Transformative Pathways for Strengthening Climate-Resilient Health Systems Among Indigenous Communities: Advancing Equity and Sustainability in Global Health

Most climate-resilience health interventions are designed at the global level, with minimal attention to Indigenous communities' needs. The lack of consideration can lead to unintended harm and exacerbate health risks. This study aims to identify the capacities of Indigenous communities that can serve as transformative pathways in safely adopting global climate-resilient health approaches within Indigenous contexts, ensuring the aims of the Sustainable Development Goals, such as Good Health and Well-being (SDG3) and Reduced Inequalities (SDG 10). The World Health Organization's climate-resilient health systems approach was used as a starting point to identify the transformative pathways. We collaborated with the Indigenous Peoples' Observatory Network (IPON) and conducted key informant interviews (n = 17) with partners who maintain ongoing collaborations with Indigenous communities across 11 countries: Australia, Canada, Fiji, Ghana, India, Kyrgyzstan, Namibia, Peru, South Africa, Sri Lanka, and Uganda. The interview process was guided by two objectives: (i) to identify and examine how transformative pathways contribute to climate-resilient health systems and (ii) to provide recommendations for strengthening transformative pathways based on key informants' insights. We identified five transformative pathways to support the resilience of health systems to climate change risks: (i) government-community interactions, (ii) traditional medicine and spiritual beliefs, (iii) experience-based practices, (iv) community-based collective actions, and (v) community-based policies. Based on the key informant interviews, we provide three recommendations to enhance the identified transformative pathways: (i) Indigenous mentorship in knowledge, health education, and research, (ii) identify opportunities to develop an Indigenous inclusive health workforce, and (iii) enhance indigeneity in health policies.