Indigenous knowledge, community resilience, and health emergency preparedness

The COVID-19 pandemic and the climate change emergency are among the greatest socioenvironmental crises of our time. These crises have exacerbated health inequalities,1Appleby J The public finance cost of COVID-19.BMJ. 2022; 376: o490Crossref PubMed Scopus (4) Google Scholar revealing substantial weaknesses in health systems and community preparedness.2Shroff ZC Marten R Vega J Peters DH Patcharanarumol W Ghaffar A Time to reconceptualise health systems.Lancet. 2021; 3972145Summary Full Text Full Text PDF PubMed Scopus (9) Google Scholar Indigenous peoples globally face some of the greatest risks associated with pandemics and global environmental changes. In the past 3 years (since Nov 16, 2020), we have collaborated with Indigenous communities as part of the COVID Observatories Project, to document their lived experiences, perceptions, and responses to the COVID-19 pandemic in the context of climatic stresses. In this Commentary, we reflect on the commonalities of Indigenous actions across multiple settings, recently synthesised at a COVID Observatories workshop at the Keystone Foundation in Kotagiri, India (March 19–21, 2023). We also provide examples of the use of Indigenous knowledge and practices that aligned with public health responses and underpinned community resilience in response to the COVID-19 pandemic. In real-time, we observed and documented Indigenous peoples’ holistic vision and responses to the pandemic and climate stressors. Some of the strategies used by Indigenous peoples are based on lived experiences of previous pandemics and the use of ancestral knowledge about food generation and health protection. These responses include use of natural resources (eg from forests), family farms, identifying medicinal plants, implementing collective efforts to protect their food security, and use of their communication systems in Indigenous languages to translate and transmit knowledge about food security and the COVID-19 vaccination within their communities. In the Peruvian Amazon, the elders from the Shawi and Ashaninka Peoples have shared how measles killed many of them, and to protect themselves, they would temporarily live in the forest. During the first4 months of the COVID-19 pandemic, the Shawi people closed their borders, and some families went to live in the forest, built new houses and relied on forest food, while others who had access to fish farms, home-grown foods, and food from small farms stayed in their communities. Similarly, during the first wave of COVID-19, Indigenous communities in the Nilgiris district in Tamil Nadu, India, moved far into the forest. In India, Peru, and Sri Lanka, communities revived traditional agricultural practices and reflected on the importance of their territory and food sovereignty in responding to global emergencies and climate change. For the Irula and Kurumba communities in Tamil Nadu, the revival of millet, a weather-adaptable crop, allowed Indigenous farmers to become self-sufficient during the pandemic when food chains were disrupted and prices increased.3Guleria S Paithankar P Prakash A Mohan K Ensuring food and nutrition security in climate fragilities and disasters: the 31 inspiring practices. National Institute of Disaster Management, Delhi, India2021Google Scholar In the case of older Ashaninka women in the central Peruvian Amazon, during the pandemic they transferred Indigenous knowledge to young women about producing and generating nutritious foods in accordance with Indigenous diets, and about how to use medicinal plants to promote and support health within their communities (which we have described previously4Arotoma Rojas I Chicmana V Anza-Ramírez C et al.Policy recomendations from the COVID-19 Observatories in Indigenous peoples for Peruvian stake holders. March 30, 2023 (in Spanish).https://doi.org/10.6084/m9.figshare.22357822.v1Date accessed: July 20, 2023Google Scholar). In Sri Lanka, Coastal Vedda families spent more time on home gardening and chena cultivation. In the Eastern Cape province of South Africa, Xhosa communities returned to home gardens that had been forgotten due to drought and focused on resilient crops. Indigenous leadership and community cohesion have been crucial in building resilience during ongoing climate disasters and the COVID-19 pandemic. Coastal Vedda Peoples took early action in Sri Lanka before cyclone Burevi in December, 2020, to maintain pandemic precautions. They organised to take COVID-19 preventive measures despite an absence of government interventions for COVID-19 awareness. In the South African town of Makhanda, Xhosa communities have been experiencing severe droughts for several years, exacerbating food insecurity during the pandemic and reducing agricultural production. By collaborating with civil society organisations and establishing community kitchens, the Xhosa people showed resilience, facing the consequences of the pandemic and the droughts. In Nilgiris, community health workers were instrumental in providing awareness and demystifying the complications of COVID-19 vaccination. They also supported the dissemination of information on dietary practices that include wild foods, and the revival of traditional recipes. Ashaninka women leaders in the Peruvian Amazon have recovered medicinal plants and protected natural water sources to adapt to changes in seasonal patterns affecting water availability. These actions demonstrate the innovative thinking and self-organisation within communities that help to overcome challenges and create solutions when resources and support are limited. In other regions, however, we documented how structural socioeconomic inequities reduced Indigenous peoples' community capacity to respond to the COVID-19 pandemic and increased their vulnerability to multiple stresses. In Ghana and Namibia, our work with the Dagaaba, Ovatjimba, and San Peoples showed how inadequate economic resources, unemployment, illiteracy in the dominant language, and weak social networks increased vulnerability. Government attempts to address these challenges have mainly focused on emergency relief, which fails to address the root causes of inequality and creates dependency on the government, and often does not meet community needs. Similar challenges with governmental aid were noted by Ashaninka communities in Peru.4Arotoma Rojas I Chicmana V Anza-Ramírez C et al.Policy recomendations from the COVID-19 Observatories in Indigenous peoples for Peruvian stake holders. March 30, 2023 (in Spanish).https://doi.org/10.6084/m9.figshare.22357822.v1Date accessed: July 20, 2023Google Scholar In Uganda, three decades ago, the Batwa, who are known as Keepers of the Forest, lost access to their ancestral lands—the source of their typical foods, forest resources, and herbal medicines. Reduced access to these Indigenous lands has increased vulnerability among the Batwa communities to the impacts of climate change and recently COVID-19, as we have described previously.5Zavaleta-Cortijo C Ford JD Arotoma-Rojas I et al.Climate change and COVID-19: reinforcing Indigenous food systems.Lancet Planet Health. 2020; 4: e381-e382Summary Full Text Full Text PDF PubMed Scopus (30) Google Scholar Livelihoods such as making and selling crafts, dancing for tourists, and manual labour for money and food came to a halt due to the pandemic and lockdown restrictions.6Namanya D Nuwagira R Ainembabazi T et al.Prevention, impacts, and response to COVID-19 among the Batwa Indigenous Peoples in Uganda: a policy brief.https://figshare.com/articles/online_resource/Prevention_Impacts_and_Response_to_COVID-19_among_the_Batwa_Indigenous_Peoples_in_Uganda_A_Policy_Brief/21394974/2Date: 2022Date accessed: July 6, 2023Google Scholar However, our work has shown how Batwa resilience to COVID-19 was based on long-standing knowledge of traditional herbal medicines and well established community support systems like sharing food. There are commonalities between Indigenous worldviews and public health approaches around the health–disease process and how communities respond to health emergencies. Both acknowledge the interconnected relationship between humans and the socioecological system and the need for balance in this relationship. These commonalities indicate synergies that could be used to strengthen health system responses to current and future health risks (table).TableCommonalities between Indigenous knowledge and public health approaches to understand the health–disease processIndigenous knowledgePublic health approachesCommonalitiesEpidemiological triangleWhen diseases, environmental crises, or disasters happen, many Indigenous peoples understand the event as being a consequence of an imbalance in the relationship between humans, mother nature, and spiritual influences7Arotoma-Rojas I Berrang-Ford L Zavaleta-Cortijo C Ford JD Cooke P Indigenous peoples' perceptions of their food system in the context of climate change: a case study of Shawi men in the Peruvian Amazon.Sustainability (Basel). 2022; 1416502Google ScholarThis concept is closely related to the epidemiological triangle to understand causes of infectious diseases:8Smith E The effect of potential climate change on infectious disease presentation.J Nurse Pract. 2019; 15: 405-409Summary Full Text Full Text PDF Google Scholar host (eg, humans), agent (eg, other species in nature), and environment in which the disease is transmitted (eg, land and weather conditions)There are relationships in the socioecological dimensions that need to be balanced to prevent diseases; for example, changes in the global climate system might affect human behaviours and other species’ behaviours, implying that humans and non-humans are part of the same collective (eg, the concept of mother nature taking care of everything and everyone)One HealthIndigenous knowledge has a strong health–nature nexus, similar to the One Health frameworkIn the One Health framework, when a virus jumps the species barrier is when imbalance among species is present and there is a risk of a new disease emerging9Leifels M Khalilur Rahman O Sam IC et al.The One Health perspective to improve environmental surveillance of zoonotic viruses: lessons from COVID-19 and outlook beyond.ISME Commun. 2022; 2: 107Crossref PubMed Google ScholarIndigenous knowledge about imbalance among species causing disease in the past aligns with the fact that health systems have faced multiple pandemics; previous learning processes enable Indigenous communities to produce responses informed by empirical data, communicated in Indigenous languages (an example of community resilience)Planetary healthIn the Indigenous worldview, imbalance has repercussions on human health and reflects the Indigenous concept of holistic linkages between humans, other species, and the land where Indigenous peoples liveFrom a planetary health perspective, the long-term, unwise behaviours of human populations are changing our planetary system and are creating unprecedented challenges to sustain healthy life on Earth10Horton R Lo S Planetary health: a new science for exceptional action.Lancet. 2015; 386: 1921-1922Summary Full Text Full Text PDF PubMed Scopus (102) Google ScholarThe notion of a planet is closely related to the land, community, or space where Indigenous peoples and families live; even when we do not see the whole Earth, the reality of a space that needs to be healthy, to produce a healthy life, implies that we are part of a major whole system, and all people need to respect it Open table in a new tab The knowledge of Indigenous peoples is central to community resilience, and their holistic vision of population health aligns with public health approaches. As efforts develop to build health emergency preparedness, support climate adaptation, and promote sustainable development, we conclude it is imperative that Indigenous knowledge, practices, and worldviews underpin policy development and decision-making processes. CZ-C declares that the university where she works received funds from the UK Research and Innovation (UKRI) agency under a Global Challenges Research Fund and Newton Fund Consolidation Account (GCNA) award, via the University of Leeds, to complete the current research in Peru. DBN declares that the institution where he works received funds from UKRI under a GCNA award, via the University of Leeds, to complete the current research in Uganda. JJM declares that grant support and payments have been made to his institution from the Alliance for Health Policy and Systems Research, Bloomberg Philanthropies (via the University of North Carolina Gillings School of Global Public Health), the Chilean National Fund for Scientific and Technological Development (via CIENCIACTIVA/CONCYTEC), the British Council, the British Embassy and the Newton-Paulet Fund, Wellcome Global Health Trials, Fogarty International Center, Grand Challenges Canada, International Development Research Center Canada, the Inter-American Institute for Global Change Research, the US National Cancer Institute, the US National Heart, Lung and Blood Institute, the US National Institute of Mental Health, the Swiss National Science Foundation, the UKRI Biotechnology and Biological Sciences Research Council, the UKRI Engineering and Physical Sciences Research Council, the UKRI Medical Research Council, and the World Diabetes Foundation, and had a contract with Health Action International, all of which were unrelated to this work. JJM is also co-chair of the UN Independent Group of Scientists 2023 Global Sustainable Development Report, a member of the Scientific Expert Committee of the Global Data Collaborative for CV Population Health of the World Heart Federation, Microsoft, and Novartis Foundation, a member of the Scientific and Technical Advisory Committee of the Alliance for Health Policy and Systems Research, WHO, a member of the WHO Technical Advisory Group on NCD-related Research and Innovation of the Department of Noncommunicable Diseases, WHO, and a member of the Advisory Scientific Committee of the Instituto de Investigación Nutricional (Peru). JJM also participated in the data safety monitoring board for the Nigeria Sodium Study (NaSS), the trial steering committee of the Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Haemorrhage trial (INTERACT 3), the international advisory board of the Latin American Brain Health Institute of Universidad Adolfo Ibáñez (Chile), the consultative board of the Programa de Gastronomía of the Facultad de Estudios Interdisciplinarios, Pontificia Universidad Católica del Perú, and an advisory board for the InterAmerican Heart Foundation. All other authors declare no competing interests. Download .pdf (.08 MB) Help with pdf files Supplementary appendix