Climate Change and Indigenous Peoples’ Health in Canada

First Nations, Inuit, and Métis peoples in Canada are a youthful and fast-growing population. In 2016, the Indigenous population reached 1,673,785 million (4.9% of the total Canadian population), which represents an increase of 42.5% from the 2006 Census (Statistics Canada, 2017). From 2006 to 2016, the First Nations population grew by 39.3% to reach 977,230; the Inuit population grew by 29.1% to reach 65,025; while the Métis population grew by 51.2% to reach 587,545. The average age of the Indigenous population in 2016 was 32.1 years, which is almost a decade younger than the non-Indigenous population. Approximately 29.2% of First Nations, 33% of Inuit, and 22.3% of Métis people were 14 years of age or younger in 2016, compared to 16.4% of the non-Indigenous population (Statistics Canada, 2017). The proportion of Indigenous people over 65 years of age is also on the rise and accounted for 7.3% of First Nations, Inuit, and Métis populations in 2016 (Statistics Canada, 2017).

There are more than 600 First Nations communities in Canada, representing more than 60 Indigenous languages (Statistics Canada, 2017). The largest proportion of First Nations people live in Ontario (24.2%), followed by the western provinces of British Columbia (17.7%), Alberta (14.0%), Manitoba (13.4%), and Saskatchewan (11.7%) (Statistics Canada, 2017). In 2016, the majority of Inuit (72.8%) lived in the 53 communities of Inuit Nunangat (the traditional homelands of Inuit), with the largest proportion living in Nunavut (63.7%), followed by Nunavik (24.9%), Inuvialuit (6.6%), and Nunatsiavut (4.8%) (Statistics Canada, 2017). Inuktut is the term used for all Inuit languages; it includes 12 main dialects and nine different writing systems³ (The Royal Canadian Geographical Society, 2018). The majority of the Métis population (80.3%) live in communities and settlements⁴ in Ontario and the western provinces. Alberta has the largest Métis population (19.5%), followed by Manitoba (15.2%), British Columbia (15.2%), Quebec (11.8%), Saskatchewan (9.9%), and the Atlantic provinces (7.2%). Métis have their own unique language called Michif, a combination of French and Cree languages that also borrows from English and other Indigenous languages.

Recent Statistics Canada data suggest Indigenous Peoples are increasingly urbanized. Among First Nations with registered or treaty Indian status, 44.2% lived on reserve in 2016, while the remainder lived off reserve. Growth was noted for both on-reserve (+12.8%) and off-reserve (+49.1%) First Nations over the period 2006 to 2016 (Statistics Canada, 2017). While most Inuit lived in Inuit Nunangat in 2016, approximately 27.2% lived outside its borders; of those, 56.2% lived in a metropolitan area of at least 30,000 people, with the largest Inuit populations living in Ottawa, Gatineau, Edmonton, and Montreal (Statistics Canada, 2017). Of the three Indigenous groups, Métis are most likely to live in a city, with 62.6% living in a metropolitan area of at least 30,000 people. Winnipeg has the highest Métis population in Canada, followed by Edmonton, Vancouver, and Calgary (Statistics Canada, 2017).

Before colonization, “Indigenous categorizations of gender emerged within other cultural and social practices, and were as diverse as Indigenous cultures themselves” (Hunt, 2016, p. 7). Historic and ongoing colonial processes imposed new social norms and legal rights that altered these often egalitarian and matrifocal gender roles and responsibilities, creating significant gender inequalities as well as discrimination against gender fluidity and homosexuality (Vinyeta, et al., 2015; Hunt, 2016). In the context of climate change, gender intersects with other determinants of health — such as education, race, income, and social status — to create unique climate change vulnerabilities, resiliencies, and lived experiences among First Nations, Inuit, and Métis women, men, boys, girls, and gender-diverse people (WHO, 2014; Vinyeta, et al., 2015; Williams et al., 2018). In Canada, the majority of gender and climate change research conducted with First Nations, Inuit, and Métis populations to date has focused on food security, mental health, unintentional injury, and deaths (Sellers, 2018); attitudes and behaviours toward climate change (Bunce, 2015; Bunce et al., 2016); and environmental governance (Natcher, 2013; Staples & Natcher, 2015a; Staples & Natcher, 2015b; Sellers, 2018).

Climate change impacts are experienced differently across genders due to cultural differences in gender-based responsibilities. In a study by Bunce (2015), activities such as picking berries, making clothing, and preparing and preserving food were identified as central to identity and the well-being of Inuit women. Changes in berry production, thickness and duration of sea ice, and the quality and quantity of furs and pelts can hinder fulfillment of these traditional roles and the transmission of these skills to younger generations (Dowsley et al., 2010; Pauktuutit, 2011; Bunce, 2015; Bunce et al., 2016). For First Nations, Inuit, and Métis women, a key part of female identity is the special relationship to water and the responsibilities to care for and protect it (Anderson, 2010; McGregor, 2012; Szach, 2013; Powys Whyte, 2014). Climate change may affect the availability and quality of fresh water, which can significantly affect emotional, mental, and spiritual health and well-being (Longboat, 2013; Szach, 2013).

It is well recognized that warming temperatures are expected to increase the frequency and intensity of extreme heat events and the range and survival of vectors of infectious diseases, such as mosquitoes and ticks. Kovats and Hajat (2007) found that men are more likely to be active in hot weather, which makes them more vulnerable to heat stress. Pregnant women are at increased risk of poor health outcomes from placental abruption in full-term pregnancies (He et al., 2018) (see Chapter 3: Natural Hazards).  Since First Nations, Inuit, and Métis men spend considerable time outdoors engaging in land-based activities (e.g., hunting, fishing, trapping), climate change can be expected to disproportionately place Indigenous men at increased risk of heat-related conditions and vector-borne diseases such as Lyme disease and West Nile virus (Vinyeta et al., 2016; Sellers, 2018).

However, at present, there is a lack of surveillance and reporting on these types of climate-related impacts. For example, despite the expanded range and frequency of vector-borne illnesses such as West Nile virus, Lyme disease, and Zika virus, and recognition of the importance of vector-borne disease surveillance and monitoring programs, including among First Nations communities (PHAC, 2018b), systematic vector surveillance does not occur in all provinces and territories (Awuor et al., 2019), and Indigenous status has not been identified in human case surveillance data. As a result, there are no publicly available data from surveillance programs that identify the prevalence of vector-borne illnesses among specific populations, including Indigenous populations.

Indigenous men may also be at greater risk of accidents as the environments in which they carry out their traditional activities become more hazardous (Vinyeta et al., 2016). Changes in weather and climate, including decreases in wildlife populations or safe access to hunting areas, can also limit the transmission of gender-based knowledge and skills to younger generations (Jacob et al., 2010; Downing & Cuerrier, 2011; Pauktuutit, 2011; Bunce, 2015; Bunce et al., 2016).

Emotional responses and coping strategies related to climate change effects may also be gendered. For example, Inuit women experienced stronger emotional reactions (e.g., fear, distress, helplessness, anger, sadness, and frustration) to climate change effects than Inuit men, while men were more likely to experience anxiety in response to climate change (Cunsolo Willox et al., 2012; Sellers, 2018). Inuit women are also more likely to share their feelings with others and manage stress in healthy ways, including becoming strong activists in climate change actions at global and local levels (Bunce, 2015; Williams et al., 2018; Hania, 2019; Santisteban, 2020). First Nations, Inuit, and Métis men may experience increased stress as a result of losing access to places and resources critical to masculine identities, especially those tied closely to livelihoods, which may exacerbate problems of substance abuse, suicide, and family violence that have been associated with colonization and cultural loss and are particularly prevalent in some First Nations and Inuit communities (Cunsolo Willox et al., 2012; Cunsolo Willox et al., 2015; Vinyeta et al., 2016).

“The sea ice has really changed. I used to travel both by dog team and skidoo to and from Pond Inlet. In my recent trip, the snow has changed. The snow on top and snow condition on top has changed. Normally, in the spring, the snow on the top will freeze at night. This process is called qiqqsuqqaqtuq. This frozen layer can be seen when the day just starts getting daylight; it is sparkling because of the recent freeze up on top. I noticed it wasn’t like that anymore. This process, the freezing, isn’t happening anymore.” ⁹

First Nations, Inuit, and Métis peoples are uniquely sensitive to the health impacts of climate-related events, given their close reliance on the environment for their sustenance, livelihoods, and cultural practices (Ford, 2012; Kipp et al., 2019b). The related health impacts are experienced both directly and indirectly. In the Arctic, rising temperatures are affecting permafrost stability, ground snow cover, sea ice extent and thickness, sea levels, and weather patterns (Ford et al., 2014; Durkalec et al., 2015; ITK, 2016). These changes are exacerbating the loss of knowledge and land skills related to weather prediction, transportation to hunting grounds, and wildlife patterns, leading to increased risk of injuries and fatalities, more search and rescue missions, and reduced access to country foods¹⁰ (Lemelin et al., 2010; Andrachuk & Smit, 2012; Pearce et al., 2012; Sheedy, 2018). For example, the rate of unintentional injuries was more than three times higher than the Canadian average among Inuit land-users in Nunavut over the period 2006 to 2015, and the number of search and rescue operations has more than doubled over the past decade due to changes in temperature and ice (Clark et al., 2016a; Clark et al., 2016b). The loss of knowledge and land skills also threatens Inuit identity and well-being by decreasing opportunities for land- and sea-based activities and for sharing and teaching knowledge and skills, particularly for youth (ITK, 2016).

Permafrost degradation, heavy storms, and coastal erosion can result in the destruction of places that have cultural significance, with potential mental health impacts (Government of Nunavut, 2010; Government of Nunavut, 2012; Donatuto et al., 2014). Such events can also destabilize housing, pipelines, and local civic water, wastewater, and transportation infrastructure and systems, increasing the risk of injury, water-borne illnesses, and environmental contamination, as well as causing disruptions in supply chains (Government of Nunavut, 2010; Government of Nunavut, 2014; Berner et al., 2016; FRMFNMES, 2016). In the Inuvialuit hamlet of Tuktoyaktuk, for example, coastal erosion is already forcing residents to relocate their homes further inland and onto higher ground (Faris, 2019). Such impacts place additional financial strains on Inuit households and communities in the context of high living costs, low household income, low population base, and inadequate local government revenues (ITK, 2016). In response to these changes, local Inuit youth formed a collective — Tuk TV — and captured these experiences in the documentary Happening to Us, which was screened at the 25th session of the Conference of the Parties (COP 25) to the United Nations Framework Conventions on Climate Change (UNFCCC) in Madrid, Spain, in 2019.¹¹

Warming temperatures and changes in precipitation patterns have led to the increased frequency and severity of extreme weather events such as flooding, wildfires, and heat events (Berry et al., 2014; Bush & Lemmen, 2019). Some First Nations, Inuit, and Métis communities are more vulnerable to these events because of their geographic location, as well as existing socio-economic conditions and infrastructure (CIER, 2008; Christianson et al., 2012; Collier, 2015; McNeill et al., 2017). Over the period 2006 to 2016, approximately 67 First Nations communities experienced a combined total of nearly 100 flooding events, causing significant property and infrastructure damage, disruptions to community services, and impacts to health and well-being (McNeill et al., 2017).

Climate change has contributed to an increased number of extreme heat events and droughts, and to proliferation of pests such as the mountain pine beetle, which, in turn, is increasing the prevalence, magnitude, and intensity of wildfires and the devastation of forests (see Chapter 5: Air Quality). These are taking a tremendous social, psychological, emotional, and financial toll on First Nations and Métis communities across Canada (Scharbach & Waldram, 2016; Howard et al., 2017; Dodd et al., 2018a; Dodd et al., 2018b; ISC, 2018). Many Indigenous communities are located in regions that are expected to see increased wildfire activity over the next 40 years, including parts of British Columbia’s coast and Haida Gwaii, Northeastern Alberta, central Saskatchewan, Southern Manitoba and Ontario, and the Northwest Territories (B.J. Stocks Wildfire Investigations Ltd., 2013).

The increased prevalence and severity of extreme weather and climate-related events can have both direct and indirect impacts on human health (see Chapter 3: Natural Hazards). Extreme weather events can lead directly to increased injuries and fatalities (Kipp et al., 2019b). Droughts can affect respiratory health, mental health, exposure to environmental toxins, food security, water security, and rates of injury and infectious diseases, as well as causing increased stress on water treatment systems (Yusa et al., 2015). Flooding can result in water and food contamination from the release of environmental contaminants, bacteria, and other pathogens (Patrick, 2011; Huseman & Short, 2012; Daley et al., 2015). This can lead to increased water- and food-borne infections, skin conditions, and birth defects, as well as obesity, diabetes, hypertension, mental stress, heart disease, liver disease, kidney problems, neurological problems, immunopathology, cancers, thyroid conditions, and infant mortality (Bradford et al., 2016). Flooding and wildfires can damage fish and wildlife habitat important for species reproduction, with subsequent impacts on food security (Kipp et al., 2019b). Wildfires can degrade air quality, contributing to high rates of respiratory and cardiovascular diseases (Liu et al., 2015; Reid et al., 2016), as well as leading to psychological impacts such as stress, anxiety, and depression (Cunsolo Willox et al., 2015; Dodd et al., 2018a; Dodd et al., 2018b; Manning & Clayton, 2018). Extreme heat can result in heat-related illnesses and mortality, especially in Southern Canada and urban centres (Council of Canadian Academies, 2019). While research on Indigenous populations and extreme heat is limited, a comparative study of climate-related morbidities among urban and rural Indigenous populations in Ontario found that urban populations may be at greater risk because of inequities associated with access to health services, health status, poverty, housing, and political marginalization (Tam, 2013).

Climate-related emergencies can also lead to temporary evacuations or long-term displacements from traditional territories, which affect all aspects of Indigenous health and well-being. They disrupt lives; create financial hardship; increase stress, anxiety, and post-traumatic stress disorder; and can bring back historical traumas associated with forced relocations and government interventions in the lives of Indigenous Peoples (Thompson et al., 2014; Scharbach & Waldram, 2016; Bedard & Richards, 2018; Dicken, 2018; Hassler et al., 2019). First Nations people living on reserve, in particular, have been disproportionately affected by displacement due to climate-related events. For example, over the period April 2017 to March 2019, nearly 15,000 First Nations residents were evacuated because of floods, fires, and extreme heat (ISC, 2019, as cited in Parliamentary Information and Research Service, 2020). Going forward, emergency responses to these climate-related events will require adequate funding for emergency planning activities; capacity-building and training; the inclusion of Indigenous Peoples in coordination activities; the use of Indigenous knowledges and expertise; direct and immediate emergency response; evacuation processes that are sensitive to Indigenous Peoples; as well as ongoing efforts for Indigenous communities to recover from such events (Standing Committee on Indigenous and Northern Affairs, 2018).

Climate change threatens the cultural dimensions of Indigenous Peoples’ lives and livelihoods that are central to identity, community cohesion, and a sense of place and belonging (Adger et al., 2013). The impact of climate change on mental health and well-being can disproportionately burden some groups, including Indigenous women, children, and individuals from socio-economically disadvantaged communities (see Chapter 4: Mental Health and Well-Being), as well as Elders, who can be deeply disturbed by the changes they are witnessing (FNMFNMES, 2016; Manning & Clayton, 2018). Since First Nations, Inuit, and Métis peoples have disproportionately higher rates of suicide, substance abuse, and violence as a result of intergenerational trauma and socio-economic marginalization (Aguiar & Halseth, 2015; Kumar & Tjepkema, 2019), these climate change impacts can compound existing mental health issues.

First Nations, Inuit, and Métis peoples have a deep economic, social, and spiritual connection to their lands as a source of food, clothing, teaching, recreation, and connection to past, current, and future generations (Mecredi, 2010; Tobias & Richmond, 2014;) and see it as “intertwined and interconnected” to other determinants of health (Harper et al., 2015c, p. 6). Engaging in land- and culture-based activities can provide mental, emotional, social, cultural, and spiritual benefits that support individual and community resilience in the face of climate change. These activities can, for example, help to replenish the spirit, reduce stress, increase physical activity and nutrition, facilitate access to traditional medicines, build self-confidence, foster positive relationships, enhance cultural identities, and increase opportunities for intergenerational knowledge transmission (Cunsolo Willox et al., 2012; Nisga’a First Nation, 2012; Arias-Bustamante, 2013; Cunsolo Willox et al., 2013a; Ulturgasheva et al., 2014; Durkalec et al., 2015; Harper et al., 2015c).

Climate change can disrupt Indigenous Peoples’ ability to hunt, fish, trap, forage, and spend time on the land, which can negatively affect their mental and emotional health and well-being. It can introduce new hazards, leading to increased stress and anxiety about the safety of family members travelling on the land (Harper et al., 2015c). It can disrupt the transmission of intergenerational knowledge and land skills to younger generations, which is critical to the formation of a strong cultural identity and resilience (Chandler & Lalonde, 1998; Kral & Idlout, 2009; Wexler, 2013). Extreme climate events, such as wildfires, and resulting evacuations, along with impacts from slow-onset climate change effects can cause stress or worries about the future (Cunsolo Willox, 2012a; Cunsolo Willox, 2012b; Cunsolo Willox et al., 2012; Scharback & Waldram, 2016; Asfaw, 2018; Dodd et al., 2018a; Dodd et al., 2018b; Manning & Clayton, 2018).

Indigenous Peoples may also experience “ecological grief” from past and future climate-change–related losses of land, ecosystems and species, environmental knowledge, and cultural identity (Cunsolo & Rigolet Inuit Community Government, 2014; Cunsolo & Ellis, 2018; Meloche, 2018). As the climate warms, anxiety, stress, and “ecological grief” are expected to become increasingly more common (Cunsolo Willox et al., 2013b, Bourque & Cunsolo Willox, 2014; Cunsolo Willox et al., 2015; Harper et al., 2015c; Cunsolo & Ellis, 2018; Cunsolo et al., 2020) (see Chapter 4: Mental Health and Well-Being). Responding to increasing mental health issues will be difficult and challenging, especially given that many First Nations, Inuit, and Métis communities lack adequate mental health services (Mental Health Commission of Canada, 2016; Standing Committee on Indigenous and Northern Affairs, 2017; Carrière et al., 2018). Jurisdictional fragmentation of health care between federal and provincial governments and a lack of dedicated long-term funding for mental health services continue to be significant barriers to achieving health and well-being in First Nations, Inuit, and Métis communities (Boksa et al., 2015).

Exploration of the mental health impacts of climate change for First Nations, Inuit, and Métis peoples is an emerging area of study and has focused primarily on the strong emotional and psychological responses experienced in the face of rapid ecological changes. For Inuit, these responses include intense feelings of anxiety, fear, stress, anger, sadness, disorientation, grief, loss and lament, increased drug and alcohol use, suicide ideation and attempts, violence, and decreased place-based mental solace (Cunsolo Willox, 2012a; Cunsolo Willox, 2012b; Cunsolo Willox et al., 2013a; Cunsolo Willox et al., 2013b; Petrasek MacDonald et al., 2013a; Petrasek MacDonald et al., 2013b; Ulturgasheva et al., 2014; Cunsolo Willox et al., 2015; Harper et al., 2015c; Bunce et al., 2016). As noted by Durkalec and colleagues (2015), climate change is reinforcing environmental dispossession for Inuit, compounding disruption and denigration of Inuit knowledge and ways of life. Research on the mental health impacts of climate change on First Nations and Métis peoples is more limited. One study focused on the impacts of a summer of wildfires on the health and well-being of four First Nations communities in the Northwest Territories. Participants in this study reported experiences of evacuation and isolation, as well as feelings of fear, stress, and uncertainty about the future (Dodd et al., 2018a; Dodd et al., 2018b).

Indigenous Services Canada provides funding for several targeted national strategies, including the National Aboriginal Youth Suicide Prevention Strategy, the National Native Alcohol and Drug Abuse Program, mental health counselling, and the Indian Residential Schools Mental Health Support Program (ISC, 2019c). Most of these programs are accessible to only a relatively small proportion of First Nations and Inuit¹² and do not provide the range and quality of services required to address the complex mental health problems that exist in First Nations, Inuit, and Métis communities (Maar et al., 2009; Boksa et al., 2015). Greater cooperation is needed among federal, provincial, and territorial governments to ensure that these communities have sustainable, dedicated funding to meet the potentially growing need for mental health services in response to climate change impacts.

Weather and climate can affect indoor and outdoor air quality and have impacts on human health (Kinney, 2008) (see Chapter 5: Air Quality). Warming temperatures can increase levels of air pollutants (e.g., ground-level ozone, particulate matter) and the production of aeroallergens (e.g., pollens, molds) that are associated with a greater risk of cardiovascular and respiratory diseases, as well as premature death (Berry et al., 2014; Reid et al., 2016). First Nations, Inuit, and Métis peoples experience a disproportionate burden of chronic respiratory diseases, such as asthma¹³ and chronic obstructive pulmonary disease,¹⁴ compared to non-Indigenous people, and these diseases can become exacerbated by poor air quality (Gershon et al., 2014; Ospina et al., 2015; Carrière et al., 2017; PHAC, 2018a; Koleade et al., 2018). Higher rates of respiratory infections, such as bronchitis, bronchiolitis, pneumonia, and tuberculosis, are also reported for First Nations, Inuit, and Métis children (Kovesi, 2012; Konrad et al., 2013). The risks of exposure to poor air quality are greater for First Nations, Inuit, and Métis peoples because of underlying health determinants such as poor housing conditions (e.g., homes in need of repair, overcrowding, poor ventilation, mold) in many communities, increased exposure to tobacco smoke and wood/oil heating, and geographic proximity to forests that are prone to wildfires and consequent smoke (CIER, 2008; B.J. Stocks Wildfire Investigations Ltd., 2013; Dodd et al., 2018a; Dodd et al., 2018b).

Food insecurity is an urgent public health issue in Canada (Tarasuk et al., 2014) (see Chapter 8: Food Safety and Security), particularly for Indigenous Peoples in geographically remote regions with high rates of poverty (Loring & Gerlach, 2015; Bhawra et al., 2017; Human Rights Watch, 2020). Many Northern, remote communities rely on traditional or country foods to meet their nutritional needs (Earle, 2011). For example, Statistics Canada data indicate that 65% of Inuit, 35% of Métis, and 33% of First Nations living off reserve hunted, fished, or trapped in 2017, while 30% of off-reserve First Nations and 47% of Inuit gathered wild plants or berries¹⁶ (Kumar et al., 2019). Traditional or country foods are high in nutritional value and offer a number of physical and mental health benefits (Bunce, 2015; Bunce et al., 2016; Cyre & Slater, 2019). Harvesting traditional or country foods promotes physical activity, contributes to social cohesion through food sharing, facilitates spiritual renewal and cultural expression, and plays a role in the development of personal and community self-sufficiency and food sovereignty (Receveur & Kuhnlein, 1998; Earle, 2011; Cidro et al., 2015; Hirsch et al., 2016).

Climate change is affecting the size, distribution, health, and behaviours of wildlife, fish, fowl, and other traditional sources of foods which, in turn, affect the ability to harvest and share them with family, Elders, and other community members (Organ et al., 2014; Statham et al., 2015; Archer, 2016; Spring et al., 2018). These impacts can be both positive and negative for enhancing food security. Warming temperatures have introduced new wildlife and plant species, allowed certain species to flourish, and lengthened growing seasons, making it easier for Northern communities to grow their own foods (Sheedy, 2018). However, a warming climate has altered the timing of harvesting periods and changed ecosystems and habitats in ways that negatively affect species reproduction, leading to declines or disappearances of specific species that constitute traditional livelihoods.

Considerable research has already been undertaken on various climate-related aspects of food security for Indigenous populations, especially studies assessing the availability of traditionally important food sources. For example, many First Nations have been worried about declining numbers of some fish, shellfish, and goose species; the availability and quality of specific berries; and changes to caribou population size, health, distribution, and migration patterns (Mecredi, 2010;  Hermann et al., 2012; Teslin Tlingit Council, 2012; Arias-Bustamante, 2013; Donatuto et al., 2014; Kluane First Nations & AICBR, 2016; Parlee & Caine, 2018; Spring et al., 2018; Human Rights Watch, 2020). Inuit have also been alarmed by the changing population size, health, distribution, and/or migration patterns of caribou and other Arctic species, including muskox, seals, whales, and polar bears (Pauktuutit, 2011; Henry et al., 2012; Cuerrier et al., 2015; MacDonell, 2015; Quinn, 2016a; Quinn, 2016b; Mallory & Boyce, 2017; Parlee & Caine, 2018; Waugh et al., 2018). While little research has been conducted specifically on the climate-related food security impacts on Métis people, some have expressed concerns about a shortened goose hunt; changes in the movement and location of fish and their habitat; changes to the health, behaviour, and distribution of caribou and moose; changes in the availability and quality of specific berries; and the impacts of warmer weather on food preservation methods (Guyot et al., 2006; North Slave Métis Alliance community members, Shiga, Evans, King, & Keats, 2018).

First Nations, Inuit, and Métis populations share a common concern about the unpredictability of weather and environmental conditions related to climate change on their ability to travel on the land and access traditional foods. These impacts can place pressure on already stressed food systems, leading to increased food insecurity in Indigenous communities and a greater reliance on retail foods (Statham et al., 2015; Sheedy, 2018). The move away from traditional or country foods to market foods, often of inferior quality, can exacerbate already high rates of chronic diseases prevalent among Indigenous Peoples, including obesity, diabetes, and cardiovascular diseases (Kolahdooz et al., 2015; Reading, 2015).

The challenge that climate change poses for heightening food insecurity is compounded by the negative environmental impacts of resource development on the safety of traditional foods and a food system imposed through colonization that leaves Indigenous Peoples increasingly reliant on imported market-based foods (Penner et al., 2019). The ability of Indigenous Peoples to exercise autonomy over their lands and traditional foods is crucial for redressing the colonial narrative of socio-economic marginalization and health disparities (Coté, 2016). This autonomy is embodied in the concept of “food sovereignty,” a human rights–based model founded on the notion that Indigenous Peoples have a right to “healthy and culturally appropriate food produced through ecologically sound and sustainable methods, and [the] right to define their own food and agricultural systems” (Sélingué, 2007, as cited in Coté, 2016, p. 8). Indigenous food sovereignty recognizes mino-pimatwisin, the Anishinaabe term for “good life,” and maligit, the Inuktitut term for “balance” in Qaujimajatuqangit (Inuit TK) (Penner et al., 2019). Innovative examples of Indigenous food sovereignty have been initiated across Canada, including school and community gardens, greenhouses, traditional foods education programs (e.g., conservation), market garden and food cooperatives, country food harvesting and sharing programs, wild food banks, and fish-buying clubs (Thompson et al., 2011; Thompson et al., 2012; Kamal et al., 2015; Martens, 2015; Robin, 2019)

“Water is what sustains us. Water is what brings us into this world, and water is what keeps us in this physical world. And so it’s our life.” ¹⁷

Climate change impacts, such as increased precipitation, flooding, and drought, can significantly affect the quality, quantity, and accessibility of water (Berry et al., 2014) (see Chapter 7: Water Quality, Quantity, and Security), exacerbating health risks related to water quality, safety, and security challenges already present in many First Nations and Inuit communities in Canada. Inadequate water and wastewater systems, a lack of trained staff, and increased exposure to pollutants or environmental contaminants has led to dozens of short- and long-term boil water advisories (White et al., 2012; Medeiros et al., 2016; Wright et al., 2018a; Wright et al., 2018b; ISC, 2020a; ISC, 2020b) While some progress has been made in improving the quality of drinking water in many Indigenous communities across Canada, a recent federal government  report noted that Indigenous Services Canada was not on track to meet its 2015 commitment to eliminate all long-term drinking water advisories on reserves by March 31, 2021 (Office of the Auditor General of Canada, 2021). For example, there were 51 long-term (as of June 16, 2021) and 26 short-term (as of July 15, 2021) drinking water advisories in place for First Nations public water systems¹⁸ (ISC, 2021a; ISC, 2021b). A further 6 boil water advisories and seven “do not consume” advisories were in place in First Nations communities across British Columbia as of June 31, 2021 (First Nations Health Authority, 2021). Many Inuit communities have a single established water source, which leads to challenges around water infrastructure, water shortages, municipal water treatment, environmental contamination of water sources, and boil water advisories. The result is that these communities face water emergencies under certain climate conditions or must rely on trucked water and drinking water stored in containers, thus increasing the risk of contamination (Medeiros et al., 2016; Wright et al., 2018a). As recently as October 12, 2021, the Government of Nunavut flew in 80,000 litres of bottled water to Iqaluit after a state of emergency was declared following the detection of fuel in the community’s drinking water (CBC News, 2021).

High-visibility events like boil water advisories can increase distrust in water quality and lead to avoidance of the use of household drinking water supplies (Ekos Research Associates, 2011; Allaire et al., 2019). Small water systems face drinking water advisories as often or more frequently than large municipal water systems and often lack the proper resources to adequately address the advisory (Lane and Gagnon, 2020). Examinations of boil water advisories in Canada have identified that advisories are most often issued for operational or process-related concerns (Environment and Climate Change Canada, 2018; Lane and Gagnon, 2020). Climate-related events, such as intense rainfall, severe storms, dry spells, extremely hot days, and storm surges, can damage water supply infrastructure, diminish the availability of water resources, and reduce the quality of water used for consumption (Kohlitz et al., 2020). Increased pressures on drinking water infrastructure at small drinking water systems are forecasted as climate change accelerates (Kohlitz et al., 2020).

Climate change has already had a significant impact on water security in Indigenous communities. Numerous First Nations communities have reported rapid declines in water levels, with significant impacts on the availability of fish resources and the migration and movement of other animal resources that are important for food security (Mecredi, 2010; Nisga’a First Nation, 2012; Teslin Tlingit Council, 2012; Harper et al., 2015a; FRMFNMES, 2016; Sheedy, 2018). In the Arctic, climate change has increased evaporation of the freshwater supply, the contribution of groundwater to river flows, and permafrost degradation. These impacts will place increasing pressure on the availability of drinking water, diminish water quality as a result of the release of stored environmental contaminants, and place cumulative and increasing pressure on freshwater resources (Nilsson et al., 2013; Goldhar et al., 2014; Bakaic & Medeiros, 2016; Medeiros et al., 2016).

The lack of access to clean, safe water can make it difficult to maintain personal hygiene and contribute to the increased spread of water-borne infectious diseases such as gastrointestinal illness (Harper et al., 2015a; Harper et al., 2015b; Bradford et al., 2016; Chen, 2016), as well as infectious illnesses such as influenza, coronavirus (COVID-19), and methicillin-resistant Staphylococcus aureus (Boyd, 2011; Sarkar et al., 2015; Bharadwaj & Bradford, 2018; Stoler et al., 2020). In a scoping review of drinking water quality in Indigenous communities and health outcomes in Canada, Bradford et al., (2016) found gastrointestinal infections were the most commonly reported health concern in the studies reviewed. Other health concerns reported in relation to contaminated drinking water included skin conditions, such as eczema and skin cancer, increased infant mortality and birth defects, as well as elevated levels of obesity, diabetes, and cardiovascular diseases resulting from a reliance on carbonated and sugary drinks in the absence of clean drinking water (Bradford et al., 2016).

The potential mental and spiritual health impacts of climate change on water security cannot be overstated. Several studies across Canada indicate that water insecurity is linked to mental health issues and psychosocial distress in Indigenous individuals (Anderson, 2010; Hanrahan et al., 2014; Sarkar et al., 2015; Cruddas, 2017). Considered life-giving and sacred by First Nations, Inuit, and Métis peoples, water is often used for ceremonial and cultural purposes (Anderson, 2010; McGregor, 2012; AFN, 2013; Omosule, 2017). It is also needed to pursue cultural practices and livelihoods (Bharadwaj & Bradford, 2018). Gathering water from the land is an important part of subsistence culture and Inuit identity, as well as a potential source of healing (Watson, 2017; Wright et al., 2018b). Negative impacts on water security can thus affect mental and spiritual well-being (Powys Whyte, 2014; Lam et al., 2017). Given the physical, emotional, and spiritual importance of water, greater Indigenous sovereignty is needed to protect First Nations, Inuit, and Métis communities from environmental harms to the quantity, quality, and accessibility of water resources arising from climate change and natural resource development projects in their territories.

Changes in weather patterns, such as warmer temperatures, increased precipitation, and more frequent drought and wildfires, are expected to affect the incidence and distribution of water-borne, food-borne, vector-borne, and zoonotic diseases (Greer et al., 2008; Berry et al., 2014; Chen, 2016) (see Chapter 6: Infectious Disease). Indigenous Peoples globally and across Canada have significantly higher rates of infectious diseases than non-Indigenous populations (Gracey & King, 2009; Hotez, 2010), placing them at greater risk for climate-related infectious diseases. Determinants of health, such as poverty, malnutrition, decreased access to health care, and poor socio-economic conditions, influence an individual’s resistance to infection, the progression of disease, and the treatment and management of disease (CPHO, 2013).

First Nations, Inuit, and Métis peoples are at an increased risk of exposure to climate-related infectious diseases because of a strong reliance on traditional or country foods. Recent studies, for example, indicate an increased prevalence of parasites in wildlife, causing trichinellosis in walrus and polar bear, brucellosis in caribou, lungworm infection in muskox, giardiasis in beaver, as well as tularemia, rabies, and cryptosporidiosis (Jenkins et al., 2013; Jenkins et al., 2015; Quinn, 2016a; Quinn, 2016b; Yansouni et al., 2016; Tomaselli et al., 2017; Sheedy, 2018). These diseases have the potential to be transmitted from animals to humans, either directly, from the consumption of traditional foods, or indirectly, through exposure to domestic animals carrying these pathogens (Himsworth et al., 2010; Goyette et al., 2014; Bowser & Anderson, 2018).

A high burden of parasitic and food-borne infectious diseases has been detected among some Indigenous populations in Arctic regions. Associations have been found between the consumption of marine mammals and outbreaks of trichinellosis (Yansouni et al., 2016). A disproportionately high burden of acute gastrointestinal illness, which can be related to both water- and food-borne disease, has been reported in several Inuit communities (Harper et al., 2015a; Harper et al., 2015b). More specifically, a high prevalence of giardiasis has been detected in Northern Canada (Yansouni et al., 2016), while rates of cryptosporidiosis appear to be extremely high among Inuit in the Qikiqtani region of Nunavut (Goldfarb et al., 2013) and the Nunavik region of Quebec (Thivierge et al., 2016) compared to the Canadian average. While acute gastrointestinal illness is generally mild and easily self-resolves, it remains a leading contributor to infant mortality among young children in the Arctic (Yansouni et al., 2016). There is also some evidence that increasing exposure to infected marine and terrestrial animals may be contributing to increasing prevalence of toxoplasmosis among Inuit, with rates ranging from 60% to 87% in some communities (Lavoie et al., 2007; Messier et al., 2009; Elmore et al., 2012; Jenkins et al., 2013; Goyette et al., 2014). Toxoplasmosis manifests most severely in immunocompromised people and in women infected for the first time during pregnancy, leading to miscarriage, stillbirth, and fetal deformities (Jenkins et al., 2015). In addition to physical health impacts, the potential increase in environmentally transmitted parasites and pathogens can have a significant impact on the sustainability, availability, and suitability of animal species that have nutritional, material, cultural, and economic importance to Indigenous Peoples (Government of Nunavut, 2010; Dudley et al., 2015; Sheedy, 2018), which can have implications for mental and spiritual health as well.

A rise in the abundance of mosquitoes, ticks, and other biting insects is also evident across Canada, including in Northern regions, with the potential to transmit new vector-borne diseases, such as Lyme disease and West Nile virus (Nickels et al., 2002; Cuerrier et al., 2015; Chen, 2016; Wudel & Shadabi, 2016; Nelder et al., 2018; Awuor et al., 2019; Bouchard et al., 2019). West Nile virus and Lyme disease have already expanded across all provinces and are recognized as potential health risks by some First Nations (First Nations Centre, 2004; PHAC, 2018b). While enhanced surveillance and monitoring for vector-borne diseases in Canada is needed (Awuor et al., 2019), it appears that Arctic communities are not yet at risk of sustained transmission of such diseases (Chen, 2016).

First Nations, Inuit, and Métis peoples face unique challenges in accessing health care, including mental health services. Inadequate health human resources, high staff turnover, low population density, geographic remoteness, jurisdictional conflicts over health care provision, lack of health and/or transportation infrastructure, reduced political power, increased travel costs, and a deficit of information on Indigenous Peoples’ health to inform evidence-based practices all present significant challenges (Ford et al., 2010b; NCCIH, 2019). In rural and remote Indigenous communities, individuals and families must often leave the community for medical emergencies, hospitalization, or appointments with medical specialists, and to access mental health counselling and addictions rehabilitation services (Rondeau, 2012; Harper et al., 2015c; NCCIH, 2019).

Climate-related events can disrupt or damage communication, hospital, and transportation infrastructure, which can restrict travel for health services outside the community. They can also delay the supply of essential pharmaceuticals and medical supplies, compromise patient safety, leave communities isolated and unable to reach help in an emergency, and make it challenging to implement cultural land-based programs focused on promoting health and well-being (Health Care without Harm, n.d.; Paterson et al., 2014; Harper et al., 2015c; Canadian Coalition for Green Health Care, 2020) (see Chapter 10: Adaptation and Health System Resilience). With climate change expected to have considerable impacts on human health, especially in Northern populations, existing health systems may be strained beyond capacity to address emerging health issues such as pandemics. To withstand and respond to climate risks, it will be important to draw on local, Indigenous, and scientific knowledges to develop climate change responses that meet needs in locally specific contexts and build the capacity of the health sector and emergency response systems (Kipp et al., 2019b).

Additionally, to ensure Indigenous health systems and services can effectively respond to extreme weather and climate events, broader-level determinants of health need to be addressed. Specifically, there is a need to (Ford et al., 2010a):

• address the material conditions and behaviours associated with poverty that increase Indigenous Peoples’ sensitivity to climate change and capacity to adapt;
• enhance surveillance in remote regions to more quickly identify emerging health risks and vulnerabilities;
• develop comprehensive, culturally specific, health assessment measures to assess climate change impacts;
• address issues related to inequitable access to health information, diagnosis, and treatment in Indigenous communities;
• respect the rights and needs of Indigenous Peoples to address continued and persistent inequalities that exacerbate climate change health vulnerability; and
• resolve the jurisdictional issues that limit the ability to identify and prepare for climate change risks and address inequalities.

“Indigenous people have drawn on Indigenous knowledge and science for millennia to understand and respond to climate and environmental changes they faced.… What is different and challenging today is the rate of manmade climate change and our ability to respond to it. We must correct the path we are walking on and return to the special relationships, the teachings, the knowledge and practice that maintains respect, honor, and relationship with the natural world.” ²¹

Indigenous knowledges have been critical to the survival and resilience of Indigenous Peoples since time immemorial. Although these knowledges are increasingly recognized as equal to scientific information in understanding and adapting to climate change, the meaningful engagement of Indigenous Peoples and their knowledge systems in climate change research and policy remains a challenge. Indigenous-focused content has, for example, been under-represented in the Intergovernmental Panel on Climate Change (IPCC) assessment reports, as well as in policy discussions surrounding the UNFCCC (Ford, 2012; Ford et al., 2016b; Belfer et al., 2019). This disconnect is rooted, in part, in how Indigenous Peoples and Indigenous knowledge systems have been framed in the Western climate change discourse — as powerless victims with static knowledge that is increasingly undermined or made irrelevant by the rapid pace of climate change (Ford et al., 2016b). Critiques of the IPCC and UNFCC suggest this contributes to the homogenizing of knowledge, cultures, and ways of knowing, and situates Indigenous Peoples alongside marginalized or vulnerable social groups without contextualizing their unique lived experiences or cultural and colonial realities (Ford et al., 2016b). Increased participation of Indigenous scholars, knowledge holders, and organizations is slowly expanding through procedural changes, such as the establishment of the Local Communities and Indigenous Peoples Platform (LCIPP) at the UNFCCC Conference of the Parties (COP) 21 in 2015 and the Facilitative Working Group at UNFCCC COP 24 in 2018. The LCIPP is the first “formal, permanent, and distinct space” created for Indigenous Peoples and is focused on knowledge, capacity for engagement, and climate change policies and actions (Belfer et al., 2019, p. 27). Although recognized as an important first step, the LCIPP has the potential to “silo” Indigenous Peoples’ concerns exclusively to the platform (Reed, 2019) and arguably undermines Indigenous Peoples’ status and rights by “grouping and conflating Indigenous Peoples with local communities” (Inuit Circumpolar Council, 2020, p. 2).

The use of Indigenous knowledges in climate change and health research is evolving. Indigenous knowledges were initially used in conjunction with scientific knowledge to document observations of climate and environmental changes (Riedlinger & Berkes, 2001). More recently, they have been used as part of community-based studies that engage and are led by Indigenous Peoples in identifying their exposure and vulnerability to climate change effects, real and perceived impacts to their health and well-being, and potential adaptation strategies (Cameron, 2012; Donatuto et al., 2014; Cunsolo Willox et al., 2015; Rosol et al., 2016; Ford et al., 2018; Sawatzky et al., 2018; Kipp et al., 2019a; Sawatzky et al., 2020). Indigenous and scientific knowledge systems can accentuate and strengthen one another, since they identify different types of impacts brought about by climate change (Royer et al., 2013; Baldwin et al., 2018; Makondo & Thomas, 2018). Indigenous knowledges can enrich understanding of environmental change because they focus on the dynamics of the whole system under multiple stressors rather than on a single phenomenon (Mantyka-Pringle et al., 2017).

Indigenous knowledges can inform climate change and health-related decision-making at a variety of levels to benefit diverse stakeholders, including researchers, decision makers and community members (Finn et al., 2017; Mantyka-Pringle et al., 2017). They have been used to establish multiple ecosystem indicators and baselines, which are useful for identifying priority areas for environmental monitoring, protection, and potential remediation (Uprety et al., 2012; Sanderson et al., 2015; York et al., 2016; Baldwin et al., 2018; Gérin-Lajoie et al., 2018). Indigenous knowledges have been used to develop predictive models for identifying climate change vulnerabilities and adaptation options, such as potential impacts on traditional livelihoods and subsequent health implications (Turner & Spalding, 2013; Research Northwest & Herschfield, 2017; Flynn et al., 2018). Indigenous knowledges can and have been used with scientific knowledge to improve risk assessments, enabling individuals to make informed decisions about weather-related risks and hazards associated with traditional harvesting and land-use activities (Riedlinger & Berkes, 2001; Pennesi et al., 2012; Deemer et al., 2018), and aiding the planning and location of future infrastructure (Turner & Spalding, 2013; Flynn et al., 2019). The foundational values and traditional teachings related to Indigenous knowledges around reciprocity, inter-relationships, and spirituality can teach environmental stewardship and enhance governance of biodiversity and ecosystems for human health and well-being (Tengö et al., 2014; Hansen & Antsanen, 2018). This aspect of Indigenous knowledges is relevant not just for Indigenous communities, but also for non-Indigenous communities, nationally and globally (Maldonado et al., 2016; Hansen & Antsanen, 2018).

In the past, the inclusion of Indigenous knowledge systems in adaptation interventions has been variable (Ford et al., 2017). This stems not only from the fact that climate change considerations are often secondary in decision-making, but also from confusion remaining across all levels of government about what it means to include Indigenous knowledge systems in these interventions and how best to do so (MacDonell, 2015; Ford et al., 2017; Ford et al., 2018). Examples are emerging in which Indigenous knowledge has been incorporated into the design, monitoring, and evaluation of adaptation interventions (Debels et al., 2009; Champalle et al., 2015; Ford et al., 2018). Key tenets of these interventions are the adoption of community-driven, participatory, and collaborative approaches and the integration of science and Indigenous knowledge systems, using knowledge co-production²² frameworks that seek to address the challenge of inequitable power differentials. Several knowledge co-production case studies suggest this approach helps foster community engagement and buy-in, ensures Indigenous Peoples’ needs and interests are meaningfully incorporated, reflects local context in terms of available resources and capacity for implementation, and enables learning to maximize adaptive capacity (Armitage et al., 2011; Reid et al., 2014; Schuttenberg & Guth, 2015; Ford et al., 2016a; Diver, 2017). Latulippe & Klenk (2020) caution knowledge co-production scholars, however, to “move away from seeking to better ‘integrate’ Indigenous knowledges into western science” and instead make way for Indigenous research leadership and Indigenous knowledge sovereignty.

Indigenous Peoples in Canada and globally have increasingly reframed the discussion around climate change, research, and policy within a rights-based, distinctions-based approach. For well over two decades, Inuit have reported how a rapidly changing climate has affected their practices and knowledge around a way of life that is based on the land, sea, and ice. They have also voiced the direct and indirect impacts to their health and human rights caused by climate change (Prior & Heinämäki, 2017; ITK, 2019b). For example, in 2005, Sheila Watt-Cloutier, then chair of the Inuit Circumpolar Conference, presented an “Inuit Petition” on behalf of Inuit in Canada and the United States to the Inter-American Commission on Human Rights that sought “relief from human rights violations resulting from the impacts of climate change” due to greenhouse gas emissions from the United States (Sabine Center for Climate Change Law, 2005). Although the petition was never resolved, various bodies of the United Nations have acknowledged the threat that climate change poses to “the enjoyment of all human rights, including the rights to health, water, food, housing, self-determination, and life itself” (Office of the High Commissioner for Human Rights, 2018, p. 1). The need for climate justice,²³ and the participation of those disproportionately impacted  in finding solutions to climate change, have also been recognized. Climate change is “inherently discriminatory” in that Indigenous Peoples, like other populations, are the most vulnerable to climate change, yet have contributed the least to it (UNHRC, 2016, p. 19). As a consequence, decisions around climate change adaptation interventions, “must accord with the obligations owed to those peoples, including, where applicable, the duties to facilitate their participation in the decision-making process and not to proceed without their free, prior and informed consent” (UNHRC, 2016, p. 20).

Robust adaptation requires collaboration at all levels of government and across a range of sectors (see Chapter 10: Adaptation and Health System Resilience). At the federal level, the Pan-Canadian Framework on Clean Growth and Climate Change (PCF) (ECCC, 2018) and the report “A Healthy Environment and a Healthy Economy: Canada’s Strengthened Climate Plan to Create Jobs and Support People, Communities and the Planet” (ECCC, 2020b) articulate Canada’s commitment  to reduce greenhouse gas emissions to meet 2030 targets, to build capacity to adapt to the impacts of climate change, including risks to human health, and to support clean technology in collaboration with provinces and territories. The Pan-Canadian Framework reiterates Canada’s commitment to a renewed relationship with Indigenous Peoples, including mitigation and adaptation action that is based on recognition of rights, respect, cooperation, and partnership, and the importance of Indigenous knowledges in understanding climate impacts and adaptation measures (ECCC, 2018). As part of this process, the Assembly of First Nations, Inuit Tapiriit Kanatami, and the Métis National Council are working collaboratively with government through distinctions-based senior bilateral tables to ensure a structured, collaborative approach for ongoing engagement in the implementation of the PCF (ECCC, 2019). The proposed objectives of the distinctions-based senior bilateral tables are to (Trudeau, 2016):

• jointly develop real and meaningful approaches for Indigenous Peoples that position them as leaders of climate action, with clear timelines, objectives, and reporting in support of the PCF and other climate change activities;
• ensure inclusive, meaningful, and adequately resourced Indigenous engagement that emphasizes collaborative planning and participation in decision-making;
• advise on and track progress on the implementation of relevant acts, regulations, policies, and programs, such as advancing clean energy solutions for Indigenous Peoples;
• share information and jointly identify and monitor levers, indicators, and results, contributing to transparent reporting on the implementation of the PCF; and
• provide local and regional views, perspectives, and proposals on the implementation of the PCF to federal, provincial, and territorial intergovernmental structures.

These tables also support broader First Nations, Inuit, and Métis-specific clean growth and climate change priorities and actions, including those related to human health and well-being. In 2019, Inuit Tapiriit Kanatami (ITK) developed a National Inuit Climate Change Strategy that laid out objectives, actions, and long-term outcomes for the following five priority areas:

• knowledge and capacity;
• health and well-being, and the environment;
• food systems;
• infrastructure; and
• energy.

A rights-based approach to the development of any climate policies and actions affecting Inuit Nunangat is central to this strategy, with the understanding that climate change is one of many socio-economic and health inequities that challenge their populations and communities (Huntington et al., 2019).

In addition to the work of the Assembly of First Nations, Inuit Tapiriit Kanatami, and the Métis National Council at the national level, grassroots Indigenous-led organizations, such as Indigenous Climate Action, are also playing an important role in climate change in Canada by pushing for the incorporation of Indigenous rights and knowledges in climate change discussions and solutions. Through a series of community engagement activities and grounded in Indigenous rights and knowledge, the organization is developing resources and programs to assist Indigenous communities to take action on climate change.

Several federal policies, programs, and services are already in place to support Indigenous Peoples’ health and climate change mitigation and adaptation. At the federal level, the Department of Crown-Indigenous Relations and Northern Affairs Canada (CIRNAC)²⁶ is responsible for the Climate Change Preparedness in the North²⁷ and First Nations Adapt²⁸ programs that work with Indigenous communities, territorial and regional governments, and other relevant stakeholders to identify climate change adaptation vulnerabilities and priorities (INAC, 2018a; INAC, 2018b). CIRNAC also funds the Indigenous Climate Hub,²⁹ which includes stories, tools, and resources by Indigenous Peoples across Canada in order to exchange information on how they can monitor and adapt to climate change. Other CIRNAC programs include the Indigenous Community-Based Climate Monitoring Program, which supports the use of Indigenous knowledges and scientific knowledge, collaborative approaches to data management and information sharing systems, as well as the Northern Responsible Energy Approach for Community Heat and Electricity to reduce diesel fuel use for electricity and heating in Northern communities. CIRNAC also has several initiatives that address the determinants of health and can enhance First Nations, Inuit, and Métis peoples’ resilience to climate change effects. These include the Nutrition North Program, which subsidizes the cost of healthy foods to address food insecurity in the North; the Harvesters Support Grant Program, to help lower the costs associated with traditional hunting and harvesting activities; and a Working Group on Food Security to focus on sustainable food systems. An Arctic and Northern Policy Framework has also been developed in collaboration with First Nations, Inuit, and Métis communities; national Indigenous organizations; and provincial and territorial governments. The framework aims to reorganize and reprioritize federal activities in the Arctic related to infrastructure, sustainable and diversified economies, environmental protection and conservation, the strengthening of peoples and communities, Arctic science and Indigenous knowledge, and Arctic sovereignty and leadership (Government of Canada, 2018).

Other stakeholders have a role to play in supporting Indigenous Peoples’ health in relation to climate change mitigation and adaptation. Provincial governments, for example, work with the federal government to adapt their own targets and take their own actions to reduce greenhouse gas emissions from various economic sectors. They may also take actions to improve health outcomes, develop comprehensive strategies to address climate change, undertake climate change disaster mitigation and infrastructure planning, and develop new technologies and zero emission strategies. All sectors of the economy, including the natural resources sector, have a responsibility to help reduce greenhouse gas emissions, which can be done through the adoption of more environmentally friendly practices. In remote Northern Indigenous communities, mitigating greenhouse gas emissions will have limited impact on slowing the speed of climate change, given the absence of a sizeable industrial base and limited consumption levels; thus, priority must be given to adaptation in these areas (Ford et al., 2010b). In this process, Indigenous stakeholders and communities play important roles in monitoring climate change effects, as they are often the first to observe and experience them. They must also work cooperatively with decision makers to assess vulnerability and develop effective interventions to reduce risks and adapt to climate change (Ford et al., 2010b).