Health and Wellbeing among Arctic Indigenous Peoples: Leveraging Legal Determinants of Health
View of the U.S.-Canada fourth joint mission to map the continental shelf in the Arctic Ocean in August and September 2011. Photo: U.S Department of State
The Arctic Institute Health and Wellbeing Series 2025
- The Arctic Institute Health and Wellbeing Series 2025: Introduction
- Health and Wellbeing among Arctic Indigenous Peoples: Leveraging Legal Determinants of Health
News Update
- The Arctic is increasingly warmer, less frozen, and wetter, with regional extremes in weather, climate patterns, and ecosystem responses.
- The summer of 2023 was the warmest in the Arctic since 1900.
Climate change is real and threatens the livelihood of Arctic Indigenous peoples. It does so by negatively impacting relational connections between the environmental ecosystem and Indigenous peoples residing in the Circumpolar North. The Arctic is home to approximately four million people, nine percent of whom are Indigenous peoples living in Canada, Greenland, Iceland, Norway, Sweden, Finland, Russia, and the United States and comprise many different groups. Among these groups are Inuit, Athabaskan, Gwich’in and Sami peoples. Notably, the Arctic environment is distinct in that the “majority of Arctic settlements are located on permafrost, and nearly half of them are coastal permafrost settlements.”1)
Climate change has an impact on both the physical and mental health among Indigenous communities in the north, while amplifying health inequities. These impacts encompass weather-related accidents, infectious diseases, food insecurity, ecological grief and eco-anxiety. Such grief and anxiety can “emerge from physical ecological losses, such as inability to travel on the ice, or sustain reindeer herding, but also from disruptions of environmental knowledge systems and senses of identity, as well as anticipated future losses.”2)
The United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) explicitly states that Indigenous peoples have the right to the highest attainable standard of physical and mental health. Achieving this UNDRIP standard requires expanding beyond Western biomedicine and social determinants of health as intervention frameworks because these frameworks, while impacting up to 20 percent and 80 percent of health outcomes respectively, are circumscribed by structural determinants of health.3) Enter: legal determinants of health.4) The right to health is a foundation for advancing health with justice and doing so requires structural intervention by leveraging legal determinants of health. Law has been a structural strategy to advance health throughout the past century: for example, tobacco control through enactment of taxes on tobacco and childhood vaccinations through the enactment of immunisation requirements for school entry.5)
This article highlights case examples of legal determinants of health being leveraged to protect the health and rights of Indigenous peoples in the Arctic. The following question guides the analysis presented here: how can legal determinants protect the health and wellbeing among Arctic Indigenous peoples? This article highlights the potency of structural intervention at the nexus of law and health within the context of climate change impacts that are disproportionately affecting Indigenous communities in the Arctic.
Legal Determinants of Health
Legal determinants of health, identified as LDOH, are structural determinants of health, expanding beyond and distinct from social determinants of health. LDOH refer to macro-level factors, including laws, policies, institutional practices, governance processes and social norms that structure and shape social determinants of health. Specifically, the term law encompasses “legal instruments such as statutes, treaties, and regulations that express public policy, as well as the public institutions (eg, courts, legislatures, and agencies) responsible for creating, implementing and interpreting the law.”6)
Social determinants of health, identified as SDOH, refer to living conditions and environments where people learn, work, play, worship, and call home which affect health outcomes. SDOH can help support health or harm health. Examples of SDOH include housing, healthcare, employment, economic stability, education, neighborhood environment, social context and interpersonal discrimination.7)
Laws structure social and economic relations by establishing the rules of engagement that are sanctioned by society and, therefore, exert a powerful force upon SDOH. Impacting Indigenous communities worldwide, laws entrenched structural violence in colonial histories. For example, the Sexual Sterilization Acts in Alberta (1928–1972) and British Columbia (1933–1973), resulted in hundreds of forced sterilizations performed on Indigenous women across Canada.8) In the United States, the Boarding School Era between 1869 and the 1960s was guided by assimilationist federal policies that forcibly removed tens of thousands Indigenous children from their homes and families to boarding schools operated by the federal government, which created conditions of abuse and punishment against these children for their Indigenous cultural ways of life.9) These examples of Indigenous colonial histories, the legacies of which continue today, show how laws and government structures have failed Indigenous peoples and communities.
Notably, laws can be designed and implemented with various intentions. Laws can structure conditions that advance health and equity or conditions that are weaponized against marginalized groups, as in eugenically guided legislation targeting Indigenous women. However, laws can also unintentionally harm people as a result of poor design. Advancing health begins with well designed laws. For example, as Gostin et al. (2019) explain:
“Well designed laws can help build strong health systems, ensure safe and nutritious foods, evaluate and approve safe and effective drugs and vaccines, create healthier and safer workplaces, and improve the built and natural environments. However, laws that are poorly designed, implemented, or enforced can harm marginalised populations and entrench stigma and discrimination.”10)
In sum, laws address social and economic factors that shape and interconnect with SDOH to either help or harm health. The LDOH framework includes four primary determinants that significantly influence local-to-global health and equity. These include:
- LDOH 1: law can translate vision into action regarding sustainable development.
- LDOH 2: law can strengthen the governance of national and global health institutions.
- LDOH 3: law can implement fair, evidence-based health interventions.
- LDOH 4: law can be used to build and strengthen legal capacities for health – which reinforces all legal determinants of health.11)
Combined, these legal determinants comprise the LDOH intervention framework and are a key site of intervention to advance global health and wellbeing particularly among Arctic Indigenous peoples. Notably, law and health are mutually reinforcing. As Gostin et al. (2019) explains: domestic and international law “are interrelated and bidirectional in their impact on health and justice.”12)
Case Examples
Climate change such as global warming has accelerated permafrost thaw and sea ice melt, resulting in conditions that directly impact Arctic Indigenous peoples and communities. Such conditions yield multiple limitations and losses, many of which threaten the livelihoods among Indigenous peoples in the Circumpolar North. These include access to natural resources and ancestral lands, as well as loss of land and housing, which can lead to forced relocation.
More specifically, global warming yields changes in ecosystems with a direct impact on Indigenous peoples’ everyday physical health, mental health and overall wellbeing. From losses of Indigenous traditional knowledge and connection to cultures to increasing food insecurity and health risks related to water quality, Indigenous peoples and communities experience disproportionate impacts as a result of climate change. In the Circumpolar North:
“For instance, coastal erosion and thawing permafrost are destroying or threatening culturally significant archaeological sites across the Arctic. In Alaska, this includes the erosion of an Ipiutak cemetery, while in northwestern Canada, the most significant Inuvialuit archaeological sites are at high risk of deterioration. Climate change is also affecting culturally important wildlife populations and access to subsistence harvests by impeding safe access and travel across the land, water, and ice for hunters and fishers in Alaska, Greenland, Siberia, and Canada”13)
This diminished ability to engage in traditional activities such as subsistence activities contributes to food insecurity. Yet, this diminished ability to engage in traditional activities also leads to loss of identity among Indigenous peoples. “For the Saami in Europe and Russia, some of the most significant health impacts stem from the adverse effects on mental health arising from stress and navigating pressures to change their traditional way of life.”14)
Leveraging LDOH can help protect the health and wellbeing among Arctic Indigenous peoples. LDOH are a legal strategy to hold nation-states accountable to address climate change effects that cause human rights violations, particularly within the context of UNDRIP. Specifically, areas in international law including human rights law and law of the sea – which are underutilized and often overlooked – can protect land and marine resources that are critical for Arctic Indigenous livelihoods. Areas in domestic law too can protect resources that sustain Indigenous livelihoods, traditional practices and cultural activities.
Human Rights Law: The Right to Property
In the case of human rights law, the right to property presents a viable pathway for developing nation-state obligations to respond to climate change effects in such a way that helps protect livelihoods among Arctic Indigenous peoples. The right to property ensures “enjoyment of land and marine resources that contributes to Indigenous peoples’ access to housing, food and water; the exercise of their culture; and the improvement of their health and sanitation.”15) Accordingly, this right to property entails social and health functions.
Advancing an understanding of the right to property beyond individual ownership to include collective property rights of Indigenous peoples, which encompass social, cultural, environmental and cosmology aspects, has been the innovative work of the Inter-American Court of Human Rights, an international human rights body. Within context of this understanding of collective property rights, land is viewed not just as a possession or economic resource, but also as a spiritual resource that is critical in supporting Indigenous cultural, economic and spiritual survival.16)
Law of the Sea: Rights of Persons at Sea
Associated with the United Nations Convention on the Law of the Sea (UNCLOS or LOSC), the rights of persons at sea presents another viable pathway for developing nation-state obligations to respond to climate change effects in such a way that helps protect Arctic Indigenous peoples’ livelihoods. Established during the 1982 UNCLOS or LOSC, the International Tribunal on the Law of the Sea (ITLOS) is an international human rights body whose provisions include climate change.17) ITLOS has indicated through its jurisprudence that disputes involving law of the sea cannot be resolved without the consideration of human rights.
Human rights include Indigenous peoples’ rights, which are among rights of persons at sea as identified by Article 51 of UNCLOS. In this Article 51, Indigenous peoples’ rights are referenced in context of traditional fishing rights.18) In leveraging LDOH, the international human rights body of ITLOS can strategically account for the human rights of coastal communities to include Arctic Indigenous communities. In so doing, Indigenous peoples’ rights pertaining to traditional fishing rights can be protected and, therefore, so can Indigenous subsistence ways of life as a cultural practice and source of livelihood.
Finland Law: Sámi Climate Council
In addition to the above case examples in areas of international law, areas of domestic law as well can be leveraged to protect resources that sustain Indigenous livelihoods, traditional practices and cultural activities. For example, in Finland, the Sámi Climate Council was recently established, as of August 2023. “According to the Finnish Government, the Sámi Climate Council is a new independent expert body, tasked with bringing the knowledge base and perspectives of the Sámi people into the climate policy processes.”19) This climate council not only puts into action Finland’s Arctic strategy, which emphasizes Sámi indigenous knowledge input into national and international climate policies, it advocates for Sámi rights.
According to the head of the Sámi Climate Council, Klemetti Näkkäläjärvi, who also served as the president of the Finnish Sámi parliament from 2008 to 2015, the aim of the council is “to participate in all stages of decision-making by conducting research, making reports and giving statements.”20) On the controversies associated with wind farm projects, Näkkäläjärvi advocates that Sámi perspectives and evidence-based information be incorporated before decision-makers make any final conclusions. For example, Näkkäläjärvi explained the following about the planned Davvi wind farm in Lebesby, Norway: “If built, the Davvi wind farm would not only affect the Sámi community in Norway but also in Finland.”21)
As identified above, areas of both international and national law are sites for leveraging LDOH to help protect Arctic Indigenous peoples within the context of a changing climate, the effects of which threaten Indigenous traditional activities and livelihoods. While Arctic nation-states are actively leveraging LDOH on behalf of Indigenous peoples and communities, such as Finland with the establishment of Sámi Climate Council, it is a viable option for Indigenous peoples in the Circumpolar North to appeal to supranational organizations to resolve issues of nation-state governments. International-level organizations are forums for not only cooperation among Arctic countries but also Indigenous advocacy. As Anja Márjá N. Keskitalo, who lives in Norway and is an advisor at the EU unit of the Saami Council, explains about the Sámi Climate Council: “If this model works well in Finland it could be worthwhile to expand it. There could be a Sámi Climate Council bringing together representatives from all the countries Sámi reside in. Or climate councils in each country. Time will tell.”22)
Reflections
Law plays a key role in protecting natural resources and ancestral lands that are vital for the livelihoods and wellbeing of Arctic Indigenous peoples. Creativity and innovation in leveraging LDOH can transform the Arctic judicial landscape by strengthening nation-state obligations in addressing climate change effects in such a way that protects Arctic Indigenous livelihoods. Doing so contributes to collective futures:
“It is crucially important for the Arctic countries that Indigenous-related laws, economic programs, and state support measures are sensitive to the sustainability of Indigenous economies and provide efficient measures to also sustain their traditional way of life, as it contributes to the sustainability of the whole planet.”23)
As climate change continues, the link between law and health becomes an increasingly valuable strategy to sustain the health and wellbeing among all of us.
Strengthening nation-state obligations to our collective and sustainable futures in the Arctic ultimately rests upon cooperation among all Arctic states. Inter-governmental institutional developments in the Arctic are mechanisms by which such cooperation occurs. One such example is the Arctic Council:
“The Arctic Council is the leading intergovernmental forum promoting cooperation, coordination and interaction among the Arctic States, Arctic Indigenous Peoples and other Arctic inhabitants on common Arctic issues, in particular on issues of sustainable development and environmental protection in the Arctic.”
The Arctic Council, the only permanent forum in the region, is a leading advocate protecting the environment. Given that climate change is identified as the largest security problem in the region, the Arctic Council has played an important role in promoting sustainable development.24)
Notably, the current and ongoing war between Russia and Ukraine has impacted the work of the Arctic Council. Yet, options for continuing to move forward do exist. According to Alan Cunningham (2024):
“Allowing the Arctic Circle to be unprotected is not a solution, but also cooperating with a nation-state that has proven time and time again to be a threat to global security in return for an uneasy alliance in the Arctic is not a viable solution either. By removing Russia from the Arctic Council and reorganizing the entity in total, this allows for an entity that can secure the Arctic region on its own terms, in accordance with international law, and promote security and stability without having to compromise their beliefs or working with nations that violate those international norms.”25)
Ensuring intergovernmental cooperation in the Arctic is necessary for designing, implementing and enforcing laws that structure conditions – the SDOH- that are beneficial for everyone, and particularly Indigenous peoples whose livelihoods and traditional practices are relationally integral with the environment.
As the legacy of Indigenous colonial histories continues today, the effects of climate change upon Arctic Indigenous peoples and communities contributes to a situation of compounding adverse impacts and health inequities. These impacts affect all aspects of health including physical, mental, emotional, cultural and spiritual health. Leveraging LDOH is a critically important strategy to ensure protection of the Arctic environment and all its peoples. Doing so will help advance health equity in the Arctic and across the globe.
Dr. Jean E. Balestrery is Founder and CEO of Integrated Care Counsel, LLC, a consultancy advancing integrated care in the health and well-being industry, and also a licensed independent behavioral health clinician.
References