UNPFII Study on Indigenous Health as a Systems Integrator: Advancing UN System Coherence Through the Indigenous Determinants of Health Framework - UNPFII25 Side Event

Good afternoon, everyone. We're about to get started. I'd like to welcome you and thank you for joining us at this side event presenting our latest study titled Restoring Indigenous Health by Connecting Systems through the Indigenous Determinants of Health, Local to Global Evidence. My name is AC Locklear. I am a citizen of the Lumbee tribe of North Carolina, and I serve as the chief executive officer for the National Indian Health Board. I'm also a board member for Capital Nation and a member of Indigenous Determinants of Health Alliance. I would also like to thank my fellow IDHA members, partners, and collaborators for helping bring this conversation forward at such an important moment. I'm honored to be joined today by an incredible group of speakers, and I'll briefly introduce them. First, Mr. Jeffrey Roth, Lakota, chair of the Indigenous Determinants of Health Alliance and CEO of Cedar Rock Alliance. Amina Amara, UN expert member, leader, indigenous network and IDHA member. Jennifer Proctor Andrews, vice chair of Kokoa tribe, North American representative for the UN decade on indigenous languages and also IDHA member. Vinay Boyner, IDHA member and former trustee of Alaska Mental Health Trust. Valentina Sofkina, UN expert, UN Permanent Forum expert member, member of the Sami Women's Forum and member of the IDHA. And Maria Kinalainen, Indigenous midwife, representative of the Continental Alliance of Traditional Indigenous Midwives. So thank you all for being here. Now, just to frame our session, the study we are presenting today, it builds on several years of work around Indigenous determinants of health. which was created to educate agency officials on how to approach indigenous issues in a culturally safe and rights-based manner. Throughout the first three studies, our framework has provided indigenous-specific constructs on indigenous-specific indicators, structures, operationalizing guidance and evaluation systems. Based on these three pillars, we now present a study that shows how indigenous health as a sector reflects how the entire systems are functioning. including major systemic challenges and barriers, and where opportunities lie to advance indigenous rights in a coordinated fashion. And importantly, how we move towards coherence instead of fragmentation. With that, I'd like to turn it over to our first speaker, Mr. Jeffrey Roth, to begin with an overview of the study.

Hey, thank you, AC. I really appreciate it. I also want to acknowledge another one of our indigenous determinants of health members who has been with us from the beginning and a mentor to me. Miss Toni Lodge is the CEO of an urban Indian health program and has for many years run in Spokane, Washington and providing health care services, clinical and behavioral health care services to the indigenous population in Spokane, Washington. So thank you for being here. It's an honor to be here with everybody. I really appreciate it and I'm excited to talk about our newest report. As AC mentioned, the study builds on a series of reports that we've done here at the Permanent Forum that were presented in 2023, 2024, and 2025. Each of those studies served a specific purpose. In 2023, we introduced the concept of Indigenous Determinants of Health framework grounded in Indigenous holistic and intergenerational worldviews in connection to Mother Earth and centered on the concept of indigeneity as a determinant of health. We identified specific risk factors and protective factors that shape indigenous wellbeing globally. In 2024, our study then moved into how to operationalize this. It asked a practical question, how do institutions implement the UN Declaration on the Rights of Indigenous Peoples provisions and provide cultural safety for indigenous peoples? and it provided concrete guidance on how to meaningfully engage indigenous leaders in full policy cycles, modifying structures and decision-making processes in accordance with indigenous rights. Then last year in 2025, we introduced a measurement instrument, a tool that allows institutions to evaluate whether they are complying with indigenous rights and if they are structured to create culturally safe systems that address the Indigenous determinants of health specifically. So we have built over time three key pillars, a conceptual framework, an operational guide, and an evaluation instrument on the Indigenous determinants of health. Now this study in 2026, represents the next step as it brings all that work together to show how Indigenous health is not only a sector, but a reflection of how entire systems are functioning. The study shows very clearly that Indigenous health is not produced in isolation. It is shaped by decisions across multiple domains, climate, biodiversity, food systems, language, governance and knowledge systems. And I think we heard about this so much just on Tuesday during the theme specifically. We heard about all of the ways that Indigenous health is affected from around the globe, from Indigenous people around the globe. These current domains are far from operating in coordination though across the UN system. They're very often fragmented. So what we see in this study is that indigenous health becomes a diagnostic tool to shed light, to assess whether systems are aligned or whether they're pulling in different directions. So for example, a policy may advance biodiversity goals, but restrict access to traditional lands for indigenous peoples. A food systems initiative may increase production, but undermine traditional diets. A climate intervention may reduce emissions, but displace indigenous peoples off their homelands. We've seen that in Kenya in the past year. So when we look at indigenous health outcomes, we are seeing the cumulative effects of these decisions. And this is why the study reframes Indigenous health as a cross-sectorial system indicator, not just something we measure at the end, but a signal to understand whether systems are functioning overall. The study also identifies two more core structural issues. fragmentation and the conflation of indigenous as rights holders with other stakeholder groups. We face fragmentation of our issues and priorities across institutions, across mandates, and across policy processes. And importantly, the burden of that fragmentation falls on us as indigenous peoples. The burden becomes heavier because we rights holders, as per the UN Declaration on the Rights of Indigenous People, are forced to negotiate our priorities and representation with groups of stakeholders who are not related to us and don't share our values or visions and systems, and they force us to work together. What we're proposing is not the creation of a new system here. but a shift in how these existing systems work together. A shift towards coherence, coordination, accountability, and using the Indigenous Determinants of Health framework. So that with that, I will invite AC Locklear to go a little bit more into the indigenous health as a system integrator and talk about how it can show indicators, cross-sectoral indicators as well. So, AC.

Thanks so much, sir. So I would like to take a moment to elaborate on what we mean when we say the indigenous health is a systems integrator and a cross-sectoral indicator. When agencies speak about health in most institutional settings, they're usually referring to services, programs, or outcomes. They are mostly referring to hospitals, clinics, or public health interventions. But for indigenous peoples, health has never been understood that way. Health is not produced in a facility. Health is produced in relationships between people and land, people and water, people and biodiversity, people and governance systems, and across generations. So when those relationships are in balance, health is strong. And when those relationships are disrupted, health is disrupted. Likewise, if land is degraded, if water is contaminated, if biodiversity is lost, agencies categorize these as environmental issues. But for Indigenous people, these are direct health impacts because land is just not territory, it is food systems, it is medicine, it is identity, and it is governance. So when land is impacted, we indigenous people are affected in terms of nutrition, physical health, mental health, and cultural continuity. The same applies to when water systems are disrupted. We see increased disease risk, loss of food sources, displacement, disruption of cultural practices. Now let's take it a little bit further. When language is lost, food systems are replaced and governance systems are weakened. The current systems treat these as separate policy issues, but in reality for indigenous peoples, these are all determinants of health. So what this study does is bringing all of these connections together and provide evidence on how indigenous well-being is directly tied to land, water, biodiversity, culture, identity, language, and governance. Equally important is that for us, these are not separate domains, but rather part of one interconnected system along with us human beings. So when a decision is made in one area, it immediately impacts others. A climate decision affects food systems, a biodiversity decision affects medicine, a governance decision affects identity and mental health because everything is connected. And this is where the idea indigenous health as an indicator becomes powerful. Because Indigenous health reflects the cumulative impact of all these decisions across systems. Indigenous health therefore becomes a signal, a reflection, a way of understanding whether systems are working together or whether they're pulling in different directions. We already are seeing how this can be applied in global perspectives. For example, our engagement with the UNFCCC, we have proposed integrating the Indigenous Determinants of Health framework into loss and damage discussions, particularly around non-economic loss and damage, because what Indigenous people are losing is not only economic. Rather, the effects of climate change are creating loss in our culture, language, identity, knowledge systems, and relationships to land. These losses are directly connected to health and well-being. So by integrating Indigenous determinants of health into frameworks including the non-economic loss damages mechanisms, we can better capture the full impact of climate change on Indigenous peoples, not just what can be measured in economic terms, but what is lived, experienced, and transmitted across generations. And this is exactly the kind of systems integration that this study is calling for. So instead of only measuring health outcomes at the end, we use indigenous health to understand how these systems are functioning overall, whether they are coherent and aligned with our rights under UNDRIP and whether they are culturally safe or producing harm. And this is why the study positions indigenous health not just as an outcome, but as a systems integrator, a way to connect sectors that are currently operating in isolation. as well as to access coherence across institutions and to guide decision making moving forward. Because if we truly want to improve indigenous health, we cannot act in silos. We must act across systems. And that brings us directly to our next issue the study highlights, what happens when those systems are fragmented. I will now pass it to the UN Permanent Forum expert member, Amina.

Good afternoon, dear friends. Thank you so much. Thank you so much for this presentation. I'd like now to tackle another element. Now, with these two presentations, we just noticed the indigenous health is reflecting into the systems themselves. and how these different silos can in fact have an impact as well, be it direct or indirect, in terms of outcome for Indigenous health. I'd like now to move on to an essential element, specifically from our last study or report. It has to do with fragmentation. What does it mean? We are in fact noticing this fragmentation even among different agencies themselves, but also within themselves. What are we talking about when we say fragmentation? Is that a way of working in the different domains when it comes to the indigenous health? Or does that mean that they are not connected with one another? Of course, this has an impact on the ability for indigenous peoples to advocate and to participate fully, to be able to influence the systems. We are, in fact, facing a lack of means, access, and, for instance, not obtaining our visas and to be a part of these different spaces. We want to take part in these spaces, but how can we do that if we do not have the financial means or even to obtain a visa. So the more we are fragmented these groups and the further away we will be as indigenous peoples from this possibility to bring our perspective and our effective participation. Now, fragmentation is not just about bringing some results. but it also creates this kind of power that still exists. So we are talking about structural challenges, and they are crucial, and they are the ones that we are facing today. We cannot have equal or be on equal footing when in fact we are not able to master all these systems. And so long they also stay like these, then we'll just get further away. So, fragmentation happens when the policies and political processes are created in such a way that it's not possible to participate, in other words, isolatedly among institutions, sectors, mandates without any coordination or even coherence. In other words, we can find different domains and topics to discuss, but we'll never have access to them, either because we cannot be there physically, or just because we are not part of the list of contacts, and therefore we will never be contacted, or simply because some agencies might just refer to resource people, but they do not have this kind of knowledge that we have. and which is fundamental also to take decisions and for an effective part. Climate changes in discussion about biodiversity, engagement in terms of food systems and also health altogether. All these are just multiple domains and we need to face all of them. But the thing is that we are not able to express our vision here. because this kind of unilateral vision or approach from top to bottom and and it's rather bottom top, I should say, because it's a rather holistic, it should in fact encompass all the domains. We are not going to fragment all these, but rather to bring them together, even like merging them. We need to merge all these elements. Of course, we all have our different rules and each space, each system, each institution has its own rules and different from one another with different timelines and also different expectations and very often without any kind of alignment among themselves. But they are not responding or replying at least to our needs as indigenous peoples. So If the institutions are fragmented, then of course the burden will lie on indigenous peoples, and we are the ones who are trying to see whether we can find these topics, like for instance health. and we want to show that we need to try to bring them together. We cannot talk about health without referring to food systems or climate changes, desertification and the loss of natural resources, land, territories, mobility, access. We need to explain all these elements. and very often without the right time and without the effort. And we know exactly what it means in terms of energy consuming. This is a real cost and this also is not just a financial burden, but indigenous leaders need to travel, they need to participate, they need to get ready for world processes. And very often the only communication language is English. Now, we know that Portuguese, French, Spanish are not even mother tongues for these people, but to work with a language that is not even your own, or even for indigenous peoples, again, this is another barrier. We just limit ourselves to one language. And of course, this does not allow us to express ourselves, and they do not find the means to communicate. Now, if you're going to Bonn, for example, everything is carried out in English. Either you understand or you don't, and that's your problem. But they know exactly what they're doing, and that's the way that they want things to be done, because it is up to their own benefit and interest. And this is exactly the kind of power that is being created. Now, without any kind of sustainable effort for the resources, people or persons, and of course, that means a lack of opportunities and loss. We navigate in fragmented systems and again, time consuming and we lack of our responsibilities in terms of governance. So these responsibility or accountability needs to be acknowledged. and indigenous peoples are in fact the right holders and they should be in fact treated as such. And by doing so, we will be respecting this kind of relationship and also value their knowledge. Resilience of these, resilience of that, restoring these, restoring that, it's very important, but then you are not valued. So how can you possibly explain that? You've got your knowledge, we want your knowledge, but you are not being valued. Then another element of this fragmentation, we tend to forget that when we're talking about indigenous knowledge when it comes to health related matters or other, we need to contextualize things. This is very important. If you take a knowledge, but then you put it outside the context or out of the context, this is not going to produce results. All knowledge do not depend on all contexts. And it's not just like standardized everything. These kind of standards are not necessarily positive, rather negative. There again, fragmentation also generates these kind of imbalances. There is no engagement, there is no equality. And very often the participation is very limited or even absent. engagement and decision-making processes left behind and indigenous peoples are just invited to take part, but like a folklore, not necessarily as influencing results. In fact, they are just being tolerated to a certain extent, just to make it beautiful, to take some pictures, and then what they say, we don't hear them. It's not just about new problems, but rather old structural barriers that still limit a full effective participation. And this fragmentation is still aggravated by the confusion between indigenous peoples as hold rights and the stakeholders groups. But still again, this confusion between indigenous peoples and local communities. And very often they are simulated to vulnerable groups. So many different processes worldwide and indigenous peoples are grouped with the local communities and other vulnerable groups, just like initiatives or intercultural initiatives and many other spaces. This way, this world vision just reminds us that indigenous peoples do not have the same systemic governance rights, accountability. We are different. We've got our own knowledge, our own identity, but our own definition based on the universal declaration of the UN on indigenous rights. Of course, this is extra cost, but we are now negotiating our rights and our knowledge systems and our priorities. We are here in spaces that do not acknowledge our statutes as holders, as knowledge holders, and also to advocate. And we see clearly in political arenas worldwide throughout the systems, specifically from the UN, like COP, for example. And the summit about the food system plus four in 25, we were there, but indigenous peoples never had, in fact, a session with the stakeholders, which is happy with the session, a very small session where we could, in fact, present what we wanted to present. And we had to fight, in fact, for this session just to have like an exclusive space that will be dedicated to indigenous peoples and also resisting institutional pressures. And we wanted to share these with other groups, non-indigenous, and the agency wanted to include that. Lots of efforts and to be very firm about this space. Now, of course, we're going to be worn out with all these. And every time that we've got these kind of constraints, it is also an impact on our health, physical health. Because when traveling around all the time and always doing the same thing, fighting for the same thing, we'll never get some to get some rest. We just arrive very tired and then we need to feel all the pressure. And obviously that despite a strong participation, all these kind of things will have an impact on us. We're talking about health determinants, we're talking about physical, mental, psychological health, we always put at a test and this is not our imagination and this has an impact directly. So it's not just about a lack of policies, but rather a fragmented involvement. And as we said earlier on, this has to do with health and This can also be as like a criteria. Where are we now as indigenous peoples in our daily life, our access to our territories, natural resources, knowledge, our traditional medicine, and to everything that has to do the fact that we are the right holders and we need to preserve this right no matter what. So in order to align all these systems, we need to reduce fragmentation, reinforce accountability. And I'd like to pass the floor now to, I don't know. Okay, Jeffrey, you're next then. And you're going to explain better than I do the determinants of the health determinants from indigenous. Thank you very much, brother.

Amina. So we've heard two critical points. First, that indigenous health reflects how systems function. And second, that fragmentation across those systems affects not only outcomes, but also indigenous people's ability to engage, advocate, and influence decisions. So the question we now turn to is what do we do about it? As AC and I mentioned earlier, this work has been developed across four different studies, conceptualization in 2023, operationalization in 2024, evaluation in 2025, and now systems integration in 2026. And what is important here is that these are not separate efforts. All studies are designed to work together as a practical system, a system that institutions can use to understand, adjust, measure, and align. Let me briefly explain how that works in practice. The first function is orientation. Institutions need to understand how their decisions affect indigenous peoples beyond their immediate sector. The Indigenous Determinants of Health provides that reference. It allows agencies to see their role within a broader system and recognize cross-sector impacts. The second function is adjustment. Once those impacts are understood, institutions can begin to adapt. This includes adjusting policies, modifying structures, embedding indigenous participation across decision-making processes, and aligning actions with indigenous rights. This is where operationalization becomes real. The third function is accountability. It is not enough for institutions to just act. Institutions must assess whether their actions are effective. The evaluation instrument allows agencies to ask, are we aligned with the UN Declaration on the Rights of Indigenous Peoples? Are we culturally safe? Are we strengthening or undermining indigenous well-being? This creates measurable accountability. The fourth function is coordination, and this is where this study adds a critical dimension. Because these tools are not meant to be applied in isolation. They are meant to be applied across sectors and systems in the UN. So that climate, biodiversity, food systems, health and governance are not operating independently, but are working from a shared framework. This is what allows for coherence and for institutions to identify where actions are aligned, what gaps still exist, and where unintended impacts are occurring. So in practical terms, the framework can be used as a sequence to understand impacts, to adjust systems, to evaluate performance, and to align across sectors. And a very important point is that this can be done within existing mandates. We believe it does not require a new system, but a shift in how systems work together, a shift towards coordination, accountability, and coherence. grounded in indigenous rights and in indigenous knowledge systems. So what we are offering is not only a diagnosis, but a pathway forward to connect systems, reduce fragmentation, and improve both outcomes and participation. I now want to invite I will say practicing almost doctor, working to be a doctor, very close to being a doctor, Renee Burner, to speak about how this approach is already being reflected across UN processes and what pathways exist moving forward. Thanks, Renee.

It is good and thank you. What Jeffrey has just outlined is a practical pathway and what I would like to highlight is that the incorporation of the indigenous determinants of health is not hypothetical. We are already seeing elements of this approach emerging across different UN processes and agencies. Although still in a siloed way, there are important entry points that we can build on. For example, in 2024, the Convention on Biological Diversity adopted its decision 16/19, which explicitly recognizes the Indigenous determinants of health. This is very relevant because the Convention on Biological Diversity decisions guide how countries design biodiversity policies and programs. When the Indigenous Determinants of Health frame is referenced there, it opens the door for governments and institutions to formally integrate our vision of Indigenous health, knowledge systems, and rights into biodiversity planning and implementation. In other words, it moves this conversation from concept into the policy space. This has been reflected in our ongoing work under CBD's Article 8 that focuses on the respect, preservation, and use of indigenous knowledge and the role of indigenous peoples in biodiversity governance. So this is one of the primary entry points within the UN system for advancing indigenous rights, knowledge systems, and participation in environmental decision making. Through this process, the Indigenous Determinants of Health Alliance has been actively engaged in advancing the connection between biodiversity, governance, and Indigenous well-being, helping to reinforce that biodiversity is not only an environmental issue, but a foundational determinant of Indigenous health. Another equally important incorporation of our framework is that the WHO and its 2025 World Report on Social Determinants of Health Equity recognizes indigeneity as a determinant of health and elaborates on the role of the indigenous determinants of health, reinforcing the need for specific rights-based approaches. In this same space, in 2024, the Indigenous Determinants of Health Alliance collaborated with the WHO to produce a document entitled Recommendations Towards a Resilient Future for Biodiversity and Human Health Through Ancestral and Indigenous Knowledge Systems. Through that process, the Indigenous Determinants of Health Framework was brought into the report as a reference for improving the collaboration between traditional and biomedical systems, establishing indicators and evaluation approaches, and strengthening intersectoral coordination between biodiversity and health. We are now working to ensure that the Indigenous Determinants of Health are incorporated as relevant as a relevant compass in the drafting of the WHO Global Plan of Action for Indigenous Health, which we can discuss during the Q&A section. Regarding the climate change processes, as Emma mentioned, I'm sorry, as A.C. mentioned, there are ongoing opportunities to integrate the Indigenous determinants of health within the UNFCCC's mechanisms. including the work around the non-economic loss and damage. So across biodiversity, health, and climate, the initial building blocks are already there, but they are not yet connected. In such areas, in areas such as food systems, language, intellectual property, and traditional medicine, we are still facing systemic barriers. Although we see the opportunity in front of us, we are all, sorry, we are still in need of assistance and support for or to advance the and achieve the equitable inclusion of our framework, which brings me to the question, what does the adoption of the indigenous perspective look like in practice? It means moving from isolated recognition to coordinated implementation. For UN agencies, this includes integrating indigenous determinants of health indicators into monitoring and reporting frameworks. Aligning program design across sectors so that climate, biodiversity, health and food systems are working towards shared outcomes. Embedding indigenous participation as rights holders in decision making separate from any stakeholder group and in line with the UN. So thank you, I need that declaration rights of indigenous people. and using the Indigenous Determinants of Health framework as a common reference point across agencies. Let us now turn to some concrete examples. Thank you. I will turn it over to Maria.

I'm greeting you in my mother tongue. My name is Maria Quinelen in the civil registry as ID, but my name is what you just heard, the voice of the goddess singing in the waters. This is what determined. My work, my work as midwife, I am Mapuche. I am in the South Cone of America in Chile, an indigenous community that has been there prior to Columbus. I am a midwife. More than 1,000, 1,301 were born through my help in the pathway to life. I have a long standing tradition in my family. and knowledge that come from the Mapuche community, which embraces all of the southern part of Chile. I do have a school of indigenous medicine which follows our cultural knowledge. I am a live example of the situation affecting us and this is because of the state decision of the academia and the western medicine, whether worldwide or just in the Americas. I'd like to share with you some examples of indigenous midwifery so that you can see how this happens in real life. Midwife is not just being a midwife, it's not just a health. service is connected to culture. Every human being, every group of human beings do have a culture and they inhabit a territory. Midwifery, as I said, is not just health services. We are connected to land, to climate, to seasons, to the ups and downs of water courses, to the heat waves. Midwifery is not just a health service. It is a connected system, connected to our knowledge, to astronomy. I mean, we do have a name for all of the constellations, the 13 constellations that exist. Eponauk, Boonie, and interpreter apologizes for the repetition, Namunchoiki. the three Mary or the Orion's belt because midwifery is not just a health service, it's, as I said, connected to governance, connected to administration, governed by somebody who thinks, a woman who has a brain and a knowledge and is educated in peace, She's the warrior in discovering where the best food is, where the trees are, where the birds are nesting. Because midwifery is not just, again, a health service. It is a connected system, connected to community relationships. Our communities, indigenous communities, are at the moment governed by an oppressing colonial system. And we, the indigenous midwives, are the carriers and the bearers of knowledge that has gone generation after generation. And our knowledge about birth is incredible, not just about the birth of human beings. We are just one little tiny part of the healing process. We have medicine that comes from centuries of trial and error. because we are a nation that preexisted. We, the indigenous midwives, are the carriers and the bearers of the knowledge coming from plants. And because everything that gets sick does have a medicine on earth. to heal. Midwifery is a right, the right of women, indigenous women, to decide how birth occurs, how life comes, with actions, with prayers, with rituals, reading the placenta, reading the day the baby is coming. I mean, all of that depends on all of the knowledge system that we've been upheld in for years, human rights, human virtues, ancestral practices. This is not simply Western resources. Our hands are enough. The knowledge held in our hands is enough. And this entitles us to be midwives according to indigenous knowledge, with no subordination to external models. Today, indigenous midwifery not only is practiced, but is upheld and defended because the conditions permitting our existence are governed by multiple decisions outside our world, like health regulations. Let's go to the sources and the origins of the disease so we can heal with earth, with words, with fire, with land. We have legal framework, but we also have our framework. If you are creating damage, you cannot continue governing. You have to go back to the masters of knowledge. We have education systems. Ever since we are born, this is transmitted through words, through silence. We have environmental policies to restore health through the seeds, through our plants. And we also have access to earth, to soil and to land. Before, even before 200 years ago, those systems of domination got to our place, we were nomadic. The Mapuche people went all over the place. I am still a nomad. I've been here for a week, then I'll go to Argentina, then I'll go to Chile. I'm still nomadic. And I go wherever birth occurs and wherever labor occurs. And those systems should be aligned with health, education, the environment, earth health. Midwifery is directly impacted by mercury, lead, contamination of water, plastic everywhere. When the systems, the legal systems are not acknowledging our existence, Our practices are restricted, even criminalized, prosecuted. Every time I get involved in labor, the parents have to go to the civil registry to register the names, and they have to wait for three months to get a birth certificate. little respect is paid to my certificate where I say this was the mother, this was the baby, this is how the baby was born. Civil registry is threatening my parents and tell them you will be arrested, you will be arrested. This is what is happening. You and your midwife, you will all be arrested. And there we are. You know, we have to tell them you need to wait for 90 days to get your birth certificate. When these systems are working that way, excluding indigenous traditional medicine, knowledge is marginalized. When access to soil is restricted, we lose access to plants, to medicine, to water sources, to streams, to lakes. And when biodiversity is undermined, our own medicine disappears and we have to travel further and further away in search of our plants. Remember where the blossoming is occurring. I am also the guardian of seeds for medicinal plants that are no longer flowering where I live. So decisions made away from us are affecting very negatively the results and the outcome of birth and labor. This is what we are seeing in all of the reports. When the midwife system is weakened, impact is immediate on mother's health, in mother's milk, in the scarring of the uterus, in the baby's skin. in the health of each and every member of the family. This has an impact of babies health when there is lack of care, lack of guidance in education. Community is impacted if the baby is not doing okay, the family is not doing okay, and community is not doing great. Intergeneration knowledge has to be transmitted, we are further and further away from our culture, from our territories. But also we have to say that when everything is aligned, indigenous midwifery is supported, traditional medicine is respected, and the earth and the biodiversity are protected. And when that happens, we have a nation that is protected and in good status physically, mentally, and spiritually, the outcome for the health is wonderful, communities are reinforced, strengthened, knowledge is preserved, it's good life for everyone and the permanent care will persist. respected and paid homage to. So indigenous midwifery shows something very important. Indigenous health does not improve just with one single action. It's boosted when systems work together, respecting one another with no fragmentation. And through our health, through the environment, through governance and through culture, the moon culture, our own calendar, all of that will help us to continue preserving our health. We have schools that have been there for centuries. We have medicine that has been there for centuries. We have the word that's been there for centuries. Our midwives have been there for centuries, millennia, allowing us to see the connection acting upon all of those axes. Why do we have to come to the UN over and over? And we come to Jeffrey, who is allowing us the space to talk. So my warmest greetings from the Continental Alliance of Indigenous Midwives encompassing most of the countries in North America, Central America, and South America. Good life to your indigenous peoples and to all of you.

Thaychilsaw, Jen Proctor Andrews, Sin Sanu, Ko Kweul Ka U, Hal Kamish Mikam, Ihtesan, Kala Na Lua, Kla Da Maria, Kla Ijao, Kla Mits Mits Tias, His Kla United Nations via the Indigenous Determinants of Health and Jeffrey Roth. Hello, everybody. It's great to be working with you here today. My name is Jen Proctor Andrews. I'm vice chair of the Coquille Tribe. I want to thank Maria for her words of wisdom and for the Indigenous Determinants of Health holding this space for us at the UN this week to share our important wisdom. I'm really happy to be learning here alongside all of you today. I'm going to talk about indigenous languages as a prime example of how systems are connected. Our languages are often treated as cultural, but for indigenous peoples, language is a determinant of health. Language carries ecological knowledge, medical knowledge, governance systems, and cultural identity. Through language, we understand how to relate to land, how to use medicines, how to care for one another, and how to transmit knowledge across generations, even from the very first words or thoughts or sounds that a baby hears upon birth. So when language is strong, systems are strong, and when language is lost, multiple systems are disrupted. Let me make that more concrete. When language are weakened or disappear, we lose access to traditional knowledge, including knowledge of medicinal plants, healing practices, food systems, and environmental stewardship. All of these have direct impacts on health, but it also affects identity because language is how we understand who we are. And when language is lost, we see impacts on mental health, community cohesion, and intergenerational continuity. One of those important parts that makes us human. All of these have direct impacts, and they're not isolated. Language loss is often linked to education systems, governance policies, land displacement, and historical and ongoing assimilation processes. very specifically in assimilation processes that are ongoing. So what we see is that language is not separate from our lands, biodiversity, and it is integrately connected to health. Language revitalization is also a form of health intervention because when languages are strengthened, knowledge systems are restored or maintained, identity is reinforced, and communities become more resilient. It's also important that when the languages are reinforced in their communities, they grow alongside our communities, as it should be, as opposed to being appropriated from outside sources and used outside of the community in which they exist, which is a whole other topic. But it's important that we have the right to use our Indigenous languages in our communities as our languages have evolved alongside our ancestors for generations. So language shows us again that Indigenous health is not produced in one sector. It is shaped by multiple systems working together. And this is exactly what the Indigenous Determinants of Health framework helps us to understand. Thank you. I'm sorry. I would like to pass the mic to Valentina.

I will speak, I will make my presentation in Russian. I would like to talk about intellectual property. and also commercialization, traditional knowledge, traditional indigenous people knowledge. The world is changing very quickly. It's getting more humane, but alongside with that, it loses links to the systems that support life. And we can observe that there is crisis, crisis in health, in biodiversity, instability of systems. For us indigenous people, those are not new processes. Our systems, our knowledge system through our generations are based on understanding of interlink between human beings, nature, everything that goes outside the measurable world. And we are talking about balances and loss of balance. It's not something that is rooted in the past. It's our present. It's an issue of the present. That's why it's absolutely impossible to think about health of indigenous people without our systems, because our traditional knowledge is the basis for health system, ecological governance and intergenerational cohesion. It's a simple example, a very little example that I would like to run by you. I was present at a meeting with our very respectful people, our midwives. And the important system, the important factor that was presented there, that everything is interconnected, food systems, languages, how the mother would eat, what she's going to eat, what language she's going to use, how her baby comes to this world. Everything is going through our traditions. It's so close that sometimes intervention is kind of not needed. But those are alive collective systems. They are linked to language to land and to biodiversity. That's where we see the lack of cohesion. Modern regimes of intellectual property and commercial models, they do not provide any protection. They fragment it. So they just break it down to pieces. Knowledge becomes individual. Knowledge is far from the person who is the carrier of this knowledge, but our knowledge, Our traditional knowledge functions in a different way. Because when we use those models, we don't see integration. What we see, we see a gap. And it's a global process. We can see it today. Our knowledge is seized. Well, they think, you know, they come, they take a look, they learn from it, and then they will be able to use it. but traditional knowledge come from the roots, from the heart, from the soul, from the fingers. So it is something that we feel, we feel when we transfer it to someone else, when we heal someone. Not everyone understands that for some reason, people think, well, technical progress will substitute absolutely everything. And no, it's not like that. Very often it happens in pharmaceutical systems, in economics and it's very important to call a spade a spade here because it happens without the agreement, without exception, without any just distribution of benefits. Traditional knowledge are taken away from territories, from governors, from cultural context, and they turn into a commodity. But it relates to our health because we're not talking about separate elements. We need to talk about cohesion of the systems. And traditional knowledge, when they are commercialized, where they go into pharmaceutical system, then the health system is weakened and also when food security is not observed, when it's broken, we cannot use it for the benefit of the people. The basis of the health is being destroyed. So that's the result of commercialization. That's why it weakens our determinants, health determinants. If health is an integrator of the systems, so current practices of intellectual property, they act as a mechanism for deintegration. What they do, they actually break the links between governance, health and our territories. And we see what happens because the intergenerational transfer of knowledge is weakened and as a result of it, our health systems are weakened. It's not a separate issue, it's not a separate legal issue, it's the issue of rights and system justice. If we talk about health of indigenous people, and if we think that these systems should be connected, there should be cohesion, it cannot exist without our systemic shift. The traditional knowledge of Traditional knowledge should be accepted. Our right to manage this knowledge should be accepted. And commercial mechanism cannot be determinants of our health. And the framework for determinant is becoming a responsible tool. We are responsible for what is going on with us, what is happening to us. And it allows us to see how this cohesion works, intersectional cohesion, how to connect local to global processes without this, uh, global, uh, global frame, without, without global meetings, we will have. gaps and we need to bridge those gaps and when we meet we want to share our opinion we want to make a decision we want to influence impact other systems and actually own what we have we want to own our traditional knowledge and we want to transfer this traditional knowledge thank you.

So, you know, what we've heard today is a series of examples, indigenous midwifery, indigenous languages, indigenous knowledge systems in addition to the referenced circumstances on climate change and food systems and biodiversity. And each of these examples has shown us something very concrete, not only how systems function, but how they impact our daily lives, our communities, and our future generations. These are not separate issues. as they reflect a single pattern across systems, a pattern that we see repeated across regions, sectors, and across institutions. When systems are fragmented, knowledge is separated from land, health is separated from culture, and governance is separated from decision making. And what happens is that decisions are made without fully understanding their impact, and Indigenous peoples are left to carry the burden of reconnecting these systems, of navigating multiple institutions, and of responding to impacts we did not create. This is not only inefficient, but it's inequitable. The results are clear. Inequity increases, participation is weakened, and health outcomes are negatively affected. These impacts are also cumulative. They build over time, affecting not only individuals, but entire communities and future generations. Nonetheless, we have also seen the alternative. When systems are coherent, indigenous knowledge is respected, rights are upheld, and participation is meaningful, and decisions reflect full system impacts. And this change changes outcomes because when systems are aligned, health improves, communities are stronger, knowledge is sustained, and systems become more resilient. So what we're seeing is not theoretical, but practical and observable, and it is already happening. Fragmentation produces harm, while coherence produces wellbeing. And this is where the Indigenous Determinants of Health Framework becomes essential because it provides a shared reference across sectors, a way to guide decisions, and a mechanism for accountability. As we are seeing ongoing discussions within the WHO and the World Health Assembly on the development of the Global Plan of Action for Indigenous Health, we have a critical opportunity here because the decisions being made now will shape how Indigenous health is approached globally and whether it continues to be addressed in isolation or through coordinated rights-based systems. If we want to improve indigenous health, we cannot act in silos and must act across systems grounded in indigenous rights, knowledge, and self-determination. So this is not only a technical shift, but rather a structural shift in how institutions work. I want to thank all of the members of the Indigenous Determinants of Health that are here today. I think this is the largest gathering we've had before. I'm greatly honored to have all of you here and to be with us. And I really thank you. Thank you for that. I don't know, Chair, if we have time for maybe a question or two or--?

I think we may have a few minutes for one question.

Yeah. Hello everyone. Thank you to especially all the teachers who have shared so much with us today. My name is Daisy Bugarin Avila Tutu. I'm from the autonomous indigenous community of Askelton in Jalisco, Mexico. And I'm a trained physician, but I'm also finishing a dissertation in public health right now where I'm evaluating the autonomous health system of the Zapatistas, which has been functioning for over 30 years. So I really think the ancestors, because as I, I been dealing with sort of academia and public health and the lack of public health frameworks and models for indigenous peoples. I really feel like crossing paths and that you guys are doing this work is really such great and good timing. My question is, Have you looked at autonomous models being that UNDRIP states that autonomy is so vital in order to address health inequities? Have you looked at models such as like the Zapatista model or the Creek that's been around for over 50 years? In the case of the Zapatistas evaluation that I'm doing right now, I think really aligns with your framework as it is collectively ran and it has been around so much for so long now, they have casas de salud, access to midwives, health clinics, and four hospitals recently building an operating room. This is all indigenous led, not dependent on the state or support or funding from any NGOs. It's completely autonomous indigenous led by the indigenous health promoters, although they do collaborate with doctors and other allies who adhere to the principles of the indigenous health promoters. Thank you.

Absolutely. That's the basis of what we're doing is finding autonomous health models and giving.

-- Real life examples.

Real life examples.

Using implementation science and

-- Yes, exactly.

This is about self-determination. But we see this as a framework that can be used as a structural system to help make policy change happen that ensures that autonomous health systems can occur, that self-determination can occur. That's our goal here with this. explaining the holistic view of health for the policymakers of the world, whether they be at the international or the member state or the local and regional level. We need to explain our holistic health system so that we can see these changes and we can support these autonomous health systems. And in the US, we use the word self-governed health systems. But yes, absolutely. Thank you. Yeah, please.

Thank you. It's a great question. And I just wanted to add just a little bit to that. In Alaska, the Alaska Tribal Health System is a true system of care. They have a single compact negotiated with the U.S. government, and they still maintain their sovereignty amongst the different groups. So they have common language, and then each individual organization, tribal health organization, is able to negotiate their individual agreements with the federal government as well. But they created this true system of care that stretches across the entire state of Alaska, 660,000 square miles, 80% of the communities off the road system providing care through a hub and spoke model. And they are able to share data, share resources, and negotiate differences and it's to such a point that the Alaska tribal health system is Alaska's is Alaska's public health system and so it's it's a great model to show that if you work with indigenous peoples and if you embrace self-determination you cannot you don't just benefit from those communities but those communities benefit the whole as well including all of the individuals in those communities regardless of their tribal affiliation or enrollment. And so there are some really great models and we know that it runs the full spectrum, but we do have some models like that.

I just want to take a second and thank Mr. Alejandro Bermudez. is the coordinator and the sole employee of the Indigenous Determinants of Health Alliance and does everything to make us look really good. And I want to say thank you for that work.

Thank you to all of our speakers and all the members here today. Thank you for sharing this space and your knowledge with us. Sorry we ran out of time for questions.

I would like to thank the organizers for providing interpretation into Russian and from Russian. It's rare nowadays. I'm here at the forum and it is a huge problem for me to take part in many events where main languages are not offered.

So I'm really grateful for Russian interpretation at this side event. Thank you.

Thank you everyone. Thank you for coming.