Hello listeners and welcome back to Connecting Citizens to Science, a podcast where we discuss current research and debates in global health. I'm your host, Dr. Kim Ozano, and today we're exploring indigenous knowledge systems and their crucial role in health equity and research. Indigenous communities across the world have long maintained holistic approaches to health that are rooted in their environments and collective ways of knowing. Yet these perspectives have often been overlooked or misunderstood within global health systems.

I think when you say the word Indigenous, there becomes this concept of monolith that we're all the same. And I think that is one of the biggest misconceptions is that realising that while we may have shared value systems that really understanding us as individual communities really is important to understanding our own practices in each of our different regions.

In this episode I am joined by Dr. Walter Flores, who is a research professor from the Accountability Research Center at the American University in Washington, DC. I am also joined by Dr. Rebecca Rae, who is a research lecturer and Dr. Lorenda Belone, who is a professor. Both Lorenda and Rebecca are from the University of New Mexico College of Population Health within the Center for Participatory Research. All three of our guests today are Indigenous researchers who have dedicated their careers to advocating for community-led participatory approaches that align with Indigenous values. We'll discuss the challenges of working across knowledge systems, the intersections of research and activism, and how indigenous methodologies are gaining recognition in global health. Walter, welcome to the podcast. It's great to have you with us today. Walter, what is the relationship between indigenous communities globally with health systems and health, both historically and now?

I would say that from historians, we know that there is evidence that before the European colonisation, say Indigenous communities all around the world, they already had systems to understanding, to work toward health, being in unity with the environment. And these systems, despite all the repressive measure of colonisation, are still very much alive in many parts of the world. For instance, in the Americas, particularly in the Magian Indigenous communities, the view and the philosophy that to be healthy you need to maintain harmony in between your family, your community, but also with your environment and to live a balanced life. That's a central part of well being and what is very relevant is that this view, this philosophy, although it has been known, but has been ignored for many years, but nowadays, I've seen that in my three decades of work, now that we are in the middle of this climate crisis, and also that we are recognising that we are in a mental health crisis, is that I'm seeing that there is an interest for this way of working.

Lorenda, would you like to add any overlooked aspects around the understanding of Indigenous communities and health?

We may be viewed as similar, but we are really very different. I introduce myself as a Navajo woman, and for me, we, as Navajos, as a Diné woman, Diné is a Navajo term for ourselves, we are matriarchal, matrilineal, so the clans of our mothers is how we identify ourselves. But the communities I may work with may be patriarchal and it's being respectful of the communities you go into and listen and learn rather than imposing our ways of being.

Lorenda and Rebecca, do you feel this increased interest in Indigenous communities and their relationship with land, as we've already heard, and with environment is increased because of climate change and mental health?

I believe there is a huge interest. My colleague and I, Dr. Nina Wallerstein, we co-teach what we call a Summer CBPR Institute. And it's grounded in Indigenous knowledge, Indigenous methodologies, and the approaches that Indigenous people use to inform research, to inform participatory work with communities. There is a huge interest in how better to do that type of work and that Indigenous people approaches make sense.

You mentioned CBPR, that's community based participatory research, and I understand in the University of New Mexico and the work with Nina Wallerstein, there's a big focus on participatory research methods. Rebecca, perhaps you could chat us through why this approach is so well known within Indigenous communities and how it relates to Indigenous ways of knowing within the research that we do.

Sure, but I also like to touch based on what Walter talked about. I think there's also an interest in Indigenous ways of knowing connected to land, because it's part of the restoration of land. And I think it's also because there's been a lot more advocacy from Indigenous people. Historically, we've been left out of these conversations, right? Our knowledge way systems have been left out of ways to manage our land, ways to really keep that, as Walter was talking about, that harmony and balance. We have a long history of really maintaining our lands. So, it's not always an open door. It's us knocking on the door to get into these spaces. And so part of that is when we talk about CBPR, that is really that doorway to bring communities in because community based participatory research is really bringing in community partners as partners. We want to make sure people use that as an equal partnership and not just as a mechanism to get people to the door to be able to extract knowledge as well, right? So, I think we need to be mindful we're not just extracting knowledge for the gain of academia, but really how is that knowledge being centered in community? How is the knowledge that is being shared really beneficial for the community? And that's really a huge push of CBPR is that we're using community driven initiatives that come from the community to benefit their communities, not to benefit academia. It can benefit academia, but that shouldn't be the driving force, right? The driving force should be how the initiatives really impact and benefit the communities as the forefront.

What is very crucial is that we need to understand and realise that for Indigenous communities, a lot of the challenges that they are facing in terms of health and development is because of the historical exclusion, marginalisation, and oppression. So for us as researchers, our goal should not only be doing the research to generate evidence, but how our research works and facilitate these processes of evidence generation with communities, disseminating knowledge, but more importantly, an empowering process that would open and facilitate inclusion. So, for me, the only way that you can really do that is through participatory action research, because any other way of doing research is extractive, or it just isolates itself from the goal of solidarity with those people facing this exclusion or with people oppressed, which to me, that cannot be separated. Once you know the historical conditions of why Indigenous communities face these development challenges, then we have the responsibility, in my view, that the work contributes in closing these gaps, but also in facilitating conditions for community empowerment. To facilitate the process of inclusion we started working with communities about issues of access to health. But because for communities, health is important, but also the food security, also the environment, then gradually, with what we have learned about how to engage with the state, with government, with public policies, we have expanded now with communities to do monitoring elicit evidence about food security programmes, about policies for the environment. It started with health, but it has expanded to a more integrated way of seeing health and also seeing the environment. So this has been the process that we have been following for the past 15 years.

I'll just follow up, it's really creating a co-learning experience. You have a lecture, and then you're listening. There really isn't an engagement process, but then when you're bringing people together to learn in a different way of frameworking. It brings in a space of listening. It brings in a place of understanding. It brings in other world views that people may not have been introduced to. And that's what you learn when you're working with communities is you learn other people's world views. And so when you're doing that type of training, we're really trying to turn that process around to, to, understand when we're bringing people together to teach that this isn't just to be able to push the academic agenda. It's really to push the community agenda and what is important for indigenous communities specifically for us. And so CBPR is the tool to be able to come into space to help communities really think about creating programmes that can impact the health and being of their own communities, coming from perspectives of their own historical knowledge that has been in our community since time immemorial.

Yes, in my experience, we as researchers interested in health and social justice, we need to develop the skills for moving and understanding two very different languages. One is the language that already exists, that has existed for many years, of how communities approach understanding the issues, how they have dialogues to analyse, how they collect the information, the ways of knowing and learning. And then we have the language of the academia, the Western academia. And we need to learn those two languages because the goal is not to teach communities how to learn the language academia, also is not how to we show academia that they should do in this way, because this has to do also with power relationships... so what I've seen is that by developing the skill of moving between those two languages, our role as researchers is also to mediate in between the ways of learning, knowing communities, and how that can be translated into the language of academia. And then we go back to communities to see, okay, how can we also represent this so we can communicate with academia, which is the language that influence public policy, influence public services.

I think an important role as an Indigenous researcher, it's not only do we do research with Indigenous communities, but we're in a really unique position in the academy, and that we were able to access resources, for example, with the National Institutes of Health, we're able to seek research funding, we're able to advocate research topics of interest by our communities, we're able to have a voice at the national level on Indigenous issues and we're able to move forward how to conduct research with Indigenous communities. So I, for myself, I see a big part of my role as an Indigenous researcher is just navigating the systems, so that I can be able to bring resources to communities to address their health topics of interest in the way they deem best to address those issues.

And to add on to Lorenda's point, as Indigenous researchers in academia, I think the other role is that we are also in the space of protecting our communities too, right? Like we have to be at the tables protecting our communities so that we aren't also those people who are coming in extracting knowledge.

Thank you very much. And it's really interesting to hear the role of an Indigenous researcher. Walter, do you consider yourself an Indigenous researcher or explain the kind of positionality and role you feel you have?

Yeah, I would say that I consider myself an Indigenous researcher, but also that I'm able to move between the indigenous and the academia as well. I see that my role is that, to mediate into that because it's a very important role, it allows communities to maintain their identity without having to deal with, with academia, but also it helped me to help to mobilise resources, to advancing the community's interest in their own research, but also interest and their demands for rights. So, I feel fluid in this role and I could be fluid within academia, but also when I work with communities, I also feel very comfortable there. So, I feel that this kind of role is very important because as I'm saying, it's not that one way should impose the other. It's just knowing that those are different, that they coexist and they should benefit from each other.

Rather than extractivism. Thank you. So, last question, in the last episode we talked with the Journal of Community Systems for Health, and it was raised that there is a lot of fear around the changing political landscape that we're seeing. But also within the literature, within discussions online, we're seeing a lot of talk about opportunities as well as the stress and the epistemic injustices that are coming forward. Do you have an opinion or anything you would like to add around the current political landscape and how it's affecting Indigenous communities?

Yes. And I would say that the political landscape for at least for Indigenous communities around the world, it's not changed, but it's just exacerbated because throughout history, the level of oppression to Indigenous communities has not really changed. It's only different peaks and periods of exacerbation. And still nowadays, there are still Indigenous communities around the world that are still being oppressed because they trying to protect the land, the environment where they live, and it's being oppressed by this transnational interest for mining, for monoculture, and for all these other commodities. For Indigenous communities, this has been going on since colonial times, and it's still very present. I really hope that this also will give the opportunity to see that this level of a oppression is affecting many different communities, even non-Indigenous, that should realise that we really need to work all together for solidarity for collective well being and for having a more inclusive societies around the world.

We've had some really good movements in the past two decades being able to voice an Indigenous agenda, particularly at the National Institutes of Health. There has been established a tribal health office with an Indigenous director and there have been calls, funding opportunities, to focus on Indigenous health. So, there's been a lot of positive movement, attention, and research that has been conducted for the last decade through the Indigenous research. I guess, there are concerns there's potential to dismantle. So, I think that's a huge concern.

Yeah, a huge concern about reversing some of the gains that you've worked so hard to achieve over the years. Understandable, entirely. Very sadly, we've come to the end of our discussion and we could talk all day, I think, and explore more issues, but Lorenda, what would you advise for anyone who wants to work with Indigenous communities moving forward?

When we teach the CBPR Institute, one of the approaches we use is reflexivity, and reflexivity is really just reflecting on yourself and your actions. In working with Indigenous communities, you really have to reflect on your actions and working with communities. Whatever you do in the community, whether it's positive or negative, impacts that community and at the end of the day you get to leave, so if you've misstepped, the individuals you partner with there feel the brunt of it. So, as a researcher, reflexivity becomes very important in reflecting on myself and what I'm doing in the community.

A real call to ensure that reflexivity is embedded in your research and your approach. Thank you very much. Walter?

I would recommend the intellectual humility because millennial systems, they are very resilient. When we approach the system, understand that this system have survived over 500 years of very oppressive colonialism. They're still very present and they are very much alive. So, we have so much to learn from the system as long as we keep intellectual humility.

Excellent term, intellectual humility. A real call there to engage with that, to address our own behaviours moving forward. Rebecca, take us home with one final piece of advice.

I think, we say this in a lot of our work, is how do you be a good relative? Because that can be interpreted in many concepts, right? And that's not just to people, but that's how are we being a good relative to our land, to our animals, to our whole wellbeing. And so really when we think about working collectively, how are we being good relatives to each other so that we're working towards the collective wellbeing of all.

Well, that brings us to the end of this very insightful conversation. A huge thank you to Walter, Rebecca, and Lorenda for sharing their knowledge, their experiences, and reflections of power within Indigenous led research and the importance this has on equity in global health. We've heard about the need for reflexivity, intellectual humility, and being a good relative, not just to each other, but to our environments, our knowledge systems, and for our future generations. These are critical considerations for anyone working in health research and policy. So, if you found this episode valuable, please take a moment to subscribe, rate, and review on your preferred podcast platform. That really helps us to reach more listeners and grow these important discussions. You can also follow us on X at podcast underscore CCS and on Blue Sky at CCS podcast. Here, you can get updates, conversations, and new episode releases. We'd love for you to share this episode with colleagues and with your peers and networks as that really helps us to amplify these very important voices. Until next time, stay curious, stay engaged, and let's continue challenging the systems that shape global health.