You Say “Natural Resources,” We Say Part of Our Community Health: Using Indigenous Health Indicators to Evaluate Coast Salish Priorities when the Environment Is Polluted

Background: There has long been a call for metrics that effectively evaluate Indigenous community health based on an Indigenous community’s worldviews and priorities. Indigenous definitions of health are often not considered in decision-making, which contributes to environmental pollution disproportionately impacting American Indian and Alaska Native communities. The Indigenous Health Indicators (IHIs) were established by the Swinomish Indian Tribal Community specific to their knowledge of health and well-being, to better reflect the integral connections to coexistence with other humans, nature, and all animate beings. The IHIs combine elements of quantification and replicability while incorporating Indigenous priorities. This collaboration sought to evaluate an amended set of IHIs for a broader Coast Salish representation of Indigenous health values and priorities using four workshops, involving Tribal members from each participating Tribe: Lower Elwha Klallam Tribe, Port Gamble S’Klallam Tribe, Suquamish Indian Tribe of the Port Madison Reservation, and Stillaguamish Tribe. Methods: Workshop participants were asked to rank indicators during two hypothetical pollution scenarios that impacted traditional foods. Effectiveness was measured using statistical analyses and qualitatively by transcribing discussion. Results: The four workshops demonstrate that the IHIs are useful in communicating what participants feel are important regarding Indigenous and Coast Salish values of community health and well-being. Discussion and Conclusion: Workshop participants and Tribal leaders indicated an interest in exploring this tool for different contexts. Additional research is needed to evaluate whether these indicators would be useful in diverse geographic regions.