An Indigenous perspective: August edition of the Decolonising Global Health blog series

About the author: Dr Nicole Redvers, DPhil, ND, MPH, is a member of the Denı́nu Kų́ę́ First Nation (Northwest Territories, Canada) and is a recent DPhil graduate from the University of Oxford in the Evidence-Based Health Care programme. She is also an Associate Professor, Western Research Chair, and Director of Indigenous Planetary Health at the Schulich School of Medicine & Dentistry at Western University in Canada, and serves as the Vice President Research at the Association of Faculties of Medicine of Canada (AFMC). Dr Redvers has been actively involved at regional, national and international levels promoting the inclusion of Indigenous perspectives in both human and planetary health research and practice. Her scholarly work engages a breadth of scholarly projects attempting to bridge gaps between Indigenous and Euro-Western ways of knowing as it pertains to individual, community and planetary health.

The process and practice of colonisation imposed the belief that there is only ‘one’ culture, one ‘universal’ way of thinking, believing, acting, trusting, feeling and living predicated on EuroWestern traditions, beliefs, values and ways of being. In the case of Indigenous Peoples, the coercion to believe in the superiority of EuroWestern ways of both knowing and practice was applied through systematic dispossession, oppression, violence, ethnocide, and epistemicide (Hall and Tandon, 2020 and Redvers et al, 2024).

Epistemicide is currently an ongoing phenomenon with 'The International Work Group for Indigenous Affairs' stating that, '[f]or five centuries, a systematic attack has persisted in a bid to bring an end to the creation, conservation, and transmission of the knowledge of [Indigenous] Peoples' (Redvers et al, 2024 and Elías, 2020). From an Indigenous perspective, current biomedical structures within health systems have also evolved from past and present colonial eras while carrying with it EuroWestern colonial biases and prejudices (Redvers et al, 2024). This has resulted in health system structures that actively marginalise Indigenous traditional medicine systems and ways of knowing around the globe (Redvers and Blondin, 2020).

In recent years there has been increasing discourse around decolonisation within institutional settings, including within universities. (Redvers et al, 2020, Hall and Tandon, 2020, McCoy et al 2024, Kumar, Khosla and McCoy, 2024). This dialogue has been particularly amplified within global health spaces where correcting power imbalances between high-income and low-income countries and challenging ideas and values of some wealthy countries that shape the practice of global health has been platformed (McCoy et al 2024). This has been an important movement forward. Within institutional settings, however, the response has sometimes more often been focussed on simply encouraging fairer partnerships within individual research projects instead of the more needed emphasis on 'shifting the balance of decision-making power, redistributing resources and holding research funders and other power-holders decision makers accountable to the places and peoples involved in and impacted by global health research' (Kumar, Khosla and McCoy, 2024).

The decolonising narratives increasingly prevalent within some global health spaces can be but are not always aligned with conversations around decolonisation within Indigenous settings. Indigenous Peoples currently make up around 6% of the global population, live on around 20% of the world's surface, including on all the liveable habitable continents and have themselves been noted to be a key determinant of planetary health (Redvers et al, 2022). With thousands of years of evidenced-informed Indigenous knowledges including but not limited to Indigenous science, Indigenous traditional medicine and Indigenous ecological knowledges – Indigenous Peoples are on an important journey to reclaim, revitalise and repatriate their place within the world's scholarship.

For Indigenous Peoples, the process of 'decolonisation' (ie the countering or outright resistance of colonising thought, actions and governance) is based on a framework that centres and privileges Indigenous life, community and epistemology and is directly rooted in land and country (Redvers et al, 2020). Given this, the ability of a colonial situated university to simply decolonise itself might seem to be impossible, as most institutions are inherently colonial or set up with the structure derived from EuroWestern-centric worldviews. To truly have a decolonial place or process from an Indigenous perspective would mean developing an Indigenous place or process from the ground up rooted within Indigenous worldviews, Land, ways of being and ways of knowing.

Within some North American university settings, 'Indigenising' has been a concept that has increasingly been leveraged. To need to 'Indigenise' something means that there wasn't something Indigenous to start with (ie a different framing and starting point than decolonising which is Indigenous-based first and foremost). Indigenisation therefore could be seen as the addition or redoing of Indigenous elements, with Indigenisation moving beyond tokenistic gestures of recognition or inclusion to meaningfully change practices and structures (Coulthard, 2014). 

Indigenising allows room for EuroWestern institutional settings to have a directionality towards being cultural safe places of belonging whilst recognising at their core they are still EuroWestern-centric spaces of thought and operation. EuroWestern-centric institutions (including health systems) could, however, deliberately carve out space (including resource backing) to allow for decolonised programmes to arise without interference as has been done in some regions of the world (see University of North Dakota School of Medicine & Health Sciences and University of Toronto Dalla Lana School of Public Health). In addition, EuroWestern-centric universities could formally engage with truth and reconciliation processes internally, recognising the harm done from the subjugation of other knowledge systems (eg Indigenous knowledges), whilst forging paths forward that allow space for students to explore other methodological approaches (eg Indigenous research methodologies) and other knowledge systems without EuroWestern-centric evaluation metrics.

These may seem like small steps but are symbolic necessary steps that can also be used as a framework for health professional and health systems evolution. Health practitioners, health systems and the research that underpins them need to be engaged in working towards cultural safety and critical consciousness. 'To do this, they must be prepared to critique the "taken for granted" power structures and be prepared to challenge their own culture and cultural systems' (Curtis et al, 2019). In a place like Oxford, becoming a 'culturally safe' institution is therefore a prerequisite for any meaningful conversation around supporting the decolonisation of global health research and practice from an Indigenous perspective or otherwise.

'If we're ever going to achieve equity across populations…we have to walk through truth'.