 4.

Expanded Conceptual framework of climate change impacts on indigenous health

How does the Literature on Climate Change and Health Impacts Engage with Indigenous Perspectives and Participation?

The indigenous peoples (especially those relying on natural resources) have an experienced and inherited knowledge of their environments, ecosystems, and local society. Therefore, their perspectives have an important role in determining and mitigating the impacts of climate change on local societies. Indigenous Peoples in the Arctic and Boreal have expressed concerns about potential effects on Indigenous rights and food sovereignty as a result of policy initiatives focused on hunting, consumption, sharing, and local trade of wildlife. These populations are frequently at the forefront of protecting wild food systems, livelihoods, and cultural values. When the socioeconomic, cultural, and nutritional aspects of Indigenous subsistence methods were not taken into account, negative effects resulted. For instance, prior culturally insensitive and inadequately developed communication outreach efforts regarding health and traditional and country foods (on contaminants) resulted in adverse health effects for the affected populations from avoiding traditional foods altogether, given the dearth of healthy alternatives. For local communities of hunters, trappers, and fishermen throughout the area, zoonotic health hazards have also risen (Keatts et al., 2021). From the perspectives of indigenous peoples of Circumpolar North, the changing environmental conditions have led to a decrease in the abundance of lichens and other forage plants such as horsetails, resulting in reduced reindeer weight and has forced the herders to move to new areas resulting into the instability of reindeer husbandry livelihoods. (Callaghan et al., 2020) Similarly, among Nenets reindeer herders from Russia, the later arrival of freezing temperatures in the autumn followed by the earlier spring thaws and more open water, delay in transmigration, and reduced access to health care are major concerns (Amstislavski et al., 2013). There are also concerns about how public health policy and discourse fail Indigenous peoples living in the colonial nation-states of Canada and Aotearoa New Zealand especially not taking into account Indigenous knowledge and Indigenous feminist perspectives (Lewis et al., 2020). Indigenous Women of the Batwa tribe in Uganda indicated that food insecurity was common during pregnancy and had a bidirectional relationship with antenatal health issues. (Bryson et al., 2021).

Paetnerships with Indigenous people: Within the twenty-nine studies, included in the review eleven studies were conducted in partnership with Indigenous communities namely, the Swinomish Indian Tribal Community (Swinomish)- a Coast Salish nation located in present-day Washington State (Schramm et al., 2020); Khasia, Tripura, Garo, and Manipuri are living in and around Lawachara National Park (LNP) located in North-eastern Bangladesh (Rahman & Alam, 2016), Bhotiya tribe of Johar, Byans, Niti Valley in the Northern frontier of Uttarakhand state, India (Rautela & Karki, 2015), Youths of Sami community from Kautokeino, Norway, Yakutia indigenous community in the Republic of Sakha, Russia (Kowalczewski & Klein, 2018), Inuit Community of Arctic Canada (Durkalec et al., 2015), Fort William First Nation—an Anishinaabe community in Northern Ontario, Indigenous Batwa Communities from Uganda, Ni-Vanuatu Communities, and five indigenous African communities (Afar, Borana, Endorois, Fulani, and Hadza). (Leal Filho et al., 2021) Out of the 29 studies around half of them studied the local climate adoption methods also.

The Swinomish Tribe had adjusted the CDC’s BRACE framework in a more local, indigenized context where several needs and activities of the community which were affected by climate change (for example, traditional hunting, fishing, and harvesting practices) along with community-held perceptions of climate change were incorporated in the ‘value-based’ decision-making for key adaptation strategies (Schramm et al., 2020). Focus group discussions on three indigenous communities of LNP revealed a handful of community-based adaption strategies through local knowledge and perceptions, such as, using medicinal plants, organic and compost fertilizers, lime oil, and cake to tackle rising temperature and low rainfall, storing extra firewood for high rainfall, early harvesting of crops and livestock rearing for tackling natural calamities, etc. Increasing temperature and drying up of streams and wells were the highest priority climate risk from the perspective of the indigenous tribes (Rahman & Alam, 2016). The Bhotiya tribe of the Higher Himalayas, Uttarakhand perceived a decline in agricultural productivity and reduced agro-biodiversity as the major impacts of climate changes like reduced rainfall on livelihood. The indigenous perspective of coping and adaptation measures comprised improvising with cash crops, delayed sowing, shifting to smaller livestock, etc. (Rautela & Karki, 2015). The Health of the Sami community has been impacted by climate change, for instance, an increase in safety issues and anxiety due to less stable ice and snow routes. Health-seeking process for people from the Sami community exhausts beyond individual and family-level coping strategies towards professional aid (conventional Norwegian medicine and traditional Sami medicine) as per the severity of climate change impact; which are separated by social norms and health-seeking behavior (Kowalczewski & Klein, 2018). African indigenous communities (Afar, Borana, Endorois, Fulani, and Hadza) have been observed to use their local knowledge and perception in climate-change adaptation strategies (e.g., temporary migration, livestock diversification, a shift in settlement patterns, mixed cropping) as it is seen that traditional knowledge and local perception on climate change could help in, apart from mitigating it, sustainable management of the ecosystem, bolstering food security, benefit livelihood, and promote socio-economic resilience. (Leal Filho et al., 2021).

Discussion

In this review, we assessed the potential size and scope of available research literature on climate change impacts on Indigenous health. We observed that globally, many Indigenous Peoples face higher exposure to climate change risks due to close relationships and dependence on livelihoods associated with natural resources, and the location of communities in remote areas that are exposed to natural hazards of cyclones, fires, and droughts. (Natural Hazards & Disaster Risk Reduction, 2015) For indigenous communities from arctics and circumpolar north, rising temperatures and reduced ice cover are causing serious impacts on both the physical and mental health of the various Indigenous communities (Kowalczewski & Klein, 2018). Increased heatwaves, droughts, floods, storms, and other extreme weather phenomena on the African continent led to a shortage of fresh produce and drinking water as well as the spread of zoonotic diseases.

Similarly in other parts of the world, extreme weather changes, prolonged heat periods, smoke, and exposure to ultraviolet radiation, causes poor physical health, strain, and discomfort from physical exertion, episodes of heat stroke, as well as poor mental, emotional, and spiritual health. Their vulnerability is also increased manifold due to wide prevalent inequity and multiple disadvantages faced by the indigenous communities. They are suffering from a ‘triple burden of disease’, due to the combined effect of chronic diseases, infectious diseases and climate change impacts where climate change impacts further exacerbate existing health inequalities. (Kumar et al., 2020).

In our study, out of the 29 studies around half of them studied the local climate adoption methods also. The majority of the response mechanisms consist of impact measurement, assessment of the health system in the community, and bringing out resilient community action through capacity building and resource management, which were context-specific. In an earlier review conducted only three studies reported being conceived, designed, or conducted in partnership with Indigenous communities or informed by Indigenous pieces of knowledge and values. (Lebel et al., 2022) In our study, we found that in eleven studies there was an involvement of indigenous peoples in the climate mitigation and adaptation process.

Research Gap

The climate change impacts on health and its examination through indigenous perspectives has been a less explored area. The lack of studies on the health impacts of climate change on indigenous people worldwide has resulted in a lack of understanding and failure to comprehend the related domains. Also, despite the clear implications of climate change on indigenous health and the associated multiple disadvantages, there were strikingly few studies examining the possible pathways and mechanisms. Though in the past few years this topic has seen an accelerated momentum, most of the studies were done in a piecemeal manner lacking holistic treatment. Importantly, a comprehensive understanding of how Indigenous people’s health could be affected by climate change holistically, with the identification of strengths, weaknesses, and gaps in the literature to guide future research, policy, and practice is urgently needed. Promising trends like the increase in research on the adaptation and mitigation efforts for Indigenous health, along with an increase in studies that are seeking Indigenous partnership and participatory methods of research are the call of the hour.

In response to this challenge, the present paper attempts to contribute to the existing body of knowledge by systematically mapping the various climate factors influencing indigenous health with diverse methodologies based on the multiple disadvantage model.

Policy Implications

In drawing attention to the impact of changing climate on indigenous health with the backdrop of multiple disadvantages, this review provides a powerful argument for the need for policymakers to have an indigenous approach in decision-making and acknowledge their differing needs.

The variety of sources considered in this study allows the identification of major principles that can inform policymakers on the topics of climate mitigation and adaptation efforts to contribute to Indigenous health equity. As per our review findings, the climate mitigation policy formulation must be done with keeping in mind the specific features and contextual factors for the particular indigenous community for generating impacts. This will also require a deliberate, carefully planned approach to community engagement. Genuine climate solutions must seek to disinvest from institutions and systems that are complicit in fuelling the climate crisis, and instead must be grounded in different ways of knowing, doing, and being that reflect Indigenous values to fully account for the unique realities of Indigenous peoples. Indigenous communities’ contributions are essential in designing and implementing solutions for changing ecosystems.

Strengths and Limitations

The majority of the evidence that currently exists on climate change and its impact on health is limited to a colonial/western perspective and is from generic equity analyses. Very few studies have tried exploring climate change impacts using an indigenous lens. Our review with its particular emphasis complements existing literature and also adds some fresh insights on relevant outcomes, which can have serious implications for informing future climate policy and their translation into action. However, it only captures information included within the identified articles. Also, given the wide scope of the review and the heterogeneity of terminology used in article titles, abstracts, and keywords, our search might have missed a few relevant studies. The review also had an emphasis on publications in the peer-reviewed literature, which may further have decreased the number of articles. Also, the authors did not reach out to authors individually to gather further information nor did infer or extrapolate what the authors of these articles may or may not have done in their research processes.

What the Scoping Review Adds

Drawing on the review of the previous studies, the authors synthesized the determinants from the literature review to frame the: Expanded Conceptual framework of climate change impacts on indigenous health (Fig. 4). This framework sought to synthesize the complex interplay of factors across the physical, mental, social, and spiritual health of Indigenous people directly or indirectly because of climate change and multiple disadvantages.

Conclusion and Recommendations

Climate change has a significant impact on the health of indigenous people and multiple disadvantages were found to have a ‘compounding’ effect on their vulnerabilities that appears to be much more prominent for Indigenous people than for others. Hence adaptation and mitigation policies and practices should be inclusive of the indigenous communities to address this growing threat. Because of large geographic variations in climate impacts, and differences in vulnerability and adaptation capabilities of different indigenous populations; policies and programs must be tailored to cater to specific health needs at a local scale utilizing local data and expertise. Despite the complexity of this field of research, it is possible to improve the quality of evidence about co-impacts on Indigenous health to inform pro-equity climate mitigation. This will require partnership with Indigenous communities, recognition and privileging of indigenous pieces of knowledge, and study design that fully embeds Indigenous values, realities, and priorities. Fundamentally, sharing of power, both in the research process and in the conception, design, and implementation of climate policy and interventions, will be essential for Indigenous rights and health equity.

Appendix A: Sample Search Strategy (MEDLINE)

Search Strategy (PubMed/MEDLINE):

1. "Indigenous Peoples"[MeSH Terms] OR "native people*"[Title/Abstract] OR "indigenous population*"[Title/Abstract] OR "first nation people*"[Title/Abstract] OR "trib*"[Title/Abstract] OR "indigenous communit*"[Title/Abstract] OR "indigenous group"[Title/Abstract] OR "aboriginal people*"[Title/Abstract] OR "aboriginal communit*"[Title/Abstract] OR "primitive communit*"[Title/Abstract] OR "primitive group"[Title/Abstract]

2. "climate change*"[Title/Abstract] OR "climate variabilit*"[Title/Abstract] OR "climatic variabilit*"[Title/Abstract] OR "climatic change*"[Title/Abstract] OR "climate uncertaint*"[Title/Abstract] OR "climatic uncertaint*"[Title/Abstract] OR "global warming*"[Title/Abstract] OR "Global Warming"[MeSH Terms] OR "Climate Change"[MeSH Terms]

3. 1 AND 2

4. Limit 3 to full-texts, Publication date from 01.01.2000 to 31.05.2022, and studies on human.

Author’s Contribution

M.S. conceived the study and M.S. and B.C., contributed to the development of the research methods and conducted the literature searches, screening and selection of studies, data charting and analysis, and prepared the first draft of the manuscript. R.D. & S.C. undertook the independent review of study selection and. M.S., B.C, R.D. & S.C. advised on the literature search strategy, data analysis, and interpretation of findings. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding. No funding was received to assist with the preparation of this manuscript.

Declarations

Conflict of Interest

We declare no other competing interests. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.