US State and Territorial Indigenous Consultation Laws: A Potential Strategy to Improve the Social Determinants of Health.

OBJECTIVES: The United Nations (UN) has articulated the right to self-determination as a human right for Indigenous people; however, US states and territories have been slow to operationalize this aspect of the UN Declaration on the Rights of Indigenous Peoples. Indigenous consultation laws require all federal executive agencies to consult with tribal nations before implementing policies that have a "tribal implication," and these form the cornerstone of US efforts to implement the UN Declaration on the Rights of Indigenous Peoples. Despite these federal efforts, less is known about the degree to which state and territorial laws require consultation with Indigenous communities. METHODS: We reviewed all Indigenous consultation laws identified through a search of 50 US states, the District of Columbia, and 5 territories to provide a holistic picture of how jurisdictions have regulated Indigenous consultation efforts. RESULTS: Of the 56 states, 49 (87.5%) had at least 1 Indigenous consultation law; the remaining 7 jurisdictions had none. States engaged in Indigenous consultation in various ways, generally falling into 1 of 3 categories: (1) centralized consultation facilitated through an agency or department, (2) indirect consultation through a designated commission, and (3) fragmented Indigenous consultation through discrete laws. Important gaps were identified, including the lack of a definition for Indigenous consultation, the absence of an appeal process, and the need to train state officials on existing policies. CONCLUSIONS: The results provide a baseline on the degree to which US states and territories consult with Indigenous communities and can be used to identify gaps in US compliance with UN human rights mandates.

Community-Focused Policy Advocacy: Evaluating Hawai'i's Historical Trauma Legislation.

Research aimed at reducing health disparities must move beyond the academic and provide practical value. Developing policy briefs that provide a description of the current policy framework along with evidence-based recommendations that can be shared with decision-makers is one way to accomplish this. Researchers, then, can lend their authority to increase awareness moving the policy process forward. The purpose of this paper is to outline a way to develop policy briefs and provide an example of this methodological framework through a case study. The case study was developed as part of a community-engaged research project exploring the conceptualization of historical trauma among Native Hawaiian youth. The policy brief was developed by first searching the Hawai'i State Legislature database in Westlaw limiting the search to the past 10 years for legislation related to historical trauma, structural racism, or related concepts. The results encompassed 104 bills and resolutions, of which 11 passed and 93 failed to pass. Successful legislation acknowledged the role of racism to health and supported the use of trauma-informed care but stopped short of addressing historical trauma. Several gaps were identified including a failure to address collective trauma or trauma specific to colonization suggesting a reluctance to acknowledge intergenerational trauma as an element of present experiences. The policy brief developed for this project was provided to community partners to support their advocacy efforts. This manuscript showcases a process researchers can use to analyze legislative records and develop policy briefs that can support their community partners.

Addressing Native Hawaiian historical trauma: Opportunities for increased economic, environmental, and social advancement.

Many people view Hawai'i as a tropical paradise where people can relax on idyllic beaches. However, for many Native Hawaiians, the Indigenous people of Hawai'i, the desire to continue to reside in their homelands has become impossible. Native Hawaiians have lower socio-economic status, home ownership, and educational attainment compared to non-Hawaiians. Simultaneously, Native Hawaiians have higher rates of chronic disease, asthma, and mental health issues, which impact their quality of life. Despite efforts to address these stubborn problems, the gap between the Indigenous Native Hawaiian community and those that settled these islands continue to exist. Native Hawaiian scholars have attributed these persistent challenges to the historical trauma that the community has experienced and continues to experience stemming from the mass trauma events of colonization. Although the community acknowledges the heavy impact that historical trauma has had on Native Hawaiians, many policymakers and individuals in position of authority have expressed a need for evidence of this concept. This project seeks to develop a scale to measure Native Hawaiian historical trauma to support evaluation and advocacy efforts. Moreover, healing Native Hawaiian historical trauma would facilitate increased economic mobility, improved environmental policies, and an enriched social advancement.

Ke ala i ka Mauliola: Native Hawaiian Youth Experiences with Historical Trauma.

Native Hawaiians (NH), like other Indigenous peoples, continue to experience the subversive impacts of colonization. The traumatic effects of colonization, especially the forced relocation from land that sustained their life and health, have led to complex, interconnected health disparities seen today. NHs have described a collective feeling of kaumaha (heavy, oppressive sadness) resulting from mass land dispossession, overthrow of the Hawaiian Kingdom, cultural loss, and early loss of loved ones. Although historical trauma is linked to high rates of substance misuse, depression, suicidality, and other mental health disparities in American Indian populations. However, the link between NH historical trauma and health disparities among NHs has been less explored. This qualitative study used Indigenous talk story interviews with 34 NH 'opio (youth) and ka lawelawe (service providers) to explore how NH 'opio understand and experience historical trauma. Eight themes and 35 sub-themes were identified covering individual, community, and systemic domains representing the first step in addressing NH historical trauma.

Much Needed Medicine: A Qualitative Study of Hawai'i Resident Views During COVID-19.

The precarious financial status of the majority of Hawai'i residents coupled with the state's heavy reliance on tourism suggests that residents are particularly vulnerable to increased economic hardship resulting from the COVID-19 pandemic, which temporarily shut down the tourism industry and continues to erect barriers for resuming operations. Understanding how Hawai'i residents prioritize access to health care, food economics, care of 'aina, and culturally informed community in light of the current and future economic situation can inform policy actions that will support public health. To that end, this paper analyzes: (1) Hawai'i residents' views on health, specifically food security and healthcare, and their priorities for the future of these areas; (2) the differences between Native Hawaiian and non-Native Hawaiian views and priorities; and (3) the differences in views and priorities between families with higher and lower levels of economic stability. The authors close with policy recommendations that can be seen as medicine, or ways to heal Hawai'i, as the state shifts towards a more equitable and sustainable future.

A Scoping Review of Nature, Land, and Environmental Connectedness and Relatedness.

The importance of nature and the environment in relation to human health is coalescing, as demonstrated by the increased research that attempts to measure nature connectedness and relatedness. These findings align with constructs of cultural connectedness that assess for land connectedness as part of Indigenous ways of knowing. From an Indigenous worldview, relationships with the environment are critical to wellbeing. The purpose of this comprehensive systematic scoping literature review was two-fold: (1) identify and summarize existing measures of land, nature, and/or environmental connectedness, relatedness, and attitudes and (2) evaluate the psychometric properties of these scales. In total, 1438 articles were retrieved from select databases including PubMed/MEDLINE, PsycINFO, CINAHL (EBSCO), and Academic Search Complete (EBSCO). The final searches and application of the inclusion/exclusion criteria resulted in 57 unique articles and 38 scales categorized as connectedness and relatedness scales (n = 9 scales), attitudinal and values-based scales (n = 16 scales), cultural and spiritually based scales (n = 9 scales), and paradigm-based scales (n = 4 scales) (articles could be placed in multiple categories). Psychometric properties and general outcomes associated with nature-related scales are reported, with implications for future education, research, practice, and policy.