'Indigenous Peoples have resiliently weathered continued assaults on their sovereignty and rights throughout colonialism and its continuing effects. Indigenous Peoples’ sovereignty has been strained by the increasing effects of global environmental change within their territories, including climate change and pollution, and by threats and impositions against their land and water rights. This continuing strain against sovereignty has prompted a call to action to conceptualise the determinants of planetary health from a perspective that embodied Indigenous-specific methods of knowledge gathering from around the globe. A group of Indigenous scholars, practitioners, land and water defenders, respected Elders, and knowledge-holders came together to define the determinants of planetary health from an Indigenous perspective. Three overarching levels of interconnected determinants, in addition to ten individual-level determinants, were identified as being integral to the health and sustainability of the planet, Mother Earth.

• View related content for this article

Introduction

Indigenous Peoples have resiliently weathered continued assaults to their sovereignty and rights throughout colonialism and its continued effects. 1 Human-caused global environmental changes (eg, climate change, biodiversity loss, and pollution) have created new challenges for Indigenous communities due to “habitation in regions undergoing rapid change” platformed on an already “disproportionate burden of morbidity and mortality” 2 stemming from colonisation. 3,  4,  5 The inequitable impacts of these environmental changes are despite Indigenous communities worldwide contributing the least to greenhouse gas emissions 6 and other global environmental changes.

Historically, Indigenous-focused content and knowledge has mostly been overlooked in climate discourse and in assessment reports such as the UN Intergovernmental Panel on Climate Change (IPCC) 7 and the Sustainable Development Goals (SGDs). 8 In the past decade, there has been increasing recognition of the importance of Indigenous Peoples and their traditional knowledges in climate mitigation and adaptation strategies. 9,  10,  11 Despite the increasing recognition of traditional knowledges, it has often been more symbolic than practically applied across the globe. 12 Traditional knowledges are not meant to be an assortment of information that can be simply merged with western scientific knowledge systems. 12 Instead, traditional knowledges are collective, holistic, community-based, land-informed ways of knowing that are inherently interconnected with people and the environment. 13 In other words, traditional knowledges are contextual. As such, they can be a source of knowledge for environmental strategic management in distinct ecosystems. Therefore, attempting to globalise these knowledges can cause them to lose their meaning, purpose, and focus on understanding the relationships between knowledge making and knowledge applications regionally. 14 For example, Indigenous-specific land pedagogies are embedded directly within the respective lands stewarded by Indigenous Peoples. 15 Stewardship is premised on a deep appreciation for Indigenous Natural or First Law, 16 which warrants recognition and respect for an earth-centred and relational jurisprudence system. 17 These Land-specific and Country-specific Natural or First Laws are rooted in complex notions of reciprocity and responsibility, which view biospheric values as human values. 18

Indigenous Peoples’ ontology (ie, way of being) and epistemology (ie, way of knowing) are intricately connected with Land and Country (the term Land is used in some parts of the world and Country in others). Land and Country's innate importance is emphasised by the capitalisation of the words and also encompasses all natural elements no matter whether they are on the ground, in the water, or in the air. 15 Human-centric (ie, anthropocentric) hierarchies are most often absent in Indigenous languages and lifeways with a profound and deep respect given for all human and non-human entities. Indigenous perspectives are therefore in direct contrast to the human-centric worldview that continues to permeate climate discourse and action and from the so-called modern conceptualisations of health and wellbeing. For example, the determinants of health have been an increasingly well understood construct in public health and medical circles. With the goal to promote health equity, increase collaboration, and make the stark power differentials in society more explicit, the evolving determinants of health discourse have bridged social justice movements in a unique way. 19 These health movements are undoubtedly important; however, from an Indigenous perspective, there has been something missing. For example, it is not currently clear where planetary health fits into the existing determinants of health language. In 2021, it was proposed that the world needs to “take a truly ecocentric approach in order to understand and clearly conceptualise the determinants of wellbeing for Mother Earth herself”. 20 By utilising a new determinant framing (ie, the determinants of planetary health) to better elucidate “the combined factors and conditions that affect the health of the planet”, 20 we might be able to better inform research, policy, and on-the-ground solutions. This renewed framing is meant to expand the call for the inclusion of equity rights to all of our relations, including Mother Earth and all of her inhabitants.

This call to action conceptualises the determinants of planetary health from an Indigenous perspective, which prioritises Indigenous-specific methods of knowledge sharing from around the globe. A group of Indigenous scholars, practitioners, land and water defenders, respected Elders, and knowledge-holders have led this effort to answer the question: what are the determinants of planetary health?

Methods

Within various Indigenous research methodologies, a focus is often placed on personal preparation, self-location, prayer, and a decolonising lens of benefiting the community. 21, 22 Use of Indigenous research methodologies are crucial to ensure that Indigenous research processes maintain their standing, validity, sophistication, and strength within and across communities. 23 In this Personal View, we therefore used an Indigenous-led approach that was actioned by a broad base 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]). Collectively, these group members have a deep breadth of experience across Indigenous health, Mother Earth advocacy, Indigenous rights, spiritual traditions, leadership, governance, and organisational participation at regional, national, and international levels. There was no formalised selection process or eligibility requirements for participation in the consensus process; however, due to established networks among group members working in notable positions at the international level, a form of purposive sampling was used to ensure broad representation across regions. Group members asked to participate were well known for their advocacy, knowledge, and representation of Indigenous communities within the various spaces as noted.

The deep listening method was engaged throughout the process of this work. 24 The deep listening method is a way of learning and working in a state of togetherness that is informed by the concepts of community and reciprocity. 24 Deep listening was specifically engaged within an adapted consensus development panel that brought regional experts together from various backgrounds and Indigenous communities. Consensus development panels are useful for bringing knowledge-holders together to produce consensus or guiding statements that address the topic at hand in a way that is accessible to lay people and professionals. 25 Consensus development panels also contribute to research by describing the current levels of agreement on important topics. 25 Consensus development panels can be adapted to suit the long-standing traditions within many Indigenous communities that utilise some form of consensus method in leadership and governance. 26,  27 In this Personal view, we refer to the adapted consensus development panel as an Indigenous consensus process to differentiate it from other standard definitions and methods.

The Indigenous consensus process was undertaken in three phases from January 6 to April 15, 2021, using a perspective that considers Indigenous “research as ceremony”. 28 For these methods to be consistent with an Indigenous research methodology, it was essential to begin from the collective group rather than using consensus method processes (eg, nominal group processes) that start from a place of independent synthesis. 29 The first phase of the process was managed virtually in two steps. The first step was an initial online meeting that set the stage for the work, utilising a sharing-circle method 30 adapted to the virtual environment. Sharing was done from an interdependent perspective, with the belief in a responsibility for the communal survival and progress of others and their future. 30 This method is in contrast to sharing from the more familiar use of the word, which often “begins from a sense of individualized ownership, where one party allows another access to his or her property”. 30 In the second step, another online meeting identified shared views on the determinants of planetary health. Phase one resulted in an outline that was circulated to the group for higher-level comments and edits between Jan 22 and Feb 13, 2021.

In the second phase, the feedback was collated into a draft document that was recirculated to the entire group for more specific review and comments over several weeks. A final online meeting occurred to re-engage any remaining areas for consensus and to ensure clarification on any remaining areas of discussion. Two subsequent drafts were produced with a virtual comment period engaged before a final draft was agreed. The research process was reviewed and approved as exempt by the University of North Dakota Office of Research Compliance and Ethics (IRB-202101–096).

Results

The consensus effort was used to reiterate existing knowledges thought to be crucial for the world to understand, regarding how the global community needs to move forward in “a good way”. 31 The participants also emphasised that despite the many synergies among global Indigenous Peoples’ responsibility and relationships to Land and Country, they were speaking from the heart of their respective communities and with the spirit of their ancestors. The group identified ten main determinants of planetary health in three main interconnected levels that were largely appreciated in their communities: Mother Earth level, interconnecting level, and Indigenous Peoples’ level (see the panel).

Panel

Although these distinct determinants of planetary health were identified, the group noted that there were other potential interconnecting determinants that could not be included as formal headings in this Personal View. However, the group felt that the main headings identified effectively encapsulated other potential determinants. Nevertheless, any omission in this regard was not meant to minimise the importance of other community-derived determinants. With this deep appreciation for the complexity of the topic area, the figure visually depicts the main levels of determinants and their deep and fundamental interconnectedness. This interconnected representation ensures communities with unique cultures and land bases can amplify the determinants of planetary health relevant to them. Throughout this work, the group also acknowledged that the identified determinants are vast and complex topics that cannot adequately be categorised in this short Personal view. Nonetheless, we have attempted to categorise these determinants to elevate this crucial conversation.

Figure as above The interconnectedness of the determinants of planetary health

• View Large Image
• Download Hi-res image
• Download (PPT)

MOTHER EARTH-LEVEL DETERMINANTS

Ancestral legal personhood designation as a determinant of planetary health

Indigenous Peoples globally have the sacred mandate and right to give voice to rivers and to all of Nature. 32 This right is often not respected by common law; however, Indigenous Peoples continue to stand up to protect their human and non-human relatives. Indigenous leadership in the rights of Nature movements have led to global interest in examining and promoting models of Indigenous-led governance that draws on Indigenous-rooted law and practice as a source of legitimacy and authority. 33 Approaches that extend legal pluralism while illuminating the interconnectedness in Nature have recently been exemplified. 34 For example, the Whanganui River Claims Settlement 35 has granted legal personhood to the Whanganui River and the Protection Act 2017 legally recognises the Yarra River (the traditional name is Willip-gin Birrarung Murron) as a living entity in Australia. 36 Both rivers have been a source of ideas and inspiration for ancestral personhood in coexistence with earth laws, setting the stage for the extension of legal pluralism to ancestral beings. 37 Outside of these important examples, current political and economic narratives continue to deprive the land, water, and air of being in the world as equal rights-holders. The denial of being is a deficit discourse that perpetuates negativity, deficiency, and the disempowerment 38 of Nature through current legal statutes. This denial of the right of being is a direct product of ongoing capitalist and colonial mandates, which will continue to exacerbate the environmental crisis. Indigenous Peoples share here ancestral legal personhood as a decolonised counter-narrative worthy of voice, protection, and identity.