Water in the Native World

Chief, Karletta

doi:10.1111/j.1936-704x.2020.03328.x

Cited by 8 publications

(4 citation statements)

References 16 publications

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“…This strategy was designed with community stakeholder input to meet community needs and address unique Indigenous determinants of health . Cardiovascular health disparities among American Indian and Alaska Native people are due to the enduring impacts of settler colonialism; 1 in 3 people living on the Navajo Reservation lack running water or electricity, and significant access issues include lack of paved roads and transportation . IHS sites are chronically underfunded by the US government, and specialty access is limited .…”

Section: Discussionmentioning

confidence: 99%

Telephone-Based Guideline-Directed Medical Therapy Optimization in Navajo Nation

Eberly,

Tennison,

Mays

et al. 2024

JAMA Intern Med

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ImportanceUnderutilization of guideline-directed medical therapy for heart failure with reduced ejection fraction is a major cause of poor outcomes. For many American Indian patients receiving care through the Indian Health Service, access to care, especially cardiology care, is limited, contributing to poor uptake of recommended therapy.ObjectiveTo examine whether a telehealth model in which guideline-directed medical therapy is initiated and titrated over the phone with remote telemonitoring using a home blood pressure cuff improves guideline-directed medical therapy use (eg, drug classes and dosage) in patients with heart failure with reduced ejection fraction in Navajo Nation.Design, Setting, and ParticipantsThe Heart Failure Optimization at Home to Improve Outcomes (Hózhó) randomized clinical trial was a stepped-wedge, pragmatic comparative effectiveness trial conducted from February to August 2023. Patients 18 years and older with a diagnosis of heart failure with reduced ejection fraction receiving care at 2 Indian Health Service facilities in rural Navajo Nation (defined as having primary care physician with 1 clinical visit and 1 prescription filled in the last 12 months) were enrolled. Patients were randomized to the telehealth care model or usual care in a stepped-wedge fashion, with 5 time points (30-day intervals) until all patients crossed over into the intervention. Data analyses were completed in January 2024.InterventionA phone-based telehealth model in which guideline-directed medical therapy is initiated and titrated at home, using remote telemonitoring with a home blood pressure cuff.Main Outcomes and MeasuresThe primary outcome was an increase in the number of guideline-directed classes of drugs filled from the pharmacy at 30 days postrandomization.ResultsOf 103 enrolled American Indian patients, 42 (40.8%) were female, and the median (IQR) age was 65 (53-77) years. The median (IQR) left ventricular ejection fraction was 32% (24%-36%). The primary outcome occurred significantly more in the intervention group (66.2% vs 13.1%), thus increasing uptake of guideline-directed classes of drugs by 53% (odds ratio, 12.99; 95% CI, 6.87-24.53; P &lt; .001). The number of patients needed to receive the telehealth intervention to result in an increase of guideline-directed drug classes was 1.88.Conclusions and RelevanceIn this heart failure trial in Navajo Nation, a telephone-based strategy of remote initiation and titration for outpatients with heart failure with reduced ejection fraction led to improved rates of guideline-directed medical therapy at 30 days compared with usual care. This low-cost strategy could be expanded to other rural settings where access to care is limited.Trial RegistrationClinicalTrials.gov Identifier: NCT05792085

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Section: Discussionmentioning

confidence: 99%

Telephone-Based Guideline-Directed Medical Therapy Optimization in Navajo Nation

Eberly,

Tennison,

Mays

et al. 2024

JAMA Intern Med

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“…In an earlier social networks study, Chaffin et al (2016) (Weir 2009, Holtgren et al 2014, Vaughan et al 2016, Diver 2018, Vaughan 2018, Arsenault et al 2019, Norman 2019. This body of scholarship also involves the evaluation of water governance problems on Indigenous lands by biophysical scientists, many of whom are themselves Indigenous scholars or tribal managers (Middleton et al 2019, Bulltail and Walter 2020, Chief 2020, Conroy-Ben and Crowder 2020, Kozich et al 2020, Martin et al 2020; N. Bartolome et al 2019, unpublished manuscript).…”

Section: Current Research Gap: Indigenous Water Quality Governance An...mentioning

confidence: 99%

“…Indigenous knowledge and leadership are therefore an important part of salmon protection and restoration efforts in the Klamath (Fricke et al 2019, Sarna-Wojcicki 2019. Although some of these efforts are specific to the Klamath, this speaks to a broader body of literature describing how a wide range of Indigenous nations and their allies are leveraging Indigenous knowledge, law, science, and activism to forward water protection and restoration, despite ongoing struggles (e.g., Holtgren et al 2014, Chief et al 2016, Middleton-Manning et al 2018, Yazzie and Baldy 2018, Estes and Dhillon 2019, Chief 2020.…”

Section: Introductionmentioning

confidence: 99%

Indigenous nations at the confluence: water governance networks and system transformation in the Klamath Basin

Diver¹,

Eitzel²,

Brown³

et al. 2022

E&S

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Collaborative approaches to complex water quality problems can facilitate collective action across large watersheds with multiple, overlapping political jurisdictions, including Indigenous territories. Indigenous nations are increasingly engaging in collaborative water governance, in part, as a response to colonial legacies that have excluded Indigenous peoples from watershed management. This study uses social network analysis to explore emerging Klamath water governance networks. We seek to understand ongoing system transformation in contemporary water governance through tribal engagement in multi-jurisdictional water governance networks, from a system of Indigenous dispossession and exclusion (late 1800s-1980s) toward a yet unrealized system that centers Indigenous peoples. To envision the meaningful inclusion of Indigenous peoples in adaptive water governance, we first draw on criteria established by Indigenous water governance scholars. Then, we examine a snapshot of Indigenous participation in water quality governance in the Klamath Basin that focuses on the Karuk Tribe from 2018-2019. Specifically, Karuk tribal managers identified 21 different science-policy coalitions that they worked with on a range of water quality issues. We then used social network analysis methods to generate a network in which 210 different organizations were linked through co-membership in one or more coalitions. Our findings indicated that the Karuk and other Klamath Basin tribes play a central role in Klamath water quality governance and were not relegated to "stakeholder status." Using a community detection algorithm, we found that tribes were key players in the central technical working group that emerged through network connections. Applying a log-linear statistical model, we also observed a high level of mixing in the network across all types of organizations, including tribes. Finally, through a multi-membership model, we found that tribes were more strongly connected to influential network actors than NGOs, despite environmental NGOs being more numerous. These analyses demonstrate how tribal engagement can activate key mechanisms for water quality governance transformation, e.g., shifting information flows and changing system structures to more effectively center Indigenous nations. In addition to insights from social network analysis, we also highlight the limitations of technical water management in supporting the deep connections held between Indigenous peoples and their waters that are central to Indigenous water governance.

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“…It fails to address broader and deeply rooted threats to water, such as historic and ongoing industrial point source pollution and the diversion of waters for industry and hydroelectric development, threats compounded by climate change (Bradford et al, 2016;Emanuel, 2018;Sanderson et al, 2020;Thompson et al, 2014;Usher, 2003;). It fails to account for the violent system in which the drinking water crisis is produced and sustained, a system driven by the ongoing settler-colonial imperative to extract resources at the expense of life and lands, particularly of Indigenous Peoples, people of colour, and the poor (Chief, 2020;Neville & Coulthard, 2019;Sultana, 2018).…”

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confidence: 99%

Zaagtoonaa Nibi (We Love the Water):

Latulippe

McGregor

2022

iipj

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This paper presents Indigenous community-led, collaborative, and community-engaged water governance research with a First Nations community in the Georgian Bay and Lake Huron region in northeastern Ontario, Canada. The methodology draws on Indigenous approaches to understanding and developing knowledge and is designed to build community capacity in research and in water protection and governance. This approach recognizes existing community strengths, including traditional knowledge, experiences, perspectives, and associated cultural perspectives and values, laws, responsibilities and lived experience in relation to water. Results identify and contextualize community-held responsibilities and legal principles pertaining to water that support culturally relevant water governance and strategic planning. By synthesizing and extending previous water protection initiatives, this research meaningfully supports the community’s position and leadership on water security and governance. This, in turn, strengthens Indigenous water governance and sustainable water governance broadly as Indigenous understandings and approaches to water are holistic and concern relationships with and responsibilities to all of Creation.

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Water in the Native World

Cited by 8 publications

References 16 publications

Telephone-Based Guideline-Directed Medical Therapy Optimization in Navajo Nation

Telephone-Based Guideline-Directed Medical Therapy Optimization in Navajo Nation

Indigenous nations at the confluence: water governance networks and system transformation in the Klamath Basin

Zaagtoonaa Nibi (We Love the Water):

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