Local perspectives of the ability of HIA stakeholder engagement to capture and reflect factors that impact Alaska Native health

BACKGROUND: Health impact assessment (HIA) is a process used to inform planning and decision making in a range of sectors by identifying potential positive and negative health effects of proposed projects, programs, or policies. Stakeholder engagement is an integral component of HIA and requires careful consideration of participant diversity and appropriate methodologies. Ensuring that the engagement process is able to capture and address Indigenous worldviews and definitions of health is important where Indigenous populations are impacted, particularly in northern regions experiencing increases in natural resource development activities on Indigenous lands. OBJECTIVE: Investigate local participant perspectives of an HIA of a proposed Alaska coal mine, with a focus on the ability of the HIA process to capture, reflect, and address health concerns communicated by Alaska Native participants. DESIGN: A qualitative approach guided by semi-structured interviews with purposeful sampling to select key informants who participated in the coal mine HIA stakeholder engagement process. RESULTS: Qualitative data identified three key themes as important from the perspective of Alaska Native participants in the Alaska coal mine HIA stakeholder engagement process: (i) the inability of the engagement process to recognize an Indigenous way of sharing or gathering information; (ii) the lack of recognizing traditional knowledge and its use for identifying health impacts and status; and (iii) the inability of the engagement process to register the relationship Indigenous people have with the environment in which they live. Issues of trust in the HIA process and of the HIA findings were expressed within each theme. CONCLUSIONS: Recommendations derived from the research identify the need to acknowledge and incorporate the history of colonialism and assimilation policies in an HIA when assessing health impacts of resource development on or near Indigenous lands. These historical contexts must be included in baseline conditions to understand particular vulnerabilities and potential health risks and impacts. Further, HIA practitioners should recognize the range of definitions for “health” and demonstrate this recognition throughout the stakeholder engagement process, as well as in the HIA recommendations and suggested mitigations.