Self-determination and Indigenous peoples

Nixon’s upbringing in Southern California and mentorship under a Native coach at Whittier College highly influenced his understanding of Native communities. With advocates like LaDonna Harris, a prominent Comanche leader, lobbying for tribal rights, Nixon’s administration set a new standard for federal-tribal relations. This includes but is not limited to, municipal and local organizations and businesses, workplaces and educational institutions.

There are few studies that report on and evaluate shared decision making interventions with Indigenous Peoples. Overall, Indigenous-oriented studies sought to make health care systems more amenable to shared decision making for Indigenous Peoples, while Western-oriented studies distanced shared decision making from the health care settings. Our administration has prioritized efforts that will empower tribal self-determination long after this administration comes to an end. That includes leveraging co-stewardship agreements, which commit tribes and the federal government to the shared co-management of certain public lands and waters. Since time immemorial, ancestral homelands have been central to the social, cultural, spiritual, mental and physical wellbeing of Indigenous peoples.

In the early years, each of these Reconciliation milestone reports were met with such great political resistance, that much of the work was not supported in any significant way, if it all. The Responsible Land-Based Investment (RLBI) Navigator helps government, civil society and private sector actors identify and access the practical guidance most relevant to their work, to protect land rights in investment processes. It is operated jointly by the Land Portal and the International Institute for Environment and Development (IIED), as part of the Advancing Land-based Investment Governance project. ALIGN supports governments, civil society, local communities and other relevant actors in strengthening the governance of land-based investments. It is funded with UK aid from the UK government, however the views expressed do not necessarily reflect the official views or policies of ALIGN partners or the UK Government. We call upon all stakeholders to deepen their commitment to integrating the rights of Indigenous Peoples into policies, programs, and practices.

Creating capacity-bridging initiatives to overcome the funding barriers currently experienced by ICCOs when trying to access or apply for research funding from mainstream funders emerged as a promising best practice. Over the past three years of operating the BC NEIHR, each ICCO project that was funded was place-based and autonomous, and the research was conducted by the community and for the community. Figure 1 below highlights the keywords used by ICCOs to describe their research within their 2021–2022 funding applications. The types of research activities led by ICCOs are fundamentally strength-based, culturally grounded, and self-determined. Indigenous and decolonial methodologies and Indigenous research ethics work together to uphold and advance Indigenous governance and self-determination. Indigenous methodologies include the unique ways researchers use Indigenous positionality and perspectives (a distinction-based approach) to conduct research with and within ICCOs 26.

• The ongoing impacts of colonisation mean that self-determination is particularly important to Aboriginal and Torres Strait Islander peoples.
• While it is critical that ICCOs have ownership and control over research in which they are involved, they must also be supported in this leadership role.
• For example, one study describes an approach to shared decision making to overcome intergenerational grief and trauma experienced by the Indigenous communities and that positions families and communities to reclaim customary practices.

Rights and permissions

At the same time, having effective and legitimate governing structures in place is crucial if Aboriginal and Torres Strait Islander nations are to realise their self-determined goals. Aboriginal and Torres Strait Islander rights to self-determination have been ignored or undermined, or acknowledged or modestly supported over the years. Still, Aboriginal and Torres Strait Islander peoples’ desire to govern themselves – and to build their capacity to do that well – persists. Indigenous-led health research networks that support self-determination and prioritize Indigenous ways of knowing and being are crucial to both capacity-bridging and reconciliation efforts in Canada.

Theme 3: Community is a partner in shared decision making

While there are examples of health care settings that have been designed to provide culturally appropriate care that include care for Indigenous Peoples 102,103,104, there are limited descriptions of interventions to support Indigenous Peoples to participate in health decision making. Shared decision making tools and approaches are complex interventions that are developed to facilitate shared decision making process with people who span health systems, from patients and families to policy makers 105. Our review was conducted to identify interventions about shared decision making for Indigenous Peoples making health decisions, to synthesize evidence and to identify factors (barriers and facilitators) that impact the use of shared decision making interventions (Fig. 4).

Funding Statement

The report reads in part, “Indigenous communities, Peoples, and Nations are those who, having a historical continuity with the pre-invasion and pre-colonial societies that developed in their territories, consider themselves distinct from other sectors of the societies that now prevail in those territories or in part of them. They now constitute non-dominant sectors of society and are determined to preserve, develop, and transmit to future generations their ancestral territories and ethnic identity as the basis of their continued existence as a people, in accordance with their cultural patterns, social institutions and legal systems.” Finally, the IACHR recognizes the high level of interest and engagement of representatives of indigenous and tribal peoples of the continent in the regional workshops and in the responses sent to the questionnaire for the report. With that in mind, the IACHR thanks them for sharing their testimonies, stories, views, and proposals concerning the self-determination of their peoples.

Shared decision making has also been found to benefit those who are more likely to experience disadvantage in health support Indigenous self-determination systems 30. Shared decision-making facilitates collaboration between patients and health care providers for informed health decisions. The objectives were to synthesize evidence and identify factors that impact the use of shared decision making interventions. Many of the funding barriers and gaps that ICCOs continue to encounter stem from their ineligibility to hold and control health research funds awarded through mainstream funders. Helping ICCOs to become host institutions eligible to receive CIHR and other funds is an important step toward transforming the funding landscape.

That is, the core environments, systems, and institutions of research determine what is seen and what is ignored, what is valued and what is rejected, what is protected and what is neglected. The BC NEIHR aims to catalyze a shift in the present research environments, systems, and institutions through our strong and collaborative partnerships. In our partnerships, we have found a balance that both works with and pushes back against these structures so that ICCOs can engage in health research to their full potential. We must work together to create a healthier, safer, and more inclusive research environment that respects and prioritizes Indigenous ways of knowing and being. The BC NEIHR is a large provincial Indigenous health research network that is dynamic and constantly changing over time. As of June 2023, we have over 300 registered members, including Indigenous trainees (37.8%), allies (22.4%), Indigenous academics/professionals (21.4%), and ICCOs (18.4%).