Meaningful Indigenous representation across the globe: a call to action
Implementing the Indigenous determinants of health framework must be led by Indigenous leaders if the resolution is to be impactful and a driver of systemic change in institutions that have proven slow to evolve
The resolution on ‘The Health of Indigenous Peoples’ adopted at the 76th World Health Assembly in May 2023 resulted from decades of relentless advocacy and educational efforts by Indigenous leaders. Although this was a celebratory moment, Indigenous peoples across the globe are acutely aware that this resolution will only be impactful and drive systemic change if its implementation, through the Global Plan of Action, is led by Indigenous leaders representing their communities’ perspectives. The United Nations Declaration on the Rights of Indigenous Peoples calls for ensuring substantial Indigenous representation from high-level decision-making positions through the design and management of implementation measures. Meaningful Indigenous representation is the only right, moral and equitable political choice to expedite systemic change in institutions that have proven too slow to change.
The provisions enshrined in foundational documents, such as UNDRIP with its requirement of free, prior and informed consent, the International Labour Organization Indigenous and Tribal Peoples Convention 169 and other international instruments protecting the rights of Indigenous peoples, are undoubtedly significant advances in terms of legal and policy matters. However, the implementation and application of such instruments are, in the best-case scenario, inconsistent across the United Nations system agencies and national ministries and, in the worst-case scenario, used as tools to continue marginalisation and neo-colonisation. For instance, while institutional policies for implementing the principle of free, prior and informed consent may exist and be codified in agencies such as the Food and Agriculture Organization, other agencies lack clearly defined procedures. Without these procedures across institutions, policy is applied inconsistently, and this often results in detrimental policy decisions and continued discrimination and marginalisation. Most agencies lack a process for decision makers to ensure Indigenous rights are secure and protected in an ongoing fashion (as established in the principle of free, prior and informed consent) and, most importantly, in ways that Indigenous peoples can use to effect change.
Ill-equipped agencies
Most UN agencies, whether focused on health or not, are ill equipped to approach Indigenous issues in a holistic and optimal manner. The lack of proper understanding is a critical issue across the UN system because for Indigenous communities, health is connected to all spheres of human activity. As articulated by the UN Permanent Forum on Indigenous Issues, Indigenous peoples’ holistic conceptualisation entails approaching “health as an equilibrium of spirituality, traditional medicine, biodiversity, and the interconnectedness of all that exists. This leads to an understanding of humanity in a significantly different manner than non-Indigenous peoples.” Such understanding is especially relevant regarding non-Indigenous agency staff deciding how to approach Indigenous affairs from their institutional platforms. Most officials find it difficult to perceive cultural nuances and thus may insist on minoritising Indigenous issues by grouping them with local communities (see, for example, the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystems) or stakeholders rather than regarding them as rights holders. Other local populations may have nothing in common except shared geographical regions, but they are completely foreign to the Indigenous holistic understanding of health and well-being. Even though we, Indigenous peoples, are the guardians of the planet’s biodiversity, and have used Indigenous ancestral knowledge to protect it for millennia, the institutions leading the world are mostly unknowing of the Indigenous holistic perspective and insist on dissecting its components to make them fit into the existing system. History has shown this to be ineffective, incredibly time consuming and often counterproductive to the stated goals.
The Indigenous Determinants of Health framework, composed of two studies sponsored by the UNPFII, was developed precisely as an educational and expedited solution to the institutional apathy and slow appetite for consequential and equitable change facing the urgent, and largely unmet needs of Indigenous peoples worldwide. The IDH is a concept coined by the UN Indigenous Youth Caucus in 2022, and was embraced and developed by three UNPFII expert members, 22 Indigenous researchers and community leaders representing the seven UNPFII regions. The conceptualisation of Indigeneity as an overarching social determinant of health provides the foundation for 33 risk and protective factors unique to the circumstances faced by Indigenous peoples and the systemic marginalisation challenging Indigenous lifeways. The constructs included in the first study, ‘Indigenous determinants of health in the 2030 Agenda for Sustainable Development’ published in 2023, provide Indigenous health-specific circumstances explained in terms of intergenerational holistic healing, the health of Mother Earth and the re-Indigenisation of culture. For non-Indigenous officials’ education purposes, these concepts were compared to World Health Organization levers to be used in the World Report of Social Determinants of Health Equity, to be released in 2024.
Practical guidance
Having experienced resistance and barriers to ideal Indigenous representation and rights implementation themselves, the UNPFII expert members decided to sponsor a second study, focused on operationalising the IDH for institutions to have clear guidance on the structural modifications needed to accelerate systemic change in culturally safe and concrete manners. The ‘Improving the health and wellness of Indigenous peoples globally: operationalization of the Indigenous determinants of health’ study (to be published in 2024) provides practical implementation guidance on the institutional components that must be developed or modified to meet the defined principles of UNDRIP and free, prior and informed consent. Developed from the perspective of Indigenous rights, the guidance incorporates components on Indigenous representation and meaningful engagement, incorporation of meaningful interventions and approaches, equitable integration of Indigenous research and evaluation methodologies, land ownership and environmental management, and optimal participation in policymaking.
All the structural components are vital to ensuring a system that is equitable and cultivates protections for Indigenous peoples’ rights. The next critical step is the political decision to include appropriate representation and authentic engagement of Indigenous leadership in the WHA resolution’s Global Plan of Action and in all the work of UN agencies. This includes Indigenous representation in high-level advisory bodies, technical and scientific workgroups, and discussions on planetary health across the UN system. Substantial representation will accelerate the development of the other Indigenous health operationalisation components. If systemic change is to be expedited, Indigenous leaders must be the ones steering the work to define the policies, initiatives and projects affecting Indigenous populations at the global and national levels.
Therefore, we call for our Indigenous brothers, sisters, and individual and state allies to advocate from their platforms and positions for two key objectives:
- For Indigenous leadership to be integrated in a weighty and meaningful manner in the Global Plan of Action and other pertinent decision-making instances across the UN system, and
- To make the Indigenous Determinants of Health a guiding framework to ensure all aspects of our Indigenous holistic and intergenerational perspective, and the operationalisation of our Indigenous health rights are included, respected and protected.
