The Indigenous Peoples Observatory Network (IPON): Understanding and responding to complex climate-health emergencies

Background: Complex climate-health emergencies (CCHEs) are crises/disasters caused by co-occurring and compounding medical, social, cultural, political, and environmental stressors that overwhelm health systems, create economic and political instability, undermine social systems, and exacerbate poverty1-4. CCHEs increase morbidity and mortality associated with a variety of health risks, including food insecurity, (non)communicable diseases, and the impacts of environmental and climatic change5-7. In an interconnected world that is undergoing rapid change, CCHEs are becoming increasingly common, posing significant threats to marginalised populations such as Indigenous Peoples , who make up ~5% of the global population4,8-10. CCHEs pose a major threat to health in the global South, especially for Indigenous Peoples who face unique health challenges, while also inhabiting areas seeing rapid environmental change10-13. These challenges are linked to the social determinants of health including poverty, inadequate access to health services, discrimination, land dispossession, and colonization which continue to restrain and undermine Indigenous values and decision-making structures10,14-17. Interventions and policies targeting Indigenous health are often ineffective as they fail to consider local understandings of health and health seeking behaviours, inappropriately ‘scaling-up’ from the experiences of non-Indigenous populations16-20. Indigenous Peoples have been uniquely impacted by COVID-19 and will face highly context-specific combinations of factors creating CCHEs in the future2,9,21. There is a lot we can learn from the ongoing experience of such complex health emergencies including the recent COVID-19 pandemic and extreme climatic events in terms of: i) characterizing how different health risks combine to create CCHEs in specific places, and for health and food systems; ii) understanding the factors that shape the creation and evolution of CCHEs, and determine health and food system resilience and vulnerability, and iii) generating evidence on the strengths and weaknesses of different policies and interventions. To do this, a transdisciplinary approach offers the tools to promote collaboration across sectors, disciplines, and ways of knowing, and will be employed here to deliver a research project that will have real impact on Indigenous People's lives. Our Overarching goal is to document, understand, and monitor the factors affecting the creation, evolution, and impact of CCHEs among Indigenous communities in the global South, examining the interaction between climatic and non-climatic stresses, and co-generating knowledge and capacity to build resilience in health and food systems and support pilot interventions. Conceptual underpinnings: This study starts from the premise that Indigenous Peoples are active players in how they experience and respond to environmental crises like climate change and biodiversity loss15,22,23. Resilience and vulnerability to climate impacts are socially constructed and closely linked to issues of sovereignty, power, social justice, land tenure, development, and history15,24-27. To further the design and implementation of co-produced health and food systems resilience and adaptation for Indigenous Peoples, research needs to focus on these root causes, which vary by location and Peoples15,23 . Methods: We will work with on-the-ground Indigenous Peoples Observatories we have established in the global South, working in 6 countries, and partnering with 12 Indigenous groups living in 30 communities: Asháninka and Shawi (Peru); Batwa (Uganda); Coastal-Vedda (Sri Lanka); Mapuche (Argentina); Yukarés and Tacana (Bolivia) and Paniya, Kattunayakan, Kurichiya, Pahari Korwas and Gond (India). These regions and Indigenous Peoples are experiencing wide-ranging food system shifts due to social, economic, and political transitions rooted in colonization and globalization, which are exacerbated by climate and environmental change. While focusing on CCHEs in their broadest sense and thus covering a diversity of health risks specific to each location, across the study regions an in-depth focus will be directed to the intersection between climate-related hazards (e.g. wildfires, flooding, storms, drought) and food and nutrition sovereignty and security. Within each country, the Observatories will be composed of i) community observers ii) policy observers, and ii) in-country researchers. We will complete repeated semi-structured interviews with our community observers monthly for 1 year to collect real-time information (e.g. observations, stories, perceptions, understanding) about the presence, experience and responses to extreme climatic events as they intersect with health and food systems. Study pillars and principal research questions: The study is structured around 5 Pillars. Pillar 1 provides the scientific grounding, asking: based on the experience of recent extreme climatic events, what combination of factors interact to create CCHEs for Indigenous communities in the global South? Pillar 2 focuses on supporting health systems, asking: what types of intervention can strengthen health and food systems to manage CCHEs? Pillar 3 asks what can we learn from the study regions for Indigenous communities more broadly? Pillar 4 focuses on catalyzing impacts at local and global levels, and Pillar 5 supports individual and institutional capacity strengthening and development. Team overview: The project will leverage and strengthen cross-cultural transdisciplinary partnerships, building from existing partnerships and creating new ones. Team members have expertise in climate research, public health, geography, epidemiology, international development, ecology, food and nutrition security, sociology, philosophy, ethics, Indigenous studies, and medicine. The gender-balanced team includes researchers who identify as Indigenous (including the PI), globally renowned senior researchers, directors of global research institutes, early and mid-career researchers, and is multilingual (e.g. Spanish, English, Portuguese, Indigenous languages), and are building leadership in applied climate-health. Each country partner had identified Indigenous Knowledge holders to collaborate with in the implementation of the research and intervention activities. Our proposal has the support of UN officers from the FAO Indigenous Peoples Unit, Alliance of WHO for Health Policy and Systems Research, and PAHO to help us translate our findings from specific communities and regions to inform global policies. This project brings together researchers who have been working in the study regions collectively and independently for over a decade. In addition to our past individual productivity, in coming together to build this proposal, the team has already co-authored 6 articles, including in the Lancet Planetary Health.