In 2023, unprecedented extreme heat, wildfires, and floods demonstrated just how unprepared North Americans are for various climate change health hazards.
While last year was a wake-up call for many, Dr. Nicole Redvers, ND, MPH, wasn’t one of them. Dr. Redvers, a member of the Deninu K’ue First Nation, advocates for Indigenous perspectives in human and planetary health research and practice. Throughout her career, she has worked closely with Indigenous patients, scholars, and communities.
Dr. Redvers addressed global leaders at the September 2023 G20 Summit in New Delhi, India. Her presentation focused on planetary health aspects of climate change and responsibilities that fall squarely on the shoulders of healthcare systems. By the summit’s end, G20 ministers had created a final report and joint commitment to consider climate change within health systems. “That was a success not only for my efforts but [for] the combined efforts of many people at that meeting to bring about this dialogue specifically within the health context,” Redvers recalls. “Whether or not [it] leads to concrete action is yet to be seen. But it shows the importance of diverse voices and the impetus and urgency we face.”
Uplifting Traditional Medicine
This G20 summit is one recent initiative dedicated to creating climate-resilient healthcare systems. In October 2023, the World Health Organization (WHO) convened global experts on sustainable human and planetary health at “A Defining Year for Global Health Action” in Berlin, Germany, to discuss G7/G20 measures for health equity and security.
WHO also established the Global Centre for Traditional Medicine in March 2022 to bridge ancient wisdom and modern science for more robust, accessible, and sustainable health systems. In August 2023, WHO held its first-ever summit on traditional medicine’s potential to transform health care. As far as how traditional medicine and climate-resilient healthcare intersect, Dr. Redvers notes the two are inextricable in many ways.
Reimagining WHO’s role in ensuring global access to some level of primary health care may start with knowledge developed long before modern medicine, acquired over generations. “There is clear recognition that we are unlikely to achieve this goal without the cooperation and uplifting of traditional medicine systems,” Redvers explains. “The majority of folks (particularly within Global South communities) tend to access most of their primary services from traditional providers.” Nearly 90 WHO member states report using traditional medicine.
De-commercializing Approaches to Traditional Medicine
While Dr. Redvers was encouraged to see planetary health in traditional medicine discussions on such a high level, she knows there’s more to the story. “Just because the term ‘traditional medicine’ is being used doesn’t mean that it’s performed in a way that supports planetary health,” she notes. Dr. Redvers points to the high commercialization of certain traditional medicine products (such as herbal medicines) and the corresponding waste and pollution that may result from unsustainable production, transport, and disposal.
“Greater care is needed within traditional medicine dialogues,” she says. “Although pharmaceuticals create their own havoc and raw materials, many plants are at risk [for] overharvesting. This contributes to the loss of biodiversity for local populations that may rely on these medicines. We don’t talk about this enough within Westernized traditional medicine approaches or even within country contexts.”
Pollution, local access to medicines, and biodiversity changes can influence each other in complex ways. “How do we plan for anticipated growth in the most sustainable way from the front end,” Redvers asks, “instead of trying to build up so quickly that the climate is cut out of that equation in favor of profit?”
An Indigenous Vision for Holistic Health
“In Indigenous traditional medicines, there is a strong spiritual connection,” Dr. Redvers notes. “Most of the medicine is premised within that realm, compared to more modern practice, which tends to focus on physical, mental, and emotional components.”
How we think of plants is also fundamentally different in Western and Indigenous contexts. Western medicine often views plants as “source material” for herbal medicine. “This is where Indigenous Peoples and their knowledge become incredibly important,” says Redvers, “ensuring that as we continue to build bridges across Western and traditional medicine, it’s done in a way that continues to respect Earth as a relative. We embody the relational responsibility and reciprocity inherent in using medicines that come from our spaces. We must ensure that kind of narrative and presence is maintained as increasing interest in traditional medicine starts to occur at the global level.”
Transforming Healthcare Systems for Climate Resilience
What might a new era of traditional medicine look like? In its evolution, acknowledging sources of Indigenous knowledge sought out by Western healthcare systems is first and foremost.1Redvers N, Aubrey P, Celidwen Y, Hill K. Indigenous peoples: traditional knowledges, climate change, and health. PLOS Glob Public Health. 2023;3(10):e0002474. https://doi.org/10.1371/journal.pgph.0002474 “What I’ve been seeing at the national and international level is greater interest in Indigenous knowledge, says Dr. Redvers, “but no mention of the peoples [who] actually hold that knowledge. Of course, it’s the other way around. It’s about meaningfully including Indigenous Peoples because that needs to come first.”
The best way to provide culturally informed health care that considers historical traumas is through diverse provider representation. Although extensive research has been published2Feliz VA, Hobbs SD, Borunda R. Strengthen and respect each thread. Int J Environ Res Public Health. 2022;19(21):14117. https://doi.org/10.3390/ijerph192114117about the lack of Black and other racialized healthcare practitioners in the United States, even more work lies ahead to expand on American Indian and Alaska Native representation.
“It’s a huge issue in the United States, here in Canada, and many other places around the globe—being able to receive care from folks that understand the cultural norms, traditional protocols, and nuances of working with traditional healers,” Redvers explains. “The reliance on outside workforces for Indigenous communities has been a reality since colonization, and it’s clearly not resulting in better health outcomes. Representation has been a huge call from communities for decades. Finding ways to get more American Indian and Alaska Native students through that trajectory is incredibly important.”
Data from the Association of American Medical Colleges shows only 1% of total enrolled medical students self-identified as American Indian (AI)/Alaska Native (AN), compared with 2.9% of the 2021 U.S. population. Stats from 2021 show a mere 0.4% of active physicians in the United States self-identified as AI/AN.3Lopez-Carmen VA, Redvers N, Calac AJ, Landry A, Nolen L, Khazanchi R. Equitable representation of American Indians and Alaska Natives in the physician workforce will take over 100 years without systemic change. Lancet Reg Health Am. 2023;26:100588. https://www.sciencedirect.com/science/article/pii/S2667193X2300162X?via%3Dihub Often serving communities with significant doctor shortages, AI/AN physicians practice medicine according to their cultural values and worldview.
Dr. Redvers sees promising developments on the horizon. More U.S. states are offering tuition-funded seats for medical school, and some universities now offer full tuition waivers for Tribal members. “The hope is that this will start to improve the presence of Indigenous folks within these spaces. However, there’s a long way to go before we can say confidently that we’re reaching some sort of equity bar.”
Lessons Learned from 2023 Climate Records
When asked what we can take away from the extreme effects of climate change in 2023, Dr. Redvers doesn’t hesitate. “We can learn that we’re completely unprepared,” she says. “The North [of Canada] is an example of difficulties from the health system standpoint of being able to manage multiple climate emergencies at the same time with unanticipated effects. The lack of good, appropriate planning for how to respond completely fell through the floor. There will be a lot of reports coming out to understand the repercussions and consequences that occurred for communities not being well prepared, at least within their [climate] adaptation measures.”
When Redvers spoke to the G20 delegation, she summoned more than decades of insight from clinical work and research. The wildfires that had recently jeopardized air quality in her Northwest Territories (NWT) hometown were fresh in her mind.4Redvers N. Communities in Northern Canada are feeling the health system implications of climate breakdown. BMJ. 2023;383:2173. https://doi.org/10.1136/bmj.p2173
She recalls that within a week, multiple communities in the NWT’s South Slave Region faced evacuations down a single highway route with nowhere else to go. Shortly after that, fiber optic lines burned through. There was no cell phone or internet coverage and no way for people to reach each other. “Figuring out how to manage acute care patients and hospitals was an absolute mess,” Redvers says, “[not to mention] the impacts to marginalized community members. We’re still trying to figure out where some people are.”
Although 2023 had a particularly high-impact wildfire season, it certainly wasn’t the first “summer of smoke” Northern and Western Canada experienced. “What was different this year,” Dr. Redvers explains, “was the sustained smoke impacts on other geographic areas in Canada but also the United States, which started to wake up Canadians living in so-called Southern bubbles or places that may not have traditionally felt the effects that people were talking about.” With grim images of dark, smoky skies in downtown Toronto and New York dominating the media, wildfires were no longer a “Northern issue” that urban residents could ignore.
Indigenous People’s Health Begets Planetary Health
Indigenous Protected and Conserved Areas (IPCAs) are “lands and waters” protected by Indigenous laws, governance, and knowledge systems. This approach supports Indigenous self-determination and encourages partnerships between Indigenous and other governments, environmental NGOs, and the philanthropic sector. Underlying IPCA initiatives is a long-term commitment to conserve sacred spaces for future generations.
Given that Northern (and predominantly Indigenous) communities disproportionately experience climate change impacts, place-based approaches to Indigenous-led conservation are vital. In October 2023, the Canadian government recently signed a framework to support one of the world’s largest Indigenous-led land conservation initiatives. The Northwest Territories Project Finance for Permanence could more than double conservation in the territory, contributing 2.5% or more toward Canada’s commitment to protect 30 percent of the country’s land and inland water by 2030. This project will support cultural and Indigenous language programs with a conservation focus and help communities prepare for global warming–related impacts through climate monitoring and assessment and fire preparation.
With respect to what Indigenous-led conservation efforts might mean for climate-resilient healthcare systems, Dr. Redvers’ G20 closing remarks say it all:
“Thinking about Indigenous health in a holistic way, the acknowledgment of the purposeful and honoring practices that Indigenous communities have had for millennia, and being able to honor those and uplift those within various contexts is absolutely integral in my mind to healthy people and a healthy planet.”
Footnotes
- 1Redvers N, Aubrey P, Celidwen Y, Hill K. Indigenous peoples: traditional knowledges, climate change, and health. PLOS Glob Public Health. 2023;3(10):e0002474. https://doi.org/10.1371/journal.pgph.0002474
- 2Feliz VA, Hobbs SD, Borunda R. Strengthen and respect each thread. Int J Environ Res Public Health. 2022;19(21):14117. https://doi.org/10.3390/ijerph192114117
- 3Lopez-Carmen VA, Redvers N, Calac AJ, Landry A, Nolen L, Khazanchi R. Equitable representation of American Indians and Alaska Natives in the physician workforce will take over 100 years without systemic change. Lancet Reg Health Am. 2023;26:100588. https://www.sciencedirect.com/science/article/pii/S2667193X2300162X?via%3Dihub
- 4Redvers N. Communities in Northern Canada are feeling the health system implications of climate breakdown. BMJ. 2023;383:2173. https://doi.org/10.1136/bmj.p2173
