Introduction

Humanity’s impact on the Earth has been profoundly leading to the Anthropocene epoch. The striking acceleration since the mid-twentieth century of carbon dioxide emissions and the transformation of land by deforestation and development has marked change in climate by effects like a rise in earth’s average temperature, sea level rise, and increased episodes of drought change in global average precipitation over land areas and increased incidences of natural disasters. The term “Climate change” refers to changes in climate properties (temperature, precipitation, extreme events, and wind patterns) that persist for a long period (decades or longer). (Liang & Gong, 2017) It is a powerful determinant of current and future health for all human populations. Though its far-reaching impact is on all parts of society; the impact of climate and ecosystem change has a direct impact on local livelihoods and sustenance of Indigenous people. Indigenous peoples are descent from populations, who inhabited the country or geographical region at the time of conquest, colonization, or establishment of present state boundaries. They retain some or all of their own social, economic, cultural, and political institutions, irrespective of their legal status. (Who Are the Indigenous & Tribal Peoples, 2016) The territories of the world’s 370 million indigenous peoples cover 24% of land worldwide and contain 80% of the world’s biodiversity. (The Role of Indigenous Peoples in Combating Climate Change | Humanities and Social Sciences Communications, 2022) Due to their subsistence economies and spiritual connection to lands and territories, most indigenous peoples suffer disproportionately from loss of biological diversity and environmental degradation resulting from climate change. (Indigenous Peoples & the Nature They Protect, 2020) Climate change presents substantial risks to their health and well-being.

Indigenous peoples also face multiple disadvantages and intersecting inequalities in terms of their economic situation (e.g., income), social support (e.g., social networks), and personal characteristics (e.g., health and educational attainment). (Research_summary_no1_2004_-_multiple_disadvantage)They are among the poorest of the poor; though they make up just 6 percent of the global population, they account for about 19 percent of the extreme poor. (Indigenous Peoples, 2022) They often lack formal recognition over their lands, territories, and natural resources, are often last to receive public investments in basic services and infrastructure, and face multiple barriers to participating fully in the formal economy, and participating in political processes and decision-making. (Indigenous Peoples, 2022) This legacy of inequality and exclusion has made Indigenous peoples the most threatened segment of the world’s population in terms of social, economic, and environmental vulnerability and hence at the receiving end of the impacts of climate change and impending natural hazards. This also highlights an important and difficult challenge in achieving the 2030 Agenda for Sustainable Development, which was adopted with the pledge that “no one will be left behind”. (Social Development for Sustainable Development | DISD, 2022) Surmounting this challenge will require focusing on indigenous peoples with inclusive policies. In particular, protecting Indigenous health now and into the future with rapid, equitable, and effective policies and practices.

It is thus imperative that climate mitigation policies and practices are designed to maximize positive impacts and minimize adverse outcomes for Indigenous health. However, evidence on which to base these decisions is limited.

Research Question: This sco** review sought to explore the current evidence for important potential impacts of climate change on Indigenous health in the background of multiple disadvantages and how it engages with Indigenous perspectives and experiences.

Methodology

We identified sco** review, as the most appropriate review method for map** the impacts of climate change on Indigenous health as sco** reviews are useful for bodies of research that have cross-disciplinary and methodological boundaries, which is undoubtedly the case with the indigenous health and climate change literature. Sco** reviews are also helpful for identifying research gaps and emerging research priorities. We utilized standard sco** review methods for this study according to the relevant sections of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-ScR guidelines. (Tricco et al., 2018).

Information Source and Search Strategy

The review was undertaken conforming with the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Sco** review (PRISMA-ScR) statement. (Tricco et al., 2018) We searched three major electronic databases of MEDLINE/PubMed (https://www.ncbi.nlm.nih.gov), Google Scholar (https://scholar.google.com), and Cochrane Library for pre-print and published literature from January 1, 2000, until May 31, 2022. Initial database search was done through field search using Boolean Operators with a combination of the following text words: “Indigenous people*”, “indigenous population*”, “indigenous health”, “indigenous communit*”, “tribal population”, “native peoples”, “climate change”, and “global warming”. A search strategy was formulated following a detailed analysis of the keywords and index terms (Medical Sub-Headings or MeSH terms for MEDLINE) based on their presence in the title and text of the articles. (Refer to Appendix A) Furthermore, reference lists from the identified articles selected through electronic databases were searched manually (backward chronological search).

Eligibility Criteria and Study Selection

The selection of articles was restricted to human studies published in the last 20 years. Original research findings based on both primary and secondary data were explored and included if found suitable. After completing the literature search with various databases with the search strategy discussed, the data for the found articles were transferred to Zotero 5.0 software (AGPL). In the next step, the duplicate articles in different databases were identified and merged. All titles and abstracts were examined to remove irrelevant studies or documents. In the next step, the available full texts of the selected studies were retrieved by filtering the abstract-only papers, and then the full texts were screened in detail.

Article entries were included in the review based on the following criteria:

  1. (i)

    Description of the impact of climate change, in its various form, on the health and well-being of indigenous communities

  2. (ii)

    Perspective of the indigenous population towards climate change,

  3. (iii)

    Association of disruption of health services in the indigenous community due to climate change.

Articles that were protocols and methodological studies were further excluded, and after reading the full texts, articles that did not fulfill the research question, or included any specific population or health-related outcomes were also excluded.

The search strategy was first developed and completed by MS & BC independently. To validate the process, RD and SC independently reviewed a random sample of 10% of the documents included for full-text review, and any discrepancies concerning inclusion were discussed by MS, BC, RD, and SC to reach consensus.

Data Extraction and Charting

Data extraction was done from individual full-text studies in two separate structured extraction sheets in Microsoft Excel. The following data items were collected during the data charting process:

  1. 1.

    Publication characteristics: title, author name, journal, year of publication, country of origin.

  2. 2.

    Contextual characteristics of the study: Study design (e.g., review study, intervention study, qualitative or mixed-methods design study), study setting, sample characteristics including sampling design, source of data

Relevant output data from each full-text study were extracted for further analysis. Namely,

  1. (a)

    Nature of climate change and its influence on the indigenous population. (e.g., unexpected weather changes, reduction of ice levels, heatwaves, bushfires)

  2. (b)

    Health outcomes (e.g., mortality, morbidity, risk factors, various determinants of health affected)

Few additional outcomes were extracted from articles, whenever applicable and necessary, such as the perspective of the indigenous community about climate change and its effect on their health and adaptive measures if taken any.

Results

From the 506 unique citations identified in the initial database search; the screening and eligibility assessments resulted in a final set of 29 (See Fig. 1).

Fig. 1
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Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) flow diagram for study inclusion

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In the following sections, we summarize the reviewed literature in terms of general characteristics and our research questions.

General Characteristics of Papers

Our review included empirical studies, non-empirical review studies, and some editorial/ commentaries/ perspectives that examined a range of climate change events, with health-related outcomes and analyzed by ethnicity. The search identified 518 articles. After, removing duplicates, and applying exclusion criteria detailed full-text search was done for 134 articles. On full-text screening it was found that 60 articles did not discuss climate change impacts; 10 were not related to health; 22 of them were not discussing Indigenous peoples, five articles were an editorial call for data collection and another five were protocols. Hence, finally, twenty-nine publications remained eligible for inclusion. Out of these 29 articles, five articles were incorporating qualitative research (Bryson et al., 2021; Keatts et al., 2021; Kowalczewski & Klein, 2018; Rautela & Karki, 2015; Westoby et al., 2020), two articles incorporated Mixed Method Research (Chatwood et al., 2017; Durkalec et al., 2015); case studies, time series, community-based project and symposium report were one piece each(Amstislavski et al., 2013; Galway et al., 2022; Huber et al., 2020b; Rahman & Alam, 2016); Seven review articles (1 systematic review, 2 Sco** Review, 4 narrative review) (Ellwanger et al., 2020; Galway et al., 2019; Jones et al., 2020; Lansbury Hall & Crosby, 2022; Lebel et al., 2022; Schramm et al., 2020; Standen et al., 2022); 6 commentaries (Hernandez et al., 2022; Leal Filho et al., 2021; Lewis et al., 2020; Redvers et al., 2022; Richards et al., 2019; Zavaleta-Cortijo et al., 2020); 4 perspectives (Callaghan et al., 2020; Houde et al., 2022; Redvers et al., 2020; Timler & Sandy, 2020) and 1 editorial was included in the final analysis. (Pollock & Cunsolo, 2019) We did not find any meta-analyses, randomized controlled trials, cohort, or case–control studies.

The studies examined a diverse set of both direct and indirect adverse effects of climate change on indigenous health worldwide. Out of these articles, most of them concentrated on physical health; five articles emphasized mental and psychosocial aspects of health (Galway et al., 2019; Huber et al., 2020b; Kowalczewski & Klein, 2018; Lebel et al., 2022; Standen et al., 2022); One article had discussed majorly on the access to health care system (Amstislavski et al., 2013); and another one discussed in detail about Health stewardship for indigenous peoples. (Chatwood et al., 2017) A few articles also discussed adaptive measures against climate change undertaken by various tribes and some community-based projects on climate-ready tribe initiatives. (Schramm et al., 2020) One article particularly discussed Gardening as an important solution to overcome climate change-led food insecurity. (Timler & Sandy, 2020) One article discussed how youth are being affected by climate change and how they can play a role in mitigation measures. Another article discussed how vulnerable groups like pregnant mothers are being affected by climate change. (Bryson et al., 2021) Tables 1, 2, and 3 have summarized the findings and spatial distribution of included reviews, empirical studies, and editorial/comments/perspectives respectively.

Table 1 Summarized findings and spatial distribution of included reviews (n = 8)
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Table 2 Summarized findings and spatial distribution of included empirical studies (n = 9)
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Table 3 Summarized findings and spatial distribution of included editorial/ commentaries/ perspectives. (n = 12)
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Spatial Distribution of the Articles

Concerning geographic distribution among the papers in our final sample, there is a clear predominance of circumpolar countries underlying the imminent impact of climate change that the indigenous population of those countries is facing. Of these 29 articles, nearly half had a focus on the Canadian region; and another 11 (38%) had a focus on the United States; seven studies (24%) focused on Russia; Australia (five articles) and the Scandinavian countries (Sweden five, Norway and Finland and Denmark three apiece) were next for the most-focused countries in the review. Very few articles studied the indigenous communities of Asia (India, China) and Africa (Uganda, Kenya, Tanzania, Ethiopia). The Global South was underrepresented in the review as a whole. Figure 2 provides the geographic distribution of articles within the globe.

Fig. 2
figure 2

Choropleth Map showing the geographical distribution of the indigenous population within the articles included in the review

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Temporal Distribution of the Articles

There was an increasing trend in the number of articles published over the last twenty years’ time, especially after 2015–May 2022 (Fig. 3). The number of Indigenous health research articles has been increasing over time with a few notable drops and peaks. In 2020, there was a steep increase in, which had 11 published articles. A potential reason for the increase in publications may be attributed to the COVID-linked lockdown and increased overall publication frequency of research papers that may have contributed to the increased publications during that year.

Fig. 3
figure 3

Number of included studies by years of publication (n = 29)

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How Climate Change is Affecting Indigenous Health?

To better understand the impacts of climate change on Indigenous health, we focused on the subset of studies with empirical data, specifically (n = 20). Study populations were quite varied and ranged from geographically based residents of specific regions and culturally identified subpopulations such as Pregnant Batwa women of Uganda, Sami youths in Norway, Swinomish tribes in Washington, and Bhotia Tribe in India, etc. It was found that Indigenous health is impacted by climate change in three main stages (primary, secondary and tertiary impacts):

Firstly, climate change can directly or primarily cause injury and death from extreme weather events including heat waves and droughts, violent storms, cyclones, flooding, landslides, bushfires increasing sea levels, and rising infectious disease. It was reported that extreme weather events and decreased thickness and extent of ice lead to increased safety hazards. Among the Inuit community in northern Canada, the changing nature and increasing variability of environmental hazards are predicted to increase the frequency and severity of physical health impacts from environmental exposure reporting increasing injuries related to changing ice and weather conditions (ACIA 2005, 2022; Prowse & Furgal, 2009). The Yakutia indigenous community in the Republic of Sakha, Russia has reported increased illness resulting from extreme weather events. (Kowalczewski & Klein, 2018). Indigenous remote settlements in Australia suffer from various physical health impacts due to the severity and frequency of extreme weather events—namely heatwaves, bushfires, floods, cyclones, and drought. (Lansbury Hall & Crosby, 2022) In indigenous communities from Bangladesh (Khasia, Tripura, and Garo) changes in temperature and rainfall patterns, have led to increased frequency of landslides, soil erosions, flash floods, heavy cold, and fog, increasing injuries, diseases, and deaths. (Rahman & Alam, 2016) Productivity and other workforces also get impacted by hotter/colder working conditions, and damage to infrastructure from extreme events, such as on housing and healthcare systems further devastating for the indigenous people.

Secondly, indirect or secondary impacts are triggered through environmental and ecosystem changes and manifest as impacts on water quality and availability, food quality, security, and sovereignty. For example, it was reported that extreme weather events and decreased thickness and extent of ice lead to decreased access to country food and result in impaired food security and sovereignty. In the higher Himalayan Region increase in average temperatures and abrupt changes in the precipitation regime have resulted in water scarcity, food insecurity due to crop failure, increased incidences of pest infestations, and animal attacks affecting the indigenous people adversely. (Rautela & Karki, 2015). In-utero exposure to climate change effect like food insecurity also leads to poor maternal and child health.

Impact on air quality secondary to climate change leads to a rise in associated respiratory health and other chronic diseases, and on distribution and breeding/propagating conditions for vector-borne diseases and pathogens of various infectious diseases. Climate change is also altering the epidemiological triad resulting in ‘the epidemiological transition’ through a changing climate and a resulting change in the environmental component of the triad. (Lansbury Hall & Crosby, 2022) Also, the interaction between hosts and pathogens is regulated in part by highly synchronized temperature and photoperiod changes during seasonal transitions. (Casadevall & Pirofski, 2000) With a warming climate and altered humidity, these key biological cues are undergoing drastic changes, resulting in drastic consequences on host–pathogen interactions especially on indigenous populations as they have a greater dependence on environmental resources for their basic needs. The Yakutia indigenous community in the Republic of Sakha, Russia has reported increased incidences of zoonotic diseases resulting from extreme weather events. (Kowalczewski & Klein, 2018). In Amazonia, deforestation and climate change have become the major drivers of emerging diseases in the indigenous population. (Ellwanger et al., 2020) In forest-based indigenous communities, namely, Khasia, Tripura, and Garo from Bangladesh changes in temperature and rainfall patterns, and natural calamities have increased pests, diseases, and the attack by wild animals. (Rahman & Alam, 2016).

Finally, impacts can be tertiary or indirect through changes to social systems; affecting socio-economic, mental, emotional, and spiritual well-being. Indigenous peoples have a deep sense of their place and belongingness which gets perturbed due to climate-related changes compelling them to migrate resulting in solastalgia. It was also reported that extreme weather events and decreased thickness and extent of ice that adversely affects food security and sovereignty, indirectly bring changes in culture and identity, accentuating interpersonal stress and conflicts.

Impacts of climate change on mental health happen due to restricted mobility and disrupted livelihoods and are further accentuated through changes in culture and identity, food insecurity, interpersonal stress and conflicts, and housing problems. (Lebel et al., 2022). In the Inuit community in northern Canada which has deep cultural connections with sea ice, the changing ice and weather conditions have been reported to result in anxiety-related episodes (ACIA 2005, 2022; Prowse & Furgal, 2009).

Indigenous People and the Multiple Disadvantages

In addition, Indigenous people across the world tend to suffer multiple types of socioeconomic disadvantages, including extreme poverty, poor living conditions, low educational attainment, unemployment due to failure of traditional livelihoods, racism, and limited access to various healthcare services which are important determinants of Indigenous health. Living on marginal land with poorer infrastructure, socioeconomic deprivation, various inequities, and political marginalization; they are doomed to suffer from a greater burden of disease, and poorer access to quality health care.

In this review we analyzed the data from a vast body of heterogenous literature and synthesized an expanded framework with the background of multiple disadvantages, depicting the effects of climate change on Indigenous health through various direct and indirect pathways.

Figure 4 proposes an expanded framework of climate change impacts on indigenous health.

Fig. 4
figure 4

Expanded Conceptual framework of climate change impacts on indigenous health

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How does the Literature on Climate Change and Health Impacts Engage with Indigenous Perspectives and Participation?

The indigenous peoples (especially those relying on natural resources) have an experienced and inherited knowledge of their environments, ecosystems, and local society. Therefore, their perspectives have an important role in determining and mitigating the impacts of climate change on local societies. Indigenous Peoples in the Arctic and Boreal have expressed concerns about potential effects on Indigenous rights and food sovereignty as a result of policy initiatives focused on hunting, consumption, sharing, and local trade of wildlife. These populations are frequently at the forefront of protecting wild food systems, livelihoods, and cultural values. When the socioeconomic, cultural, and nutritional aspects of Indigenous subsistence methods were not taken into account, negative effects resulted. For instance, prior culturally insensitive and inadequately developed communication outreach efforts regarding health and traditional and country foods (on contaminants) resulted in adverse health effects for the affected populations from avoiding traditional foods altogether, given the dearth of healthy alternatives. For local communities of hunters, trappers, and fishermen throughout the area, zoonotic health hazards have also risen (Keatts et al., 2021). From the perspectives of indigenous peoples of Circumpolar North, the changing environmental conditions have led to a decrease in the abundance of lichens and other forage plants such as horsetails, resulting in reduced reindeer weight and has forced the herders to move to new areas resulting into the instability of reindeer husbandry livelihoods. (Callaghan et al., 2020) Similarly, among Nenets reindeer herders from Russia, the later arrival of freezing temperatures in the autumn followed by the earlier spring thaws and more open water, delay in transmigration, and reduced access to health care are major concerns (Amstislavski et al., 2013). There are also concerns about how public health policy and discourse fail Indigenous peoples living in the colonial nation-states of Canada and Aotearoa New Zealand especially not taking into account Indigenous knowledge and Indigenous feminist perspectives (Lewis et al., 2020). Indigenous Women of the Batwa tribe in Uganda indicated that food insecurity was common during pregnancy and had a bidirectional relationship with antenatal health issues. (Bryson et al., 2021).

Paetnerships with Indigenous people: Within the twenty-nine studies, included in the review eleven studies were conducted in partnership with Indigenous communities namely, the Swinomish Indian Tribal Community (Swinomish)- a Coast Salish nation located in present-day Washington State (Schramm et al., 2020); Khasia, Tripura, Garo, and Manipuri are living in and around Lawachara National Park (LNP) located in North-eastern Bangladesh (Rahman & Alam, 2016), Bhotiya tribe of Johar, Byans, Niti Valley in the Northern frontier of Uttarakhand state, India (Rautela & Karki, 2015), Youths of Sami community from Kautokeino, Norway, Yakutia indigenous community in the Republic of Sakha, Russia (Kowalczewski & Klein, 2018), Inuit Community of Arctic Canada (Durkalec et al., 2015), Fort William First Nation—an Anishinaabe community in Northern Ontario, Indigenous Batwa Communities from Uganda, Ni-Vanuatu Communities, and five indigenous African communities (Afar, Borana, Endorois, Fulani, and Hadza). (Leal Filho et al., 2021) Out of the 29 studies around half of them studied the local climate adoption methods also.

The Swinomish Tribe had adjusted the CDC’s BRACE framework in a more local, indigenized context where several needs and activities of the community which were affected by climate change (for example, traditional hunting, fishing, and harvesting practices) along with community-held perceptions of climate change were incorporated in the ‘value-based’ decision-making for key adaptation strategies (Schramm et al., 2020). Focus group discussions on three indigenous communities of LNP revealed a handful of community-based adaption strategies through local knowledge and perceptions, such as, using medicinal plants, organic and compost fertilizers, lime oil, and cake to tackle rising temperature and low rainfall, storing extra firewood for high rainfall, early harvesting of crops and livestock rearing for tackling natural calamities, etc. Increasing temperature and drying up of streams and wells were the highest priority climate risk from the perspective of the indigenous tribes (Rahman & Alam, 2016). The Bhotiya tribe of the Higher Himalayas, Uttarakhand perceived a decline in agricultural productivity and reduced agro-biodiversity as the major impacts of climate changes like reduced rainfall on livelihood. The indigenous perspective of co** and adaptation measures comprised improvising with cash crops, delayed sowing, shifting to smaller livestock, etc. (Rautela & Karki, 2015). The Health of the Sami community has been impacted by climate change, for instance, an increase in safety issues and anxiety due to less stable ice and snow routes. Health-seeking process for people from the Sami community exhausts beyond individual and family-level co** strategies towards professional aid (conventional Norwegian medicine and traditional Sami medicine) as per the severity of climate change impact; which are separated by social norms and health-seeking behavior (Kowalczewski & Klein, 2018). African indigenous communities (Afar, Borana, Endorois, Fulani, and Hadza) have been observed to use their local knowledge and perception in climate-change adaptation strategies (e.g., temporary migration, livestock diversification, a shift in settlement patterns, mixed crop**) as it is seen that traditional knowledge and local perception on climate change could help in, apart from mitigating it, sustainable management of the ecosystem, bolstering food security, benefit livelihood, and promote socio-economic resilience. (Leal Filho et al., 2021).

Discussion

In this review, we assessed the potential size and scope of available research literature on climate change impacts on Indigenous health. We observed that globally, many Indigenous Peoples face higher exposure to climate change risks due to close relationships and dependence on livelihoods associated with natural resources, and the location of communities in remote areas that are exposed to natural hazards of cyclones, fires, and droughts. (Natural Hazards & Disaster Risk Reduction, 2015) For indigenous communities from arctics and circumpolar north, rising temperatures and reduced ice cover are causing serious impacts on both the physical and mental health of the various Indigenous communities (Kowalczewski & Klein, 2018). Increased heatwaves, droughts, floods, storms, and other extreme weather phenomena on the African continent led to a shortage of fresh produce and drinking water as well as the spread of zoonotic diseases.

Similarly in other parts of the world, extreme weather changes, prolonged heat periods, smoke, and exposure to ultraviolet radiation, causes poor physical health, strain, and discomfort from physical exertion, episodes of heat stroke, as well as poor mental, emotional, and spiritual health. Their vulnerability is also increased manifold due to wide prevalent inequity and multiple disadvantages faced by the indigenous communities. They are suffering from a ‘triple burden of disease’, due to the combined effect of chronic diseases, infectious diseases and climate change impacts where climate change impacts further exacerbate existing health inequalities. (Kumar et al., 2020).

In our study, out of the 29 studies around half of them studied the local climate adoption methods also. The majority of the response mechanisms consist of impact measurement, assessment of the health system in the community, and bringing out resilient community action through capacity building and resource management, which were context-specific. In an earlier review conducted only three studies reported being conceived, designed, or conducted in partnership with Indigenous communities or informed by Indigenous pieces of knowledge and values. (Lebel et al., 2022) In our study, we found that in eleven studies there was an involvement of indigenous peoples in the climate mitigation and adaptation process.

Research Gap

The climate change impacts on health and its examination through indigenous perspectives has been a less explored area. The lack of studies on the health impacts of climate change on indigenous people worldwide has resulted in a lack of understanding and failure to comprehend the related domains. Also, despite the clear implications of climate change on indigenous health and the associated multiple disadvantages, there were strikingly few studies examining the possible pathways and mechanisms. Though in the past few years this topic has seen an accelerated momentum, most of the studies were done in a piecemeal manner lacking holistic treatment. Importantly, a comprehensive understanding of how Indigenous people’s health could be affected by climate change holistically, with the identification of strengths, weaknesses, and gaps in the literature to guide future research, policy, and practice is urgently needed. Promising trends like the increase in research on the adaptation and mitigation efforts for Indigenous health, along with an increase in studies that are seeking Indigenous partnership and participatory methods of research are the call of the hour.

In response to this challenge, the present paper attempts to contribute to the existing body of knowledge by systematically map** the various climate factors influencing indigenous health with diverse methodologies based on the multiple disadvantage model.

Policy Implications

In drawing attention to the impact of changing climate on indigenous health with the backdrop of multiple disadvantages, this review provides a powerful argument for the need for policymakers to have an indigenous approach in decision-making and acknowledge their differing needs.

The variety of sources considered in this study allows the identification of major principles that can inform policymakers on the topics of climate mitigation and adaptation efforts to contribute to Indigenous health equity. As per our review findings, the climate mitigation policy formulation must be done with kee** in mind the specific features and contextual factors for the particular indigenous community for generating impacts. This will also require a deliberate, carefully planned approach to community engagement. Genuine climate solutions must seek to disinvest from institutions and systems that are complicit in fuelling the climate crisis, and instead must be grounded in different ways of knowing, doing, and being that reflect Indigenous values to fully account for the unique realities of Indigenous peoples. Indigenous communities’ contributions are essential in designing and implementing solutions for changing ecosystems.

Strengths and Limitations

The majority of the evidence that currently exists on climate change and its impact on health is limited to a colonial/western perspective and is from generic equity analyses. Very few studies have tried exploring climate change impacts using an indigenous lens. Our review with its particular emphasis complements existing literature and also adds some fresh insights on relevant outcomes, which can have serious implications for informing future climate policy and their translation into action. However, it only captures information included within the identified articles. Also, given the wide scope of the review and the heterogeneity of terminology used in article titles, abstracts, and keywords, our search might have missed a few relevant studies. The review also had an emphasis on publications in the peer-reviewed literature, which may further have decreased the number of articles. Also, the authors did not reach out to authors individually to gather further information nor did infer or extrapolate what the authors of these articles may or may not have done in their research processes.

What the Sco** Review Adds

Drawing on the review of the previous studies, the authors synthesized the determinants from the literature review to frame the: Expanded Conceptual framework of climate change impacts on indigenous health (Fig. 4). This framework sought to synthesize the complex interplay of factors across the physical, mental, social, and spiritual health of Indigenous people directly or indirectly because of climate change and multiple disadvantages.

Conclusion and Recommendations

Climate change has a significant impact on the health of indigenous people and multiple disadvantages were found to have a ‘compounding’ effect on their vulnerabilities that appears to be much more prominent for Indigenous people than for others. Hence adaptation and mitigation policies and practices should be inclusive of the indigenous communities to address this growing threat. Because of large geographic variations in climate impacts, and differences in vulnerability and adaptation capabilities of different indigenous populations; policies and programs must be tailored to cater to specific health needs at a local scale utilizing local data and expertise. Despite the complexity of this field of research, it is possible to improve the quality of evidence about co-impacts on Indigenous health to inform pro-equity climate mitigation. This will require partnership with Indigenous communities, recognition and privileging of indigenous pieces of knowledge, and study design that fully embeds Indigenous values, realities, and priorities. Fundamentally, sharing of power, both in the research process and in the conception, design, and implementation of climate policy and interventions, will be essential for Indigenous rights and health equity.