Published secondary literature at the nexus of climate change and Indigenous Peoples’ health and wellbeing is geographically clustered in the Circumpolar North.

Overall, 16 published review articles (42%) focused on the Circumpolar North [28–43], nine of which focused specifically on Circumpolar North America, and particularly Inuit Nunangat. The range of geographic locations included Africa [44–46]; Asia [47]; Oceania [48–50]; North America (not Circumpolar) [51,52]; and Latin America [53] (Table 2).

Reviews focused on the wellbeing of a wide geography of Indigenous Nations, groups, or organizations in their respective research studies. Only one record was explicitly focused on the experiences of urban Indigenous Peoples [51], with the majority of records focused on rural and/or remote locales. In total, five reviews were included as per a weighted criteria [see protocol, [21]] and covered Africa [44–46]; Latin America [53]; and Indigenous groups who broadly identified as being from mountainous regions [54]. In addition, 12 reviews focused on Indigenous Peoples’ health and wellbeing globally (Tables 1 and 2).

The grey literature search retrieved 37 relevant publications consisting of policy briefs, discussion papers, organization reports, and media content (e.g., presentations, website resources) from across Africa, Latin America and the Caribbean, Australia, New Zealand, Oceania, and Asia. Ten publications (27% of grey literature) were global reports retrieved from United Nations (UN) databases (S3 Table).

Biodiversity impacts: Globally, ecosystems are changing in place-specific, localized ways.

The reviewed literature invariably discussed ecosystem changes and specific impacts on biodiversity as a result of climate change. Ecosystem changes were often described as resulting from human activities based in capitalism and colonialist systems that drive broader climatic and environmental change. Two reviews (5.3%) integrated climate change and biodiversity impacts within their overall framing or focus [36,54]. When discussed, changes to biodiversity were characterized broadly as ecosystem changes, encompassing both changes to physical environments and the plant and animal species therein.

Reported changes to physical environments were extensive and severe, characterized as "[the risk of] large scale ecological transformation" [53:12] and "dramatically declining" [49:3]. Aquatic [e.g., 48,49], atmospheric [e.g., 33], and terrestrial [e.g., 41,53] changes were described, as well as, most notably, cryospheric changes across Arctic and Subarctic regions (e.g., ice depth, extent, and timing of break-up/freeze-up) [e.g., 32,35,37,43,58,59] (Table 3).

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Table 3. Type of water-, air-, and land-related effects of climate change, as discussed in the reviewed published literature, and associated references.

https://doi.org/10.1371/journal.pgph.0002995.t003

These changing environments were linked to changes to wildlife and plant ecology, across the reviewed literature, including changes to species important for Indigenous food systems, medicines, and–more broadly–livelihoods. The overall health, abundance, distribution, migratory patterns, and predator-prey balance of key animal species relied upon for Indigenous Peoples’ livelihoods were reportedly altered with climatic/environmental change [40,41,51], including that of marine mammals (e.g., ringed and hooded seals, narwhal, polar bears) [28,30,33,39], Rangifer species (e.g., reindeer, caribou) [29,36,60], birds (e.g., wild ptarmigan) [29,42,59], and fish (e.g., char) [30,34,35,42,52], some of which were referred to as ’keystone species’ for ecosystem services and functioning, as well as Indigenous Peoples’ livelihoods and wellbeing (e.g., bees in Melanesia [49], and Rangifer in North America [36]). Changes to the health, productivity, and "agrodiversity" of both cultivated and wild plant species (e.g., berries, medicinal plants) were also noted [35,43,48,52,54:1131], alongside an increase in invasive plant species that alter agriculturally significant crops and trees [49].

Overall, across geographic regions, the reviewed literature reported vast ecological changes that have impacted livelihoods [61,62], altered community dynamics [61,63,64], and disrupted knowledge-sharing practices [63,65,66]. As noted by Leal Filho and colleagues, degradation of land and biodiversity loss has had "cascading effects" on local people relying on ecosystem services [46:7].

Proximal impacts: Ecosystem changes are challenging Indigenous Peoples’ health outcomes.

A total of 33 reviews (86.8%) identified and described the proximal impacts of observed ecosystem changes on human health, often tied to higher temperatures and variable precipitation. Records identified an overall increase in disease susceptibility [43,51,58] and mortality [32,46], alongside an array of acute and chronic physiological impacts, such as increased heat stress and prevalence of cardiovascular diseases [48,51], respiratory illnesses like asthma and airborne diseases [32,33,43,48,51,58], and increased UVB exposure [56]. Mental health challenges were also reported, including emotional responses of worry, sadness, anger, and emotional distress [32,35,58,60].

An increase in infectious diseases was also identified in 19 articles (50%), including vector-, food-, and waterborne diseases, which were observed across geographies [26,28,31–33,39,42,44–46,48,50,51,53,56–59]. Foodborne diseases (e.g., E. coli, botulism, salmonella, trichinella, brucellosis) were found to be particularly significant concerns among Indigenous communities in Circumpolar North America, where temperature changes compromise traditional food storage methods [32,51,55,59]. Moreover, several reviews underscored challenges to healthcare access and high quality infrastructure in rural areas, exacerbating the impacts of infectious disease prevalence due to climate change [44,45,53,55].

Beyond threats to food safety from foodborne illnesses, nutrition-related impacts were reported in 15 reviews (39.4%). Micronutrient deficiencies were reported across geographies [44,48,49,57,58]. Climate-driven food insecurity negatively impacts diet quality, particularly in relation to traditional foods access [30,52,55]. This shift away from traditional foods, known for their nutrient density [31], has invariably led to an increased reliance on market foods, resulting in increased prevalence of metabolic conditions and nutrition-related diseases [30,34]. Further, changing exposures and sensitivities to contaminants in food sources were also reported through bioaccumulation in the food chain [28,32–34,40,41,52,56].

Finally, 17 articles (44.7%) identified that ecosystem changes globally are creating threats to human safety. Most notably, natural calamities or environmental hazards such as flooding were known to increase accidental injury or death [32,35,38,48,50,58]. Subsequent erosion, particularly in coastal regions of Latin America and the Circumpolar North, was also tied to these health risks by causing infrastructure instability [42,53]. While relocation was discussed as an adaptation strategy to these risks by two reviews [53,57], Dannenberg et al. (2019) noted that injury can occur before, during, and after these managed retreat actions. In the Circumpolar North, literature discussed the danger of unstable ice conditions or unpredictable weather patterns for people travelling on the land to engage in activities such as hunting, harvesting, or herding [28,30,37–39,43,56].

Intermediate impacts: Ecosystem changes are changing human environments.

Across the secondary literature (n = 32; 84.2%), ecosystem changes were linked to intermediate impacts on human environments and systems of livelihoods. These included challenges to food and water systems as well as local economic and built environments.

Climate change impacts on Indigenous food and water systems were discussed in 28 reviews (73.6%) and recognized as a global phenomenon [67]. Many studies focused on harvesting-related vulnerabilities [39] that constrain subsistence activities such as hunting, fishing, and foraging [32,35,39,43,52,55]. Across geographies, agroecosystem productivity constraints were identified, which significantly reduced land productivity, food and medicine diversity, and drinking water quality and availability [29,42,48,49,52,54,58,59]. Water scarcity was a particular concern in the Global South (Latin America, Africa, South Asia, Oceania) and seen as a key driver of food insecurity and disease [44,46,48,53,54]. Ecosystem changes affected the access and availability of traditional food sources and exacerbated existing food insecurity prevalence [30,39,52,55,57], changing traditional food cultures [28].

Economic environment challenges were also described by 11 reviews (28.9%), particularly as climate change and associated biodiversity loss disrupts economic activities that are part of the subsistence economy [28]. Indigenous food systems and their security hold significant economic benefits to Indigenous communities around the world [67]. Yet, as seen in the Circumpolar North, hunting activities require more economic resources to adapt to new challenges, exacerbating social inequalities [28,35,40,43,52,56]. Beyond food, a reduction in other natural resources, such as fuel wood and non-timber forest products, were observed to impact other parts of the world where these resources make important contributions to local economies [29,32,44,54,68]. These challenges also impacted agricultural livelihoods, as reported in multiple grey literature reports [61,69].

More broadly, 12 reviews (31.5%) reported how ecosystem changes are altering built environments. For instance, land changes such as erosion and permafrost melt deteriorate transportation routes [32,51,52], lead to loss of housing and secure shelter [48], and threaten cultural sites [28,51]. In turn, the integrity of community infrastructure and community viability are also threatened [32,33,37,49]. Notably, most reviews that included built environment impacts focused on health care access or system deficiencies caused or amplified by extreme weather events or infrastructure damage [31,32,44,48,55,57]. These changes have had profound impacts on communities, necessitating climate-induced mobility, migration or relocation, as per the global literature [35,48,49,51,53,58].

Distal impacts: Human environment changes are impacting Indigenous Peoples’ relationships to place, culture, and each other.

Changes to human environments and livelihood systems were shown to have distal consequences on Indigenous Peoples’ ways of life globally. Specifically, 27 review articles (71.1%) indirectly associated ecosystem changes with interpersonal and relational changes tied to spiritual and family life, oral history, and culture [55].

Sixteen reviews (42.1%) identified these relational challenges as concerning a person’s sense of place, kinship, and identity and disrupting relationships with the land [e.g., 35,43,56]. Ecosystem changes that alter physical landscapes were reported to be especially significant to Indigenous contexts, because “when physical landscapes change, stories, memories, or meanings may also change or fade away” [29:1079]. Several articles reported reduced cultural, historical, or social, or physical ties to the land [28,29,35,36,38,48,57,60] with implications for community-level kinship [36]. For example, challenges to traditional food access and availability threatened the viability of food sharing networks and other practices dependent on community collaboration [30,34,39,52].

Traditional knowledge and cultural practices were also indirectly associated with ecosystem changes in 23 reviews (60.5%). Articles reported impacts on traditional knowledge in terms of loss, disruption, reduced relevance, and unreliability in its use and transmission [26,27,29,30,35,37,38,43,48,49,51,52,54,57,60]. In reviews focused on the Circumpolar North, there was notable concern for the transmission of this knowledge to younger generations given the observable erosion of land skills and institutional memory [28,32,37,39,58]. Ecosystem changes were reported to disrupt daily activities [57] and, in turn, contribute to ‘culturecide’ [48].

Changing human environments were also found to challenge the fabrics of Indigenous cultures by indirectly advancing cultural shifts or negotiations. Overall, five reviews (13.1%) reported changes in traditional practices or networks [28,35,40,43,49], such as hunters requesting cash payment for traditional foods [28,43]. Some articles drew attention to other contextual forces, such as economics and the effects of modernization (e.g., nutrition transition, wage-based economy), as compounding these impacts and forcing people to negotiate needs [28,40,49].

Many of these distal changes contributed to emotional and psychological health challenges, as identified in 15 reviews (39.4%). Some reviews characterized ecosystem changes as constraining Indigenous Peoples’ abilities to engage with the land in ways that are necessary to sustain mental and emotional wellbeing [26,32,34–36,41,42,48,58,60]. Several reviews also discussed an increase in social pathologies (e.g., family violence, addiction, poverty, suicide) [51,56] and interpersonal stress, conflicts, and intrafamilial tension [35,46,57,58], sometimes over resource rights or a result of resource deficits [46,57].

Four review articles (10.5%) discussed the impact of climate change on Indigenous sovereignty and self-determination. These impacts included worries of loss of autonomy and Inuit sovereignty in the Circumpolar North [30,35], or the loss of nationality and state sovereignty in other global regions [48]. As Middleton et al. (2020) identified, ecosystem changes can be perceived to limit people’s ability for self-determination, “such that climate change was framed as a driver of ‘environmental dispossession’” [60:11]. In certain contexts, Indigenous populations were reported to be not only vulnerable to climate change, but also to policies of climate mitigation that put livelihoods at risk [70]. Grey literature reports highlighted circumstances of Indigenous Peoples’ eviction from ancestral lands [61] as well as how livelihood changes affect Indigenous Peoples’ legal, cultural, and spiritual obligations to care for ancestral lands and waters [14].

Engaging multiple, diverse knowledge systems supports adaptation to and deepens understandings of climate-health impacts.

Reviews characterized non-Westernized knowledge systems as: "Indigenous and Local Knowledge" [53,68]; "Traditional and Local Knowledge" [54]; "Traditional Knowledge" [39,49]; "Traditional Ecological Knowledge" [50]; and Indigenous Knowledge (IK) [26,46,70]. Regardless of how it was termed, reviews broadly acknowledged the value of engaging multiple forms of knowledge, beyond Western systems, in response to climate change. However, reviews varied in how they positioned IK within this narrative and in relation to other knowledge systems (e.g., in how they proposed engagement with IK). Reviews posited a need to: ’integrate’, ’incorporate’, or ’include’ IK within Western knowledge systems [26,50,68] or resource management approaches [53]; to ’mobilize’ IK, in general [54]; to broadly support Indigenous Knowledge-sharing or ’intergenerational knowledge transmission’ [36,37]; to prioritize "preservation or documentation of [Traditional and Local Knowledge] and practices" [54:1133,55]; and to advance some form of ’knowledge co-production’ or ’bilateral information sharing’ (e.g., within partnerships between Indigenous Peoples and researchers, governments, or other organizations) [27,50,70]. Fewer articles explicitly positioned IK as integral or foundational to Western science understandings of climate-health impacts [58,70].

Nevertheless, engagement with diverse knowledge systems was recognized as deepening and broadening understandings of health-related climate change and biodiversity loss impacts [29,34,39] as well as "improv[ing] quality of evidence about co-impacts" [70:14], e.g., "[through] collecting more responsive and representative data" [59:17]. Many articles highlighted that ecosystems have always been changing to some extent, that "adaptation to environmental change is a constant in their lives and they will continue to adapt" [43:12] and that embedded in many IK systems is the ability to flex and adapt to these changes [34,38,46,55], with some reviews identifying IK itself as a "determinant of adaptability/resilience" to climate/environmental change [39:816]. In this light, reviews pointed to the need to both support community-led adaptation and also address broader sociopolitical constraints on community-determined responses.

Continue to platform localized, Indigenous-led action for climate change adaptation.

Across the secondary literature, reviews characterized the needed response to climate change and biodiversity loss as being primarily at the locus of community (10 articles; 26.3%), rather than regional, national, or international responses (four; 10.5%), for effectiveness but also in alignment with normative values and principles. Reviews identified a need for "community-driven" responses [68:56]; strengthened "community engagement" [37,54:1138,70]; "community centered discourse" [27:167]; or ’community-based’ or ’bottom-up’ approaches [e.g., community-based monitoring] [41,67]. One review focused squarely on the voices and ’untold stories’ of Indigenous Peoples with respect to climate change [43]. Others focused on "community empowerment" without explicit discussion of self-determination in community responses [54,55:1264]. Similarly, others applying a ’vulnerability framework’ to analyze community adaptive capacity advocated for community-led responses; however, they did not go further to interrogate the processes, institutions, and structures that constrain these adaptation responses and underly existing vulnerabilities [28,37,39,51,55]. On the other hand, some reviews went further to underscore institutions that create structural violence and risk [38] and, more foundationally, to link localized health-related climate and biodiversity vulnerabilities to broader sociopolitical contexts and colonialism.

Interrogate the structural, institutional, and processual constraints to Indigenous-led adaptation, explicitly naming colonialism where it exists.

Eighteen reviews (47.4%) explicitly situated their findings regarding the health-related impacts of climate change and biodiversity loss in the context of historic and ongoing colonialism and associated power imbalances (e.g., rated ’high’ or ’medium’ with respect to degree of attentiveness to colonial influences in quality appraisal) (S1 Table). Colonialism was acknowledged as an "underlying root cause of vulnerability" to climate/environmental change [55:1260], that "there needs to be a shift from a focus on ’vulnerable peoples’ to the underlying processes and institutions that put people at risk" [38:15]. Colonialism, in the form of land dispossession and degradation [49], "top-down governance structures [and] inflexible policies regarding land use and resource management" [40:387] and hegemony of Western knowledge systems and structures [31,42,55], was named as antecedent to and driver of climate-change vulnerabilities [43]. These anthropogenic factors reportedly challenged intergenerational knowledge sharing [30,56] and affected access to health services, as well as food and water safety and security [44,46,50], contributing to and compounding climate change-vulnerabilities. Three reviews (7.9%) named settler colonialism, specifically, in the framing of the review [26,42] and situating of results [38], whereas most of the reviews discussing colonialism used the term broadly (i.e., to possibly include other forms such as franchise or exploitation colonialism).

A total of 18 articles (47.4%) were rated ’low’ in the quality appraisal process in terms of attentiveness to colonial influences on climate-health and biodiversity impacts. For some, this discussion was less relevant to the type/aim of the article [32,36], or colonization was briefly mentioned but not engaged with extensively [52]. Many reviews also identified broader health and social inequities–disparities in social determinants of health–that affect Indigenous Peoples’ vulnerability to climate change and biodiversity loss impacts on health [44,49,51,53,55], including poverty, inaccessibility of health services, poor infrastructure and public service systems, and racial discrimination. These articles identified the need for responses (i.e., policy, research) to be targeted towards these broader health and wellbeing challenges, to buffer the impacts of climate and environmental change.

Climate-health research is needed that is strengths-based, trans- and interdisciplinary, embedded in partnership with Indigenous Peoples, and that applies a broader health lens.

Based on their respective literature syntheses, reviews identified the need for future climate-health research approaches that are trans- and interdisciplinary [32,34]; strengths-based [43,48]; and that apply a broader lens and conceptualization of health, reflective of Indigenous concepts of health and wellbeing [55,56]. A research response to climate-health and biodiversity impacts needs to engage the complexity of socio-ecological relationships [56]. Reviews proposed OneHealth [26], ’nature-based solutions’ [27], and ’ecosystem-based adaptation’ [50] as frameworks for inquiry with these embedded systems or relational lenses, or that apply an eco-centric view to the design and development of adaptation approaches, and further examined the interfacing or integration of IK into these Western-science frameworks or models. Cottrell proposed that "nature-based thinking" (e.g., focused on the intrinsic value of nature)–a more inclusive and expansive framework to climate response–could help bridge the ’divide’ between the Western scientific community and Indigenous communities [27:167]. Moreover, practitioners of a ’nature-based solutions’ approach, in particular, "can support the sovereignty of Indigenous peoples by advocating for local management and control over project lands" [27:167].

More fundamentally, reviews proposed that primary research studies: be embedded in partnership with Indigenous Peoples [32,36,40,51,54]; involve a bilateral sharing of information rather than the scientific community, "providing unilateral advice" [43:6]; and involve a "sharing of power" and privileging of IK [34,70:14], through diverse methodological approaches [60] and "study design that fully embeds Indigenous values, realities, and priorities" [70:14].

Among the reviewed secondary literature itself, however, only 6 records [15.8%] explicitly reported a high degree of involvement of Indigenous Peoples across the research process (S1 Table). These reviews were led by Indigenous scholars [70] or teams involving ’knowledge users’ or community researchers from the study context [32,39]. Review methodologies were informed by Indigenous partners or a broader steering committee [36,60], or reviews reported that Indigenous Peoples had input on the final manuscript to ensure framing aligned with their priorities [30].

Shift the narrative within climate-health adaptation from prioritizing community-based approaches to community-driven, rights-based approaches that emphasize Indigenous sovereignty and autonomy.

Reviews discussed the crucial need to advance priorities and processes related to Indigenous sovereignty, rights, and autonomy within the climate-health, planetary health space. Records identified that, across the primary literature, there existed recognition of a need to prioritize and respect Indigenous sovereignty and autonomy within climate-adaptation efforts, whether related to food systems [30,34,40,52], health systems [31,51], or monitoring and surveillance systems [35,41,67]. As Van Bavel et al. (2020) named, there exists "an ethical practice gap in the recognition and actualization of Indigenous and local autonomy, intellectual property rights, and data sovereignty in integrated [monitoring and surveillance systems]" as well as a need across the literature to move "from inclusion to ownership" [59:18].

This need extended to research and policy spheres, where reviews identified a gap in approaches that are rights-based [51,58,70], and noted that "even the ability to define the problem on one’s own terms represents in many places a move away from the status quo" [40:388]. Moreover, a focus on rights within policy responses would reportedly look like "local management and control over project lands" [27:167], and "greater Indigenous autonomy over mobility, time, education and land use" [38:15], as well as "a new ethos of coordination and cooperation among government levels" to address institutional determinants of health [51:677]. Taken together, these findings are reflected in Loring & Gerlach’s (2015) underscoring of a "need to see beyond past concepts such as adaptation and resilience and look instead to rights-based reform" [40:387]. Responses to climate change and biodiversity loss, then, need to interrogate the locus of power–question who is holding it–and move towards a model of equitable and shared decision-making [70], focused on supporting Indigenous Peoples’ sovereignty, rights, and autonomy as outlined in the UNDRIP.