Developing Indigenous health indicators for cumulative effects management

Resource development projects impact Indigenous communities' health, leading to increased chronic conditions prevalence and reduced access to health services. Through an analysis linking colonization on Turtle Island, ongoing industrial development, and the social determinants of health in an Indigenous context, this research aims to identify culturally relevant indicators that can give early signals of increased chronic conditions prevalence and reduced access to health services for the Metlakatla First Nation. This research took place within the Metlakatla Cumulative Effect Management Program, a community-partnered resource management system for monitoring the status of Metlakatla values and responding proactively to cumulative change in Metlakatla Territory. To identify indicators, a thematic analysis of qualitative data gathered through three focus groups with Metlakatla members and staff (n = 6) and five interviews with health experts (n = 8) was carried out using a collaborative approach. Additionally, the Metlakatla Membership Census provided quantitative data to corroborate the indicators identified. Results suggest that the most appropriate indicators linking resource development impacts to increased chronic conditions prevalence and limited access to health services for the Metlakatla First Nation include Social and Cultural Connectedness (metric: Sense of Connectedness to Metlakatla Culture, Community, History, and Traditional Lands and Waters), Continuity of Care (metric: Presence of a Primary Care Provider), and a food-related indicator (metric: further investigation required). Our findings emphasize the importance of engagement and collaboration with Indigenous peoples to ensure cultural relevance and appropriateness of health indicators in a resource development context.