This Degree Project studies health promotion and strengths-based approaches in an Indigenous Australian context. The study focuses on an Indigenous Australian organisation called the Deadly Choices and their health-related promotion. The study is informed by postcolonial theory as well as cultural identity theory, and it was conducted through a textual analysis by analysing Deadly Choices’ Facebook posts and Twitter tweets both qualitatively and quantitatively. The study set out to determine what kind of features and what style language could contribute to the notion of a strengths-based approach and thus could empower Indigenous people to become change agents themselves.  The aim of the study was to understand if there are certain repetitive, identifiable features that construct the basis for a strengths-based approach and thus contribute to the matters of empowerment and decolonising health promotion in the context of Deadly Choices. In total 151 samples were analysed. I was able to conclude that Deadly Choices uses a strengths-based approach to an extent, but they tend to focus on only the resilience approach rather than the more prominent sociocultural approach.

This doctoral dissertation examines the holistic health and wellbeing of a First Nation community to understand several factors relating to environmental racism and water contamination that support and hinder community health and wellbeing to inform future policy. This dissertation incorporates a mix of methodological approaches across three interrelated research studies to better understand the direct and indirect factors influencing water security and community health and wellbeing. Study 1 consists of a theoretical approach to co-creating knowledge between Indigenous collaborators and medical anthropologists. It highlights the importance of community-based participatory research in medical anthropology and frames the co-creation of a health survey through three phases as a boundary object that can create dialogical space for Indigenous and settler-scholar pedagogies and priorities. It demonstrates how CBPR and co-creation work allows for the reciprocal development of long-term partnerships that work in solidarity with the Two-Row Wampum (Kaswentha) treaty established by the Haudenosaunee Nation and European settler nations. Study 2 presents an analysis of household water access, quality, and use, specifically how E. coli and mercury contaminations of household tap water are related to reported household health conditions for a sample of 66 households (representing 226 individuals) living in Six Nations First Nation. Logistic regression models were built to identify possible associations with water use and treatment variables for mental health, eczema, and gastroenteritis, with a second model adding contaminants as predictor variables. In the second model, E. coli was found to be a significant predictor for the presence of mental health conditions within the household, and households primarily purchasing bulk bottled water were more likely to report mental health conditions. Those using bleach/chlorine to treat their tap water were more likely to report gastroenteritis. Reported tap water uses indicated that 57% of contaminated tap water was still being used for activities that may heighten exposure risks (such as washing produce). Investigating household tap water uses beyond drinking water demonstrates alternative pathways for contaminant exposures for Six Nations Peoples, who have deep cultural relationships with water. Study 3 contains a mixed methods approach to investigate the effects of water access, satisfaction, and experiences of water insecurity for the sample of 66 households in Six Nations of the Grand River First Nations, to inform culturally effective ways of assessing water insecurity for Indigenous Nations experiencing long term water shortages, contamination, and other water- related concerns. Water security was measured using the Household Water InSecurity Experiences (HWISE) scale and Likert-scale questions on water access at household, community, service, and environmental levels, and contextualized using interviews. Results demonstrate a high level of water insecurity in the sample of Six Nations households (57.5%, n=38); women were more dissatisfied with their drinking water (p=0.005), and younger participants were more likely to report contamination issues (p=0.02) and higher monthly water costs (p=0.03). Qualitative interviews informed these results, revealing that experiences of water insecurity and poor health were shaped by the degradation of traditional lands. This posed specific barriers for Six Nations women, who face physical and geographical barriers to household and community water access while caretaking for their communities and fulfilling their roles as water protectors. / Thesis / Doctor of Philosophy (PhD) / The goal of this doctoral dissertation was to explore the connections between water security and health with Six Nations of the Grand River First Nation, to explore the nuanced factors that inform perceptions of drinking water and better understand who in the community faces higher challenges and barriers throughout the water crisis. This project was co-created research using Indigenous Knowledge (IK) with medical anthropology approaches to understand water security, satisfaction, quality, and relationships as they relate to Haudenosaunee health. Water security was explored through tap and well water contamination tests, survey data, and interviews and focus groups. Water insecurity was reported for 57.5% of 66 households in this sample, with 21.2% having E. coli contamination in their tap water, 25.4% having mercury in their tap water exceeding provincial drinking water limits, and 77% of households relying primarily on bottled drinking water rather than their tap water. While water insecurity experiences were quite high in this study, Western metrics are not able to capture the crucial elements of Indigenous water relationships, such as community and cultural relationships with the land, environmental racism, and the consequences of environmental degradation, such as grief or poor mental health, relating to water and climate crisis. Water insecurity experiences are best understood as highly localized experiences that have mental health, physical health, and environmental consequences for Indigenous communities. To fully untangle the specific cultural, spiritual, racial, and colonial landscapes or structures that have shaped Six Nations experiences and perceptions of their local water, co-created and flexible place- based methodologies are needed.

<p><em>Helicobacter pylori </em>is a bacterial infection of the stomach lining known to cause ulcers and stomach cancer This infection has become a major concern of Indigenous peoples living in the Northwest Territories, where <em>H. pylori </em>infection and stomach cancer are more prevalent relative to much of southern Canada and the United States. I joined the Canadian North <em>Helicobacter pylori</em> (CAN<em>Help</em>) Working Group in 2010 to conduct participant observation in the Aklavik <em>H. pylori </em>Project (AHPP) and identify ways that ethnography can be integrated into the ongoing multi-pronged research that incorporates epidemiology, microbiology, gastroenterology, knowledge translation, and the development of public health policy.</p> <p>Between September, 2011 and June, 2012, I lived as a participant observer in Aklavik. I led an epidemiological study of the incidence and re-infection of <em>H. pylori </em>infection. I examined how different risk perceptions emerge from processes of “making sense” of <em>H. pylori </em>as a “pathogen” or as a “contaminant” and described how these different constructions influence people’s behaviours. Ethnography, in this way, can make visible the lenses through which different groups of actors perceive, experience, and react to <em>H. pylori </em>infection. The recognition that the social inequities most strongly associated with <em>H. pylori </em>infection and re-infection that exist today are the result of Aklavik’s colonial history is one example of a space in which different lenses can be brought into a shared focus. From such shared understandings, consensus knowledge can be built collaboratively between outside researchers and Indigenous Arctic communities in an ongoing, and community-driven, research project. Furthermore, I critically examined the definition and use of the “household” as a level-unit of risk assessment and have outlined steps for assessing possible risk factors as these are distributed across multi-household extended kin groups that can be identified and followed in long-term research.</p> / Doctor of Social Science

Title: Indigenous Masculinity and HIV Disclosure Aim/Objective: The goal of this this research project is to explore how self-regulation of a masculine identity is impacted by colonization in the context of HIV disclosure for Indigenous men. Specific objectives under this goal include the following: (1) Understanding Indigenous men’s ideas about Indigenous masculinity; (2) understanding how Indigenous men come to understand the impact of colonization on their masculine identity; and (3) understanding how colonization affects Indigenous men’s experience of HIV disclosure. Methods: This project adopts an Indigenous directed process consistent with principles of community-based research (CBR) and driven by decolonizing and Indigenous methodologies. Following an examination of relevant literature, six Indigenous men living with HIV were interviewed to discuss the significance of Indigenous masculinity in the context of HIV wellness and HIV disclosure. The findings from the literature review and interviews were coded within NVivo qualitative analysis software to compare emerging themes. Findings: Following a discussion of the several aspects of Indigenous masculinity, the participants described the hinderances of colonization and stigmatization in disrupting healthy practices and conceptualization of Indigenous masculinity. Throughout the journey of healing, a process of deconstructing western ideals was necessary towards developing a personal sense of Indigenous masculinity which aligned with their Indigenous identity. Upon successful negotiation of the relationship between Indigenous masculinity and HIV status, disclosure was used at various stages of the healing journey to affirm Indigenous masculinity, discover a personal sense of purpose, and to educate others. Conclusion: The use of disclosure was found to be a vital component towards the development and practice of Indigenous masculinity. The findings of this project will be used to apply for future grants to design a service or intervention which provides Indigenous men living with HIV with a safe and healthy environment to practice Indigenous masculinity. / Thesis / Master of Social Work (MSW)

O que o mundo indígena nos ensina sobre o sonhar? Esta pesquisa foi realizada na aldeia de Ipavu, onde vivem os índios Kamaiurá, no Parque Indígena do Xingu, e situase no campo da Interculturalidade. O trabalho teve como objetivo inicial investigar as concepções de sonho dos Kamaiurá, bem como verificar se o sonho poderia ser tomado como uma faceta de enraizamento, índice de saúde diante do crescente contato da comunidade com elementos da cultura ocidental. A partir das experiências de campo, discutiu-se também a função do sonho em sua dimensão comunitária, bem como o uso dos sonhos como comunicação etnográfica. Tanto as concepções ameríndias sobre o sonhar como a experiência de encontro onírico permitiram ampliar os pressupostos da psicologia e da psicanálise sobre os sonhos, pois ofertaram elementos para compreendê-los não somente na dimensão individual, mas também na dimensão compartilhada e comunitária / What does the indigenous world have to teach us about dreaming? This intercultural research was carried out in the village of Ipavu, inhabited by the Kamaiurá Indians, in the Xingu Indigenous Park. The objective of this work was to investigate the dream conceptions of the Kamaiurá as well as to verify if the dream could be taken as a rooting factor, a health index in the face of the growing community contact with elements of Western culture. Field research was the starting point to discuss the function of dreams in its community dimension, as well as the use of dreams as ethnographic communication. The Amerindian conceptions of dreaming and their experience of dream-encounter allowed us to expand the presuppositions of psychology and psychoanalysis on dreams, since they offered elements to understand them not only in the individual dimension, but also in the shared and communitarian dimension

OBJETIVO: O perfil epidemiológico dos povos indígenas no Brasil ainda não é suficientemente conhecido, principalmente no que se refere aos aspectos oftalmológicos das etnias residentes na região Centro-Oeste. Sendo assim, o objetivo do presente estudo foi conhecer as condições de saúde ocular da população indígena Kadiwéu, que habita as aldeias da serra Bodoquena, no Mato Grosso do Sul. MÉTODO: Foi conduzida uma pesquisa observacional, transversal e descritiva, desenvolvida na Aldeia Alves de Barros, na Serra da Bodoquena, no município de Porto Murtinho, Mato Grosso do Sul. Foram sujeitos da pesquisa 193 índios de um total estimado de 1.197. RESULTADOS: Da amostra avaliada, 74,9% apresentaram acuidade visual maior ou igual a 0,8. Dentre as ametropias, a hipermetropia foi o achado mais comum (9,3%) e a miopia o menos comum (2%). Dentre os achados da conjuntiva, a melanose e o pterígio foram os mais frequentes, com porcentagens de 25,4 e 14,7, respectivamente; em relação à avaliação das pálpebras, o achado mais comum foi a dermatocálase, com frequência de 4,5%. Quanto à córnea, encontraram-se casos de leucoma (n=4) relacionados a trauma ocular e uma suspeita de ceratocone; opacificação de cristalino foi observada em 5,6% dos indígenas avaliados e um caso de coloboma de íris foi verificado. Apenas um dos avaliados apresentou estrabismo convergente e um estrabismo divergente e não foram observados casos de hipertensão ocular ou glaucoma. Nenhum caso de discromatopsia foi encontrado. CONCLUSÃO: Pode-se concluir que os indígenas desta etnia apresentam, na sua maioria, boas condições oculares, com acuidade visual >=0,8, tendo apresentado, como alterações mais comuns, melanose da conjuntiva, pterígio, opacificação do cristalino, dermatocalaze e sequelas de traumatismos. A hipermetropia foi a ametropia mais comum (9,3%) e a miopia a menos comum (2%) / PURPOSE: The epidemiological profile of indigenous population in Brazil still remains insuffiently known.Considering ethnic groups living in the Center-West region of Brazil a limited number of reports is available regarding their ocular aspects. Based on these facts this study was conducted to elucidate the ocular conditions of Kadiwéus population, a specific ethnic group living in Bodoquena\'s Mountains in the state of Mato Grosso do Sul. METHODS: This is a crosssectional, descriptive and observational study performed with 193 Kadiwéus indians of a total of 1197 residents in the small villages in Bodoquena\'s Mountains. RESULTS: Of the selected sample, 74,9% had visual acuity better than 0.8. Among the refractive errors, hypermetropia was the most common (9,3%) and miopia the less frequent (2%). Melanosis and pterigyum are the conjunctiva most frequent findings, with percentages of 25,4 and 14,7 respectively; dermatochalasis had a frequency of 4,5%. Among corneal detected alterations, corneal clouding related to trauma was the most frequent and, one case of suspected keratoconus was found. Cataract was observed in 5,6% of the sample and one case of iris coloboma was verified. One case of convergent strabismus and one case of divergent strabismus were found. Ocular hypertension, glaucoma or dyschromatopsias were not verified. CONCLUSIONS: This study concluded that the Kadiwéus presented good ocular conditions, with visual acuity better than 0.8, in which, melanosis, pterigyum, cataract, dermatochalasis, trauma sequelae were the most frequent findings and hyperopia was the most common refractive error (9,3%)

Este trabalho se inscreve no campo da saúde pública em sua perspectiva interdisciplinar, pois mobiliza conhecimentos oriundos da epidemiologia, do planejamento e das ciências humanas e sociais. Nosso objetivo central foi analisar a viabilidade política do planejamento participativo na Terra Indígena Tirecatinga, DSEI Cuiabá, Estado de Mato Grosso, Brasil. A fundamentação teórica utilizada foi a Teoria do Jogo Social de Carlos Matus que visita e amplia duas outras teorias formuladas pelo autor: a Teoria das Situações e a Teoria da Produção Social. A estratégia metodológica escolhida foi o Estudo de Caso tendo em vista que a formulação de um plano local por meio do planejamento estratégico situacional tratou-se de um caso não significando que o processo e os resultados obtidos poderão ser generalizados para as demais comunidades indígenas do território nacional. Os depoimentos foram submetidos à Análise do Discurso segundo hipóteses de Dominique Mainguenau. Esperamos que o exercício do planejamento em território indígena amplie a compreensão da situação de saúde dos índios que vivem na Terra Indígena Tirecatinga, território adstrito ao DSEI Cuiabá; estenda a compreensão sobre as lógicas de ação que permeiam as práticas dos sujeitos nos espaços de participação social; que o planejamento seja um instrumento de reflexão e mudança para a organização fornecendo subsídios para a institucionalização do mesmo tendo em vista as necessidades dos sujeitos e, sobretudo, promova a reflexividade e a atividade crítica na comunidade indígena participante / This work falls within the field of public health from an interdisciplinary perspective as it mobilizes knowledge from epidemiology, planning and human and social sciences. Our main objective was to analyze the political viability of participatory planning within Tirecatinga Indigenous Territory, DSEI Cuiaba, Mato Grosso, Brazil. The theoretical framework used was the Theory of Social Game by Carlos Matus, created by visiting and extending two other theories formulated by the same author: the Theory of Situations and the Theory of Social Production. The selected methodological strategy was a case study with a view to formulate a local level situational strategic planning used to treat a case. Therefore the process and the results cannot be generalised to other indigenous communities within the national territory. All reports were submitted to Discourse Analysis according to Dominique Mainguenaus hypothesis. We hope that the exercise of planning within indigenous territories can expand the understanding of the health status of Indians living within Tirecatinga Indigenous Territorry, a territory attached to the DSEI Cuiabá; extend the understanding of the logic of action that permeates the practices of the subjects in the spaces of social participation; that planning can be used as a reflection tool and promote changes to the organization providing support for the institutionalization from a perspective which recognizes the needs of individuals and, above all, promote reflexivity and critical activity within the participating indigenous community

Made available in DSpace on 2015-04-22T22:06:27Z (GMT). No. of bitstreams: 1 gabriel cortes.pdf: 6425050 bytes, checksum: 04e6ed2fef6be8960b0f8f25cf58eacb (MD5) Previous issue date: 2013-02-25 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Aim: The aim of this study was to assess the prevalence of caries and investigate its association with socioeconomic, feeding and oral hygiene factors in Kotiria Indians from the Upper Uaupés River, Amazonas, Brazil. Methods: A cross sectional study was conducted with 93,5% of the indigenous population aged from 1-5 (n=54), 12 (n=11), and 15-19 (n-22) years old resident at the traditional Kotiria land. Caries and treatment needs were assessed using the World Health Organization criteria. The Simplified Debris Index (DI-S) and gingival bleeding (SG) were taken as oral hygiene status. Interview was used to record socioeconomic, feeding and oral hygiene data. Cariogenic food intakes frequency was assessed using 24 hours recall alimentary inquiry. Data analyses included exploratory statistics, Pearsons Chi-Square Test, Likehood Ratio, Fisher´s Exact Test, Pearson´s Correlation, T Test and Anova. Results: The dmft was 4,72 at 1-5 years and 8,11 at 5 years. The DMFT was 5,36 at 12 and 6,45 at 15 - 19 years. Only 21,8 % of the indigenous evaluated were caries free. The most frequent treatment need was filling followed by extraction for all ages. DI-S and SG status was considered good to 9,93% and 13,2% of all participants. Exclusive breastfeeding until the sixth months was reported to 72% of the children aged 1-5 years and 35,9% reported to use baby bottle. The average consumption of sucrose was 1,4 times a day, and 0,7 times in between meals. The average house income was 366,00 US dollars, and 6 houses (16%) had no income. Parents education was 8,7 and 5,1 years of study for fathers and mothers respectively. Higher sucrose intake between meals and interrupted toothpaste access were associated to higher caries frequency (p<0,05). DMFT/dmft was positive correlated to gingival bleeding (p=0,034). Conclusions: The Kotiria indigenous group presented high caries prevalence and treatment needs. Good oral hygiene, permanent toothpaste access, less sucrose intake between meals were associated or correlated to better oral health conditions. / Objetivo: O presente estudo buscou verificar a prevalência de cárie dentaria e investigar sua associação com fatores socioeconômicos, alimentares e de higiene bucal em indígenas Kotiria do Alto Rio Uaupés, Amazonas, Brasil. Metodologia: O estudo foi do tipo epidemiológico transversal do qual se avaliou 93,5% da população indígena residente no território tradicional Kotiria, pertencentes às faixas etárias de 1 a 5 (n=54), aos 12 (n=11) e de 15 a 19 (n=22) anos. Foi realizado exame clínico intrabucal para aferir a experiência de cárie (índice CPOD/ceod) e necessidade de tratamento por meio de metodologia e critérios definidos pela OMS (1997). Níveis de higiene bucal foram determinados a partir do Índice de Induto Simplificado (DI-S) e do componente de sangramento gengival (SG) do Índice Periodontal Comunitário (CPI). Foram usados questionários para coleta de dados socioeconômicos, de higiene bucal e alimentares. Em acréscimo, foi aplicado um inquérito alimentar recordatório das últimas 24h em três dias não consecutivos para investigar frequência do consumo de alimentos cariogênicos. Também foi realizada observação descritiva para identificar características da prática de higiene bucal e dos hábitos alimentares. A análise foi realizada por meio de estatística descritiva, teste qui quadrado de Pearson, razão da verossimilhança, exato de Fisher, correlação de Pearson, teste t e Anova. Resultados: O índice ceod foi de 4,72 e 8,11 em crianças de 1 a 5 anos e aos 5 anos respectivamente, o CPOD foi de 5,36 e 6,45 em indígenas aos 12 e de 15 a 19 anos. Estavam livres de cárie apenas 21,8% dos avaliados. A necessidade de tratamento mais frequente foi o restaurador seguido da extração. Relataram escovar os dentes 91% dos entrevistados, no entanto apenas 9,4% e 13,2% apresentaram boa higiene bucal (DI-S≤0,6) e boa condição gengival (SG=0). Aleitamento materno exclusivo até os 6 meses foi realizado para 72% das crianças entre 1 a 5 anos, e 35,9% relataram uso de mamadeira. A frequência média do consumo de sacarose foi de 1,4 vezes ao dia e de 0,7 vezes para o consumo de sacarose entre as refeições. A renda média domiciliar foi de R$ 732, sendo renda nula para 16% (n=6) dos domicílios. A escolaridade média em dos pais foi de 8,7 e das mães de 5,1 anos de estudo. Apresentou-se associado à maior frequência de cárie o maior consumo de sacarose entre as refeições (p=0,019) e o acesso descontínuo ao dentifrício (p=0,048). O índice CPOD/ceod apresentou correlação positiva (p=0,034) com o sangramento gengival. Conclusão: Foi possível concluir que a população Kotiria avaliada apresenta elevados índices de cárie e necessidade de tratamento. E que a higiene bucal adequada, acesso ininterrupto ao dentifrício e o menor consumo de sacarose entre as refeições estiveram associados ou correlacionados com melhores condições de saúde bucal.

Este trabalho se inscreve no campo da saúde pública em sua perspectiva interdisciplinar, pois mobiliza conhecimentos oriundos da epidemiologia, do planejamento e das ciências humanas e sociais. Nosso objetivo central foi analisar a viabilidade política do planejamento participativo na Terra Indígena Tirecatinga, DSEI Cuiabá, Estado de Mato Grosso, Brasil. A fundamentação teórica utilizada foi a Teoria do Jogo Social de Carlos Matus que visita e amplia duas outras teorias formuladas pelo autor: a Teoria das Situações e a Teoria da Produção Social. A estratégia metodológica escolhida foi o Estudo de Caso tendo em vista que a formulação de um plano local por meio do planejamento estratégico situacional tratou-se de um caso não significando que o processo e os resultados obtidos poderão ser generalizados para as demais comunidades indígenas do território nacional. Os depoimentos foram submetidos à Análise do Discurso segundo hipóteses de Dominique Mainguenau. Esperamos que o exercício do planejamento em território indígena amplie a compreensão da situação de saúde dos índios que vivem na Terra Indígena Tirecatinga, território adstrito ao DSEI Cuiabá; estenda a compreensão sobre as lógicas de ação que permeiam as práticas dos sujeitos nos espaços de participação social; que o planejamento seja um instrumento de reflexão e mudança para a organização fornecendo subsídios para a institucionalização do mesmo tendo em vista as necessidades dos sujeitos e, sobretudo, promova a reflexividade e a atividade crítica na comunidade indígena participante / This work falls within the field of public health from an interdisciplinary perspective as it mobilizes knowledge from epidemiology, planning and human and social sciences. Our main objective was to analyze the political viability of participatory planning within Tirecatinga Indigenous Territory, DSEI Cuiaba, Mato Grosso, Brazil. The theoretical framework used was the Theory of Social Game by Carlos Matus, created by visiting and extending two other theories formulated by the same author: the Theory of Situations and the Theory of Social Production. The selected methodological strategy was a case study with a view to formulate a local level situational strategic planning used to treat a case. Therefore the process and the results cannot be generalised to other indigenous communities within the national territory. All reports were submitted to Discourse Analysis according to Dominique Mainguenaus hypothesis. We hope that the exercise of planning within indigenous territories can expand the understanding of the health status of Indians living within Tirecatinga Indigenous Territorry, a territory attached to the DSEI Cuiabá; extend the understanding of the logic of action that permeates the practices of the subjects in the spaces of social participation; that planning can be used as a reflection tool and promote changes to the organization providing support for the institutionalization from a perspective which recognizes the needs of individuals and, above all, promote reflexivity and critical activity within the participating indigenous community

Background: Food nourishes us, sustains us, and has the potential to both heal us and make us sick. Among many Indigenous cultures, traditional activities, ceremonies, events and practices often involve or use food, grounding Indigenous peoples within the context of their local, natural surroundings. This suggests that food is important not only for physical health, but also emotional, mental and spiritual health. The relationships that Indigenous peoples have with food can help us to understand the health of individuals, and the communities in which they live. Purpose: The following qualitative study explores how three generations of adults who live in one Labrador Inuit-Metis community experience and understand their relationships to food in a context of global change. Theoretical Orientation: The research is guided by Two-Eyed Seeing. Two-Eyed Seeing acknowledges that there are many different ways of seeing and understanding the world, some of which can be encompassed through a Western eye and some through an Indigenous eye. If we learn to see through both eyes, we can gain a perspective that looks very different than if we only view the world through a single lens. Methods: For the study, twenty-four people from the south-eastern Labrador community of St. Lewis participated in individual and joint story-telling sessions. A group story-telling session also took place where community members could share their stories with one another. During many of the story-telling sessions, participants shared photographs, which helped to illustrate their relationships to food. Findings/Discussion: Historically, the people of St. Lewis relied almost entirely upon their own wherewithal for food, with few, if any, government services available and very little assistance from the market economy. This fostered and upheld an Inuit-Metis culture that promoted sharing, reciprocity and respect for the natural world. Currently, greater access to government services and the market economy has led to the creation of certain policies and programs that undermine or ignore established social and cultural norms in the community. Conclusions: Existing Inuit-Metis knowledge should work alongside non-Indigenous approaches to policy and program development. This would serve to protect and promote the health of both individuals and communities.