Global Health Promotion

This paper describes a poverty reduction approach to addressing an important determinant of health and well-being among Canada’s First Nations. The Poverty Action Research Project (PARP) has its origins in the Make Poverty History Committee established by the Assembly of First Nations (AFN) in 2008. Academic members of the Committee in cooperation with the AFN subsequently applied for an action research grant to the Canadian Institutes of Health Research (CIHR). The project selected five volunteer First Nations from different parts of Canada, hiring a coordinator in each, undertaking background research, developing a profile and working with First Nation representatives in the development of a strategy to address upstream determinants of health and well-being. Subsequently, project team members within each region assisted where needed with plan implementation, supporting some initiatives with small grants. This paper provides insights from the project in several key areas, including First Nation rejection of the concept of poverty as usually defined, the importance of taking action to strengthen collectivities as well as individuals, the feasibility of assisting First Nations who are at different points in their development journey, the strengths of the leadership within the First Nations, and finding the appropriate balance between the elected and business leadership. These insights emerged from dialogue and reflection among project team members and community participants over the life of the project. We also describe what we have learned about how to engage effectively and with mutual respect with First Nations in this kind of project. The paper concludes with a review of our experiences with the policies and practices of the national research granting councils and the universities, which have not fully adjusted to the requirements of action research involving First Nations.

This research explores and supports the importance of Indigenous cultural knowledge and practices as guiding factors in understanding the agency and actions of Indigenous youth in seeking justice while journeying across the land. The article examines the work of Indigenous scholars and the significance of Indigenous knowledge in connecting to the land and natural environment, thus contributing to ‘being alive well’. An example from Indigenous youth-focused research is highlighted to hear from the youth about the importance of being on ancestral land, journeying with peers and more importantly (re)gaining a sense of well-being and health through culture-based activism.

In caring for Country, Indigenous Australians draw on laws, knowledge and customs that have been inherited from ancestors and ancestral beings, to ensure the continued health of lands and seas with which they have a traditional attachment or relationship. This is a reciprocal relationship, whereby land is understood to become wild/sick if not managed by its people, and in turn individuals and communities suffer without a maintained connection to Country. It is well understood by Indigenous people that if you ‘look after country, country will look after you’. Indigenous knowledge systems that underpin the local care (including use and management) of Country are both unique and complex. These knowledge systems have been built through strong observational, practice-based methods that continue to be enacted and tested, and have sustained consecutive generations by adapting continually, if incrementally, to the local context over time. This paper describes a research partnership that involved the sharing and teaching of Ngan’gi Aboriginal ecological knowledge in order to reveal and promote the complex attachment of Ngan’gi language speakers of the Daly River, Australia, to water places. This engagement further led to the incremental co-development of an Indigenous seasonal calendar of aquatic resource use. The seasonal calendar emerged as an effective tool for supporting healthy Country, healthy people outcomes. It did this by facilitating the communication of resource management knowledge and connection with water-dependent ecosystems both inter-generationally within the Ngan’gi language group, as well as externally to non-Indigenous government water resource managers. The Indigenous seasonal calendar form has subsequently emerged as a tool Indigenous language groups are independently engaging with to document and communicate their own knowledge and understanding of Country, to build recognition and respect for their knowledge, and to make it accessible to future generations.

Connections and belonging to ancestral lands are strongly and consistently argued as fundamental to Māori education, health and wellbeing. When our connections with and access to health-promoting places of belonging are damaged, we lose more than component parts of wellbeing. An entire cultural infrastructure integral to identity, community, spirituality, sustainability and even material sustenance is eroded, compromising health, wellbeing and vitality. Young people in rural areas are often seen as missing out on the amenities and attractions available in cities, but are assumed to have compensatory access to and positive relationships with ‘nature’. For multiple reasons, many arising from colonial legacies, this is often not so for young Māori and there are initiatives underway that seek to reconnect them with customary environments. Place-based learning approaches that use local environments and ecosystems as living laboratories, reimagining the way students engage with knowledge, science and understandings of the natural world can be valuable in this respect.

Te Rārawa Noho Taiao projects in the Far North of Aotearoa have been operating for nearly a decade, using indigenous pedagogy that promotes Māori science, science leadership, and learning, applying them in ways that produce a range of health and wellbeing benefits. These include enhanced educational engagement, strengthened capabilities, increased participation/belonging, stronger connections, constructive peer processes and positive intergenerational interactions, all based in Māori values and praxis. Such elements are widely recognised in health-promoting frameworks as highly implicated in the creation and maintenance of health and wellbeing for individuals, communities and populations. In this paper, we use interviews with organisers and teachers of these Noho Taiao and a survey of student participants, to explore the educational and health promotion effects.

For Māori in Aotearoa New Zealand, land is not only an economic foundation but an anchor for tribal identity and a spiritual base. The forced alienation of Māori land since the 1800s, due to colonisation, has distanced communities from a direct relationship with their lands. There is little published research on Māori community gardens (māra) and their potential to reconnect Māori with ancestral lands. This study explores the motivations for developing māra and examines the role of māra in Māori health promotion. The paper describes findings from kaupapa Māori research that involved interviews with seven leaders of māra initiatives. Our findings suggest that the development of māra is motivated by a desire to empower Māori collectives towards a vision of vital communities thriving as Māori. Māra provide a rich site for community development grounded in a cultural connection to ancestral land. The utilization of ancestral lands enables groups to draw on a deep sense of shared identity that is rooted in those lands and fosters an intergenerational orientation. Māra offer activity linked with ancestral knowledge, customary practices and tribal connection. They provide opportunities to practice Māori language and cultural processes in functional everyday ways, and thereby strengthen a sense of commitment to protect cultural heritage as a resource for community life. Importantly, hands-on collective activity with shared decision-making, which is characteristic of māra, fosters social cohesion and collective efficacy. Overall our findings indicate that māra are land-centred community development initiatives that fit within the parameters of Māori health promotion and have much potential to contribute to achievement of Māori health promotion outcomes.

While land is a nexus for culture, identity, governance, and health, as a concept land is rarely addressed in conversations and policy decisions about Indigenous health and well-being. Indigenous food sovereignty, a concept which embodies Indigenous peoples’ ability to control their food systems, including markets, production modes, cultures and environments, has received little attention as a framework to approach Indigenous health especially for Indigenous people living in urban spaces. Instead, discussions about Indigenous food sovereignty have largely focused on global and remote and rural communities. Addressing this gap in the literature, this article presents exploratory work conducted with Waasegiizhig Nanaandawe’iyewigamig and Shkagamik-Kwe Health Centre, two Indigenous-led Aboriginal Health Access Centres in urban service centers located in Northern Ontario, Canada.

Indigenous learning traditionally comes from the land. Akiikaa (‘it is the land’ in Algonkian) is designed to assist graduate students in thinking beyond the classroom and understanding the elements of life as known by Indigenous people to live a healthy life. Akiikaa will provide graduate students (both Indigenous and non-Indigenous) with opportunities to learn about Indigenous ways of knowing. They will learn from an instructor, Elders and their peers about how the land is an instrumental part of all aspects of Indigenous life including health and well-being. One of the goals of the Master of Public Health in Indigenous Health program (at the University of Toronto) and the land-based experiences is to shift the thinking away from humans being the dominating force on Mother Earth to equality amongst all aspects of life. Graduate students are introduced to ‘personhood’ rights for plants, animals, water, and air, which is a shift from the current World Health Organization’s view of public health that builds upon a population health approach but neglects the elements that surround humans as necessary for living a healthy life. It has been suggested that Indigenous land-based education acts as a method of decolonization through reclamation of Indigenous ideology and use of land. Land and land experience are highly prized by Indigenous people around the world as cultures and languages are based on the interaction of people with nature/land. This move to delivering the curriculum in the natural environment using Indigenous knowledges as its pedagogy is anticipated to change attitudes about Indigenous people and issues as well as improving the health and well-being of graduate students and, over time, Indigenous peoples’ health and well-being.

Climate change poses a serious threat to the health and well-being of Indigenous peoples around the world. Despite living in diverse contexts, Indigenous peoples face a number of common challenges. Disproportionate threats from climate change exist due to a range of factors including unique relationships with the natural environment, socioeconomic deprivation, a greater existing burden of disease, poorer access to and quality of health care, and political marginalization. Responses to climate change at global, national, and local levels also threaten Indigenous people’s rights. While climate action presents many opportunities to improve health and reduce inequities, there is also significant potential for climate mitigation and adaptation policies to inflict harm on Indigenous peoples. An important aspect of this is the impact on traditional lands, which are acknowledged as a fundamental determinant of Indigenous health and well-being. This article seeks to elucidate the relationships between climate change and Indigenous health and to inform health promotion solutions to achieve climate justice for Indigenous peoples. The underpinning analysis is founded on a Kaupapa Māori positioning, which seeks transformative change and involves critiquing Western knowledges and structures that undermine Indigenous rights. A central theme is that anthropogenic climate change is intimately connected to the ideologies, systems and practices of colonialism, and that the impacts on Indigenous peoples can be conceptualized as an intensification of the process of colonization. It is not possible to understand and address climate-related health impacts for Indigenous peoples without examining this broader context of colonial oppression, marginalization and dispossession. The challenge for health promotion is to engage in a process of decolonization. This involves deconstructing its own systems and practices to avoid reinforcing colonialism and perpetuating inequities. It also requires health promotion practitioners to support Indigenous self-determination and recognize Indigenous knowledges as a critical foundation for climate change and health solutions.

This commentary explores the relationships between land, knowledge, and health for Indigenous peoples. Indigenous knowledge is fundamentally relational, linked to the land, language and the intergenerational transmission of songs, ceremonies, protocols, and ways of life. Colonialism violently disrupted relational ways, criminalizing cultural practices, restricting freedom of movement, forcing relocation, removing children from families, dismantling relational worldviews, and marginalizing Indigenous lives. However, Indigenous peoples have never been passive in the face of colonialism. Now more than ever, Indigenous knowledge in three critical areas—food and water security, climate change, and health—is needed for self-determination and collective survival in a rapidly changing world.

Prior to western arrival in 1778, Native Hawaiians possessed a sophisticated culture and resource management system conducive to an island ecosystem. However, disenfranchisement from ancestral lands and traditional food sources as a result of colonization led to Native Hawaiians being forced to abandon many of their traditional practices. Today, many Native Hawaiians experience food insecurity, placing them at further risk for obesity and other nutrition-related chronic diseases. Consequently, there is a growing need for place-based and culturally relevant strategies rooted in Hawaiian epistemology to address these issues. This paper describes the history and development of one such intervention – the MALAMA study – in the community of Waimānalo that innovatively merges the modern technology of aquaponics with traditional Native Hawaiian practices and values.